{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,3,10]],"date-time":"2026-03-10T02:21:38Z","timestamp":1773109298046,"version":"3.50.1"},"reference-count":53,"publisher":"Oxford University Press (OUP)","issue":"1","license":[{"start":{"date-parts":[[2023,10,17]],"date-time":"2023-10-17T00:00:00Z","timestamp":1697500800000},"content-version":"vor","delay-in-days":1,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"funder":[{"name":"National Institute for Health and Care Research Applied Research Collaboration Greater Manchester"},{"DOI":"10.13039\/501100000272","name":"National Institute for Health and Care Research","doi-asserted-by":"publisher","id":[{"id":"10.13039\/501100000272","id-type":"DOI","asserted-by":"publisher"}]},{"DOI":"10.13039\/501100000276","name":"Department of Health and Social Care","doi-asserted-by":"publisher","id":[{"id":"10.13039\/501100000276","id-type":"DOI","asserted-by":"publisher"}]}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":[],"published-print":{"date-parts":[[2023,12,22]]},"abstract":"<jats:title>Abstract<\/jats:title>\n               <jats:sec>\n                  <jats:title>Objectives<\/jats:title>\n                  <jats:p>To assess the feasibility and implementation, usability, acceptability and efficacy of virtual reality (VR), and augmented reality (AR) smartphone applications for upskilling care home workers in hand hygiene and to explore underlying learning mechanisms.<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>Materials and Methods<\/jats:title>\n                  <jats:p>Care homes in Northwest England were recruited. We took a mixed-methods and pre-test and post-test approach by analyzing uptake and completion rates of AR, immersive VR or non-immersive VR training, validated and bespoke questionnaires, observations, videos, and interviews. Quantitative data were analyzed descriptively. Qualitative data were analyzed using a combined inductive and deductive approach.<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>Results<\/jats:title>\n                  <jats:p>Forty-eight care staff completed AR training (n\u2009=\u200919), immersive VR training (n\u2009=\u200921), or non-immersive VR training (n\u2009=\u20098). The immersive VR and AR training had good usability with System Usability Scale scores of 84.40 and 77.89 (of 100), respectively. They had high acceptability, with 95% of staff supporting further use. The non-immersive VR training had borderline poor usability, scoring 67.19 and only 63% would support further use. There was minimal improved knowledge, with an average of 6% increase to the knowledge questionnaire. Average hand hygiene technique scores increased from 4.77 (of 11) to 7.23 after the training. Repeated practice, task realism, feedback and reminding, and interactivity were important learning mechanisms triggered by AR\/VR. Feasibility and implementation considerations included managerial support, physical space, providing support, screen size, lagging Internet, and fitting the headset.<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>Conclusions<\/jats:title>\n                  <jats:p>AR and immersive VR apps are feasible, usable, and acceptable for delivering training. Future work should explore whether they are more effective than previous training and ensure equity in training opportunities.<\/jats:p>\n               <\/jats:sec>","DOI":"10.1093\/jamia\/ocad200","type":"journal-article","created":{"date-parts":[[2023,10,17]],"date-time":"2023-10-17T11:34:43Z","timestamp":1697542483000},"page":"45-60","source":"Crossref","is-referenced-by-count":26,"title":["Virtual reality and augmented reality smartphone applications for upskilling care home workers in hand hygiene: a realist multi-site feasibility, usability, acceptability, and efficacy study"],"prefix":"10.1093","volume":"31","author":[{"ORCID":"https:\/\/orcid.org\/0000-0001-7801-7417","authenticated-orcid":false,"given":"Norina","family":"Gasteiger","sequence":"first","affiliation":[{"name":"Division of Nursing, Midwifery and Social Work, The University of Manchester , Manchester, United Kingdom"},{"name":"Division of Informatics, Imaging and Data Sciences, Centre for Health Informatics, The University of Manchester , Manchester, United Kingdom"},{"name":"Division of Population Health, Health Services Research and Primary Care, The University of Manchester , Manchester, United Kingdom"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-0929-436X","authenticated-orcid":false,"given":"Sabine N","family":"van der Veer","sequence":"additional","affiliation":[{"name":"Division of Informatics, Imaging and Data Sciences, Centre for Health Informatics, The University of Manchester , Manchester, United Kingdom"},{"name":"Manchester Academic Health Science Centre, The University of Manchester , Manchester, United Kingdom"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-2657-5780","authenticated-orcid":false,"given":"Paul","family":"Wilson","sequence":"additional","affiliation":[{"name":"Division of Population Health, Health Services Research and Primary Care, The University of Manchester , Manchester, United 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