A Pilot Study on the Use of Virtual Reality to Educate Community Members about Dementia

Abstract

Aim

To understand the impact of using an immersive dementia video via a virtual reality (VR) device to educate community members.

Methods

A single group before/after comparison test design was employed. One trial session was provided. We used Angle Shift, a VR program that provides an immersive narration of the experiences of dementia. We then measured the participants’ perceived understanding of the experience of people with dementia, willingness to learn more about dementia, and satisfaction with the immersive experience.

Results

We analyzed the responses of 67 participants. Pre-intervention, most perceived to have a good understanding and a willingness to learn. They also expressed readiness and interest in supporting people with dementia. Post-intervention, participants expressed satisfaction and a deeper understanding.

Conclusion

Motivation can be a key indicator of the VR’s impact on learners’ understanding, willingness to learn, and satisfaction. The program should capture the learners’ interests in various learning stages.

Keywords:

• Immersive technologies
• extended reality
• disability awareness
• older people with dementia
• narrative
• Japan

Introduction

Japan has one of the largest proportions of older adults in the world, with 36% of its total population categorized as older adults.¹ The Ministry of Health, Labor and Welfare expects the number of people living with dementia to be over 20% of the older adult population by the year 2025.² Hence, they formulated the “New Orange Plan” so that people with dementia can continue to live in their familiar environment as they age. The “New Orange Plan” supports using integrated community care systems to develop dementia-friendly communities.³ To date, various programs have been made to support this policy including training dementia supporters to aid people with dementia and their families and programs to support dementia caregivers, among others.

The perspectives of people with dementia and their families are key to creating a dementia-friendly community.³ Educating the community members about the experiences of people with dementia is a viable means to meet this end. Educational programs, however, within the community depend on their members’ voluntary initiative, as interest, motivation, and purpose play a role in pursuing learning opportunities.

In recent years, there have been attempts to use virtual reality (VR) to educate and promote understanding of people with disabilities through promoting experiential learning. According to the experiential learning theory, learning happens when concrete experiences are reflected upon and assimilated into abstract concepts.⁴ Immersive videos offer an interactive learning experience that can improve the acquisition of knowledge using multisensory pathways thereby promoting a higher level of immersion, interest, and involvement.^5,6

Presently, there is a conflicting discourse on using VR as an instrument for experiential learning. Lara and Rueda⁷ argued that VR could potentially change a person’s perspectives by putting them in “someone else’s shoes,” evoking empathy. In contrast, Ramirez et al.⁸ argued that experiential learning via VR evokes sympathy and is deceptive and manipulative. An hour of experiencing what it means to be disabled will not fully capture the lived reality of a person with a disability. Having said this, storytelling and narratives are still considered one of the best ways to educate others without amplifying stereotypes, paternalism, and ableism.⁹

In Japan, Silver Wood Corporation¹⁰ strived to transform dementia narratives into a more immersive experience. In contrast to “experiencing disability,” the company created VR videos to immerse learners in the story of a person with dementia. To better understand the perspective of people with dementia, they collaborated with people with dementia and turned their realities into materials for VR videos. Two case studies have reported the effectiveness of VR video sessions. Shiroyama et al.¹¹ recruited participants from a community with an aging population of 46.8% (higher than the national average of 26.6% as of 2015). Their study found a reduced prejudice among participants post-intervention.

On the other hand, Sari et al.¹² combined an original educational program by nurses with a VR video session. They delivered the intervention to community members and shoppers, wherein they observed an improvement in the participants’ attitude toward dementia and sense of community post-intervention. These studies report that immersive videos may improve community members’ understanding of people with dementia, reduce prejudices, and improve perceptions about community contributions.

The Ministry of Health, Labor and Welfare of Japan supports the creation of dementia-friendly communities in each region.¹³ Efforts are being made to develop the physical environment and human resources, reflecting the unique characteristics of each region, so that people with dementia can continue to live in their familiar neighborhoods. Following the Japanese governmental direction, the development of volunteer education programs to support people with dementia should also reflect the characteristics of each local community. Therefore, we designed and implemented this research as a trial in the area where our team will conduct further research. This article also responds to the gap in current studies by investigating the potential of using VR video intervention to educate communities in urban areas.

