Metaverse- and VR-Supported Education in a Digital Breastfeeding Museum: Long-Term Effects on Breastfeeding Process, Self-Efficacy, and Motivation

The Long-Term Effects of Metaverse- and Virtual Reality-Supported Education Delivered to Mothers in a Digital Breastfeeding Museum on the Breastfeeding Process, Self-Efficacy, and Motivation: A Prospective Randomized Controlled Study

This randomized controlled prospective study aimed to evaluate the long-term effects of Metaverse- and virtual reality (VR)-supported education provided in a digital breastfeeding museum on the breastfeeding process, breastfeeding self-efficacy, breastfeeding motivation, and breastfeeding-related problems in primiparous mothers. While the intervention group received Metaverse- and VR-supported breastfeeding education in the digital breastfeeding museum, the control group received standard education provided in routine antenatal classes. The study population consisted of primiparous mothers who had participated in the previous randomized controlled study and voluntarily agreed to take part in this new prospective study. Participants were followed at four postpartum periods: 0-6 months, 6-12 months, 12-18 months, and 18-24 months. Data were collected using the Breastfeeding Self-Efficacy Scale-Short Form (BSES-SF), the Breastfeeding Motivation Scale, the Breastfeeding Problems Assessment Scale, and a questionnaire form (including breastfeeding duration and other parameters). Assessments were conducted at the planned follow-up intervals.

Breastfeeding is the most ideal method for ensuring infants' healthy growth and nutrition and is a public health priority due to its short- and long-term health benefits. Emerging technologies in the 21st century have added new dimensions to educational processes, and tools such as virtual reality (VR) and the Metaverse support traditional educational methods by offering multimodal learning opportunities. The literature indicates that the use of VR in breastfeeding education is limited, and no Metaverse-based studies have been reported.

This study represents a prospective follow-up of a randomized controlled trial conducted between July 2023 and April 2024 in three hospitals. In the previous study, 53 primiparous pregnant women-who were attending antenatal classes for the first time in their third trimester and had no prior breastfeeding experience-were randomly assigned to an intervention group (n=28) and a control group (n=25). In the new prospective study, 20 mothers from each group were reached, resulting in a total of 40 participants who continued to be followed in their originally assigned groups.

Participants in the intervention group received Metaverse- and VR-supported breastfeeding education in a digital breastfeeding museum consisting of multiple educational rooms. They explored the museum through personalized avatars using VR headsets, accessing educational content that included photo frames, written boards, and instructional videos. The control group continued to receive routine antenatal breastfeeding education at the participating hospitals. In the prospective follow-up, no additional postnatal interventions were applied; data were collected only on long-term outcomes at four postnatal periods: 0-6 months, 6-12 months, 12-18 months, and 18-24 months. Data collection tools included maternal and infant demographic forms, a breastfeeding knowledge questionnaire, the Breastfeeding Motivation Scale, the Breastfeeding Self-Efficacy Scale-Short Form, and the Breastfeeding Problems Assessment Scale. Participants were contacted by phone, and data were collected via online surveys.

This study is the first to prospectively evaluate the long-term effects of Metaverse- and VR-supported digital breastfeeding education on postnatal breastfeeding practices, self-efficacy, and motivation. It provides evidence on the sustained impact of technology-based educational models on breastfeeding behavior.

Inclusion Criteria:

• Having previously participated in a randomized controlled trial by providing written informed consent,
• Primiparous mothers who voluntarily agree to participate in the new study,
• Being reachable by telephone and having digital access to complete an online questionnaire,
• Being able to read and understand Turkish,
• Having sufficient cognitive ability to recall the breastfeeding process,
• The infant not having any health condition requiring prolonged hospitalization in a neonatal intensive care unit.

Exclusion Criteria:

• The presence of a serious health condition in the mother or infant that may contraindicate breastfeeding,
• Having experienced infant loss during the postpartum period,
• A diagnosis of a severe psychiatric or physiological condition in the mother during the postpartum period that may interfere with breastfeeding.