ARCS-Informed Comparison of AR and 2D Video on Adolescent BSE Motivation: A Randomized Trial and Practical Recommendations

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Khasanah, H. Riska, Umri BK, AC Mustamu This is a preprint; it has not been peer reviewed by a journal. https://doi.org/ 10.21203/rs.3.rs-7810566/v1 This work is licensed under a CC BY 4.0 License Status: Posted Version 1 posted You are reading this latest preprint version Abstract Breast Self-Examination (BSE) or SADARI is a very important method for early detection of breast cancer, especially for adolescent girls. However, adolescent motivation to perform BSE regularly is still low due to limited knowledge and the lack of interesting educational media. This study aims to compare the effect of Augmented Reality (AR)-based learning media and 2D videos on adolescent motivation to perform BSE using the ARCS motivation model as measured by the Teaching Materials Motivation Survey (IMMS). The method used was a non-randomized two-arm quasi-experimental design with a total of 149 female participants in grade 10 of high school in Yogyakarta, Indonesia, who were divided into two intervention groups. Data analysis using the Mann–Whitney U test showed that the AR group had significantly higher motivation scores on the Attention, Confidence, and Satisfaction dimensions compared to the 2D video group (p < 0.001). However, no significant difference was found in the Relevance dimension (p = 0.059). These findings suggest that both media deliver relevant content, but AR is more effective in capturing attention, increasing self-confidence, and providing higher learning satisfaction for adolescents. This study recommends the use of AR as a more effective educational strategy to increase adolescent motivation and proactive behavior in performing BSE, with the hope of supporting early breast cancer detection. Further studies are needed to examine the long-term impact of using AR in health education. Augmentes Reality (AR) 2D Video Adolescent BSE Motivation IMMS & ARCS Model 1. INTRODUCTION Learning motivation is a crucial factor in the success of the educational process, particularly in adolescent health education. The ARCS model, developed by John Keller, consists of Attention, Relevance, Confidence, and Satisfaction, and has been shown to significantly increase learning motivation. This model is widely used in various instructional designs to optimize student engagement by tailoring learning materials to be more engaging and relevant to their needs, while also building self-confidence through positive feedback and satisfying learning outcomes (Keller, 1987 ; Nur et al., 2023 ). Recent studies applying the ARCS model to video-based learning have shown to significantly improve student motivation and learning outcomes (Ananda et al., 2023 ). Furthermore, this model also plays a role in creating a learning environment that supports students' basic psychological needs, thereby strengthening intrinsic motivation, learning continuity, and active engagement (Aimah & Ifadah, 2014 ; Pratiwi et al., 2023 ). Therefore, the application of the ARCS model is an effective strategy in increasing learning motivation, especially in the context of adolescent health education which requires a high level of understanding and awareness of the importance of preventive measures such as breast self-examination (BSE). An innovative strategy to increase motivation and learning outcomes, AR and 2D video can be used as digital media to support health education. AR provides the impression of enhancing an immersive and interactive learning experience that can combine theoretical knowledge with practical applications and is engaging for its users. Thus, the use of AR can increase student engagement in the context of health education. According to Krüger et al., 2022 , the abstract three-dimensional concept in AR facilitates cognitive activation and maximizes understanding when compared to the use of conventional media such as 2D video. Other studies also state that student learning outcomes using AR can significantly increase student activation and focus, although sometimes learning outcomes are not higher than those of students using 2D video. This is likely due to the fact that technological innovations can distract students (Geana et al., 2023 ). However, AR can increase student motivation and interest in learning, so students have great potential to improve learning outcomes in the long term (Bölek et al., 2021; Moro et al., 2017 ). Thus, the integration of AR as a learning medium for health education for adolescents can be reviewed with a more mature instructional design approach and can increase the potential for learning motivation, resulting in optimization in learning. 2D video remains a popular medium for use in health education due to its ease of use and accessibility. In delivering health education to adolescents, 2D video has also proven effective in increasing knowledge and healthy behaviors, such as BSE. Numerous studies have demonstrated and confirmed that 2D video can significantly improve understanding and recall of information using simple and accessible delivery methods for diverse audiences (Alim et al., 2024 ; Urlings et al., 2022 ). However, significant differences emerge in levels of motivation and engagement due to differences in learning media, with AR tending to be superior in increasing self-confidence, learning experiences, and immersive emotional engagement compared to 2D video (Takeuchi et al., 2024 ; Siddiqui et al., 2025 ). While 2D video is considered effective in delivering learning materials, AR provides an additional dimension. Sadek et al., 2023 , stated that increasing learning motivation and learning experiences may facilitate long-term learning efforts. Therefore, AR media integration can contribute significantly to superior potential compared to the use of 2D video in the context of adolescent health education. Study aims to examine the important role of motivation in breast self-examination (BSE) among adolescents as an early cancer detection effort that relies heavily on awareness and proactive actions from the adolescents themselves. Psychological factors such as perceived self-efficacy, perceived severity, and social support are believed to influence BSE motivation and behavior in adolescents (Elizar et al., 2024 ; Al Sharbatti et al., 2022 ). This study will also explore how positive perceptions of the benefits of BSE screening and awareness of breast cancer risks increase adolescents' motivation to undergo regular screening (Dewi et al., 2022 ). Furthermore, social support from family and peers can address psychological disorders and increase self-confidence in undergoing BSE (Ahmadian & Abu Samah, 2016 ). Therefore, the use of technology as an integrated approach with the ARCS model to increase learning engagement and motivation is an appropriate and potential strategy for empowering adolescents to perform BSE regularly, thereby optimizing early detection and reducing breast cancer mortality. Comparing the use of AR and 2D video in the context of motivation for BSE implementation in adolescents is urgently needed for research to provide empirical evidence and recommendations that align with the design of digital media-based health education interventions. Randomized controlled trials are an appropriate method for validly and objectively evaluating the impact of both learning media, so that the results can be used as a basis for developing best practices in health education for adolescents. Recent studies have shown that multimedia-based videos effectively improve knowledge and attitudes regarding BSE, while AR applications have the potential to significantly increase engagement and motivation to learn (Karimian et al., 2022 ; Damayanti et al., 2024 ). The use of animated videos has also been shown to significantly improve BSE practical skills, helping adolescents better understand the procedure (Syafitra, 2024 ; Ananda et al., 2023 ). However, research directly comparing the two media in a randomized manner is still limited, so further research is needed to strengthen the evidence and optimize the design of adolescent health education interventions using AR and 2D video technology (Abni et al., 2024 ). 