Virtual Reality for Caregiver Assembly, Relief, Empowerment, and Support (VR-CARES)

The escalating demand for home-based caregiving, combined with a high turnover rate and prevalence of stress and burden in this workforce, presents a unique challenge within the healthcare sector. High turnover rates are especially difficult for care recipients with dementia who benefit from consistency. Caregivers are often socially isolated at work due to the intimate care they provide to socially isolated clients. The VR-CARES initiative is an innovative response to these issues built upon Rendever's existing social engagement VR platform and vast content to provide a novel caregiver support virtual reality (VR) platform for dementia caregivers providing in-home care that generates real community and connectivity. Rendever, a pioneer in VR for older adults, enables shared experiences with networked communication technology that overcomes geographical distance, lack of transportation, mobility issues, low vision, or cognitive impairment so they can connect with others for group travel, activities, games, and sharing life stories.

Study Design. The proposed 3-aim project takes a human-centered design approach grounded in an in-depth qualitative understanding of the target population with multiple stages of user feedback to inform an iteratively developed VR platform to support home care workers and to test the feasibility of the resulting VR Caregiver platform with them. The investigators refer to this project as "VR Cares: Virtual Reality for Caregiver Assembly, Relief, Empowerment, and Support to improve social connection, health, and at-home dementia care" (VR CARES). The process followed has been summarized by the IDEAS framework and the Stanford d.school as encompassing 5 phases: "empathize" (understand target population), "define" (identify goals and scope), "ideate" (brainstorm potential solutions), "prototype" (build potential solutions), and "test" (gather feedback from target users).

Participants. The investigators will recruit dementia caregivers (n=30) to participate in pre/post-focus groups/interviews and up to 16 weeks of product use. The investigators will recruit caregivers across the United States who are employed by an in-home care agency. Demographics will be gathered during the screening process to help ensure our study represents the general population of direct care workers with roughly 34% White, 26% Hispanic, 26% Black, and 14% Non-Hispanic Other racial identification. Direct care workers will be at least 18 years of age, proficient in English, and provide care for at least one older adult client living with mild cognitive impairment (MCI) or dementia. Exclusion criteria include extreme motion sickness preventing an individual from participating in VR activities or a history of seizures.

AIM 1: Once enrollment is complete, at Time 1 (T1), the investigators will conduct the baseline survey (Survey #1). A trainer/implementation specialist from Rendever will provide each caregiver with a Rendever social engagement VR system consisting of 2 VR headsets and 1 control tablet and will train them on how to use the basic Rendever engagement platform in VR that will be the backbone of the VR-CARES support platform. During this baseline period, RAND will conduct focus groups/interviews with caregivers to empathize with the target users and gather their insights to ground the development in a behavioral theory with responses to qualitative research questions such as, "How can a VR platform support social gatherings and support groups to help manage stress and improve job satisfaction?". RAND will analyze findings from these focus groups/interviews and share them with the Rendever researchers and Rendever's CTO to inform the development of the VR-CARES platform prototype.

AIM 2: During the \~4-8 weeks Rendever's development team of software engineers builds the platform, the Caregivers will use the core Rendever social engagement VR platform alone and/or with their clients to familiarize themselves with what can be done on the basic platform, allowing them to become familiar with using the basic platform before being introduced to the additional features and capabilities of the VR-CARES platform that will be added to it. This will also allow the researchers to tease out the barriers to use of the basic VR platform versus the barriers to use of the added features of the VR-CARES platform. It also allows us to control for the impact of using Rendever's basic VR engagement platform alone and with clients versus the additional impact of using the VR-CARES platform to engage with other direct care workers for social support.