In this study, we aimed to understand how the VR video session can be used to educate community members by examining changes in the participants’ (1) understanding of the experience of people with dementia, (2) willingness to learn about dementia, (3) satisfaction with the intervention, and (4) educational needs. Factors to be considered in creating an educational program were also discussed. This study identified how community members perceive the VR video program and the content and considerations required for future community educational programs on dementia. It will also aid in planning for larger-scale research using appropriate methodology.

Materials and methods

Study design

This study used a single-group pretest-posttest design. This design is a feasible and cost-effective strategy to explore the merit of an intervention before investing and conducting an experiment to establish causality.

Participants and context

Participants were recruited in Arakawa-Ku, one of Tokyo, Japan’s 23 urban wards, with a population of approximately 210,000 people and an aging rate—which indicates the rate of increase in a population’s median age—of 23.40%, as of the 2015 census.¹⁴ Community members include those who live in the area and those working in the said ward. Recruitment posters were advertised on bulletin boards in two community support centers and one university campus. Flyers were also distributed during relevant local events such as town meetings, leisure club gatherings, and health promotion events hosted by the community support centers. Due to financial and logistical constraints, we aimed to recruit up to 80 participants. No statistical sample size calculations were conducted. Post hoc power was calculated for the primary endpoint only.

Inclusion criteria are as follows: (1) adults aged 20 and above, (2) without any visual impairments (or impairments that eyeglasses or contact lenses can correct), (3) can comprehend and communicate using the Japanese language in daily life (both written and verbal), and (4) can participate throughout the 2-h duration of the study. While we wanted to be inclusive, the conditions are set as these can influence one’s immersive experience with VR. Participants are excluded if they reported any visually induced motion sickness (such as nausea, dizziness, and blurred vision when viewing moving images) to maintain their safety. Reading ability was not specifically set, with the assumption that those who responded to the recruitment posters/flyers were able to comprehend the written information and handle adequate technologies to correspond using emails.

Resources and equipment

The program was held in a university classroom with a dimension of 9 m × 15 m. This has a maximum capacity of 70 people. The front of the classroom has a whiteboard and audiovisual equipment (projector, screen, and speakers) to facilitate the didactic part of the program. The classroom is well-lit using overhead lighting and well-ventilated using a centralized air conditioning system. The classroom has two exits located at the front of the room with clear aisles for easy movement within the room.

A total of 40 VR systems were prepared to use on the day of the program. These systems underwent checking before the event to ensure they were functioning as intended. The equipment used (see Figure 1) included a smartphone (Samsung Galaxy S8), a Head-Mounted Display (HMD; Samsung Galaxy Gear VR SM-R323NBKAXJP), and headphones (JVC HA-S400-R). We selected the VR video program “Angle shift” which was pioneered and commercialized by Silver Wood Corporation (n.d.), focusing on the experience of people with dementia in Japan. This program has already been used in the educational context.^11,12 It is a VR system with an accompanying video output and narrative to understand the story of a person with dementia. It also includes a self-learning version for the person with dementia and a service provider version. Educational programs using the VR system are commonly available at present.

Figure 1. The equipment for the VR system (Silver Wood Corporation).

Study process

There are many potentially eligible members, given the population of the study setting. However, the specific number of eligible individuals is not known due to the non-randomized nature of recruitment. Individuals who are interested in joining the research reached out to the research team via email. We have recruited 74 people for the study (recruitment rate of 92.5% out of 80). We offered two timeframes for the VR experience sessions, asked each participant to specify their preferred timeframe, and allocated accordingly. On the day of the program, 72 people showed up (participation rate of 97.3%), 38 of whom participated in the morning session and 34 in the afternoon session. At the start of each session, the research team explained the intervention to the participants and highlighted the voluntary nature of the research. Informed consent was then sought wherein all participants consented to the study. Upon signing the informed consent form, they were then asked to respond to a pre-intervention questionnaire. The program then commenced and was provided to all participants simultaneously. Specific details of the program can be found in the next sub-section. The training was provided by a representative of Silver Wood Co. Ltd., who is not part of the research team. At the end of the session, participants were asked to respond to a self-administered questionnaire. Figure 2 provides a more visual representation of the entire study process.

