Feasibility and usability of a virtual reality intervention to enhance men’s awareness of testicular disorders (E-MAT)

  • Mohamad M. SaabEmail author
  • Margaret Landers
  • Eoghan Cooke
  • David Murphy
  • Josephine Hegarty
Original Article


Testicular cancer is the most common cancer among men younger than 50, and benign testicular disorders such as torsion and epididymitis can be life-threatening if left untreated. Men’s awareness of testicular disorders is lacking, and their intentions to see help for symptoms of testicular disease are low. This study aimed to describe the development, feasibility, and usability of a virtual reality (VR) intervention designed to enhance men’s awareness of testicular disorders (E-MAT). We designed E-MAT as a three-level VR experience and tested its feasibility and usability with 15 men recruited from a university. Following exposure to the intervention, participants filled a 43-item questionnaire. Participants agreed that the technology was comfortable to use, testicular disorders were well represented, the use of light humor was appropriate, and the scientific facts were easy to understand. Participants also agreed that the intervention was suited for men from different sociodemographic backgrounds and felt confident using VR. Overall, participants perceived the intervention as user-friendly, enjoyable, and aesthetically appealing. To the best of our knowledge, VR has not been used to promote men’s health in the past, let alone increasing their awareness and help seeking for testicular disorders. We recommend testing the effectiveness of E-MAT and making it available on public platforms that men can access at their own leisure. VR can be used in future interventions to educate men about various health topics.


Feasibility Health promotion Testicular cancer Testicular diseases Usability Virtual reality 



This study was supported by a PhD scholarship granted by the School of Nursing and Midwifery, University College Cork.

Compliance with ethical standards

Conflict of interest

The authors declare that they have no conflict of interest.

Ethical approval

Granted by the Clinical Research Ethics Committee, University College Cork, Ireland, ECM 4 (ss) 15/11/16.


