The Impacts of Immersive Virtual Reality (iHealthEd-IVR) and a Mobile Online Game (V-Care) on Interprofessional Education: A Multi-Methods Study
Phase: NA
Conditions: Interprofessional Education, Serious Games
Sponsor: The Hong Kong Polytechnic University

 
Official Title: The Impacts of Immersive Virtual Reality (iHealthEd-IVR) and a Mobile Online 
Game (V-Care) on Interprofessional Education: A Multi-Methods Study 
 
Date of document: 29-Aug-2024 

 
Project Proposal 
The Impacts of Immersive Virtual Reality (iHealthEd-IVR) and a Mobile Online Game (V-
Care) on Interprofessional Education: A Multi-Methods Study 
Introduction 
Interprofessional education (IPE) is essential in healthcare education, promoting effective 
collaboration and improving health outcomes [1]. IPE encourages collaborative practice by having 
students from various healthcare fields learn with, from, and about each other [2]. Research shows 
that IPE enhances patient care, teamwork, and recognition of professional roles, crucial for 
managing complex health issues collaboratively [3]. As IPE is integral to the curriculum, exploring 
diverse pedagogical approaches for its implementation is vital. 
Immersive virtual reality (IVR) creates an artificial environment that convincingly replaces 
users' real-world surroundings, allowing full immersion in the simulation. Rapid advancements in 
IVR technology have increased its use in healthcare education. As a form of simulation-based 
learning, IVR enables students from different disciplines to share knowledge and perform activities 
together based on real clinical cases, consistently showing positive outcomes in IPE [3]. A recent 
scoping review of 12 studies concluded that VR for IPE effectively promotes interprofessional (IP) 
collaboration and communication [4]. A systematic review of 11 studies involving 1,711 
undergraduate students from diverse healthcare backgrounds further revealed that simulation 
positively impacts team-based and IP communication practices, and the acknowledgment of values, 
ethics, roles, and responsibilities of IP team members [5]. 
Game-based learning is another approach to IPE. Evidence suggests that gamification 
enhances engagement and is an effective learning strategy [6]. In game-based learning, shared 
goals, meaningful narratives, autonomy, and relevance anchor learning in context. Students can 
problem-solve through collaboration and competition, motivating them to engage and achieve 
learning outcomes [7]. In game-based IPE, students engage in interactive activities with gamified 
elements like earning trophies and leaderboard rankings, fostering a fun, competitive, and 
engaging environment that promotes both discipline-specific and IP learning outcomes. 
Gamification has positively impacted healthcare education, showing increased motivation and 
engagement in learning [8] and improved competence [9]. 
While both IVR and game-based training have shown potential in IPE, it remains unclear 
which is a more effective pedagogical approach. This study aims to compare the effectiveness of 
IVR and game-based learning in IPE, with significant implications for IPE delivery. 
Research Design 
This study will use a multi-methods design, involving knowledge checking games, surveys 
and focus groups, to gain a comprehensive understanding of the effectiveness of both IVR training 
and a mobile gaming platform in promoting IPE.  
For the quantitative component, a between-group design (IVR training vs. mobile game 
training) with pre- and post-measurements will investigate the students' outcomes after the 
programs. Data will be collected at two time points: T0 (before the program) and T1 (after the 
program). Focus groups will explore students' experiences within one week after the program, 
providing in-depth insights to complement the quantitative findings. This multi-methods approach 

