InterventionTesting the effects of educational strategies on comprehension of a genomic concept using virtual reality technology
Introduction
Genetic research is making it increasingly possible to provide patients with information about inherited susceptibilities to common diseases [1]. The challenges involved in educating patients about such genomic information are significant, however. For one, applying genomic information to improve health will likely require patients to have some understanding of the complex, multifactorial nature of common diseases and knowledge of related scientific concepts.
Communication about genomics can therefore place substantial information demands on patients, particularly those without related training or experience [2], and those who have limited genetic-related skills and knowledge (“genetic literacy”). About 38% of U.S. adults have limited health literacy [3], and the proportion of adults with limited genetic literacy might well be higher. In particular, levels of conceptual knowledge (i.e., knowledge of background concepts required to understand and use health information [4]) may be insufficient to understand genetic information for many individuals. Although the general public is reasonably aware of genetic risk factors for multifactorial diseases, awareness ranges greatly across different conditions [5], and individuals may not have conceptual understanding of terms like “genes” or “DNA” [6], [7].
The development of educational strategies to improve conceptual knowledge is therefore important to provide patients with the foundation necessary to understand and apply genomic information. Public understanding of how environmental and behavioral factors impact the effects of genes on health will likely be a critical part of future disease prevention efforts [8]. Prior research provides limited guidance for developing strategies to improve knowledge of the concept that genetic and environmental factors interact to affect common disease risk, and this has been highlighted as an important future direction for communication research [9]. Existing genetic education and communication studies have generally focused on the specialized genetic counseling encounter or the communication of genetic test results within high-risk families [10], [11]. The purpose of this experimental study was to compare two strategies based on different educational approaches to teach lay individuals about the genomic concept of gene–environment interactions.
Theory and empirical research in pedagogy and science education suggest that learning mode (the way in which information is presented to learners) has a critical influence on learning outcomes. These literatures indicate that the traditional mode of didactic learning through listening or reading might not be optimal for education about abstract scientific concepts, because developing an understanding of these concepts often requires building mental models of unfamiliar and intangible objects [12]. Active learning, in which learners are asked to construct their own knowledge through self-driven, interactive activities, has been suggested as a better educational approach for building such mental models [12], [13]. These interactive approaches are thought to promote deep cognitive processes, resulting in active construction of new knowledge [14]. However, little research has examined active learning approaches for educating adults about abstract scientific concepts. Some related research in medical and college science education has shown greater increases in comprehension with active learning compared to more traditional learning approaches [15], [16], but other studies have found no differences [17], [18].
In addition, the mediating mechanisms underlying the proposed effects of learning mode on conceptual understanding are not understood. The limited research in this area has generally not been theoretically based, and potential mediating variables have not been operationalized and examined systematically. Therefore, we chose to explore possible mediating variables suggested by the Elaboration Likelihood Model (ELM), a dual process theory of cognition which distinguishes between central and peripheral routes of information processing [19]. Use of deeper (i.e., central) processing is desired for education because it results in cognitions and attitudes that are more stable over time. Individuals who are motivated to think about and have the ability to process information use the central route [19].
For this study, we therefore identified possible mediating variables related to increased motivation, greater ability, and deeper processing. These variables included elaboration (i.e., thinking deeply about the information), and motivation to engage in the learning activity, as well as factors related to motivation: attention to the information, involvement (i.e., perceived personal relevance of information) and interest in the information [19], [20]. We also identified enjoyment of the activity and believability of the information as variables possibly related to motivation, and perceived difficulty as related to individuals’ ability to process the information.
To test the effects of learning mode, we used an immersive virtual reality platform. This technology immerses users in a three-dimensional digital environment created via a combination of graphics and scripting software. Wearing an interface, users can be exposed to and act within virtual environments [21]. Immersive virtual reality technology holds promise as an experimental setting for social and behavioral research in genomics [22], as virtual worlds reduce the trade-off between internal and external validity in experiments [23].
For this study, we developed virtual worlds for both active learning and didactic learning approaches. We hypothesized that comprehension of the gene–environment concept would be higher for active learning than that for didactic learning, and that this association would be mediated by elaboration, motivation, attention, involvement, interest, believability, enjoyment, and perceived difficulty, as described above. In addition, we explored whether education and having a scientific occupation would modify the hypothesized association, due to differences in learning skills and prior conceptual knowledge.
