Table 3 Facilitators to implementation and the number of publications they were mentioned in (n)

Category 1: Condition ( n  = 1 facilitator)

 Socio-demographics

Young age

Younger people may be more open to new technology and feel comfortable to use VR during treatment

2

[34, 38]

Category 2: Technology ( n  = 5 facilitators)

 Technical functionality

Client safety

Client is physically safe in treatment room while using VR hardware

6

[13, 34, 44, 53,54,55]

Reliability

VR hardware is reliable and stable while in use

1

[55]

 Usability

Patient comfort

The patient is comfortable while using VR hardware and software

4

[34, 44, 52, 56]

Easy to use

The VR hardware and software is easy to use by end-users

3

[34, 53, 55]

 Effect of VR on treatment

Realism and immersion

VR is able to induce feelings of realism and immersion

4

[13, 40, 41, 57]

Category 3: Value proposition ( n  = 8 facilitators)

 Influencing treatment

Safe and controlled environment

Having a virtual environment that is controlled by the healthcare provider and therefore offers a safe space to practice behavior

5

[39,40,41, 45, 51]

Different reality

Practice behavior in a virtual environment of choice, while physically in the treatment room

4

[41, 44, 48, 51]

Personalizing treatment

VR can be adapted to fit patient needs and treatment goals

3

[51, 54, 55]

Facilitate human interaction

VR could facilitate human contact by practicing virtual roleplays, which other technologies can not

3

[39, 45, 47]

Control and self-efficacy

VR could increase behavioral control and self-efficacy in patients

2

[41, 51]

Insight into behavior and experiences

VR could increase insight of healthcare provider into behavior of patients and their experiences

1

[34]

 Practical resources

Financial viability

VR demonstrates financial viability and has a strong business case

1

[34]

Time and resource efficient

VR is time and resource efficient to use compared to other treatment forms

1

[40]

Category 4: Adopter system ( n  = 18 facilitators)

 Factors that influence opinion towards VR—healthcare providers

Evidence of VR value

Availability of validated evidence on the value of VR for treatment

10

[13, 34, 37,38,39, 41, 43, 44, 46, 58]

Experience with technology

Having experience with technology in general and/or with VR

7

[35, 40, 43,44,45,46, 49]

Added value of VR

Being aware of the benefits of VR for patients and treatment

4

[34, 36, 46, 48]

Improvement in patients

Perception of improvement in patients’ health and treatment goals

2

[37, 50]

Satisfaction with VR

Being satisfied with the usability of VR hardware and software

2

[38, 49]

Support from management

Perceived support from management to use VR

2

[43, 58]

Innovativeness

Being intrigued by the innovativeness of VR in existing treatment

1

[45]

 Attitude towards VR—patients

Patient motivation

VR could enhance patient motivation and engagement in treatment

11

[13, 34, 35, 40, 43, 48, 50, 51, 53, 57,58,59]

Positive

VR is perceived as positive, fun and engaging by patients

1

[50]

Less stressful

Exposure in VR is less stressful than in-vivo exposure

1

[51]

Encouraged by healthcare provider

Patient feels encouraged and supported by healthcare provider to use VR

1

[50]

 Attitude towards VR—colleagues

Positive social influence

Positive opinion of VR of colleagues causes a “domino effect”

1

[37]

 Integrating VR in routines

Combine and integrate VR

The capacity to combine and integrate VR in existing treatment

2

[36, 48]

 Knowledge and skills needed to use VR

Training

Offering training on how to use VR hardware and software

8

[34, 35, 37, 39, 45, 46, 48, 50]

Knowledge and skills

Developing sufficient knowledge and skills to feel confident and comfortable using VR

5

[34, 44, 46, 52, 53]

Intervision

The possibility of frequent contact with colleagues on VR for support, troubleshooting and reviewing VR use

2

[13, 45]

Protocols

Having protocols or guides available on how to use VR

2

[46, 60]

Technological capabilities

The use of VR may increase technological capabilities and vice versa

1

[45]

Category 5: Organization ( n  = 18 facilitators)

 Readiness to innovate

Innovative culture

Having an innovative culture within the organization

2

[34, 44]

Champions

Strategic recruitment of champions to promote VR uptake and credibility

2

[34, 44]

Willingness to invest

Organization is willing to invest time and money in VR

1

[58]

 Introducing VR to healthcare providers

Try out VR

Giving the opportunity and time to healthcare providers to try out VR for themselves

8

[13, 34, 37, 38, 47, 48, 50, 54]

Educational materials

Creating access for healthcare providers to educational materials on VR

5

[43, 46, 54, 58, 60]

E-mail updates

Sending e-mail updates on VR use and added value of VR to keep healthcare providers informed on VR progress in the organization

2

[13, 60]

Staff meetings

Introduce VR and opportunities of VR during staff meetings

1

[34]

 Providing support for healthcare providers

Time to learn VR

Offering enough time for healthcare providers to learn how to use VR

13

[13, 34, 38, 42,43,44,45,46, 50, 53, 58, 60]

Technical system support

Offering technical system support to healthcare providers who work with VR

12

[13, 34, 38, 42,43,44,45,46, 50, 53, 58, 60]

Rooms availability

Having enough rooms available for VR use

8

[13, 35, 37, 38, 44, 48, 50, 58]

Support staff

Having support staff available that helps set up the VR system

6

[35,36,37, 43, 45, 58]

VR systems

Sufficient VR systems to use in treatment

5

[13, 35, 38, 43, 56]

Staff who operate VR

Having selected healthcare providers available who operate VR for multiple patients, instead of training all staff on VR

4

[35,36,37, 58]

Staff who supervise VR

Having technical support staff available who supervise VR sessions and help healthcare providers

4

[37, 38, 45, 53]

Training on patient suitability

Organizing training in determining patient suitability for VR

4

[34, 35, 39, 59]

Train-the-trainer

A learning model in which colleagues who have experience with VR train colleagues that are new to VR

1

[59]

 Integrating VR in organizational structure and workflow

Fit current protocols

VR should fit with current treatment protocols

2

[42, 44]

Reinforcement from management

Reinforcement from management to refer clients to VR treatment

2

[35, 37]

Category 6: Wider system ( n  = 2 facilitators)

 Societal development

Innovation minded

Opinion leaders being innovation-minded and open towards VR

2

[44, 46]

Opinion of society

General positive opinion of society on VR

1

[41, 46]

Category 7: Embedding and adoption over time ( n  = 1 facilitator)

 Challenge to scale up

Commonplace and affordable

VR becomes more commonplace and affordable, making it easier to scale up VR use

1

[41]