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Effects of Immersive Virtual Reality Cardiopulmonary Resuscitation Training on Prospective Kindergarten Teachers' Learning Achievements, Attitudes and Self-Efficacy

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Title: Effects of Immersive Virtual Reality Cardiopulmonary Resuscitation Training on Prospective Kindergarten Teachers' Learning Achievements, Attitudes and Self-Efficacy
Language: English
Authors: Liu, Ze-Min (ORCID 0000-0001-9331-1374), Fan, Xianli, Liu, Yujiao, Ye, Xin-dong (ORCID 0000-0003-4187-0160)
Source: British Journal of Educational Technology. Nov 2022 53(6):2050-2070.
Availability: Wiley. Available from: John Wiley & Sons, Inc. 111 River Street, Hoboken, NJ 07030. Tel: 800-835-6770; e-mail: cs-journals@wiley.com; Web site: https://www.wiley.com/en-us
Peer Reviewed: Y
Page Count: 21
Publication Date: 2022
Document Type: Journal Articles
Reports - Research
Education Level: Early Childhood Education
Elementary Education
Kindergarten
Primary Education
Higher Education
Postsecondary Education
Descriptors: Kindergarten, Preservice Teachers, First Aid, Computer Simulation, Academic Achievement, Self Efficacy, Student Teacher Attitudes, Video Games, Knowledge Level
DOI: 10.1111/bjet.13237
ISSN: 0007-1013
1467-8535
Abstract: Children's unexpected cardiac arrest warrants cardiopulmonary resuscitation (CPR) by kindergarten teachers. Yet, recent research revealed trained personnel reporting poor transfer of acquired skills during real-world emergencies with conventional CPR training. Immersive virtual reality (IVR) training induces a greater sense of presence and agency than conventional CPR training and may be more effective in terms of increasing trainees' intention and initiative to perform CPR in real-world emergencies. A quasi-experiment was conducted to assess the effectiveness of the IVR-based CPR training method in terms of enhancing the intention to perform CPR. The trial enrolled 50 participants, 25 of whom examined a child patient in an IVR virtual scenario, using an AED, and performed two rounds of two-minute chest compressions. The remaining 25 participants were trained using a video with consistent content on a monitor. A generalised estimating equation analysis demonstrated that the IVR training method significantly increased prospective kindergarten teachers' self-efficacy for performing CPR, positive attitudes towards CPR, and CPR knowledge. This advantage was also maintained after the five-week follow-up. Thus, CPR teaching via IVR looks to be an excellent way to enhance the intention to perform CPR and may be of great value in improving existing CPR training systems.
Abstractor: As Provided
Entry Date: 2022
Accession Number: EJ1350631
Database: ERIC
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  Value: <anid>AN0159504378;58i01nov.22;2022Oct07.06:52;v2.2.500</anid> <title id="AN0159504378-1">Effects of immersive virtual reality cardiopulmonary resuscitation training on prospective kindergarten teachers' learning achievements, attitudes and self‐efficacy </title> <p>Children's unexpected cardiac arrest warrants cardiopulmonary resuscitation (CPR) by kindergarten teachers. Yet, recent research revealed trained personnel reporting poor transfer of acquired skills during real‐world emergencies with conventional CPR training. Immersive virtual reality (IVR) training induces a greater sense of presence and agency than conventional CPR training and may be more effective in terms of increasing trainees' intention and initiative to perform CPR in real‐world emergencies. A quasi‐experiment was conducted to assess the effectiveness of the IVR‐based CPR training method in terms of enhancing the intention to perform CPR. The trial enrolled 50 participants, 25 of whom examined a child patient in an IVR virtual scenario, using an AED, and performed two rounds of two‐minute chest compressions. The remaining 25 participants were trained using a video with consistent content on a monitor. A generalised estimating equation analysis demonstrated that the IVR training method significantly increased prospective kindergarten teachers' self‐efficacy for performing CPR, positive attitudes towards CPR, and CPR knowledge. This advantage was also maintained after the five‐week follow‐up. Thus, CPR teaching via IVR looks to be an excellent way to enhance the intention to perform CPR and may be of great value in improving existing CPR training systems. Practitioner notesWhat is already known about this topic Many trainees who have received traditional cardiopulmonary resuscitation (CPR) training hesitate to perform the skills learned in a real‐world emergency.The critical determinant of whether an individual performs a behaviour is the individual's 'intention' to perform that behaviour.Individual's self‐efficacy to perform CPR, attitudes towards CPR, and perceived social norms are three determinants that influence intention to perform CPR.Immersive media such as virtual reality may elicit more attitudinal changes and a greater sense of learner self‐efficacy than current mainstream media.What this paper adds The study's results indicated that compared to conventional technology‐supported video training, immersive virtual reality (IVR) training significantly increased participants' self‐efficacy about performing CPR, positive attitudes towards CPR and CPR knowledge.CPR training through IVR may enhance trainees' intention to perform CPR in real‐world emergencies.Implications for practice and/or policy The effectiveness of combining IVR technology into existing CPR training methods such as mixed reality training, which blends virtual environments with realistic mannequins, should be further examined in the future.IVR may be a more effective medium for enhancing the intention to perform behaviour than conventional technology. Future research could further experiment with the use of IVR as a behavioural intervention technique in education</p> <p>Keywords: cardiopulmonary resuscitation; medical education; teacher training; virtual reality</p> <hd id="AN0159504378-2">INTRODUCTION</hd> <p>Unexpected cardiac arrest in children is a severe threat to their health and safety, with over 10,000 children experiencing cardiac arrest each year in the United States alone (Topjian et al., 2016), including over 7000 out‐of‐hospital cardiac arrests (OHCA) (Benjamin et al., 2017). There is a survival rate of only 6.4% for children with non‐traumatic OHCA, and even if they survive, many patients have a poor neurological prognosis (Fuchs, 2018). Cardiopulmonary resuscitation (CPR) of high quality soon after cardiac arrest can double or triple survival rates (Chen et al., 2017; Cheng et al., 2015). However, only between 15% and 40% of children who suffer a cardiac arrest receive prompt bystander CPR (Atkins & Berger, 2012), and most children do not obtain timely CPR. Kindergartens are the best place to care for children in the absence of parents or caregivers. Teachers are often the first to administer first aid in kindergartens (Ganfure et al., 2018; Kiyohara et al., 2020), making CPR training for kindergarten teachers critical.