 
will enable a comprehensive evaluation of the IVR and game-based learning training in facilitating 
IPE. 
Study Participants and Setting 
For the quantitative component, we will recruit undergraduate and pre-registration master's 
nursing students, as well as undergraduate physiotherapy students, from the School of Nursing and 
the Department of Rehabilitation Sciences at the Hong Kong Polytechnic University. The 
programs will be embedded within a nursing subject (SN 402/5012). Nursing students will need 
to take this course to fulfill their normal credit requirements, while physiotherapy students can 
earn practicum hours by participating. Students in both training conditions will be assigned to 
small IP groups comprising 7-8 student nurses and 1-2 student physiotherapists. 
A power analysis determined the sample size. Previous studies of similar educational 
interventions reported medium to large effect sizes in learning outcomes from pre- to post-
intervention [10-12]. Adopting a conservative approach, we based our power analysis on detecting 
a medium effect using a 2 x 2 mixed multivariate analysis of variance (MANOVA). Results 
indicated a sample size of 128 is sufficient to detect a medium two-tailed effect at a significance 
level of p < 0.05 with 80% power. We anticipate a sample size of around 150-160 to account for 
potential missing data. Based on the nurse-physiotherapist ratio, this would translate to 
approximately 112-128 student nurses and 32-38 student physiotherapists. 
For the qualitative component, we will use stratified purposive sampling to include students 
from different study years and academic majors. This will help explore their perspectives on both 
the iHealthEd IVR and V-Care training in the context of IPE. According to Hennink, Kaiser [13], 
four focus groups typically suffice to reach data saturation. With 4 to 5 students in each semi-
structured focus group, we anticipate a total of approximately 16-20 students from different 
disciplines or study years. The selected sample will be in proportion to the ratio of nursing to 
physiotherapy students. 
Programs 
Both training programs will be integrated into the nursing subject. The program content 
was collaboratively developed by faculty from nursing and rehabilitation sciences. The training 
will feature the theme of managing fall-related risks in the care of older adults with frailty. The 
scenario is structured across three levels, progressively building students' knowledge and skills 
related to fall prevention. Level 1 focuses on addressing patient concerns and identifying fall risk 
factors, Level 2 involves conducting a comprehensive fall risk assessment and evaluation, and 
Level 3 covers discharge planning and implementing fall prevention strategies in the community 
setting. The IP team will comprise approximately 7-8 nursing students and 1-2 physiotherapy 
students, which will enhance their understanding of values, ethics, and the roles and 
responsibilities of IP team members, aiming to establish core IPE collaborative competencies. 
In the Inter-professional Healthcare Education (iHealthEd-IVR) Training, the learning will 
take place in a classroom at the School of Nursing using IVR technology. Students will collaborate 
within the virtual environment to locate items and complete tasks based on the above scenarios. 
Minimal instructions will be provided, allowing students to come together experientially and 
function as an IP team. All activities will involve group work, enabling students to collaborate and 
communicate with all team members via live audio chat and group text chat. Finally, the IP team 

 
will interview a virtual client to discuss discharge management and care goals, then create an 
educational pamphlet about a care plan based on the client's health needs. 
In the V-Care Training, the IPE can take place remotely at a predefined timeslot among the 
group, as V-Care is an online mobile game environment. The game features interactive elements, 
including avatar customization, virtual clinical rounds, IP clinic scenarios, knowledge checks, 
assignment submissions, peer evaluations, and leaderboards. These components are intended to 
engage students, reinforce learning, and promote IP collaboration. 
Data Collection 
Quantitative Methods 
All nursing students enrolled in the course will be invited to join the study. Physiotherapy 
students will be invited to fulfill practicum hours. These two teaching innovations are embedded 
in the nursing subject (SN 402/5012) and a PT practicum. Due to the restructuring of the students' 
timetable, randomization is impossible. Both nursing and PT students will be assigned to either 
the (iHealthEd) IVR training or the V-Care training based on their tutorial timetable. They will be 
grouped based on a nurses to PT students ratio mentioned above.  
Participation in this study is voluntary and anonymous. Subject lecturers will not be 
involved in data collection. An information sheet about the research project will be provided to 
students, and any questions will be thoroughly addressed by the research personnel. Once students 
understand the project, they will provide informed consent via the Qualtrics XM Online Surveys 
Platform. Data will then be collected through this platform. 
Research personnel will assign unique codes to each participant’s information, ensuring 
anonymity. Only these codes will appear in the dataset for analysis, preventing subject lecturers 
from knowing which students participated. All collected data will remain confidential, accessible 
only to research personnel. Aggregated data will be reported or published without including 
personal information. 
Measures 
The Intrinsic Motivation Inventory (IMI) is a multidimensional measure used to assess 
participants' subjective experience related to a target activity in laboratory experiments [14]. The 
IMI evaluates several subscales, including interest/enjoyment, perceived competence, effort, 
value/usefulness, pressure/tension, perceived choice, and relatedness. The interest/enjoyment 
subscale is considered the self-report measure of intrinsic motivation, while perceived choice and 
perceived competence are theorized to be positive predictors, and pressure/tension a negative 
predictor, of intrinsic motivation. The IMI consisted of 18 items scored on a Likert scale from 1 
(not at all true) to 7 (very true). The overall IMI scale had strong internal consistency, with a 
Cronbach's alpha of .85. 
The Readiness for Interprofessional Learning Scale (RIPLS) was used to measure the 
"readiness" of healthcare students for shared IP learning [2]. The RIPLS comprised a 19-item, 3-
factor scale assessing students' perceptions of: 1) teamwork and collaboration, 2) professional 
identity, and 3) professional roles and responsibilities. The RIPLS uses a 5-point Likert scale for 
responses, ranging from 1 (strongly disagree) to 5 (strongly agree). Overall, higher total and 
subscale scores on the RIPLS would demonstrate greater "readiness" and more positive 

