Virtual Reality and Lived-Experience Speakers in Homelessness Education: A Mixed-Methods Study of Medical Sciences Students' Empathy and Attitudes Toward People Experiencing Homelessness

This mixed-methods educational intervention study examined whether a perspective-taking virtual reality simulation could complement lived-experience teaching about homelessness in an undergraduate medical sciences course. The study was conducted at Western University in London, Ontario, Canada, with students enrolled in two sections of a community-engaged learning course. The course was selected because many students in the program intend to pursue careers in healthcare or related health professions.

Participants were recruited from two course sections. Students self-enrolled into course sections, and one section was randomly assigned to complete the virtual reality intervention before a lived-experience speaker session. The other section heard from the lived-experience speakers without prior virtual reality exposure. The virtual reality intervention was We Live Here, an immersive simulation in which users take the perspective of a person experiencing homelessness. The lived-experience teaching session involved guest speakers who shared personal experiences of homelessness and responded to student questions.

All participants completed a baseline survey at the beginning of the academic term. The baseline survey included validated measures of empathic concern, perspective-taking, and attitudes toward people experiencing homelessness. Three weeks later, one group completed the virtual reality simulation. One week after that, both groups attended the lived-experience speaker session. After the speaker session, both groups completed a post-intervention survey that repeated the attitude measures and included short-answer questions about how the educational activities affected their understanding of homelessness. The comparison group completed the virtual reality simulation after the post-intervention survey so that all students had access to the same educational experience.

The quantitative component compared pre- to post-intervention changes in attitudes toward people experiencing homelessness between students who completed virtual reality before the speaker session and students who heard from the speakers without prior virtual reality exposure. The primary hypothesis was that students who completed virtual reality before hearing from lived-experience speakers would show greater improvement in attitudes toward people experiencing homelessness and would report greater engagement with the speaker session. Survey responses were analyzed using Bayesian ordinal multilevel models to account for repeated responses by participant and variation across survey items.

The qualitative component was designed to help explain and extend the survey findings. Short-answer survey responses and focus group discussions were analyzed using inductive thematic analysis. Focus groups were organized by intervention sequence to explore how students perceived the distinct contributions of virtual reality and lived-experience speakers, and whether the order of these activities influenced empathy development, perspective-taking, engagement, and understanding of homelessness.

The study was approved by the Western University Research Ethics Board. Informed consent was obtained from all participants.

Inclusion criteria

• Students must be enrolled in MedSci 4995E and be able to put on and experience the VR simulation.

Exclusion criteria

• Students with visual/audio impairments may not be able to participate in the VR experience.