VR implementation in mental healthcare: A marathon, not a sprint - A qualitative longitudinal evaluation of a VR training program

Despite the potential of Virtual Reality (VR) in mental healthcare, its implementation in practice remains limited. One contributing factor is the lack of research into effective implementation strategies for VR. This longitudinal study examines therapists experiences with a VR training program designed as an implementation strategy for VR and explores key factors influencing VR implementation over time. This longitudinal qualitative evaluation involved eleven therapists from a Dutch mental healthcare organization. The therapists participated in a six-session VR training program and completed semi-structured interviews at three time points: pre-training, post-training, and three months after the training concluded. Data were deductively analyzed using the Capability, Opportunity, Motivation-Behavior model and Theoretical Domains Framework to capture changes in capability, motivation, and opportunity. The study showed how VR training influenced the implementation process of VR in mental healthcare. Therapists self-reported knowledge and skills improved during training, emphasizing the importance of integrating both technical and therapeutic aspects. However, despite improvements in capability, actual VR usage remained limited. Post-training barriers included workflow incompatibility, hierarchical dynamics, and lack of organizational vision and sustained support. This longitudinal study provided insights into how implementation determinants shifted over time and were influenced by training. While initial training is crucial for developing skills, training alone is insufficient for successful implementation. Organizations must foster a supportive environment, including a clear vision, adequate resources, and an ongoing supportive attitude. The findings highlight the importance of ongoing evaluation and adaptation of implementation strategies over time to ensure sustainable integration of VR into mental healthcare. Author SummaryVirtual reality (VR) offers exciting opportunities to enhance mental healthcare, for example by helping patients practice challenging situations in a safe, controlled environment. But despite its potential, VR is still not widely used in daily clinical practice. In this study, we followed therapists who took part in a VR training program, and interviewed them before, after, and three months after the training. This gave us a unique look at how their experiences and needs evolved over time. We found that the training helped therapists feel more capable and motivated to use VR. Yet, in practice, many still faced barriers--like technical challenges, lack of time, and minimal organizational support. What stood out is that these barriers often only became clear after the training, once therapists tried to apply VR in real-life settings. Our study shows that implementing new technologies is not a one-time effort, but a process that unfolds in phases. The factors that influence success shift over time, which means organizations need to keep checking in: what do therapists need now, and how can we support that? By tracking the process over time, our study helps to better understand what sustainable implementation really takes.