Content area
Aim
This study aimed to examine the effects of an integrated fall educational intervention on nursing students’ knowledge, attitude and self-efficacy. In addition, both immersive and non-immersive virtual simulations which were used in fall education were investigated in terms of usability, user experience and satisfaction among the participants.
BackgroundFalls among the older population have a significant impact on morbidity, mortality and healthcare costs, making it essential to incorporate fall risk assessment and management education into the geriatric nursing curriculum to prepare future nurses for improving older patients' health.
DesignThis study was a quasi-experimental study with a two-group, pretest-posttest design.
MethodNinety-two undergraduate nursing students were recruited with 36 in the experimental group and 56 in the control group. Data were collected through survey questionnaires before and after the intervention.
ResultsThere were significant improvements in both fall knowledge and self-efficacy following the intervention in the experimental group ( p < .001). In particular, compared with the control group, self-efficacy was significantly improved in the experimental group ( p < .01). Participants reported greater usability, attractiveness, perspicuity, novelty, stimulation, dependability, efficiency and satisfaction in the immersive compared with the non-immersive virtual simulation. However, some participants experienced some discomfort such as dizziness, motion sickness and the heaviness of the head-mounted display device.
ConclusionAn integrated fall educational intervention using virtual-reality simulations for nursing students can increase fall-related knowledge and self-efficacy. When designing an effective educational program, educators should consider the strengths and weaknesses of immersive and non-immersive virtual simulations.
Falls among older population are a significant concern in geriatric nursing, contributing to increased morbidity, mortality and healthcare costs ( Rubenstein, 2006). As the older population grows worldwide, incorporating fall risk assessment and management education into the geriatric nursing curriculum is essential to ensure future nurses are well-equipped to improve the health of older patients ( Brownet al., 2018; Turjamaa et al., 2020).
With advancements in healthcare technology, there is growing recognition of the potential benefits of innovative educational methods such as virtual simulations. Nursing education has shifted from instructor-centered to learner-centered approaches, making it important to examine students’ perceptions about new educational methods. Incorporating these methods alongside traditional face-to-face lectures and practicums can address various learning styles and integrate theoretical knowledge with practice.
Traditional lectures provide foundational knowledge but may lack engagement ( Lamanauskas and Makarskaite-Petkeviciene, 2021). Clinical case seminars offer practical insights by examining real patient cases, yet they might not cover the diverse range of real-life situations students need to learn ( McLean, 2016). Virtual simulation has emerged as an alternative, overcoming limitations related to time, space and human resources ( Shin et al., 2015). This method is particularly beneficial in nursing education for teaching clinical contents that are difficult to access in clinical practice ( Chen et al., 2020; Ma et al., 2024; Salameh et al., 2024). Virtual simulations allow for repetitive practice in a safe and interactive environment, enabling learners to master complex nursing skills that might be difficult to perform in a real hospital setting ( Shin et al., 2019). Additionally, virtual clinical simulation training can be cost-effective over time despite high initial costs ( Shorey and Ng, 2021). Recent studies have highlighted the effects of virtual simulations on the improvement of learners' competencies ( Liu, 2021; Shorey and Ng, 2021; Chang et al., 2024; Ma et al., 2024).
Virtual simulations can be non-immersive and immersive. Non-immersive virtual simulation involves interactive learning with virtual scenarios through a computer screen, offering greater accessibility and ease of use without requiring specialized equipment ( Dubovi et al.,2017; Cant and Cooper, 2014). While computer-based virtual simulation can still be interactive, this method may be less engaging and realistic compared with immersive virtual simulation, influencing learning outcomes ( Qiao et al., 2023). Immersive virtual simulations allow learners to navigate virtual worlds using virtual reality (VR) headsets like head-mounted display devices ( Weiss et al., 2018; Saab et al., 2021). The technology provides a fully immersive experience for integrating theoretical and practical contents that mimics real life-like scenarios ( Foronda et al., 2017; Saab et al., 2021). Using virtual simulations can enhance nursing students' learning experience and capacity to care for patients ( Cant et al., 2023; Davis, 1989). Integrating virtual simulations into fall risk assessment and management education and examining its effects on learning outcomes can contribute to improving the quality of nursing care.
