Virtual reality versus theoretical training in CPR among adolescents: a randomized trial with a one-year longitudinal follow-up.

Objective This study evaluated the effectiveness of a virtual reality (VR)-based cardiopulmonary resuscitation (CPR) training program compared with traditional theoretical instruction and a non-intervention control group, on improving and retaining knowledge, attitudes, and self-efficacy of secondary school students. DesignRandomized trial with three parallel groups and longitudinal follow-up at baseline (T0), immediate post-intervention (T-Immediate), one-month follow-up (T-Month), and twelve-month follow-up (T-Year). Participants: 102 secondary school students (aged 14-15 years) from the Region of Murcia, Spain were randomly assigned to three groups (n = 34 each). Intervention: Group 1: immersive VR training (interactive 360° video); Group 2: Traditional theoretical training; Group 3: control (no intervention). The primary outcome was the objective CPR knowledge. The secondary outcomes were attitude towards CPR, perceived self-efficacy, and system usability (only in the VR group), and correlations between motivational variables and knowledge.Results All groups showed changes after the intervention, but improvements were significantly greater in the two instructional groups. The VR group achieved the highest scores in knowledge, attitude, and self-efficacy immediately after the intervention (p < 0.001), and maintained more stable results at 1-month and 1-year follow-ups as compared to the theoretical group, whose initial gains declined over time. The control group did not show relevant changes in any of the variables. Additionally, the System Usability Scale (SUS) (0-100) of the VR system was rated positively (SUS = 75.3 ± 4.5), supporting its applicability in educational contexts.Conclusions Both virtual reality training and theoretical instruction were effective in improving cardiopulmonary resuscitation knowledge, attitudes, and self-efficacy among adolescents. However, virtual reality showed a greater long-term retention of effects and received high usability ratings, reinforcing its potential as an educational tool in school settings.