An Andragogical Evaluation of Immersive Virtual Reality for Nursing and Midwifery Education: A Descriptive Pilot Mixed-Methods Study in Uganda.: Education in Uganda

Steve Ronald Mwanje; Abbey Ssekalem; Ambrose Felix  Okello; Lilian Ritah  Barungi; Martin  Okoed; Agnes  Asiimwe

doi:10.51168/sjhrafrica.v7i2.2757

Authors

Steve Ronald Mwanje United Nations Regional Service Centre, Entebbe, Uganda
Abbey Ssekalem Cyberprints Limited, Kampala, Uganda
Ambrose Felix Okello Enabel, Belgian agency for international cooperation, Kampala, Uganda
Lilian Ritah Barungi Enabel, Belgian agency for international cooperation, Kampala, Uganda
Martin Okoed Enabel, Belgian agency for international cooperation, Kampala, Uganda
Agnes Asiimwe Guardian Health Services, Kampala, Uganda

DOI:

https://doi.org/10.51168/sjhrafrica.v7i2.2757

Keywords:

Virtual Reality Training, Nursing and Midwifery Education, Immersive Learning, Adult Education, Simulation-Based Learning, Healthcare Workforce Development, Educational Technology, Low-Resource Settings

Abstract

Background:

Nursing and midwifery education in low‑resource settings often has limited access to simulation facilities and opportunities for repeated practice. This study examined how immersive Virtual Reality (VR) supports learning among healthcare professionals in Uganda.

Methods:

This pilot mixed‑methods study involved forty healthcare professionals (nurses, midwives, emergency care providers, and instructors). Participants completed a two‑day VR training using four locally developed modules: postpartum hemorrhage (EMOTIVE), cardiopulmonary resuscitation, ABCDE (Airway, Breathing, Circulation, Disability, Exposure) emergency assessment, and eclampsia management. A retrospective pre-post questionnaire assessed perceived knowledge, engagement, relevance, usability, and adoption. Cronbach’s alpha for learning and adoption domains was 0.853 (95% CI 0.776-0.913). Qualitative responses were thematically analyzed to capture participant perspectives.

Results:

Self‑rated knowledge increased across all groups, with the largest gains among those with less than one year of experience. Engagement (M = 4.88), motivation (M = 4.60), and theory-practice connection (M = 4.42) received consistently high ratings across professional groups. Module use matched professional roles: midwives preferred the EMOTIVE and Eclampsia modules, whereas emergency care providers preferred the ABCDE and Resuscitation modules. Usability challenges included motion discomfort (23/40; 58%), controller use (23/40; 58%), limited practice time (21/40; 53%), and navigation difficulties (20/40; 50%). Despite these, 97.5% of participants supported recommending VR and integrating it into curricula. Qualitative findings reinforced quantitative results, highlighting stronger theory-practice links, active participation, confidence building, and learning through repetition.

Conclusion:

Immersive VR was feasible and acceptable for continuing professional development in nursing and midwifery education in Uganda. These findings suggest that VR can complement existing training in resource-constrained settings.

Recommendation:

Future studies should assess long‑term learning outcomes, cost‑effectiveness, and implementation across larger, more diverse cohorts.

Author Biographies

Steve Ronald Mwanje, United Nations Regional Service Centre, Entebbe, Uganda

Steve Ronald Mwanje is an ICT professional, ICDL trainer, and Virtual Reality (VR) trainer with a Master of Information Technology. His professional and research interests include ICT for Development (ICT4D), digital literacy, immersive learning technologies, virtual reality in education, and digital transformation in low-resource settings. He has participated in several digital skills and innovation initiatives aimed at strengthening workforce capacity and technology adoption across Uganda. St Simon Peter's Vocational Institute -Hoima, Uganda

Email: mwanjesteve2@gmail.com

ORCID: https://orcid.org/0009-0006-0686-4119

Abbey Ssekalem, Cyberprints Limited, Kampala, Uganda

is a Virtual Reality content creator, animator, and digital media specialist at Cyberprints Ltd. He specializes in the design and development of immersive learning environments, educational simulations, animation, and interactive digital content. His work focuses on applying emerging technologies to enhance learning experiences and professional skills development. Email: abbey700@gmail.com

Ambrose Felix Okello, Enabel, Belgian agency for international cooperation, Kampala, Uganda

is an ICT4D professional with experience in software development and digital transformation initiatives in Uganda and beyond. He has contributed to technology integration in health training institutions and secondary schools, supporting innovation in teaching, learning, and institutional management. He holds a Master of Information Technology.