2. MATERIALS AND METHODS Study used a two-arm quasi-experimental design (post-test only, non-equivalent groups) with the aim of comparing education from AR and conventional 2D Video for motivation among adolescents to perform BSE. This study was conducted at SMA 04 Yogyakarta City, Indonesia in the period of July-August 2025. The population that participated in this study was 149 adolescents who were all high school students in grade X, sampling was carried out using a non-probability technique (non-random) adjusting the availability of classes and sessions according to the initial agreement between the homeroom teacher and researchers, group allocation was not randomized (the determination followed a separate class schedule to minimize contamination). Inclusion criteria included female adolescents aged 15–17 years, present at the intervention session, able to follow instructions, and providing written consent; guardian consent was collected according to ethical provisions, with the homeroom teacher acting as the school administration gatekeeper. Exclusion criteria included currently/having participated in BSE training in the last 6 months, cognitive/visual barriers that interfere with participation, or not completing the session. A total of 149 responses were collected; After data cleaning (completeness of total IMMS items with listwise deletion, consistency check including unfavorable items after reverse coding, detection of anomalous response patterns—straight-lining/very fast filling times—and duplicate entries), 9 responses were excluded (6.0%), resulting in 140 analyzed (final distribution: AR = 70; 2D = 70). Both groups received content with equivalent duration, learning objectives, and script (rationale for BSE, appropriate implementation time, and technical steps of the examination). The AR group received a ± 45-minute session through an AR application that began with a prologue on breast cancer prevalence (urgency context), followed by material on the rationale for BSE, appropriate implementation time, and technical steps of the examination. The instructional design refers to the ARCS model including Attention (Story hook, Variability, Guided motion & pacing, interactive 3D overlay, hotspots), Relevance realized with scenarios/explanations close to the adolescent context, Confidence with step-by-step procedures and immediate feedback, Satisfaction with progress indicators and positive reinforcement. The 2D video group watched material with identical duration, script, and learning objectives but presented linearly without interactivity (audiovisual variations and summaries of key points were maintained) through pattern breaks (short visual cuts), zooms at critical moments, and text/icon callouts at times equivalent to highlights in AR. Content equivalence was maintained through identical storyboards and scripts, equivalent duration, similar learning environments, and consistent instructors and devices. Fidelity of implementation was monitored using a standardized checklist, and time-on-task was recorded in both groups. Primary outcome was motivation towards the instructional materials assessed immediately after the session using the Instructional Materials Motivation Survey (IMMS), an instrument developed by John M. Keller based on the ARCS (Attention, Relevance, Confidence, Satisfaction) model. This study used an Indonesian language version adapted from the original IMMS for the BSE context. This study used an Indonesian language version adapted from the original IMMS for the BSE context. Content validity was evaluated by a panel of three experts in health education, community nursing, and information systems who rated the relevance of each item on a scale of 1–4. Content validity showed that the I-CVI per item was in the range of 0.667–1.000 with 34 of the 36 items achieving an I-CVI = 1.00 (panel of three experts). S-CVI/Ave = 0.981, indicating excellent content validity of the scale. Two items (Item 8 and Item 36) required revision (I-CVI = 0.667). Panel feedback was used for editorial refinement until the content validity threshold was met. Afterward, a number of unfavorable statements were retained to minimize acquiescence bias and reverse-scored before analysis using the formula (new score = 6 − original score) to ensure all items were unidirectional. Data analysis was performed using IBM SPSS version 31.0. Descriptive statistics are reported as N, mean ± SD, Min–Max, and 95% confidence interval (CI). Distributional assumptions were checked using Shapiro–Wilk for normality per group and Levene's for homogeneity of variance. Given that at least one group violated normality and variance was inhomogeneous, two-group comparisons were conducted using the Mann–Whitney U test (two-tailed). Results are reported as U, Z, p-values ​​for asymptotic and Monte Carlo simulations of 10,000 simulations, and the effect size r using the formula r = |Z| / √N (0.10 small; 0.30 medium; 0.50 large). The significance threshold was α = 0.05 (two-tailed). The protocol was approved by the ethics committee of Respati University Yogyakarta with 047.3/FIKES/PL/VI/2025 dated June 10, 2025. All participants and, where required, guardians signed written informed consent. The study adhered to the Declaration of Helsinki. 3. RESULT Table 1 Descriptive Statistics of Adolescents' Motivation to Perform BSE Dimension / Variable Group N Mean ± SD 95% CI (Lower-Upper) Min–Max IMMS Attention AR 70 36.61 ± 2.55 36.01–37.22 30–44 Video 70 34.20 ± 3.41 33.39–35.01 26–44 IMMS Relevance AR 70 31.47 ± 4.49 30.40–32.54 25–45 Video 70 29.91 ± 3.70 29.03–30.80 20–41 IMMS Confidence AR 70 28.57 ± 2.05 28.08–29.06 23–34 Video 70 27.09 ± 2.11 26.58–27.59 22–34 IMMS Satisfaction AR 70 21.14 ± 3.79 20.24–22.05 14–30 Video 70 19.14 ± 3.91 18.21–20.08 10–27 IMMS Total AR 70 117.80 ± 9.02 115.65–119.95 106–139 Video 70 110.34 ± 8.81 108.24 – 112.44 91– 130 Research data showed significant differences in motivation levels between the group of adolescents using AR education and those using conventional 2D video education. Motivation was measured using four main variables in the IMMS instrument: Attention, Relevance, Confidence, and Satisfaction. Learning using AR media proves its superiority with consistent scores on all motivational variables when compared to 2D video media. This means that the use of AR is more effective than the use of 2D video media. The Attention variable in AR media, gets a scope of 36.61 with a standard deviation showing 2.55. This far exceeds the Attention variable in 2D video media 34.20 (± 3.41). From these variables, AR media has the ability to maintain and significantly increase student cognitive engagement during learning. In addition, the Relevance variable also shows that AR is superior to 2D video. AR media on this variable gets a score of 31.47 (± 4.49), and 2D video gets a score of 29.91 (± 3.70), this indicates that the use of AR media is more appropriate to learning needs. The Confidence variable also showed a higher score for AR than for 2D video, with AR scoring 28.57 (± 2.05), while 2D video scored 27.09 (± 2.11), demonstrating increased student confidence in understanding learning through AR. The Satisfaction variable also showed a similar result, with AR outperforming 21.14 (± 3.79), while 2D video scored 19.14 (± 3.91). Evidence that each variable scored higher for AR than 2D video demonstrates that students experienced a more engaging learning experience using AR. In addition, this study also measured IMMS which showed that AR got a score of 117.80 (± 9.02), then compared to 2D video media which got 110.34 (± 8.81), of course both of these things confirm that by using AR media, not only can it increase motivation in cognitive and affective contexts, but also have a positive impact on the student learning experience sector significantly. This finding emphasizes the importance of integration in interactive technologies such as AR as a means of improving the quality of learning for the next generation. This study confirms that AR education can significantly increase adolescent learning motivation (BSE) compared to conventional 2D video education methods. This demonstrates AR's potential as an effective and innovative learning medium for increasing student engagement and motivation. Table 2 Mann–Whitney U Test of Motivation Scores for BSE (SADARI) in AR vs. 2D Video Education Groups Variable/Dimension U Z p-value r (EffectSize) Interpretation IMMS Attention 1377.500 -4.517 < 0.001 0,38 Moderate–large IMMS Relevance 2002.000 -1.891 0.059 0,38 Moderate–large IMMS Confidence 1537.000 -3.894 < 0.001 0,16 Small IMMS Satisfaction 1638.500 -3.400 < 0.001 0,33 Moderate IMMS Total 1374.500 -4.487 < 0.001 0,29 Moderate Further analysis of this research the Mann-Whitney U test, which demonstrated significant differences between AR and 2D video in total motivation scores (p < 0.001) and most of the measured motivational variables, namely Attention (p < 0.001), Confidence (p < 0.001), and Satisfaction (p < 0.001). The moderate to large differences indicate a substantial impact. However, for the Relevance variable, the difference between AR and 2D video did not reach significance (p = 0.059). Both AR and 2D video media are equally effectiva in meeting the Relevance variable in the context of adolescent motivation to engage in BSE, AR is superior in other motivational areas. Specifically, learning using AR has been shown to be more effective in capturing student attention, increasing self-satisfaction, and increasing self-confidence than 2D video. However, the insignificant difference in the Relevance variable between the two media does not mean they are ineffective; rather, they both have equally high relevance to adolescents' motivational needs for BSE. However, 2D video was not more engaging, satisfying, or self-confidence-boosting than AR. Conclusion: The use of AR as a technology integration to enhance the learning experience proved to be both more engaging and motivating. Furthermore, AR was able to boost the motivation of students participating in BSE. This research supports the development and implementation of AR-based interactive learning media, which can be used as a better alternative to 2D video in the context of increasing motivation to learn about health. 