</p> <p>However, this conventional technology‐supported approach to CPR training typically focuses on improving CPR knowledge and skills but is perhaps ineffective in terms of increasing motivation to perform CPR in emergencies (Panchal et al., 2015; Winkelman et al., 2009). For example, Swor et al. (2006) interviewed 684 first witnesses of out‐of‐hospital cardiac arrest. They discovered that 54.1% had received CPR training, but only 35% of those trained performed CPR in an emergency. The primary causes for not performing CPR were feeling panicked and believing that they could not perform CPR properly, making it difficult to predict whether trainees receiving traditional CPR training would be able to perform the skills learned in a real‐world emergency.</p> <p>Long‐standing research has established a difference between the factors that influence CPR skills and those that predict whether or not to perform CPR in an emergency (Nolan et al., 1999; Vaillancourt et al., 2013). According to the theory of planned behavior (TPB), the critical determinant of whether an individual performs a behaviour is the individual's 'intention' to perform that behaviour, also known as 'behavioural intention', which represents the strength of the individual's willingness to perform the behaviour (Panchal et al., 2015; Vaillancourt et al., 2013). When an individual possesses the necessary skills and abilities to perform an activity, changes in intentions result in changes in behaviour (Sheeran, 2002; Webb & Sheeran, 2006). Interventions that enhance kindergarten teachers' intentions to perform CPR in an emergency may increase their probability of performing CPR in an emergency.</p> <p>The concept of changing behaviour through influencing an individual's intention to perform a behaviour has been used in a variety of health behaviour interventions, including glove use by healthcare workers (Levin, 1999), exercise (Mummery et al., 2000), smoking cessation (Norman et al., 1999) and condom use (Fazekas et al., 2001). Typically, these studies affect intentions by intervening in the major determinants of intentions. Panchal et al. (2015) summarised three major determinants of an individual's intention to perform CPR (see Figure 1): perceived ability to perform the behaviour (self‐efficacy), personal attitudes towards CPR (positive or negative) and perceived social norms (what people would think if they did not perform the behaviour, ie, social pressure). According to several studies, self‐efficacy for performing CPR, attitudes towards CPR, and knowledge of CPR are the most salient elements impacting an individual's CPR performance, and are easily improved by interventions (Glanz et al., 2015; Jung & Uhm, 2015; Park & Jun, 2018). Therefore, CPR training can design interventions that address these three salient factors to enhance trainees' intentions to perform CPR and their probability of performing CPR in emergencies.</p> <p> <img src="https://imageserver.ebscohost.com/img/embimages/rdk/58I/01nov22/bjet13237-fig-0001.jpg?ephost1=dGJyMNXb4kSepq84yOvqOLCmsE6epq5Srqa4SK6WxWXS" alt="bjet13237-fig-0001.jpg" title="1 Diagrammatic representation of the study model" /> </p> <p></p> <p>Conventional CPR training is typically classified into two broad categories: formal instructor‐led classroom‐based CPR training and alternative CPR training. The latter category includes the increasingly popular video self‐training, interactive computer instruction, and so on. These conventional training methods typically place a higher premium on skills such as CPR compression quality (location, pace, depth, and release) and knowledge of CPR (Ali et al., 2021). The majority of conventional training is focused on improving CPR skills performance and knowledge, with less emphasis on establishing a realistic and immersive atmosphere. As a result, there is a significant disconnect between conventional CPR training environments and real‐world emergencies. It is difficult for trainees to have a meta‐awareness of their actual skill acquisition and to know how to perform CPR skills when needed in real‐world situations (Winkelman et al., 2009). Trainees in real‐world emergencies have inadequate self‐efficacy for performing CPR, negative attitudes regarding conducting CPR, and a lower intention to perform CPR. This results in an inability to perform CPR skills learnt, despite CPR training. Immersive virtual reality (IVR) might be the solution to this issue.</p> <p>IVR is a highly effective training medium because it creates a realistic virtual environment simulating emergency or dangerous situations that are difficult to recreate in real life (Farra et al., 2019), such as sudden cardiac arrest in children. In comparison to conventional training media (eg, video, PowerPoint), IVR has different psychological affordances, namely a high sense of presence and agency (Makransky et al., 2020). Makransky and Petersen (2021) describes presence as a sensation of 'being there' and agency as a sense of generating and controlling action.</p> <p>According to Bandura's self‐efficacy theory (Bandura, 1977), the source of information that most enhances self‐efficacy is performance accomplishments, that is, the experiences that individuals gain from their performance in a particular activity. Makransky and Lilleholt (2018) argue that the high degree of presence in VR enables learners to perceive the virtual experience as 'real', while the high degree of agency enables learners to feel in control of their behaviour, allowing them to gain mastery in the virtual course experience, experiencing the activity as performance accomplishments. When compared to traditional media, IVR training may result in a better sense of self‐efficacy for learners.</p> <p>A heightened sense of presence and agency increases the user's sense of embodiment in IVR, triggering a feeling of embodiment of the virtual body, which they view as their own, a phenomenon also known as 'illusion of virtual body ownership' (Barbot & Kaufman, 2020; Cummings & Bailenson, 2016). Embodiment has been associated with changes in attitudes, such as a significant decrease in racial bias following participants' usage of a virtual body of a different race than their own (Banakou et al., 2016). Additionally, the illusion of a strong feeling of agency leads users to self‐attribute actions of the virtual body, for example, after the virtual body performs a pro‐social behaviour, users attribute it to a voluntary execution (Bertrand et al., 2018). Thus, subjective experiences in IVR can aid in a shift in real‐world attitude (Riva et al., 2014; Tussyadiah et al., 2018). For example, studies have found that advertisements broadcast using media with a higher presence lead to more positive attitudes and liking of the advertisement and product (Keng & Lin, 2006). Immersive news presented via virtual reality elicits more attitudinal changes from viewers than simple text‐based media (Bujić et al., 2020). Therefore, participants may be more likely to have positive attitudes about certain behaviours than after training with conventional media.