Email: ambokello@gmail.com

Lilian Ritah Barungi, Enabel, Belgian agency for international cooperation, Kampala, Uganda

An Intervention Officer – Public Health (EMS), and contributed to the organization and coordination of the training activities, as well as supporting adaptation of the training content to align with real workplace and clinical practice environments. Email:

Martin Okoed, Enabel, Belgian agency for international cooperation, Kampala, Uganda

is a digital transformation and learning innovation specialist with experience in ICT integration, professional development, pedagogy, and institutional development. He holds a Master of Information Technology and a Postgraduate Diploma in Educational Policy, Leadership, and Management. His work and research focus on digital transformation, technology adoption, educational innovation, and grassroots innovation in low-resource settings.

Agnes Asiimwe, Guardian Health Services, Kampala, Uganda

is a registered nurse and healthcare practitioner at Guardian Health Services. She has experience in clinical practice, patient care, healthcare training, and workforce development. Her professional interests include healthcare quality improvement, emergency care preparedness, and the use of innovative technologies to strengthen healthcare education and service delivery. Email: agnesasimwe54@gmail.com

References

Abeni, E.-A. (2020). Andragogy: A Theory in Practice in Higher Education. Journal of Research in Higher Education, 4(2), 54–69. https://doi.org/10.24193/JRHE.2020.2.4

Aufenanger, S., Bastian, J., Bastos, G., Castelhano, M., Dias-Ferreira, C., Fokides, E., Gavalas, D., Kasapakis, V., Agelada, A., Kostas, A., Koutromanos, G., Makrides, G., Morgado, L., Pedrosa, D., Szemberg, T., Sofos, A., & Szpond, J. (2025). Immersive virtual reality learning environments for higher education: A student acceptance study. Computers & Education: X Reality, 7, 100105. https://doi.org/10.1016/j.cexr.2025.100105

Birkheim, S. L., Calogiuri, G., & Martinsen, R. (2023). Advancing immersive virtual reality-based simulation practices: developing an evidence-based and theory-driven pedagogical framework for VR-based simulations of non-technical skills among healthcare professionals. Interactive Learning Environments, 1–13. https://doi.org/10.1080/10494820.2023.2186896

Braun, V., & Clarke, V. (2021). One size fits all? What counts as quality practice in (reflexive) thematic analysis? Qualitative Research in Psychology, 18(3), 328–352. https://doi.org/10.1080/14780887.2020.1769238

Briese, P., Evanson, T., & Hanson, D. (2020). Application of Mezirow’s Transformative Learning Theory to Simulation in Healthcare Education. Clinical Simulation in Nursing, 48, 64–67. https://doi.org/10.1016/j.ecns.2020.08.006

Cheng, L., Pang, W. Y. J., & Kong, A. (2025). A virtual reality game for older adults’ immersive learning. Scientific Reports, 15(1), 22195. https://doi.org/10.1038/s41598-025-07354-2

Clay, C. J., Budde, J. R., Hoang, A. Q., & Gushchyan, A. (2024). An evaluation of the effectiveness of immersive virtual reality training in non-specialized medical procedures for caregivers and students: a brief literature review. Frontiers in Virtual Reality, 5. https://doi.org/10.3389/frvir.2024.1402093

Epuitai, J., Adongo, P. R., Oboth, P., Apili, F., Kumakech, E., Owusu-Sekyere, S., & Wandabwa, J. N. (2025). Experiences and perceptions of students and faculty with clinical simulation in Uganda: an exploratory study. BMC Medical Education, 25(1), 746. https://doi.org/10.1186/s12909-025-07322-4

Fealy, S., Jones, D., Hutton, A., Graham, K., McNeill, L., Sweet, L., & Hazelton, M. (2019). The integration of immersive virtual reality in tertiary nursing and midwifery education: A scoping review. Nurse Education Today, 79, 14–19. https://doi.org/10.1016/j.nedt.2019.05.002

Fetters, M. D., Curry, L. A., & Creswell, J. W. (2013). Achieving integration in mixed methods designs: principles and practices. Health Serv Res., 6(2), 2134–2156.

