# Psychoeducation on Stress and Anxiety Using Virtual Reality: A Mixed-Methods Study
## 2 Materials and Methods
### Measures  
At the beginning of the experimental session, participants were asked to complete the following questionnaires:  
1. _Demographic_: individuals indicated their gender (male or female), age, years of education, profession (doctor, nurse), hospital, work department, and professional seniority. 2. _Ad hoc questionnaire on the use of technological solutions and VR_: a 4-item questionnaire on a 7-point Likert scale (1 = \"not at all\", 5 = \"very much\") on the level of use in general of technologies, the level of acceptance of technologies, the level of knowledge of VR, and the level of interest in using VR. Individuals were also asked if they have ever tried VR before (yes or no). 3. _Ad hoc questionnaire on the background knowledge of stress and anxiety_: a scale evaluating the use of psychological support programs and the knowledge of stress and anxiety (see [31] for details). Furthermore, at the end of the experimental session, individuals were asked to complete the following questionnaires that served to study the usability, sense of presence, and effect on learning of MIND-VR:  
* _System Usability Score (SUS)_[87]: a 10-item questionnaire on a 5-point Likert scale (1 = \"strongly agree\", 5 = \"strongly disagree\") about the ease of use or possible difficulty or critical issues experienced by individuals while using the VR system. A measure is provided on usability, namely \"the extent to which a product can be used, by specified users, to achieve specified goals with effectiveness, efficiency, and satisfaction in a specified context of use\" [88; 89; 90]. The reported reliabilities of the SUS are between 0.79 and 0.97 (e.g., ref. [91]). * _Net Promoter Score (NPS)_[92]: a satisfaction measurement on a scale from 0 (\"not at all\") to 100 (\"very much\"), assessed to rate the likelihood that users would recommend the product MIND-VR to a family member or friend. The NPS adds depth to a product analysis through a quantitative measure of engagement [92]. * _Slater-Usolt-Steed Presence Questionnaire (SUS-II)_[93]: a self-report scale on the perceived sense of presence. The SUS-II consists of 6 items on a 7-point Likert scale and offers a single total score. Its internal consistency is 0.75 [94]. * _Igroup Presence Questionnaire (IPQ)_[95]: it consists of 14 items on a 7-point Likert scale. This questionnaire has three subscales: Spatial Presence (IPQ-SP) (i.e., the sense of being physically present in the virtual environment); Involvement (IPQ-INV),  
Figure 2: Along the three paths of MIND-VR, users are given information on stress and anxiety via text and audio. measuring the attention devoted to the virtual environment and the involvement experienced; Experienced Realism (IPQ-REAL), assessing the subjective experience of realism in the virtual environment. The additional general item (IPQ-G) measure the broad \"sense of being there\". The IPQ has a Cronbach \(\alpha\) coefficient of 0.87 [94,96]. * _Ad hoc questionnaire on learning using VR_: a questionnaire to assess self-rating of effort, understanding, motivation, and interest for the subject explained in the virtual experience. This questionnaire was developed and adapted using the methods adopted in a previous study [73]. It includes 8 items on a 7-point Likert scale (Table 1). In addition, to measure changes in the emotional states of users, participants filled in the following measures before and after the use of MIND-VR:  
* _Visual Analogue Scale for Emotion (VAS-E)_[97,98]: participants indicate on a scale from 0 to 100 their current experienced level of six primary emotions: Anger (VAS-AN), Happiness (VAS-HP), Disgust (VAS-DS); Fear (VAS-FE), Sadness (VAS-SD) and Surprise (VAS-SP). Several studies have confirmed its reliability [99]. Several studies have confirmed its reliability and validity (e.g., ref. [99]). * _State-Trait Anxiety Inventory--Y1 (STAI-Y1)_[100]: a validated psychological measure of state anxiety, defined as a temporary emotional condition characterized by apprehension, tension, and fear about a particular situation.