</p> <p>IVR has the potential to improve generative processing by facilitating user engagement through a high sense of presence and agency (Makransky et al., 2020). IVR leads to high levels of embodiment, and embodied cognition theory suggests that learning is enhanced when the physical activity and visual features of this particular concept are coordinated (Jang et al., 2017). Embodiment is particularly relevant to the development of procedural knowledge, and IVR is also most commonly used to acquire procedural knowledge (Radianti et al., 2020), particularly for procedures that are difficult to train in real life (Makransky & Petersen, 2021). Simultaneously, research indicates that implementing generative learning strategies into IVR promotes procedural knowledge acquisition and transfer (Makransky et al., 2020). CPR training in IVR enables trainees to learn and practice specific CPR operations using a controller in a cardiac arrest virtual situation, with a good match for generative learning strategies. Therefore, CPR training in IVR may have better learning achievements compared to conventional media.</p> <p>Compared to conventional training media, IVR training may be more effective in terms of enhancing trainees' self‐efficacy for performing CPR, attitudes towards CPR, and consequently increasing their intention to perform CPR in reality, while improving their learning achievements. As a result, this study used a quasi‐experimental design to compare the effectiveness of IVR‐based CPR training techniques to conventional technology‐based CPR training methods in terms of enhancing prospective kindergarten teachers' intention to perform CPR and CPR knowledge. The following research questions were posed:</p> <p></p> <ulist> <item> Do prospective kindergarten teachers who received IVR training have greater self‐efficacy for performing CPR and more positive attitudes towards CPR than those who received conventional technology‐supported training?</item> <p></p> <item> Do prospective kindergarten teachers who received IVR training have greater knowledge of CPR than those who received conventional technology‐supported training?</item> </ulist> <hd id="AN0159504378-4">LITERATURE REVIEW</hd> <p></p> <hd id="AN0159504378-5">The theory of planned behavior</hd> <p>The theory of planned behavior (TPB) is today one of the most widely utilised theories in the social and behavioural sciences (Bosnjak et al., 2020) as a means of explaining individual behaviour (Ajzen, 1991). TPB assumes that individuals' conduct is determined by their behavioural intentions, which are influenced by three factors: the individual's attitudes towards the behaviour, subjective norms, and perceived behavioural control (Ajzen, 1991). Attitudes towards a behaviour is described as a person's positive or negative feelings towards performing that behaviour. Subjective norms refer to others' perceptions of an individual's behaviour or perceived social pressure to conduct the relevant behaviour. Perceived behavioural control is described as an individual's self‐efficacy for performing that behaviour (Bosnjak et al., 2020; Cheon et al., 2012). Panchal et al. (2015) applied the TPB model to the behavioural performance of CPR, proposing to infer an individual's intention to perform CPR from three factors: self‐efficacy for performing CPR, attitudes towards CPR, and perceived norms about performing CPR. Several studies have also revealed a favourable link between CPR knowledge and intent to conduct CPR (Park & Jun, 2018), with CPR knowledge impacting behavioural performance (Barsom et al., 2020). Synthesising previous research, the model on which this study is based is illustrated in Figure 1. Kindergarten teachers generally have perceived high norms about performing CPR because of the specificity of their profession. This variable was not measured in this study. Given the susceptibility of the factors to the training intervention and the ease of measurement, this study only measured intention to perform CPR (as indicated by self‐efficacy for performing CPR and personal attitudes towards CPR) and knowledge of CPR.</p> <p>The primary dependent variable in this study was the intention to perform CPR rather than actual behaviour because the more robust an individual's intentions to perform the behaviour, the greater the likelihood of actually performing that behaviour, and the positive correlation between intentions to perform a behaviour and actual behaviour has been demonstrated in numerous studies (Cheon et al., 2012; Venkatesh et al., 2000; Willis et al., 2020). As a result of applying behavioural theory to CPR performance, this study intended to focus CPR training on the individual's intentions to perform CPR.</p> <hd id="AN0159504378-6">Virtual reality</hd> <p>Virtual reality (VR) is often considered as 'a way of simulating or replicating an environment' (Makransky & Lilleholt, 2018). VR's capacity to create realistic virtual environments that fully immerse learners, combined with its repeatability and controllability, has been successfully employed in various fields, such as education (Chang et al., 2020; Wu et al., 2020) and healthcare (Issleib et al., 2021), with good results. There is an increasing amount of evidence suggesting that VR's realistic virtual worlds can support effective experiential learning (Pottle, 2019). For example, the use of VR in surgical training has been shown to significantly improve surgical skills and overall outcomes (Bric et al., 2016). Rehabilitation training using VR for patients with Parkinson's disease has been shown to achieve not only the same results as traditional rehabilitation training but also to improve gait and balance performance (Lei et al., 2019).</p> <p>VR can be accessed via a variety of different displays (Bower & Jong, 2020), such as traditional desktop computers, head‐mounted displays (HMDs), and cave automated virtual environments (CAVEs). Typical HMDs include tracking systems that enable intuitive interaction with the environment via the tracking of the user's head and position, as well as devices such as handles (Meyer et al., 2019). IVR systems delivered via HMDs typically have better immersion, interactivity and representational fidelity (Makransky & Lilleholt, 2018); these technical factors provide users with a greater sense of presence and agency. It is also the key feature that distinguishes IVR from other immersive media such as desktop VR, video, or powerpoint sessions (Johnson‐Glenberg, 2019). The related theories suggest that as participants' sense of presence and agency in the virtual environment is enhanced, they achieve higher self‐efficacy, more positive attitudes, and better learning achievements (Johnson‐Glenberg, 2019; Makransky & Petersen, 2021). Recent reviews have also verified the overall benefit of HMD‐based immersive learning over non‐immersive learning approaches on learning performance (Wu et al., 2020). As a result, the HMD system was chosen as the medium for CPR training in this study, as it provides a superior level of immersion and interactivity, bridging the gap between reality and the training environment.