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.