Adaptation and Validation of the Interprofessional Socialization and Valuing Scale (ISVS-24) for Utilization in Multiplayer Virtual Reality Environments

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However, instruments to measure interprofessional socialization in MPVR-based education are limited. The Interprofessional Socialization and Valuing Scale (ISVS) is a useful tool for evaluating interprofessional socialization. This pilot study aimed to adapt and validate the ISVS-24 for use in interprofessional MPVR-based simulations settings. Methods Seventy-two participants, including anesthesiology residents (at novice, junior, and senior levels), general physicians, and professional nurses, were recruited voluntarily. The ISVS-24 was cross-culturally adapted and reviewed by experts for content validity in the MPVR simulation context. Participants completed the adapted ISVS after undergoing an interprofessional MPVR-based simulation. Structural validity was assessed using factorial analysis through principal component analysis. Content validity was measured using the mean content validity index (CVI). Consistency validity was evaluated with Pearson correlation coefficients (PCC), and reliability was assessed using Cronbach’s alpha. Results The Kaiser-Meyer-Olkin test indicated sampling adequacy (0.885), and Bartlett’s sphericity test was significant (χ2(42) = 472.725, p < 0.05). A three-section structure was confirmed. The mean CVI was 0.815, with 21 valid items (Aiken’s V ≥ 0.5). Among the 72 respondents, 40 were female (55.6%) and 32 were male (44.4%); 26 were anesthesiology residents (36.1%), 23 were general physicians (31.9%), and 23 were professional nurses (31.9%). The overall Cronbach’s alpha was 0.959. PCC for all items exceeded the r table value (> 0.232) with p < 0.05, showing significant item relationships. Conclusions The adapted version of ISVS for MPVR simulation-based education has good validity and reliability to assess interprofessional socialization in an MPVR-based simulation setting. 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F1000Research 2026, 14 :169 ( https://doi.org/10.12688/f1000research.160939.3 ) NOTE: If applicable, it is important to ensure the information in square brackets after the title is included in all citations of this article. Close Copy Citation Details Export Export Citation Sciwheel EndNote Ref. Manager Bibtex ProCite Sente EXPORT Select a format first Track Share ▬ ✚ Research Article Revised Adaptation and Validation of the Interprofessional Socialization and Valuing Scale (ISVS-24) for Utilization in Multiplayer Virtual Reality Environments [version 3; peer review: 4 approved with reservations] Riyadh Firdaus https://orcid.org/0000-0002-5326-5227 1 , Aida Rosita Tantri https://orcid.org/0000-0002-5535-985X 1,2 , Rafidah Binti Atan 3 , [...] Sidharta Kusuma Manggala https://orcid.org/0000-0002-0974-5864 1 , Anggara Gilang Dwiputra https://orcid.org/0000-0002-4821-0758 1 , Andy Omega 1 , Imelda Rosalyn Sianipar 2 , Dina Muktiarti https://orcid.org/0000-0002-0828-3354 2 , Adisti Dwijayanti 2 , Rima Maulida Hidayati 2 , Tasya Claudia 2 , Dewi Anggraeni Kusumoningrum https://orcid.org/0000-0002-0626-8492 4 , Luthfi Saiful Arif https://orcid.org/0000-0003-3065-5262 4 Riyadh Firdaus https://orcid.org/0000-0002-5326-5227 1 , Aida Rosita Tantri https://orcid.org/0000-0002-5535-985X 1,2 , [...] Rafidah Binti Atan 3 , Sidharta Kusuma Manggala https://orcid.org/0000-0002-0974-5864 1 , Anggara Gilang Dwiputra https://orcid.org/0000-0002-4821-0758 1 , Andy Omega 1 , Imelda Rosalyn Sianipar 2 , Dina Muktiarti https://orcid.org/0000-0002-0828-3354 2 , Adisti Dwijayanti 2 , Rima Maulida Hidayati 2 , Tasya Claudia 2 , Dewi Anggraeni Kusumoningrum https://orcid.org/0000-0002-0626-8492 4 , Luthfi Saiful Arif https://orcid.org/0000-0003-3065-5262 4 PUBLISHED 21 Jan 2026 Author details Author details 1 Department of Anesthesiology and Intensive Care, Faculty of Medicine, Universitas Indonesia, Central Jakarta, Jakarta, 10430, Indonesia 2 Simulation-Based Medical Education and Research Center Cluster, Indonesia Medical Education and Research Institute (IMERI), Faculty of Medicine, Universitas Indonesia, Central Jakarta, Jakarta, 10430, Indonesia 3 Department of Anesthesiology, Faculty of Medicine, Malaya University, Kuala Lumpur, Kuala Lumpur, 50603, Malaysia 4 Medical Technology Cluster, Indonesia Medical Education and Research Institute (IMERI), Faculty of Medicine, Universitas Indonesia, Central Jakarta, Jakarta, 10430, Indonesia Riyadh Firdaus Roles: Conceptualization, Methodology, Supervision, Writing – Original Draft Preparation Aida Rosita Tantri Roles: Conceptualization, Formal Analysis, Project Administration, Writing – Original Draft Preparation Rafidah Binti Atan Roles: Conceptualization Sidharta Kusuma Manggala Roles: Conceptualization, Methodology, Software Anggara Gilang Dwiputra Roles: Conceptualization, Methodology, Software Andy Omega Roles: Conceptualization, Methodology, Software Imelda Rosalyn Sianipar Roles: Resources, Software, Writing – Original Draft Preparation Dina Muktiarti Roles: Resources, Software, Writing – Original Draft Preparation Adisti Dwijayanti Roles: Resources, Software, Writing – Original Draft Preparation Rima Maulida Hidayati Roles: Project Administration, Resources, Supervision, Writing – Review & Editing Tasya Claudia Roles: Data Curation, Formal Analysis, Writing – Original Draft Preparation Dewi Anggraeni Kusumoningrum Roles: Conceptualization, Methodology, Software Luthfi Saiful Arif Roles: Conceptualization, Methodology, Software OPEN PEER REVIEW DETAILS REVIEWER STATUS Abstract Background Multiplayer Virtual Reality-Based Simulations (MPVR-based simulations) with immersive 3D environments have become an important tool in interprofessional education (IPE). However, instruments to measure interprofessional socialization in MPVR-based education are limited. The Interprofessional Socialization and Valuing Scale (ISVS) is a useful tool for evaluating interprofessional socialization. This pilot study aimed to adapt and validate the ISVS-24 for use in interprofessional MPVR-based simulations settings. Methods Seventy-two participants, including anesthesiology residents (at novice, junior, and senior levels), general physicians, and professional nurses, were recruited voluntarily. The ISVS-24 was cross-culturally adapted and reviewed by experts for content validity in the MPVR simulation context. Participants completed the adapted ISVS after undergoing an interprofessional MPVR-based simulation. Structural validity was assessed using factorial analysis through principal component analysis. Content validity was measured using the mean content validity index (CVI). Consistency validity was evaluated with Pearson correlation coefficients (PCC), and reliability was assessed using Cronbach’s alpha. Results The Kaiser-Meyer-Olkin test indicated sampling adequacy (0.885), and Bartlett’s sphericity test was significant (χ 2 (42) = 472.725, p < 0.05). A three-section structure was confirmed. The mean CVI was 0.815, with 21 valid items (Aiken’s V ≥ 0.5). Among the 72 respondents, 40 were female (55.6%) and 32 were male (44.4%); 26 were anesthesiology residents (36.1%), 23 were general physicians (31.9%), and 23 were professional nurses (31.9%). The overall Cronbach’s alpha was 0.959. PCC for all items exceeded the r table value (> 0.232) with p < 0.05, showing significant item relationships. Conclusions The adapted version of ISVS for MPVR simulation-based education has good validity and reliability to assess interprofessional socialization in an MPVR-based simulation setting. READ ALL READ LESS Keywords Interprofessional Socialization and Valuing Scale, Medical Education, Interprofessional, Multiplayer Virtual Reality Questionnaire, Validation Corresponding Author(s) Aida Rosita Tantri ( [email protected] ) Close Corresponding author: Aida Rosita Tantri Competing interests: No competing interests were disclosed. Grant information: This work was supported by the Universitas Indonesia under the Publikasi Terindex Internasional (PUTI) Q2 Tahun 2022-2023 grant scheme [grant number: NKB-1217/UN2.RST/HKP.05.00/2022]. The funders had no role in study design, data collection and analysis, decision to publish, or preparation of the manuscript. Copyright: © 2026 Firdaus R et al . This is an open access article distributed under the terms of the Creative Commons Attribution License , which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited. How to cite: Firdaus R, Tantri AR, Atan RB et al. Adaptation and Validation of the Interprofessional Socialization and Valuing Scale (ISVS-24) for Utilization in Multiplayer Virtual Reality Environments [version 3; peer review: 4 approved with reservations] . F1000Research 2026, 14 :169 ( https://doi.org/10.12688/f1000research.160939.3 ) First published: 06 Feb 2025, 14 :169 ( https://doi.org/10.12688/f1000research.160939.1 ) Latest published: 21 Jan 2026, 14 :169 ( https://doi.org/10.12688/f1000research.160939.3 ) Revised Amendments from Version 2 Several substantive improvements have been made to enhance methodological clarity, transparency, and alignment with standard psychometric reporting practices. The Methods section has been expanded to provide a clearer description of the translation and back-translation procedures, including identification of items that required discussion during the adaptation process. Statements related to study limitations have been relocated from the Methods and Results sections to the Discussion to improve structural coherence. The reporting of factor analysis has been strengthened through the addition of normality assessment, communalities, rotation method, and clearer justification for factor retention. The Discussion section has been revised to better justify the adequacy of the sample size, drawing on psychometric literature supporting exploratory analyses with small samples when communalities and loadings are high. Comparisons with previous ISVS validation studies have also been expanded to