Creating a Virtual Reality Intervention to Increase LGBTQ+ Competence Among Social Workers and Other Health Professionals

Background and Purpose: LGBTQ+ youth experience increased health issues due to stress exposure caused by external prejudice and discrimination, internalized stigma, and significant barriers to accessing healthcare—leading to high levels of unmet needs. They expect to face discrimination and lack of competence from health professionals (HPs; e.g., social workers, doctors, nurses), leaving them hesitant to disclose their LGBTQ+ status. Concurrently, rapidly expanding policies across the United States have blocked the ability of HPs to provide gender-affirming care to minors. In this context, competent, evidence-based healthcare delivery to LGBTQ+ youth aimed at prevention and intervention is critical to their well-being.

This paper discusses the development, implementation, and pilot evaluation of a 60-minute digital training application leveraging immersive virtual reality and simulation-based learning principles to improve cultural humility, implicit bias awareness, and clinical competence among HPs regarding LGBTQ+ youth. The training also provides knowledge, resources, and strategies that may help mitigate access issues and health disparities.

Methods: Co-design is an innovative approach to equitable engagement with stakeholders. In this study it was employed with (1) interdisciplinary HPs and (2) LGBTQ+ youth (age 14-24). Both stakeholder populations were recruited online and via community partners to engage in multiple forms of co-design—identifying relevant concepts and subject material for the proposed intervention. They also participated in prototyping the virtual reality components, testing potential technologies and assessing possible delivery mechanisms.

Co-design generates novel mixed methods data. This study resulted in design session (focus group) recordings, as well as various physical and digital artifacts. Pilot evaluation during and after the prototyping process generated further mixed methods data on the feasibility, acceptability, and effectiveness of the training application. Quantitative data were summarized and analyzed using descriptive statistics. Qualitative data were analyzed using thematic analysis due to its flexibility and compatibility with a wide variety of approaches and types of data.

Results: The digital training immerses HPs in the first-person perspective of a racial minority LGBTQ+ youth engaging with healthcare in various ways. Iterative analyses during the application development, prototyping, and preliminary evaluation phases determined that the learning objectives, curricula, and delivery of the training were accurate, appropriate, and relevant to the practice of HPs.

Consistent with the conference’s emphasis on program impacts, as of January 2025 more than 750 HPs have fully completed the training. It is particularly popular among nurses (32%) and non-clinical personnel (e.g., support staff; 24%), with the other participants coming from diverse healthcare disciplines (e.g., social workers, doctors). Early impact metrics include 88% of participants indicating the training equipped them with new knowledge and resources to apply to their clinical practice and 92% intended to apply at least one thing they learned during the simulation experience. Participants also created implementation plans to help them achieve their self-determined objectives.

Conclusions and Implications: Collaborative efforts between social work and design resulted in a virtual training simulation beneficial to HPs as they gain knowledge, understanding, and resources tailored to meet the needs of LGBTQ+ youth in a challenging professional and political climate.