Acceptability and Utility of a Virtual Reality Diabetes‐Related Foot Disease Training Program for First Nations People: A Pragmatic Quasi‐Experimental Case Series Study

ABSTRACT

Objective

To test the utility and acceptability of a novel VR training tool for community health practitioners in assessing diabetes‐related foot disease in Aboriginal and Torres Strait Islander people.

Methods

The VR program featured five virtual patient models and a range of interactive assessments covering essential clinical and triage skills.

Design

Pragmatic quasi‐experimental case series.

Setting

The VR training program was completed in collaboration with three Aboriginal Community‐Controlled Health Organisations in regional South Australia, with recruitment directed internally at each organisation.

Participants

Forty‐one primary healthcare staff participated, of which 34 were matched on pre‐ and post‐VR surveys and 20 completed at least three training scenarios.

Main Outcome Measures

Evaluation consisted of pre‐test self‐efficacy scores immediately prior to participants undergoing training, submission of post‐test self‐efficacy scores, the System Usability Scale, and Training Evaluation Inventory scores after completing all training modules.

Results

Following completion of VR training, participants reported increased self‐efficacy scores (n = 20) for performing key assessment and triage skills. User feedback (n = 39) demonstrated that participants generally agreed that the training user experience was engaging, acceptable, and of value for clinical education.

Conclusion

Community health practitioners generally found the VR training tool acceptable, useful, and increased their self‐confidence in assessing and managing diabetes‐related foot disease for Aboriginal and Torres Strait Islander people, highlighting the potential of VR to upskill community practitioners.

What Is Already Known on This Subject?

• Telehealth can help bridge the care gap between primary and multidisciplinary services for people living in rural and regional communities, but community practitioners may not be substantively trained in foot assessment and triage, which limits their ability to fully engage in telemedicine.

• Virtual reality (VR) may be used for delivering clinical skills training for practitioners in rural and remote areas—particularly in assessment and management of foot disease in Aboriginal and Torres Strait Islander people.

What Does This Study Add?

• We demonstrate that co‐designed VR training can be useful and acceptable to primary care staff serving the Aboriginal and Torres Strait Islander Community in rural locations.

• Despite limitations in scope and depth of testing, we show that community practitioners can use VR to develop skills and self‐efficacy that aid in collaborating on multidisciplinary telehealth consultations.

1. Introduction

Aboriginal and Torres Strait Islander people and communities have flourished across the Australian continent for thousands of generations [1]. It has only been in recent Australian history that colonisation has systematically attempted to erase Indigenous culture [2], the intergenerational impacts of which have been felt by many communities. These traumas have resulted in inequitable health for Indigenous People; for example, Aboriginal and Torres Strait Islander people have diabetes‐related foot disease (DFD) risk three‐ to six‐times higher than that of non‐Aboriginal Australians [3]. This effect is especially pronounced for those living in rural and remote communities who often experience the most severe outcomes from DFD regardless of Indigenous status [4, 5], at least in part owing to the paucity of access to multidisciplinary care.

Telehealth has the potential to improve the delivery of evidence‐based care in the prevention and treatment of disease for people living rural and remote [6] as it enables rapid collaboration between geographically‐distant health professionals. However, it is important for service delivery even via telehealth to conform to cultural safety to meet the needs of First Nations people [7]. In Australia, culturally‐safe practice has been defined as ‘ongoing critical reflection of health practitioner knowledge, skills, attitudes, practising behaviours and power differentials in delivering safe, accessible and responsive healthcare free of racism’ [8]. In our context, this includes: mutually respectful communication and personalised care; pre‐existing relationships; understanding the context and culture of the individual patient; and community knowledge [7]. In many cases, this cultural safety depends on having a community practitioner that the patient and their family knows present and engaged in order to account for cultural safety deficits of specialists [3]. The potential value of culturally‐safe telehealth is highlighted by feedback from both Aboriginal and Torres Strait Islander patients [9] and their health practitioners [10].

