Scenario-Driven Virtual Reality Game for Dementia Education Among Healthcare Students: Protocol for a Four-Arm Study
Phase: NA
Conditions: Dementia
Sponsor: Universitas Airlangga

 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
NCT number:  
Document date: 2025/09/20 
 
 
 
 
 
UNIVERSITAS AIRLANGGA 
September, 2025 
 
 
 
Research Title 
Scenario-Driven Virtual Reality Game for Dementia 
Education Among Healthcare Students 

Clinical Trial 
Tittle: Scenario-Driven Virtual Reality Game for Dementia Education Among Healthcare 
Students: Protocol for a Four-Arm Study 
Study Description 
• Terminology Clarification: 
In the previous study (NCT06629844), the term ' virtual reality (VR)' referred to a 360-
degree video viewed through a VR headset. This format offered an immersive 
experience but was non-interactive. In contrast, the current study uses an 'ASA VR' 
intervention, which is a scenario-driven, interactive virtual reality simulation. 
Participants take part in role-playing with an artificial intelligent (AI) character 
representing a person living with dementia. This distinction is crucial for understanding 
the study design and results, as the cognitive and experiential demands of the two 
formats differ greatly. 
 
• Brief Summary:  
This nested 2x2 factorial quasi-experimental design study focuses on Indonesian 
nursing students and aims to examine the effectiveness of scenario-driven virtual reality 
(VR) dementia educational programs. The study uses a four-arm design to evaluate 
different combinations of interventions. 
The study addresses the following research questions: 
What is the effect of a Scenario-Driven VR dementia education program on improving 
participants' attitude, knowledge, intention to help toward people living with dementia, 
ageist attitudes, and how do participants satisfaction of the Scenario-Driven VR 
dementia education program? 
 
 
 
 
 
 
 
Participants will voluntarily join a 30-minute class education program, with each 
participant attending only once. The program, integrated into the faculty's dementia-
related courses, will be structured around a series of components, including 
introduction, Scenario-Driven VR, post-program questionnaire, and conclusion. 
 
• Detailed Description:  
1) Research Implementation  

a. ASA Program Overview 
ASA VR is a scenario-driven, interactive virtual reality (VR) learning 
experience designed to cultivate dementia-competent attitudes and behaviors 
among healthcare students. Unlike the passive 360° video used in the prior 
study, ASA requires learners to make decisions, engage in role-play with an AI 
character portraying a person living with dementia (PLWD), and receive 
immediate, context-specific feedback. 
b. Educational Concept and Design Rationale 
ASA operationalizes evidence-informed instructional principles: (1) problem-
centered, authentic tasks with demonstration and guided practice; (2) anchored, 
scenario-based learning to encourage transfer; and (3) first-person immersive 
perspective-taking shown to strengthen empathy in healthcare education using 
VR. Together, these elements aim to move learners beyond recognition-level 
knowledge to a situated judgment and prosocial intention. 
2) Research Method 
This study is randomized with parallel assignment. The study aims to evaluate 
scenario-driven VR dementia education programs among nursing students in 
Indonesia. The participants will be nursing students who are enrolled in specific 
semesters and courses designated for the implementation of this educational 
program. The study will be conducted with students in the sixth semester (third 
year). Participants in this study were drawn from the previous study 
(NCT06629844). The previous study was a quasi-experimental, two-arm design, 
consisting of an intervention group that received an education program using VR 
and a control group that attended conventional classes. In the previous study, we 
collected questionnaires at three time points: pre-questionnaire (T1), post-
questionnaire (T2), and a follow-up questionnaire three months later (T3). In this 
study, we continue our research using the Scenario-Driven VR Dementia Education 
Program. We will conduct a randomized with parallel assignment study with four 
arms. The intervention group from the previous study who had prior VR experience 
will be divided into two groups: one receiving the Scenario-Driven VR Dementia 
Education Program and one serving as a control group. Similarly, the control group 
from the previous study will also be divided into two groups: one receiving the 
Scenario-Driven VR Dementia Education Program and one serving as a control 
group. After finish the Scenario-Driven VR Dementia Education Program we will 
gave post-questionnaire (T4).  
 