Section snippets
Study design
This study employed a two group, between-subjects, repeated measures randomized design to test which learning mode (active versus didactic) best conveyed the concept of gene–environment interactions.
Sample
We enrolled 165 participants who responded to advertisements placed through a clinical research volunteer program; they received $40 for participation. Inclusion criteria included being age 18–40, and not working in genetics or having taken a human genetics course within the past five years.
Results
As shown in Table 1, about half (47%) of participants were female and aged 25 or younger (42%), and the majority were white (67%). Sixty-seven percent had a college degree or higher; 39% had a household income of less than $40,000. Just over half (56%) worked in scientific occupations, while the remaining 44% had other occupations or were not working. Seventeen percent reported that a family member or friend had been diagnosed with a gallbladder problem; 20% reported having a family member or
Discussion
The purpose of this study was to examine the effect of learning mode on comprehension of the genomic concept that genetic and environmental factors interact to affect risk of common disease. Comprehension improved with both active learning and didactic learning approaches. However, contrary to our hypothesis, comprehension was significantly higher with didactic learning than that with active learning. We observed this effect for three measures of comprehension, both closed-ended and open-ended,
Acknowledgments
This research was supported by the Intramural Research Program of the National Human Genome Research Institute, National Institutes of Health. We thank Rajiv Rimal, Celeste Condit, Colleen McBride, and Beth Ford for their comments on a previous draft of this manuscript and Ibrahim Senay for assistance with data collection.
This manuscript was written in the course of employment by the United States Government and it is not subject to copyright in the United States.
References (44)
- et al.
Educating the general public about multifactorial genetic disease: applying a theory-based framework to understand current public knowledge
Genet Med
(2008) - et al.
Confounder selection in environmental epidemiology: assessment of health effects of prenatal mercury exposure
Ann Epidemiol
(2007) - et al.
Self-regulation and the behavioural response to DNA risk information: a theoretical analysis and framework for future research
Soc Sci Med
(2006) - et al.
Educational games in an obstetrics and gynecology core curriculum
Am J Obstet Gynecol
(2005) - et al.
Implications of the Human Genome Project for medical science
J Amer Med Assoc
(2001) - et al.
Genomics—the perfect information-seeking research problem
J Health Commun
(2005) - et al.
The health literacy of America's adults: results from the 2003 national assessment of adult literacy
(2006) - et al.
General public's knowledge, interest and information needs related to genetic cancer: an exploratory study
Eur J Cancer Prev
(2005) - et al.
Exploring the public understanding of basic genetic concepts
J Genet Couns
(2004)
Behavioral health outcomes associated with religious faith and media exposure about human genetics
Health Commun
An interactive computer program can effectively educate patients about genetic testing for breast cancer susceptibility
Am J Med Genet
Genetic counseling for BRCA1/2: a randomized controlled trial of two strategies to facilitate the education and counseling process
Am J Med Genet
Using virtual reality technology to convey abstract scientific concepts
Enhancing instructional efficiency of interactive e-learning environments: a cognitive load perspective
Educ Psychol Rev
A comparison between traditional and constructivist teaching in college biology
Innovative Higher Educ
The effect of active learning on student characteristics in a human physiology course for nonmajors
Adv Physiol Educ
Teaching physiology by combined passive (pedagogical) and active (andragogical) methods
Am J Physiol
Incorporating active learning into a traditional curriculum
Am J Physiol
Communication and persuasion: central and peripheral routes to attitude change
Cited by (12)
Future Health Applications of Genomics. Priorities for Communication, Behavioral, and Social Sciences Research
2010, American Journal of Preventive MedicineCitation Excerpt :Some interpret this concept as meaning that behavior is the major contributor to health outcomes; others see the two as working together in an additive relationship (i.e., genes plus behavior).36 These interpretations will likely be sensitive to differences in how the information is conveyed.37 However, it is unclear how this understanding will influence uptake and use of, for example, genetic testing.
Development of a patient-oriented Hololens application to illustrate the function of medication after myocardial infarction
2021, European Heart Journal - Digital Healthvirtual reality as an introduction to improve some visual perception skills for Children with cerebral palsy and a mild mental disability
2020, Journal of the Faculty of EducationThe effects of virtual reality learning environments on improving the retention, comprehension, and motivation of medical school students
2020, Advances in Intelligent Systems and ComputingInternet Versus Virtual Reality Settings for Genomics Information Provision
2019, Cyberpsychology, Behavior, and Social Networking