Zest: Promoting Psychological Health of Women with SCI in the Virtual World of Second Life
1Robinson-Whelen S, 2Hughes R, 3Taylor H, 3Markley R, 3Vega J, 1Nosek M
1TIRR Memorial Hermann / Baylor College of Medicine, Houston, TX, USA; 2University of Montana, Missoula, MT, USA; 3TIRR Memorial Hermann, Houston, TX, USA
Objective: Psychological health, a term often used interchangeably with mental health and subjective well-being, is an important aspect of health and represents more than the mere absence of mental illness (World Health Organization and International Spinal Cord Society, 2013). There is little research on the psychological health of women with SCI. This lack of research is concerning yet not surprising as women represent a significant minority of people living with SCI (National Spinal Cord Injury Statistical Center, 2015). Building on previous work on women with mobility impairments (Nosek et al., 2016) and utilizing input from a community advisory board of women with SCI, the project team has developed a theory-driven psychological health promotion program for women with SCI that will be tested in a national study using the free online virtual world of Second Life (SL). The presentation describes partnering with community advisors with SCI to modify an existing group self-esteem enhancement intervention, presents our model for promoting psychological health, and reviews our intervention content and activities. Finally, the presentation reports on the qualitative and quantitative results of our feasibility study and describes plans for a full-scale randomized controlled trial of ZEST, our expanded psychological health promotion intervention for women with SCI.
Design/Methods: The presentation describes a feasibility study of a group intervention for women with SCI offered in SL. The feasibility study consisted of 21 community-living women with SCI who participated in a 2 group (intervention versus control) randomized controlled feasibility test of the intervention with 2 times of testing (pre and post-intervention). Criteria for determining feasibility were: 1) participant engagement, 2) acceptability of the SL platform, 3) acceptability of the intervention, and 4) preliminary evidence of improvement on outcomes.
Results: Engagement was strong with low attrition and high session attendance (Mean=5.7 of 7 sessions). Participants rated SL as more enjoyable and more convenient than in-person programs, and provided favorable feedback, with all study completers rating the program as good or very good and reporting positive life changes. Effect size calculations indicated a medium-large effect on two of the three health-promoting behaviors assessed (Cohens d = .92 and .72) and two depression measures (Cohens d = .76 and .79), and small effect sizes on measures of self-esteem (d = .32), social support (d = .37), and stress management behaviors (d = .24).
Conclusion: SL holds promise for offering psychoeducational group interventions for women with SCI, a population that has limited access to health promotion programming and limited opportunities to interact with other women with SCI. The SL platform may help circumvent disability-related and environmental barriers to accessing mental health services. With the encouraging findings of the feasibility study, the research team, with input from a team of community advisors, has refined and expanded the intervention, ZEST, to be tested in a full-scale randomized controlled trial.
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