Co-design of virtual reality cognitive remediation program (bWell-D) with patient end-users and clinicians: A qualitative study (Preprint)

BACKGROUND Major depressive disorder (MDD) is the leading cause of global disability, however, existing treatments do not always address cognitive dysfunction – a core feature of MDD. Immersive virtual reality (VR) has emerged as a promising modality to enhance real-world effectiveness of cognitive remediation. To this end, we have developed the first prototype VR cognitive remediation program for MDD (‘bWell-D’). OBJECTIVE This study gathered qualitative data from end-users early in the design process of bWell-D, to enhance its efficacy and feasibility in clinical settings. METHODS Semi-structured end-user interviews were conducted remotely (patients n=15; clinicians n= 12), assessing participants’ perceptions and goals for a VR cognitive remediation program. Video samples of bWell-D were also shared to obtain feedback regarding the program. Interviews were transcribed, coded, and analysed via thematic analysis. RESULTS End-users showed an optimistic outlook towards VR as a treatment modality, and perceived it as a novel approach with the potential of having multiple applications. Participants expressed a need for an engaging VR treatment that included realistic and multisensorial settings and activities, as well as customizable features. Some skepticism about its effectiveness was also reported, especially when the real-world applications of the practiced skills were not made explicit, as well as some concerns about equipment accessibility. A home-based or hybrid (i.e., home and clinic) treatment modality was preferred. CONCLUSIONS Patients and clinicians considered bWell-D interesting, acceptable, and potentially feasible, and provided suggestions to enhance its real-world applicability. The inclusion of end-user feedback is encouraged when developing future VR programs for clinical purposes.