Figure 2. Study process diagram.

The angle shift program

The program spanned 90 min and consisted of (1) a didactic lecture using the company’s produced initially educational materials that provide basic knowledge on dementia, (2) an immersive VR video experience, (3) group work, (4) an explanation by the lecturer, and (5) video footage of the narratives of people with dementia. The program is manualized (in Japanese language only) by Silver Wood Co. Ltd. Copyright belongs to the company. It is not publicly available.

The didactic lecture lasted 30 min, explaining dementia from societal and medical perspectives. These included (1) What is your image of dementia? What words come to your mind? (2) Core symptoms, and (3) Behavioral and psychiatric symptoms.

The immersive VR video consists of three short stories that delved into experiences with (1) dealing with the physical and social environment when alighting a bus (entitled “What are you going to do with me?”), (2) commuting on a train alone (entitled “Where am I?”), and (3) having visual hallucinations—which is experienced by a person diagnosed with Lewy Body dementia (entitled “Lewy Body visual hallucinations”). After the short stories centering on the experiences of people with dementia, a situation-specific scenario on how family members should respond to a person with dementia is added to educate family members.

After each story lasted 3–5 min, the participants were given 5 min to share their impressions of what they had watched in a group work session, followed by the instructor’s explanation of the story (to clear out/correct misconceptions generated). For example, video footage shows a female older adult with dementia being ushered by caregivers to get off a van. She sees the height of the van step as high off the ground as if she is forced to jump off a cliff. The instructor explains to the group that this may be due to the visual and perceptual disturbances of dementia.

Outcome measures

The participants responded to a self-administered questionnaire provided before and after the intervention. The use of a self-administered, non-standardized questionnaire is valuable in gathering initial insights and a deeper understanding of the program. In addition to demographic information such as age, gender, and experience living with a person with dementia, participants rated their understanding of the experiences of people with dementia, willingness to learn more about dementia, and satisfaction with the intervention through a four-point scale; of “strongly agree (4 points),” “agree (3 points),” “disagree (2 points),” and “strongly disagree (1 point).” Then, the participants answered an open-ended question justifying their satisfaction/dissatisfaction with the program. The items in the questionnaire were adapted from a course evaluation form for university students.

Data analysis

Descriptive statistics and frequency data were tallied. Data were then analyzed using the statistical software R Statistical Software version 4.3.1 with a two-tailed significance level set at 5%. Spearman’s rank correlations were calculated for age, gender, and the level of understanding (pre- and post-trial session), willingness to learn (pre- and post-trial session), and satisfaction (post-trial session) to see if there were any trends regarding these primary attributes.¹⁵

The primary outcomes sought were the change in the participants’ understanding and their willingness to learn more about it. A Wilcoxon-signed-rank-sum test was conducted to determine the statistical significance of the change. The same test was also conducted to compare the understanding and willingness to learn, using gender and caregiving experience as stratification factors. Lastly, a Wilcoxon-rank-sum test was conducted for satisfaction, with gender and caregiving experience as stratification factors.

All open-ended responses were coded and categorized using thematic analysis.¹⁶ Thematic analysis interprets and reports patterns within data through (1) familiarizing with the data, (2) generating initial codes, (3) searching for themes, (4) reviewing themes, (5) defining and naming themes, and (6) producing the report. The sixth author, who has extensive experience in qualitative research, along with the second and third authors, conducted this process. The labels were reviewed by three other individuals (the primary investigator and two contributors), who discussed and verified the results.

