title: Acceptance, Usability and Health Applications of Virtual Worlds by Older Adults: A Feasibility Study.
abstract: BACKGROUND
  Virtual worlds allow users to communicate and interact across various environments, scenarios, and platforms. Virtual worlds present opportunities in health care to reduce the burden of illness and disability by supporting education, rehabilitation, self-management, and social networking. The application of virtual worlds to older adults who bear the burden and cost of health conditions associated with age has not been evaluated.
  
  
  OBJECTIVE
  The aim of this study is to explore the usability, ease of use, and enjoyment of a virtual world by older adults, the types of virtual world activities that older adults may engage in, and the perceptions of older adults regarding the application of virtual worlds in health care.
  
  
  METHODS
  This quasi-experimental pre-post design research was guided by the Technology Acceptance Model (TAM). Participants were recruited from a Lifelong Learning Institute (LLI) program at Nova Southeastern University. Participants attended four training sessions over a 5-week period in the Second Life (SL) virtual world. Subjects were surveyed before and after the training on perceived ease of use, attitudes towards technology, behavioral intention to use the system, facilitating conditions, effort expectancy, and self-efficacy.
  
  
  RESULTS
  Older adults (N=19) completed the informed consent and attended the first training session, and 11 participants (58%, 11/19) completed the full training and the post survey. Completers (82%, 9/11) were more likely than non-completers (37%, 3/8) to consider themselves technologically savvy (P=.048), and to express confidence in being able to use the virtual world (100%, 11/11 vs 37%, 3/8; P=.002). All completers (100%, 11/11) perceived that SL has application in health behaviors and disease and reducing social isolation among people who are homebound. Of the completers, 10 (91%, 10/11) responded that they enjoyed learning how to use SL. Completers suggested that future trainings include more assistants and smaller groups.
  
  
  CONCLUSIONS
  This pilot study suggests that virtual worlds can be both a feasible and an applicable method to promote health among some seniors. Future research on virtual worlds with older populations should consider using state-of-the art technology including large monitors, providing a minimum of one trainer for every two to three participants, and distributing a comprehensive training manual at the start of the training to support organization and recall.
authors.affiliation: Master of Public Health program, College of Osteopathic Medicine, Nova Southeastern University, Fort Lauderdale, FL, United States. nc570@nova.edu.
authors.forename: Nicole
authors.identifier: http://orcid.org/0000-0003-3863-7587
authors.initials: N
authors.lastname: Cook
authors.forename: Sandra L
authors.identifier: http://orcid.org/0000-0002-4160-7672
authors.initials: SL
authors.lastname: Winkler
keywords: Second Life; health care; older adults; seniors; training; virtual worlds