Thus, this study first aimed to investigate the effects of an integrated fall educational intervention, including immersive and non-immersive simulations, on nursing students' knowledge, attitudes and self-efficacy. Second, this study explored nursing students’ perceptions regarding usability, user experience and satisfaction with immersive and non-immersive virtual simulation.
2 Methods2.1 Study design and study participants
This study employed a quasi-experimental design without random allocation. Study participants were recruited from a university in Seoul, South Korea. Eligibility criteria included undergraduate nursing students with no prior clinical practicum experience and exposure to an integrated fall education program as part of their required coursework. Students who had previously experienced side effects, such as dizziness, nausea, eye fatigue, or motion sickness when using a head-mounted display (HMD) device, were excluded.
Based on the result of a previous study confirming that the effect size was 0.71, which meant a medium-to-large effect of education using simulation in nursing education ( Shin et al., 2015), the number of participants required for this study was calculated. After designating the effect size of 0.71, alpha value of 0.05 and power of 0.95 in the G-power 3.1.9.7 program, the number of subjects required was calculated as 106. One hundred eleven subjects were recruited and conveniently allocated to the experimental group and the control group. The 49 participants in the experimental group completed the survey on the usability and experience of the simulation program. Finally, 36 in the experimental group and 56 in the control group completed the pre-test and the post-test, resulting in 92 participants used for the analysis.
2.2 InterventionThe experimental group participated in the integrated fall-related educational intervention which included lecture, clinical case seminar, non-immersive and immersive virtual simulations, debriefing session after simulations and clinical skill test ( Table 1). The Integrated Fall Prevention and Management Program for Older Adults included a 3-hour lecture, a 1-hour and 20-minute case study seminar, a 2-hour and 20-minute combination of immersive and non-immersive virtual simulations, a 1-hour debriefing session and a 5–10-minute clinical skill test. On the other hand, the control group did not receive the integrated fall educational intervention related to falls in older adults but only participated in the general school curriculum.
2.3 LectureThe 3-hour lecture was conducted by a PhD-prepared faculty member during the class of gerontological nursing. The lecture consisted of the definition of falls, indoor and outdoor risk factors for falls and nursing activities related to fall prevention. Students learned about methods and tools for assessing fall risk and were educated on tools and measures for safety and fall prevention and how to manage falls.
2.4 Virtual simulationNon-immersive and immersive simulations were used in the experimental group. Each simulation was conducted individually and guided by clinical instructors. The clinical instructor received prior training on the scenarios and tasks to be achieved in the non-immersive simulation. Additionally, they were trained on providing explanations and guidance to participants before, during and after the immersive simulation, as well as on the methods for conducting the simulation.
2.5 vSIM practice (non-immersive simulation)Students participated in a simulation of the real-world nursing scenario through a program called vSIM. They used desktops or personal laptops without additional equipment to access the program and run the simulation for two hours. During the simulation, students checked virtual patients’ information, talked with patients and their caregivers, provided the necessary education and assessed the patient's condition using the Fulmer SPICES assistance (Sis for Sleep Disorders) and Morse Fall Scale.
2.6 VR bathroom safety education (immersive simulation)Students participated in an immersive virtual simulation while wearing a head mounted display (HMD). The HMD used in this study was the Oculus Quest 2, developed by Meta. This educational simulation was provided in a game format, allowing participants to learn about fall safety measures by using both hands to operate keys that identified safety risk elements located in a bathroom simulated by virtual reality. The content of the VR simulation was developed based on evidence-based guidelines from the Seoul Metropolitan Government (2017). The virtual bathroom environment included common elements found in a home bathroom, such as a bathtub, sink and toilet. Participants were able to find hazards as they navigated through the bathroom, approaching those factors and clicking fall safety-related elements using the operating keys. When they selected a bathroom safety risk element, the environment transformed into a safe setting, while a visual and auditory explanation of the changed surroundings was provided.