All prospective participants will be assigned new ID numbers to ensure the 
confidentiality of their student ID numbers. Each new ID will correspond to the 
participant’s ID number from the previous study, with the addition of a code to 
classify them into four groups. This approach will allow us to link participant data 
in the current study with data from the previous study. The protocol has been 
reviewed and approved by the Ethics Committee of the Faculty of Nursing, 
Universitas Airlangga. The Scenario-Driven VR dementia education program will 
not be integrated into a specific class, but will cover themes related to dementia care. 

Participants will be recruited through class announcements. An overview of the 
research process will be provided, and detailed instructions regarding the study will 
be given shortly before it begins. The research team will announce the study 
approximately one week in advance, and recruitment will be conducted via Google 
Forms. Students who register will be randomly assigned into four groups. Selected 
participants will receive their ID numbers along with details about the program’s 
schedule and location through a class announcement three days prior to the 
intervention. 
 
On the day of the intervention, participants will attend the designated location and 
sign an attendance sheet using their IDs. The Principal Investigator (PI) will explain 
the study's stages and emphasize that participants can withdraw at any time without 
any consequences. Participation in the study will be entirely voluntary, and there 
will be no coercion. Students who agree to participate in the study will provide 
informed consent. Those in the program will complete a questionnaire after the 
intervention. Regarding recruitment, eligible participants will be identified through 
the previous study’s data. Students registered in the selected courses for the 
2025/2026 academic year. All eligible students will receive comprehensive 
information about the study and an invitation to participate. Both the intervention 
and control groups will complete post-intervention questionnaires.  
 
The intervention group will receive the Scenario-Driven VR Dementia Education 
Program, while the control group will attend an online class to receive information 
about the study, provide informed consent, and complete the post-test questionnaire. 
Both the intervention and control sessions will be conducted once. Students who 
provide informed consent in the intervention group will attend a classroom lecture 
to participate in the Scenario-Driven VR Dementia Education Program and then 
complete a post-lecture survey (T4). The control group will follow the same timeline 
for completing the survey (T4). 
 
In the previous study, students experienced a non-interactive 360° video via a 
headset, which likely enhanced presence and baseline attitude but required no active 
problem-solving. In this follow-up study, we investigate whether ASA’s interactivity 
provides incremental value (in the form of additive or synergistic effects) beyond 
prior passive immersion. This design allows us to disentangle (A) the main effect of 
ASA and (B) whether prior 360° exposure primes learners for greater gains when 
interactivity is introduced. 
 
Arms Intervention 
Arms 
Assigned Intervention 
A four-arm post design will be 
employed 
in 
this 
study, 
meticulously structured to evaluate 
various educational approaches. 
As previously mentioned, the intervention for this 
study will involve a scenario-driven ASA VR content 
designed to enhance healthcare students' attitudes 
toward dementia care. in which participants from a 

There 
will 
be 
four 
groups, 
strategically divided based on 
participants' 
prior 
engagement 
with 
a 
VR-based 
dementia 
education program: 
1. Arm 1: VR-Experienced + 
ASA VR Group 
• 
Description: 
This 
arm 
includes participants who 
have previously engaged 
with a VR-based dementia 
education program. For 
this study, they will receive 
the full intervention, which 
combines the ASA VR 
content. 
• 
Purpose: This group helps 
assess 
the 
incremental 
benefit of the ASA content 
when integrated with prior 
VR exposure, evaluating 
how additional structured 
content enhances existing 
VR learning. 
2. Arm 2: VR-Experienced + 
Standard Control Group 
• 
Description: 
This 
arm 
consists 
of 
participants 
who have also previously 
engaged with a VR-based 
dementia 
education 
program. However, for this 
study, 
they 
will 
only 
receive the standard course 
material 
on 
dementia 
through the university's e-
learning platform. They 
will not receive any ASA 
VR exposure. 
• 
Purpose: 
This 
group 
serves as a comparison to 
Arm 1, helping to isolate 
the specific impact of the 
ASA VR intervention for 
those 
with 
prior 
VR 
experience, by observing 
outcomes when no further 
structured intervention is 
provided beyond regular 
curriculum. 
previous study are assigned to new intervention and 
control groups. 
 
