JMIR Publications

ABSTRACT

Formative evaluation is widely used in implementation science to anticipate barriers and facilitators prior to the deployment of health technologies, typically relying on stakeholders’ reported beliefs collected before real-world exposure. This approach has proved informative for many digital health tools, but its application to immersive and embodied technologies such as extended reality (XR) warrants closer scrutiny. XR interventions delivered through head-mounted displays depend on spatial perception and sensorimotor engagement, meaning that implementation-relevant properties, including comfort, perceived intrusiveness, safety, and workflow disruption, often become apparent only through direct interaction. At the same time, large segments of the healthcare workforce remain XR-naïve, such that pre-use judgements are frequently shaped by anticipation rather than experience. Drawing on literature from implementation science, grounded cognition, and human–computer interaction, this viewpoint argues that perception-based formative evaluation, when applied through frameworks developed for screen-based technologies, is vulnerable to misclassifying barriers and facilitators in XR adoption. Rather than questioning formative evaluation as a methodological approach, we identify a boundary condition for its interpretability in experience-dependent technologies and propose a pragmatic refinement: incorporating brief experiential familiarisation before eliciting stakeholder perceptions to strengthen early-stage assessment and improve alignment with real-world implementation decisions.