A new study published in JMIR XR and Spatial Computing demonstrates that the way virtual reality therapeutics (VRx) are introduced to patients is a critical factor in how successfully they adopt the technology. The randomized feasibility pilot study builds on growing evidence that virtual reality digital therapeutics show strong clinical potential for managing symptoms such as anxiety, pain, and distress. Rather than evaluating clinical efficacy, the study focuses on a critical implementation question: how structured onboarding and provider involvement can help drive consistent patient engagement, adherence, and adoption of VRx in real-world care.
While previous digital therapeutic research has focused primarily on clinical efficacy, this study experimentally isolated the onboarding process to evaluate how different implementation strategies affect early technology acceptance, usability, and protocol fidelity.
The Onboarding Experiment
The research team evaluated 31 adult participants with limited prior virtual reality experience across three distinct implementation environments:
- Unguided Use: Participants received the VR headset preloaded with the therapeutic application and minimal instructions.
- Self-Directed Support: Participants received the headset alongside asynchronous physical materials, quick-start guides, an in-app tutorial, and access to a troubleshooting chatbot.
- Provider-Led Support: Participants received the self-directed materials combined with a brief, scripted 5-minute consultation with a trained provider who conducted a simulated prescription, safety screening, device fitting, and guided initial setup.
Key Findings
- Increased Adherence: Participants who received provider-supported onboarding demonstrated significantly greater time-based adherence ($P=.04$) and longer overall duration of engagement with the VRx intervention compared to the unguided group.
- Improved Technology Acceptance: Across all groups, brief exposure to the VR therapy led to statistically significant improvements in overall technology acceptance ($P<.001$), though scores remained moderate, indicating that early perceptions shift quickly but require ongoing reinforcement.
- Favorable Usability: The provider-supported group demonstrated the most favorable usability pattern, including fewer observed errors and higher usability ratings. Observational data showed that human-guided setup reduced early frustration and apprehension compared to relying on self-directed physical or digital materials alone.
- High Tolerability: The intervention was well tolerated across all cohorts, with low reported levels of cybersickness and no study discontinuations due to adverse effects.
“Virtual reality therapeutics are often talked about in terms of clinical outcomes, but real-world adoption depends on much more than whether the technology works. In this pilot study, even a brief provider-supported onboarding interaction appeared to make a difference in how participants engaged with VRx, how confident they felt, and how closely they followed the intended use,” said lead author Ashlyn Zebrowski, PhD. “To scale digital therapeutics and new technologies in routine care, we have to think beyond the intervention itself. We need to better define the roles of providers and patients and design the pathway for how these tools are introduced, supported, and integrated into the clinical workflow and the patients’ day-to-day lives.”
The qualitative findings contextualized these metrics, revealing that brief provider involvement established clinical legitimacy and set clear expectations, which directly altered how participants engaged with the technology.
Recognition for Excellence
Lead author Ashlyn Zebrowski, PhD, from the Carolina Health Informatics Program and the School of Information and Library Science at the University of North Carolina at Chapel Hill, was one of five recipients of the 2025 JMIR Publications Early Career Researcher Award. This study in JMIR XR and Spatial Computing represents a key component of the research recognized by this award.
About the Author Team
This study was a collaborative effort conducted by Ashlyn Zebrowski, R Jackson Fernandez, Cameron Pinkelton, Rebecca Kitzmiller, Adam W Kiefer, Laura Stanley, Gita Mody, Carlton Moore, and Lukasz Mazur representing the Carolina Health Informatics Program, the Division of Healthcare Engineering in the Department of Radiation Oncology, School of Medicine, School of Nursing, Department of Exercise and Sport Science, and UNC Lineberger Comprehensive Cancer Center at the University of North Carolina at Chapel Hill, as well as Montana State University.
Original article:
Zebrowski A, Fernandez R, Pinkelton C, Kitzmiller R, Kiefer A, Stanley L, Mody G, Moore C, Mazur L. Evaluating the Effects of Clinician Prescribing and Implementation Materials on Adoption of Virtual Reality Therapeutics: Randomized Feasibility Pilot Study. JMIR XR Spatial Comput 2026;3:e90626