</p> <hd id="AN0159504378-7">Related work</hd> <p>As technology has advanced in recent years, a growing body of research has sought to employ virtual reality to train CPR. This research has used PCs (Khanal et al., 2014; Latif et al., 2017), mobile devices (Barsom et al., 2020; Leary et al., 2019), and consumer‐grade HMDs with six degrees of freedom (6‐DOF) head tracking and motion capture (Bench et al., 2019; Semeraro et al., 2019). CPR training research in virtual reality has often evaluated the effect on knowledge (Khanal et al., 2014; Latif et al., 2017; Leary et al., 2019), skill performance (Bench et al., 2019; Semeraro et al., 2019), or self‐confidence (Liaw et al., 2020) and self‐efficacy (Bench et al., 2019). Some studies have also assessed the combined effects of multiple factors (Buttussi et al., 2020). However, few studies have attempted to combine IVR with TPB theory and use it for CPR training. We argue that there is a strong fit between IVR and TPB theory, and that the high level of immersion and interactivity in IVR contributes to the user's presence and agency, and thus the intention to perform the behaviour. This helps make up for the deficiencies of conventional CPR training.</p> <hd id="AN0159504378-8">METHODS</hd> <p></p> <hd id="AN0159504378-9">IVR system to support CPR training</hd> <p>As a training tool for CPR methods, this study used the software named 'Virtual Reality CPR (VR‐CPR)' developed by Studio Evil and Italian Resuscitation Council (Semeraro et al., 2019). Participants were trained in the Basic Life Support and Defibrillation for Children (PBLS‐D) procedure for paediatric patients in the 'school child cardiac arrest' scenario chosen for this study: assessing consciousness, checking breathing, calling for help, performing CPR, and AED (Automated External Defibrillator) use. The IVR system chosen for this study was the consumer HMD system HTC Vive, developed by HTC Corporation, via the Lighthouse tracking system, which can track motion with six degrees of freedom (6DoF), and allows users to interact naturally with the environment using the HTC Vive controllers and other accessories (Borges et al., 2018).</p> <p>The procedure of CPR training for IVR systems is broken down into three main parts.</p> <hd id="AN0159504378-10">Phase of examination</hd> <p>Following the virtual patient's cardiac arrest, the learner must secure the situation and then tap the patient's shoulder with the controller to determine whether he or she is unconscious (Figure 2a). The controller is then used to tilt back the patient's head and lift the chin to open the airway (Figure 2b). Finally, the learner closely listens to the patient's respiration for no more than 10 seconds to check whether he or she is breathing. Then CPR is initiated.</p> <p> <img src="https://imageserver.ebscohost.com/img/embimages/rdk/58I/01nov22/bjet13237-fig-0002.jpg?ephost1=dGJyMNXb4kSepq84yOvqOLCmsE6epq5Srqa4SK6WxWXS" alt="bjet13237-fig-0002.jpg" title="2 During the examination step, (a) confirm the patient's consciousness and (b) open the patient's airway." /> </p> <p></p> <hd id="AN0159504378-12">Performing CPR</hd> <p>To begin compressions, stack one controller on top of the other so that the hands are stacked and placed in the centre of the patient's chest. The IVR system gives instant feedback during compressions, as illustrated in Figure 3a, where the green field indicates the proper compression depth and range of compression frequencies, the numbers indicate the current specific compression depth and frequency.</p> <p> <img src="https://imageserver.ebscohost.com/img/embimages/rdk/58I/01nov22/bjet13237-fig-0003.jpg?ephost1=dGJyMNXb4kSepq84yOvqOLCmsE6epq5Srqa4SK6WxWXS" alt="bjet13237-fig-0003.jpg" title="3 (a) Real‐time feedback on CPR chest compressions and (b) AED use." /> </p> <p></p> <hd id="AN0159504378-14">Using the AED</hd> <p>The AED will arrive after conducting a set of CPR. After activating the AED and attaching the electrode pads (Figure 3b), the trainee ensures that no one touches the patient and instructs anyone nearby to 'stand clear'. The patient's heart rhythm is then analysed with the push of a button, and defibrillated by electric shock, followed by a 2‐minute CPR session (approximately 5 cycles). The AED is used again to analyse the heart rhythm, defibrillate by electric shock, and perform another 2‐minute CPR session.</p> <hd id="AN0159504378-15">Participants</hd> <p>Fifty prospective kindergarten teachers (48 females; Mean age = 20.14 ± 1.69 years) from Wenzhou University's preschool education department volunteered to participate, and each participant had completed a professional internship in a kindergarten. Of the 50, 25 were randomly assigned to receive the IVR training approach as part of the experimental group. The remaining 25 were trained using the conventional technology‐supported training method.</p> <hd id="AN0159504378-16">Procedure</hd> <p>The experiment was conducted as depicted in Figure 4. All participants completed a pre‐test before the trial started to ascertain baseline levels. This was followed by a quick 10‐minute teaching session by the same principal examiner in the same place on the fundamentals of CPR and the proper methods to conduct it. After that, the experimental group wore the IVR Headset and followed the hand model guidance and auditory guidance to check the child patient's condition (assessing consciousness, checking breathing) in an immersive CPR scenario, used the AED, and performed two rounds of chest compression‐only CPRs, for 2 minutes per round. We recorded a screen video of a CPR professional using the software to execute a successful CPR, which had the same scenario and application settings as the experimental group. The video group watched this typical video on a 24‐inch computer monitor (1920 × 1080 pixel, 60 Hz) to learn the procedures and key points of the three modules. Thus, both groups of participants trained for approximately the same period.</p> <p> <img src="https://imageserver.ebscohost.com/img/embimages/rdk/58I/01nov22/bjet13237-fig-0004.jpg?ephost1=dGJyMNXb4kSepq84yOvqOLCmsE6epq5Srqa4SK6WxWXS" alt="bjet13237-fig-0004.jpg" title="4 Experimental flow chart of the study" /> </p> <p></p> <p>During the chest compression practise phase, participants in the experimental group used the IVR Controller to perform compressions on the floor; participants in the video group were asked to practise compressions empty‐handed on a tabletop where the monitor was placed, following the rhythm and movements (as shown in Figure 3a) of the video.</p> <p>After the experiment, all participants completed a post‐test questionnaire and were followed up after 5 weeks using the same questionnaire as the post test. All participants completed the questionnaire three times: at baseline (T0), immediately following training (T1), and 5 weeks after training (T2).</p> <hd id="AN0159504378-18">Measuring tools</hd> <p>The Basic Resuscitation Skills Self‐Efficacy scale (BRS‐SES) was used to assess self‐efficacy for performing CPR. It was designed by Hernández‐Padilla et al. (2016) to assess self‐efficacy in reacting effectively to cardiac arrest. The questionnaire comprises 18 items and, according to Bandura's theory of self‐efficacy (Bandura, 2006), to avoid ceiling effects and produce maximised responses, it reflects participants' confidence ratings on a '0–100 response format', where 0 represents 'no confidence at all', and 100 indicates 'complete confidence'. The Cronbach's alpha coefficient for content reliability was 0.96, while S‐CVI for content validity was 0.98. Cronbach's alpha was 0.97 in this study.