contextualize the findings and support the retained factor structure within the broader evidence base. Several substantive improvements have been made to enhance methodological clarity, transparency, and alignment with standard psychometric reporting practices. The Methods section has been expanded to provide a clearer description of the translation and back-translation procedures, including identification of items that required discussion during the adaptation process. Statements related to study limitations have been relocated from the Methods and Results sections to the Discussion to improve structural coherence. The reporting of factor analysis has been strengthened through the addition of normality assessment, communalities, rotation method, and clearer justification for factor retention. The Discussion section has been revised to better justify the adequacy of the sample size, drawing on psychometric literature supporting exploratory analyses with small samples when communalities and loadings are high. Comparisons with previous ISVS validation studies have also been expanded to contextualize the findings and support the retained factor structure within the broader evidence base. See the authors' detailed response to the review by Danielle Rulli See the authors' detailed response to the review by Bau Dilam Ardyansyah See the authors' detailed response to the review by Siti Munawaroh READ REVIEWER RESPONSES Introduction Interprofessional Education (IPE) has become a crucial aspect of advanced medical studies, playing a vital role in enhancing patient safety and refining healthcare services. 1 – 3 IPE promotes collaborative learning among individuals from different professional fields, which augments knowledge-sharing and problem-solving capabilities in delivering the highest quality of patient care and producing significant health outcomes. 4 IPE has been found to significantly improve clinical engagement, teamwork, and collaborative abilities in healthcare students. 5 According to studies, students who participate in IPE activities build stronger interprofessional partnerships, enhanced team dynamics, and increased confidence in collaborative settings. Exposure to such educational events positively improves their attitudes about teamwork, communication, and patient-centered care. 6 A teaching method for accomplishing learning objectives that is also used to give IPE is simulation-based education. It is modelled after real-world situations. In this case, multiplayer VR simulation-based education (MPVR-based education) has an important role in realizing interprofessional education (IPE) in promoting collaboration and communication competencies among professionals. 7 VR has recently emerged as a potent tool for medical education that enables users to immerse themselves in and engage with computer-created three-dimensional environments, replicating real situations or simulating fictitious scenarios. 8 , 9 These interactive virtual experiences have been shown to outperform traditional or other digital educational methods regarding knowledge retention and skill development among health professionals. This superiority is attributed to VR’s ability to offer an immersive, interactive learning space, and its capacity to produce realistic clinical scenarios in a risk-free setting for learners. 10 Recent studies have demonstrated the educational advantages of virtual reality (VR) over traditional methods across various domains. VR-based simulation training significantly improved procedural accuracy and performance in orthopedic surgical tasks compared to standard surgical guides. 11 A randomized study on spinal surgery education showed that VR-based instruction yielded comparable or better outcomes in practical skills than conventional lecture-based teaching. 12 In neuroanatomy education, VR not only enhanced knowledge retention but also increased student motivation while reducing anxiety toward the subject. 13 Similarly, VR training has been shown to outperform traditional methods in improving both theoretical understanding and procedural safety in radiation protection among cardiology teams. 14 Moreover, VR was found to be more effective than conventional instruction in teaching ECG interpretation skills to medical students. 15 MPVR-based education offers group-oriented learning, teamwork simulations, and collective problem-solving activities by seamlessly incorporating interpersonal interactions within the virtual world. 16 The platform facilitates real-time communication, collaboration, and joint activities or simulations as a team in a shared virtual space. 9 Although MPVR-based simulation is a rapidly developing modality in medical education, there remains a gap in validated instruments specifically designed to assess interprofessional socialization outcomes within immersive virtual environments. Existing tools that measure changes in attitudes, actions, and beliefs, such as those relevant to interprofessional socialization, have not yet been formally validated or adapted for use in MPVR-based educational settings. Effective interprofessional socialization is essential as it will enhance the utilization of each individual’s skills during collaborative practice, promote efficient patient care, and enhance patient safety. 