Research management

The research team consists of individuals with varying levels of expertise. Most of them have been engaged in research work for at least five years and are therefore capable of managing the research program. In addition, 10 student therapists and nurses were present to provide logistic support to the participants, as needed (e.g., locating the bathroom, passing and collecting questionnaires, collecting equipment, and ensuring to remove any trip hazards while participants are standing wearing head mounted displays).

Results

Seventy-four people signed up for the study, but two canceled before the day, leaving 72 participants in the group. Of these, those with missing data were excluded from the analysis. Responses of 67 participants were analyzed. 76.6% (n = 52) were women and 22.4% (n = 15) were men. The mean age was 51.9 years (SD: 23.7, range: 21–86 years) and a median of 55 years. 61.2% (n = 41) had no caregiving experience, and 38.8% (n = 26) had some degree of experience.

Perceived understanding of the experiences of people with dementia

Before the intervention, 71.6% of the total accounted for those who positively appraised their understanding of the experience of people with dementia. Distribution is as follows: 7.5% (5 persons) answered “strongly agree,” 64.2% (43 persons) answered “agree,” 26.9% (18 persons) answered “disagree,” and 1.5% (1 person) answered, “strongly disagree.” During post-intervention, those who positively appraised their understanding of dementia rose to 88.1% of the total. Remarkably, 10.4% (7 persons) “strongly agree,” 77.6% (52 persons) “agree,” while only 11.9% (8 persons) “disagree.”

No significant differences were found between age groups pre- and post-intervention. Spearman’s rank correlation coefficient ρ = 0.0942 (p = 0.448) for age and understanding (pre-intervention), and ρ = 0.0389 (p = 0.754) for age and understanding (post-intervention).

Regarding the comparison between pre- and post-intervention, significant differences were found in the score of all participants. In the sub-group comparison, significant differences were found in the level of understanding for women and in the level of understanding for the group with no caregiving experience (Table 1).

Table 1. Level of understanding of the experience of people with dementia.

Category	Pre VR program		Post VR program		Test statistics (V)	p Value	Post hoc power
	Mean (SD)	Median (IQR)	Meas (SD)	Median (IQR)
Total(N = 67)	2.78(0.599)	3.00 (2.0, 3.0)	2.97(0.491)	3.00 (3.00, 3.00)	98	0.013*	0.728
Female(N = 52)	2.71(0.605)	3.00 (2.00, 3.00)	2.98(0.464)	3.00 (3.00, 3.00)	46	0.003*
Male(N = 15)	3.00(0.535)	3.00 (3.00,3.00)	2.93(0.594)	3.00 (3.00, 3.00)	9	0.766
With caregiving experience(N = 26)	3.08(0.484)	3.00 (2.00, 3.00)	3.12(0.516)	3.00 (3.00, 3.00)	20	0.79
No caregiving experience(N = 41)	2.59(0.591)	3.00 (3.00, 3.00)	2.88(0.458)	3.00 (3.00, 3.00)	285	0.001*

Scores allocated: Strongly agree = 4, Agree = 3, Do not agree = 2, Strongly disagree = 1 Increase in score = Increase of self-evaluated willingness to learn

Willingness to learn

Before the trial session, 43.3% (29 persons) answered “strongly agree,” and 56.7% (38 persons) answered “agree” to the question “I want to learn more about dementia.” After the trial session, 59.7% (40 persons) “strongly agree” and 40.3% (27 persons) “agree.” Comparing the pre- and post-trial sessions, the level of motivation to learn more about dementia further increased among participants.

The relationship between age and willingness to learn (pre-) was ρ = −0.351 (p = 0.004*), and the same for age and willingness to learn (post-), ρ = −0.351 (p = 0.004*), indicating that the young tended to be more willing than the older both before and after the trial session. As for the pre- and post-intervention comparisons, no differences in willingness to learn were found either overall or when tested as a stratified factor by gender or caregiver status (Table 2).

Table 2. Willingness to learn.

