Effectiveness of Immersive and Embodied Enhancement Via "Virtual Reality" on the Sustainability of Hand Hygiene Compliance: School-based RCT With 10-month Follow-up (HKU-VR-2026)

June 15, 2026 updated by: King-wa Fu, The University of Hong Kong

This study aims to evaluate the effectiveness of a VR intervention on teaching handwashing skills which are promoted by the Centre for Health Protection, Department of Health, HKSAR. A 7-step handwashing approach will be taught through a customized VR game in secondary schools in Hong Kong. Participant's handwashing skills and prolonged effects on handwashing habits and hygiene level will be assessed.

The main questions it aims to answer are:

  • Does an intervention of our VR handwashing game enhance handwashing skills amongst junior secondary students?
  • What are the factors hinder or enhance students' learning of handwashing skills in the intervention?

Participating students will be assigned into 3 groups. Each group will receive two sessions of educational training with different kinds of intervention throughout one school year (9 months). The first intervention group will participate in two VR-game sessions on handwashing skill; the second intervention group will participate in one VR-game session and one video session about handwashing; the baseline group will participate in two sessions of other VR activities unrelated to hand hygiene and view a handwashing skill poster. The research will compare the handwashing performance between the three groups.

Participants will:

  • participate into a VR handwashing game intervention, or a video-based intervention, or placebo VR activities as stated hereinafter;
  • perform handwashing in the VR game, and their hand-motion data will be captured;
  • participate a UV lighting test after handwashing away fluorescent lotion; and,
  • fill up questionnaires

Study Overview

Status

Status

Indicates the current recruitment status or the expanded access status.
Recruiting

Conditions

Conditions

The disease, disorder, syndrome, illness, or injury that is being studied. On ClinicalTrials.gov, conditions may also include other health-related issues, such as lifespan, quality of life, and health risks.

Intervention / Treatment

Intervention / Treatment

A process or action that is the focus of a clinical study. Interventions include drugs, medical devices, procedures, vaccines, and other products that are either investigational or already available. Interventions can also include noninvasive approaches, such as education or modifying diet and exercise.

Detailed Description

Schools are often the site of infection outbreaks, including COVID-19, influenza and other infectious diseases. COVID-19 pandemic has accelerated the need to enhance hygiene levels at primary and secondary schools and, specifically, nurturing and enforcing students' regular handwashing practices is one of the key components of a preventive strategy to reduce the transmission of infectious illnesses. Meanwhile, Virtual Reality (VR) intervention has been shown to be an efficacious tool for behavioural change. It manipulates an array of behavioural and environmental variables to construct an immersive virtual environment for changing certain human behaviours. VR handwashing education system may be more helpful than conventional verbal explanation in encouraging school children to wash their hands thoroughly, especially overcoming difficult to wash areas including wrists. Nevertheless, a school-based VR intervention on handwashing education is lacked in Hong Kong.

Objective:

This study aims to evaluate the effectiveness of a VR intervention on teaching handwashing skills which are promoted by the Centre for Health Protection, Department of Health, HKSAR. A 7-step handwashing approach will be taught through a customized VR game in secondary schools in Hong Kong. Participant's handwashing skills and prolonged effects on handwashing habits and hygiene level will be assessed.

Methods:

A 3-arm randomized controlled trial will be adopted. About 500 students will be assigned into 3 groups which will be randomly assigned on class-basis. Each group will receive two sessions of educational training with different kinds of intervention throughout one school year (9 months). The first intervention group will participate in two VR-game sessions on handwashing skill; the second intervention group will participate in one VR-game session and one video session about handwashing; the baseline group will participate in two sessions of other VR activities unrelated to hand hygiene and view a handwashing skill poster. Comparison of pre- and post-intervention hand-images of participants will serve as primary measurement. Ultraviolet-sensitive fluorescent lotion will be applied to the participants' hands and digital photos will be taken under UV lighting environment. Image comparisons will adopt quantitative method of calculating the percentage of fluorescent pixels over total hand areas. Post-intervention hand-images will be collected 3 months after the second intervention in order to capture any prolonged effect on handwashing over the whole intervention period. The secondary measures will be deployed through pre-invention, immediate post-intervention and follow-up (3 months after intervention) surveys. The survey will comprise scales measuring self-efficacy, knowledge on hand hygiene, handwashing habits and intentions, attitudes, subjective norms, and perceived behavioral control, VR embodiment and VR experience.