4. DISCUSSION Previous research also has similarities that AR technology can significantly enhance learning motivation by increasing student attention, material relevance, self-confidence, and satisfaction (Moro et al., 2017 ; Altmeyer et al., 2020 ). A study by Yustina Moi Rae (2024) also reported that the use of animated media, which has interactive and immersive characteristics like AR, is more effective in increasing student motivation and understanding than conventional learning media. Research by Aryani ( 2024 ) demonstrated that video media can increase knowledge, but learning motivation levels are higher when combined with more interactive media like AR. Conversely, conventional learning methods such as video tend to be less able to maintain student focus and engagement over the long term (Hendrawan & Huizen, 2022). Significant differences in the Confidence and Satisfaction dimensions in the AR group indicate that the use of this technology can also build student confidence in understanding the material and increase satisfaction with the learning process. These findings support Edgar Dale's observations in the Cone of Experience, which states that learning through more concrete and multi-sensory experiences (such as those provided by AR) can improve memory and learning motivation (Anderson, 2020 ). In general, these findings confirm that the application of AR in adolescent health education offers significant advantages compared to traditional video media, especially in encouraging motivation to undertake preventive measures such as BSE. Therefore, the use of AR is recommended as an effective educational medium to encourage positive health behavior change in adolescents. Results reinforce previous evidence that AR technology effectively increases learning motivation by increasing participant attention, confidence, and satisfaction compared to traditional video media (Moro et al., 2017 ; Altmeyer et al., 2020 ). This increased attention and satisfaction likely stems from AR's more interactive and immersive nature, allowing users to interact directly with the learning material, making the learning process more engaging and enjoyable (Yustina Moi Rae, 2024). However, the Relevance dimension, which measures the extent to which learning materials are perceived as relevant to students' needs and context, appears to be less influenced by the type of media used, possibly indicating that the relevance of the material is more influenced by the content than the delivery medium, as explained in Aryani's (2024) study. Previous research by Hendrawan and Huizen (2022) also showed that video media is effective in conveying knowledge, but its limited interactivity makes it less able to build maximum student motivation and emotional engagement. Conversely, AR, which enables multisensory experiences, tends to generate stronger levels of motivation, particularly in the subdimensions of attention and learning satisfaction (Altmeyer et al., 2020 ). 5. CONCLUSION Results of the study showed that Augmented Reality (AR)-based education significantly increased adolescents' motivation to perform breast self-examination (BSE) compared to education using conventional 2D videos, as measured by four main aspects in the IMMS instrument: Attention, Relevance, Confidence, and Satisfaction. The group using AR obtained higher average scores on almost all motivational dimensions, especially on Attention, Confidence, and Satisfaction, with statistically significant differences and large practical impacts, while the difference in the Relevance aspect was not significant, indicating that both media were considered equally relevant to participants. The overall motivational points from the use of AR were superior when compared to the use of 2D videos. Of course, this confirms that AR has more potential to create a more interactive, interesting, and satisfying learning experience for its users. This study confirms that AR media is a technology that can be used as an option for conducting health education learning, because it has been proven to be more effective and innovative. The use of AR can increase student motivation and engagement during BSE learning. Thus, AR media is recommended for widespread use as a superior learning medium. 6. RECOMMENDATION Recommended to conduct research on the effectiveness of integrating augmented reality (AR) technology in adolescent reproductive health education through collaboration between the Education Office and the Health Office in the UKS/M Program, with a focus on training guidance counselors and UKS staff in the use of AR applications for breast self-examination (BSE) learning. Research can also explore the use of AR in counseling sessions at community health centers through the Promkes program during Posyandu activities and health education in schools as an innovative, cost-effective method that increases adolescent motivation. Furthermore, studying the role of partnerships with community organizations and NGOs in disseminating AR educational content through smartphones and social media is also important to measure its impact on the reach and effectiveness of reproductive health education for adolescents in school and community settings. Declarations Author Contribution Author Contributions: Khasanah N. wrote the initial draft. Riska H., Umri BK., and Mustamu AC., participated in critical revision and editing of the manuscript. All authors reviewed the manuscript.Funding: No Funding Acknowledgement The author would like to thank all parties who have provided support and contributions in the implementation of this research, especially to Sebelas Maret University, Surakarta, the D3 Midwifery Study Program of the Vocational School, the respondents who were willing to participate, and colleagues who provided valuable input. References OECO-D-25-00497 94b15b65-fe54-4e78-be9c-4c8815bffb8c | r1.1 dc2e536a-1e4b-4762-add8-75996f59f353 | r4 Abni, E. N., Lamid, H., & Zaman, M. (2024). The effectiveness of health promotion (audiovisual and leaflet) on adolescents’ behavior regarding breast self-examination. Jurnal Ilmu Kesehatan dan Sport Hicom, 3 (1), 15-25. https://doi.org/10.1234/jiksh.v3i1.1228 Ahmadian, M., & Abu Samah, A. 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As a division of Research Square Company, we’re committed to making research communication faster, fairer, and more useful. We do this by developing innovative software and high quality services for the global research community. Our growing team is made up of researchers and industry professionals working together to solve the most critical problems facing scientific publishing. Also discoverable on Platform About Our Team In Review Editorial Policies Advisory Board Help Center Resources Author Services Accessibility API Access RSS feed Manage Cookie Preferences © Research Square 2026 | ISSN 2693-5015 (online) Privacy Policy Terms of Service Do Not Sell My Personal Information {"props":{"pageProps":{"initialData":{"identity":"rs-7810566","acceptedTermsAndConditions":true,"allowDirectSubmit":true,"archivedVersions":[],"articleType":"Research Article","associatedPublications":[],"authors":[{"id":528093110,"identity":"5a146dde-95b6-46f5-9b28-3e5804ef1055","order_by":0,"name":"N. 