Experiences and user perceptions of virtual-reality-based mindfulness interventions: protocol for a systematic review and thematic synthesis

Abstract

Introduction

Virtual reality (VR) technology is increasingly being explored as a medium for delivering mindfulness-based interventions. While studies have investigated the feasibility and efficacy of VR-based mindfulness interventions, there has been limited synthesis of user experiences and perceptions across diverse applications, hindering the iterative refinement of these technologies and limiting evidence-based guidance for effective deployment in real-world settings. This systematic review aims to comprehensively identify, appraise and synthesise qualitative research on end-user experiences and perceptions of VR-based mindfulness interventions. Understanding user experiences is critical for translating research findings into practical design improvements and implementation strategies that enhance intervention effectiveness and user adoption.

Methods and analysis

A systematic search will be conducted in PubMed, Web of Science, Embase, CINAHL, MEDLINE, The Cochrane Library, PsycINFO and Scopus from inception to present. Studies reporting qualitative data on adult participants’ experiences, perceptions, attitudes or opinions related to VR-based mindfulness interventions will be included. Two independent reviewers will screen studies, extract data and assess methodological quality using the Critical Appraisal Skills Programme checklist. Thematic synthesis will be used to analyse the qualitative data. The Grading of Recommendations Assessment, Development and Evaluation-Confidence in the Evidence from Reviews of Qualitative Research approach will be applied to assess confidence in the review findings.

Ethics and dissemination

Ethical approval is not required as this review will be based on published studies. The findings will be disseminated through peer-reviewed publication and conference presentations.

PROSPERO registration number

CRD42024594330.

STRENGTHS AND LIMITATIONS OF THIS STUDY.

• Comprehensive search across eight databases from inception to present with no language restrictions ensures broad capture of relevant qualitative evidence.

• The broad inclusion criteria will enable a holistic understanding beyond controlled clinical settings, capturing insights from emerging applications and preliminary user testing while including studies in any language to enhance global representativeness and reduce language bias in the review.

• Rigorous methodology including comprehensive searches, independent study selection and data extraction, critical quality appraisal and transparent reporting enhances the credibility of findings.

• The thematic synthesis approach allows identification of patterns across heterogeneous studies while staying grounded in participants’ own perspectives.

• Limitations include potential overrepresentation of small pilot studies in non-clinical samples and inability to directly assess intervention effectiveness.

Introduction and background

Mindfulness interventions

Mindfulness, commonly defined as the practice of purposefully directing attention to the present moment with an attitude of openness, curiosity and non-judgement,¹ has gained widespread recognition for its potential to enhance mental health and well-being. A substantial body of research indicates that cultivating mindfulness through regular practice can help reduce stress, anxiety, rumination and reactivity, while improving emotion regulation, cognitive functioning and overall quality of life.2,4

The core techniques and principles of mindfulness trace back to ancient contemplative traditions but have been adapted and secularised into structured interventions such as mindfulness-based stress reduction (MBSR)⁵ and mindfulness-based cognitive therapy (MBCT).⁶ These typically involve weekly group sessions where participants learn anpractisece various mindfulness meditation exercises (eg, breath awareness, body scans, mindful movement) along with psychoeducation about stress, cognition and how to integrate mindfulness into daily life.⁷ Extensive clinical research supports the efficacy of MBSR, MBCT and similar mindfulness-based interventions for a range of clinical and non-clinical populations.8,10

In recent years, the growing popularity of digital mindfulness interventions, including web-based programmes and smartphone applications, has emerged as a response to barriers in accessing traditional face-to-face mindfulness training, such as geographical limitations, scheduling constraints and cost considerations.^{11 12} While these digital platforms enable more flexible self-guided training and have shown promising results in preliminary studies,^{13 14} they face significant challenges in sustaining user motivation and adherence, ensuring quality of practice without direct instructor feedback and maintaining immersive focus in environments prone to external distractions.^{15 16} These limitations have created an opportunity for exploring alternative delivery methods that can better address engagement and immersion challenges. Virtual reality (VR) presents a novel and promising medium for addressing some of these limitations in delivering effective self-guided mindfulness training. VR’s ability to minimise external distractions through immersive sensory engagement and foster a strong sense of ‘presence’ directly addresses the adherence and immersion challenges commonly observed with traditional app-based mindfulness interventions.

