Development of Virtual Reality Health Literacy: Delphi Expert Consensus Study.

Background: Virtual reality (VR) is a promising tool in health care, offering immersive and interactive environments that can enhance patient education, rehabilitation, and mental health interventions. However, effective patient engagement with head-mounted display (HMD)-based immersive VR depends on a combination of functional competencies and readiness-related determinants that have not yet been systematically defined. Objective: This study aimed to conceptualize an initial framework of VR health literacy, focused on HMD-based immersive VR in clinical settings, and to achieve expert consensus on its definition, domains, and subdomains. Methods: A 3-phase modified Delphi study was conducted between January and April 2024, including a literature review in MEDLINE (via PubMed) and Embase (2017-2023) informed by scoping review methodology, a multidisciplinary expert panel formation, and 2 online survey rounds, in which panelists rated each subdomain on a 4-point necessity scale and provided open-ended feedback, with 15 experts from the health care, VR, and health literacy fields. Consensus was defined using IQRs and agreement thresholds; items with moderate consensus were further evaluated through structured internal deliberation. Results: A total of 15 experts participated in Round 1, and 13 continued to Round 2 (retention rate, 87%). An initial structure of 7 candidate domains with 23 subdomains was iteratively refined across the two rounds based on consensus levels, expert panel feedback, and internal deliberation, with consensus thresholds applied as guiding criteria rather than automatic exclusion rules; subdomains with moderate consensus were further evaluated through structured internal deliberation to determine theoretical necessity within the framework. The final framework comprised 5 domains and 14 subdomains: performance expectancy (perceived usefulness of VR for health management; expectations of future VR benefits); effort expectancy (perceived immersion or embodiment; perceived interactivity and responsiveness; understanding of VR-related terms); facilitating conditions (access to VR devices and platforms; digital knowledge and confidence; technical proficiency with VR devices; digital self-efficacy); attitudes toward VR (awareness of VR in health contexts; interest in VR technology; problem-solving ability using VR content); and behavioral intention (intention to use VR technology or services; willingness to engage with VR for health). Conclusions: This study presents an initial consensus-based framework of VR health literacy for HMD-based immersive VR in clinical settings. Developed through a multidisciplinary Delphi process, the framework combines operational competencies with engagement-related determinants to provide both theoretical clarity and practical use, offering guidance for clinicians, educators, and policymakers to design and implement VR interventions that are accessible, equitable, and effective in health care contexts.