Development and evaluation of a 3D augmented reality application for respiratory anatomy education

Respiratory anatomy presents substantial learning challenges due to its complex three-dimensional (3D) spatial organization and dynamic functional relationships. Traditional two-dimensional instructional resources, including textbooks and static images, may limit students’ spatial understanding and integration of anatomical knowledge. Augmented reality (AR) technology provides interactive and immersive visualization that may enhance spatial cognition and active learning. This study aimed to develop a respiratory anatomy application incorporating 3D visualization and augmented reality, and to evaluate its content alignment, short-term within-group knowledge-score change and learner-reported experiences in a classroom setting of health science students. A quasi-experimental pre–post study was conducted among 80 first-year physiotherapy students at Srinakharinwirot University, Thailand. The 3D AR application was developed based on defined respiratory anatomy learning objectives and incorporated interactive 3D visualization, layered anatomical structures, and real-time AR manipulation. The application content validity was evaluated using the Item–Objective Congruence (IOC) index by three experts in the content of the application. Two additional experts in the content of the satisfaction and engagement questionnaires. Thus, five experts contributed across these evaluation roles. Respiratory anatomy knowledge was assessed on a 0–10 scale using pre- and post-intervention multiple-choice tests that underwent expert review for content relevance and item–objective alignment using the IOC index. Student engagement and satisfaction were measured the 1–5 range by using structured Likert-scale questionnaires. Descriptive statistics were calculated for all variables. Differences between pre- and post-test scores were analyzed using the Wilcoxon matched-pairs signed-rank test. The application demonstrated high item–objective alignment, with IOC values ranging from 0.90 to 1.00 across the evaluated application components. Students reported high levels of engagement (4.08 ± 0.69) and satisfaction (4.14 ± 0.82). Post-test knowledge scores were higher than pre-test scores after the seven-day period of application use alongside usual learning activities ( p < 0.001). These findings describe within-group changes and learner-reported experiences in this single-group classroom evaluation. In this one-group pre-test/post-test study, students demonstrated higher respiratory anatomy knowledge scores at post-test than at baseline following a seven-day period of application use alongside usual learning activities, together with positive engagement and satisfaction ratings. These findings support further evaluation of the application as a supplementary learning resource for respiratory anatomy education; however, the observed changes cannot be attributed specifically to the application because the study did not include a control group. Controlled studies are required to determine its educational effectiveness.