Adolescents' perceptions and user experiences with a virtual reality-based alcohol prevention tool in Germany: A focus group study.

Background: Excessive alcohol consumption is a major public health problem, with substance use early in life contributing to higher levels of use later in life. Virtual reality (VR) is an innovative technology for alcohol prevention among adolescents that could solve the problem of insufficient outreach to the target group of young people. The co-created German Virtual LimitLab simulation is one of the few examples of VR-based alcohol prevention tools and consists of a virtual house party simulation. The aims of Virtual LimitLab are to increase the users' awareness of how social pressure can influence their own decision-making as well as to enable various actions and communication strategies in order to train competencies when dealing with alcohol. The present study thus aims to explore adolescents' content- and technique-specific perceptions of Virtual LimitLab in order to gain insights into user experiences and to test the prototype with the German target group. Methods: Four semi-structured focus groups with adolescents aged 15-18 years (n = 13) were conducted and analyzed using thematic analyses. A user experience questionnaire (UEQ-S) was applied in order to quantitatively assess adolescents' satisfaction with Virtual LimitLab. Results: Three main themes were identified (VR experience, content, and technical aspects). Participants positively assessed both the content and the technical aspects of Virtual LimitLab. This trend was also seen by the UEQ-S data, which yielded positive ratings for both pragmatic and hedonic quality. The broad variety of options in the simulation that allow the user to try new behaviors was perceived particularly positively. In general, Virtual LimitLab was regarded as an innovative tool that encourages adolescents to think critically about their personal alcohol consumption. Technical errors in the simulation and users' difficulties in identifying with the simulation were the main points of criticism. Conclusions: Feedback from adolescent users revealed positive and therefore promising results when using Virtual LimitLab as a gaming alcohol-prevention tool. Some technical aspects still need to be improved in order to further refine the prototype, and suggestions for expanding the content of the application have already been made.

LGBTQIA+ Adolescents' Perceptions of Gender Tailoring and Portrayal in a Virtual-Reality-Based Alcohol-Prevention Tool: A Qualitative Interview Study and Thematic Analysis.

Gender-sensitive interventions in alcohol-prevention that target adolescents often lead to binary tailoring for girls and boys. However, increased societal and legal recognition of sexual and gender minorities as well as research with this age group demand a broader understanding of gender. Therefore, the present study addresses the question of how interventions should be further developed to include sexual and gender diversity by exploring LGBTQIA+ adolescents' perceptions of gender portrayal and gender-tailoring using Virtual LimitLab-a virtual-reality simulation for training refusal skills under peer pressure to consume alcohol. Qualitative interviews with 16 LGBTQIA+ adolescents were conducted after individual simulation testing. Using a thematic analysis with reflexive orientation, four themes were identified: Statements on relevance of gender, opinions on tailoring- and flirting options, and opinions on characters. Participants called for greater diversity representation among the characters, regarding gender identity and sexual orientation, as well as for representing, e.g., racialised peers. Moreover, participants suggested expanding the simulation's flirting options by adding bisexual and aromantic/asexual options. Divergent views on the relevance of gender and wishes for tailoring options reflected the participant group's heterogeneity. Based on these findings, future gender-sensitive interventions should conceptualise gender in a complex and multidimensional manner that intersects with further diversity categories.

Co-creating Virtual Reality Interventions for Alcohol Prevention: Living Lab vs. Co-design.

Addressing the need for collaborative involvement in health intervention design requires application of processes that researchers and practitioners can apply confidently to actively involve end-users and wider stakeholder groups. Co-creation enables participation by focusing on empowering a range of stakeholders with opportunities to influence the final intervention design. While collaboration with users and stakeholders during intervention design processes are considered vital, clear articulation of procedures and considerations for various co-creation methodologies warrants further research attention. This paper is based on two case studies conducted in Australia and Denmark where researchers co-created virtual reality interventions in an alcohol prevention context. This paper explored and reflected on two co-creation methods-co-design and the Living Lab-and showcased the different processes and procedures of each approach. The study demonstrates that both approaches have merit, yet highlights tensions in distinguishing between the application of each of the respective steps undertaken in each of the processes. While a lot of similarities exist between approaches, differences are evident. Overall, it can be said that the Living Lab is broader in scope and processes applied within the Living Labs approach are more abstract. The co-design process that we applied in the first case study is described more granularly delivering a clear a step-by-step guide that practitioners can implement to co-design solutions that end-users value and that stakeholders support. An agenda to guide future research is outlined challenging researchers to identify the most effective co-creation approach.

User Experiences with a Virtual Alcohol Prevention Simulation for Danish Adolescents.

This pilot study explores 31 Danish adolescent user experiences for the newly developed virtual party simulation app-Virtual Reality (VR) FestLab. The main objective of this study was to investigate usability for VR FestLab, which aims to improve alcohol resistance skills for Danish adolescents. A secondary objective was to understand gameplay experiences. The study is a mixed method study that draws on questionnaire data (n = 31) and focus group interviews (n = 10) of boarding school students participating in the pilot study. Descriptive statistics were used to examine quantitative data, and qualitative data were analyzed thematically. Quantitative findings indicated that gameplay experiences of the VR simulation were positive, and all User Experience Questionnaire (UEQ) items were answered positively. The focus group interviews showed that adolescents found the simulation to be realistic. Feedback indicated that the group pressure experienced in the simulation was regarded to be less than in real life. Adolescents had varying approaches to playing the VR simulation, they thought the quality of the simulation was good, and only a few users experienced technical difficulties. These initial study findings indicate that VR FestLab is a promising tool for the prevention of alcohol use among adolescents.

Co-Creating a Virtual Alcohol Prevention Simulation with Young People.

Collaborative knowledge generation and involvement of users is known to improve health promotion intervention development, but research about the roles and perspectives of users in the co-creation process is sparse. This research aimed to study how young people perceived their involvement in a co-creation process focussed on the development of a gamified virtual reality (VR) simulation-VR FestLab. The Living Lab methodology was applied to structure and guide the co-creation process. Living Lab participants were comprised of students, health promotion practitioners, researchers, and film and gaming experts who collaboratively designed and created the content and structure of the VR FestLab. Semi-structured interviews were conducted with nine students who participated in the Living Lab and represented young end users. Interviews were tape-recorded, transcribed and thematically analysed. Students described that they had influence on their tasks. They felt included and expressed that the collaboration with and feedback from peers and other stakeholders increased their self-efficacy and empowered them to take ownership and generate new ideas. Participants voiced that they lacked information about the final production of VR FestLab. Co-creation guided by the Living Lab methodology produced added value in terms of empowerment and increased self-efficacy for the students involved. Future Living Labs should plan for communication with participants about further development and implementation processes following ideation and prototyping phase.