UMMS Affiliation

Department of Medicine, Division of Preventive and Behavioral Medicine; UMass Worcester Prevention Research Center

Publication Date


Document Type



Behavioral Disciplines and Activities | Behavior and Behavior Mechanisms | Community Health and Preventive Medicine | Preventive Medicine


BACKGROUND: Virtual world environments have the potential to increase access to diabetes self-management interventions and may lower cost.

OBJECTIVE: We tested the feasibility and comparative effectiveness of a virtual world versus a face-to-face diabetes self-management group intervention.

METHODS: We recruited African American women with type 2 diabetes to participate in an 8-week diabetes self-management program adapted from Power to Prevent, a behavior-change in-person group program for African Americans with diabetes or pre-diabetes. The program is social cognitive theory-guided, evidence-based, and culturally tailored. Participants were randomized to participate in the program via virtual world (Second Life) or face-to-face, both delivered by a single intervention team. Blinded assessors conducted in-person clinical (HbA1c), behavioral, and psychosocial measurements at baseline and 4-month follow-up. Pre-post differences within and between intervention groups were assessed using t tests and chi-square tests (two-sided and intention-to-treat analyses for all comparisons).

RESULTS: Participants (N = 89) were an average of 52 years old (SD 10), 60% had < /=high school, 82% had household incomes < US $30,000, and computer experience was variable. Overall session attendance was similar across the groups (6.8/8 sessions, P = .90). Compared to face-to-face, virtual world was slightly superior for total activity, light activity, and inactivity (P = .05, P = .07, and P = .025, respectively). HbA1c reduction was significant within face-to-face (-0.46, P = 02) but not within virtual world (-0.31, P = .19), although there were no significant between group differences in HbA1c (P = .52). In both groups, 14% fewer patients had post-intervention HbA1c > /=9% (virtual world P = .014; face-to-face P = .002), with no significant between group difference (P = .493). Compared to virtual world, face-to-face was marginally superior for reducing depression symptoms (P = .051). The virtual world intervention costs were US $1117 versus US $931 for face-to-face. CONCLUSIONS: It is feasible to deliver diabetes self-management interventions to inner city African American women via virtual worlds, and outcomes may be comparable to those of face-to-face interventions. Further effectiveness research is warranted.

TRIAL REGISTRATION: NCT01340079; (Archived by WebCite at


African Americans, clinical trials, feasibility, health behavior, health disparities, minority health, randomized clinical trial, technology, type 2 diabetes, virtual systems

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Copyright ©Milagros C Rosal, Robin Heyden, Roanne Mejilla, Roberta Capelson, Karen A Chalmers, Maria Rizzo DePaoli, Chetty Veerappa, John M Wiecha. Originally published in JMIR Research Protocols (, 24.10.2014. This is an open-access article distributed under the terms of the Creative Commons Attribution License (, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work, first published in JMIR Research Protocols, is properly cited. The complete bibliographic information, a link to the original publication on, as well as this copyright and license information must be included.

DOI of Published Version



JMIR Res Protoc. 2014 Oct 24;3(4):e54. doi: 10.2196/resprot.3412. Link to article on publisher's site

Journal/Book/Conference Title

JMIR research protocols

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