Preparing Facilitators From Community-Based Organizations for Evidence-Based Intervention Training in Second Life

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Original Paper

Preparing Facilitators From Community-Based Organizations for Evidence-Based Intervention Training in Second Life

Angel Felix Valladares, MPH;
Michelle Aebersold, RN, PhD;
Dana Tschannen, RN, PhD;
Antonia Maria Villarruel, RN, FAAN, PhD

University of Michigan, School of Nursing, Ann Arbor, MI, United States

Corresponding Author:
Michelle Aebersold, RN, PhD

University of Michigan
School of Nursing
400 N Ingalls Street
Ann Arbor, MI, 48109
United States
Phone: 1 (734) 615 8498
Fax: 1 (734) 647 2416

1]. While rigorously tested evidence-based interventions (EBIs) have the potential to influence health outcomes, challenges related to training and capacity building access (eg, funding, high travel costs, limited to no technical assistance offered, and limited guidance on appropriate adaptations) [2,3] can impede implementation fidelity and the effectiveness of the EBI. Due to these challenges, more accessible training modalities on how to deliver the intervention accurately are needed to better disseminate EBIs and to ensure their effectiveness. Virtual environments such as SL have not been extensively used for EBI training of individuals who work in community-based organizations and deliver training to adolescents (ie, facilitators). This is important as facilitators deliver the curriculum to the adolescents and facilitate group discussions and other activities that are part of the curriculum. As a cost-effective and highly interactive MUVE, SL has potential to serve as a delivery platform for comprehensive EBI facilitator training.

A MUVE is a computer-based, simulated virtual environment allowing users to inhabit an online virtual world and interact with others via self-representations known as avatars in synchronous sessions [1]. The advantage of MUVEs like SL is that they increase access to capacity building opportunities [2] and are a promising alternative to face-to-face training due to substantial features mirroring human interactions. These features include advanced and realistic voice chat, speech gestures, and the ability to manipulate voices in a multidimensional space just as one would experience in real life [4]. This study describes the process of preparing individuals from community-based organizations to participate in a SL ¡Cuídate! (Take care of yourself) Training of Facilitators [5].

Second Life Training

SL has been previously used for small-scale health-related programs focusing on education and awareness, support, training, marketing, and promotion of health services [1,6-11]. For example, SL was used to implement a 1-hour seminar to enhance clinician knowledge of insulin therapy for type 2 diabetics for primary care physicians (n=14) [9]. Results of the training indicated a positive impact on self-efficacy to perform insulin therapy, gains in clinical competence around the use of insulin therapy, and positive feedback on the sense of presence attributed to the use of avatars. There was high variability in the SL user learning curve depending on past experience with video games, but an average of 78 minutes was spent with each participant to gain proficiency in SL. Similarly, Mitchell et al pilot-tested motivational interviewing training in SL with primary care physicians (n=13) focusing on colorectal cancer screening [10]. A self-directed approach to learning SL skills was used to reduce the amount of time necessary to prepare participants in SL. The actual amount of time participants spent on preparation was not explicitly reported. Finally, Tschannen et al used SL for diabetes self-management training for nurses. Participants reported that they were highly satisfied with the virtual simulation experience. Further, participants’ ability to apply knowledge gained was comparable to those who completed a face-to-face training alternative [11]. While these studies demonstrate the utility of SL for training, none of these studies reported quantitative data on SL proficiency outcomes, or self-efficacy of SL skills. Further, training participants were limited to highly trained clinicians.

Technical Challenges

Virtual training presents a number of technical challenges, including computer system capacity and security issues [10]. For example, training participation requires minimum system specifications, installation of a separate computer program, and the development of specific computer skills to facilitate the interaction required in SL to engage fully in the training. Specifically, SL requires a high level of processing power, graphical memory, and a need for a large bandwidth with high-speed Internet access [12]. Individuals may encounter network policies that do not allow access to public virtual worlds like SL or allow downloads of software or a continuous Internet connection [9]. Despite the technological complexities, SL has proven to be an accessible medium for effective training and education.


The purpose of this study was to examine the feasibility of using SL to train facilitators to use an EBI, ¡Cuídate! (Take Care of Yourself), one of the few sexual risk reduction interventions developed and tested with Latino youth [13]. The participants received training in SL to prepare them to deliver the ¡Cuídate! curriculum to Latino youths in their community. This paper examines the management of technical issues and participant self-evaluation of SL skills.


This is a descriptive study. The study protocol was reviewed by the institutional review board at the University of Michigan and was deemed exempt and not regulated.

A virtual training center (Figure 1) was developed in SL to deliver the ¡Cuídate! training. This training center was built on university-owned space in SL (Wolverine Region). The training center consisted of a conference room with a table and chairs and a training room with movable chairs, which were scripted to provide avatars with gestures such as hand-raising. The training was set up with Web prims to display interactive posters and Google Docs.

Preparation to use SL consisted of four phases: (1) recruitment and computer capacity screening, (2) enrollment, (3) orientation to the SL program, and (4) technical support throughout the synchronous training sessions.

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