2.7 Safety considerations in virtual simulationImmersive virtual simulation was limited to 15 minutes to prevent dizziness, motion sickness and visual fatigue that can occur as side effects during virtual reality experiences, based on the result of previous study that limited immersion time to up to 15 minutes to prevent eye fatigue ( Servotte et al., 2020). In addition, to prevent motion sickness due to cognitive dissonance, content of this virtual simulation was developed and organized except for visual effects that may cause dizziness. Because it takes time for participants to adapt the virtual reality space and learn how to use the hand operated controller, the total time required was set to 20 minutes.
For the safety of the participants, the simulation was conducted in a stationary chair with a supportive backrest and armrests. During virtual simulation, the researcher was on standby to provide immediate help to research participants. Students were also notified if side effects occurred or they felt uncomfortable, they could stop the practice at any time and can rest.
In this virtual simulation, two HMD devices were used and several research participants used them alternately. To minimize the risk of contamination or infection, a disposable face cover was used separately. In addition, after the use of a hand-operated controller, it was cleaned with disinfectant tissue and then prepared for the next person.
2.8 DebriefingA debriefing session was conducted after both non-immersive and immersive virtual simulation by clinical instructors in charge of this curriculum. This process was performed in a group for 60 minutes. Participants discussed the assessment or intervention they performed, the difficulty they felt while performing nursing activities and what they earned through simulation.
2.9 Clinical patient case seminarStudents were educated about fall management risk assessment methods used in actual clinical field by a hospital nurse educator. In addition, they conducted a case study on falls which actually occurred in hospital under the guidance of the hospital nurse educator. After learning about the fall case, students took time to discuss the issues and suggested solutions for fall cases which occurred in a hospital setting.
3 MeasurementsGeneral characteristics such as age, gender and religion of participants were collected. In addition, previous educational experiences related to falls, as well as any personal experiences with fall events involving people around them, were recorded. Before and after the intervention, fall knowledge, attitude toward falls and self-efficacy for fall prevention were measured. Additionally, for overall evaluation, system usability, user experience, satisfaction and discomfort of immersive and non-immersive virtual simulations were identified.
3.1 Fall knowledgeFall knowledge was measured using a tool developed by Kim (2002) and modified by Kim and Seo (2017). The instrument is a 16-item questionnaire, with the “yes” response receiving a value of 1 and the “no” or “I don’t know” response receiving a value of 0. The total score ranged from 0 to 16 points. A higher score indicates having a higher level of fall knowledge. The Kuder-Richardson formula 20 (KR-20) of the original tool was 0.76 and the reliability of modified tool was 0.70 ( Kim, 2002; Kim and Seo, 2017).
3.2 Attitude toward fallsAttitude toward falls was assessed using a scale developed by Kim (2002). This is 13-item questionnaire with a 5-point Likert scale and the total score ranged from 13 to 65 points. Among them, 5 items were scored in reverse and at the time of development, Cronbach’s alpha was 0.75 for this tool. Higher scores indicate a more positive attitude toward falls ( Kim, 2002).
3.3 Self-efficacy for fall preventionIn this study, self-efficacy for fall prevention was measured using the Korean version of Self-Efficacy for Preventing Falls (K-SEPF) ( Eom and Jung, 2014), which was modified from the original Self-Efficacy for Preventing Falls (SEPF) tool developed by Dykes et al. (2011) to suit the Korean context. K-SEPF is a 11-item questionnaire using a 6-point Likert scale with the total score range of 11–66 points. Higher scores indicate a higher level of self-efficacy for fall prevention, meaning that participants actively carry out fall prevention activities. The Cronbach’s alpha of SEPF tool was 0.89 and Cronbach’s alpha of the K-SEPF tool was 0.95 ( Dykes et al., 2011; Eom and Jung, 2014).