 
perceptions towards the value of IPE and collaborative practice among healthcare students. The 
overall RIPLS scale demonstrated strong internal consistency reliability (α = 0.90). 
The Brief Sense of Community Scale (BSCS) is an 8-item scale designed to measure the 
dimensions of sense of community as defined by the McMillan and Chavis [15] model [16]. The 
BSCS includes items representing the four dimensions of needs fulfillment, group membership, 
influence, and emotional connection. Participants responded to the BSCS items using a 5-point 
Likert-type scale ranging from 1 (strongly disagree) to 5 (strongly agree). A higher score on the 
BSCS indicates a stronger sense of community. The BSCS demonstrated strong internal 
consistency reliability, with Cronbach's alpha of .92. 
Multiple choice questions (MCQs) were developed as a measure of student learning 
outcome on the knowledge of IPE. The questions and answers were collaboratively developed by 
academics from nursing and rehabilitation sciences. 
The socio-demographic variables included gender (male, female), age, online gaming 
experience (whether participants had any prior experience playing online games, yes vs. no), and 
for those with gaming experience, total play time per day (less than 1 hour, 1-10 hours, or 10 or 
more hours). Participants also identified their specific program of study. 
Data Analyses 
Data cleaning and statistical analyses will be conducted using IBM SPSS. A mixed 2 x 2 
MANOVA will explore the interactions between group differences (iHealth-IVR vs. V-Care) and 
the within-subject factor (pre vs. post) for our outcome measures. 
Qualitative Methods 
To ensure representativeness and comprehensiveness of the qualitative data, participants 
will be recruited using stratified purposive sampling based on characteristics relevant to their 
learning experiences, such as field and year of study [17]. The questionnaire will include 
demographic questions to facilitate cluster sampling. The researcher will conduct face-to-face 
semi-structured focus group interviews. A senior research assistant and another research assistant, 
both trained in conducting focus group interviews with students, will help facilitate sessions. The 
assistant will take notes during each focus group. The focus group will begin with a guiding 
question: "What was your IPE learning experience?" Participants will then discuss how the 
experience impacted their studies, elements they liked or disliked, and skills, knowledge, and 
benefits gained. 
Data Analyses 
The interviews will be transcribed verbatim and processed using Atlas.ti. A three-level 
coding and thematic analysis approach will be employed [18]. First, in open coding, distinct 
concepts and categories in the transcripts will be identified, forming preliminary themes for 
analysis. Second, axial coding will categorize the themes defined in the initial phase and explore 
their interrelationships. Third, selective coding will formulate core themes, integrating and refining 
other sub-themes, and establishing their connections to the core themes. 
 
 

 
Project Significance 
More evidence is needed to understand how technology-based strategies can enhance IP 
learning. Managing patient conditions from multiple perspectives and engaging in IP interactions 
is vital for students to achieve program/course outcomes and improve patient outcomes. Evaluating 
the proposed IPE approaches can facilitate integrating more effective IPE activities into the 
curriculum. Integrating this project into the learning activities of nursing and physiotherapy 
departments will provide a large and diverse sample, improving the generalizability of findings 
and their potential to influence IPE practices.  
The study's findings can therefore refine and improve the pedagogical framework guiding 
the development of IPE learning activities, assessment rubrics, and innovative teaching methods, 
driving advancements in IPE design and delivery. Additionally, enhancing students' abilities to 
collaborate and deliver integrated, patient-centered care can ultimately improve overall patient 
outcomes. 
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