Category	Pre VR program		Post VR program		Test statistics (V)	p Value	Post hoc power
	Mean (SD)	Median (IQR)	Meas (SD)	Median (IQR)
Total(N = 67)	3.43(0.499)	3.00 (3.00, 4.00)	3.40(0.524)	3.00(3.00, 4.00)	104.5	0.686	0.069
Female(N = 52)	3.44(0.502)	3.00 (3.00, 4.00)	3.38(0.530)	3.00(3.00, 4.00)	80	0.51
Male(N = 15)	3.40(0.507)	3.00 (3.00, 4.00)	3.47(0.516)	3.00(3.00, 4.00)	2	0.773
With caregiving experience(N = 26)	3.58(0.504)	3.00 (3.00, 4.00)	3.46(0.581)	3.00(3.00, 4.00)	24	0.407
No caregiving experience(N = 41)	3.34(0.480)	3.00 (3.00, 4.00)	3.37(0.488)	3.50(3.00, 4.00)	30	0.802

Scores allocated: strongly agree = 4, agree = 3, do not agree = 2, strongly disagree = 1 Increase in score = increase of self-evaluated willingness to learn

Five categories emerged from the free-text entries regarding willingness to learn. These are (1) knowing how to interact with people with dementia, (2) knowledge of dementia and preventive measures, (3) supporting people with dementia in the community, (4) more opportunities to interact with people with dementia in the future, and (5) interest in the dementia experience and the feeling of accomplishment. Table 3 expounds on these categories further.

Table 3. Emerging themes on why participants are willing to learn.

Category	Sample comments	Total item numbers
Knowing how to interact with people with dementia	Being able to assist when needed.	Pre-VR experience	33
	When faced with someone with dementia, I want to know how best to talk to the person.	Post-VR experience	23
Knowledge of dementia and preventive measures	My family member is elderly. I want to be informed about how to prevent dementia.	Pre-VR experience	23
	Dementia is a part of the ageing process, but I want to know how to delay that.	Post-VR experience	18
Supporting people with dementia in the community	I can help someone with dementia when I see them in the community.	Pre-VR experience	6
	Supporting dementia should be done by families, professionals, and residents.	Post-VR experience	8
More opportunities to interact with people with dementia in the future	Dementia is common, and meeting these people will also be a frequent event.	Pre-VR experience	6
	I never know when I will meet people with dementia.	Post-VR experience	3
Interest in the dementia experience and the feeling of accomplishment	No one around me has dementia, so I never had a chance to experience it.	Pre-VR experience	2
	The lesson today brought me new findings and awareness.	Post-VR experience	7
No answer	N/A	Pre-VR experience	13
		Post-VR experience	11
Others	I don’t want to be a nuisance to my family and neighbors.	Pre-VR experience	3
	I wish happiness for people with dementia and their families.	Post-VR experience	9

Under willingness to learn, it is notable that there are inaccuracies in knowledge of dementia post-program. The team made attempts to correct the inaccuracies after gathering their response. We acknowledge that the VR experience program alone is not sufficient to provide comprehensive education, hence there is a need to supplement learning with appropriate add-on components.

Satisfaction with the intervention

In rating the participants’ satisfaction with the intervention, 68.7% (46 persons) “strongly agree” and 29.9% (20 persons) “agree,” indicating that 98.5% of the persons were satisfied with the experience. The 1.5% (1 person) who “disagreed” stated that they would like to retake the course because they did not understand something.

Regarding the correlation between age and satisfaction, ρ = 0.274 (p = −0.025*), indicating that young people tend to be more satisfied. There were no significant differences in satisfaction based on gender or caregiving experience (Table 4).

Table 4. Satisfaction with the intervention.

Item for analysis	Post VR program Means (SD)	Post VR program Median (IQR)	Difference between groups
Total (n = 67)	3.67(0.504)	4.00 (3.00, 4.00)	–
Female (n = 52)	3.65(0.520)	4.00 (3.00, 4.00)	W = 415.5, p = 0.641
Male (n = 15)	3.73(0.458)	4.00 (3.50, 4.00)
With caregiving experience(N = 26)	3.73(0.452)	4.00 (3.00, 4.00)	W = 575, p = 0.508
No caregiving experience (N = 41)	3.63(0.536)	4.00 (3.25, 4.00)

Scores allocated: strongly agree = 4, agree = 3, do not agree = 2, strongly disagree = 1

Four categories from free text entries emerged, including (1) the quality of the program (35 responses), (2) a deeper understanding of dementia (27 responses), (3) a more precise understanding of actions one should take in the future (15 responses), and (4) a deeper self-awareness of dementia (7 responses). Table 5 expounds on these categories further.