When telehealth is implemented without substantial forethought, it risks unintended consequences such as diverting resources from rural to metropolitan health centres [11]. Importantly, while telehealth has the capacity to complement and upskill rural generalists by interfacing them with metropolitan specialists they otherwise would not have direct access to, it also risks removing rural practitioners' involvement and oversight over care for rural and/or Indigenous patients. To deliver a foot health assessment, a skilled community nurse or Aboriginal Health Practitioner should be able to assess the presence of pedal pulses, determine the presence of neuropathy, and assess correct triage pathways based on patient presentation; if the local practitioner does not have these skills, despite access to telehealth they will likely need to refer the patient to attend a metropolitan hospital for assessment. A strengths‐based approach to improving telehealth should focus on upskilling rural practitioners to assess and triage patients so rural and metropolitan practitioners can collaborate seamlessly with specialists over telehealth.

Expanding access to high‐quality training for rural practitioners remains a significant challenge [12], particularly in specialised areas such as DFD care. Virtual reality (VR) offers a promising solution by providing an immersive, hands‐on learning environment without the constraints of traditional classroom‐based training or risks to real patients, with evidence that it improves skills outcomes of health professionals [13]. VR has already been successfully implemented in various health training programs, such as diabetes education [14], nurse education [15], blood transfusion training [16], and endoscopy [17]. However, to our knowledge, it has not yet been applied to DFD care—an area where hands‐on assessment and treatment skills are critical. Importantly, VR has also been used to represent Aboriginal cultural heritage [18], highlighting its potential as a culturally appropriate training tool. By incorporating First Nations design and perspectives, VR‐based education could create a more relevant, engaging, and culturally‐safe learning experience for practitioners working with Aboriginal and Torres Strait Islander communities.

The aim of this project was to evaluate the utility and acceptability of VR‐based education modules for training health practitioners to assess and triage DFD in Aboriginal and Torres Strait Islander people. Our study was designed to strengthen culturally‐appropriate care coordination through the leadership of South Australia's Aboriginal Health Workers (AHWs) and Aboriginal Health Practitioners (AHPs), along with other practitioners providing primary care to people through Aboriginal Community‐Controlled Health Organisations (ACCHOs).

2. Methods

Ethics approval was obtained from the local Aboriginal Health Research Ethics Committee, with notification and approval from the local hospital network and university HREC. This study was reported in accordance with the Transparent Reporting of Evaluations with Nonrandomized Designs (TREND) statement [19].

2.1. Research Design

A pragmatic quasi‐experimental case series design was employed to evaluate the utility, acceptability, and perceived educational value of an immersive VR training program featuring simulated Aboriginal patients. The training was developed to support community health practitioners who need to be able to assess and manage diabetes‐related foot complications among Aboriginal and Torres Strait Islander peoples in rural and regional healthcare settings. The VR training included a series of simulated clinical scenarios with varying levels of complexity designed to support the development of clinical skills, cultural responsiveness, and practitioner self‐efficacy in managing diabetes‐related foot presentations.

2.2. Participants and Setting

Target sites for implementing the educational training were three regional ACCHOs respectively serving rural, regional, and remote locations in South Australia. Participating ACCHOs were subcontracted as part of our funding to allocate a staff member to identify and recruit participants to the study internally.

One staff member at each location–identified by the ACCHO CEO or delegate–was provided the necessary training by our research staff. The identified local staff member was tasked with recruiting relevant staff at their location by direct approach, and distributing information on the use of the headset. All staff at the location with potential clinical management of patients with foot complications were eligible to participate. During the study, participants were able to use the devices at any time, and their data were only recorded via online surveys (i.e., no training data was stored on the devices). Participants provided informed consent as part of submitting their survey.

2.3. Measures

As the training occurred in rural and remote locations, the following information was recorded via a Qualtrics XM web survey (Qualtrics International Inc.): demographics, self‐efficacy before and after VR training, system usability, training utility, simulator sickness and two open‐ended questions: ‘What aspect did you find challenging during the VR training?’ and ‘What aspect of the VR training did you find helpful?’ Finally, to capture aspects of usability related to the VR hardware, two additional closed questions (yes/no) were included: ‘Did you have any difficulty putting the headset on?’ and ‘Did you have any difficulty using the controllers?’

