# Identifying behaviour change techniques, technical features and implementation options for a virtual reality intervention to motivate adult smokers to quit: A focus group study with healthcare and virtual reality experts

## TL;DR

Experts in healthcare and virtual reality suggest ways to design a VR program to help adult smokers quit by using tailored content and behavior change techniques.

## Contribution

The study identifies specific behavior change techniques and implementation strategies for a VR smoking cessation intervention based on expert input.

## Key findings

- Experts suggested using behavior change techniques like 'prompt comparative imagining of future outcomes' and 'imaginary reward'.
- Customizable avatars and tailored narratives were proposed to enhance user engagement in VR smoking cessation.
- Safety and inclusivity considerations, such as seated experiences and screening for health risks, were emphasized for VR implementation.

## Abstract

In this study, individuals working in healthcare or virtual reality (VR) were invited to contribute towards developing a VR intervention to encourage adults to quit smoking, by building upon user-generated ideas from a previous co-design study with adult smokers.

Three online focus groups were with healthcare workers (n = 26), and one was with VR experts (n = 4). Transcripts were analysed using thematic analysis.

In the first theme, experts agreed that previous co-design content showing the outcomes of quitting or not quitting could be helpful. Suggested behaviour change techniques included ‘prompt comparative imagining of future outcomes’, and ‘imaginary reward’. Experts suggested a format where users could customise an avatar and select what content they see, creating a tailored narrative. There was a subtheme about the potential unsuitability of co-design content based on extreme fear appeals, which experts thought could trigger fatalism or defensiveness. The second theme covers considerations to make VR safe and inclusive. For example, making the experience seated for those with limited mobility, hygiene protocols and a screening process to exclude smokers at risk of harm (individuals with frailty, photosensitive epilepsy or a serious mental health condition). The last theme outlines the benefits and potential barriers of implementing VR with the ‘ask, advise, act’ model for smoking cessation used in healthcare contexts.

Findings suggest that VR has the potential to deliver embodied, interactive and customisable smoking cessation messages, rooted in behavioural theory. The suggestions will inform the development of a prototype which will subsequently be evaluated.