An iterative, user-centered design process to guide the development of a virtual reality (VR) experience that supports motivational interviewing for young adult drinking.

Background Brief motivational interventions (BMIs) reduce hazardous drinking among young adults, but their effects are modest, prompting interest in enhancements. BMIs may work partly by developing discrepancy between clients' current behavior and important life priorities or values. Virtual reality (VR) has been used to complement addiction treatment and facilitate transformative experiences. We developed Fresh Start , a VR experience designed to make this discrepancy tangible within a BMI, and evaluated it through iterative user research. Methods We used a mixed-methods, build-test-refine design across three cycles with 32 hazardous-drinking young adults (ages 18-35). In each cycle, participants completed a mock BMI and reviewed a progressively more complete VR prototype, from 2D still images (Cycle 1) to a "grey box" build (Cycle 2), and finally a fully-functional version embedded in a complete BMI session (Cycle 3). Participants thought aloud while using the prototype, then completed a semi-structured interview and an online survey rating acceptability, feasibility, appropriateness, usability, tolerability, and engagement. Results Participants found Fresh Start acceptable, feasible, and appropriate, with ratings near the top of each scale ( M s = 4.2-4.3 on a 1-5 scale) and higher ratings as prototype sophistication increased. Usability was good in both functional builds (Cycle 2 System Usability Scale M  = 84.6, SD  = 8.5; Cycle 3 M  = 75.0, SD  = 9.0). Functional builds were safe and well tolerated, with mild, transient symptoms, low simulator sickness scores, and no serious adverse events. By Cycle 3, when counselors asked what Fresh Start made them think about, nearly all participants reflected on the intended discrepancy. Conclusions Fresh Start is an acceptable, feasible, and safe way to incorporate VR into BMIs for young adults, and it reliably prompts users to reflect on the discrepancy it was designed to highlight. Future research will conduct a fully powered randomized controlled trial testing its effect on alcohol-related outcomes among mandated college students.