The following demographic information was captured: ACCHO location; gender; Aboriginal status; occupation; years in current occupation.

Self‐efficacy in assessment and triage of DFD in community care was measured with a set of ten questions, for example: ‘I am confident in my ability to describe a DFU in clinical records’. Scales were 100‐point Likert scales that snapped at 10‐point intervals and described as percentage confidence (see Supporting Information S1A). The efficacy questions were determined by agreement of the clinical team on the ten most important components of assessment and triage for diabetes‐related foot disease. Two validated scales were also used for evaluating feasibility and acceptability of the system—the System Usability Scale (SUS) [20, 21] for user experience [α = 0.91], and the Training Evaluation Inventory (TEI) [22] to determine the value of training [α = 0.7] (see Supporting Information S1B).

The SUS is a widely used and technology‐agnostic measure of perceived usability. The scale contains 10 items rated on a 5‐point Likert scale ranging from 1 (strongly agree) to 5 (strongly disagree). Scores are adjusted depending on the valence of the question, summed and weighted (*2.5) to produce a SUS score out of 100 [21]. The score out of 100 is not a percentage, but interpreted relative to prior research on SUS benchmarks. Scores ~68 represent average usability, and scores above 80 indicate excellent usability [23]. Individual items were modified to include the word ‘application’ in reference to the VR training software instead of the original term ‘system’, such modifications have been shown to have no change on the reliability of the scale [24].

The TEI is designed to assess participants' perceptions of the VR training program and captures broader perceptions of the learning experience that are not covered by the SUS. Our study used 20 questions covering 5 themes from the following scales: subjective enjoyment, perceived usefulness, perceived difficulty, subjective knowledge gain and attitude toward training. Similar to the SUS, the TEI also used a 5‐point Likert scale. As no standardised cut‐offs exist for TEI scores, heuristic benchmarks were used to identify areas for improvement and acceptability. For example, items scored 3.5 and above indicate a positive evaluation. However, as the TEI is multidimensional, the number of items per scale was also taken into account and means out of 5 were calculated. As recommended by Ritzmann et al. [22], minor modifications were made to the wording to be more applicable to the VR training as the focus of the evaluation.

Simulator sickness items were also included to determine whether nausea, dizziness, or eyestrain had influenced participants' perceptions of the acceptability of the VR application, as these symptoms have been reported across a range of virtual reality environments and applications [25]. To minimise participant burden, a brief version inspired by the simulator sickness questionnaire was administered [26]. Participants rated the severity of symptoms using a 4‐point scale ranging from 0 (‘none’) to 3 (‘severe’).

2.4. Intervention

The VR training software was created by a local business partner, with the help of expertise and co‐design from stakeholders in podiatry, vascular surgery, cultural knowledge, psychology and lived‐experience consumers. Hardware used was Meta Quest 2 (Reality Labs, Meta Platforms). Example graphical representations of the virtual module are presented in Figure 1 and case details in Table 1.

FIGURE 1.

VR training screenshots. Top‐left: The virtual clinic waiting room with five virtual patients. Bottom‐left: User conducting a virtual assessment of neuropathy using a monofilament, with inset image of a physical Aboriginal Health Practitioner moving the controller. Top‐right: Virtually palpating pedal pulses, with another inset showing the virtual guides and user hand position. Bottom‐right: User conducting a skin assessment of necrotic tissue and foot infection.

TABLE 1.

Details about virtual patients, assessments, and outcomes based on the NDSS.