Table 5. Emerging themes on why participants were satisfied

Category	Sample comments	Total item numbers
Quality of the program	I was happy to see the video. The explanation was easy to follow. It was good to see the world from the perspective of an actual person with dementia.	36
A deeper understanding of dementia	The experience could supplement what may be a need for more knowledge. True-like experience makes a difference in how deeply I understand.	27
A clearer understanding of actions one should take in the future	Taking it in as it is, is essential. Standing in their shoes to try and understand better is important.	15
A deeper self-awareness of dementia	I reflected on my caregiving experience. I could understand how people with dementia feel and realized I had never really tried to know before.	7
No answer	N/A	11

Discussion

This study served as a pilot test on how VR video sessions can be used to educate community members by examining changes in the participants’ (1) understanding of the experience of people with dementia, (2) willingness to learn about dementia, (3) satisfaction with intervention, and (4) educational needs.

Shiroyama et al.¹¹ compared the comprehension and other results between the group that attended the experience and the group that did not and reported that the group that attended the VR experience had better comprehension and reduced prejudice. The results of this study also confirmed that there was a positive effect on the subject’s subjective comprehension. Additionally, this tendency was extreme among women and those with no experience in caregiving. The trend of having a greater positive effect on those without prior caregiving experience is expected as most of the things covered in the session are most likely new to them. As for women, this greater increase in knowledge regarding dementia may attributed to socio-cultural factors. In Japanese society, women are most often tasked with the role of caregiving.¹⁷ Thus, they may have come across certain behaviors throughout their caregiving process. The VR video session allowed them to scaffold on this prior experience and prompted them to reflect more on their observations and interactions with an older adult with dementia. It is important to note, however, that even if the participants showed an excellent score of comprehension objectively and subjectively immediately after the trial session, it is unclear how this experience will affect the way the participants perceive dementia and their behavior in the long-term, and it requires further investigation.

The willingness to learn was high among the subjects who were interested in dementia and highly motivated to learn before participating in the trial session. Gender and experience of caregiving did not affect their perceptions before and after. A reason why many of the participants showed a high level of willingness might simply be due to sampling bias. People who are motivated and willing to learn are more likely to volunteer for the program.¹⁸ Of note, is that the young showed higher motivation to learn before and after the trial session than their older counterparts. A probable reason for this is the type of intervention. Younger people are more exposed to VR in their lifetime, they may harbor a greater amount of curiosity about both the content and the medium used.¹⁹ In relation, satisfaction was generally higher among the youth compared to the older. Other results did not change significantly before and after the trial session, suggesting that the program may not have significantly impacted the subjects’ self-perception. VR is argued to be more satisfactory for younger groups than older ones.²⁰ Regardless, the trial session had at least no negative impact on their willingness to learn. In the future, it is necessary to consider a broader range of subjects and population groups. In the survey, age, gender, and caregiving experience were stratification factors. Programs should be adjusted according to the target audience stratum.

Looking at the breakdown of comments on motivation to learn, responses such as “knowing how to treat people with dementia” and “knowledge of dementia and preventive measures” decreased, while “supporting people with dementia in the community” and “interest in and feeling of achievement for the VR experience” increased, indicating that the participants viewed the trial session positively. Their interest shifted to practical matters. The high satisfaction level was influenced by the fact that the content of the trial sessions was attractive to the subjects interested in dementia and that their learning needs were met in that they deepened their understanding and obtained hints for their future actions. Therefore, if learners were highly motivated to learn, such trial sessions could positively impact their understanding and willingness to learn about dementia and may bring out higher satisfaction.

