Professor Caitlin Notley has launched a new project that will use virtual reality technology to improve health communication, supporting families to stay smokefree, within Neonatal Intensive Care Units. The SSA caught up with Professor Notley to find out more.

SSA: How did Love My Lungs come about?

Prof. Notley: “This project has come about through many years of background development work, we started off doing a small audit with the neonatal intensive care unit here at the Norfolk and Norwich hospital. We were interested to know what the prevalence of smoking might be for parents who had a baby admitted to intensive care.  I guess we were hypothesising that there might be a higher smoking prevalence because smoking is one of the leading risk factors for having a low birthweight baby or premature baby.”

“We asked every parent admitted to the unit over the course of a couple of months about their smoking status. We found that about a third of parents were smokers and had smoked throughout pregnancy. About a third were ex-smokers, so had perhaps quit for the pregnancy, and about a third were non-smokers.”

“So, there were quite high rates of tobacco smoking – much higher than in the general population. At the time parents weren’t being asked about smoking status routinely at all. That’s partly a cultural thing because on the neonatal unit the baby is the patient, so there are not so many interventions with parents about lifestyle behaviours. There is, however, a clear opportunity to offer support to parents at this really critical time when they are feeling vulnerable and scared and want to do anything they can to help improve the chances of their baby making a good long-term recovery.”

It tricks the brain into thinking and feeling like you are there, you’d feel like you’re actually in an incubator on a unit.

How does this project follow on from your previous work in Neonatal Intensive Care Units?

“We’ve done lots of qualitative work with parents of babies admitted to NICU, lots of work with mums, dads, smokers, ex-smokers, also other family members and health professionals working on NICU, trying to find out what sort of intervention support is needed, what’s wanted, when it would be appropriate to deliver that support, what form that support should take, how the support should be delivered and how long it should continue for.”

“As a result, we’ve developed the intervention that we’re calling ‘Love My Lungs’. We heard from parents that health messages are really powerful when they come from the perspective of the baby. This approach was felt to have a major impact on parents in terms of thinking about changing their behaviour, they didn’t want to be preached to by medical professionals at this difficult time, but they were really interested to hear the hard facts about the impact smoking might have on their baby making a recovery. Particularly in relation to continued smoking in their home when they take their baby home.”

“With other interventions, perhaps we tried to be more supportive and encourage people to change their behaviour, but parents really told us that they wanted hard hitting facts that would help them make a positive change that would help their baby. So, we worked hard to develop leaflets and posters and are working on a training package for professionals working on NICU.”

“Then COVID hit, and at that time, of course, to limit infection risk, all paper was taken off the units, and visiting was heavily restricted. This made it really difficult to deliver health information to parents. We noted through our observational work that parents often use mobile phones, they might be sat around on the unit with their baby for very long periods of time looking at information on their phones. We also heard from parents that delivering health information via digital means might be a more impactful way to get key messages across.”

“We then started to work  with a colleague with a strong interest in virtual reality, and developed a pilot to try and deliver health information using virtual reality videos – and that’s the way the intervention has gone, so we’re developing it now into a series of videos that can be viewed by parents during the time when their baby is admitted to neonatal intensive care.”

Parents really told us that they wanted hard hitting facts that would help them make a positive change that would help their baby.

Has it been difficult liaising with app designers and virtual reality technicians and how to translate the evidence through those other organisations?

“Well, I guess we were quite lucky in that we had a collaborative relationship with a medic with a particular interest in virtual reality. Using virtual reality is becoming more accepted within medical education and teaching. It can be really useful to help students understand the patient experience – for example what it might be like to have a mental health condition. It seemed like it would be a fantastic way to develop impactful health messages that were easy to consume in the digital world.”

“The thing with virtual reality is that it’s a truly immersive experience. You can view the videos that we’re going to use for this project on a mobile phone and you can look around you, which is fantastic and accessible to all. To get the full experience you can use a headset which we will try to make available when we disseminate the project to people on the units.”

“It tricks the brain into thinking and feeling like you are there in the experience. So, if you imagine the filming from a baby perspective, you’d feel like you’re actually in an incubator on the unit. Imagine how you might feel as a baby in a cot being stroked by the hand of someone who has been smoking? Or at home in a cot surrounded by a smoky atmosphere. You get a real-life experience of what that must feel like. For education that’s really important, but obviously in terms of getting across health messages, there’s a huge potential for impact there beyond someone reading a leaflet and looking at some pictures.”

It sounds amazing and terrifying. So, you put on a virtual reality headset and you can be a baby in an incubator for 10 minutes?

“Have you ever had a go on a virtual reality headset?”

No, I never have, what is it like?

“It is amazing because it does really trick your brain. So, when we were playing around with it, there are some games that you can play where you have to walk a plank on top of a building and you can’t get your body to do it even though, you know, you are walking on the floor in an office, that’s not what your brain’s telling you. So yeah, it’s very powerful, and I think it has huge potential across education and clinical settings.”

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