Virtual patients	Case details	Outcome
Case #1	History: Recently diagnosed type II diabetes; smokes ASSESSMENT Vascular: Pedal pulses present Neurological: Foot sensation present Skin: No lesions Biomechanical: No foot deformities	Very low risk
		Screen every 12 months
Case #2	History: Type II diabetes, guardian of four young children; travels great distances ASSESSMENT Vascular: Pedal pulses present Neurological: Loss of foot sensation Skin: Several calluses on both feet Biomechanical: High‐arched feet; hammer toe	Moderate risk
		Screen every 3–6 months Podiatrist visit every 6–8 weeks
Case #3	History: Type I diabetes; haemodialysis 3 times a week; previous toe amputation ASSESSMENT Vascular: Pedal pulses present Neurological: No sensation Skin: No lesions Biomechanical: Missing toe on left foot	High risk
		Screen every 1–3 months and enact action plan (footwear; footcare/education) Optimise diabetes management Podiatry referral within 2–4 weeks
Case #4	History: Type II diabetes ASSESSMENT Vascular: Pedal pulses present Neurological: Loss of foot sensation on both feet Skin: Skin ulcers on both feet; no infection Biomechanical: High‐arched feet	Acute risk
		Referral to metro high‐risk foot service within 2 days
Case #5	History: Type II diabetes; does not take medication; HbA1c 11%; high alcohol intake ASSESSMENT Vascular: Pedal pulses absent Neurological: Loss of foot sensation Skin: Infected ulcer on right toe; Biomechanical: No foot deformities	Acute risk
		Address infection with appropriate antibiotic therapy Same day referral to high‐risk foot service OR send to emergency department in setting of sepsis

Note: Each highlights the relative risk for the presenting patient.

To ensure ecological validity and cultural relevance, the virtual clinic was based on local Aboriginal Health Services (Figure 1A). Five virtual ‘patients’ were developed in collaboration with Aboriginal health workers and community members who volunteered to model and provide voiceovers for the simulated patients. To support both behavioural and cultural authenticity, patient dialogue was semi‐scripted, facilitating actors to respond naturally while still ensuring consistency within the case details. As the actors themselves were Aboriginal people, this approach also supported culturally authentic patterns of communicating patient histories, foot complaints, pain and personal concerns that would have otherwise been difficult to replicate with fully scripted dialogues or non‐community actors. The actors were shown the final version of the VR training and approved the simulated patients and voiceovers. All aspects of clinical care and cultural safety were overseen by team members and stakeholders with relevant expertise, based on best‐practice national [27, 28] and international guidelines [29, 30].

Each end‐to‐end appointment included: hand washing, notes review, assessment of neuropathy using a monofilament (see Figure 1B), assessment of pedal pulses (with haptic feedback from the VR controllers; see Figure 1C), infection assessment (see Figure 1D), comparison of foot biomechanics against models of foot deformity, a skin assessment for lesions and infections, and selection of correct risk and triage pathways. All education materials were based on the 2020 version of the Diabetes Australia and Australian Diabetes Society's Foot Forward program (‘Active Foot Disease Pathway’ [31], ‘Diabetes Foot Risk Stratification and Triage’ [32]). The five virtual patients had diabetes and varying levels of risk (see Table 1 for details). Visual cues and a narrator guided participants through the tasks and assessments. Using the VR controllers, participants progressed through each task by providing accurate responses and hand placements of a virtual hand.

Prior to undergoing VR training, participants were asked to scan a QR code, which linked them to a Qualtrics web survey. The pre‐VR training survey included demographics and self‐efficacy measure. Participants were then given the choice to complete as many of the five case scenarios in any order. Training was entirely self‐directed as participants could choose any patient in the virtual clinic, and they could complete patient cases multiple times if needed. After they completed their training, participants were asked to scan a separate QR code linking to a separate post‐VR survey, which included: check boxes for cases they completed, follow‐up self‐efficacy, SUS, TEI, simulator sickness, open‐ended questions about challenges and utility, and two questions specific to VR hardware usability.

Pre‐VR and post‐VR questionnaires were matched using a person's self‐created identifier allowing participants to fill questionnaires on different days or locations depending on their capacity to complete the training while maintaining confidentiality.

2.5. Data Analysis

Data were analysed in JASP (Version 0.96.0) and plots were created in R [33]. All participants were included in the system usability analyses, but only participants who completed 3 or more scenarios were included in the self‐efficacy and training utility analyses.

