Evaluation of a Metaverse-Based Refracture Prevention Education Program for Nurses Applying the ARCS Model: A...

Background/Objectives: In aging societies, refractures after a first fragility fracture are a major public health burden, and nurses play a central role in their prevention. This study evaluated an ARCS-based metaverse refracture prevention education program for nurses. Methods: A quasi-experimental pre-test-post-test study included 63 nurses from 4 non-randomly allocated wards at a single general hospital (experimental group [EG], n = 32; control group [CG], n = 31). The EG completed eight ZEP-based sessions over four weeks; the CG received the same topics through video lectures. Post-intervention learning motivation was compared using the Mann-Whitney U test. Self-efficacy, self-reported nursing performance, self-reported clinical judgment, and knowledge were analyzed using group-by-time interactions. Results: Motivation was higher in the EG (U = 138, p < 0.001). Individual-level interactions were significant for self-efficacy (F = 7.87, p = 0.007), performance (F = 8.00, p = 0.006), and clinical judgment (F = 10.96, p = 0.002) but not knowledge (F = 3.31, p = 0.074). Four of six clinical-judgment subdimensions met the Bonferroni criterion. Performance and knowledge findings differed under baseline adjustment, and pre-post findings were not significant in exploratory ward-level comparisons. Conclusions: The program was associated with favorable short-term educational outcomes. The non-randomized four-ward design and sensitivity to analytic assumptions limit causal and practical conclusions.