3.4 System Usability Scale (SUS)The System Usability Scale (SUS), developed by Brooke in 1996, was translated into Korean and used to evaluate the ease of use of virtual reality-based simulation education. The SUS is a simple and fast measure of the overall usability of virtual reality-based simulation programs, consisting of 10 questions and evaluated on a 5-point Likert scale. Among the 10 questions, 5 positive odd number questions and 5 negative even number questions are processed differently, and the score is derived by multiplying by 2.5 to convert it into a percentile score of 0–100 points ( Lewis, 2018). At the same time, the higher final score indicates having the higher level of the system usability. And the Cronbach's alpha of the SUS was reported above 0.8 ( Vlachogianni, and Tselios, 2022).
3.5 User Experience Questionnaire (UEQ)The Korean version of the User Experience Questionnaire (UEQ) consists of 26 questions and for each question, respondents are required to select conflicting opinions based on a 7-point scale. The answer is calculated from −3 points (strong agreement on negative opinions) to + 3 points (strong agreement on positive opinions) and the score of each item was summed to calculate for six aspects of user experience: attractiveness, perspicuity, novelty, stimulation, dependability and efficiency of the simulation education program ( Laugwitz et al., 2008; Schrepp, 2015). The range of scale is formed between −3 and + 3 and If the score is + 1 or higher, it indicates that users have a positive impression, while if it is −1 or lower, it means that they have a negative feeling ( Rauschenberger et al., 2013). The Cronbach’s alpha of every aspect in the UEQ was reported to be above 0.7 ( Laugwitz et al., 2008).
3.6 HMD related discomfort and simulation satisfactionStudy participant’s discomfort associated with wearing the HMD device in immersive virtual simulation was measured through 6 items with a 5-point Likert scale. Higher score indicates that participants feel higher discomfort when wearing the device. Besides, participant’s satisfaction of virtual simulation content was assessed using 5 item measurement with a 5-point Likert scale. Higher scores also imply high level of satisfaction in non-immersive and immersive virtual simulation.
3.7 Data collection/procedureNursing students were recruited through flyers and email announcements. The purpose and process of the study were explained to students who expressed interest in participating. Those who met the eligibility criteria and voluntarily agreed to participate completed consent forms. Participants enrolled in gerontological nursing and clinical practicum were assigned to the experimental group, while those not taking the course were assigned to the control group. A pre-test was conducted to collect baseline scores on fall knowledge, attitude toward falls and self-efficacy for fall prevention, along with the general characteristics of both the experimental and control groups. Subsequently, the integrated fall educational intervention was implemented for the experimental group, while no intervention was provided to the control group. The 90-minute lecture component of the intervention was conducted in a classroom setting, while the remaining components were delivered during clinical practicum over a 6-day period. These components included a clinical case seminar, non-immersive and immersive virtual simulations, a debriefing session following simulations and a clinical skill test. After the intervention, the experimental group completed a questionnaire evaluating the usability, experience of use and satisfaction of both virtual simulations and HMD related discomfort. Both the experimental and control groups completed a post-test assessing fall knowledge, attitude toward falls and self-efficacy for fall prevention.
3.8 Ethical considerationEthical approval for this study was obtained from the Institutional Review Board of a university (Approval No. 2304/003–001). Sufficient information related to the research progress was provided to the students in advance and it was announced that the participation in the study did not affect the progress of their curriculum. In addition, even if they decided to participate in the study, they were informed that they could stop participating at any time if they did not wish to participate in the study.
3.9 Data analysisData were analyzed using the IBM SPSS Statistics 26.0 program (IBM Corp, Armonk, New York). Descriptive statistics including frequency, mean and standard deviation were performed to identify the participants’ characteristics. Additionally, a paired t-test was conducted to check whether there were significant changes in fall knowledge, attitude toward falls and self-efficacy for fall prevention after the intervention. Moreover, an independent t-test was conducted to compare the amount of change between the experimental group and the control group and to compare the usability and experience of non-immersive and immersive-simulation.
