Principal findings
The current study investigated the impact of an AR-based health education workshop on knowledge acquisition in eye diseases among the elderly in a quasi-experimental setting. Paired t-tests demonstrated that the AR-based workshop significantly increased our elderly participants’ knowledge of various ophthalmic diseases after their experience of the visual symptoms. This suggested that the integration of AR into health education initiatives for the elderly can facilitate their comprehension of eye diseases and the associated challenges faced by patients with these diseases. This would help them appraise the significance of visual health and draw their attention to their eye conditions more effectively.
Our study also identified a negative correlation between participants’ age and their knowledge gain while a positive correlation between their education level and their knowledge gain in some diseases. This indicated that the effectiveness of the AR-based workshop on the knowledge acquisition of participants might differ between elderly participants from different backgrounds, and modifications might be required to tailor the learning experience for different groups of participants.
Significance
Visual health is integral not only to the quality of life but also to the elimination of numerous social problems, drawing mounting attention to the significance of visual health education within the community [18]. While elderly participants are more likely to have a medical history of eye diseases, a study showed that having a related medical history negatively correlates with the knowledge level of eye diseases [5], highlighting the significance of further raising the understanding of eye diseases among the elderly population through health education workshops.
Previous studies have elucidated the potential roles of XR in various aspects of ophthalmology, including education, diagnostics and therapeutics [19], demonstrating how the visual features of XR make it highly relevant and applicable to the ophthalmology specialty. A study has further highlighted the potential of XR for scalable health promotion, where participants demonstrated an improved understanding of eye diseases and appraised the significance of eye screening after utilizing XR tools [20], suggesting the effectiveness of XR in raising the general public’s awareness of the significance of visual health. In addition to its educational value, XR-based educational models have been demonstrated to offer highly acceptable, safe, engaging, and enjoyable experiences for both youngsters and adults [21, 22]. Several XR systems, such as SIMVIZ [23], OpenVisSim [14, 15], and CatARact [16]. These studies have illustrated the strengths of AR in simulating the visual symptoms of various ophthalmic disorders and offering an immersive, simulative experience for the users. Our study further demonstrated the application of AR in visual health education was effective in the elderly group.
Our team has also attempted to conduct the AR-based workshop for educating medical students and high school students on common eye disorders. Beyond knowledge acquisition, the AR intervention was found effective in cultivating a high level of empathy. Apart from describing the visual impairments in different diseases, the participants could contextualize them with possible difficulties in patients’ daily lives. This reflects the suitability of this intervention for different participant groups and its potential application for broader purposes, such as training caregivers of patients with eye diseases or future healthcare practitioners. The participants also reported that the AR intervention was a delightful and meaningful experience, which enhanced their curiosity about various eye diseases. It suggests that the AR intervention can serve as a sustainable educational approach, motivating participants to actively acquire health knowledge, thus demonstrating its clinical significance in contributing to community-based health promotion and preventive care initiatives. Expanding the application of such an immersive AR simulation experiential learning workshop to different participant groups, diseases and educational purposes can further develop its potential to enhance awareness, facilitate early detection, lifestyle modifications, and patient-centred care.
In our study, a negative correlation existed between age and knowledge gain in glaucoma and DR. Declined cognitive ability as a result of aging [24, 25] might be the reason that older participants might find it harder to retain and process the new information acquired. Alternatively, older participants might be less receptive to learning with AR due to a higher chance of experiencing cyber-sickness [10]. Studies found that AR exposure could lead to symptoms of cyber-sickness, such as oculomotor disturbance, disorientation, and nausea [26]. In our study, participants were not observed to have any significant presentation of symptoms of cyber-sickness. However, further investigation of the effects of prolonged AR exposure in the setting of an interactive workshop is recommended. This also highlights the need to consider the physical and social discrepancies between different age groups when designing AR-based health education workshops.
Conversely, education level positively correlated with knowledge gain in glaucoma and DR. This is unsurprising as participants with a higher education level might have a higher health literacy and thus could grasp new health information more efficiently. This suggests the significance of raising the elderly’s health literacy and the need to tailor technology-based health education according to different learning abilities or education levels.
Strengths
This study presented an innovative and interactive approach to educate elderly participants on visual health. By overlaying virtual elements in the real-world environment, AR can present complex medical concepts in a simplified and visually engaging manner. Such a visual representation can aid participants’ comprehension, particularly for elderly learners who may have difficulty understanding abstract or complex information through text-based or verbal descriptions alone, while offering them a memorable and enjoyable learning experience.