17 Interprofessional Socialization and Valuing Scale (ISVS) is a 24-item self-assessment questionnaire that was developed based on interprofessional literature and focuses on changes in attitudes, actions, and beliefs that are essential to interprofessional socialization. 11 , 18 ISVS’s adaptability is evident in its successful adaptation and validation across various countries and interprofessional learning conditions. 18 – 20 The original ISVS-24 has demonstrated good psychometric properties, with Cronbach’s alpha coefficient for the total scale reported at 0.90. In addition, Pearson correlation coefficients among the subscales ranged from 0.34 to 0.61, indicating that the subscales measure distinct yet related dimensions of interprofessional socialization. 21 The ability of ISVS-24 to be adapted and validated across such a wide spectrum of environments indicates its applicability among diverse socio-cultural contexts across countries, healthcare systems, education frameworks, cultural perceptions of professions, and societal expectations. Although several interprofessional education (IPE) outcome measures, such as the Readiness for Interprofessional Learning Scale (RIPLS), Collaborative Interprofessional Competency Scale (CICS-29), Collaborative Practice Assessment Tool (CPAT), and the Indonesian version of the Interprofessional Socialization and Valuing Scale (ISVS-19)—have been translated and validated in Indonesian, this study opted to adapt the ISVS-24 directly from its original English version. This decision was made to maintain conceptual integrity and ensure that the instrument remains aligned with the theoretical underpinnings established by its original developers. For example tools like RIPLS are commonly used to assess readiness for interprofessional learning through constructs such as teamwork and collaboration, they do not specifically target the process of interprofessional socialisation, which is the central focus of the ISVS-24. Adapting a version that has already been translated and validated in a different context would require further modification to fit the unique characteristics of a multi-participant virtual reality (MPVR) simulation environment, which may compromise the validity of the construct being measured. Therefore, adapting the ISVS-24 from the original source allows for more controlled and context-specific refinement, ensuring that the instrument appropriately captures interprofessional socialisation within immersive VR settings. Moreover, ISVS-24 has demonstrated good psychometric properties in prior studies, including satisfactory internal consistency (Cronbach’s alpha > 0.80) and construct validity in various professional populations. 11 Nevertheless, the existing ISVS-24 has not yet been validated in immersive, interactive simulation environments such as MPVR-based simulation settings, where collaborative learning and problem-solving occur in immersive 3D environments. Consequently, there is a need to develop and validate an adapted version of the ISVS-24 specifically tailored for assessing interprofessional collaboration in MPVR-based simulation settings. The objective of this research is to adapt and validate ISVS as an assessment tool for IPE in an MPVR-based education setting. Methods Study design This study was a pilot study using a cross-sectional design aimed at determining the psychometric properties of the adapted ISVS-24 for a virtual environment setting and involved three phases. The first phase involved the translation of the original ISVS-24, which was in English, into Indonesian. The second phase was content validity assessment of the ISVS-24 by a panel of experts. The third phase was a pilot study conducted with participants who completed the questionnaire, which had undergone content validity processes and was adapted for use in a virtual environment setting ( Figure 1 ). Figure 1. Translation and validation process. Participants A total of 72 anesthesiology residents, general physicians, and professional nurses from the Faculty of Medicine, Universitas Indonesia – Dr. Cipto Mangunkusumo Hospital took part in this study and were voluntarily recruited. Participants were recruited through direct invitation to medical and nursing professionals at the institution. As inclusion criteria, the following factors were considered: (1) older than 18 years, (2) free from visual, auditory, and other sensory impairments, (3) and provide informed consent to participate. Participants were not required to have prior interprofessional team experience. However, their professional backgrounds ensured exposure to interprofessional collaboration in clinical settings. Additionally, prior exposure to VR training was not a requirement, as the study aimed to assess interprofessional socialization