VR applications for mindfulness

VR refers to interactive computer-generated environments that immerse users in realistic multisensory experiences through specialised equipment like head-mounted displays (HMDs).¹⁷ By providing rich visual and auditory stimuli that engage attention and block out external distractions, VR enables a strong sense of ‘presence’—the subjective feeling of being situated in the virtual environment.^{18 19} A growing body of research has capitalised on these unique attributes of VR to explore its potential for delivering more engaging and effective mindfulness training.

Several early studies demonstrated the technical feasibility of immersive VR applications for guiding beginners through common mindfulness practices. In one of the first examples, Gromala et al²⁰ developed a VR meditation chamber using an HMD and trackers that allowed users to interact with soothing nature scenes through breathing and posture. Evaluation in a small sample provided preliminary evidence of relaxation effects based on physiological and self-reported measures. Subsequent systems like DEEP, an underwater VR world controlled by diaphragmatic breathing,²¹ further illustrated the potential for innovative VR designs. More recent applications have explored the use of biofeedback in VR-based mindfulness interventions, such as incorporating real-time heart rate variability data to provide users with personalised guidance and support.²⁰ Other studies have investigated the potential benefits of social presence in VR mindfulness applications, suggesting that virtual co-meditation with a teacher or peer could enhance engagement and motivation.²²

Building on this groundwork, more recent applications have started evaluating effectiveness and acceptability in clinical and general population samples. Navarro–Haro et al²³ tested a VR mindfulness intervention in patients with generalised anxiety disorder, reporting significant reductions in anxiety and perceived stress comparable to a therapist-led mindfulness training control group. Seabrook et al²⁴ found a brief VR mindfulness intervention reduced experimentally induced negative affect in healthy participants more effectively than audio-only training and control conditions. Other preliminary studies have shown positive outcomes in healthy employees,²⁵ cancer patients²⁶ and healthcare providers.²⁷

While still an emerging area, several key advantages of VR-based mindfulness interventions have been proposed.28,30 The relatively nascent stage of VR mindfulness research, compared with more established mindfulness delivery methods such as traditional group-based programmes or mobile applications, underscores the critical need for comprehensive evidence synthesis to guide future development and implementation efforts.

Immersive visuals and sound can induce relaxation while blocking external stimuli that would normally distract novice meditators. The controlled virtual environment provides an optimal setting for sustained attention practice, free from the unpredictable interruptions of real-world settings. Guiding focus to virtual objects and events may support clearer understanding of abstract mindfulness concepts than verbal explanations alone. Embodied interaction and feedback (eg, using breathing or brain signals) can facilitate moment-to-moment awareness. Real-time adaptations based on performance could personalise training. Virtual teachers and social connections might enhance motivation and accountability.

However, the current evidence base for VR mindfulness remains limited and heterogeneous. Systematic reviews to date^{31 32} have focused on evaluating feasibility and effectiveness but have not comprehensively examined end-user experiences and perceptions of these novel applications across studies. Such evidence is crucial for informing ongoing research and development aimed at creating engaging, acceptable and well-targeted VR-based mindfulness interventions.

Qualitative user feedback provides specific, actionable insights for design optimisation, including preferred virtual environments, optimal session duration, interface design features and implementation contexts that maximise engagement. While individual experiences are subjective, systematic synthesis across multiple studies can identify consistent patterns and themes that directly inform evidence-based design decisions. For example, recurring user preferences for specific visual environments, feedback on optimal intervention timing or consistent barriers to engagement can guide concrete modifications to VR applications, training protocols and deployment strategies.

Rationale and objectives

To advance understanding and harnessing of the potential of VR as a medium for teaching mindfulness, it is important to synthesise available qualitative evidence on how these emerging applications are perceived and experienced by end-users. Qualitative research provides valuable in-depth insights into participants’ first-hand encounters, capturing both positive and negative aspects, contextual factors and unintended effects that can guide iterative refinement.³³ Synthesising patterns across the personal accounts of those who have used VR mindfulness applications can highlight key drivers of engagement, acceptability and benefit, as well as potential barriers, limitations and areas for improvement.^{34 35} Comparing such perspectives between different populations and contexts of use can also clarify the scope of effectiveness and accessibility.

Accordingly, the primary aim of this planned systematic review is to comprehensively identify, appraise and synthesise published qualitative research on end-user experiences and perceptions of VR-based mindfulness interventions.

Specific objectives are:

To synthesise available qualitative evidence on how VR-based mindfulness interventions are perceived and experienced by end-users across diverse applications and contexts.

To identify and characterise key factors that appear to influence user engagement, acceptability and effectiveness.