Hanson, C., Atuhairwe, S., Lucy Atim, J., Marrone, G., Morris, J. L., & Kaharuza, F. (2021). Effects of the Helping Mothers Survive Bleeding after Birth training on near miss morbidity and mortality in Uganda: A cluster‐randomized trial. International Journal of Gynecology & Obstetrics, 152(3), 386–394. https://doi.org/10.1002/ijgo.13395

Houlden, R., & Crichton, F. (2024). Want doctors to use VR simulation? Make it mandatory, accessible, educationally valuable, and enjoyable! MedEdPublish, 14, 8. https://doi.org/10.12688/mep.20040.2

Huh, Y.-J., Kim, J. W., Yoon, N., Jeong, S., Kong, H.-J., & Myung, S. J. (2026). Immersive Virtual Reality Training to Improve Novice Physicians’ Emergency Response Skills: Randomized Controlled Trial. JMIR Medical Education, 12, e71455–e71455. https://doi.org/10.2196/71455

Johansen, F., Toft, H., Stalheim, O. R., & Løvsletten, M. (2025). Exploring the potential of virtual reality in nursing education: learners’ insights and future directions. Advances in Simulation, 10(1), 7. https://doi.org/10.1186/s41077-025-00337-3

Kaakinen, J., & Arwood, E. (2009). Systematic Review of Nursing Simulation Literature for Use of Learning Theory. International Journal of Nursing Education Scholarship, 6(1). https://doi.org/10.2202/1548-923X.1688

Knowles, M. S. (1984). Andragogy in Action. Applying Modern Principles of Adult Education. Jossey-Bass.

Liu, Y. (2023). Analysis of Interaction Methods in VR: Virtual Reality. Highlights in Science, Engineering and Technology, 39, 395–407. https://doi.org/10.54097/hset.v39i.6559

Merriam, S. B. (2001). Andragogy and Self‐Directed Learning: Pillars of Adult Learning Theory. New Directions for Adult and Continuing Education, 2001(89), 3–14. https://doi.org/10.1002/ace.3

Mezirow, J. (1997). Transformative Learning: Theory to Practice. New Directions for Adult and Continuing Education, 1997(74), 5–12. https://doi.org/10.1002/ace.7401

Mosling, M., Horn, J., & Xanthoulis, A. (2026). Stepping into the virtual ward: a qualitative study on first-year residents’ experiences with VR simulation. BMC Medical Education, 26(1), 400. https://doi.org/10.1186/s12909-026-08729-3

Najjuma, J., Bajunirwe, F., Mbalinda, S., Ssedyabane, F., Mwebembezi, G., Moore, S., Kaddumukasa, M., & Atukunda, E. (2025). Barriers and Facilitators of Simulation-Based Education in Stroke Nursing Management at a Regional Referral Hospital in Southwestern Uganda: A Qualitative Study. Advances in Medical Education and Practice, Volume 16, 1317–1329. https://doi.org/10.2147/AMEP.S535086

Najjuma, J. N., Bajunirwe, F., Twine, M., Namata, T., Kyakwera, C. K., Cherop, M., & Santorino, D. (2020). Stakeholder perceptions about the establishment of medical simulation-based learning at a university in a low-resource setting: a qualitative study in Uganda. BMC Medical Education, 20(1), 379. https://doi.org/10.1186/s12909-020-02301-3

Physiopedia contributors. (2026). Bibliographic details for Adult Learning Styles and Principles. Physiopedia, 363379. https://www.physio-pedia.com/index.php?title=Adult_Learning_Styles_and_Principles&oldid=363379

