Metaverse- and VR-Supported Education in a Digital Breastfeeding Museum: Long-Term Effects on Breastfeeding Process, Self-Efficacy, and Motivation

Uludag University40 enrolled

Overview

This randomized controlled prospective study aimed to evaluate the long-term effects of Metaverse- and virtual reality (VR)-supported education provided in a digital breastfeeding museum on the breastfeeding process, breastfeeding self-efficacy, breastfeeding motivation, and breastfeeding-related problems in primiparous mothers. While the intervention group received Metaverse- and VR-supported breastfeeding education in the digital breastfeeding museum, the control group received standard education provided in routine antenatal classes. The study population consisted of primiparous mothers who had participated in the previous randomized controlled study and voluntarily agreed to take part in this new prospective study. Participants were followed at four postpartum periods: 0-6 months, 6-12 months, 12-18 months, and 18-24 months. Data were collected using the Breastfeeding Self-Efficacy Scale-Short Form (BSES-SF), the Breastfeeding Motivation Scale, the Breastfeeding Problems Assessment Scale, and a questionnaire form (including breastfeeding duration and other parameters). Assessments were conducted at the planned follow-up intervals.

Breastfeeding is the most ideal method for ensuring infants' healthy growth and nutrition and is a public health priority due to its short- and long-term health benefits. Emerging technologies in the 21st century have added new dimensions to educational processes, and tools such as virtual reality (VR) and the Metaverse support traditional educational methods by offering multimodal learning opportunities. The literature indicates that the use of VR in breastfeeding education is limited, and no Metaverse-based studies have been reported. This study represents a prospective follow-up of a randomized controlled trial conducted between July 2023 and April 2024 in three hospitals. In the previous study, 53 primiparous pregnant women-who were attending antenatal classes for the first time in their third trimester and had no prior breastfeeding experience-were randomly assigned to an intervention group (n=28) and a control group (n=25). In the new prospective study, 20 mothers from each group were reached, resulting in a total of 40 participants who continued to be followed in their originally assigned groups. Participants in the intervention group received Metaverse- and VR-supported breastfeeding education in a digital breastfeeding museum consisting of multiple educational rooms. They explored the museum through personalized avatars using VR headsets, accessing educational content that included photo frames, written boards, and instructional videos. The control group continued to receive routine antenatal breastfeeding education at the participating hospitals. In the prospective follow-up, no additional postnatal interventions were applied; data were collected only on long-term outcomes at four postnatal periods: 0-6 months, 6-12 months, 12-18 months, and 18-24 months. Data collection tools included maternal and infant demographic forms, a breastfeeding knowledge questionnaire, the Breastfeeding Motivation Scale, the Breastfeeding Self-Efficacy Scale-Short Form, and the Breastfeeding Problems Assessment Scale. Participants were contacted by phone, and data were collected via online surveys. This study is the first to prospectively evaluate the long-term effects of Metaverse- and VR-supported digital breastfeeding education on postnatal breastfeeding practices, self-efficacy, and motivation. It provides evidence on the sustained impact of technology-based educational models on breastfeeding behavior.

Interventions

Training Supported by Metaverse and Virtual Reality (VR) in the Digital Breastfeeding Museum GroupOTHER

In the previous randomized controlled study, pregnant women in this group received Metaverse- and virtual reality (VR)-supported education in a digital breastfeeding museum. The sole intervention consisted of a digital breastfeeding education program delivered via virtual reality and Metaverse platforms. All content was provided exclusively through head-mounted VR devices, without the need for any pharmacological agents or invasive procedures. The environment was explored by participants using virtual reality (VR) headsets (Meta Quest 2). In the prospective follow-up study, no additional postnatal education was provided; only long-term follow-up data were collected at four postpartum periods: 0-6 months, 6-12 months, 12-18 months, and 18-24 months.

Virtual Reality Headset (Meta Quest 2)DEVICE

A head-mounted virtual reality (VR) device used to deliver immersive educational content in a digital breastfeeding museum. Participants interacted with the virtual environment using VR headsets.

Eligibility

Sex: FEMALEMin age: 18 YearsHealthy volunteers:

Medical Language ↔ Plain English

Inclusion Criteria: * Having previously participated in a randomized controlled trial by providing written informed consent, * Primiparous mothers who voluntarily agree to participate in the new study, * Being reachable by telephone and having digital access to complete an online questionnaire, * Being able to read and understand Turkish, * Having sufficient cognitive ability to recall the breastfeeding process, * The infant not having any health condition requiring prolonged hospitalization in a neonatal intensive care unit. Exclusion Criteria: * The presence of a serious health condition in the mother or infant that may contraindicate breastfeeding, * Having experienced infant loss during the postpartum period, * A diagnosis of a severe psychiatric or physiological condition in the mother during the postpartum period that may interfere with breastfeeding.

Outcomes

Primary Outcomes

Breastfeeding Motivation Scale

The Breastfeeding Motivation Scale was developed by Kestler-Peleg and colleagues in 2015. It is a 24-item, five-point Likert-type scale with five subscales. Cronbach's alpha coefficients for the subscales range from 0.56 to 0.89. The validity and reliability of the scale for the Turkish population were tested by Mızrak in 2017 among primiparous and multiparous women.The Turkish version of the Breastfeeding Motivation Scale for primiparous women consists of 23 items, five subscales, and uses a four-point Likert format. The subscales are: (1) integrated regulation, (2) intrinsic motivation - identified regulation, (3) introjected regulation - social approval, (4) introjected regulation - social pressure, and (5) external regulation - instrumental needs. The scale does not have a total score; subscale scores are evaluated individually. A higher score on a subscale indicates greater motivation in the domain represented by that subscale.

Time frame: Assessed during ongoing breastfeeding up to 24 months postpartum.

Breastfeeding Self-Efficacy Scale - Short Form (BSES-SF) Score

The Breastfeeding Self-Efficacy Scale is used to assess how confident mothers feel about their ability to breastfeed. The original scale was developed in 1999. In 2003, the scale was shortened to a 14-item version known as the Breastfeeding Self-Efficacy Scale - Short Form (BSES-SF), which is recommended for use in research and practice. The BSES-SF is a 5-point Likert-type scale, with responses ranging from 1 ("Not at all confident") to 5 ("Always confident"). The minimum possible score is 14, and the maximum is 70. Higher scores indicate higher levels of breastfeeding self-efficacy. The Turkish validity and reliability study of the scale was conducted in 2010. In this study, the Cronbach's alpha coefficient was reported as 0.86.

Time frame: 0-6 months, 6-12 months, 12-18 months, and 18-24 months postpartum

Breastfeeding Problems Assessment Scale

The Breastfeeding Problems Assessment Scale was developed by Karen Wambach in 1990. The validity and reliability of the Turkish version were established by Uyanık in 2019, with a Cronbach's alpha of 0.776. Turkish form consists only of the first section, containing 18 items across five subscales: mechanical concerns, process concerns, insufficient milk concerns, nipple concerns, and social concerns. Items are scored as follows: 1 = none, 2 = mild, 3 = moderate, 4 = severe, 5 = unbearable. Total scores range from 18 to 90, with higher scores indicating more severe breastfeeding problems. The scale has been reported as a valid tool for the Turkish population. In the present study, Cronbach's alpha was found to be 0.83.