</p> <p>The attitudes of participants towards CPR were assessed using a questionnaire devised by Park et al. (2006). The tool consists of 11 questions, three of which are negative, on a 5‐point Likert scale. Ratings vary between 11 and 55, with higher scores indicating more positive attitudes towards CPR. Although reliability was not published during instrument development, Cronbach's alpha values of 0.86 in Kim and Lee's (2009) study, 0.77 in Song and Park's (2020) research, and 0.63 in Seol and Lee's (2020) study were reported. Cronbach's alpha was 0.769 in this study.</p> <p>Park et al. (2006) established the CPR knowledge measurement test, which Park and Jun (2018) later amended following the 2015 revised Korean CPR guidelines. The tool offers 15 multiple‐choice questions with a point value of 1 for a correct response and 0 for an erroneous response. Scores range from 0 to 15, with a higher score indicating a greater understanding of CPR. Park and Jun (2018) reported a CVI of greater than 0.80. Because this study assessed participants' knowledge of paediatric CPR, some of the adult basic life support (ABLS) knowledge items in the questionnaire were changed to paediatric basic life support (PBLS) items (eg, chest compressions to artificial respiration ratio, etc.) following the American Heart Association's CPR guidelines for 2020 (Topjian et al., 2020). A team of eight professionals in medicine, first aid, nursing, and child safety assessed the questionnaire and confirmed its validity. The questionnaire's I‐CVI scores varied from 0.87 to 1, while the S‐CVI value was 0.92.</p> <hd id="AN0159504378-19">Statistical analysis</hd> <p>The demographic features of the participants and the experiment's outcomes at each time point were summarised using descriptive statistics. The skewness statistic and normal probability plot were used to determine the normality of the data, which were reported as mean and standard deviation (SD) when normally distributed, and as the median and interquartile range (IQR) when non‐normally distributed. At three time points, before, immediately after and 5 weeks after training, all participants answered questionnaires on self‐efficacy about performing CPR, attitudes towards CPR and knowledge of CPR. The two sets of individuals' baseline demographic variables were compared using two‐tailed independent <emph>t</emph> or chi‐square tests. The three outcome variables (self‐efficacy, attitudes and knowledge scores) were compared to their baseline values using generalised estimating equation (GEE) models. The least significant difference (LSD) was used as a post‐hoc test, and differences were judged to be statistically significant when the probability was less than 5% (<emph>p</emph> < 0.05). IBM SPSS 18 was used to conduct the statistical analyses (IBM corp., Almond, NY, USA).</p> <hd id="AN0159504378-20">RESULTS</hd> <p>All data were tested for normality, and the results indicated that the knowledge questionnaire scores at time points T1 and T2 did not fulfil the normalcy assumption (<emph>p</emph> < 0.01). The self‐ratings on both the Self‐Efficacy scale and the Attitude scale were normally distributed (<emph>p</emph> > 0.05).</p> <hd id="AN0159504378-21">Participants' baseline characteristics</hd> <p>The two groups shared similar demographic features at the outset, as indicated in Table 1. There were no significant differences in gender (<emph>p</emph> = 1), educational level (<emph>p</emph> = 0.149) or CPR training experience (<emph>p</emph> = 0.112) between the two groups of participants. A significant difference in age distribution (<emph>p</emph> < 0.001) was observed. Thus, this variable was controlled for in the GEE analysis. There were no significant differences in baseline self‐efficacy for performing CPR (<emph>p</emph> = 0.856), attitudes towards CPR (<emph>p</emph> = 0.369) or knowledge of CPR (<emph>p</emph> = 0.956) between the two groups of participants (Table 2).</p> <p>1 TABLEBaseline sociodemographic characteristics of the participants</p> <p> <ephtml> <table><thead valign="bottom"><tr><th align="left">Characteristics</th><th align="left">Participants, <italic>N</italic> (%)</th><th align="left"><italic>p</italic> value</th></tr><tr><th align="left">All (<italic>N</italic> = 50)</th><th align="left">IVR group (<italic>N</italic> = 25)</th><th align="left">Video group (<italic>N</italic> = 25)</th></tr></thead><tbody valign="top"><tr><td>Age, Mean (SD)</td><td>20.14 (1.69)</td><td>21.28 (1.40)</td><td>19 (1.08)</td><td><0.001</td></tr><tr><td>Gender</td><td align="left" /><td align="left" /><td align="left" /><td /></tr><tr><td>Male</td><td>2 (4)</td><td>1 (4)</td><td>1 (4)</td><td>1</td></tr><tr><td>Female</td><td>48 (96)</td><td>24 (96)</td><td>24 (96)</td></tr><tr><td>Educational level</td><td align="left" /><td align="left" /><td /></tr><tr><td>Junior‐college</td><td>2 (4)</td><td>2 (8)</td><td>0 (0)</td><td>0.149</td></tr><tr><td>Undergraduate</td><td>48 (96)</td><td>23 (92)</td><td>25 (100)</td></tr><tr><td>CPR training experience</td><td align="left" /><td /></tr><tr><td>None</td><td>20 (40)</td><td>13 (52)</td><td>7 (28)</td><td>0.112</td></tr><tr><td>Only learned CPR knowledge</td><td>14 (28)</td><td>4 (16)</td><td>10 (40)</td></tr><tr><td>Attended CPR training</td><td>16 (32)</td><td>8 (32)</td><td>8 (32)</td></tr></tbody></table> </ephtml> </p> <p>1 Abbreviation: SD, standard deviation.</p> <p>2 TABLEDescriptive statistics of outcome variables</p> <p> <ephtml> <table><thead valign="bottom"><tr><th align="left" /><th align="left">Self‐efficacy about performing CPR</th><th align="left">Attitudes towards CPR</th><th align="left">Knowledge of CPR</th></tr><tr><th align="left">IVR group</th><th align="left">Video group</th><th align="left">IVR group</th><th align="left">Video group</th><th align="left">IVR group</th><th align="left">Video group</th></tr><tr><th align="left">Mean</th><th align="left">SD</th><th align="left">Mean</th><th align="left">SD</th><th align="left">Mean</th><th align="left">SD</th><th align="left">Mean</th><th align="left">SD</th><th align="left">Median</th><th align="left">IQR</th><th align="left">Median</th><th align="left">IQR</th></tr></thead><tbody valign="top"><tr><td>T0</td><td>48.99</td><td>(22.84)</td><td>51.64</td><td>(22.65)</td><td>44.4</td><td>(5.32)</td><td>46.76</td><td>(4.54)</td><td>10</td><td>(9, 12)</td><td>11</td><td>(10, 13)</td></tr><tr><td>T1</td><td>78.48</td><td>(12.12)</td><td>65.47</td><td>(23.29)</td><td>49.12</td><td>(4.15)</td><td>48.08</td><td>(4.23)</td><td>14</td><td>(13, 15)</td><td>14</td><td>(12.5, 14.5)</td></tr><tr><td>T2</td><td>81.36</td><td>(12.51)</td><td>63.9</td><td>(16.15)</td><td>49.28</td><td>(4.02)</td><td>46.16</td><td>(3.69)</td><td>13</td><td>(11.5, 14)</td><td>12</td><td>(10.5, 12)</td></tr></tbody></table> </ephtml> </p> <ulist> <item>2 <emph>Note</emph>: T0, Baseline; T1, Immediately after training; T2, 5 weeks after training.</item> <item>3 Abbreviations: IQR, interquartile range; SD, standard deviation.</item> </ulist> <hd id="AN0159504378-22">Self‐efficacy for performing CPR</hd> <p>After training, participants in both groups revealed a significant increase in their self‐efficacy for responding effectively to cardiac arrest; however, the magnitude of change in ratings was significantly bigger in the IVR group compared to the video group (Table 3).