Results:

The project has already commenced in March 2026. The data collection period of the randomized controlled trial will be started from Sep 2026 and will end in May 2027. Data will be analyzed during June and August 2027, and the results are expected to be released in September 2027.

Conclusion:

This study contributes to existing knowledge about infection prevention strategy through VR game as well as the hand hygiene of the student population in Hong Kong and elsewhere. The study fills a number of research gaps in the field by (1.) developing evidence-based and executable VR hand hygiene programmes in school settings; (2.) addressing the ill-solved sustainability issue of hand hygiene intervention effects; (3.) identifying factors underlying the pathway of behavioural changes on hand hygiene and issues related to barriers to change, and (4.) identifying handwashing patterns through hand motion data shaping the hand hygiene level. The experiences and results from this VR game project can be also transferable to develop other programme regarding public health by adopting VR devices.

Study Type

Study Type

Describes the nature of a clinical study. Study types include interventional studies (also called clinical trials), observational studies (including patient registries), and expanded access.
Interventional

Enrollment (Estimated)

Enrollment

The number of participants in a clinical study. The "anticipated" enrollment is the target number of participants that the researchers need for the study.
500

Phase

Phase

The stage of a clinical trial studying a drug or biological product, based on definitions developed by the U.S. Food and Drug Administration (FDA). The phase is based on the study's objective, the number of participants, and other characteristics. There are five phases: Early Phase 1 (formerly listed as Phase 0), Phase 1, Phase 2, Phase 3, and Phase 4. Not Applicable is used to describe trials without FDA-defined phases, including trials of devices or behavioral interventions.
  • Not Applicable

Contacts and Locations

This section provides the contact details for those conducting the study, and information on where this study is being conducted.

Study Contact

Study Contact

The name and contact information for the person who can answer enrollment questions for a clinical study. Each location where the study is being conducted may also have a specific contact, who may be better able to answer those questions.
  • Name: Siu-lun Chow, PhD
  • Phone Number: 852+3917 1155
  • Email: chowcass@hku.hk

Study Locations

  • Hong Kong
      • Hong Kong, Hong Kong
        • Recruiting
        • School of Future Media, The University of Hong Kong
        • Contact:
          • King-wa Fu, Professor
          • Phone Number: 852+3917 1643
          • Email: kwfu@hku.hk
        • Principal Investigator:
          • King-wa Fu, Professor

Participation Criteria

Researchers look for people who fit a certain description, called eligibility criteria. Some examples of these criteria are a person's general health condition or prior treatments.

Eligibility Criteria

Eligibility Criteria

The key requirements that people who want to participate in a clinical study must meet or the characteristics they must have. Eligibility criteria consist of both inclusion criteria (which are required for a person to participate in the study) and exclusion criteria (which prevent a person from participating). Types of eligibility criteria include whether a study accepts healthy volunteers, has age or age group requirements, or is limited by sex.

Ages Eligible for Study

  • Child

Accepts Healthy Volunteers

Yes

Description

Inclusion Criteria:

  • Hong Kong secondary school students studying junior forms

Exclusion Criteria:

-

Study Plan

This section provides details of the study plan, including how the study is designed and what the study is measuring.

How is the study designed?

Design Details

  • Primary Purpose: Prevention
  • Allocation: Randomized
  • Interventional Model: Parallel Assignment
  • Masking: Double

Arms and Interventions

Participant Group / Arm

Participant Group / Arm

A group or subgroup of participants in a clinical trial that receives a specific intervention/treatment, or no intervention, according to the trial's protocol.
Intervention / Treatment

Intervention / Treatment

A process or action that is the focus of a clinical study. Interventions include drugs, medical devices, procedures, vaccines, and other products that are either investigational or already available. Interventions can also include noninvasive approaches, such as education or modifying diet and exercise.
Experimental: Intervention 1
Participants who attend two VR game sessions
Other: VR Handwashing Game (2 sessions)

The intervention will be a VR game taught about the '7-Steps approach' of hand-washing promoted by Centre for Health Protection, HKSAR. The game is comprised of two parts: Training Mode and Challenge Mode. In Training Mode, students will be guided with text and voice feedback. A pair of 'ghost hands' will demonstrate what to do. Students follow the movements of the 'ghost hands' to complete the handwashing tasks. In the Challenge Mode, students are requested to perform all the steps at once by their own memory, hints will be given only when they encounter setback in an assigned duration.