4 Results4.1 Demographic characteristics
The mean age of the experimental group and the control group was 21.19 (SD 1.451) and 20.34 (SD 2.539), respectively, with no significant difference ( p = .070). The proportion of men in the experimental group was 16.7 %, compared with 17.9 % in the control group, showing no significant difference between two groups ( p = 0.883). Most participants in both the experimental and control groups had no religion (63.9 % and 75.0 %, respectively), with no significant difference between two groups (p = 0.340). The proportion of participants in the experimental group with prior educational experience related to falls was 36.1 %, compared with 3.6 % in the control group, showing a significant difference between two groups (p < 0.001). In terms of personal experience with fall events, 30.6 % of individuals in the experimental group and 17.9 % in the control group had such experiences, though this difference was not statistically significant (p = 0.157).
4.2 Effects on knowledge, attitude and self-efficacyThe change in scores of fall knowledge, attitude toward falls and self-efficacy for fall prevention before and after the intervention of the experimental group and the control group was confirmed ( Table 2). In the case of the experimental group, fall knowledge increased significantly after the intervention ( p < 0.001) and the self-efficacy for fall prevention also increased significantly ( p < 0.001). After the intervention, the experimental group showed an improvement in attitude toward falls; however, this change was not statistically significant (p = 0.146). In the case of the control group, scores in all three variables increased, but all the changes were not significant.
Furthermore, the difference for the change of the fall knowledge, attitude toward falls and self-efficacy for fall prevention between both groups were compared. The change of experimental group was greater than that of the control group in all three variables, but in the case of fall knowledge and the attitude toward falls, the difference was not significant and only in the change in self-efficacy for fall prevention was significant ( p = .008).
4.3 Comparison of usability and satisfaction between non-immersive and immersive virtual simulationsThe immersive virtual simulation showed significantly higher scores than the non-immersive simulation across usability and all users experience factors, including attractiveness, perspicuity, novelty, stimulation, dependability and efficiency ( Table 3). In addition, satisfaction levels for the immersive virtual simulation were significantly higher than for the non-immersive simulation (p < .05).
Regarding HMD-related discomfort, 57.1 % of participants reported the device as heavy ( Table 4). Approximately 35 % experienced dizziness during movement and 26 % felt motion sickness during rotating, while only 10 % reported nausea and 12 % experienced skin discomfort where the headset made contact.
5 DiscussionThe results of this study revealed that the integrated fall prevention and management education enhances nursing students’ knowledge and attitude about fall prevention, consistent with those of some previous studies ( Tu and Lin, 2021; Leverenz and Lape, 2018). Previous studies reported that the incorporation of virtual reality technology in education improved theoretical knowledge, practice knowledge and critical thinking ( Ma et al., 2024; Liu et al., 2023). Besides, non-immersive virtual simulation strategy showed marked improvement in nursing students’ performance, confidence and knowledge ( Qiao et al., 2023).
Incorporating virtual reality into nursing students’ learning experiences yields superior results. This study identified the feasibility and effectiveness of the virtual reality-based simulation education. These findings are consistent with those of previous studies that reported virtual simulation enhances learning satisfaction among nursing students through a high level of immersive experience in practice and learning competency ( Omlor, 2022). Furthermore, instructors also recognized that non-immersive virtual simulation helped nursing students achieve learning goals and gain confidence ( Sharoff, 2022). In particular, education that integrated virtual simulation and lectures was more effective in knowledge retention and educational gain than the teaching strategies that involved only virtual education or lectures ( Sanzana et al., 2022). When the two methods are properly fused, a greater educational effect appears compared with the traditional educational method (Vallée et al., 2020). Therefore, it is necessary to implement integrative education for more effective education.
