All health care providers from a single Veterans Affairs (VA) Veterans Integrated Services Network (VISN) were invited to participate in a web-based, anonymous, closed survey. Health care providers were selected from one VA VISN that included 8 VA medical centers to better understand views from this specific population. The Veterans Affairs Health Administration is divided into 18 VISNs (or regional systems) across the nation. These regional divisions are meant to increase access to care and resources for veterans throughout the United States.

The survey, included in Multimedia Appendix 1, was developed by an experienced nurse researcher with vast knowledge of education and evaluation and an experienced psychology researcher working on immersive VR research. Participants were allowed to take the survey only once, based on the computer IP address. Author expertise in this area includes prior experience with implementing VR in a clinical setting and as part of a national research study. Through combined experiences, the authors were aware of a portion of the potential obstacles and benefits related to provider buy-in with immersive VR devices. A more focused look into this area is needed to aid in further exploration of the field. The web-based survey was developed on the Survey Monkey platform and emailed out to the health care providers within one VA VISN for voluntary feedback. A brief explanation of immersive VR and the purpose of the survey were included in the email with the link to the survey. The estimated time of survey completion was also included. The 8-item survey was made available for approximately two weeks for participants to complete. No incentives were offered to participants for completing the survey.

The Institutional Review Board of the Central Arkansas Veterans Health Care System deemed the survey as nonresearch and preparatory to research activity and therefore exempted it from ethics review.

Descriptive statistics were used to analyze, summarize, and present the survey data findings. Frequency distribution was used to depict the frequency or count of different outcomes in the sample. The frequency distribution was presented in a table format to summarize the health care disciplines and potential VR barriers in older adults with cognitive impairment. Each entry in the table was accompanied by the count or frequency along with associated percentages.

Our data yielded results highlighting that health care providers agreed that VR devices can be used with older adults, and furthermore, with older adults who have cognitive impairment. This information matches previous data in studies where older adults engaged in VR-based research [1,23,24]. Although providers highlighted barriers to immersive VR use in this population, the majority of health care providers would refer their patients to a program where immersive VR devices are used. Key barriers included physical, social, emotional, and cognitive obstacles that providers believed could hinder VR use in older adults with cognitive impairment.

Results of this project are consistent with literature in the field addressing provider acceptance of VR use for patients. Additionally, social barriers identified by providers regarding the use of VR devices in practice have been reported [25]. A limited number of studies have explored physical factors (eg, frailty, vision impairments, or mobility issues) displayed by patients that providers believe can inhibit the use of VR devices. These physical factors have been identified as barriers for other social groups, although they have been highlighted more frequently with older adults. The two significant barriers identified in the above-mentioned study by providers were cognitive issues displayed by the patient and patient’s perceptions of technology. Even though cognitive impairment can serve as a hinderance for engagement in some VR activities, VR has also acted as an assessment tool for diagnosing mild cognitive impairment [26]. Researchers have found that VR applications can be used toward improvement of cognitive impairment [27,28]. Few studies have thoroughly evaluated the perception of technology as viewed by older adults with cognitive impairment.

Chung et al [29] conducted a similar type of work, where perceptions of VR were explored with clinicians and service managers. Their study included barriers not only from the clinician’s view but also from the patient’s and the organization’s view. Three broad themes emerged from the analysis of the survey barrier data (clinical factors, organizational factors, and professional factors). Overall, participants of the project agreed that VR could be used to break down barriers of care. Additionally, participants noted that VR could prove to be a beneficial mental health intervention for those who may have found traditional psychotherapy methods to be ineffective [30]. Two main barriers for implementation of VR use addressed in their work include concerns for proper safety or ethics and concerns for resourcing (eg, staff, costs, or space). An additional study found that providers find VR to be a valuable tool and would continue to use it in their own practice [27].

One major limitation of our study is the small sample size reported; the project yielded results from 49 respondents. Second, we included only 8 items for the total survey. It is possible that additional information was unable to be analyzed due to the low item number. The third limitation includes the restriction of sending the survey to only one VA VISN and only VA health care providers. Some health care providers may have other roles in different care settings, though they would have required a VA affiliation to have access to this project survey.

Future areas of consideration include understanding the perception of health care providers toward using VR or referring patients to engage in immersive VR-based interventions. Similarly, research can explore perceptions of technological use, specifically immersive and nonimmersive VR use, in older adults with cognitive impairment. Identifying additional barriers for both forms of VR use and brainstorming possible solutions to these barriers are also required in the future.

Immersive VR continues to emerge as a viable option for a myriad of clinical presentations and medical education purposes. Various uses of this technology are being identified and researched. Although systemic, professional, and individual barriers have been highlighted, the field continues to address these obstacles with the hopes of improving the overall VR experience.