Co-designing accessible digital mindfulness for veterans with spinal cord injury: protocol for developing and testing VA CALM-SCI for virtual reality

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.