3. Results

Forty‐one participants recruited to the study from August 2022 through April 2023; participants who did not complete the post‐VR survey were excluded. Thirty‐four (M = 8, F = 25, other = 1) pre‐ and post‐VR surveys were matched, but only 20 participants completed 3 or more scenarios. Twenty‐six were Aboriginal and/or Torres Strait Islander, and 8 non‐Aboriginal. Health work experience in their field was well distributed, with 12 reporting < 5 years', 13 had 5–15 years', and 9 had > 15 years'.

3.1. Software and Hardware Usability

According to Bangor et al. [23] our mean system usability scores (M = 82.35, SD = 13.72) were in the ‘Excellent’ range, and were statistically different from the industry benchmark of 68, t(33) = 6.1, p < 0.001, d = 1.05. To identify potential usability differences between participants (n = 20) who completed 3 or more scenarios and those who completed fewer than 3 scenarios (n = 14), the data were grouped and compared to each other. An independent‐samples t‐test indicated no significant differences in SUS scores between the groups U = 164, p = 0.41, r = 0.17. Both groups were significantly above the industry benchmark (p < 0.001, Cohen's d range 0.89 to 1.27) and participants who completed fewer scenarios did not demonstrate lower SUS scores (see Figure 2). This result suggests that incomplete participation is unlikely to be attributed to poor system usability, but rather as a consequence of other factors.

FIGURE 2.

Distribution of System Usability Scale (SUS) scores for participants who completed $\ge$ 3 scenarios and those who completed fewer scenarios. The density curve represents the concentration of participant SUS scores across the 0–100 scale. The dashed vertical line indicates the industry benchmark score of 68 for above‐average usability [23] while the solid vertical lines represent the observed means for each completion grouping.

Only 8.82% (3/34) reported having difficulty with the headset and 11.76% (4/34) reported difficulty with the controllers.

3.2. Self‐Efficacy

Participants (n = 20) demonstrated a significant improvement in self‐efficacy after completing the VR training. Mean self‐efficacy scores increased from pre‐VR M = 48.05 (SD = 27.97) to post‐VR M = 90.95 (SD = 8.87), showing a mean gain score of 42.90 (SD = 26.92). A paired‐samples t‐test showed a statistically significant improvement t(19) = −7.13, p < 0.001, with a very large effect size, d = −1.59 (95% CI [−2.25, −0.92]), indicating a clear difference between groups. Pre‐ and post‐test self‐efficacy scores are presented in Figure 3. Across all self‐efficacy questions, there was a strong and consistent increase in self‐reported confidence.

FIGURE 3.

Comparison of mean pre‐ and post‐VR self‐efficacy scores (n = 20). Error bars represent 95% confidence intervals. See Supporting Information S1A for full questionnaire.

3.3. Training Utility

Participants' Training Evaluation subscale scores were compared to a heuristic benchmark of 3.5 (above positive evaluation) and were used to identify areas for improvement and acceptability. Means were calculated for each subscale and submitted to a one‐sample Wilcoxon signed‐rank t‐test with a test value of 3.5. All subscales were statistically significant p < 0.001 with large effect sizes r ≥ 0.99. Participant responses (n = 20) to the Training Utility are reported in Figure 4. Overall, scores across all subscales were predominantly above the threshold, indicating a positive perception of the VR training software across subjective enjoyment, perceived usefulness, perceived difficulty, subjective knowledge gain, and training attitudes.

FIGURE 4.

Mean Training Evaluation Inventory subscale scores for the VR diabetes foot training. Boxplots show the range and distribution of participant mean scores for each subscale. Error bars indicate the 95% confidence intervals. The dashed line at 3.5 represents the heuristic threshold for positive evaluation (i.e., above neutral response) [22].

Qualitative responses from the open‐ended questions indicated similar experiences between participants who completed three or more scenarios (n = 20) and those who completed fewer scenarios (n = 14). Reported challenges primarily related to adapting to the VR technology rather than difficulties with the content itself. Of the 32 participants who responded to the challenges question, 12.50% (n = 4) described visuospatial issues (e.g., judging distances), while 9.38% (n = 3) reported challenges using the controls to interact with the virtual environment. Two participants also identified difficulties with specific clinical assessments, such as identifying a high‐arched foot. The remaining four participants commented on not having enough time, cybersickness, and limitations to interactions as challenges. Notably, over half of participants (56.25%, n = 18) reported no meaningful challenges during training.