To compare user experiences and perceptions between different populations (eg, clinical vs non-clinical) and contexts of use (eg, lab vs field).

To highlight implications, recommendations and directions for future research and development of user-centred VR-based mindfulness interventions.

While some individual studies have reported select qualitative feedback, to our knowledge, this will be the first systematic review to comprehensively synthesise and appraise user perceptions and experiences across the range of VR mindfulness applications implemented and evaluated to date. The review is intended to complement prior systematic reviews focused on quantitative outcomes of efficacy.

By capturing the personal experiences of diverse end-users beyond numeric ratings, this review aims to provide a richer understanding of how VR mindfulness applications are actually encountered ‘in the wild’ when deployed with target populations. Such granular qualitative feedback is invaluable for identifying both strengths to build on and limitations to address through human-centred design.

In line with the growing emphasis on stakeholder involvement throughout the development and dissemination of novel health interventions,³⁶ synthesising user perspectives can help ensure that VR mindfulness applications are optimised for the preferences and needs of intended populations before investing in large-scale trials and implementation. The results will directly inform the work of researchers, clinicians, software developers and other stakeholders working to harness VR technology for more engaging, accessible and effective mindfulness interventions.

Methods

Systematic review design

The planned systematic review will follow best practice guidelines for synthesising qualitative research and will be reported in accordance with the Enhancing Transparency in Reporting the Synthesis of Qualitative Research statement.³⁷ The protocol has been registered in the International Prospective Register of Systematic Reviews under the registration number CRD42024594330.

Search strategy

A comprehensive search strategy will be employed to identify all potentially relevant qualitative studies on end-user experiences and perceptions of VR-based mindfulness interventions.

We will search the following electronic databases from inception to present: PubMed, Web of Science, Embase, CINAHL, MEDLINE, The Cochrane Library, PsycINFO and Scopus. These databases were selected to ensure comprehensive coverage across multiple disciplines relevant to VR mindfulness research. PubMed, MEDLINE and Embase provide extensive coverage of medical and health science literature. PsycINFO covers psychological and behavioural sciences. CINAHL targets nursing and allied health literature. Web of Science and Scopus offer broad multidisciplinary coverage including engineering and computer science literature relevant to VR technology development. The Cochrane Library ensures capture of high-quality systematic reviews and controlled trials.

The search strategy will combine terms related to three key concepts: (1) VR, (2) mindfulness and (3) qualitative research. Subject headings (eg, MeSH terms) will be used where available, along with text word searches of titles and abstracts. The Boolean operators ‘AND’ and ‘OR’ will be used to combine terms within and between concepts, respectively. Table 1 shows the planned search terms. The detailed search string is provided in Appendix A. The search terms were developed through an iterative process involving preliminary scoping searches, consultation with information specialists and review of key papers in the field. Boolean logic will be carefully applied, with ‘OR’ operators combining synonymous terms within each concept area and ‘AND’ operators linking the three main concept areas.

Table 1. Planned search terms.

Concept	Search terms
Virtual Reality	“virtual reality”, VR, “head mounted display*“, HMD, “computer simulation”
Mindfulness	mindful*, meditat*, MBSR, MBCT, “mindfulness training”, “mindfulness based”
Qualitative	qualitative, interview*, “focus group*“, “user experience”, “user perspective*“, “user accept*“, “user opinion*”

The searches will be conducted by two independent reviewers (RS, AB) who will compare results to ensure consistency. Differences in the search results will be resolved through consensus or arbitration by a third reviewer (AY).

No language restrictions will be applied to the database searches. For studies published in languages other than English, titles and abstracts will be translated using professional translation services or bilingual team members where available. Full-text articles in non-English languages that meet inclusion criteria will be professionally translated for data extraction and quality assessment. 

To supplement the database searches, we will manually search the reference lists of included studies and relevant reviews. Additionally, we will search the grey literature including conference proceedings (eg, International Conference on Human–Computer Interaction, International Conference on Virtual, Augmented and Mixed Reality), dissertations and theses, and reports from relevant organisations and stakeholders.

Finally, we will conduct a web search using Google Scholar and scan the first 100 results for any additional studies not captured by the database and manual searches.

Study eligibility criteria

Inclusion and exclusion criteria for the review are defined according to the SPICE framework which covers the Setting, Perspective, Intervention/phenomenon of interest, Comparison and Evaluation.³⁸

Inclusion criteria:

Setting: Any (eg, lab, field, clinical, non-clinical).

