## 4 Results and Discussions
### Implementation Challenges
#### 4.4.3 Organizational and Human-Centric Resistance
Additionally, it can induce anxiety from heightened virtual interaction, along with physical discomorts like dizziness, tiredness, and potential loss of balance with intensive use [8; 12; 66], negatively impacting the user experience [42]. This leads to the ineffectiveness of using VR and AR for safety training, posing a significant obstacle to the use of these technologies [43; 68]. Moreover, the increased cognitive demands of advanced systems, leading to cognitive overload and mental strain, contribute to heightened stress levels, reduced memory retention, and mental fatigue among workers [12; 43; 50; 54; 81]. For instance, managing the heavy cognitive load from rapidly increasing data causes high-stress levels among employees [16], as well as the difficulty of wearing virtual headsets with safety helmets [66]. Culturally, concerns over automation, such as fear, anxiety, and job insecurity, pose significant barriers, with older workers especially affected due to their higher susceptibility to simulator sickness and stronger resistance to change. Some workers resist cooperation due to stress and fear of job loss [8]. Older, more experienced workers, who are often less familiar with modern visual technologies, are more prone to experiencing simulator sickness when using VR, acting as a resistance to its adoption [45]. These anxieties, coupled with a sense of dehumanization and alienation fostered by machine-paced work and continuous monitoring, can erode trust, lower morale, and weaken social support, ultimately impacting worker well-being and dignity. For example, the adoption of advanced technologies has led to growing concerns about dehumanization and unemployment as automation increasingly replaces industrial workers [7; 16]. User discomfort and resistance to change also reflect broader resistance, where skepticism and negative experiences with immersive technologies, especially among those accustomed to traditional, hands-on approaches, hinder adoption, illustrating the profound human and ethical dimensions that must be addressed for successful digital transformation. For example, traditional professionals still prefer hands-on physical training methods and are cautious about the long-term effectiveness and side effects of VR/AR tools [45]. To better organize the wide range of barriers identified in the literature, Figure 14 introduces a tiered framework that categorizes implementation challenges into four levels: (1) Technology and Infrastructure, (2) Operational, (3) Human and Organizational, and (4) Strategic and Economic. Each level represents increasing complexity and broader organizational impact, offering a structured lens through which to understand the multifaceted obstacles to adopting DTs, IM, and enabling technologies to enhance manufacturing OHS. Each level captures a distinct set of challenges that must be addressed for successful adoption. At the base, Technology & Infrastructure challenges are especially prevalent among SMEs, which often lack the digital maturity required for DT and IM integration. Inadequate IoT networks, limited real-time data capabilities, and outdated legacy systems contribute to fragmented data environments and hinder synchronization efforts, as highlighted in the literature. These foundational gaps create significant barriers to the deployment of responsive, real-time safety systems. Moving up the framework, operational challenges involve the practical complexities of integrating advanced technologies into existing workflows. Cybersecurity risks, system instability, and high resource demands for XR and CPS are common concerns. Many older industrial setups also struggle with the scalability and latency requirements needed for predictive analytics, making seamless integration difficult without substantial upgrades. At higher levels, Human & Organizational and Strategic & Economic barriers become more pronounced. Resistance to change, digital skill gaps, and cognitive overload from immersive systems are frequently cited persistent issues.