Responses about the utility of the VR training were highly consistent and overwhelmingly positive. Of the 30 respondees, 53.33% (n = 16) specifically stated that they found all aspects of the training helpful. Remaining responses highlighted the immersive and experiential nature of the training, which included themes of realism in the clinical scenarios and immersive environment, ‘easy‐to‐follow’ guidance, visual learning supports (e.g., virtual hand for placement), and the triage pathways. Overall, the findings suggest the training was well received, with barriers largely reflecting initial adjustments to the technology.

3.4. VR Sickness

Responses to the brief simulator sickness questionnaire indicated low levels of adverse symptoms following VR exposure (n = 34). Most participants reported no nausea (88.24%, n = 30), no eyestrain (67.67%, n = 23), and no disorientation (88.24%, n = 30). Mild symptoms were more frequent than moderate symptoms with slight nausea reported by 11.77% (n = 4), slight eyestrain by 29.41% (n = 10), and slight disorientation by 11.77% (n = 4). Only one participant (2.94%) reported moderate eyestrain, while no participants reported severe symptoms. Mean percentages of VR‐related discomfort tend to be higher [25] suggesting that our VR training was well tolerated, with simulator sickness symptoms being infrequent and mild.

4. Discussion

The VR training demonstrated high usability and acceptability among community health practitioners, with minimal difficulties and predominantly positive perceptions of the learning experience. Usability challenges reflected initial adjustments to the VR hardware and controls, such as visuospatial adaptation rather than issues with the educational content. Such issues are common in the extended reality literature especially among new VR users and usually dissipate with repeated exposure [34]. Notably, simulator sickness symptoms were infrequent and mild, with no severe symptoms reported. Participants consistently highlighted the immersive, realistic, and hands‐on nature of the training as beneficial for learning, suggesting that the VR platform was both feasible and well tolerated for delivering experiential clinical education.

Community health practitioners reported improved self‐efficacy to perform foot checks including vascular, neurological, skin and biomechanical assessments as well as documenting clinical findings and identifying appropriate referral pathways for patients with DFUs. Although participants showed considerable variability in baseline skill level and self‐efficacy prior to VR training, post‐VR responses were less variable and reflected consistent positive improvements to perform diabetes‐related foot disease evaluations. Training evaluation findings also demonstrated positive perceptions across subjective enjoyment, usefulness, difficulty, subjective knowledge gain and training attitudes. As the training and evaluations were delivered remotely, direct assessment of knowledge transfer was challenging. However, subjective knowledge gain has been identified as a useful proxy for learning transfer in settings where objective knowledge assessments are impractical or difficult to implement [22, 35]. Our findings align with previous research showing that VR‐based education can provide meaningful and engaging learning experience capable of promoting improved self‐efficacy [36]. Ultimately, the immersive and experiential nature of VR training may offer a scalable approach to deliver hands‐on education for healthcare staff who provide care for and with Aboriginal and Torres Strait Islander peoples in rural and remote regions where access to face‐to‐face training may be limited.

5. Limitations and Recommendations for Future Research

The scope of our VR training focused specifically on diabetes‐related foot disease; however, diabetes is multimorbid and successful management requires a multidisciplinary approach. Given the promising results of our VR training, future work should expand to encompass a broader range of clinical activities, including haemodialysis access and diabetes‐related eye examinations, particularly as these assessments are covered under the Medical Benefits Schedule Item 715 Aboriginal and Torres Strait Islander Peoples Health Assessment. Broadening culturally appropriate VR‐based upskilling may improve the accessibility and relevance of these free‐to‐consumer diabetes screening checks for Aboriginal and Torres Strait Islander peoples. Moreover, our study was co‐designed through community consultations and intentionally aligned with the needs of South Australian rural communities. Similarly, cultural relevance should be thoughtfully considered to ensure future VR trainings are appropriate, meaningful and accessible for those it is intended to support.

