ADDIE-guided development and pilot feasibility evaluation of a prototype VR training simulation for suicide prevention among rural U.S. veterans

Background Suicide risk is disproportionately higher for rural veterans who often lack access to specialty-trained health professionals equipped to deliver effective prevention interventions. Virtual reality offers a scalable training solution to address these gaps. This mixed-methods feasibility study systematically developed and evaluated a prototype virtual reality simulation for a training module in suicide risk identification and lethal means safety counseling during rural veteran home visits. Methods Thirty participants (10 nursing/social work students, 10 health professionals, and 10 rural community members) completed the veteran suicide prevention simulation using Meta Quest 2 headsets. Sense of presence (including negative effects) was assessed with the ITC-Sense of Presence Inventory; additional outcomes included representativeness, acceptability, and cue recall. Results Participants reported high engagement, with moderate spatial presence, and ecological validity, and low negative effects (e.g., nausea). Prominent lethal means cues were highly recalled (firearms: 93.3%; alcohol: 83.3%), while subtler cues (e.g., isolation) were less frequently noted. Most endorsed representational accuracy, with qualitative feedback praising authenticity and suggesting improvements in interactivity and navigation. Conclusions Findings support the preliminary feasibility and acceptability of the VET-SAVR prototype for suicide risk identification and lethal means counseling training. Refinements to navigation, cue salience, and mitigation of negative VR effects are warranted before future efficacy testing.