Exploring Care Home Workers' Views on Augmented Reality and Virtual Reality Hand Hygiene Training: A Realist Interview Study

Augmented reality (AR) and virtual reality (VR) hand hygiene training has been developed for healthcare workers, but has not yet been applied to care homes. This qualitative realist study seeks to capture care home workers' theories concerning how and in what contexts AR or VR training delivered via smartphone apps might work in promoting their hand hygiene practice. Semistructured interviews were conducted with 25 care home workers across three residential and three nursing care homes in Northern England. The interviews explored hand hygiene practices and training in care homes. Participants also provided feedback on an existing programme theory that explains how, for whom, and in which contexts AR/VR might be used to upskill health and care workers. Data were analysed on NVivo using a combined deductive and inductive approach. Participants had varying experiences with hand hygiene training, highlighting an opportunity to refresh skills. Repeated practice, interactive learning, feedback, reminding, and perceived task realism were considered important for hand hygiene and could be trigged by AR/VR. There was less support for other mechanisms including deep immersion, practice in a safe environment, visualisation of personal anatomy (hands) and mistakes, and perceived realism of the imagery and environment. Expected outcomes were effective learning, learner satisfaction, enhanced hand hygiene skills, and infection control. Three themes explained how context matters when implementing AR/VR training: learners (e.g., comfort and preference), care homes (e.g., policies, staffing, and infrastructure), and technology (e.g., cost and using a VR headset). Overall, participants theorised that AR/VR could refresh hand hygiene and trigger repeated practice, interactive learning, feedback and reminding, and task realism. Future work should test the mechanisms and technology in care homes. Hand hygiene training in care homes should consider implementation factors by offering alternative technologies, providing technical support, and working with managers to determine the most appropriate choice of technology.