</p> <p>3 TABLEGeneralized estimating equation analysis for the comparison of outcomes</p> <p> <ephtml> <table><thead valign="bottom"><tr><th align="left" /><th align="left">Self‐efficacy for performing CPR</th><th align="left">Attitudes towards CPR</th><th align="left">Knowledge of CPR</th></tr><tr><th align="left"><italic>B</italic></th><th align="left">95% CI</th><th align="left"><italic>p</italic> value</th><th align="left"><italic>B</italic></th><th align="left">95% CI</th><th align="left"><italic>p</italic> value</th><th align="left"><italic>B</italic></th><th align="left">95% CI</th><th align="left"><italic>p</italic> value</th></tr></thead><tbody valign="top"><tr><td>Group effect<xref ref-type="fn" rid="tfn6" /></td><td>1.46</td><td>(−14.27, 17.18)</td><td>0.856</td><td>−1.54</td><td>(−4.89, 1.82)</td><td>0.369</td><td>−0.04</td><td>(−1.55, 1.64)</td><td>0.956</td></tr><tr><td>Time effect<xref ref-type="fn" rid="tfn7" /> (T1)</td><td>13.82</td><td>(7.03, 20.61)</td><td><0.001<xref ref-type="fn" rid="tfn11" /></td><td>1.32</td><td>(−0.41, 3.05)</td><td>0.134</td><td>2.24</td><td>(0.30, 1.66)</td><td><0.001<xref ref-type="fn" rid="tfn11" /></td></tr><tr><td>Time effect<xref ref-type="fn" rid="tfn7" /> (T2)</td><td>12.26</td><td>(4.69, 19.83)</td><td>0.002 <xref ref-type="fn" rid="tfn10" /></td><td>−0.6</td><td>(−2.96, 1.76)</td><td>0.618</td><td>−0.08</td><td>(−1.32, 1.16)</td><td>0.9</td></tr><tr><td>Group * time effect<xref ref-type="fn" rid="tfn8" /> (T1)</td><td>15.66</td><td>(5.77, 25.56)</td><td>0.002 <xref ref-type="fn" rid="tfn10" /></td><td>3.4</td><td>(1.27, 5.53)</td><td>0.002<xref ref-type="fn" rid="tfn10" /></td><td>1.08</td><td>(0.11, 2.05)</td><td>0.029 <xref ref-type="fn" rid="tfn9" /></td></tr><tr><td>Group * time effect<xref ref-type="fn" rid="tfn8" /> (T2)</td><td>20.11</td><td>(8.71, 31.51)</td><td>0.001 <xref ref-type="fn" rid="tfn10" /></td><td>5.48</td><td>(2.24, 8.72)</td><td><0.001<xref ref-type="fn" rid="tfn11" /></td><td>1.92</td><td>(0.38, 3.46)</td><td>0.015 <xref ref-type="fn" rid="tfn9" /></td></tr><tr><td>Age</td><td>−1.8</td><td>(−5.62, 2.02)</td><td>0.355</td><td>−0.36</td><td>(−1.14, 0.41)</td><td>0.361</td><td>−0.34</td><td>(−0.91, 0.42)</td><td>0.082</td></tr></tbody></table> </ephtml> </p> <ulist> <item>4 <emph>Note</emph>: T1, immediately after training; T2, 5 weeks after training.</item> <item>5 Abbreviations: B, partial regression coefficients; CI, confidence interval.</item> <item>6 a Group effect is defined as the between‐group difference between the experimental and control groups at baseline.</item> <item>7 b Time effect is defined as the magnitude of change in the control group at both the T1 and T2 time points compared to the baseline score at T0.</item> <item>8 c Group * time effect defined as the group difference between the experimental and control groups in the magnitude of change in scores at T1 and T2 time points periods relative to the baseline at T0.</item> <item>9 * <emph>p <</emph> 0.05</item> <item>10 ** <emph>p</emph> < 0.01</item> <item>11 *** <emph>p</emph> < 0.001.</item> </ulist> <p>Specifically, an average increase of 13.82 points was observed relative to baseline at the T1 time point (T1: <emph>B</emph> = 13.82, <emph>p</emph> < 0.001); similarly an average increase of 12.26 points was observed relative to baseline at the T2 time point (T2: <emph>B</emph> = 12.26, <emph>p</emph> = 0.002); both were statistically significant.</p> <p>Significantly greater enhancement in self‐efficacy was observed in the IVR group compared to the video group. The IVR group's mean change ratings from baseline to T1 were on average 15.66 points higher than the video group's mean change ratings from baseline to T1 (T1: <emph>B</emph> = 15.66, <emph>p</emph> = 0.002). The IVR group's mean change ratings from baseline to T2 were on average 20.11 points higher than the video group's mean change ratings from baseline to T2 (T2: <emph>B</emph> = 20.11, <emph>p</emph> = 0.001).</p> <hd id="AN0159504378-23">Attitudes towards CPR</hd> <p>There were significant between‐group differences in the magnitude of changes in attitudes ratings after training, with the IVR group revealing significantly greater enhancement than the video group (Table 3). Specifically, the IVR group's attitudes ratings increased significantly after training, but the video group revealed no significant change in attitudes ratings following conventional technology instruction (Table 4). The mean change ratings for the IVR group from baseline to T1 and T2 were both greater than the mean change ratings for the video group from baseline to T1 and T2 (T1: <emph>B</emph> = 3.4, <emph>p</emph> = 0.002; T2: <emph>B</emph> = 5.48, <emph>p</emph> < 0.001).</p> <p>4 TABLEResults of within‐group pairwise comparisons at three time points</p> <p> <ephtml> <table><thead valign="bottom"><tr><th align="left" /><th align="left">Groups (<italic>N</italic> = 25)</th><th align="left">Paired differences</th></tr><tr><th align="left">Adjusted mean difference (SE)</th><th align="left">95% CI</th><th align="left"><italic>p</italic> value</th></tr></thead><tbody valign="top"><tr><td>Self‐efficacy for performing CPR</td><td align="left" /><td align="left" /></tr><tr><td>T0 → T1</td><td>IVR group</td><td>29.49 (3.67)</td><td>(22.29, 36.69)</td><td>0.000<xref ref-type="fn" rid="tfn15" /></td></tr><tr><td>Video group</td><td>13.82 (3.46)</td><td>(7.03, 20.61)</td><td>0.001<xref ref-type="fn" rid="tfn15" /></td></tr><tr><td>T1 → T2</td><td>IVR group</td><td>2.89 (2.63)</td><td>(−2.27, 8.05)</td><td>0.273</td></tr><tr><td>Video group</td><td>−1.56 (3.22)</td><td>(−7.87, 4.74)</td><td>0.627</td></tr><tr><td>T0 → T2</td><td>IVR group</td><td>32.37 (4.34)</td><td>(23.85, 40.90)</td><td>0.000<xref ref-type="fn" rid="tfn15" /></td></tr><tr><td>Video group</td><td>12.26 (3.86)</td><td>(4.69, 19.83)</td><td>0.002<xref ref-type="fn" rid="tfn14" /></td></tr><tr><td>Attitudes towards CPR</td><td align="left" /><td align="left" /></tr><tr><td>T0 → T1</td><td>IVR group</td><td>4.72 (0.63)</td><td>(3.48, 5.96)</td><td>0.000<xref ref-type="fn" rid="tfn15" /></td></tr><tr><td>Video group</td><td>1.32 (0.88)</td><td>(−0.41, 3.05)</td><td>0.134</td></tr><tr><td>T1 → T2</td><td>IVR group</td><td>0.16 (1.06)</td><td>(−1.91, 2.23)</td><td>0.880</td></tr><tr><td>Video group</td><td>−1.92 (1.21)</td><td>(−4.29, 0.45)</td><td>0.112</td></tr><tr><td>T0 → T2</td><td>IVR group</td><td>4.88 (1.13)</td><td>(2.66, 7.10)</td><td>0.000<xref ref-type="fn" rid="tfn15" /></td></tr><tr><td>Video group</td><td>−0.60 (1.20)</td><td>(−2.96, 1.76)</td><td>0.618</td></tr><tr><td>Knowledge of CPR</td><td align="left" /><td align="left" /><td align="left" /></tr><tr><td>T0 → T1</td><td>IVR group</td><td>3.32 (0.39)</td><td>(2.55, 409)</td><td>0.000<xref ref-type="fn" rid="tfn15" /></td></tr><tr><td>Video group</td><td>2.24 (0.30)</td><td>(1.66, 2.82)</td><td>0.000<xref ref-type="fn" rid="tfn15" /></td></tr><tr><td>T1 → T2</td><td>IVR group</td><td>−1.48 (0.44)</td><td>(−2.34, −0.62)</td><td>0.001<xref ref-type="fn" rid="tfn15" /></td></tr><tr><td>Video group</td><td>−2.32 (0.52)</td><td>(−3.35, 1.29)</td><td>0.000<xref ref-type="fn" rid="tfn15" /></td></tr><tr><td>T0 → T2</td><td>IVR group</td><td>1.84 (0.47)</td><td>(0.93, 2.75)</td><td>0.000<xref ref-type="fn" rid="tfn15" /></td></tr><tr><td>Video group</td><td>−0.08 (0.63)</td><td>(−1.32, 1.16)</td><td>0.900</td></tr></tbody></table> </ephtml> </p> <ulist> <item>12 <emph>Note</emph>: T0, Baseline; T1, Immediately after training; T2, 5 weeks after training.