Trained facilitators will teach participants how to use the VR devices and provide briefing sessions on how to play the game.

For the Intervention Group 1, they will play the game in two separate sessions (about 4 months between the two sessions).
Experimental: Intervention 2
Participants who attend one VR game session and one video-based education session
Other: VR Handwashing Game (1 session) + Video on hand hygiene (1 session)
For Intervention Group 2, participants will attain one VR game session and 1 video-instructed session.
No Intervention: Baseline Group
Participants who attend two non-hand hygiene related VR activity sessions

What is the study measuring?

Primary Outcome Measures

Primary Outcome Measures

In a clinical study's protocol, the planned outcome measure that is the most important for evaluating the effect of an intervention/treatment. Most clinical studies have one primary outcome measure, but some have more than one.
Outcome Measure
Measure Description
Time Frame
Hand-imaging Data
Time Frame: Hand-imaging data will only be collected before the 1st intervention and at the end of the data collection period (about 9 months after the 1st intervention).
Ultraviolet-sensitive fluorescent lotion (e.g., Glo Germ™) will be applied on participants' hands thoroughly to simulate full contamination (e.g., germs and pathogens) on hands. Then participants wash their hands. The areas where lotion has been washed out are considered as 'decontaminated'. The participants will put their washed hands in a black box with an Ultraviolet-A (365nm) lighting system. Both palms and dorsa of left and right hands will be photographed.
Hand-imaging data will only be collected before the 1st intervention and at the end of the data collection period (about 9 months after the 1st intervention).

Secondary Outcome Measures

Secondary Outcome Measures

In a clinical study's protocol, a planned outcome measure that is not as important as the primary outcome measure for evaluating the effect of an intervention but is still of interest. Most clinical studies have more than one secondary outcome measure.
Outcome Measure
Measure Description
Time Frame
Knowledge on Hand Hygiene and Handwashing
Time Frame: This measurement will be collected through questionnaire pre-intervention, immediately after 1st intervention, after 2nd intervention (5 months after 1st intervention) and in the follow-up survey (9 months after 1st intervention).
As this study is focused on handwashing skills and steps, questionnaires on this field are usually customized for the context of the research (i.e., steps and skills can be differed between studies). As our interventions mainly teach about the 7-handwashing steps suggested by the Centre for Health Protection, Department of Health, HKSAR, five questions will be developed to assess participants' knowledge of the handwashing procedures.
This measurement will be collected through questionnaire pre-intervention, immediately after 1st intervention, after 2nd intervention (5 months after 1st intervention) and in the follow-up survey (9 months after 1st intervention).
Handwashing Habit
Time Frame: This measurement will be collected through questionnaire pre-intervention, immediately after 1st intervention, after 2nd intervention (5 months after 1st intervention) and in the follow-up survey (9 months after 1st intervention).
Two components on handwashing habit will be measured frequency of handwashing. Five items on how often the participants cleaned their hands on five different scenarios (before meal, after using washroom, after taking public transportation, after arriving at the school and after going back home) will be asked to measure the frequency of handwashing (5-point scale from 'never' to 'always'.
This measurement will be collected through questionnaire pre-intervention, immediately after 1st intervention, after 2nd intervention (5 months after 1st intervention) and in the follow-up survey (9 months after 1st intervention).
Attitude and Intention
Time Frame: This measurement will be collected through questionnaire pre-intervention, immediately after 1st intervention, after 2nd intervention (5 months after 1st intervention) and in the follow-up survey (9 months after 1st intervention).
The attitude on automaticity of handwashing habit will be measured by the Self-Report Behaviour Automaticity Index (SRBAI), which has already been modified and validated into four items regarding handwashing in another study. The sample item is 'Hand washing is something I start doing before I realise I'm doing it'. The four items are measured on a 7-point Likert scale, ranging from 1 ("does not apply to me at all") to 7 ("completely applies to me"). Behavioural intention will be measured by a single item : "In my daily routine, I want to perform hand hygiene as correctly as possible" on a 7-point Likert scale.
This measurement will be collected through questionnaire pre-intervention, immediately after 1st intervention, after 2nd intervention (5 months after 1st intervention) and in the follow-up survey (9 months after 1st intervention).

