JMIR Publications

ABSTRACT

Background:

Outpatient hysteroscopy is one of the most commonly performed gynecological procedures in the United Kingdom, with over 100,000 procedures performed annually within the National Health Service (NHS). Procedural pain and anticipatory anxiety remain among the most frequently cited barriers to successful procedure completion and patient satisfaction. Traditional preprocedural education delivered via written leaflets or passive video has demonstrated limited efficacy in addressing these outcomes. Virtual reality (VR) technology offers an immersive, interactive educational modality with theoretical advantages in anxiety reduction through attentional distraction and cognitive engagement. However, most existing VR-based clinical interventions rely on expensive proprietary hardware, limiting scalability and practical implementation, particularly within resource-constrained publicly funded healthcare systems.

Objective:

This study aimed to evaluate the clinical effectiveness of a bespoke, low-cost, in-house developed VR educational intervention compared with standard 2D video and written leaflet in reducing procedural pain and preprocedural anxiety in patients undergoing outpatient hysteroscopy. Secondary objectives included assessment of procedure completion rates, patient satisfaction, feasibility of a bring-your-own-device (BYOD) delivery model, and preliminary health economic analysis.

Methods:

A single-center, three-arm, parallel-group randomized controlled trial was conducted at Airedale General Hospital, Keighley, United Kingdom, and approved by the Research and Development team at Airedale NHS Foundation Trust. Ninety patients scheduled for outpatient hysteroscopy were randomized (1:1:1) to receive preprocedural education via: (1) immersive 360° VR, (2) standard 2D video, or (3) written information leaflet (standard care). The VR intervention was filmed in-house using a Lenovo 3D 180° VR camera, edited using Pinnacle Studio with motion stabilization and blur optimization to minimize cybersickness, and delivered remotely to patients' own smartphones using a disposable cardboard VR headset (cost: £1.50). Primary outcome was procedural pain measured using the Visual Analogue Scale (VAS 0–10). Secondary outcomes included state anxiety (State-Trait Anxiety Inventory, STAI-S), patient satisfaction (5-point Likert scale), procedure completion rate, and cybersickness symptoms.

Results:

Ninety patients were randomized; all completed the allocated intervention. Mean VAS pain scores were significantly lower in the VR group (3.2 (SD 1.4)) compared with 2D video (4.5 (SD 1.6)) and standard leaflet (5.8 (SD 1.9)) (P<.001). Post-intervention anxiety was significantly reduced in the VR group (STAI-S: 31.2 (SD 7.4)) relative to 2D video (38.6 (SD 8.1)) and leaflet (44.8 (SD 9.3)) (P=.003). Patient satisfaction scores were highest in the VR group (4.6 (SD 0.5) vs 3.9 (SD 0.7) vs 3.1 (SD 0.9); P<.001). Procedure completion was 97% in the VR group, compared with 87% and 73% in the video and leaflet groups respectively (P=.04). Cybersickness was reported by 3 (10%) VR participants; all were mild and self-limiting. Total VR intervention development cost was £334.99, equating to £3.72 per patient.

Conclusions:

A low-cost, in-house developed VR educational intervention delivered via a BYOD model significantly reduces procedural pain and anxiety, and improves procedure completion rates in outpatient hysteroscopy. This study demonstrates that effective VR-based patient education does not require expensive proprietary infrastructure and represents a scalable, cost-effective digital health solution applicable across publicly funded healthcare systems. Broader implementation across outpatient procedural pathways warrants further evaluation. Clinical Trial: NA