Saab, M. M., McCarthy, M., O’Mahony, B., Cooke, E., Hegarty, J., Murphy, D., Walshe, N., & Noonan, B. (2023). Virtual Reality Simulation in Nursing and Midwifery Education. CIN: Computers, Informatics, Nursing, 41(10), 815–824. https://doi.org/10.1097/CIN.0000000000001010

Sadeghi, M., Nematollahi, M., Farokhzadian, J., Khoshnood, Z., & Eghbalian, M. (2023). The effect of scenario-based training on the Core competencies of nursing students: a semi-experimental study. BMC Nursing, 22(1), 475. https://doi.org/10.1186/s12912-023-01442-2

Shrestha, B., & Dunn, L. (2020). The Declaration of Helsinki on Medical Research involving Human Subjects: A Review of the Seventh Revision. Journal of Nepal Health Research Council, 17(4), 548–552. https://doi.org/10.33314/jnhrc.v17i4.1042

Sim, J. J. M., Rusli, K. D. Bin, Seah, B., Levett-Jones, T., Lau, Y., & Liaw, S. Y. (2022). Virtual Simulation to Enhance Clinical Reasoning in Nursing: A Systematic Review and Meta-analysis. Clinical Simulation in Nursing, 69, 26–39. https://doi.org/10.1016/j.ecns.2022.05.006

Spies, C., Seale, I., & Botma, Y. (2015). Adult learning: What nurse educators need to know about mature students. Curationis, 38(2). https://doi.org/10.4102/curationis.v38i2.1494

Srikasem, S., Seephom, S., Viriyopase, A., Phutrakool, P., Khowinthaseth, S., & Narajeenron, K. (2025). Comparing the Effectiveness of Multimodal Learning Using Computer-Based and Immersive Virtual Reality Simulation–Based Interprofessional Education With Co-Debriefing, Medical Movies, and Massive Open Online Courses for Mitigating Stress and Long-Term Burnout in Medical Training: Quasi-Experimental Study. JMIR Medical Education, 11, e70726. https://doi.org/10.2196/70726

Steen, C. W., Söderström, K., Stensrud, B., Nylund, I. B., & Siqveland, J. (2024). The effectiveness of virtual reality training on knowledge, skills, and attitudes of health care professionals and students in assessing and treating mental health disorders: a systematic review. BMC Medical Education, 24(1), 480. https://doi.org/10.1186/s12909-024-05423-0

Victoria, N., Isaac, G., Jonathan, K., Charles, B. H., Esther, N. D., Kintu, M. T., Elizabeth, N., Gerald, C., Nelson, L. E., Marvin, K. A., Mwaka, F. M., Tyler, L. J., Alenyo, A. N., & Fred, B. (2025). Acute trauma care training in undergraduate medical education programs in Uganda: A cross-sectional survey of final year medical students. African Journal of Emergency Medicine, 15(2), 602–606. https://doi.org/10.1016/j.afjem.2025.01.003

Waldock, W. J., Bucko, A. M., Ehigie, N., Briffa, C., Zalli, A., Brown, C., Cowell, A., Sam, A. H., & Walls, R. (2026). The effectiveness of virtual reality simulated scenarios at improving medical students’ confidence and engagement in clinical communication: an observational cohort study. BMC Medical Education, 26(1), 126. https://doi.org/10.1186/s12909-025-08384-0

Wilkes, S., Maggio, L. A., Martin, P. C., Melton, J., & Zheng, B. (2026). Self-Directed Learning in Health Professions Education: A Systematic Review and Meta-Analysis. Perspectives on Medical Education, 15(1), 37–52. https://doi.org/10.5334/pme.2128

Williams, E., Bazant, E. S., Holcombe, S., Atukunda, I., Namugerwa, R. I., Britt, K., & Evans, C. (2019). “Practice so that the skill does not disappear”: mixed methods evaluation of simulator-based learning for midwives in Uganda. Human Resources for Health, 17(1), 24. https://doi.org/10.1186/s12960-019-0350-z

World Medical Association. (2013). World Medical Association declaration of Helsinki: Ethical principles for medical research involving human subjects. JAMA (Vol. 310, Number 20, pp. 2191–2194). American Medical Association. https://doi.org/10.1001/jama.2013.281053