The findings of this study are consistent with those of others in that nursing students showed a positive perception of immersive educational virtual technology applications ( Lange et al., 2020) and immersive simulation exhibited a higher system usability score than non-immersive simulation ( Perez-Gutierrez et al., 2020). The difference in user experience of the simulation originates from the context of the delivery method. The immersive virtual reality uses a HMD device and hand controllers to provide complete immersion and interaction with the virtual environment, while vSIM program is a computer-based non-immersive simulation and projects the virtual environment onto a display screen ( Mäkinen et al., 2022; Son et al., 2022).
Non-immersive virtual simulation, while scoring lower in system usability and user experience compared with immersive virtual simulation, still offers significant advantages in terms of cost-effectiveness and resource allocation ( Qiao et al., 2023). Non-immersive virtual systems require less specialized equipment and are more accessible, making them a practical option for broader implementation in educational settings. Dubovi and colleagues (2017) highlighted that non-immersive virtual reality can still provide valuable educational benefits, particularly for theoretical learning and procedural understanding.
There is a need for integrated educational programs that interlink knowledge, critical thinking and practice to achieve educational goals. Considering the factors presented earlier, a balanced integration of both immersive and non-immersive virtual simulation could optimize educational outcomes by leveraging the strengths of each method. To verify the learning effects of virtual reality-based educational programs, this study suggests that future researchers apply theoretical frameworks to research designs such as the cognitive affective model of immersive learning ( Makransky and Petersen, 2021) and longitudinal research design that can measure long-term retention of knowledge. In addition, future research should explore effective ways to combine these technologies to enhance learning experiences while managing costs and resources efficiently.
6 LimitationsThe generalizability of the study findings is limited due to the use of convenience sampling. Participants in the experimental group were third-year students enrolled in gerontological nursing and clinical practicum, whereas second-year students, who were not enrolled in the course were assigned to the control group. However, because none of the participants had prior clinical practicum experience or previous exposure to integrated fall educational intervention, the difference in academic year between the experimental and control groups was unlikely to influence the results. Further studies at different institutions with more diverse samples are necessary to minimize selection bias.
This study was conducted in a country that is a leading consumer of information technology ( Dayton, 2020). Nursing students in countries with relatively limited access to technology may find the application of this study’s findings limited, as the factors affecting their perception of virtual simulation education may vary. Further research is needed to explore differences based on participant characteristics. Moreover, this study used a self-report questionnaire, which may have introduced response bias. Researchers need to conduct further studies using a variety of instruments to measure objective data and mitigate this bias. Finally, longitudinal studies are needed to examine whether an integrated fall educational intervention translates into actual nursing care competencies in fall risk assessment and management for older adults.
7 ConclusionThe outcomes of this study demonstrate that an integrated fall prevention and management education approach can improve knowledge and self-efficacy of how nursing students cope with falls in older adults. At the same time, the findings of this research suggest that knowledge and self-efficacy are important factors in development of fall educational programs for nursing students. In particular, the composition of the integrated fall educational approach, which consists of various educational elements, could be applied to the development of fall educational programs for individuals other than nursing students. Among them, the proper use of both non-immersive and immersive virtual simulations could play a vital role in the learning experience of nursing students.
Ethical approvalSeoul National University Institutional Review Board (IRB No. 2304/003–001)
CRediT authorship contribution statementTak Sunghee H: Writing – original draft, Visualization, Validation, Supervision, Resources, Project administration, Methodology, Funding acquisition, Conceptualization. Lee Dayeon: Writing – original draft, Visualization, Methodology, Investigation, Formal analysis, Data curation. Suh Inyoung: Writing – original draft, Methodology, Investigation, Data curation. Choi Hyein: Writing – original draft, Methodology, Investigation. Lee Eunbi: Writing – original draft, Methodology, Investigation.
FundingThis work was supported by the National Research Foundation of Korea (NRF) grant funded by the Korea government ( MSIT) (No. 2023R1A2C1006362).
Declaration of Competing InterestThe authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper.
Appendix A Supporting informationSupplementary data associated with this article can be found in the online version at doi:10.1016/j.nepr.2025.104370.