  1. Baker P, Dworkin SL, Tong S, Banks I et al (2014) The men’s health gap: men must be included in the global health equity agenda. Bull World Health 92:618–620CrossRefGoogle Scholar
  2. Bayne CE, Villanueva J, Davis TD et al (2017) Factors associated with delayed presentation and misdiagnosis of testicular torsion: a case-control study. J Pediatr 186:200–204CrossRefGoogle Scholar
  3. Brooke J (1996) SUS: a “quick and dirty” usability scale. In: Jordan PW, Thomas B, Weerdmeester BA, McClelland AL (eds) Usability evaluation in industry. Taylor and Francis, LondonGoogle Scholar
  4. Brooke J (2013) SUS: a retrospective. JUS 8:29–40Google Scholar
  5. Brown CG, Patrician PA, Brosch LR (2012) Increasing testicular self-examination in active duty soldiers: an intervention study. Medsurg Nurs 21:97–102Google Scholar
  6. Cardoş RAI, David OA, David DO (2017) Virtual reality exposure therapy in flight anxiety: a quantitative meta-analysis. Comput Hum Behav 72:371–380CrossRefGoogle Scholar
  7. Clark K, JaNeille S, Gerry H (2011) Testicular torsion: a case study and evaluation of young men’s knowledge about testicular pain. W Va Med J 107:35–37Google Scholar
  8. Craig P, Dieppe P, Macintyre S et al (2013) Developing and evaluating complex interventions: the new medical research council guidance. Int J Nurs Stud 50:587–592CrossRefGoogle Scholar
  9. Dhiman A, Solanki D, Bhasin A et al (2016) Design of adaptive haptic-enabled virtual reality based system for upper limb movement disorders: a usability study. IEEE Xplore. CrossRefGoogle Scholar
  10. Elo S, Kyngäs H (2008) The qualitative content analysis process. J Adv Nurs 62:107–115CrossRefGoogle Scholar
  11. Evans RE, Beeken RJ, Steptoe A, Wardle J (2012) Cancer information and anxiety: applying the Extended Parallel Process Model. J Health Psychol 17:579–589CrossRefGoogle Scholar
  12. Fernandes AS, Feiner SK (2016) Combating VR sickness through subtle dynamic field-of-view modification. IEEE Xplore. CrossRefGoogle Scholar
  13. Flesch RF (1981) How to write plain English. Barnes & Noble, New YorkGoogle Scholar
  14. Foreman M, Engsberg JR (2017) Feasibility of a virtual reality interface for shaping compensation during motor rehabilitation. Am J Occup Ther. CrossRefGoogle Scholar
  15. Gomez-Rodriguez M, Peters J, Hill J et al (2011) Closing the sensorimotor loop: haptic feedback facilitates decoding of motor imagery. J Neural Eng 8:1–12CrossRefGoogle Scholar
  16. Gordhan CG, Sadeghi-Nejad H (2015) Scrotal pain: evaluation and management. Korean J Urol 5:3–11CrossRefGoogle Scholar
  17. Hashibe M, Abdelaziz S, Al-Temimi M et al (2016) Long-term health effects among testicular cancer survivors. J Cancer Surviv 10:1051–1057CrossRefGoogle Scholar
  18. He J, Freeman LA (2010) Are men more technology-oriented than women? the role of gender on the development of general computer self-efficacy of college students. J Inf Syst Educ 21:203–212Google Scholar
  19. Hinton PR, Brownlow C, McMurray I, Cozens B (2004) SPSS explained. Routledge, LondonGoogle Scholar
  20. Jensen JD, King AJ, Davis LA, Guntzviller LM (2010) Utilization of internet technology by low-income adults: the role of health literacy, health numeracy, and computer assistance. J Aging Health 22:804–826CrossRefGoogle Scholar
  21. Kandalaft MR, Didehbani N, Krawczyk DC et al (2013) Virtual reality social cognition training for young adults with high-functioning autism. J Autism Dev Disord 43:34–44CrossRefGoogle Scholar
  22. Kedzierewicz R, Chargari C, Le Moulec S et al (2011) Knowledge and screening of testicular cancer in the French armed forces: a prospective study. Mil Med 176:1188–1192CrossRefGoogle Scholar
  23. Kennett A, Shaw JW, Woolley PD (2014) Testicular self-examination amongst genitourinary medicine clinic attendees. Int J STD AIDS 25:844–850CrossRefGoogle Scholar
  24. Lemole GM, Banerjee PP, Luciano C et al (2007) Virtual reality in neurosurgical education: part-task ventriculostomy simulation with dynamic visual and haptic feedback. Neurosurgery 61:142–149CrossRefGoogle Scholar
  25. Lloréns R, Noé E, Colomer C, Alcañiz M (2015) Effectiveness, usability, and cost-benefit of a virtual reality-based telerehabilitation program for balance recovery after stroke: a randomized controlled trial. Arch Phys Med Rehabil 96:418–425CrossRefGoogle Scholar
  26. McCullagh J, Lewis G, Warlow C (2005) Promoting awareness and practice of testicular self-examination. Nurs Stand 19:41–49CrossRefGoogle Scholar
  27. Miloff A, Lindner P, Hamilton W (2016) Single-session gamified virtual reality exposure therapy for spider phobia vs. traditional exposure therapy: study protocol for a randomized controlled non-inferiority trial. BioMed Central. CrossRefGoogle Scholar
  28. Mind Commerce (2016) Virtual reality market outlook: technology, solutions, content, and applications 2016–2021. Accessed 22 Feb 2018
  29. Nabi RL (2016) Laughing in the face of fear (of disease detection): using humor to promote cancer self-examination behaviour. Health Commun 31:873–883CrossRefGoogle Scholar
  30. National Cancer Institute (2016) SEER stat fact sheets: testis cancer. Accessed 22 Feb 2018
  31. Oliffe JL, Ogrodniczuk J, Bottorff JL et al (2009) Connecting humor, health, and masculinities at prostate cancer support groups. Psychooncology 18:916–926CrossRefGoogle Scholar
  32. Oliveira CR, Lopes Filho BJ, Sugarman MA et al (2016) Development and feasibility of a virtual reality task for the cognitive assessment of older adults: the ECO-VR. Span J Psychol 19:E95CrossRefGoogle Scholar
