Sound and Third-Person Perspective in Virtual Reality Improves Awe: A Prospective Study of Hospitalized Children and...

Hospitalized patients and their caregivers experience anxiety and fear, which are associated with medical noncompliance and delayed medical care. While virtual reality (VR) is a safe and effective therapeutic adjunct in reducing distress and increasing cooperation, design aspects that contribute to software effectiveness remain limited. This prospective, observational study evaluated VR elements that increased awe, a psychological state correlated with improved behavior, satisfaction, and anxiolysis.

Fifty-five patients (ages 6-25 years) and 65 parental caregivers (ages ≥18 years) at a quaternary care academic pediatric hospital interacted with a custom-developed VR program comparing design elements: sound (audible compared to mute), involvement (active compared to passive), and perspective (first person compared to third person) for 15 seconds each. Within-subject outcomes investigated included self-reported awe, perceived vastness, perceived need for accommodation, and engagement. Data were analyzed using repeated-measure analysis of variance tests.

Audible sound increased perceived awe and need for accommodation in adults, while the third-person perspective improved the need for accommodation in patients and adults. Active or passive involvement did not affect perceived awe nor aspects of awe. All measures of awe were positively correlated with game engagement.

When software designers and clinicians are designing and selecting VR applications for patients and their caregivers, third-person perspectives may be considered for all audiences, while audible sound settings are optimal for adult audiences.