I. Method

I-1. Data, procedure, stimulus, and apparatus 

The data for this study were collected from college students enrolled at a large private university in Gangwon Province, South Korea, over a 2-week period in May 2017, using the playtest method (Davis, Steury, & Pagulayan, 2005). The playtest method is a combination of traditional survey methods and a controlled laboratory environment aimed at obtaining quantitative information about users’ perception of video stimuli using survey methodology (Davis et al., 2005). In the playtest method, participants complete pre-survey questions, watch video stimuli for a given period and then answer survey questions regarding their playing or watching experience. A total of 150 students (75 female; 75 male; mean age = 21.66 years) were recruited through an on-campus job bulletin board and completed their survey. All participants obtained a small amount of compensation for their participation. Participants were informed of the general purpose of the study, and answered a pre-survey questionnaire on their demographic information (e.g. age and gender). They were then equipped with virtual reality devices, and watched a 5-minute virtual reality video promoting handwashing. Following this, participants were asked to complete a questionnaire about their virtual reality video experiences, including presence, flow, fear, attitude toward handwashing, and handwashing intention. We developed a 360-degree virtual reality video on the importance of handwashing for the prevention of infectious diseases as stimulus material for this experiment. The virtual reality handwashing promotion video content presents a first-person view of an individual (i.e. the main character of the video) engaging in a variety of ordinary daily activities without washing both hands, such as using bathrooms, driving a car, opening a door, shaking hands with other people, typing on computer keyboards, and ordering a sandwich. Bacteria and germs are portrayed using blue colored ink on the character’s hand, representing dirty hands. After the character orders the sandwich, the screen displays the following warning message, ‘Wait, please wash your hands before having the sandwich.’ After the character washes both hands with soap, the blue-stained hands become clean (i.e. from bacteria and germs) and disappears into the screen. Subsequently, the character eats the sandwich with clean hands, and the video ends. A screenshot of the virtual reality video content is shown in Figure.

The stimulus material (i.e. handwashing promotion video content) was produced with the Samsung Gear 360, a 360-degree camera for virtual reality video content. We used the Gear 360 camera to capture a 360-degree field of view with a resolution of 3840 × 1920 pixels (i.e. 4 K HD resolution). The virtual reality environment was generated using an LG smartphone, which played the virtual reality video, and VR Boss, a virtual reality head-mounted display (i.e. virtual reality interface device) that is compatible with the smartphone. The VR Boss creates a virtual reality space with a wide field of view, and allows for head-tracking by sensing the movement of users’ heads to enhance their realistic experience as participants wear the VR Boss.

II. Literature review

II-1. Elaboration likelihood model (ELM)

Specifically, the current study uses the conceptual framework of the elaboration likelihood model (ELM) to understand how people process health promotion video content in changing their attitude toward handwashing. The study applies ELM to presence and flow associated with the virtual reality environment. As the dual-process model suggests two distinct routes to attitude change, our study examines how message acceptance (i.e. the systematic and cognitive route) and fear (i.e. the heuristic and emotional route) influence participants’ attitudes toward handwashing. Thus, our findings will contribute to an understanding of the role of the dual-process model in processing health promotion messages and expanding the process model to the virtual reality environment in the area of health communication.

Further, as the theory of planned behavior suggests that attitude can influence behavioral intention (Ajzen & Fishbein, 2005), this study examines the relationship between attitude toward handwashing and handwashing intention. The findings of the study may provide an understanding of the psychological processes underlying the impact of virtual reality health promotion content on handwashing intention, with potentially significant implications for the design of virtual reality health promotion intervention.

III. Measures and Research Model 

IV. Result

After controlling age, gender, and the frequency of daily handwashing, the SEM analysis yielded that the hypothesized model had an acceptable fit to the data, χ2 (200) = 300.29 (p < .001, chi-square/degree of freedom ratio = 1.50), TLI = .91, and CFI = .92, RMSEA = .05, SRMR = .08 (Benlter, 1990; Worthington & Whittaker, 2006). Our SEM analysis also produced the results of the measurement instrument constructs (i.e. four items for presence, three items for flow, three items for message acceptance, three items for fear, three items for attitude toward handwashing, and three items for handwashing intention), showing that all factor loadings of the items were above 0.50 and confirming the convergent validity. If all factor loadings for given measurement constructs items are greater than 0.5, the convergent validity is secured (Field, 2005; Ho et al., 2017).