within a simulated VR setting, regardless of previous VR experience. Participants were excluded if they had a known history of motion sickness, balance disorders, or any medical condition that could increase the risk of discomfort during VR use. Development and Pilot Testing of VR-Local Anesthesia of Systemic Toxicity This study developed Local Anesthesia of Systemic Toxicity scenes using Virtual Reality (VR-LAST) to provide an engaging and immersive learning experience that reflects students’ real-clinical scenarios. VR-LAST is a platform that provides an immersive experience of a virtual world featuring 3D-based user-generated content that supports interactive networking. This platform is used in the simulation of systemic toxicity events due to the administration of local anesthesia in patients undergoing surgery with local anesthesia. In this platform, we created a scenario where an individual who will undergo operative action must be given anesthesia in the form of local anesthesia, which will be managed collaboratively by anesthesia residents, general practitioners, and professional nurses. As illustrated in Figure 2 : viewpoints of different users, VR-LAST incorporates multiple user viewpoints: (A) the anesthesia resident’s view of the Non-Playable Character (NPC), (B) the general practitioner’s view, (C) the nursing student’s view, and (D) the facilitator’s view. The scenario guides participants through the preparation for anesthesia, administration of anesthesia, systemic toxicity events, and subsequent interventions, including assessment and management. The specific tasks performed by participants in the virtual environment are outlined in Supplementary Table. The operating room concept was built to help participants understand the environment and provide a realistic experience. The developed VR is ready to be tested for feasibility. It can enable participants from different times and locations to come together in real-time interactive simulation training to manage LAST emergency events. IPE using simulation-based LAST is a practical approach to prepare students for a collaborative environment, develop technical skills, and enhance soft skills, such as communication and teamwork, to prepare them as work-ready graduates. Figure 2. Viewpoints of different users. After the development of the initial VR-LAST simulation, a preliminary pilot test was conducted involving six participants, including of two anesthesiology specialist, two general physician, and two nurses. The aim of this pilot was to assess the basic functionality, clarity of the scenario, and user experience within the virtual environment. During the session, the team provided structured feedback, particularly highlighting the need to include a practice mode or orientation phase before starting the actual LAST management simulation. This feature was considered important to help future users become familiar with the VR interface and controls. Based on this input, the VR developer revised the content by incorporating a pre-simulation practice session. Following these adjustments, the final version of VR-LAST was deemed ready for implementation in the main study (pilot study). It should be noted that participants involved in this preliminary VR pilot were different from those recruited for the instrument validation phase. Instruments The Interprofessional Socialization and Valuing Scale (ISVS-24) was a 24-item self-assessment questionnaire created by King et al. The self-assessment questionnaire focuses on changes in attitudes, actions, and beliefs of participants after interprofessional training. Respondents are asked to rate their agreement or disagreement with each statement based on their own experiences and perceptions after previous training. The scale aims to capture attitudes, beliefs, and behaviours that contribute to effective teamwork and collaboration across three dimensions: self-perceived ability to work for others, value in working with others, and comfort in working with others. 18 The original ISVS-24 was selected for adaptation instead of its shortened or previously translated versions to preserve the instrument’s full conceptual coverage. This approach allowed for a more precise contextual adaptation tailored to MPVR-based interprofessional learning. Using the full version enabled us to refine the items in a controlled manner while maintaining fidelity to the original construct, which was essential for measuring complex socialization processes in a virtual simulation setting. Permission to translate and adapt the ISVS-24 into Indonesian and for its use in a VR-based educational context was obtained from the original author prior to conducting the study. This study utilized virtual reality simulations that were played by three individuals. Each simulation session involved three participants, comprising an anesthesiology resident, a general physician, and a professional nurse. During the simulation, each participant took on specific interprofessional roles relevant to anesthesia