Enhancing Men's Awareness of Testicular Diseases (E-MAT) using virtual reality: A randomised pilot feasibility study and mixed method process evaluation.

INTRODUCTION: Testicular cancer is among the most common malignancies in men under the age of 50 years. Most testicular symptoms are linked to benign diseases. Men's awareness of testicular diseases and testicular self-examination behaviours are suboptimal. In this pilot feasibility study and process evaluation we examine the feasibility of conducting a future definitive randomised controlled trial (RCT) to test the effect of the Enhancing Men's Awareness of Testicular Diseases using Virtual Reality intervention (E-MATVR) compared to the Enhancing Men's Awareness of Testicular Diseases using Electric information control (E-MATE). The study protocol is registered on ClinicalTrials.gov (NCT05146466). METHODS: Male athletes, engaged in Gaelic games, and aged 18 to 50 years were included. Recruitment was via FacebookTM, XTM (formerly TwitterTM), and posters. Participants were individually randomised to either E-MATVR or E-MATE. Data were collected at baseline (T0), immediately post-test (T1), and three months post-test (T2) using surveys. Qualitative interviews were conducted with participants and researchers. RESULTS: Data were collected from 74 participants. Of those, 66 were retained. All E-MATVR participants and most E-MATE participants (n = 33, 89.2%) agreed/strongly agreed that the device was easy to use and that they were engaged to learn by the device. Most E-MATVR participants (n = 34, 91.9%) and all E-MATE participants agreed/strongly agreed that the time it took them to complete the intervention was reasonable. All 74 participants were extremely satisfied/somewhat satisfied with their overall participation in the study. E-MATVR was described as interactive, easy, fun, and close to real life. Initial difficulty using VR equipment, nausea, and technical issues were identified as challenges to engaging with E-MATVR. Recommendations were made to make VR more accessible, shorten the survey, and incorporate more interactivity. Across all participants, mean testicular knowledge scores (range 0-1) increased from 0.4 (SD 0.2) at T0 to 0.8 (SD 0.2) at T1. At T2, overall mean scores for participants were 0.7 (SD 0.2). Mean knowledge scores did not differ by trial arm at any timepoint. At T2, all E-MATVR participants and 29/32 E-MATE participants (90.6%) reported purposefully examining their testes within the past three months. CONCLUSION: Findings are promising, highlighting the feasibility of using VR to promote young athletes' awareness of testicular diseases. Considering the strengths, limitations, and lessons learned from this study, some modifications are required prior to conducing an RCT. These include but are not limited to shortening survey questions, incorporating more interactivity and visual content, and targeting more heterogenous male-dominated environments.

Virtual Reality Simulation in Nursing and Midwifery Education: A Usability Study.

Virtual reality simulation offers students the opportunity to acquire clinical and psychomotor skills in a safe and interactive environment. This study describes the usability of virtual reality simulation among undergraduate nursing and midwifery students. Participants were recruited using convenience and snowball sampling and engaged in a 20-minute virtual reality simulation scenario of their choice. They then completed a 21-item survey comprising a sociodemographic questionnaire, the System Usability Scale, a satisfaction questionnaire, and open-ended questions. Quantitative data were analyzed using descriptive statistics, and qualitative data were analyzed using deductive content analysis. Forty-three students participated in this study. The mean (SD) System Usability Scale score was 75.87 (13.7), indicating that virtual reality simulation was acceptable. Almost all participants were either "extremely satisfied" or "somewhat satisfied" with virtual reality simulation, which was perceived as informative and enjoyable, fostering safe and self-directed learning without causing patient harm. Participants recommended using virtual reality simulation to practice clinical skills, prepare for clinical placements, and learn about rare clinical situations. Virtual reality simulation needs to be underpinned by a strong pedagogy and aligned with learning outcomes. Educators and students should be trained in virtual reality simulation prior to its integration into the curriculum.

Enhancing men's awareness of testicular diseases (E-MAT) feasibility trial: Protocol for a mixed method process evaluation.

Background: Testicular cancer (TC) is the most common malignancy in men under 50 years. Athletes are particularly at risk of testicular trauma and diseases. Experiencing negative testicular symptoms does not necessarily imply that men seek help. Men's awareness of testicular diseases is often lacking and their intention to seek help for testicular symptoms is sub-optimal. The use of virtual reality (VR) may be effective in promoting men's awareness of testicular diseases. The Enhancing Men's Awareness of Testicular diseases (E-MAT) feasibility trial aims to test the effect of E-MAT VR (intervention; interactive experience using virtual reality [VR]) compared to information delivered Electronically E-MAT E (control; same information as E-MAT VR delivered as plain text and images) on testicular knowledge, and testicular self-examination among male athletes affiliated with a national sports organisation. The overall aim of this mixed method process evaluation will be to describe (i) the experiences of participants and key stakeholders (e.g., researchers); (ii) the perceived effectiveness of intervention components; (iii) acceptability of the feasibility trial and intervention procedures; (iv) the relationship between implementation, mechanisms, and context; and (v) the barriers and facilitators to support effective conduct of a future definitive trial.   Methods: This mixed method process evaluation will use a descriptive realist evaluation. Quantitative data will be gathered using a usability and satisfaction survey, in addition to fidelity checks during intervention delivery. Quantitative data will be analysed using descriptive and inferential statistics. Qualitative data will be gathered from semi-structured interviews and focus groups with participants and key stakeholders to investigate their experiences of E-MAT VR and E-MAT E, and explore areas for improvement. Thematic analysis of transcripts will be conducted. Conclusions: This process evaluation will provide an in-depth understanding of how the interventions worked within this cohort and lessons for a future definitive trial.