Perspective: adult participants (aged 18+) from any population who have used a VR-based mindfulness intervention.

Intervention/phenomenon of interest: any VR application designed to deliver mindfulness training or practice (eg, meditation, body scan, mindful movement). For the purposes of this review, VR applications designed to deliver mindfulness training include guided meditation experiences in virtual environments (eg, virtual nature settings with audio instructions), interactive mindfulness practices using biofeedback (eg, breathing-controlled virtual experiences), immersive body scan meditations and VR environments specifically created to facilitate present-moment awareness and non-judgemental attention. Studies examining VR applications for pain management, anxiety treatment or other therapeutic purposes will only be included if mindfulness training is explicitly identified as a primary design objective of the VR intervention, rather than an incidental component.

Comparison: not applicable (qualitative evidence will be considered regardless of any comparators).

Evaluation: studies reporting qualitative data (eg, from interviews, focus groups, open-ended survey questions, observation) that provide insight into participants’ experiences, perceptions, attitudes or opinions of the VR mindfulness intervention.

Exclusion criteria:

Studies focused only on quantitative outcomes (eg, effectiveness) without any qualitative data on user experiences/perceptions.

Studies where VR is used to deliver other types of therapeutic interventions (eg, exposure therapy) that do not explicitly target mindfulness.

Studies where the VR component is only a minor or supplemental feature rather than the main intervention.

Dissertations/theses, conference abstracts, posters or presentations without an accompanying full-text paper.

Commentaries, opinion pieces and other non-empirical publications.

The inclusion criteria were purposefully defined to be broad with respect to the populations and contexts studied. This is because an exploratory scoping search suggested there may be a limited number of studies meeting the narrower criteria of only healthy or clinical adult samples in controlled settings. In light of this, we opted to widen inclusion to also capture emerging applications and preliminary user testing conducted outside of clinical research settings (eg, in workplaces, community settings or online). While these may not provide direct evidence of therapeutic effects or acceptability as a clinical intervention, they can still yield valuable insights into design factors and contextual considerations that influence user engagement and experience.

Study selection

The results from the searches will be collated and deduplicated using Endnote reference management software. The study selection process will involve two stages:

Title and abstract screening: two independent reviewers will assess the titles and abstracts of all unique records against the eligibility criteria. For non-English titles and abstracts, translation will be performed prior to screening. When uncertainty exists regarding eligibility due to language barriers, the full text will be obtained and translated for more detailed assessment. Records will be categorised as ‘include’, ‘exclude’ or ‘uncertain’. Any discrepancies between reviewers will be resolved through discussion or by involving a third reviewer.

Full-text review: records categorised as ‘include’ or ‘uncertain’ will be retrieved in full-text where available. Two independent reviewers will then assess the full texts against the eligibility criteria. Reasons for exclusion will be recorded. Disagreements will again be resolved through consensus or arbitration by a third reviewer.

The study selection process will be documented in a Preferred Reporting Items for Systematic reviews and Meta-Analyses flow diagram (figure 1).³⁹ A list of studies excluded at the full-text stage with reasons for exclusion will be provided as an online supplemental file.

Figure 1. Preferred Reporting Items for Systematic reviews and Meta-Analyses flow diagram illustrating the study selection process.

Data extraction

Data will be extracted from included studies using a standardised form developed for the review. The data extraction form will be piloted on a sample of included studies and refined as necessary.

Two independent reviewers will extract data from included studies, resolving disagreements through discussion or third-party arbitration. The extraction will cover study details, methodology, setting, participants, intervention, qualitative findings and conclusions. Study details encompass authorship, publication year, country, funding and conflicts of interest. Methodological information includes study design, qualitative methods and data analysis approach. Setting specifies the research environment. Participant data covers sample size, population characteristics and demographics. Intervention details describe the VR application, its features, technology used and training duration. Qualitative findings will capture themes, categories and key concepts, including participant quotes and author interpretations. Conclusions will summarise implications for VR mindfulness application development and implementation. Missing information will be sought from study authors, with non-responses noted (online supplemental appendix B). For non-English studies, data extraction will be performed on professionally translated versions of the articles. When contacting authors of non-English studies for missing information, correspondence will be attempted in both English and the original publication language where team linguistic capabilities allow. Data Extraction Form provides a comprehensive list of variables for which the data will be extracted.

