Virtual Reality Based Interventions for Promoting Social Participation and Recover: A qualitative study of how professional health service providers perceive barriers to social participation among people in recovery from mental health and substance use disorders (Preprint)

BACKGROUND People with mental health and substance use disorders (MHD/SUD) are a highly vulnerable group, particularly affected by social exclusion, marginalization and disconnectedness. Virtual reality technology holds an extraordinary potential for simulating social environments and interactions to mitigate social barriers and marginalization for people in recovery from mental health and substance use disorders. However, it is still unclear how we can harness the greater ecological validity of virtual reality based interventions (VRIs) targeting social and functional impairments in individuals with concurrent mental health and substance use disorders. The aim of this study was to explore barriers to social participation among adults in recovery from MHD/SUD as perceived by community based health care service providers. OBJECTIVE The aim of this paper is to explore how service providers in community based MHD/SUD health care (CBHC) services perceive barriers to social participation among adults in recovery from MHD/SUD, in order to provide a broader understanding of how we can model learning experiences for promoting social participation in virtual reality environments. METHODS Two semi-structured, open ended, dual-moderator focus groups were conducted with participants representing different CBHC services. Service providers were recruited from their MHD/SUD services in our collaborating municipality in Eastern Norway. One group of participants was recruited at a municipal MHD/SUD assisted living facility for service users with ongoing excessive substance use and severe social dysfunctionality. We recruited the second participant group at a community based follow-up care service aimed at clients with a broad range of MHD/SUD and various levels of social functioning. The qualitative data extracted in the interviews were analyzed using reflexive thematic analysis RESULTS The analysis of the service providers’ perceptions of barriers to social participation among MHD/SUD clients revealed five main themes: Challenging or lacking social connections, impaired cognitive functions, negative self-perception, impaired personal functioning, and social marginalization. The barriers identified are interrelated in a cluster of cognitive, socio-emotional and functional impairments leading to a severe and diverse complex of barriers to social participation. CONCLUSIONS The findings in this study indicate a need to address cognitive functioning, socio-emotional learning, instrumental skills, and complex social functions to meet the complexity and diversity of the identified barriers to social functioning in our target group. The operationalization of successively complex levels of human and social functioning in this study enables the derivation of specific learning goals and learning taxonomies to enhance specific functional capabilities. This allows us to tie our learning objects to distinct learning taxonomies and apply didactical approaches in designing, structuring, and sequencing VRIs to promote social participation. CLINICALTRIAL The overall study is registered at clinicaltrails.gov (ref. NCT05653167).