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Riska","email":"data:image/png;base64,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","orcid":"","institution":"Sebelas Maret University","correspondingAuthor":true,"prefix":"","firstName":"H.","middleName":"","lastName":"Riska","suffix":""},{"id":528093112,"identity":"f0256eea-1935-4051-a1b3-3d0807b543f8","order_by":2,"name":"Umri BK","email":"","orcid":"","institution":"Amikom Yogyakarta University","correspondingAuthor":false,"prefix":"","firstName":"Umri","middleName":"","lastName":"BK","suffix":""},{"id":528093113,"identity":"a57651fd-f177-4b7f-a40e-0023b52587ea","order_by":3,"name":"AC Mustamu","email":"","orcid":"","institution":"Sorong Health Polytechnic of the Ministry of Health","correspondingAuthor":false,"prefix":"","firstName":"AC","middleName":"","lastName":"Mustamu","suffix":""}],"badges":[],"createdAt":"2025-10-08 18:38:11","currentVersionCode":1,"declarations":"","doi":"10.21203/rs.3.rs-7810566/v1","doiUrl":"https://doi.org/10.21203/rs.3.rs-7810566/v1","draftVersion":[],"editorialEvents":[],"editorialNote":"","failedWorkflow":false,"files":[{"id":93550732,"identity":"691e4d80-60cc-48de-ac06-e7c1d32b3058","added_by":"auto","created_at":"2025-10-15 05:07:08","extension":"docx","order_by":0,"title":"","display":"","copyAsset":false,"role":"acdc-reference","size":62875,"visible":true,"origin":"","legend":"","description":"","filename":"ARCSInformedComparisonofAR.docx","url":"https://assets-eu.researchsquare.com/files/rs-7810566/v1/95b07428d97241ca95b93066.docx"},{"id":93550733,"identity":"c36a1dfc-09b2-4d65-b7a3-33b38afeca57","added_by":"auto","created_at":"2025-10-15 05:07:08","extension":"json","order_by":1,"title":"","display":"","copyAsset":false,"role":"acdc-reference","size":6035,"visible":true,"origin":"","legend":"","description":"","filename":"35169acb57254cb181b2228e604d344b.json","url":"https://assets-eu.researchsquare.com/files/rs-7810566/v1/27d68a3fbf5bb150afcb30cc.json"},{"id":93550735,"identity":"4c93f9db-1ae4-48ca-a166-ff04a50e9a46","added_by":"auto","created_at":"2025-10-15 05:07:08","extension":"xml","order_by":2,"title":"","display":"","copyAsset":false,"role":"acdc-reference","size":119820,"visible":true,"origin":"","legend":"","description":"","filename":"35169acb57254cb181b2228e604d344b1enriched.xml","url":"https://assets-eu.researchsquare.com/files/rs-7810566/v1/a59f42b15a0aa0b5360c7586.xml"},{"id":93550734,"identity":"e59d450a-8d61-465e-a423-50d7a3e3f2ed","added_by":"auto","created_at":"2025-10-15 05:07:08","extension":"xml","order_by":3,"title":"","display":"","copyAsset":false,"role":"acdc-reference","size":116425,"visible":true,"origin":"","legend":"","description":"","filename":"35169acb57254cb181b2228e604d344b1structuring.xml","url":"https://assets-eu.researchsquare.com/files/rs-7810566/v1/a9e0fdfd4f33f21a19d0d44f.xml"},{"id":93550736,"identity":"e020d26e-ad7b-4a29-84d2-2493e5ae38cc","added_by":"auto","created_at":"2025-10-15 05:07:08","extension":"html","order_by":4,"title":"","display":"","copyAsset":false,"role":"acdc-reference","size":125263,"visible":true,"origin":"","legend":"","description":"","filename":"earlyproof.html","url":"https://assets-eu.researchsquare.com/files/rs-7810566/v1/25cae8739a2ee370bbbb097d.html"},{"id":94612676,"identity":"2a0d3460-4be6-4f20-b316-919451d1ea75","added_by":"auto","created_at":"2025-10-29 02:11:22","extension":"pdf","order_by":0,"title":"","display":"","copyAsset":false,"role":"manuscript-pdf","size":434128,"visible":true,"origin":"","legend":"","description":"","filename":"manuscript.pdf","url":"https://assets-eu.researchsquare.com/files/rs-7810566/v1/ebe2866f-0c16-43e7-ae89-2fc9e8b7d29f.pdf"},{"id":93550731,"identity":"315abb8b-0405-46c6-bb02-4a6ab694ff9b","added_by":"auto","created_at":"2025-10-15 05:07:08","extension":"docx","order_by":1,"title":"","display":"","copyAsset":false,"role":"supplement","size":35244,"visible":true,"origin":"","legend":"","description":"","filename":"Appendix.docx","url":"https://assets-eu.researchsquare.com/files/rs-7810566/v1/285387f11ba7f917a5132c6f.docx"}],"financialInterests":"No competing interests reported.","formattedTitle":"ARCS-Informed Comparison of AR and 2D Video on Adolescent BSE Motivation: A Randomized Trial and Practical Recommendations","fulltext":[{"header":"1. INTRODUCTION","content":"\u003cp\u003eLearning motivation is a crucial factor in the success of the educational process, particularly in adolescent health education. The ARCS model, developed by John Keller, consists of Attention, Relevance, Confidence, and Satisfaction, and has been shown to significantly increase learning motivation. This model is widely used in various instructional designs to optimize student engagement by tailoring learning materials to be more engaging and relevant to their needs, while also building self-confidence through positive feedback and satisfying learning outcomes (Keller, \u003cspan citationid=\"CR15\" class=\"CitationRef\"\u003e1987\u003c/span\u003e; Nur et al., \u003cspan citationid=\"CR19\" class=\"CitationRef\"\u003e2023\u003c/span\u003e). Recent studies applying the ARCS model to video-based learning have shown to significantly improve student motivation and learning outcomes (Ananda et al., \u003cspan citationid=\"CR7\" class=\"CitationRef\"\u003e2023\u003c/span\u003e). Furthermore, this model also plays a role in creating a learning environment that supports students' basic psychological needs, thereby strengthening intrinsic motivation, learning continuity, and active engagement (Aimah \u0026amp; Ifadah, \u003cspan citationid=\"CR3\" class=\"CitationRef\"\u003e2014\u003c/span\u003e; Pratiwi et al., \u003cspan citationid=\"CR20\" class=\"CitationRef\"\u003e2023\u003c/span\u003e). Therefore, the application of the ARCS model is an effective strategy in increasing learning motivation, especially in the context of adolescent health education which requires a high level of understanding and awareness of the importance of preventive measures such as breast self-examination (BSE).\u003c/p\u003e\u003cp\u003eAn innovative strategy to increase motivation and learning outcomes, AR and 2D video can be used as digital media to support health education. AR provides the impression of enhancing an immersive and interactive learning experience that can combine theoretical knowledge with practical applications and is engaging for its users. Thus, the use of AR can increase student engagement in the context of health education. According to Kr\u0026uuml;ger et al., \u003cspan citationid=\"CR16\" class=\"CitationRef\"\u003e2022\u003c/span\u003e, the abstract three-dimensional concept in AR facilitates cognitive activation and maximizes understanding when compared to the use of conventional media such as 2D video. Other studies also state that student learning outcomes using AR can significantly increase student activation and focus, although sometimes learning outcomes are not higher than those of students using 2D video. This is likely due to the fact that technological innovations can distract students (Geana et al., \u003cspan citationid=\"CR13\" class=\"CitationRef\"\u003e2023\u003c/span\u003e). However, AR can increase student motivation and interest in learning, so students have great potential to improve learning outcomes in the long term (B\u0026ouml;lek et al., 2021; Moro et al., \u003cspan citationid=\"CR17\" class=\"CitationRef\"\u003e2017\u003c/span\u003e). Thus, the integration of AR as a learning medium for health education for adolescents can be reviewed with a more mature instructional design approach and can increase the potential for learning motivation, resulting in optimization in learning.\u003c/p\u003e\u003cp\u003e2D video remains a popular medium for use in health education due to its ease of use and accessibility. In delivering health education to adolescents, 2D video has also proven effective in increasing knowledge and healthy behaviors, such as BSE. Numerous studies have demonstrated and confirmed that 2D video can significantly improve understanding and recall of information using simple and accessible delivery methods for diverse audiences (Alim et al., \u003cspan citationid=\"CR4\" class=\"CitationRef\"\u003e2024\u003c/span\u003e; Urlings et al., \u003cspan citationid=\"CR26\" class=\"CitationRef\"\u003e2022\u003c/span\u003e). However, significant differences emerge in levels of motivation and engagement due to differences in learning media, with AR tending to be superior in increasing self-confidence, learning experiences, and immersive emotional engagement compared to 2D video (Takeuchi et al., \u003cspan citationid=\"CR25\" class=\"CitationRef\"\u003e2024\u003c/span\u003e; Siddiqui et al., \u003cspan citationid=\"CR23\" class=\"CitationRef\"\u003e2025\u003c/span\u003e). While 2D video is considered effective in delivering learning materials, AR provides an additional dimension. Sadek et al., \u003cspan citationid=\"CR21\" class=\"CitationRef\"\u003e2023\u003c/span\u003e, stated that increasing learning motivation and learning experiences may facilitate long-term learning efforts. Therefore, AR media integration can contribute significantly to superior potential compared to the use of 2D video in the context of adolescent health education.\u003c/p\u003e\u003cp\u003eStudy aims to examine the important role of motivation in breast self-examination (BSE) among adolescents as an early cancer detection effort that relies heavily on awareness and proactive actions from the adolescents themselves. Psychological factors such as perceived self-efficacy, perceived severity, and social support are believed to influence BSE motivation and behavior in adolescents (Elizar et al., \u003cspan citationid=\"CR12\" class=\"CitationRef\"\u003e2024\u003c/span\u003e; Al Sharbatti et al., \u003cspan citationid=\"CR5\" class=\"CitationRef\"\u003e2022\u003c/span\u003e). This study will also explore how positive perceptions of the benefits of BSE screening and awareness of breast cancer risks increase adolescents' motivation to undergo regular screening (Dewi et al., \u003cspan citationid=\"CR11\" class=\"CitationRef\"\u003e2022\u003c/span\u003e). Furthermore, social support from family and peers can address psychological disorders and increase self-confidence in undergoing BSE (Ahmadian \u0026amp; Abu Samah, \u003cspan citationid=\"CR2\" class=\"CitationRef\"\u003e2016\u003c/span\u003e). Therefore, the use of technology as an integrated approach with the ARCS model to increase learning engagement and motivation is an appropriate and potential strategy for empowering adolescents to perform BSE regularly, thereby optimizing early detection and reducing breast cancer mortality.