The User eXperience questionnaire for Virtual Reality in Healthcare (UXVR-H): Development from Literature Analysis to Psychometric Evaluation in Older Adults

Within the framework of healthcare, virtual reality has emerged as a transformative tool for delivering therapeutic interventions through increasingly sophisticated and effective applications. The successful implementation of virtual reality-based solutions is linked to experience gained by users - the so-called user experience. Positive user experience yielded several advantages such as identification of usability barriers, accommodation of patients’ specific needs and limitations, enhanced treatment adherence, sustained patient engagement, and long-term adoption of proposed intervention. Despite this recognized importance, comprehensive instruments for evaluating the experience of users in healthcare setting remain limited. Existing tools often fail to capture the multifaced nature of novel technological solutions or lack appropriate psychometric validation. In order to fill these gaps, this doctoral dissertation developed the User eXperience questionnaire for Virtual Reality applications in Healthcare (UXVR-H), a psychometrically sound tool created to evaluate user experience in virtual reality-based applications for healthcare among older adults. The development process employed a systematic, multi-phase approach grounded in comprehensive literature analysis and rigorous validation procedures. The research comprised four interconnected studies. First, a scientometric analysis of the field, examining evolution of user experience, thematic shift, and emerging trends to delineate a more precise conceptual profile of this complex and multifaced construct. Second, the literature analysis was completed by a scoping review specifically focused on healthcare context, exploring theoretical frameworks of user experience when virtual reality is used for clinical purposes in aging. As a result, we theorized an eight-factor framework for defining user experience, encompassing: usability and functionality, aesthetics and design, engagement, emotional state, presence, environmental realism, side effects, and usage motivation. This model served as the foundation for questionnaire construction. The UXVR-H development starts with item generation (271 items), formulation of response scale, and drafting of administration instruction. The design process included the consultation of older adults to apply user-centered design principles. This participatory approach guarantees understandable, pertinent, and suitability of items for the target population. Additionally, experts in virtual reality technology, methodology, and user experience evaluated the content validity and theoretical alignment. Through integration of user feedback and expert judgment, the refined instrument includes 24 items for further study. It is aimed at evaluating the psychometric qualities of the questionnaire. It involves older adults who completed the UXVR-H following virtual reality session featuring cognitive tasks. Data screening, confirmatory factor analysis, reliability analysis, and nomological validity testing were all part of the psychometric evaluation. Results revealed a refined 13-item structure distributed across six empirically supported dimensions: usability and functionality, presence, side effects, aesthetics and design, environmental realism, and usage motivation. The UXVR-H emerges as a practical self-report instrument utilizing a 5-point Likert scale that provides balanced assessment of essential UX dimensions while minimizing respondent burden through its brevity (approximately 5 minutes administration time). In conclusion, the present research analyzes the complex framework of user experience highlights current challenges in evaluating user experience following virtual reality-based applications among clinical context for aging and offers a valuable contribution to the limited collection of validated assessment tools.