</item> <item>13 Abbreviations: CI, confidence interval; SE, standard error.</item> <item>14 ** <emph>p</emph> < 0.01</item> <item>15 *** <emph>p</emph> < 0.001.</item> </ulist> <hd id="AN0159504378-24">Knowledge of CPR</hd> <p>There were significant between‐group differences in the magnitude of changes in knowledge scores after training, with the IVR group showing significantly greater enhancement than the video group (Table 3). Specifically, both groups revealed a significant increase in knowledge scores in the immediate post‐training test, followed by a significant reduction five weeks after training. At the T2 time point, the video group had returned to baseline knowledge levels; however, the IVR group still revealed a significant increase over baseline levels (Table 4). At both the T1 and T2 periods, the magnitude of change in scores relative to baseline was significantly greater in the IVR group than in the video group (T1: <emph>B</emph> = 1.08, <emph>p</emph> = 0.029; T2: <emph>B</emph> = 1.92, <emph>p</emph> = 0.015). (Figure 5)</p> <p> <img src="https://imageserver.ebscohost.com/img/embimages/rdk/58I/01nov22/bjet13237-fig-0005.jpg?ephost1=dGJyMNXb4kSepq84yOvqOLCmsE6epq5Srqa4SK6WxWXS" alt="bjet13237-fig-0005.jpg" title="5 Changes in outcome variables over time for the experimental and control groups." /> </p> <p></p> <hd id="AN0159504378-26">CONCLUSION AND DISCUSSION</hd> <p></p> <hd id="AN0159504378-27">Conclusion 1: Prospective kindergarten teachers who received IVR training demonstrated consid...</hd> <p>The study's results indicated that prospective kindergarten teachers who received IVR training had significantly higher self‐efficacy for performing CPR and more positive attitudes towards CPR than those who received conventional technology‐supported training. Five weeks after the training, the IVR group showed no significant decrease, but maintained a considerable edge over the video group regarding self‐efficacy ratings and attitude scores. This reflects that the IVR‐based training significantly increased prospective kindergarten teachers' intention to perform CPR compared to conventional technology‐supported CPR training.</p> <p>The research confirms the benefits of IVR over traditional media in terms of increasing self‐efficacy, corroborated by prior empirical findings (Klingenberg et al., 2020; Makransky et al., 2019; Petersen et al., 2020). Additionally, the results suggest that IVR training can result in positive attitude changes in learners, as evidenced by empirical evidence from multiple research domains (Riva et al., 2014; Tussyadiah et al., 2018). In comparison, learners' attitudes towards CPR for conventional technology‐supported training did not change significantly at either time point, which may be attributed to IVR's greater presence and agency than conventional media. This confirms that a higher sense of realism in the media experience can facilitate attitude change (Schuemie et al., 2001; Tussyadiah et al., 2018).</p> <p>Thus, the current study found that IVR may be a more effective medium than conventional technology in terms of enhancing individuals' intentions to perform behaviours.</p> <hd id="AN0159504378-28">Conclusion 2: Prospective kindergarten teachers who have received IVR training have significa...</hd> <p>The study's findings indicated that both immediately after training and five weeks later, the experimental group receiving IVR training had higher CPR knowledge scores than the control group receiving conventional technology‐supported training. However, IVR's advantage was significantly less than its advantage in terms of self‐efficacy for performing CPR and attitudes towards CPR.</p> <p>The data confirm that IVR has a beneficial effect on the growth of CPR knowledge (Barsom et al., 2020). Additionally, IVR training results in greater knowledge retention as compared to conventional technology‐based training (Buttussi & Chittaro, 2018). This could be because VR‐CPR creates immersive virtual environments with a high level of presence and agency, which encourages learners to cognitively process learning material more deeply and to construct CPR knowledge through interaction with people, things, and events in the virtual world. This is consistent with a contextual approach to learning (Huang et al., 2010).</p> <p>Thus, the study confirms that IVR‐based CPR training is an effective knowledge learning method that is at least as effective as conventional technology‐supported learning methods for acquiring and retaining CPR knowledge.</p> <hd id="AN0159504378-29">Practical considerations</hd> <p>While IVR systems deliver great training results through highly immersive virtual environments, many still question the cost‐effectiveness of VR training due to its comparatively high cost in comparison to traditional video‐based or web‐based training. First, as demonstrated in this study, VR has significantly better training outcomes, in terms of CPR training alone, and provides benefits that conventional technology‐supported training cannot achieve in terms of enhancing the intent to perform CPR. Secondly, VR training is not less cost‐effective than complex live exercise training. As a result of Farra et al.'s (2019) quantitative analysis, the cost of VR comes primarily from the upfront development and initial investment, after which the cost of each additional training is only the time employees spend attending the training, with the initial cost spread over a larger number of participants. In comparison to live exercise training, VR enables the instruction of a greater number of personnel at a lower cost, and potentially faster and more frequently. Additionally, VR training is more acceptable and pleasant for trainees, as Pedram et al. (2021) discovered that trainees perceived the benefits of VR training's social subsystem to greatly outweigh the costs. Trainees viewed VR training as a success and also recommended it to their colleagues.</p> <p>This study confirms that IVR is highly beneficial for increasing an individual's intention to perform CPR, and is no weaker than conventional technology‐supported learning methods in terms of knowledge acquisition and retention, suggesting that IVR‐based CPR training may be effective for improving trainees' CPR performance in the real world. Although developing an IVR‐based CPR training system is expensive upfront, marginal costs fall as the number and frequency of training sessions grow (Diminishing Marginal Costs), and repeat training is more convenient than with conventional technology. In summary, we recommend considering the value of IVR for CPR training and for further improving existing CPR training systems.