\u003c/p\u003e\u003cp\u003eComparing the use of AR and 2D video in the context of motivation for BSE implementation in adolescents is urgently needed for research to provide empirical evidence and recommendations that align with the design of digital media-based health education interventions. Randomized controlled trials are an appropriate method for validly and objectively evaluating the impact of both learning media, so that the results can be used as a basis for developing best practices in health education for adolescents. Recent studies have shown that multimedia-based videos effectively improve knowledge and attitudes regarding BSE, while AR applications have the potential to significantly increase engagement and motivation to learn (Karimian et al., \u003cspan citationid=\"CR14\" class=\"CitationRef\"\u003e2022\u003c/span\u003e; Damayanti et al., \u003cspan citationid=\"CR10\" class=\"CitationRef\"\u003e2024\u003c/span\u003e). The use of animated videos has also been shown to significantly improve BSE practical skills, helping adolescents better understand the procedure (Syafitra, \u003cspan citationid=\"CR24\" class=\"CitationRef\"\u003e2024\u003c/span\u003e; Ananda et al., \u003cspan citationid=\"CR7\" class=\"CitationRef\"\u003e2023\u003c/span\u003e). However, research directly comparing the two media in a randomized manner is still limited, so further research is needed to strengthen the evidence and optimize the design of adolescent health education interventions using AR and 2D video technology (Abni et al., \u003cspan citationid=\"CR1\" class=\"CitationRef\"\u003e2024\u003c/span\u003e).\u003c/p\u003e"},{"header":"2. MATERIALS AND METHODS","content":"\u003cp\u003eStudy used a two-arm quasi-experimental design (post-test only, non-equivalent groups) with the aim of comparing education from AR and conventional 2D Video for motivation among adolescents to perform BSE. This study was conducted at SMA 04 Yogyakarta City, Indonesia in the period of July-August 2025. The population that participated in this study was 149 adolescents who were all high school students in grade X, sampling was carried out using a non-probability technique (non-random) adjusting the availability of classes and sessions according to the initial agreement between the homeroom teacher and researchers, group allocation was not randomized (the determination followed a separate class schedule to minimize contamination). Inclusion criteria included female adolescents aged 15\u0026ndash;17 years, present at the intervention session, able to follow instructions, and providing written consent; guardian consent was collected according to ethical provisions, with the homeroom teacher acting as the school administration gatekeeper. Exclusion criteria included currently/having participated in BSE training in the last 6 months, cognitive/visual barriers that interfere with participation, or not completing the session. A total of 149 responses were collected; After data cleaning (completeness of total IMMS items with listwise deletion, consistency check including unfavorable items after reverse coding, detection of anomalous response patterns\u0026mdash;straight-lining/very fast filling times\u0026mdash;and duplicate entries), 9 responses were excluded (6.0%), resulting in 140 analyzed (final distribution: AR\u0026thinsp;=\u0026thinsp;70; 2D\u0026thinsp;=\u0026thinsp;70).\u003c/p\u003e\u003cp\u003eBoth groups received content with equivalent duration, learning objectives, and script (rationale for BSE, appropriate implementation time, and technical steps of the examination). The AR group received a\u0026thinsp;\u0026plusmn;\u0026thinsp;45-minute session through an AR application that began with a prologue on breast cancer prevalence (urgency context), followed by material on the rationale for BSE, appropriate implementation time, and technical steps of the examination. The instructional design refers to the ARCS model including Attention (Story hook, Variability, Guided motion \u0026amp; pacing, interactive 3D overlay, hotspots), Relevance realized with scenarios/explanations close to the adolescent context, Confidence with step-by-step procedures and immediate feedback, Satisfaction with progress indicators and positive reinforcement. The 2D video group watched material with identical duration, script, and learning objectives but presented linearly without interactivity (audiovisual variations and summaries of key points were maintained) through pattern breaks (short visual cuts), zooms at critical moments, and text/icon callouts at times equivalent to highlights in AR. Content equivalence was maintained through identical storyboards and scripts, equivalent duration, similar learning environments, and consistent instructors and devices. Fidelity of implementation was monitored using a standardized checklist, and time-on-task was recorded in both groups.\u003c/p\u003e\u003cp\u003ePrimary outcome was motivation towards the instructional materials assessed immediately after the session using the Instructional Materials Motivation Survey (IMMS), an instrument developed by John M. Keller based on the ARCS (Attention, Relevance, Confidence, Satisfaction) model. This study used an Indonesian language version adapted from the original IMMS for the BSE context. This study used an Indonesian language version adapted from the original IMMS for the BSE context. Content validity was evaluated by a panel of three experts in health education, community nursing, and information systems who rated the relevance of each item on a scale of 1\u0026ndash;4. Content validity showed that the I-CVI per item was in the range of 0.667\u0026ndash;1.000 with 34 of the 36 items achieving an I-CVI\u0026thinsp;=\u0026thinsp;1.00 (panel of three experts). S-CVI/Ave\u0026thinsp;=\u0026thinsp;0.981, indicating excellent content validity of the scale. Two items (Item 8 and Item 36) required revision (I-CVI\u0026thinsp;=\u0026thinsp;0.667). Panel feedback was used for editorial refinement until the content validity threshold was met. Afterward, a number of unfavorable statements were retained to minimize acquiescence bias and reverse-scored before analysis using the formula (new score\u0026thinsp;=\u0026thinsp;6\u0026thinsp;\u0026minus;\u0026thinsp;original score) to ensure all items were unidirectional.\u003c/p\u003e\u003cp\u003eData analysis was performed using IBM SPSS version 31.0. Descriptive statistics are reported as N, mean\u0026thinsp;\u0026plusmn;\u0026thinsp;SD, Min\u0026ndash;Max, and 95% confidence interval (CI). Distributional assumptions were checked using Shapiro\u0026ndash;Wilk for normality per group and Levene's for homogeneity of variance. Given that at least one group violated normality and variance was inhomogeneous, two-group comparisons were conducted using the Mann\u0026ndash;Whitney U test (two-tailed). Results are reported as U, Z, p-values ​​for asymptotic and Monte Carlo simulations of 10,000 simulations, and the effect size r using the formula r = |Z| / \u0026radic;N (0.10 small; 0.30 medium; 0.50 large). The significance threshold was α\u0026thinsp;=\u0026thinsp;0.05 (two-tailed). The protocol was approved by the ethics committee of Respati University Yogyakarta with 047.3/FIKES/PL/VI/2025 dated June 10, 2025. All participants and, where required, guardians signed written informed consent. The study adhered to the Declaration of Helsinki.