JMIR Publications

ABSTRACT

Background:

Digital therapeutics (DTx) are emerging as effective, evidence-based interventions for mental health conditions, serving as both complements to and alternatives to traditional treatments. Virtual reality (VR) has demonstrated particular promise as a delivery modality, leveraging immersion and engagement to enhance user experience and improve clinical outcomes. Despite growing evidence supporting VR-based digital therapeutics, little is known about the implementation strategies required to support widespread adoption by patients and clinicians. In particular, the fit of VR therapeutics within clinical workflows, including prescribing, onboarding, and delivery outside the clinic, remains insufficiently explored.

Objective:

This pilot randomized study evaluated how implementation materials and provider engagement impact acceptability, usability, and fidelity of VRx use in the non-clinical setting. Three experimental conditions were evaluated: (1) unguided VRx use, (2) self-directed VRx with assistive training materials, and (3) clinician-prescribed VRx with assistive training materials.

Methods:

Healthy adults (N=31) were randomized into three conditions: (1) VRx exposure without support, (2) VRx with self-directed training and assistive materials, or (3) VRx with provider-led instruction and prescription. A mixed-methods approach grounded in human factors was applied. Technology acceptance (TAM), usability (SUS), and engagement were assessed pre- and post-intervention. Observational methods captured user interaction patterns, including task completion rates, error frequency, help-seeking behaviors, and adaptation strategies. Qualitative feedback further contextualized usability challenges, perceived workload, and the role of support systems in shaping user confidence and adoption.

Results:

All groups showed significant increases in acceptance post-intervention (p<.001). Condition 3 demonstrated the strongest improvements across all acceptability measures and the highest engagement, with participants spending 99% of prescribed time in VRx. Provider interaction reinforced perceived safety, increased adherence, and enhanced willingness to adopt VRx. In contrast, training materials alone produced modest improvements, suggesting limited effectiveness without human guidance.

Conclusions:

This is the first study to experimentally compare different implementation strategies for VRx adoption. Findings highlight the pivotal role of clinician involvement in improving acceptance, usability, and engagement. Structured instructional support and provider endorsement may be essential for scaling VRx and digital therapeutics in real-world care.