Into the wild: The what, how, and why of using virtual natural environments in residential care facilities

Lately, interest has increased in using Virtual Reality (VR) in residential care facilities to increase accessibility to nature experiences. It is widely acknowledged that nature benefits health, and various theories exist regarding its restorative effects. Studies of virtual natural environments often start from predetermined mediating mechanisms and health outcomes. However, virtual nature is fundamentally different from real nature, and people will form different expectations and reactions. Furthermore, by assuming predetermined outcomes and mechanisms, we, as researchers, decide for older adults what and how their virtual natural environments should be, and why they should use them. But we cannot design virtual natural environments with inherent meanings; users will create their own meanings and purposes. Therefore, this thesis took a step back and assumed an inductive approach to explore open-ended possibilities for virtual natural environments. To do this, we invited older adults to test and help design virtual natural environments in our labs, and to use and react to them in residential care facilities. Thus, we aimed to explore what meanings older adults make of virtual natural environments, what factors influence such meaning making, and how virtual natural environments can be meaningful at residential care facilities.
In this thesis, we have reviewed the past use of VR in health and care settings and examined the applicability of virtual nature as a complement to real nature contact. In our VR lab, we have engaged older adults to help design a virtual natural environment through a cyclic process, exploring their preferences and ideas for virtual natural environments and how these can be implemented in a prototype. We have also examined the endocrine effects of an interactive virtual natural environment on older adults in the context of an induced social stress response. Finally, in the wild, across two studies at residential care facilities, we have tested different virtual natural environments and VR devices with residents to explore what meanings they make of virtual natural environments, and how their long-term use at residential care facilities can become a meaningful activity.
This thesis found that older adults in residential care facilities can find virtual natural environments meaningful as a source of stimulation, positive emotions, mood improvement, opportunities for reminiscing and reflection, distraction from challenges, empowerment, and relation building. Further, this thesis found several principles for virtual natural environments for older adults such as realness, interactivity, relatedness and individualised adaptation. We also found that virtual natural environments may support a person-centred approach in residential care facilities if experienced in the context of engaged participation with other actors (e.g., the one who provides VR and guides the user). This process involves VR as a catalyst for relation building through the sharing of memories and emotions, and the co-shaping of virtual environments in relation to the resident’s lived reality. Thus, virtual natural environments should not be considered a one-size-fits-all turn-key solution, but require engagement and individualised adaptation.