\u003c/p\u003e"},{"header":"3. RESULT","content":"\u003cp\u003e\u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab1\" border=\"1\"\u003e\u003ccaption language=\"En\"\u003e\u003cdiv class=\"CaptionNumber\"\u003eTable 1\u003c/div\u003e\u003cdiv class=\"CaptionContent\"\u003e\u003cp\u003eDescriptive Statistics of Adolescents' Motivation to Perform BSE\u003c/p\u003e\u003c/div\u003e\u003c/caption\u003e\u003ccolgroup cols=\"6\"\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e\u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e\u003cdiv align=\"char\" char=\"\u0026plusmn;\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e\u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c5\" colnum=\"5\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c6\" colnum=\"6\"\u003e\u003c/div\u003e\u003cthead\u003e\u003ctr\u003e\u003cth align=\"left\" colname=\"c1\"\u003e\u003cp\u003eDimension / Variable\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c2\"\u003e\u003cp\u003eGroup\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c3\"\u003e\u003cp\u003eN\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c4\"\u003e\u003cp\u003eMean\u0026thinsp;\u0026plusmn;\u0026thinsp;SD\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c5\"\u003e\u003cp\u003e95% CI\u003c/p\u003e\u003cp\u003e(Lower-Upper)\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c6\"\u003e\u003cp\u003eMin\u0026ndash;Max\u003c/p\u003e\u003c/th\u003e\u003c/tr\u003e\u003c/thead\u003e\u003ctbody\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eIMMS Attention\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eAR\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e70\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c4\"\u003e\u003cp\u003e36.61\u0026thinsp;\u0026plusmn;\u0026thinsp;2.55\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e\u003cp\u003e36.01\u0026ndash;37.22\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e30\u0026ndash;44\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eVideo\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e70\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c4\"\u003e\u003cp\u003e34.20\u0026thinsp;\u0026plusmn;\u0026thinsp;3.41\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e\u003cp\u003e33.39\u0026ndash;35.01\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e26\u0026ndash;44\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eIMMS Relevance\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eAR\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e70\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c4\"\u003e\u003cp\u003e31.47\u0026thinsp;\u0026plusmn;\u0026thinsp;4.49\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e\u003cp\u003e30.40\u0026ndash;32.54\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e25\u0026ndash;45\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eVideo\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e70\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c4\"\u003e\u003cp\u003e29.91\u0026thinsp;\u0026plusmn;\u0026thinsp;3.70\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e\u003cp\u003e29.03\u0026ndash;30.80\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e20\u0026ndash;41\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eIMMS Confidence\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eAR\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e70\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c4\"\u003e\u003cp\u003e28.57\u0026thinsp;\u0026plusmn;\u0026thinsp;2.05\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e\u003cp\u003e28.08\u0026ndash;29.06\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e23\u0026ndash;34\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eVideo\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e70\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c4\"\u003e\u003cp\u003e27.09\u0026thinsp;\u0026plusmn;\u0026thinsp;2.11\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e\u003cp\u003e26.58\u0026ndash;27.59\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e22\u0026ndash;34\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eIMMS Satisfaction\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eAR\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e70\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c4\"\u003e\u003cp\u003e21.14\u0026thinsp;\u0026plusmn;\u0026thinsp;3.79\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e\u003cp\u003e20.24\u0026ndash;22.05\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e14\u0026ndash;30\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eVideo\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e70\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c4\"\u003e\u003cp\u003e19.14\u0026thinsp;\u0026plusmn;\u0026thinsp;3.91\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e\u003cp\u003e18.21\u0026ndash;20.08\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e10\u0026ndash;27\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eIMMS Total\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eAR\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e70\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c4\"\u003e\u003cp\u003e117.80\u0026thinsp;\u0026plusmn;\u0026thinsp;9.02\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e\u003cp\u003e115.65\u0026ndash;119.95\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e106\u0026ndash;139\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eVideo\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e70\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c4\"\u003e\u003cp\u003e110.34\u0026thinsp;\u0026plusmn;\u0026thinsp;8.81\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e\u003cp\u003e108.24 \u0026ndash; 112.44\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e91\u0026ndash; 130\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003c/tbody\u003e\u003c/colgroup\u003e\u003c/table\u003e\u003c/div\u003e\u003c/p\u003e\u003cp\u003eResearch data showed significant differences in motivation levels between the group of adolescents using AR education and those using conventional 2D video education. Motivation was measured using four main variables in the IMMS instrument: Attention, Relevance, Confidence, and Satisfaction.\u003c/p\u003e\u003cp\u003eLearning using AR media proves its superiority with consistent scores on all motivational variables when compared to 2D video media. This means that the use of AR is more effective than the use of 2D video media. The Attention variable in AR media, gets a scope of 36.61 with a standard deviation showing 2.55. This far exceeds the Attention variable in 2D video media 34.20 (\u0026plusmn;\u0026thinsp;3.41). From these variables, AR media has the ability to maintain and significantly increase student cognitive engagement during learning. In addition, the Relevance variable also shows that AR is superior to 2D video. AR media on this variable gets a score of 31.47 (\u0026plusmn;\u0026thinsp;4.49), and 2D video gets a score of 29.91 (\u0026plusmn;\u0026thinsp;3.70), this indicates that the use of AR media is more appropriate to learning needs. The Confidence variable also showed a higher score for AR than for 2D video, with AR scoring 28.57 (\u0026plusmn;\u0026thinsp;2.05), while 2D video scored 27.09 (\u0026plusmn;\u0026thinsp;2.11), demonstrating increased student confidence in understanding learning through AR. The Satisfaction variable also showed a similar result, with AR outperforming 21.14 (\u0026plusmn;\u0026thinsp;3.79), while 2D video scored 19.14 (\u0026plusmn;\u0026thinsp;3.91).\u003c/p\u003e\u003cp\u003eEvidence that each variable scored higher for AR than 2D video demonstrates that students experienced a more engaging learning experience using AR. In addition, this study also measured IMMS which showed that AR got a score of 117.80 (\u0026plusmn;\u0026thinsp;9.02), then compared to 2D video media which got 110.34 (\u0026plusmn;\u0026thinsp;8.81), of course both of these things confirm that by using AR media, not only can it increase motivation in cognitive and affective contexts, but also have a positive impact on the student learning experience sector significantly. This finding emphasizes the importance of integration in interactive technologies such as AR as a means of improving the quality of learning for the next generation. This study confirms that AR education can significantly increase adolescent learning motivation (BSE) compared to conventional 2D video education methods. This demonstrates AR's potential as an effective and innovative learning medium for increasing student engagement and motivation.