Clinic Validation of Three Virtual Reality Environments.

Three VR Environments

Virtual reality, Intermediate unit, Affect, Presence, VR Sickness

Background: The healthcare sector has particularly embraced Virtual Reality (VR) applications, demonstrating its efficacy in creating relaxing virtual environments reduce stress and anxiety symptoms. Recent investigations highlight the therapeutic value of nature-based "Head Mounted Display" (HMD)-VR environments as accessible and low-intensity interventions. Aim: The aim is the health validation of three HMD-VR environments to promote emotional well-being and improve the mood of patients in intermediate units. Methods: This research uses mixed methodology to validate three VR immersive environments with human-centred design and verify their impact with a study sample consisting of 80 patients from the Intermediate units; 50 women and 30 men, of whom 40 participants viewed the three environments in 3D 360° VR on HMD, and 40 participants viewed the same three environments in 2D on tablets. All participants answered the Positive and Negative Affect Schedule Questionnaire (PANAS), the Slater-Usoh-Steed (SUS), and the Simulator Sickness Questionnaire (SSQ).

This study was conducted in two phases. Phase I aimed to examine short-term affective changes following exposure to the developed VR environments, to assess perceived presence, and to evaluate adverse VR sickness symptoms in hospitalized patients. Phase II aimed to evaluate the intervention's impact on patients and the perspectives of key informants within the health centres. The study was a multicentre experimental study with a pretest-posttest, cross-sectional design and used a mixed-methods approach combining quantitative and qualitative data. This study conducted prior research to design and create three virtual reality (VR) person-centred design environments inspired by the contributions of people monitored by the Home Care Service of Manlleu City Council. The prior study aimed to identify the characteristics of HMD-VR environments most closely associated with emotional well-being in adults requiring support for daily activities. Results indicated a clear preference for natural landscapes that are highly realistic and free of digital or artificial elements. Additionally, natural elements such as vegetation, flowers, trees, and clear water were repeatedly highlighted as desirable. Regarding auditory components, natural sounds, particularly birdsong, the breeze, and the sound of sea waves, were strongly valued. Participants also valued creative and interactive audiovisual elements. Although the interactive artistic experience was well received, the final design of the environments prioritized simplicity and ease of use to ensure accessibility for the population with cognitive, sensory, or mobility limitations. Full descriptions of the VR environments are included in Annex 1. To establish implementation procedures and timelines, coordination meetings were conducted with hospital administrators and healthcare coordinators at the two participating sites (HSJM-CHV and HUSC-FHSC) following the development of the three HMD-VR scenarios. Medical staff selected appropriate participants based on established inclusion and exclusion criteria. Following a period of HMD-VR acclimatization with technician-facilitated headset fitting, participants underwent the VR session under constant supervision. Continuous monitoring was employed to detect any VR adverse effects (e.g., dizziness, eye strain). Immediate attention from the medical professional present was received if any participant reported discomfort. No participants discontinued or withdrew from the study. A dedicated, isolated room containing one table and two chairs was set up in each Intermediate Unit to maintain controlled experimental conditions. Due to mobility impairments, five participants completed the study from their hospital rooms. Of these, four were lying in bed, while one was seated in a chair next to the bed. Each participant first provided informed consent using printed information sheets and dual consent verification in both paper and electronic formats. Those who declined participation were excluded from the study. Participants visualized three environments by comparing two participant groups: Group A used a head-mounted display (HMD-VR, Oculus Quest 2) to view 3D 360° VR videos, and Group B (control group) viewed the same content in 2D 360° on tablets. Each participant completed a questionnaire (10-15 minutes) and was then randomly assigned to one of the three environments. All participants (Group A and Group B) experienced the three environments in alternating order. The total participation time was approximately 60 minutes per individual. Feedback from key informants was obtained to complement participant data. Healthcare workers completed a separate 10-minute electronic survey designed to collect their professional observations regarding the system's potential impact on patient care, alongside basic demographic and position data. Informed consent was secured from all staff members before survey completion.

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