An immersive virtual reality behaviour change intervention to support retired and non-working adults to reduce prolonged bouts of sedentary activity
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Date
2024-01-25Embargo Date
2026-01-22
Author
Healy, David
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Abstract
Background. It is currently understood that prolonged daily sedentary behaviour is
independently associated with multiple morbidities and mortality across the adult lifespan.
Epidemiological evidence suggests that older adults in particular are spending prolonged
periods of time sedentary each day. However, many retired and non-working adults report
that they ascribe meaning to sedentary activities, which appears to be one of the primary
motivators for prolonged sedentarism in this cohort. It is therefore proposed that alternative
non-sedentary activities are offered to retired and non-working adults that they can also
ascribe meaning to in order to break up sedentary bouts. Immersive virtual reality is a novel
digital technology that recent empirical research suggests older adults enjoy using. However,
it is not yet well understood whether and how a technology such as this should be integrated
into retired and non-working adults’ lives, and what conditions are necessary for it to be
accessible, usable, safe, and meaningful for them.
Aims. This thesis aimed to (1) identify factors influencing prolonged sedentary behaviour in
retired and non-working adult populations (2) understand if older adults would be interested
in using immersive virtual reality and, if so (3) develop and explore a behaviour change
intervention prototype to support retired and non-working adults to take part in non-sedentary
activities that they can ascribe meaning to in immersive virtual reality.
Methodology. Following the person-based approach to digital health intervention
development, a general examination of how meaningful non-sedentary immersive virtual
reality activities could be co-created with retired and non-working adults was completed. The
behaviour change wheel guide to intervention development was used to develop the
intervention content. Four studies were completed. Study 1 involved a systematic review and
thematic synthesis exploring older adults’ experiences and perceptions of immersive virtual
reality. Study 2 followed the behaviour change wheel guide to translate evidence into
intervention options to support retired and non-working adults to reduce their time spent
sedentary using immersive virtual reality. Study 3 was a reflexive thematic analysis exploring
the intervention content developed during Study 2 with 12 retired and non-working adults
through semi-structured qualitative interviews. In line with the person-based approach,
guiding principles were then developed to direct the design of a health behaviour change
intervention prototype. Furthermore, a logic model was created to visualise the logical flow
of the intervention and to guide the integration of intervention content into the mode of
delivery. Finally, Study 4 involved optimising the intervention prototype (STAND-VR)
informed by the knowledge generated during Studies 1-3, through a rapid analysis and
reflexive thematic analysis. Five focus group interviews were completed with 12 retired and
non-working adults to develop a refined iteration of the STAND-VR intervention prototype.
Findings. The systematic review and thematic synthesis reported that with a few
improvements to its existing hardware and software, as well as how it is first presented to
older adults, immersive virtual reality could offer new opportunities for older adults to take
part in meaningful activities tailored to their needs and preferences. Stages 1-3 of the
behaviour change wheel were followed to develop intervention content that would offer
retired and non-working adults additional, meaningful non-sedentary activities to take part in.
The qualitative interview study exploring the content of the proposed intervention content
reported how retired and non-working adults perceived immersive virtual reality before and
after use, how they would like to learn to use immersive virtual reality, the content and people
they would like to interact with and finally, their beliefs about their sedentary activity and
using immersive virtual reality. Amendments were made to the intervention content based on
this feedback and a logic model was developed, organising the content into intervention
components that could be delivered using immersive virtual reality. Finally, results from the
analysis of the focus group interviews reported that a number of improvements to the
immersive virtual reality experience should be made, offering more instructions and practice
time, minimising invasions of personal space, and a range of minor improvements to the
functionality and appearance of the prototype. Themes relating to participants’ thoughts on
immersive virtual reality as an experience as well as how immersive virtual reality compares
to reality, and in what contexts they would use immersive virtual reality were also reported. A
final iteration of the intervention prototype was developed and summarised through this final
study.
Conclusions. This thesis has generated formative evidence to support the further
optimisation, evaluation, and implementation of a health behaviour change intervention that
seeks to support retired and non-working adults to reduce their time spent sedentary through
engagement with virtual non-sedentary activities they can find meaningful. Through a
synthesis of qualitative studies exploring older adults’ experiences and perceptions of
immersive virtual reality, and the development and refinement of intervention content to
achieve the proposed target behaviour, a working prototype of the proposed intervention was developed and optimised in collaboration with key stakeholders and retired and non-working
adults. By working with retired and non-working adults throughout the design process, the
knowledge generated during this thesis offers important implications for intervention
development, immersive virtual reality use in older cohorts, and sedentary behaviour
research.