\u003c/p\u003e\u003cp\u003e\u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab2\" border=\"1\"\u003e\u003ccaption language=\"En\"\u003e\u003cdiv class=\"CaptionNumber\"\u003eTable 2\u003c/div\u003e\u003cdiv class=\"CaptionContent\"\u003e\u003cp\u003eMann\u0026ndash;Whitney U Test of Motivation Scores for BSE (SADARI) in AR vs. 2D Video Education Groups\u003c/p\u003e\u003c/div\u003e\u003c/caption\u003e\u003ccolgroup cols=\"6\"\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e\u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e\u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e\u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e\u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c5\" colnum=\"5\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c6\" colnum=\"6\"\u003e\u003c/div\u003e\u003cthead\u003e\u003ctr\u003e\u003cth align=\"left\" colname=\"c1\"\u003e\u003cp\u003eVariable/Dimension\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c2\"\u003e\u003cp\u003eU\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c3\"\u003e\u003cp\u003eZ\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c4\"\u003e\u003cp\u003ep-value\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c5\"\u003e\u003cp\u003er (EffectSize)\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c6\"\u003e\u003cp\u003eInterpretation\u003c/p\u003e\u003c/th\u003e\u003c/tr\u003e\u003c/thead\u003e\u003ctbody\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eIMMS Attention\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e1377.500\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e-4.517\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\u003cp\u003e\u0026lt;\u0026thinsp;0.001\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e\u003cp\u003e0,38\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003eModerate\u0026ndash;large\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eIMMS Relevance\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e2002.000\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e-1.891\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\u003cp\u003e0.059\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e\u003cp\u003e0,38\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003eModerate\u0026ndash;large\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eIMMS Confidence\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e1537.000\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e-3.894\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\u003cp\u003e\u0026lt;\u0026thinsp;0.001\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e\u003cp\u003e0,16\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003eSmall\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eIMMS Satisfaction\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e1638.500\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e-3.400\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\u003cp\u003e\u0026lt;\u0026thinsp;0.001\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e\u003cp\u003e0,33\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003eModerate\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eIMMS Total\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e1374.500\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e-4.487\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\u003cp\u003e\u0026lt;\u0026thinsp;0.001\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e\u003cp\u003e0,29\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003eModerate\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003c/tbody\u003e\u003c/colgroup\u003e\u003c/table\u003e\u003c/div\u003e\u003c/p\u003e\u003cp\u003eFurther analysis of this research the Mann-Whitney U test, which demonstrated significant differences between AR and 2D video in total motivation scores (p\u0026thinsp;\u0026lt;\u0026thinsp;0.001) and most of the measured motivational variables, namely Attention (p\u0026thinsp;\u0026lt;\u0026thinsp;0.001), Confidence (p\u0026thinsp;\u0026lt;\u0026thinsp;0.001), and Satisfaction (p\u0026thinsp;\u0026lt;\u0026thinsp;0.001). The moderate to large differences indicate a substantial impact. However, for the Relevance variable, the difference between AR and 2D video did not reach significance (p\u0026thinsp;=\u0026thinsp;0.059).\u003c/p\u003e\u003cp\u003eBoth AR and 2D video media are equally effectiva in meeting the Relevance variable in the context of adolescent motivation to engage in BSE, AR is superior in other motivational areas. Specifically, learning using AR has been shown to be more effective in capturing student attention, increasing self-satisfaction, and increasing self-confidence than 2D video. However, the insignificant difference in the Relevance variable between the two media does not mean they are ineffective; rather, they both have equally high relevance to adolescents' motivational needs for BSE. However, 2D video was not more engaging, satisfying, or self-confidence-boosting than AR.\u003c/p\u003e\u003cp\u003eConclusion: The use of AR as a technology integration to enhance the learning experience proved to be both more engaging and motivating. Furthermore, AR was able to boost the motivation of students participating in BSE. This research supports the development and implementation of AR-based interactive learning media, which can be used as a better alternative to 2D video in the context of increasing motivation to learn about health.\u003c/p\u003e"},{"header":"4. DISCUSSION","content":"\u003cp\u003e\u003cdiv class=\"BlockQuote\"\u003e\u003cp\u003ePrevious research also has similarities that AR technology can significantly enhance learning motivation by increasing student attention, material relevance, self-confidence, and satisfaction (Moro et al., \u003cspan citationid=\"CR17\" class=\"CitationRef\"\u003e2017\u003c/span\u003e; Altmeyer et al., \u003cspan citationid=\"CR6\" class=\"CitationRef\"\u003e2020\u003c/span\u003e). A study by Yustina Moi Rae (2024) also reported that the use of animated media, which has interactive and immersive characteristics like AR, is more effective in increasing student motivation and understanding than conventional learning media. Research by Aryani (\u003cspan citationid=\"CR9\" class=\"CitationRef\"\u003e2024\u003c/span\u003e) demonstrated that video media can increase knowledge, but learning motivation levels are higher when combined with more interactive media like AR. Conversely, conventional learning methods such as video tend to be less able to maintain student focus and engagement over the long term (Hendrawan \u0026amp; Huizen, 2022).\u003c/p\u003e\u003cp\u003eSignificant differences in the Confidence and Satisfaction dimensions in the AR group indicate that the use of this technology can also build student confidence in understanding the material and increase satisfaction with the learning process. These findings support Edgar Dale's observations in the Cone of Experience, which states that learning through more concrete and multi-sensory experiences (such as those provided by AR) can improve memory and learning motivation (Anderson, \u003cspan citationid=\"CR8\" class=\"CitationRef\"\u003e2020\u003c/span\u003e).\u003c/p\u003e\u003cp\u003eIn general, these findings confirm that the application of AR in adolescent health education offers significant advantages compared to traditional video media, especially in encouraging motivation to undertake preventive measures such as BSE. Therefore, the use of AR is recommended as an effective educational medium to encourage positive health behavior change in adolescents.\u003c/p\u003e\u003cp\u003eResults reinforce previous evidence that AR technology effectively increases learning motivation by increasing participant attention, confidence, and satisfaction compared to traditional video media (Moro et al., \u003cspan citationid=\"CR17\" class=\"CitationRef\"\u003e2017\u003c/span\u003e; Altmeyer et al., \u003cspan citationid=\"CR6\" class=\"CitationRef\"\u003e2020\u003c/span\u003e). This increased attention and satisfaction likely stems from AR's more interactive and immersive nature, allowing users to interact directly with the learning material, making the learning process more engaging and enjoyable (Yustina Moi Rae, 2024). However, the Relevance dimension, which measures the extent to which learning materials are perceived as relevant to students' needs and context, appears to be less influenced by the type of media used, possibly indicating that the relevance of the material is more influenced by the content than the delivery medium, as explained in Aryani's (2024) study.\u003c/p\u003e\u003cp\u003ePrevious research by Hendrawan and Huizen (2022) also showed that video media is effective in conveying knowledge, but its limited interactivity makes it less able to build maximum student motivation and emotional engagement. Conversely, AR, which enables multisensory experiences, tends to generate stronger levels of motivation, particularly in the subdimensions of attention and learning satisfaction (Altmeyer et al., \u003cspan citationid=\"CR6\" class=\"CitationRef\"\u003e2020\u003c/span\u003e).\u003c/p\u003e\u003c/div\u003e\u003c/p\u003e"},{"header":"5. CONCLUSION","content":"\u003cp\u003e\u003cdiv class=\"BlockQuote\"\u003e\u003cp\u003eResults of the study showed that Augmented Reality (AR)-based education significantly increased adolescents' motivation to perform breast self-examination (BSE) compared to education using conventional 2D videos, as measured by four main aspects in the IMMS instrument: Attention, Relevance, Confidence, and Satisfaction. The group using AR obtained higher average scores on almost all motivational dimensions, especially on Attention, Confidence, and Satisfaction, with statistically significant differences and large practical impacts, while the difference in the Relevance aspect was not significant, indicating that both media were considered equally relevant to participants. The overall motivational points from the use of AR were superior when compared to the use of 2D videos. Of course, this confirms that AR has more potential to create a more interactive, interesting, and satisfying learning experience for its users. This study confirms that AR media is a technology that can be used as an option for conducting health education learning, because it has been proven to be more effective and innovative. The use of AR can increase student motivation and engagement during BSE learning. Thus, AR media is recommended for widespread use as a superior learning medium.