Co-Designing a Virtual Reality Training Program for Affirmative Practice with LGBTQ+ Youth

Overview: LGBTQ+ youth experience health disparities and barriers to care. This paper describes the multiphase approach to co-designing a virtual reality training program (VRTP) with community partners. The VRTP delivers experiential education to interdisciplinary healthcare providers to raise awareness of (1) implicit biases and (2) providing affirmative healthcare to LGBTQ+ youth.Proposal text: Background

Lesbian, gay, bisexual, transgender, queer, and other sexual and/or gender minority (LGBTQ+) youth experience physical, psychological, and behavioral health disparities (Fish, 2020). Yet, LGBTQ+ youth encounter persistent barriers to accessing affirmative healthcare. LGBTQ youth anticipate experiencing prejudice and lack of competence in healthcare settings, discouraging some from seeking care (Bass & Nagy, 2021). Effective health service delivery with this population is critical to addressing inequities in access to and quality of care.

Emergent research highlights the potential effectiveness of virtual reality as an educational strategy to improve cultural competence among healthcare providers (HCPs; Chae et al., 2021). This paper describes the multiphase approach to co-designing a virtual reality training program (VRTP)—built in collaboration with youth, community partners, and healthcare providers—which delivers experiential instruction to interdisciplinary healthcare providers on (1) awareness of implicit biases and (2) providing affirmative health care to LGBTQ+ youth.

Methods

Data were collected in three phases of co-design to facilitate development of the VRTP. Co-design is an established approach to equitable engagement with stakeholder communities during the development of a product (Sanders & Stappers, 2012).

In Phase I, online surveys were administered in a Midwestern state to (1) interdisciplinary HCPs (n=71) and (2) LGBTQ+ and non-LGBTQ+ youth (n=332). In Phase II, LGBTQ+ youth (n=13) completed an online journaling activity for approximately one week. Participants used text, audio, and video messages to interact with researchers asynchronously, sharing their daily experiences (e.g., affirmation, non-affirmation). In Phase III, LGBTQ+ youth (n=10) participated in focus groups (each approx. 120 minutes), sharing their experiences with HCPs through storytelling, role-play exercises, and discussions facilitated by members of the research team.

Quantitative survey data were analyzed using SPSS 28. Qualitative data from all phases were analyzed using grounded theory (Charmaz, 2014) and are the primary focus of the results presented. The validity and reliability of study findings were maintained via independent coders, self-reflexivity (e.g., journaling), debriefing, in-depth descriptions, and an audit trail.

Results

Survey respondents described numerous behaviors that impact the quality of healthcare youth receive. For example, youth recalled moments when HCPs ignored or dismissed their health concerns. Across phases, LGBTQ+ youth indicated that the most affirming healthcare occurred when: (1) youths’ identities, chosen names, and pronouns were respected; and (2) youth were actively engaged in discussions about their symptoms, diagnoses, and treatments. LGBTQ+ youth also (3) emphasized that while HCPs should ask about and acknowledge the impacts of their intersecting identities on their health, they should not generalize research on LGBTQ+ youths’ health concerns to specific individuals.

Conclusions

Data from co-design phases were incorporated throughout development of the VRTP (i.e., scripting, visual design, structure). The conference theme, “Human Rights are Global Rights,” indicates that LGBTQ+ populations have a right to appropriate and effective healthcare. This paper describes the multi-phase development of a VRTP that provides HCPs’ with the fundamentals of delivering affirmative health care to LGBTQ+ youth. This presentation will include a demonstration of the VRTP.