Translating behavioral interventions into virtual reality: the Transcend Framework for immersive health design

Virtual Reality (VR) has evolved from entertainment to a versatile platform for clinical and public health innovation. In medicine, VR supports pain management, rehabilitation, and cognitive training, and shows growing promise for addressing chronic diseases linked to modifiable risk factors. To support this expansion, we introduce the Transcend Framework, the Translational Engineering of Behavioral Interventions into Immersive Contexts for Engagement and Design framework, a systematic model for adapting evidence-based behavioral interventions into VR platforms, illustrated by Joviality™, a positive psychological intervention designed for use during hemodialysis. The aim of this paper is to outline a clear, reproducible process for translating behavioral interventions into immersive digital formats that supports broader research, clinical, and implementation applications. The framework comprises five stages: (1) identifying the target population; (2) assessing feasibility and adapting the curriculum for VR; (3) pre-production planning, including storyboarding and design specification; (4) previsualization and asset creation of immersive environments; and (5) iterative VR development and testing to refine usability, accessibility, and engagement. Each stage emphasizes user-centered design and attention to physical limitations, cognitive load, and accessibility to ensure feasibility and effectiveness. Interactive, visually rich, modular environments foster engagement, while gamified activities enhance experiential learning and skill acquisition, and culturally attuned content ensures inclusivity. Continuous, data-informed refinement guided by end-user feedback ensures usability and sustained engagement. This methodological framework provides a practical roadmap for developing and optimizing VR-based behavioral health interventions and demonstrates how immersive technology can advance health education, promote behavior change, and enable scalable, equitable implementation across clinical contexts.