Primary caregivers’ perspectives on metaverse-based care training for home-based stroke care: a qualitative study

Every year, millions of people in China survive a stroke, a sudden blockage or bleed in the brain that leaves them with lasting physical challenges. While hospitals provide critical initial treatment, the long road to recovery usually happens at home. Here, the burden falls on family members—spouses, children, or parents—who become the primary caregivers. These individuals are tasked with helping a loved one relearn how to walk, eat, and speak, often without ever having received formal training in medical care. They must manage daily routines, prevent falls, and recognize when a medical emergency is happening again, all while navigating their own exhaustion and anxiety. The gap between what these caregivers need to know and what they actually know is a major barrier to successful recovery.

In recent years, technology has offered new ways to bridge this gap. Among the most promising is the concept of the "metaverse," a term that describes a shared, three-dimensional virtual space where people can interact using digital avatars. Unlike a standard video on a screen, this technology allows users to step inside a simulated world, look around in all directions, and practice actions repeatedly in a safe environment. For medical training, this means a caregiver could practice how to turn a patient in bed or handle a choking emergency without any risk of hurting the real person. Researchers have long suspected that such immersive tools could be more effective than traditional manuals or videos, but they lacked a clear understanding of whether the people who would actually use them—the family caregivers themselves—found them useful, understandable, or even safe.

A team of researchers from the Naval Medical University in Shanghai set out to answer these questions by listening directly to the people on the front lines. Between January and February 2026, they recruited twelve primary caregivers of stroke patients who were receiving care at home. These participants ranged in age from 35 to 62 and included both spouses and adult children. Because the idea of a "metaverse" is abstract and unfamiliar to many, the researchers did not simply ask the caregivers what they thought of it. Instead, they first showed the participants a short video and images demonstrating how the technology works, explaining how a virtual training session would look and feel. Only after the caregivers had a concrete picture of the technology did the researchers conduct in-depth interviews to explore their true needs, fears, and expectations.

The conversations revealed a stark reality: these caregivers feel unprepared and overwhelmed. The most pressing issue was a deep fear of high-risk emergencies. When a patient suddenly chokes on food, falls, or shows signs of another stroke, the caregivers described a paralyzing sense of helplessness. They often could not tell the difference between a normal recovery symptom and a dangerous warning sign, and when an emergency occurred, they froze, unsure of whether to call for help or try to intervene themselves. They lacked a clear, step-by-step guide for these critical moments. Beyond emergencies, their daily knowledge was fragmented. They learned bits and pieces from doctors during hospital stays, but once they returned home, that support vanished. They struggled to remember the correct angles for moving a patient's limbs or the safest way to feed someone with swallowing difficulties, constantly worrying that a small mistake could cause a new injury.

The emotional toll was just as heavy as the physical one. Caregivers described a life of constant vigilance, sleepless nights, and the stress of making life-or-death decisions alone. They felt isolated, with few outlets for their own emotional strain. While they appreciated the idea of talking to others in similar situations, their needs varied; some wanted emotional comfort and a listening ear, while others sought practical advice and shared tips on handling difficult behaviors.

When the researchers introduced the idea of metaverse-based training, the caregivers responded with cautious optimism. They immediately recognized the value of being able to see a procedure from every angle and to practice it over and over again until they felt confident. They imagined a system where they could make a mistake in the virtual world, receive instant feedback on what went wrong, and try again immediately. This "learning by doing" approach was a stark contrast to the passive experience of watching a video, where details are often missed or forgotten. They also expressed a strong desire for an intelligent assistant within the training that could answer their questions in real time, replacing the need to wait for a doctor to become available.

However, this enthusiasm was tempered by very practical concerns that could stop the technology from being used widely. First, many caregivers worried about the physical side effects of wearing virtual reality headsets, such as dizziness or nausea, especially since some of them or the patients they cared for had underlying health conditions like unstable blood pressure. Second, the cost was a significant barrier. These families had already spent heavily on medical treatment, and the idea of buying expensive new equipment for training was unappealing; they hoped for free or low-cost access. Finally, and perhaps most importantly, they questioned whether a virtual simulation could truly prepare them for the messy reality of home care. They worried that a computer-generated patient would be too cooperative, failing to teach them how to handle a real person who might be in pain, confused, or resistant to care.

The study concludes that while the potential of immersive technology to train family caregivers is real, its success depends on addressing these specific human and practical hurdles. The researchers suggest that future training programs should focus on the most dangerous scenarios where practice is most needed, such as emergency responses, rather than trying to simulate every aspect of daily life. They also recommend designing the software to be simple and accessible on devices people already own, like smartphones, to lower the cost and complexity. Most critically, the virtual training must be designed to include the unpredictability of real life, teaching caregivers not just the mechanics of care, but how to adapt when a patient reacts in an unexpected way. By listening to the people who will actually use these tools, the path forward becomes clearer: technology must serve the caregiver's reality, not just the designer's vision.