Abstract
BACKGROUND: College students are at a critical stage for forming long-term dietary habits. Nutrition literacy (NL) plays a key role in enabling informed food choices and supporting overall health. Virtual reality (VR) offers emerging opportunities for nutrition education by providing immersive and interactive learning experiences that may enhance engagement and behavior change. This pilot randomized controlled trial examined the preliminary effectiveness of a VR-enhanced nutrition education program in improving NL, self-efficacy, and dietary behaviors among college students, by comparing outcomes between app-based interventions with and without VR components. METHODS: This pilot randomized controlled trial was conducted from March to June 2023 and approved by the institutional review board (IRB No. NCKU HREC-E-111-022-2). Participants were recruited from a private university in Southern Taiwan and randomly assigned to one of three groups: Control (n = 51), App (n = 48), and App + VR (n = 52). The App group received a 5-week mobile app-based NL program, while the App + VR group received the same program plus three additional VR-based challenge tasks. NL, self-efficacy, and dietary behaviors were assessed at baseline, post-intervention, and one-month follow-up. Group-by-time effects were analyzed using generalized estimating equations. RESULTS: Compared to baseline, both the App group and App + VR group demonstrated significant improvements in NL, self-rated NL, self-efficacy, and dietary behaviors, whereas no significant changes were observed in the Control group. At post-intervention, both intervention groups outperformed the Control group in self-rated NL and dietary behaviors. The App group showed significant gains in NL test scores, while the App + VR group exhibited greater improvements in self-efficacy. At one-month follow-up, both intervention groups sustained improvements in dietary behaviors. The App group maintained significant gains in NL test scores, whereas the App + VR group sustained improvements in self-efficacy. No statistically significant differences were found between the two intervention groups on any outcome measures at either post-test or follow-up. CONCLUSION: These findings suggest that different digital formats may support distinct learning outcomes, with immersive technologies like VR potentially contributing to the reinforcement of self-efficacy. Future research is needed to evaluate the long-term impact and cost-effectiveness of VR-based nutrition education across broader populations.