AIM 3: Following these \~4-8 weeks of development and the caregivers' use of Rendever's basic VR platform with their clients, the caregivers will be sent via email an online survey (Survey #2) and then Rendever will send the VR-CARES platform as an update to their Rendever systems. Rendever's research team will remotely train the caregivers how to use the VR-CARES platform. The caregivers will then begin using the VR-CARES platform with each other to participate in virtual activities, training, and support groups inspired by the first focus group/interview. They will be shown how they can casually meet up with other available caregivers to gather on the virtual back porch to visit, debrief about their day, and choose fun activities to do together in Rendever just for fun and friendship building such as all go on a tour of Rome, hike the Grand Canyon, or swim with Dolphins. They will also participate in a weekly support group centered on self-care and dementia care and offered multiple times to accommodate different schedules. These will be led and moderated by a NAMI (National Alliance on Mental Illness)-certified instructor on Rendever's research team. They will also participate in group activities identified by the pre-focus group/interviews. They may continue to use the basic Rendever VR platform with their clients during this time if they wish.

Following the up to 8 weeks of using the VR-CARES platform with other caregivers, participating caregivers will complete a post-project survey (Survey #3). RAND's research team will conduct a second round of focus groups/interviews with up to 30 caregivers and share the findings with Rendever's research and development teams for further reiteration and VR-CARES platform refinement.

• Adherence to VR-CARES Intervention [Срок оценки: Assessed at end of study (T3 - 16 weeks, post VR-CARES caregiver support platform). Adherence data is collected continuously during the VR-CARES intervention period (weeks 9-16) and summarized at T3.]
• Mean Change in Study-Specific Caregiver Job Satisfaction Items [Срок оценки: Assessed at enrollment (T1 - baseline), mid-point (T2 - 8 weeks), and end of study (T3 - 16 weeks). Three-timepoint assessment allows detection of the impact of each intervention phase on job satisfaction change.]
• Technology Acceptance Model (TAM) Score [Срок оценки: Assessed at mid-point (T2 - 8 weeks, post Rendever social engagement VR platform) and end of study (T3 - 16 weeks, post VR-CARES caregiver support platform).]
• User Experience Questionnaire Short Form (UEQ-S) Score [Срок оценки: Assessed at mid-point (T2 - 8 weeks, post Rendever social engagement VR platform) and end of study (T3 - 16 weeks, post VR-CARES caregiver support platform).]
• User Experience Questionnaire+ (UEQ+) for Voice Assistants Score [Срок оценки: Assessed at mid-point (T2 - 8 weeks) only, post Rendever social engagement VR platform. This measure is specific to Intervention 1 and is not administered at T3.]
• User Experience Questionnaire+ (UEQ+) Social Survey Score [Срок оценки: Assessed at end of study (T3 - 16 weeks) only, post VR-CARES caregiver support platform. This measure is specific to Intervention 2 and is not administered at T2.]
• Study-Specific User Experience Scores - Rendever Platform (3 items) [Срок оценки: Assessed at mid-point (T2 - 8 weeks) only, post Rendever social engagement VR platform. These items are specific to Intervention 1.]
• Study-Specific User Experience Scores - VR-CARES Platform (12 items) [Срок оценки: Assessed at end of study (T3 - 16 weeks) only, post VR-CARES caregiver support platform. These items are specific to Intervention 2.]
• Mean Change in Patient Health Questionnaire-4 (PHQ-4) [Срок оценки: Assessed at enrollment (T1 - baseline), mid-point (T2 - 8 weeks), and end of study (T3 - 16 weeks). Three-timepoint assessment allows detection of the impact of each intervention phase on depression and anxiety.]
• Mean Change in Mental Health Inventory-5 (MHI-5) [Срок оценки: Assessed at enrollment (T1 - baseline), mid-point (T2 - 8 weeks), and end of study (T3 - 16 weeks). Three-timepoint assessment allows detection of the impact of each intervention phase on changes in general mental health and wellbeing.]
• Mean Change in PROMIS Companionship Short Form 4a [Срок оценки: Assessed at mid-point (T2 - 8 weeks) as the baseline measure and end of study (T3 - 16 weeks) as the post-VR-CARES intervention measure.]
• Mean Change in PROMIS Emotional Support Short Form 6a [Срок оценки: Assessed at mid-point (T2 - 8 weeks) as the baseline measure and end of study (T3 - 16 weeks) as the post-VR-CARES intervention measure.]