Effectiveness of Immersive and Embodied Enhancement via "Virtual Reality" on the Sustainability of Hand Hygiene Compliance:Protocol for a Randomized Controlled Trial of a School-Based Training Program.

Background: Regular and sustained handwashing is a key preventive measure for reducing the transmission of infectious diseases among school-aged children. Virtual reality (VR) interventions have demonstrated potential to facilitate behavioral change by creating immersive environments in which behavioral and environmental variables can be systematically manipulated. Compared with conventional verbal or video-based instruction, VR-based handwashing education may provide students with more interactive and experiential learning opportunities, and may improve cleaning of commonly missed areas, such as the wrists. However, evidence on school-based VR interventions for handwashing education in Hong Kong remains limited. Objective: This study aims to evaluate the effectiveness of a customized VR intervention for teaching handwashing skills to secondary school students in Hong Kong. The intervention teaches the 7-step handwashing technique recommended by the Centre for Health Protection, Department of Health, Hong Kong Special Administrative Region. The study will assess changes in handwashing performance and examine the longer-term effects of the intervention on handwashing habits, behavioral determinants, and hand hygiene. Methods: A 3-arm randomized controlled trial will be conducted with approximately 500 students allocated to 3 groups on a school-class basis. Each group will receive 2 educational sessions with different interventions over 1 school year (10 months). The first intervention group will receive 2 VR game sessions focusing on handwashing skills. The second intervention group will receive 1 VR game session followed by 1 video session reviewing participants' gameplay from the first session. The control group will receive 2 video-based handwashing education sessions. Pre- and postintervention UV fluorescence imaging of participants' hands will serve as the primary outcome measure. The secondary outcomes will be assessed through surveys administered before the intervention, immediately after the intervention, and at a 4-month follow-up. The survey will measure self-efficacy, hand hygiene knowledge, handwashing habits and intentions, attitudes, subjective norms, perceived behavioral control, VR embodiment, and VR experience. Results: The project was funded in March 2026, and recruitment was conducted from May to August 2026. As of August 2026, 9 schools had confirmed participation, with approximately 500 students expected to be recruited. Data collection is scheduled from September 2026 to June 2027. Data analysis is planned for August 2027, and the study findings are expected to be released in September 2027. Conclusions: This study will contribute to the development of VR-assisted infection prevention strategies. It addresses several research gaps by developing an evidence-based and feasible VR hand hygiene program for school settings, examining the sustainability of intervention effects, identifying factors and barriers underlying behavioral change in hand hygiene, and exploring handwashing patterns through hand motion data. Findings and implementation experiences from this project may also inform the development of other VR-based health promotion interventions.