Appendix A Supplementary materialSupplementary material
| Curriculum | Education strategies | Content | Delivery | ||
| Setting | Instructor | Time † | |||
| | Simulation | ||||
| HMD-based VR (immersive) | Game in which users can find fall hazards safety risk elements as they navigate through the bathroom simulated by VR | Individual | Clinical instructor | 20 | |
| Computer-based VR (non-immersive) | Self-study of the Millie Larsen Part 2 from vSim® Gerontology on computer | Individual | 120 | ||
| Debriefing | Evaluation questions related to immersive and non-immersive VR simulations | group | 60 | ||
| Clinical case seminar | Fall management risk assessment and case study of older patients in hospital | group | Hospital nurse educator | 50 | |
| Clinical skill test † | Morse Fall scale | Individual | Clinical instructor | 5–10 | |
| | Lecture | Risk assessment and fall management, tools and measures for safety and fall prevention | group | Course faculty | 90 |
| | | | | | ||||
| Mean (SD) | | | Mean (SD) | | | |||
| Knowledge | ||||||||
| | 7.22 (1.39) | 5.51 | < .001 | 7.07 (1.74) | 1.87 | ns | ||
| | 8.47 (0.91) | 7.63 (1.84) | ||||||
| | 1.25 (1.36) | 0.55 (2.22) | −1.86 | ns | ||||
| Attitude | ||||||||
| | 49.64 (4.55) | 1.49 | ns | 48.32 (5.60) | 0.22 | ns | ||
| | 50.89 (4.74) | 48.45 (4.73) | ||||||
| | 1.25 (5.05) | 0.13 (4.20) | −1.16 | ns | ||||
| Self-efficacy | ||||||||
| | 44.83 (11.62) | 3.84 | < .001 | 47.86 (11.29) | 0.42 | ns | ||
| | 51.14 (9.71) | 48.16 (11.28) | ||||||
| | 6.31 (9.86) | 0.30 (10.67) | −2.71 | < .01 | ||||
| Variable | Computer-based VR (non-immersive) | Head gear-based VR (immersive) | | |
| Mean (SD) | Mean (SD) | |||
| | 60.82 (12.38) | 72.25 (11.54) | −5.10 | < .001 |
| | ||||
| Attractiveness | 0.80 (0.97) | 1.52 (1.07) | 3.48 | < .001 |
| Perspicuity | 0.66 (1.16) | 1.99 (0.89) | 6.32 | < .001 |
| Novelty | 1.04 (0.92) | 1.54 (1.06) | 2.42 | < .05 |
| Stimulation | 1.02 (0.90) | 1.59 (0.88) | 3.17 | < .01 |
| Dependability | 1.11 (0.89) | 1.52 (1.00) | 2.12 | < .05 |
| Efficiency | 0.78 (0.92) | 1.42 (1.10) | 3.11 | < .05 |
| | 19.41 (3.05) | 20.88 (2.99) | −2.41 | < .05 |
| Question | N(%) | ||||
| Strongly disagree | Disagree | Neutral | Agree | Strongly agree | |
| I felt dizzy while moving. | 8 (16.3) | 14 (28.6) | 10 (20.4) | 13 (26.5) | 4 (8.2) |
| I felt nauseous while moving. | 10 (20.4) | 25 (51.0) | 9 (18.4) | 3 (6.1) | 2 (4.1) |
| I felt motion sickness while moving forward. | 12 (24.5) | 19 (38.8) | 8 (16.3) | 8 (16.3) | 2 (4.1) |
| I felt motion sickness while rotating. | 10 (20.4) | 17 (34.7) | 9 (18.4) | 10 (20.4) | 3 (6.1) |
| The part of the headset that touches my skin hurts. | 12 (24.5) | 19 (38.8) | 12 (24.5) | 6 (12.2) | - |
| The headset is heavy. | 4 (8.2) | 3 (6.1) | 14 (28.6) | 20 (40.8) | 8 (16.3) |
©2025. Elsevier Ltd