JMIR Publications

ABSTRACT

Background:

The integration of Virtual Reality (VR) tools in mental healthcare, such as VR relaxation, shows promise for supporting stress reduction and mental well-being. However, implementation across healthcare settings remains complex and context-dependent, influenced by organizational capacity, stakeholder readiness, and external factors such as policy and funding. This study explores how barriers, facilitators, and evolving implementation strategies shape the use of VRelax, a VR relaxation tool, in primary, secondary, and tertiary mental healthcare settings in the Netherlands.

Objective:

To identify shared and context-specific barriers and facilitators, and to develop and refine tailored implementation strategies for the integration of VR relaxation in primary, secondary, and tertiary mental healthcare, with a focus on learning from the implementation approach used within the research process itself.

Methods:

A qualitative, comparative study was conducted using a participatory approach with 33 healthcare professionals and eight patients across primary, secondary, and tertiary mental healthcare settings in the Netherlands, involving 18 interviews and eight focus groups. Thematic analysis, guided by the Consolidated Framework for Implementation Research, was used to assess implementation barriers and facilitators. The Expert Recommendations for Implementing Change tool was applied to match found barriers with evidence-based implementation strategies.

Results:

Across all settings, key lessons emerged about what supports and hinders the implementation of VR relaxation in mental healthcare. While challenges such as equipment costs, limited staff capacity, technical issues, and lack of structural funding persisted, they also revealed opportunities for improvement. In primary care, collaboration with community organizations enabled low-threshold, accessible use. In secondary care, staff feedback refined strategies and strengthened team learning. In tertiary care, co-development with professionals and patients advanced person-centered care, though time constraints and fragmented organizational structures limited full adoption. Across settings, the gap between professional assumptions about patient suitability and patients’ actual enthusiasm underscores the need for shared decision-making, patient involvement, and flexible, hybrid approaches to care.

Conclusions:

Successful integration of VR relaxation in mental healthcare requires balancing flexibility with structured, setting-specific strategies while addressing system-wide barriers. Collaboration with community facilities, iterative refinement through staff feedback, and co-development with patients show how VR can strengthen person-centered, hybrid, and sustainable mental healthcare. These findings align with efforts to ensure accessible, appropriate, and future-ready care across all mental healthcare settings. They also underscore that effective implementation requires both localized adaptation and system-level solutions, including shared infrastructure, post-discharge continuity, and long-term funding models.