The program is designed to simulate real-life dementia 
care situations, encourage reflection, and enhance 
nursing 
students' 
understanding 
of 
dementia 
management. Here's how the intervention and 
participant assignment process will generally unfold: 
1. Participant Identification 
Nursing students currently enrolled in the 
Gerontological Nursing programs at Universitas 
Airlangga 
will 
be identified as 
potential 
participants for this study. 
2. Initial Grouping  
Participants will initially be categorized based on 
their prior involvement with the scenario-driven 
VR dementia education program from the 
previous pilot study. This will create two primary 
groups: those who have been previously exposed 
to the VR program and those who have not. 
3. Subgroup Formation and Assignment 
Based on the initial grouping, participants will be 
strategically divided into four distinct arms. 
Within each main group (previous VR exposure 
and no prior VR exposure), participants will be 
assigned into respective subgroups without 
randomization to ensure balance and minimize 
bias: 
• Arm 1: VR-Experienced + ASA VR Group 
A subgroup of participants who have 
previously interacted with the VR-based 
dementia education will be assigned to 
receive the full ASA VR intervention. 
• Arm 2: VR-Experienced + Standard Control 
Group 
A subgroup of previously VR-exposed 
participants will be assigned to receive only 
standard dementia-related course material 
through the university’s e-learning platform. 
• Arm 3: VR-Unexposed + ASA VR Group 
A subgroup of participants with no prior VR 
exposure will be assigned to receive the full 
VR ASA intervention. 
• Arm 4: VR-Unexposed + Standard Control 
Group 
Another subgroup of participants without 
prior VR exposure will be assigned to this 
arm, receiving only the standard dementia-
related 
course 
material 
through 
the 
university’s e-learning platform. 

3. Arm 3: VR-Unexposed + ASA 
VR Group 
• 
Description: 
This 
arm 
comprises participants who 
have no prior exposure to a 
VR-based 
dementia 
education program. For 
this study, they will receive 
the 
full 
intervention, 
combining the immersive 
ASA VR content. 
• 
Purpose: 
This 
group 
allows 
for 
a 
direct 
assessment of the overall 
effectiveness 
of 
the 
complete 
ASA 
VR 
program for students new 
to this type of intervention, 
comparing 
it 
against 
conventional learning for a 
previously 
unexposed 
group. 
4. Arm 4: VR-Unexposed + 
Standard Control Group 
• 
Description: 
This 
arm 
includes participants who 
have no prior exposure to a 
VR-based 
dementia 
education program. For 
this study, they will only 
receive the standard course 
material 
on 
dementia 
through the university's e-
learning platform. They 
will not receive any ASA 
VR content. 
• 
Purpose: This group acts 
as 
a 
true 
control, 
representing the outcomes 
of conventional dementia 
education 
through 
the 
university's 
regular 
e-
learning, for students who 
have not had any previous 
VR exposure. 
 
4. Voluntary Participation & Informed Consent 
Prior 
to 
any 
intervention, 
the 
Principal 
Investigator (PI) will provide all potential 
participants with a clear and comprehensive 
explanation of the study procedures. Emphasis 
will be placed on the voluntary nature of 
participation, ensuring that students understand 
they may withdraw at any time without 
consequence or impact on their academic 
standing. Students who agree to participate will 
provide written informed consent. Those who 
choose not to participate will still receive 
dementia-related educational materials via the 
university’s e-learning platform but will not be 
involved in the gamified educational program or 
structured interventions included in this study. 
5. Intervention Sessions (Single 60-minute session or 
standard e-learning access) 
The delivery of the intervention will vary 
according to group assignment: 
For Arms 1 and 3 (ASA VR Groups): 
Participants will attend a single 60-minute session, 
structured as follows: 
• Introduction (5 minutes):  
A warm welcome will be extended to 
participants, along with a brief overview of 
the session’s objectives and flow. 
• Study Briefing (10 minutes):  
The PI will explain the study’s aims, the 
participants’ roles, and highlight voluntary 
participation, 
confidentiality, 
and 
the 
informed consent process. 
• Intervention Implementation (30 minutes): 
During this segment, participants will engage 
with a scenario-driven Virtual Reality 
Dementia Game. The intervention features 
role-playing game where players interact with 
an AI that takes on the role of a person living 
with dementia in a virtual world. The 
gameplay follows a structured storyline, 
ensuring that the immersive VR experience 
directly supports the learning objectives. This 
active learning approach is designed to foster 
empathy, understanding, and appropriate 
attitudes toward individuals living with 
dementia.  
• Post-Program Questionnaire (10 minutes): 
Immediately 
after 
the 
intervention, 
participants 
will 
complete 
the 
post-

