Patient engagement and presence in a virtual world world diabetes self-management education intervention for minority women.

The qualitative sample was small and purposively selected, so it may not represent all women with uncontrolled type 2 diabetes. Only the virtual-world arm was analysed, so the paper does not compare presence, engagement, or outcomes with the in-person arm. The presence survey was developed for first-person virtual reality headsets, but this study used third-person laptop-based virtual world software, so some survey items may not have fit the experience. The quantitative presence data were cross-sectional, so they cannot show that presence caused engagement or behaviour change. Some participants reported dizziness, discomfort, avatar stereotype mismatch, side conversations, and technical problems, which may limit how widely this format can be used without support. The report does not give comparative effectiveness results for diabetes control, attendance, or self-management behaviour.

The authors declared competing interests. Dr. Suzanne Mitchell consults on health communication and relationship centered care, has provided workshops and lectures funded by pharmaceutical and other industry sponsors, and holds equity in See Yourself Health LLC. The paper reports an embedded sub-study of a trial linked to NIH funding (NIDDK R01DK10653).

Do not read these presence themes as proof that virtual diabetes education improves glucose control, attendance, or self-management compared with in-person classes. The paper reports descriptive survey and interview findings from one trial arm, not a tested effect on patient outcomes.