Although the VR training and assessments were successfully delivered remotely, implementation across rural sites presented practical challenges. Despite funding being provided to partner services to support staffing and project engagement, high staff turnover commonly experienced in rural and remote clinics posed ongoing barriers to consistent uptake. Notably, 41% of participants completed fewer than three virtual cases, likely reflecting time, scheduling, staffing, and work pressures rather than usability issues. Changes in personnel disrupted continuity of training and reduced opportunities for staff to complete the training. These findings highlight broader workforce instability faced by rural health services and suggest that even flexible immersive training options may still have logistical barriers in resource‐constrained settings.

Our findings are encouraging showing excellent utility and acceptability of VR‐based training for healthcare staff in rural and remote areas. However, future research should incorporate more rigorous designs to evaluate training effectiveness. In particular, comparisons with a control group or more traditional training approaches would be valuable to determine the relative gains of VR training. VR also offers the advantage of tracking users' progress while providing valuable quantitative data on performance. These metrics could include accuracy, time efficiency, and consistency in performing assessments over multiple sessions. Performance data would be particularly useful to professional development organisations, both for measuring internal validity of training as well as to provide evidence of assessed improvement in skills across a cohort of trainees.

6. Conclusion

Our co‐designed VR training tool supported community health practitioners in developing self‐efficacy to assess diabetes‐related foot complications in Aboriginal and Torres Strait Islander peoples. This technology shows promise for accessible ‘hands‐on’ clinical education tool for community health practitioners in underserved areas, but future research is needed to determine how VR compares to traditional training. Building capacity for VR‐based training may represent a practical and scalable approach to workforce development, particularly in areas where traditional training opportunities are limited by geographic or resource contraints. A well‐implemented VR training tool can be valuable in upskilling practitioners to be active in multidisciplinary telehealth consultations alongside specialists and patients.

Author Contributions

Ancret Szpak: writing – review and editing, validation, data curation, resources, funding acquisition, conceptualization, methodology. Zygmunt Szpak: software, conceptualization, writing – review and editing, funding acquisition. Kim Morey: conceptualization, project administration, funding acquisition, writing – review and editing, resources. Joseph Agius: resources, investigation. Sara Jones: resources, funding acquisition. Tinarra Ataata: investigation. Neil McMillan: conceptualization, methodology, formal analysis, supervision, project administration, visualization, funding acquisition, writing – original draft, writing – review and editing, investigation. Robert Fitridge: writing – review and editing, conceptualization, methodology, funding acquisition, resources. Kristin Graham: data curation, formal analysis. Cathy Loughry: funding acquisition, conceptualization, supervision. Hannah Snelling: resources, investigation. Alex Brown: conceptualization, funding acquisition, resources.

Funding

This work was supported by a grant from the Australian Department of Health Indigenous Australians Health Program (4‐G19UGYN) to R.F., Z.S., C.L., A.S., K.M. and A.B. Partial salary to N.M. was provided via a grant from The Hospital Research Foundation Group (C‐PJ‐07‐2018) to R.F. The initial funding for the CALHN Telehealth Foot Service, and further distribution of the headsets in the present project, was also supported by the Department of Health Indigenous Australians Health Program via the SAHMRI Aboriginal and Torres Strait Islander Diabetes‐related Foot Complications Program.

Ethics Statement

Ethics approval was obtained from local Aboriginal Health Research Ethics Committee (04‐20‐915), Central Adelaide Local Health Network (14286, 15446), and the University of Adelaide (35336).

Conflicts of Interest

The authors derive no personal financial benefit from the outcomes of this study or the VR system; however, their organisations may derive some financial benefit from future commercialisation of this technology.

Supporting information

Supporting Information S1: (A) Self‐efficacy survey (pre‐test and post‐test). (B) Combined modified System Usability Scale (SUS) and Training Evaluation Inventory (TEI).

Data Availability Statement

The analysed data for the current study are available from the corresponding author on reasonable request. Aboriginal and Torres Strait Islander peoples' data are owned by them and stored with the SA Aboriginal Chronic Disease Consortium as data custodian.