Enhancing men's awareness of testicular diseases (E-MAT) using virtual reality: a randomised pilot feasibility study and mixed method process evaluation

Introduction
Testicular cancer is among the most common malignancies in men under the age of 50 years. Most testicular symptoms are linked to benign diseases. Men’s awareness of testicular diseases and testicular self-examination behaviours are suboptimal. In this pilot feasibility study and process evaluation we examine the feasibility of conducting a future definitive randomised controlled trial (RCT) to test the effect of the Enhancing Men’s Awareness of Testicular Diseases using Virtual Reality intervention (E-MAT_VR) compared to the Enhancing Men’s Awareness of Testicular Diseases using Electric information control (E-MAT_E). The study protocol is registered on ClinicalTrials.gov (NCT05146466).

Methods
Male athletes, engaged in Gaelic games, and aged 18 to 50 years were included. Recruitment was via Facebook^TM, X^TM (formerly Twitter^TM), and posters. Participants were individually randomised to either E-MAT_VR or E-MAT_E. Data were collected at baseline (T0), immediately post-test (T1), and three months post-test (T2) using surveys. Qualitative interviews were conducted with participants and researchers.

Results
Data were collected from 74 participants. Of those, 66 were retained. All E-MAT_VR participants and most E-MAT_E participants (n = 33, 89.2%) agreed/strongly agreed that the device was easy to use and that they were engaged to learn by the device. Most E-MAT_VR participants (n = 34, 91.9%) and all E-MAT_E participants agreed/strongly agreed that the time it took them to complete the intervention was reasonable. All 74 participants were extremely satisfied/somewhat satisfied with their overall participation in the study. E-MAT_VR was described as interactive, easy, fun, and close to real life. Initial difficulty using VR equipment, nausea, and technical issues were identified as challenges to engaging with E-MAT_VR. Recommendations were made to make VR more accessible, shorten the survey, and incorporate more interactivity. Across all participants, mean testicular knowledge scores (range 0–1) increased from 0.4 (SD 0.2) at T0 to 0.8 (SD 0.2) at T1. At T2, overall mean scores for participants were 0.7 (SD 0.2). Mean knowledge scores did not differ by trial arm at any timepoint. At T2, all E-MAT_VR participants and 29/32 E-MAT_E participants (90.6%) reported purposefully examining their testes within the past three months.

Conclusion
Findings are promising, highlighting the feasibility of using VR to promote young athletes’ awareness of testicular diseases. Considering the strengths, limitations, and lessons learned from this study, some modifications are required prior to conducing an RCT. These include but are not limited to shortening survey questions, incorporating more interactivity and visual content, and targeting more heterogenous male-dominated environments.