intervention questionnaire (T4) to assess 
changes in outcomes. 
• Closing (5 minutes): 
A brief summary will be provided, including 
an opportunity for questions and a word of 
thanks to the participants. 
For Arms 2 and 4 (Standard Control Group): 
Participants in these arms will access dementia-
related content through the university’s existing e-
learning platform as part of their regular 
curriculum. These groups will not receive a special 
intervention session from this study and will serve 
as control groups for the ASA VR program. All 
participant groups will complete the post-
intervention (T4) questionnaires at designated 
times to measure the study’s primary and 
secondary outcomes. 
 
Analysis Methods: 
After calculating descriptive statistics, chi-squared test and Student’s t test will be used to 
examine the homogeneity of the baseline participants’ characteristics between the two groups. 
The main analysis will be to compare the changes in the primary and secondary outcomes from 
T3 to T4 between the intervention and control groups using Student’s t test and to estimate the 
effect size (Hedges’ g). Small effect sizes will range from 0 to 0.17, moderate effect sizes from 
0.18 to 0.43, and large effect sizes from 0.44 to 0.84 (Brydges, 2019). As post hoc analysis, the 
changes from T3 to T4 scores in each group will be examined using paired t test. All participants 
who complete the T3 and T4 surveys will be included in the analyses. To compare the scores 
among four time points (T1–T4) in the intervention group, a one-way repeated measures 
analysis of variance will be performed. Complete case analysis will be used to handle missing 
values. For sensitivity analysis to confirm the consistency of results in the main analysis, 
analysis of covariance (ANCOVA) will be conducted for the primary outcome. The following 
variables will be used as adjustment variables: involvement with people living with dementia, 
knowledge of dementia, ageism, and intention for helping behaviour. 
Outcome Measures 
Primary Outcome Measure:  
1. Participants' attitudes toward persons living with dementia (PLWD) will be assessed 
using the Attitudes Toward People with Dementia Scale, developed by Kim K and 
Kuroda K. (Kim K, Kuroda K. Factors related to attitudes toward people with dementia: 
Development of the Attitude Toward Dementia Scale and Dementia Knowledge Scale. 
Bulletin of Social Medicine. 2011; 28(1), 43-55). The original scale was published in 
Japanese, and a forward-backward translation process was conducted to produce the 
Indonesian version of the scale. 
The questionnaire consists of 14 items and is designed to evaluate participants' attitudes 
toward PLWD. The estimated time to complete the questionnaire is 3-5minutes. 

[Time Frame: Immediately post-intervention (T4), on the same day, within 0–60 
minutes after session end.] 
Secondary Outcome Measures 
1. Knowledge of Dementia 
Participants' knowledge of dementia will be assessed using the Dementia Knowledge 
Scale, developed by Kim and Kuroda (2011). This scale was originally designed to 
measure various aspects of dementia knowledge, including symptoms, causes, 
progression, and caregiving strategies. The scale consists of 15 multiple-choice and 
true/false questions that cover a broad range of dementia-related topics. The Indonesian 
version of the scale was created through a forward-backward translation process to 
ensure cultural and linguistic accuracy. Higher scores on this scale indicate a better 
understanding of dementia. 
[Time Frame: Immediately post-intervention (T4), on the same day, within 0–60 
minutes after session end.] 
 
