Enhancing the Predictive Value of Formative Evaluation in Extended Reality Adoption: Addressing the Experience Gap

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 proven informative for many digital health tools; however, its application to immersive and embodied technologies such as extended reality (XR) warrants closer scrutiny. Most XR interventions in health care are delivered through head-mounted displays, which depend on spatial perception and sensorimotor engagement. Several 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 health care workforce remain XR-naive, such that preuse judgments are frequently shaped by anticipation rather than experience. Drawing on concepts from implementation science, grounded cognition, and human-computer interaction, this Viewpoint examines a plausible interpretive problem in XR adoption and argues that perception-based formative evaluation, when applied through frameworks developed for screen-based technologies, may misclassify barriers and facilitators. 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 familiarization before eliciting stakeholder perceptions to strengthen early-stage assessment and improve alignment with real-world implementation decisions.