Co-designing accessible digital mindfulness for veterans with spinal cord injury: protocol for developing and testing VA CALM-SCI for virtual reality
Hilary N. Touchett, Kathryn E. Kanzler, Zina Trost, Jan Lindsay, Felicia Skelton
Frontiers in Digital Health October 8, 2026 DOI: 10.3389/fdgth.2026.1923501 (opens in new tab)
Study at a glance
AI-extracted from the abstract| Characteristics | Clinical protocol Qualitative Peer reviewed |
|---|---|
| Sample size | 10 |
| Population | Veterans with spinal cord injury (SCI) |
| Topics | Meditation |
| Key points | The protocol proposes a participatory co-design process, guided by the Method for Program Adaptation through Community Engagement (MPACE), to adapt VA CALM mindfulness content for Veterans with SCI and then test its delivery via virtual reality. The authors contend that this approach may improve accessibility, reduce travel burden, enhance engagement, and expand clinical capacity, with findings intended to inform future development and testing of the adapted program. |
Abstract
Introduction: Virtual reality (VR)-based mindfulness programs are gaining traction as innovative, engaging, and low-cost tools to address chronic pain, depression, and anxiety. However, these programs are often designed for neurologically normative populations while lacking accessibility for people with disabilities, such as spinal cord injury (SCI). This protocol describes a participatory co-design approach adapting the Department of Veterans Affairs Compassionate Awareness Learning Module (VA CALM) content for individuals with SCI to improve access and accessibility and then evaluate the feasibility and acceptability of delivering this program via VR to enhance effectiveness and engagement. Methods and analysis This 2-phase formative study uses the Method for Program Adaptation through Community Engagement (MPACE) to guide our co-design process. In Phase 1, 10 Veterans with SCI will complete VA CALM to identify needed adaptations. Quantitative measures will assess mindfulness, pain (interference, catastrophizing, and acceptance), depression, anxiety, and quality of life (QOL). Qualitative data include field notes, facilitator reflections, and focus groups. A 10-member steering committee of clinicians and Veterans will review findings and adjudicate adaptations. In Phase 2, preliminary VA CALM–SCI modules will be delivered via a VR platform. Feasibility and acceptability will be evaluated for usability, user experience, and embodiment alongside qualitative feedback.
Discussion: This study advances equitable digital health by co-designing accessible mindfulness content for SCI and testing a VR delivery model that may reduce travel burden, enhance engagement, and expand clinical capacity. Findings will inform future efforts in developing and testing this adapted program and reinforce the value of prioritizing accessibility and inclusion when developing future healthcare innovations.
Citations in the library
Cites 6
- Construct Validity of the Five Facet Mindfulness Questionnaire in Meditating and Nonmeditating Samples Assessment February 29, 2008
- Mindfulness-based Stress Reduction (MBSR) Reduces Anxiety, Depression, and Suicidal Ideation in Veterans Medical Care November 13, 2014
- Grieving a disrupted biography: an interpretative phenomenological analysis exploring barriers to the use of mindfulness after neurological injury or impairment. BMC Psychology August 24, 2021
- Brief Mindfulness Meditation Induces Gray Matter Changes in a Brain Hub Journal of Neural Transplantation and Plasticity November 16, 2020
- Mindfulness for pain, depression, anxiety, and quality of life in people with spinal cord injury: a systematic review BMC Neurology January 21, 2020
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