BACKGROUND: Virtual reality (VR) and augmented reality (AR) training delivered via smartphone applications (apps) poses a novel and cost-effective means of promoting hand hygiene. However, the effectiveness of VR/AR training for health and care workers is often context-dependent. Existing hand hygiene apps have also not yet been tested in care homes. Through a realist evaluation approach, this research has investigated (1) how and under what circumstances AR/VR smartphone apps can be implemented to upskill care home workers on hand hygiene practices; and determined (2) how and under what circumstances they work. METHODS: First, I reviewed existing hand hygiene apps to assess their content, technical and functional features, quality and VR/AR use. The IMS Institute for Healthcare Informatics functionality score and the Mobile App Rating Scale (MARS) were used. Second, a realist synthesis developed a programme theory on how AR/VR has been used to upskill health and care workers. I tested and refined the theory with empirical studies. Third, realist interviews with care home staff explored the context, refined the theory and identified mechanisms for testing. Finally, I conducted a mixed-methods study to explore the feasibility and implementation, acceptability, usability, and efficacy of AR/VR apps for promoting hand hygiene in care home workers. Measures included bespoke questionnaires, the System Usability Scale (SUS), videos, observations and interviews. Staff completed AR, immersive VR, or non-immersive VR training. Evidence was provided for the learning mechanisms. I also noted implementation considerations during the realist synthesis and primary studies. RESULTS: Only 61 (68%) of the 90 reviewed apps met the MARS minimum acceptability score, and two had been tested/trialled. Four used VR/AR. For the realist synthesis, I used 80 papers to form the initial programme theory and 46 empirical studies to refine it. There was moderate to high confidence in nine of the 41 context-mechanism-outcome configurations. I interviewed four care home managers and 21 carers from six care homes. The interviews identified a need for hand hygiene training in care homes. Participants perceived repeated practice, interactive learning, feedback and reminding and perceived task realism as most important for effective learning, learner satisfaction, enhanced hand hygiene skills and infection control. Forty-eight staff in five care homes participated in the feasibility study, with 19 completing the AR training, 21 the fully immersive VR training and eight the non-immersive VR training. The VR and AR training had good/acceptable usability with SUS scores of 84.40 and 77.89 (out of 100). The non-immersive VR training was borderline unacceptable, scoring 67.19. Knowledge and skill appeared to improve, with learners increasing from 65% to 71% on the knowledge questionnaire and 4.77 (out of 11) to 7.23 on the skills score. Repeated practice, task realism, feedback and reminding, and interactivity were important learning mechanisms triggered by AR/VR. Feasibility and implementation considerations throughout included the care home infrastructure (e.g., policies, Internet, space) and managerial support, the learners (e.g., preferences) and the technology (e.g., wearing the VR headset). CONCLUSIONS: Existing AR and immersive VR apps are feasible, acceptable and usable for improving hand hygiene knowledge and skill in care home staff. However, the technologies must trigger repeated practice, task realism, feedback and reminding, and interactivity to be effective. Implementation efforts should include working with care home managers, providing support and ensuring that the training content reflects care home tasks. Future work should explore whether they are more effective than previous training, determine the cost-effectiveness of the training and ensure equity in training opportunities.
- extended reality
- qualitative
- mixed-methods
- long-term care
- nursing homes
- care homes
- smartphone
- realist evaluation
- augmented reality
- hand hygiene
- infectious diseases
- hand washing
- education
- virtual reality
- training
Virtual reality and augmented reality for upskilling care home workers in hand hygiene practice: A realist evaluation
Gasteiger, N. (Author). 31 Dec 2023
Student thesis: Phd