Quality appraisal

The methodological quality of included studies will be critically appraised using the Critical Appraisal Skills Programme (CASP) Qualitative Checklist.⁴⁰ The CASP checklist is a well-established tool for systematically assessing the trustworthiness, relevance and results of qualitative studies based on 10 criteria. While primarily designed for informing evidence-based practice in healthcare settings, the CASP checklist can be applied flexibly to appraise qualitative research across disciplines.

Two independent reviewers will appraise each study against the CASP criteria, with disagreements resolved through discussion or arbitration by a third reviewer. Studies will not be excluded based on quality appraisal scores, as the aim is to comprehensively synthesise all available qualitative evidence with transparent reporting of its methodological strengths and limitations. However, sensitivity analyses will be considered to examine whether including studies of lower quality changes the review’s conclusions. These sensitivity analyses will involve comparing thematic findings derived from studies scoring highly on CASP criteria (ie, demonstrating clear research questions, appropriate methodology, rigorous data collection and analysis) against the complete dataset including all studies regardless of quality scores. If substantial differences in themes or conclusions emerge, this will be reported and discussed as a limitation affecting confidence in findings.

The quality appraisal results will be summarised in a table with a brief justification for each judgement. The details are provided in online supplemental appendix C. Each CASP criterion will be rated as ‘Yes’, ‘No’, or ‘Can't tell’, with accompanying rationale based on information provided in the published studies. Studies will be categorised as higher quality (meeting ≥8 of 10 criteria), moderate quality (6–7 criteria) or lower quality (≤5 criteria) to facilitate sensitivity analyses.

Data synthesis

The extracted qualitative data will be synthesised using thematic synthesis, following the approach described by Thomas and Harden.³⁸ Thematic synthesis is a well-established method for identifying and interpreting patterns across heterogeneous qualitative studies, while grounding findings in participants’ perspectives .³⁹

The synthesis will involve three main stages:

Line-by-line coding of participant quotes and author interpretations from the included studies. Codes will be inductively generated to capture the meaning and content of each extracted data element.

Organising codes into related areas to construct descriptive themes. This will involve an iterative process of comparing codes, examining similarities and differences and grouping them into a hierarchical tree structure.

Developing higher-order analytical themes that go beyond the primary studies. This will involve interpreting the descriptive themes to address the review questions and generate new insights or hypotheses about user experiences and perceptions of VR-based mindfulness interventions.

The data synthesis will be led by two reviewers (RS, AB) with guidance and oversight from a senior reviewer (AM) highly experienced in qualitative evidence synthesis. The preliminary codes and themes will be discussed among the full review team to incorporate multiple perspectives and reach consensus on the final thematic framework.

We will use qualitative data analysis software (NVivo) to facilitate the coding and data management. Memos and a reflexive journal will be used throughout the synthesis to document decisions, interpretations and personal reflections.

The data synthesis will incorporate a critical lens, actively seeking to capture the full range of user perspectives including both positive experiences and perceived benefits as well as negative experiences, challenges, barriers and unintended consequences. We will analyse user experiences and perceptions in connection with key contextual factors (eg, population, setting, VR design features) to understand potential moderating influences and boundary conditions.

In line with thematic synthesis methodology, participant quotes will be used extensively to illustrate themes and ground findings in users’ own voices. However, we will be careful not to over-extract quotes out of context or make interpretations beyond what is supported by the primary data.

If there are sufficient studies, we will explore the potential for subgroup analyses comparing user experiences and perceptions across different populations (eg, clinical vs non-clinical) and contexts of use. However, the ability to draw meaningful comparisons will depend on the availability and commensurability of the primary data.

Confidence in cumulative evidence

The Grading of Recommendations Assessment, Development and Evaluation-Confidence in the Evidence from Reviews of Qualitative Research (GRADE-CERQual) approach will be applied to assess confidence in the review findings.⁴⁰ CERQual provides a systematic and transparent framework for evaluating confidence in the evidence for each individual review finding, based on consideration of four components:

Methodological limitations of the studies contributing to the review finding.

Coherence of the review finding.

Adequacy of data supporting the review finding.

Relevance of the included studies to the review question.

After assessing each component, overall confidence in a review finding is judged as high, moderate, low or very low. High confidence indicates that the finding is a reasonable representation of the phenomenon of interest, while very low confidence indicates that it is uncertain whether the review finding is a reasonable representation.