Collaborators and Investigators

This is where you will find people and organizations involved with this study.

Sponsor

Sponsor

The organization or person who initiates the study and who has authority and control over the study.
The University of Hong Kong

Publications and helpful links

The person responsible for entering information about the study voluntarily provides these publications. These may be about anything related to the study.

General Publications

Study record dates

These dates track the progress of study record and summary results submissions to ClinicalTrials.gov. Study records and reported results are reviewed by the National Library of Medicine (NLM) to make sure they meet specific quality control standards before being posted on the public website.

Study Major Dates

Study Start (Actual)

Study Start

The actual date on which the first participant was enrolled in a clinical study. The "anticipated" study start date is the date that the researchers think will be the study start date.
March 1, 2026

Primary Completion (Estimated)

Primary Completion

The date on which the last participant in a clinical study was examined or received an intervention to collect final data for the primary outcome measure. Whether the clinical study ended according to the protocol or was terminated does not affect this date. For clinical studies with more than one primary outcome measure with different completion dates, this term refers to the date on which data collection is completed for all the primary outcome measures. The "anticipated" primary completion date is the date that the researchers think will be the primary completion date for the study.
August 30, 2027

Study Completion (Estimated)

Study Completion

The date on which the last participant in a clinical study was examined or received an intervention/treatment to collect final data for the primary outcome measures, secondary outcome measures, and adverse events (that is, the last participant's last visit). The "anticipated" study completion date is the date that the researchers think will be the study completion date.
August 30, 2027

Study Registration Dates

First Submitted

First Submitted

The date on which the study sponsor or investigator first submitted a study record to ClinicalTrials.gov. There is typically a delay of a few days between the first submitted date and the record's availability on ClinicalTrials.gov (the first posted date).
June 15, 2026

First Submitted That Met QC Criteria

First Submitted That Met QC Criteria

The date on which the study sponsor or investigator first submits a study record that is consistent with National Library of Medicine (NLM) quality control (QC) review criteria. The sponsor or investigator may need to revise and submit a study record one or more times before NLM's QC review criteria are met. It is the responsibility of the sponsor or investigator to ensure that the study record is consistent with the NLM QC review criteria.
June 15, 2026

First Posted (Actual)

First Posted

The date on which the study record was first available on ClinicalTrials.gov after National Library of Medicine (NLM) quality control (QC) review has concluded. There is typically a delay of a few days between the date the study sponsor or investigator submitted the study record and the first posted date.
June 22, 2026

Study Record Updates

Last Update Posted (Actual)

Last Update Posted

The most recent date on which changes to a study record were made available on ClinicalTrials.gov. There may be a delay between when the changes were submitted to ClinicalTrials.gov by the study's sponsor or investigator (the last update submitted date) and the last update posted date.
June 22, 2026

Last Update Submitted That Met QC Criteria

Last Update Submitted That Met QC Criteria

The most recent date on which the study sponsor or investigator submitted changes to a study record that are consistent with National Library of Medicine (NLM) quality control (QC) review criteria. It is the responsibility of the sponsor or investigator to ensure that the study record is consistent with the NLM QC review criteria.
June 15, 2026

Last Verified

Last Verified

The most recent date on which the study sponsor or investigator confirmed the information about a clinical study on ClinicalTrials.gov as accurate and current. If a study with a recruitment status of recruiting; not yet recruiting; or active, not recruiting has not been confirmed within the past 2 years, the study's recruitment status is shown as unknown.
June 1, 2026

More Information

Terms related to this study

Keywords

Other Study ID Numbers

Other Study ID Numbers

Identifiers or ID numbers other than the NCT number that are assigned to a clinical study by the study's sponsor, funders, or others. These numbers may include unique identifiers from other trial registries and National Institutes of Health grant numbers.
  • 23244181

Plan for Individual participant data (IPD)

Plan to Share Individual Participant Data (IPD)?

NO

Drug and device information, study documents

Studies a U.S. FDA-regulated drug product

No

Studies a U.S. FDA-regulated device product

No

This information was retrieved directly from the website clinicaltrials.gov without any changes. If you have any requests to change, remove or update your study details, please contact register@clinicaltrials.gov. As soon as a change is implemented on clinicaltrials.gov, this will be updated automatically on our website as well.

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