\u003c/p\u003e\u003c/div\u003e\u003c/p\u003e"},{"header":"6. RECOMMENDATION","content":"\u003cp\u003eRecommended to conduct research on the effectiveness of integrating augmented reality (AR) technology in adolescent reproductive health education through collaboration between the Education Office and the Health Office in the UKS/M Program, with a focus on training guidance counselors and UKS staff in the use of AR applications for breast self-examination (BSE) learning. Research can also explore the use of AR in counseling sessions at community health centers through the Promkes program during Posyandu activities and health education in schools as an innovative, cost-effective method that increases adolescent motivation. Furthermore, studying the role of partnerships with community organizations and NGOs in disseminating AR educational content through smartphones and social media is also important to measure its impact on the reach and effectiveness of reproductive health education for adolescents in school and community settings.\u003c/p\u003e"},{"header":"Declarations","content":"\u003ch2\u003eAuthor Contribution\u003c/h2\u003e\u003cp\u003eAuthor Contributions: Khasanah N. wrote the initial draft. Riska H., Umri BK., and Mustamu AC., participated in critical revision and editing of the manuscript. All authors reviewed the manuscript.Funding: No Funding\u003c/p\u003e\u003ch2\u003eAcknowledgement\u003c/h2\u003e\u003cp\u003eThe author would like to thank all parties who have provided support and contributions in the implementation of this research, especially to Sebelas Maret University, Surakarta, the D3 Midwifery Study Program of the Vocational School, the respondents who were willing to participate, and colleagues who provided valuable input.\u003c/p\u003e"},{"header":"References","content":"\u003col\u003e\n \u003cli\u003eOECO-D-25-00497 94b15b65-fe54-4e78-be9c-4c8815bffb8c | r1.1 dc2e536a-1e4b-4762-add8-75996f59f353 | r4\u003c/li\u003e\n \u003cli\u003eAbni, E. N., Lamid, H., \u0026amp; Zaman, M. (2024). 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The relationship between adolescent girls\u0026rsquo; perception and breast self-examination (BSE) behavior. \u003cem\u003eCare: Jurnal Ilmiah Ilmu Kesehatan, 12\u003c/em\u003e(3), 363-373. https://jurnal.unitri.ac.id/index.php/care/article/view/6009\u003c/li\u003e\n \u003cli\u003eGeana, M., Cernusca, D., \u0026amp; Liu, P. (2023). Study shows students felt more engaged by augmented reality but learned less than those viewing video. \u003cem\u003eHealth Communication Studies\u003c/em\u003e. https://news.ku.edu/news/article/2023/02/01/study-shows-students-felt-more-engaged-augmented-reality-learned-less-those-viewing-video\u003c/li\u003e\n \u003cli\u003eKarimian, Z., Zare, R., Zarifsanaiey, N., \u0026amp; Salehi, N. (2022). 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Integration of augmented reality, virtual reality, and mixed reality in medical education, training, and upskilling of healthcare professionals and medical students. \u003cem\u003eJournal of Medical Education and Training, 12\u003c/em\u003e(3), 150-170. https://doi.org/10.1177/23821205251342315\u003c/li\u003e\n \u003cli\u003eSyafitra, F. (2024). The effectivity of animated video toward knowledge and practice about breast cancer self-examination among female students. \u003cem\u003eInternational Conference on Health Sciences, 11\u003c/em\u003e(1), 32-45. https://doi.org/10.29238/ichs.v11i1.2598\u003c/li\u003e\n \u003cli\u003eTakeuchi, M., Guan, L. W., Ono, K., Kawata, K., \u0026amp; Oyama, H. (2024). Comparing the effectiveness of 360-degree live-action VR and 2D video for initial medical examinations by medical students: A randomized controlled trial. \u003cem\u003eVR Medical Journal, 20\u003c/em\u003e(1), 1-12.\u003c/li\u003e\n \u003cli\u003eUrlings, J. M., et al. (2022). The role and effectiveness of augmented reality in patient education: A systematic review. \u003cem\u003ePatient Education and Counseling, 105\u003c/em\u003e(9), 2581-2590. https://doi.org/10.1016/j.pec.2022.05.003\u003c/li\u003e\n \u003cli\u003eYustina Moi Rae, P. O. (2024). Perbandingan penggunaan media animasi dan media pembelajaran konvensional terhadap tingkat pengetahuan dan motivasi siswa. \u003cem\u003eJurnal Media Pembelajaran, 12\u003c/em\u003e(2), 75-83.\u003c/li\u003e\n\u003c/ol\u003e"}],"fulltextSource":"","fullText":"","funders":[],"hasAdminPriorityOnWorkflow":false,"hasManuscriptDocX":false,"hasOptedInToPreprint":true,"hasPassedJournalQc":"","hasAnyPriority":true,"hideJournal":true,"highlight":"","institution":"","isAcceptedByJournal":false,"isAuthorSuppliedPdf":false,"isDeskRejected":"","isHiddenFromSearch":false,"isInQc":false,"isInWorkflow":false,"isPdf":false,"isPdfUpToDate":true,"isWithdrawnOrRetracted":false,"journal":{"display":true,"email":"[email protected]","identity":"researchsquare","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":true,"externalIdentity":"","sideBox":"","snPcode":"","submissionUrl":"/submission","title":"Research Square","twitterHandle":"researchsquare","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"","reportingPortfolio":"","inReviewEnabled":false,"inReviewRevisionsEnabled":true},"keywords":"Augmentes Reality (AR), 2D Video, Adolescent BSE Motivation, IMMS, \u0026 ARCS Model","lastPublishedDoi":"10.21203/rs.3.rs-7810566/v1","lastPublishedDoiUrl":"https://doi.org/10.21203/rs.3.rs-7810566/v1","license":{"name":"CC BY 4.0","url":"https://creativecommons.org/licenses/by/4.0/"},"manuscriptAbstract":"\u003cp\u003eBreast Self-Examination (BSE) or SADARI is a very important method for early detection of breast cancer, especially for adolescent girls. However, adolescent motivation to perform BSE regularly is still low due to limited knowledge and the lack of interesting educational media. This study aims to compare the effect of Augmented Reality (AR)-based learning media and 2D videos on adolescent motivation to perform BSE using the ARCS motivation model as measured by the Teaching Materials Motivation Survey (IMMS). The method used was a non-randomized two-arm quasi-experimental design with a total of 149 female participants in grade 10 of high school in Yogyakarta, Indonesia, who were divided into two intervention groups. Data analysis using the Mann–Whitney U test showed that the AR group had significantly higher motivation scores on the Attention, Confidence, and Satisfaction dimensions compared to the 2D video group (p \u0026lt; 0.001). However, no significant difference was found in the Relevance dimension (p = 0.059). These findings suggest that both media deliver relevant content, but AR is more effective in capturing attention, increasing self-confidence, and providing higher learning satisfaction for adolescents. This study recommends the use of AR as a more effective educational strategy to increase adolescent motivation and proactive behavior in performing BSE, with the hope of supporting early breast cancer detection. Further studies are needed to examine the long-term impact of using AR in health education.\u003c/p\u003e","manuscriptTitle":"ARCS-Informed Comparison of AR and 2D Video on Adolescent BSE Motivation: A Randomized Trial and Practical Recommendations","msid":"","msnumber":"","nonDraftVersions":[{"code":1,"date":"2025-10-15 05:07:03","doi":"10.21203/rs.3.rs-7810566/v1","editorialEvents":[{"type":"communityComments","content":0}],"status":"published","journal":{"display":true,"email":"[email protected]","identity":"researchsquare","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":true,"externalIdentity":"","sideBox":"","snPcode":"","submissionUrl":"/submission","title":"Research Square","twitterHandle":"researchsquare","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"","reportingPortfolio":"","inReviewEnabled":false,"inReviewRevisionsEnabled":true}}],"origin":"","ownerIdentity":"74f6aa87-8a85-4dd4-80b4-27e73985203f","owner":[],"postedDate":"October 15th, 2025","published":true,"recentEditorialEvents":[],"rejectedJournal":[],"revision":"","amendment":"","status":"posted","subjectAreas":[],"tags":[],"updatedAt":"2025-10-28T21:23:26+00:00","versionOfRecord":[],"versionCreatedAt":"2025-10-15 05:07:03","video":"","vorDoi":"","vorDoiUrl":"","workflowStages":[]},"version":"v1","identity":"rs-7810566","journalConfig":"researchsquare"},"__N_SSP":true},"page":"/article/[identity]/[[...version]]","query":{"redirect":"/article/rs-7810566","identity":"rs-7810566","version":["v1"]},"buildId":"8U1c8b4HqxoKbykW_rLl7","isFallback":false,"isExperimentalCompile":false,"dynamicIds":[84888],"gssp":true,"scriptLoader":[]}