Enhancing home care safety: a randomized controlled trial of VR-based training for informal caregivers

Abstract

Background: Europe’s aging population and the move to home-based long-term care place growing demands on informal caregivers, who often lack formal training. This substantially increases both caregiving and medication errors and caregiver burden. Virtual reality (VR) enables experiential training but is seldom tailored to non- professional caregivers or evaluated in real-world conditions. Objective: To analyze the ability of a brief training based on VR to reduce informal caregivers’ burden and their caregiving/medication errors at home. Methods: Two-arm randomized controlled trial in three Spanish regions. Informal caregivers were randomized to structured VR training or usual materials; N = 140 (70/70) caring for people with chronic conditions. Assess ments at baseline and 3 months, aligned with the Kirkpatrick model: L1 satisfaction; L2 video-based error detection; L3 self-reported caregiving/medication errors; L4 emotional burden. The intervention delivered 18 immersive scenarios reflecting common home-care tasks. Results: Satisfaction was high in the intervention arm (≥90% positive on usefulness, relevance, and applicability). Level 2: the intervention group improved error recognition in video scenarios (mean identified errors 5.41 to 6.64; mean change + 1.23; P = 0.0001), with 46/70 (65.7%) showing improvement (χ2 =33.114; p < 0.0001). Level 3: self-reported errors decreased in the intervention group (62 to 23) but increased in controls (46 to 77); the time-by-group interaction was significant (F = 11.53; P = 0.0009). Level 4: emotional burden shifted toward lower categories at follow-up in the intervention group (χ2 = 17.73; P = 0.0014). Complementary measures showed an increase in COM-B total score from 6.38 to 7.43 (P = 0.0017), with improvements in Opportunity (P = 0.0325) and positive trends in Capability and Motivation. Conclusions: A short, structured VR training improved recognition of unsafe practices and reduced self-reported caregiving/medication errors among informal caregivers, with concurrent reductions in emotional burden. Findings support integrating immersive, user-centered training into caregiver support programs to enhance the safety and quality of home care.