This is the first study to develop and evaluate a metaverse-based intervention specifically designed for adolescents with spina bifida (SB). Adolescents with SB face challenges in developing self-management skills and peer relationships, both critical for healthcare transition [1]. Avatar-based interactions in the metaverse offer psychological safety and reduced stigma that may facilitate engagement in sensitive health discussions [2]. It is hypothesized that a metaverse-based program grounded in the Life Course Model would be feasible and acceptable for supporting healthcare transition among adolescents with SB. This study aimed to: (1) develop a metaverse-based healthcare transition program; and (2) evaluate its feasibility and acceptability among adolescents with SB.

This pilot study followed the Medical Research Council framework for complex interventions, encompassing the development and feasibility phases [3]. The program was developed based on the Life Course Model, addressing three domains: self-management and health, personal and social relationships, and major life areas. Content validity was established through a seven-member expert panel, with all sessions achieving a content validity index exceeding 0.80. The intervention comprised four 60-minute weekly sessions delivered via a metaverse platform, incorporating animated educational videos on SB self-management (bladder and bowel management, mobility, healthcare systems, and sexual health), quizzes, mentorship from an undergraduate student with SB and paediatric nurse practitioners, and peer discussion activities. Eight adolescents with SB (aged 13–15 years) were recruited from a tertiary SB clinic using convenience sampling. Eligibility criteria included current middle school enrolment, ability to use digital devices, no cognitive impairments, and voluntary assent with parental consent. Feasibility was assessed using predefined criteria: ≥75% attendance, ≥80% retention, and <20% survey attrition. Acceptability was measured via a 16-item satisfaction questionnaire (10-point scale). Pre- and post-intervention questionnaires assessed self-management, transition readiness, self-efficacy, social support, sexuality knowledge, SB-related worries, career preparation, and health-related quality of life. Quantitative data were analysed using Wilcoxon signed-rank tests, and semi-structured interviews were analysed using thematic analysis.

All eight participants (mean age 14.6 years, SD = 0.7) completed the programme, achieving 100% retention and attendance, exceeding all predefined feasibility thresholds. Half had lipomyelomeningocele, 62.5% required clean intermittent catheterization, and 37.5% reported urinary and fecal incontinence. Acceptability was high, with mean satisfaction scores of 9.25/10 for the overall program and 9.13/10 for the metaverse platform. Although mean scores on all outcome measures improved, none reached statistical significance. Qualitative analysis yielded four themes: (1) barriers and adaptation in the metaverse–initial technical difficulties were quickly overcome; (2) positive affect and engagement–the avatar-based format enhanced motivation; (3) emotional support through mentorship–connecting with peers with similar conditions reduced isolation and stigma; and (4) improved understanding of SB-related challenges–participants gained greater awareness of self-management strategies, sexuality, and future planning.

The 100% retention and high satisfaction scores provide strong preliminary evidence that a metaverse-based intervention is both feasible and acceptable for adolescents with SB. Avatar-based anonymity appeared to facilitate open discussion of sensitive topics, including sexuality and self-management, which are often difficult to address in conventional clinical settings. The absence of statistically significant changes is expected given the small sample size and brief intervention.

Metaverse platforms represent a feasible and acceptable modality for delivering transition-related health education and psychosocial support to adolescents with SB. Healthcare providers should consider incorporating avatar-based virtual platforms as complementary tools to conventional transition services, particularly for addressing sensitive topics. Future research should evaluate efficacy in larger, multi-center randomized controlled trials with longer follow-up.

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