</p> <hd id="AN0159504378-30">LIMITATIONS AND FUTURE RESEARCH</hd> <p>This study had a randomised controlled design and adjusted for the variables of gender and education level, but the participants were still predominantly female and the sample size was small due to the limitations of the preschool education profession. Also, due to the specificity of the teacher population, this study excluded an intervention for perceived norms about performing CPR. Therefore, the findings may not fully extend to a larger sample or other professional groups. Additionally, while there was no significant difference between the IVR and video groups at the baseline time point, the IVR group scored lower on all three outcome variables than the video group, which may indicate that the IVR group had more room for growth. We therefore suggest that future studies will be necessary to repeat the experiment with larger and more diverse groups.</p> <hd id="AN0159504378-31">ACKNOWLEDGEMENTS</hd> <p>This research is supported by the Chinese National Social Science Fund of China (BCA190089) and the Graduate Scientific Research Foundation of Wenzhou University (316202001007). The authors express their gratitude to Zhengzheng Wang and Congcong Yang for assisting them with the execution of the experiments.</p> <hd id="AN0159504378-32">CONFLICT OF INTEREST</hd> <p>There is no potential conflict of interest in this study.</p> <hd id="AN0159504378-33">DATA AVAILABILITY STATEMENT</hd> <p>The data that support the findings of this study are available in the supplementary material of this article.</p> <hd id="AN0159504378-34">ETHICS STATEMENT</hd> <p>The participants were protected by hiding their personal information during the research process. 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(2020). Effectiveness of immersive virtual reality using head‐mounted displays on learning performance: A meta‐analysis. British Journal of Educational Technology, 51 (6), 1991 – 2005. https://doi.org/10.1111/bjet.13023</bibtext> </blist> </ref> <aug> <p>By Ze‐Min Liu; Xianli Fan; Yujiao Liu and Xin‐dong Ye</p> <p>Reported by Author; Author; Author; Author</p> </aug>
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  Label: Education Level
  Group: Audnce
  Data: <searchLink fieldCode="EL" term="%22Early+Childhood+Education%22">Early Childhood Education</searchLink><br /><searchLink fieldCode="EL" term="%22Elementary+Education%22">Elementary Education</searchLink><br /><searchLink fieldCode="EL" term="%22Kindergarten%22">Kindergarten</searchLink><br /><searchLink fieldCode="EL" term="%22Primary+Education%22">Primary Education</searchLink><br /><searchLink fieldCode="EL" term="%22Higher+Education%22">Higher Education</searchLink><br /><searchLink fieldCode="EL" term="%22Postsecondary+Education%22">Postsecondary Education</searchLink>
– Name: Subject
  Label: Descriptors
  Group: Su
  Data: <searchLink fieldCode="DE" term="%22Kindergarten%22">Kindergarten</searchLink><br /><searchLink fieldCode="DE" term="%22Preservice+Teachers%22">Preservice Teachers</searchLink><br /><searchLink fieldCode="DE" term="%22First+Aid%22">First Aid</searchLink><br /><searchLink fieldCode="DE" term="%22Computer+Simulation%22">Computer Simulation</searchLink><br /><searchLink fieldCode="DE" term="%22Academic+Achievement%22">Academic Achievement</searchLink><br /><searchLink fieldCode="DE" term="%22Self+Efficacy%22">Self Efficacy</searchLink><br /><searchLink fieldCode="DE" term="%22Student+Teacher+Attitudes%22">Student Teacher Attitudes</searchLink><br /><searchLink fieldCode="DE" term="%22Video+Games%22">Video Games</searchLink><br /><searchLink fieldCode="DE" term="%22Knowledge+Level%22">Knowledge Level</searchLink>
– Name: DOI
  Label: DOI
  Group: ID
  Data: 10.1111/bjet.13237
– Name: ISSN
  Label: ISSN
  Group: ISSN
  Data: 0007-1013<br />1467-8535
– Name: Abstract
  Label: Abstract
  Group: Ab
  Data: Children's unexpected cardiac arrest warrants cardiopulmonary resuscitation (CPR) by kindergarten teachers. Yet, recent research revealed trained personnel reporting poor transfer of acquired skills during real-world emergencies with conventional CPR training. Immersive virtual reality (IVR) training induces a greater sense of presence and agency than conventional CPR training and may be more effective in terms of increasing trainees' intention and initiative to perform CPR in real-world emergencies. A quasi-experiment was conducted to assess the effectiveness of the IVR-based CPR training method in terms of enhancing the intention to perform CPR. The trial enrolled 50 participants, 25 of whom examined a child patient in an IVR virtual scenario, using an AED, and performed two rounds of two-minute chest compressions. The remaining 25 participants were trained using a video with consistent content on a monitor. A generalised estimating equation analysis demonstrated that the IVR training method significantly increased prospective kindergarten teachers' self-efficacy for performing CPR, positive attitudes towards CPR, and CPR knowledge. This advantage was also maintained after the five-week follow-up. Thus, CPR teaching via IVR looks to be an excellent way to enhance the intention to perform CPR and may be of great value in improving existing CPR training systems.
– Name: AbstractInfo
  Label: Abstractor
  Group: Ab
  Data: As Provided
– Name: DateEntry
  Label: Entry Date
  Group: Date
  Data: 2022
– Name: AN
  Label: Accession Number
  Group: ID
  Data: EJ1350631
PLink https://search.ebscohost.com/login.aspx?direct=true&site=eds-live&db=eric&AN=EJ1350631
RecordInfo BibRecord:
  BibEntity:
    Identifiers:
      – Type: doi
        Value: 10.1111/bjet.13237
    Languages:
      – Text: English
    PhysicalDescription:
      Pagination:
        PageCount: 21
        StartPage: 2050
    Subjects:
      – SubjectFull: Kindergarten
        Type: general
      – SubjectFull: Preservice Teachers
        Type: general
      – SubjectFull: First Aid
        Type: general
      – SubjectFull: Computer Simulation
        Type: general
      – SubjectFull: Academic Achievement
        Type: general
      – SubjectFull: Self Efficacy
        Type: general
      – SubjectFull: Student Teacher Attitudes
        Type: general
      – SubjectFull: Video Games
        Type: general
      – SubjectFull: Knowledge Level
        Type: general
    Titles:
      – TitleFull: Effects of Immersive Virtual Reality Cardiopulmonary Resuscitation Training on Prospective Kindergarten Teachers' Learning Achievements, Attitudes and Self-Efficacy
        Type: main
  BibRelationships:
    HasContributorRelationships:
      – PersonEntity:
          Name:
            NameFull: Liu, Ze-Min
      – PersonEntity:
          Name:
            NameFull: Fan, Xianli
      – PersonEntity:
          Name:
            NameFull: Liu, Yujiao
      – PersonEntity:
          Name:
            NameFull: Ye, Xin-dong
    IsPartOfRelationships:
      – BibEntity:
          Dates:
            – D: 01
              M: 11
              Type: published
              Y: 2022
          Identifiers:
            – Type: issn-print
              Value: 0007-1013
            – Type: issn-electronic
              Value: 1467-8535
          Numbering:
            – Type: volume
              Value: 53
            – Type: issue
              Value: 6
          Titles:
            – TitleFull: British Journal of Educational Technology
              Type: main
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