Nursing students' views of using virtual reality in healthcare: A qualitative study.

AIMS AND OBJECTIVES: This study explored nursing students' views of using virtual reality in healthcare. BACKGROUND: The popularity and use of virtual reality in healthcare delivery and education is on the rise. Yet, the views of future nurses regarding this technology remain underexplored. DESIGN: This is a qualitative descriptive study guided by a naturalistic inquiry and reported using the Standards for Reporting Qualitative Research checklist. METHODS: Nursing students (n = 26) were recruited using convenience and snowball sampling. They were first exposed to a virtual reality intervention aimed to enhance men's awareness of testicular diseases. This was attempted to familiarise participants with the technology and initiate conversations around its use in healthcare. Participants were then interviewed face-to-face, either individually or within focus groups. Data were analysed using thematic analysis. RESULTS: Four themes were identified: (i) positive experiences of virtual reality; (ii) challenges to using virtual reality; (iii) settings where virtual reality can be implemented; and (iv) blue-sky and future applications of virtual reality. Participants described this technology as novel, enjoyable, immersive, memorable and inclusive. They questioned, however, the suitability of virtual reality for older adults, reported minor technical difficulties and stressed the importance of prior preparation in the use of the technology. Virtual reality was recommended for use in outpatient healthcare settings, schools and the community. Participants suggested using virtual reality in health promotion, disease prevention and management, and to promote nurses' empathy towards patients. CONCLUSIONS: Findings highlight the potential role of virtual reality in assisting nurses in promoting health and managing disease. Future research is needed to establish the long-term effect of virtual reality interventions among more diverse participants. RELEVANCE TO CLINICAL PRACTICE: Virtual reality can be implemented in outpatient, educational and community settings in order to promote health, prevent disease, enhance disease and self-management, and increase nurses' empathy towards patients.

Enhancing Men's Awareness of Testicular Disorders Using a Virtual Reality Intervention: A Pre-Post Pilot Study.

BACKGROUND: The incidence of benign and malignant testicular disorders is on the rise. Three literature reviews and one qualitative study found that men's awareness of testicular disorders was lacking, and their intentions to seek help for symptoms of testicular disease were low. OBJECTIVES: The aim of the study was to enhance men's awareness of testicular disorders, help-seeking intentions for testicular symptoms, and intention and behavior to feel their testes. METHODS: Men aged 18-50 years were recruited from a university and asked to engage in a three-level, educational, virtual reality experience. The Medical Research Council framework guided the development and pilot testing of the intervention. Knowledge, awareness, perceived risk, implementation intentions, help-seeking intentions, and behaviors were measured at pretest (T0), immediately posttest (T1), and 1 month posttest (T2). RESULTS: Data were available from 49 participants. In comparison to T0, a significant increase in knowledge (mean difference [MD] = 3.5, 95% CI [2.8, 4.26]); testicular awareness (MD = 0.2, 95% CI [0.01, 0.41]); implementation intentions (MD = 0.6, 95% CI [0.33, 0.90]); and help-seeking intentions for testicular swelling (MD = 0.3, 95% CI [0.12, 0.51]), lumpiness (MD = 0.3, 95% CI [0.08, 0.46]), and pain (MD = 0.6, 95% CI [0.25, 1.01]) was noted at T1. This increase was maintained at T2. Participants who expressed an intention to feel their testes at T0 were more likely to report performing this behavior at T2. DISCUSSION: The intervention succeeded in promoting knowledge, testicular awareness, implementation intentions, help-seeking intentions, and behaviors. A randomized controlled trial of the Enhancing Men's Awareness of Testicular Disorders intervention with a larger sample size is warranted.

Promoting men's awareness, self-examination, and help-seeking for testicular disorders: a systematic review of interventions.

Background: Testicular cancer (TC) is among the most commonly diagnosed cancers in men aged 15-40 years. The incidence of TC is on the rise. Benign testicular disorders, such as testicular torsion and epididymitis, can lead to testicular ischemia, sepsis, and infertility if left untreated. This updated systematic review aims to evaluate the effectiveness of studies promoting men's knowledge and awareness of testicular disorders and/or self-examination, behaviours and/or intentions to examine their testes, and help-seeking behaviours and/or intentions for testicular disorder symptoms. Methods: Academic Search Complete, Medline, CINAHL, PsycINFO, ERIC, the Cochrane Library, the World Health Organisation International Clinical Trials Registry Platform, and Clinicaltrials.gov were searched for studies published between April 2018 and August 2023. Methodological quality was assessed and results were synthesised meta-narratively. Results: Five studies were included. The majority of the reviewed interventions were successful in increasing men's awareness of TC and self-examination, including a PowerPoint presentation, an online educational brochure, video-assisted teaching, a motivational video, and a virtual reality game. Only one study addressed help-seeking for testicular symptoms and promoted men's awareness of benign as well as malignant testicular diseases. Conclusions: This review highlights the importance of evaluating innovative educational interventions aimed at younger men, whilst raising their awareness of testicular disorders and increasing their help-seeking intentions for testicular disorder symptoms. Given the lack of consensus around scheduled testicular self-examination among younger men, clinicians are encouraged to instruct men to familiarise themselves with the look and feel of their own testes and to seek timely medical attention for abnormalities. Registration: The protocol of the previous version of this review was registered with the International Prospective Register of Systematic Reviews (PROSPERO) under the registration number CRD42018093671.