  33. Oosterom-Calo R, López R (2016) Teaching older adults with multiple chronic conditions to use a tablet and patient application for health management. In: International conference on human aspects of IT for the aged population, pp 342–351Google Scholar
  34. Orsmond GI, Cohn ES (2015) The distinctive features of a feasibility study: objectives and guiding questions. OTJR Thorofare N J 35:169–177Google Scholar
  35. Powe BD, Ross L, Wilkerson D et al (2007) Testicular cancer among African American college men: knowledge, perceived risk, and perceptions of cancer fatalism. Am J Men’s Health 1:73–80CrossRefGoogle Scholar
  36. Rioja J, Sánchez-Margallo FM, Usón J, Rioja LA (2011) Adult hydrocele and spermatocele. BJU Int 107:1852–1864CrossRefGoogle Scholar
  37. Robinson M, Robertson S (2010) Young men’s health promotion and new information communication technologies: illuminating the issues and research agendas. Health Promot Int 25:363–370CrossRefGoogle Scholar
  38. Saab M, Noureddine S, Huijer HAS, Dejong J (2014) Surviving testicular cancer: the Lebanese lived experience. Nurs Res 63:203–210CrossRefGoogle Scholar
  39. Saab MM, Landers M, Hegarty J (2016a) Males’ awareness of benign testicular disorders: an integrative review. Am J Mens Health. CrossRefGoogle Scholar
  40. Saab MM, Landers M, Hegarty J (2016b) Promoting testicular cancer awareness and screening: a systematic review of interventions. Cancer Nurs 39:473–487CrossRefGoogle Scholar
  41. Saab MM, Landers M, Hegarty J (2016c) Testicular cancer awareness and screening practices: a systematic review. Oncol Nurs Forum 43:E8–E23CrossRefGoogle Scholar
  42. Saab MM, Landers M, Hegarty J (2017a) Exploring men’s preferred strategies for learning about testicular disorders inclusive of testicular cancer: a qualitative descriptive study. Eur J Oncol Nurs 26:27–35CrossRefGoogle Scholar
  43. Saab MM, Landers M, Hegarty J (2017b) Exploring awareness and help-seeking intentions for testicular symptoms among heterosexual, gay, and bisexual men in Ireland: a qualitative descriptive study. Int J Nurs Stud 67:41–50CrossRefGoogle Scholar
  44. Saab MM, Landers M, Hegarty J (2018a) The preconscious awareness to action framework: an application to promote testicular awareness. Nurs Res 67:169–176CrossRefGoogle Scholar
  45. Saab MM, Reidy M, Hegarty J et al (2018b) Men’s information-seeking behaviour regarding cancer risk and screening: a meta-narrative systematic review. Psychooncology 27:410–419CrossRefGoogle Scholar
  46. Shallwani K, Ramji R, Ali TS, Khuwaja AK (2010) Self examination for breast and testicular cancers: a community-based intervention study. Asian Pac J Cancer Prev 11:383–386Google Scholar
  47. Shanmugalingam T, Soultati A, Chowdhury S et al (2013) Global incidence and outcome of testicular cancer. Clin Epidemiol 17:417–427Google Scholar
  48. Shteynshlyuger A, Yu J (2013) Familial testicular torsion: a meta analysis suggests inheritance. J Pediatr Urol 9:683–690CrossRefGoogle Scholar
  49. Sigrist R, Rauter G, Riener R, Wolf P (2013) Augmented visual, auditory, haptic, and multimodal feedback in motor learning: a review. Psychon Bull Rev 20:21–53CrossRefGoogle Scholar
  50. Sprauten M, Darrah TH, Peterson DR et al (2012) Impact of long-term serum platinum concentrations on neuro- and ototoxicity in cisplatin-treated survivors of testicular cancer. J Clin Oncol 20:300–307CrossRefGoogle Scholar
  51. Szymanski DM, Henard DH (2001) Customer satisfaction: a meta-analysis of the empirical evidence. J Acad Mark Sci 29:16–35CrossRefGoogle Scholar
  52. Thornton CP (2015) Best practice in teaching male adolescents and young men to perform testicular self-examinations: a review. J Pediatr Health Care 30:518–527CrossRefGoogle Scholar
  53. Trojian TH, Lishnak TS, Heiman D (2009) Epididymitis and orchitis: an overview. Am Fam Physician 79:583–587Google Scholar
  54. Umeh K, Chadwick R (2016) Early detection of testicular cancer: revisiting the role of self-efficacy in testicular self-examination among young asymptomatic males. J Behav Med 39:151–160CrossRefGoogle Scholar
  55. van der Meijden OAJ, Schijven MP (2009) The value of haptic feedback in conventional and robot-assisted minimal invasive surgery and virtual reality training: a current review. Surg Endosc 23:1180–1190CrossRefGoogle Scholar
  56. Vankipuram A, Khanal P, Ashby A et al (2014) Design and development of a virtual reality simulator for advanced cardiac life support training. IEEE J Biomed Health Inform 18:1478–1484CrossRefGoogle Scholar
  57. Verhagen T, Feldberg F, van den Hooff B, Meents S, Merikivi J (2011) Satisfaction with virtual worlds: an integrated model of experiential value. Inf Manag 6:201–207CrossRefGoogle Scholar
  58. Wampler SM, Llanes M (2010) Common scrotal and testicular problems. Prim Care 37:613–626CrossRefGoogle Scholar
  59. Whitehead AL, Sully BG, Campbell MJ (2014) Pilot and feasibility studies: is there a difference from each other and from a randomised controlled trial? Contemp Clin Trials 38:130–133CrossRefGoogle Scholar
  60. Yoo BN, Choi KS, Jung KW, Jun JK (2012) Awareness and practice of breast self-examination among Korean women: results from a nationwide survey. Asian Pac J Cancer Prev 13:123–125CrossRefGoogle Scholar

Copyright information

© Springer-Verlag London Ltd., part of Springer Nature 2018

Authors and Affiliations

  1. 1.School of Nursing and MidwiferyUniversity College CorkCorkIreland
  2. 2.Department of Computer ScienceUniversity College CorkCorkIreland

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