Kyou et al.²¹ provided the public with dementia training consisting of 90-min lectures on dementia symptoms, treatment, and care. Physicians and others specializing in dementia developed the program. While they found that medical knowledge on dementia has significantly improved, it did not lead to reduced participants’ anxiety when involved with people with dementia. Our finding shows that immersing participants in the stories of people with dementia, rather than a medical view of dementia, can boost their confidence in supporting people with dementia. While some participants in our studies tend to have inaccuracies in their knowledge of dementia as a medical condition (as exemplified by a statement in Table 3), the stories within the VR program highlighted the humanity of people with dementia rather than pathologizing them, possibly leading to an increased level of empathy.

Jütten et al.²² found no significant difference in terms of empathy and care burden among informal caregivers post- VR educational program. While this may contradict our assertion, we argue that a VR intervention may be more fruitful for community members who do not directly interact with people with dementia regularly as more than 60% of our participants do not have any caregiving experience. Moreover, Jütten et al.²² found that the VR intervention contributed to a change in the caregiving approach and understanding of the experience of people with dementia. Hence, this study demonstrates that VR educational programs may be useful for caregivers and community members. This study also highlights the need to further examine the fit between the program and the target population’s situation and outcomes. Learners’ interests are influenced by their environment, learning stage, internal motivation, and learning materials that match learners’ needs and the quantity and quality of their knowledge are necessary.²³ Examining how to adopt more effective teaching methods for learners, lecture content that supplements the contents of the VR materials, and support for participants’ emotions is necessary.¹²

Implication to occupational therapy practice

Occupational therapists provide interventions to support caregivers in reaching their care goals, however, a successful intervention in one country does not guarantee the same when introduced elsewhere.²⁴ In Japan, informal and active caregivers are motivated to expand their knowledge about dementia care and practically apply it to their families and community members.²⁵ Our study demonstrated that willingness to learn was important in benefiting from the immersive dementia video. Understanding the person with dementia’s intrinsic view of distressing symptoms is essential, yet difficult to be fully elicited in case of significantly affected cognitive function.²⁶ The VR education intervention by occupational therapists could positively impact learners’ understanding, facilitate conversation, and prevent caregivers from exhibiting problematic behaviors due to misunderstanding or incorrect expectations.

Limitations and future research directions

The results of this study should be interpreted on the premise that the participants were already highly interested in dementia, that the results focused on the subject’s self-perception, and that the results were based on data measured immediately before and after the trial session. In addition, since this is a single-group pre- and post-comparison study conducted from an exploratory perspective, there is no control group and no comparison with another teaching method. Finally, the validity and reliability of the questionnaire used in this study were not established. Nonetheless, this study highlights the potential of VR and the need to conduct a larger-scale study to establish generalizability.

To make effective use of VR materials, it is necessary to prepare a program that matches the willingness and understanding of the target audience. For example, a different approach may be necessary for those not interested in the subject. In addition, it is necessary to conduct research from a long-term, practical viewpoint to see if the attempts to educate community members about the experience of people with dementia are reflected in their daily lives.

Conclusion

The intervention could positively impact learners’ understanding, willingness to learn, and satisfaction if they were highly motivated to learn even before the intervention. The program should also accord to the learners’ interests in various learning stages. The program’s content concerning the person with dementia’s experience, the learner’s context, and the long-term effects of the immersive narrative should be explored in the future.

Ethics statement

This study was conducted in compliance with the Declaration of Helsinki, approved by the Research Ethics Committee of Tokyo Metropolitan University (approval number 19041), and with the consent of the participants.

Acknowledgments

We express our sincere gratitude to everyone who contributed to this study.

Disclosure statement

The trial sessions by Silver Wood Corporation were conducted under contract with the company’s original educational package. No data was shared, and there were no conflicts of interest between the company and the members of this research team.

Additional information

Funding

This research was funded by the 2019 Tokyo Metropolitan University Slope Allocation Research Fund President’s Discretionary Framework.