Barriers and facilitators to implementing immersive virtual reality in long-term care settings: an interdisciplinary...

Immersive virtual reality (VR) has attracted growing interest in long-term care (LTC) as a potential tool to enhance well-being and alleviate pain. However, its effective implementation by LTC staff remains understudied. In a participatory action, mixed-methods study co-developed with knowledge users (LTC frontline staff and managers, and a VR developer), we applied the Decomposed Theory of Planned Behaviour (DTPB) to examine VR adoption in LTC and clarify barriers and facilitators to sustainable implementation.

Knowledge users were consulted to design and develop a single-phase, cross-sectional, convergent mixed-methods study. LTC staff (n = 16) were then recruited to complete an online self-report questionnaire specific to staff adoption of VR through the assessment of attitudes, social norms, perceived behavioural control and facilitating conditions. Quantitative data were analyzed descriptively. Qualitative data underwent content analysis via DTPB-guided deductive and inductive codes.

LTC staff indicated overall favourable attitudes towards VR use, yet only 25% (n = 4) of participants rated VR as easy to use and 50% (n = 8) deemed it suitable for LTC settings. Staff confidence with VR use was moderate, with resident selection and troubleshooting highlighted as particular challenges. Barriers such as lacking time to learn and use VR systems, as well as potential resident discomfort, were highlighted. Facilitators included adequate activity space, organizational support, and person-centred delivery, which staff linked to residents' relaxation, positive affect, and progressive engagement. Content analysis identified four key themes explaining these patterns: (1) Barriers outweighing promise, (2) Personalization of the VR experience, (3) Enabling conditions-Environment and organization, and (4) Staff ambivalence to VR.

VR adoption appears to be linked to alignment between compatibility, ease-of-use, facilitating conditions, and social support. Person-centred delivery and organizational support may enable consistent use and enhance residents' relaxation, positive affect and progressive engagement, relevant to pain care. Findings offer a practical roadmap for integrating VR as a low-burden intervention, while highlighting areas needing further attention to promote sustainable implementation.