Two independent reviewers will apply the CERQual criteria to the review findings, with disagreements resolved through discussion or arbitration by a third reviewer. The CERQual assessments will be presented in a Summary of Qualitative Findings table, listing each review finding alongside its confidence assessment and explanation. The details are provided in Appendix D.

Translation and cross-cultural considerations

For non-English studies, particular attention will be paid to cultural context during data extraction and synthesis. Cultural factors that may influence user experiences and perceptions of VR mindfulness interventions will be noted and incorporated into the thematic analysis. Translation accuracy will be verified through back-translation of key extracted passages where resources permit, and any uncertainties in translation will be clearly documented and discussed as potential limitations in the interpretation of findings from those studies.

Discussion

Strengths and limitations

This systematic review will have several strengths. To our knowledge, it will be the first to comprehensively synthesise qualitative evidence on end-user experiences and perceptions of VR-based mindfulness interventions. By capturing rich, detailed insights from participants across diverse applications and contexts, the review will move beyond effectiveness outcomes to understand how VR mindfulness training is actually perceived and encountered by target users. The broad inclusion criteria will enable a more holistic understanding than prior reviews limited to controlled clinical settings.

Methodologically, the review will adhere to current best practices for systematic reviews of qualitative evidence, including a comprehensive search strategy, independent study selection and data extraction, critical quality appraisal and transparent reporting. The inclusive thematic synthesis approach will allow patterns to be identified across heterogeneous studies while staying grounded in participants’ own language and perspectives.

However, some limitations should be noted. The exploratory nature of many early VR applications means the evidence base is likely to consist of mostly small pilot studies in non-clinical samples. User experiences may differ when interventions are applied in higher-stakes clinical contexts. Finally, as a qualitative evidence synthesis, the review will not directly answer questions about effectiveness or efficacy.

Implications and future directions

Despite the limitations, this systematic review is expected to make several important contributions. By providing a comprehensive synthesis of end-user perspectives, it will highlight key factors that appear to influence engagement, acceptability and usefulness of VR-based mindfulness interventions across populations and contexts. This can directly inform the ongoing research and development of user-centred applications that optimise these parameters. Specifically, the synthesis will identify actionable recommendations for VR mindfulness intervention design including preferred virtual environment characteristics (eg, nature vs abstract settings), optimal intervention format and duration, essential user interface features, effective guidance and feedback mechanisms and contextual factors that influence implementation success. These concrete insights will enable developers to make evidence-based design decisions rather than relying on assumptions about user preferences.

Comparing user experiences between different subgroups and settings can also suggest tailoring opportunities and boundary conditions for VR mindfulness training. For example, some populations may benefit from different design features or implementation approaches. Insights into both positive and negative user experiences can guide the development of best practices to maximise benefits and minimise unintended consequences.

More broadly, the review will lay a foundation for informing evidence-based decision-making around investing in and scaling VR-based mindfulness interventions. Regardless of an application’s efficacy in controlled trials, real-world implementation depends on how target users actually perceive and interact with it. Synthesising those subjective experiences is therefore critical for designing interventions that people will be motivated and able to engage with in everyday life.

Finally, the review will identify key gaps in current knowledge of users’ perspectives and highlight directions for future research. This may include recommendations for standardised qualitative methods, exploring mediators and moderators of effectiveness or probing emergent issues identified by participants. By centring users’ lived experiences, the review aims to advance the person-centred development and evaluation of VR as a tool for promoting more engaging and accessible mindfulness training.

Translating qualitative insights into design improvements

While qualitative data are inherently subjective, systematic synthesis enables the identification of consistent patterns that can inform specific design improvements. The review findings will be translated into practical recommendations through several mechanisms. User feedback on virtual environments, interface elements and interaction modalities will inform specific technical specifications for VR mindfulness applications, enabling design feature optimisation based on empirical evidence rather than assumptions. Insights into user preferences for session timing, duration and frequency will guide evidence-based implementation protocol development for different populations and settings, ensuring interventions are delivered in formats that maximise user engagement and adherence. Systematic identification of common user challenges will enable proactive design solutions and support strategies through barrier identification and mitigation approaches that address recurring obstacles to adoption and sustained use. Comparative analysis of user experiences across different populations will inform targeted design modifications for clinical vs non-clinical users, different age groups and varying technological familiarity levels, allowing for population-specific adaptations that enhance intervention relevance and effectiveness. These practical applications demonstrate how qualitative evidence synthesis can bridge the gap between user experiences and concrete design improvements, ultimately enhancing the real-world effectiveness of VR-based mindfulness interventions.