Besides, the current AR-based workshop involved interactive components. The AR application was coupled with specially designed tasks relevant to the main symptoms of the eye diseases. Unlike the traditional passive, didactic approach, the participants were encouraged to actively explore with the AR headset via experiential learning. Through task completion, participants also participated in problem solving and decision making. These cognitively stimulating activities and the hands-on experience would help participants strengthen their memory of the knowledge gained and maintain their attention, especially for elderly participants who might have a shorter attention span and potentially struggle to stay engaged with traditional instrumental methods.
Apart from the simulative tasks, our application has a remote-control system, which allows our simultaneous control of multiple devices, facilitating our running of group-based workshop or even larger class workshops. With the flexible manipulation of the AR application, the current AR-based workshop can be customized to address specific visual symptoms and levels of severity of common age-related eye diseases, offering personalised education relevant to individuals’ needs. Given the accessibility of the AR headset, prevalence of mobile devices, easy manipulation of the application and portability of the set-up, such an intervention can be widely available in different settings for health education. Apart from community-based health promotion, it can be deployed for educating patients about various visual disorders, complications, and disease progression in a clinical setting [16]; or offering healthcare practitioners insights into patients’ experience of their visual impairments, facilitating informed discussion, and promoting patients’ engagement in visual health management. It can also be used for educating caregivers of patients with eye diseases, helping them experience patients’ visual symptoms and their daily challenges and increasing their empathy.
Limitations and future improvements
The current study has proven the effectiveness of our AR intervention in facilitating our elderly participants’ learning of eye diseases with a large effect size. However, several limitations were presented. First, our study lacked a control group. Despite the large effect size demonstrated by the statistical analyses, uncertainties remain over whether the AR intervention is more effective than other educational approaches. Further studies should be done to compare the AR-based workshop with other strategies, such as health talks, individual counselling, and other multimedia, such as videos, as well as combined methods that incorporate AR with other approaches, to identify the best way to facilitate visual health education among the elderly. Nevertheless, in our current study, we performed multiple regressions that controlled the effects of confounding factors, including gender, age, and education level of the participants.
Secondly, the pre-workshop and post-workshop tests used were not validated knowledge surveys. This is because the questions involved in the current tests were rather direct and simple. The participants were asked about symptoms of the diseases that were directly simulated by the AR application. Additionally, the test was developed by professionals in the field, so it has faced validity regarding the content. Answers of the test were not revealed to the participants until they finished the post-workshop test. This procedure ensured that the participants did not get a higher score in the post-workshop test by simply memorising the answers, but through our intervention.
The current study aimed to serve as a pilot evaluation of our elderly participants’ performance in acquiring simple basic knowledge from the AR intervention before testing its effectiveness in facilitating the elderly’s acquisition of more advanced knowledge and other aspects of learning effectiveness. Future studies should include more parameters of learning effectiveness, such as content quality, self-efficacy, and application, as well as other parameters related to participants’ learning experience, such as learners’ attitudes towards AR, flexibility, enjoyment and the application’s interface design, considering that some elderly individuals may have limited memory, attention span and executive functions due to declined cognitive ability. This will help evaluate the suitability of an AR intervention in health education targeting the elderly more comprehensively.
Finally, the current study was a one-off intervention. Further investigations should be performed to assess the effectiveness of the AR-based workshop on participants’ long-term knowledge acquisition, especially for the elderly, who might have shorter memory due to declined cognitive functions. Whether the knowledge gained from the AR-based workshop could effectively raise the elderly’s awareness of their own visual health should also be evaluated.
Future directions
This study has demonstrated the effectiveness of an AR-based workshop in facilitating visual health education in the elderly, and it could potentially be applied in a wider context, such as other aspects of health education beyond visual symptoms of eye diseases, or in other settings beyond community health promotion, such as patient education in clinical settings, caregiver training, or healthcare profession training. Further expansion of the subject recruitment beyond Hong Kong elderly centers can be done to increase the diversity of the participant pool and enhance the generalizability of the intervention across regions. To evaluate the suitability of applying AR in more aspects of elderly health education, apart from evaluating the effectiveness of knowledge acquisition by participants, the user experience in interacting with AR technologies could be further examined to assess the accessibility and acceptability of AR applications by the elderly and identify areas for improvements in the application’s interface design and user guidance during the AR-based workshop. Further studies can focus on exploring methods to tailor the intervention to participants of different ages and education levels. Besides, multimodal approaches involving the combination of AR with other pedagogical strategies, such as gamification, or technologies like VR, can be explored to maximize participants’ learning experience. Finally, a cost-effectiveness analysis can be conducted to evaluate the economic viability of implementing AR-based health education interventions for the elderly population, especially in less developed areas. The potential cost savings, scalability, and sustainability of using AR technologies should be assessed and compared with those of traditional educational methods to evaluate their suitability for large-scale and long-term implementation in community-based health education.
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