2. Intention to Help Persons Living with Dementia (PLWD) 
To assess participants' intention to help PLWD, we will use a set of four vignettes based 
on the study by Matsumoto et al. (2022). Each vignette presents a realistic scenario in 
which a person with dementia may need assistance, such as confusion in a public place, 
difficulty with daily tasks, or issues related to memory loss. Participants will read 
through each vignette and indicate their intended helping behavior on a 4-point Likert 
scale (ranging from "definitely would not help" to "definitely would help"). The 
vignettes are designed to assess the participants' willingness to offer practical, 
emotional, or social support to PLWD in everyday situations. The Indonesian version 
of the vignettes and Likert scale has also undergone a forward-backward translation to 
ensure that the language and context are appropriate for Indonesian nursing students. 
[Time Frame: Immediately post-intervention (T4), on the same day, within 0–60 
minutes after session end.] 
 
3. Ageist Attitudes Towards Older Adults 
Participants’ ageist attitudes will be assessed using selected items from the Fraboni 
Scale of Ageism (FSA). The FSA is a validated instrument developed by Fraboni et al. 
(1990) that measures stereotypes, prejudice, and discriminatory attitudes toward older 
adults. In this study, a subset of key items will be adapted and translated into Indonesian 
version using a forward-backward translation process to ensure cultural and linguistic 
appropriateness. The selected items cover three main domains: Stereotyping, Social 
distancing, Discriminatory attitudes. Each item will be rated on a 5-point Likert scale 
(1 = strongly disagree to 5 = strongly agree), with higher scores indicating stronger 
ageist attitudes. This measure will allow researchers to explore how underlying biases 
may impact students’ empathy, communication, and willingness to provide equitable 
dementia care to older adults. This questionnaire is relevant to the study’s aim of 
evaluating the impact of VR ASA not only on knowledge and behavior but also on deep-
seated attitudes toward aging. 
[Time Frame: Immediately post-intervention (T4), on the same day, within 0–60 
minutes after session end.] 

 
4. User Experience Questionnaire (UEQ) 
To assess participants' perceptions of the VR dementia education program, we will use 
the User Experience Questionnaire (UEQ). This questionnaire evaluates users' 
experiences with the VR program across several dimensions, such as attractiveness, 
perspicuity, efficiency, dependability, stimulation, and novelty. The UEQ was used 
previously in similar studies and provides valuable feedback on the user experience. 
The Indonesian version of the UEQ, authored by Harry B. Santoso https://www.ueq-
online.org/ , will be employed to ensure the questionnaire is culturally and linguistically 
appropriate. 
[Time Frame: Immediately post-intervention (T4), on the same day, within 0–60 
minutes after session end.] 
 
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UNIVERSITAS AIRLANGGA 
 
Faculty of Nursing 
Kampus C Jl. Mulyorejo, Surabaya 60115 Telp. (031) 5913756 Fax (031) 5913752 
Website : https://ners.unair.ac.id,  e-mail : humas@fkp.unair.ac.id 
 
 
 
INFORMED CONSENT 
 
Dear Participant, 
 
We invite you to complete the questionnaire below: 
 
Information about this study: 
 
Title: Scenario-Driven Virtual Reality Game for Dementia Education Program 
Objective: To evaluate the effectiveness of an educational program using a Scenario-Driven 
Virtual Reality Game to improve attitudes toward people living with dementia among 
healthcare students. 
Principal Investigator: Dianis Wulan Sari, Faculty of Nursing, Universitas Airlangga 
Contact Person: Dianis; dianis.wulan.sari@fkp.unair.ac.id 
Study Duration: September 2025 – June 2026 
 
This survey will be conducted once and will take approximately 30 minutes to complete. 
 
We would like to assure you that: 
o Your participation in this study is voluntary. You have the right to refuse or agree to participate. 
o Your information will be treated anonymously and confidentially, and will not be used for any 
purpose other than this study. 
o You may leave questions unanswered without penalty. 
o Your responses will be stored in an encrypted drive and destroyed five years after publication 
of the study. 
o Participants who are willing to provide their phone number will receive mobile credit 
compensation after all data collection has been completed. 
 
Completion and return of this questionnaire will be considered as your consent to participate in 
this study. Once your responses are submitted, they cannot be withdrawn. 
 
Do you agree to participate in this survey? 
 
  Yes, I agree 
  No, I do not agree 
 
This statement is made to be used as necessary.