Table 1.

Summary of drivers, barriers and possible actions and solutions regarding use of Virtual worlds (VWs) for PPE

	Results gathered from in-depth interviews	Possible actions/solution regarding results
Advantages of using VWs for PPE	Use of VWs could enhance patient engagement by connecting people VW use by patients could result in strengthening of patient-led support networks VW use can be cheaper than meeting face to face (less need for paid spaces and travel) VWs might be particularly useful for those with communication difficulties and it is possible to switch between verbal and non-verbal communication	The prospect of using VWs could be disseminated among patient groups who traditionally less engaged with care, those who have limited monetary resources and those who have mobility and communication difficulties as these groups may benefit most VW facilities could be made available to patient-led groups with the aim of enabling the strengthening of these networks
Barriers to using VWs for PPE	Not everyone has home access to technology enabling use of VWs Synchronous use of verbal and written communication can be confusing for users Technical problems outside of users’ control can occur. Firewalls can block use of VWs from some areas, including some hospital networks Non-human avatars can potentially make virtual worlds feel less ‘real’	Initially, further research could involve those who currently have access to VWs, with a view to expanding access to more users when technology needed for VW access is cheaper and more is known of how best to use VWs for PPE Rules could be established in certain regions so that only text-based communication is permitted at certain times, if people who are unable to speak are present at meetings Technical support would help users to know how to address issues such as firewalls and technical problems with software Rules could be established for meetings associated with certain user groups that attendees must have human avatars