Virtual worlds versus game-based virtual reality in dementia education: a two-group pretest-posttest comparative study

Dementia is a progressive neurodegenerative disease, and despite its rising global prevalence, public knowledge and attitudes toward dementia remain inadequate. Virtual reality (VR) offers immersive learning environments that may enhance dementia education; however, limited research has compared the effectiveness of different VR teaching modalities. This study compared 360-degree video virtual reality (VR-360), representing Virtual Worlds, and computer-generated virtual reality (CG-VR), representing Games, in improving dementia knowledge and attitudes among college students.

A two-group pretest-posttest study was conducted with 129 college students from the Colleges of Health Sciences and Nursing at a university in central Taiwan. Participants were assigned to either the VR-360 group (n = 65), which presented real-life dementia scenarios using 360-degree immersive video, or the CG-VR group (n = 64), which provided interactive, game-based learning tasks. Teaching content was based on the "Ten Warning Signs of Dementia" and "Five Preventive Strategies." Dementia knowledge and attitudes were measured using the Dementia Knowledge Assessment Scale (DKAS) and the Dementia Attitudes Scale-Chinese Version (DAS-C). Paired-samples t-tests and analysis of covariance (ANCOVA) were used for analysis.

Both groups demonstrated significant improvements in dementia knowledge (CG-VR: t = 8.99, p < .001, d = 1.12; VR-360: t = 17.79, p < .001, d = 2.21) and attitudes (CG-VR: t = 5.94, p < .001, d = 0.74; VR-360: t = 10.06, p < .001, d = 1.25). ANCOVA results showed that the VR-360 group achieved significantly higher post-test knowledge scores (F = 18.32, p < .001, η² = 0.127; adjusted mean difference = 4.14 points) and attitude scores (F = 14.94, p < .001, η² = 0.106; adjusted mean difference = 3.77 points) than the CG-VR group.

Both VR modalities were associated with significant short-term improvements in dementia-related knowledge and attitude scores. Under the specific implementation used in this study, the VR-360 condition, which combined real-scene 360° narratives with embedded quiz questions, was associated with greater gains than the task-oriented CG-VR condition. However, these differences should be interpreted as reflecting the particular instructional design used in this study rather than the inherent superiority of one VR modality over another. Given the single-session design and reliance on self-reported measures, the findings should be interpreted as reflecting short-term changes in knowledge and attitude scores only.

ClinicalTrials.gov (NCT07366073), retrospectively registered on 17 January 2026.