management, ensuring a realistic team-based training environment. VR is conceived with specific learning objectives; comprehension of cognitive, motor, communicative, and interpersonal skills in managing local anaesthetic systemic toxicity cases in an immersive surgical room environment. A patient was standardized as NPCs (non-playable characters) with specific scenarios. Procedure Phase 1: Translation of the ISVS-24 Two professional bilingual translators, both fluent in English and Indonesian and with backgrounds in healthcare and medical education, independently translated the original ISVS-24 into Indonesian. Their translations were reviewed and synthesized into a single preliminary version by the research team, all of whom are native Indonesian speakers with expertise in interprofessional education, simulation-based training, and health professions education. To ensure conceptual and semantic equivalence, a back-translation was performed by an independent bilingual translator who had no prior exposure to the original ISVS-24. The back-translated version was compared with the original English instrument to identify discrepancies or wording that might introduce differences in interpretation. Several items required clarification during this step, particularly those referring to “clients” (e.g., Items 5, 7, and 16), as the equivalent terminology in Indonesian health-professional contexts can vary and may not align directly with the original phrasing. Items involving expressions such as debating or speaking out in team settings (e.g., Item 19) also prompted discussion to ensure clarity and conceptual accuracy. These issues were addressed through a series of consensus meetings involving the translators and research team, during which minor refinements were made to improve clarity while maintaining fidelity to the original construct. Phase 2: Content validation of the Indonesian ISVS-24 To evaluate content validity, the Indonesian ISVS-24 was assessed by a panel of four senior anesthesiology consultants with a minimum of 10 years of experience in health professions education and simulation-based interprofessional training. All panelists had extensive involvement in MPVR-based simulation research and had served as facilitators in interdisciplinary training programs. However, as the instrument targets interprofessional socialization more broadly, the composition of the panel presents a limitation in that it did not include experts from other health professions or individuals with formal training in IPE assessment. Each item was rated on a Likert scale of 1-5 based on its relevance to MPVR simulation-based setting. The scale was as follows: 1 - highly irrelevant, 2 - irrelevant, 3 - moderate, 4 - relevant, 5 - highly relevant. The experts were also requested to provide qualitative feedback or suggestions on clarity and revisions on certain questions they deemed less appropriate for multiplayer VR. Content validity was then analyzed using Aiken’s V formula, and items that failed to meet the minimum validity threshold (V < 0.80) were either revised or removed based on expert recommendations. Phase 3: Construct validation of the Indonesian ISVS-24 This phase aimed to assess the clarity, comprehensibility, and preliminary psychometric properties of the translated ISVS-24 instrument. A total of 72 participants were recruited through purposive sampling, consisting of anesthesiology residents, general physicians, and professional nurses. The participants were provided with information regarding the purpose of the study. They were given consent forms after being reminded of the voluntary nature of their participation and the confidential and anonymous handling of their data. Once they had signed the informed consent, the participants were assembled by the principal investigator in the pilot trial, who convened them in a single classroom. All participants in the pilot study were introduced and trained using VR equipment, specifically the Oculus Quest 2 headset. Before each simulation, participants received a 10-minute orientation on VR headset use, scenario overview, and simulation flow. Roles (resident, physician, nurse) were assigned and briefed to ensure shared understanding and coordination. They were divided into small teams consisting of three persons, with one individual assigned as the team leader. All groups underwent MPVR simulation-based training. Once the simulation was finished, participants reviewed the clarity and content of the scale. Items identified as invalid in Phase 2 were removed, resulting in a 21-item version of the ISVS-24. This version was administered to assess internal consistency and to conduct an exploratory evaluation of dimensionality. An Exploratory Factor Analysis (EFA) was performed using Principal Component Analysis (PCA) as the extraction method. Given the preliminary nature of this validation phase and the modest sample size (N = 72), PCA was selected as an extraction method to explore the initial component structure. Data analysis We used digital scoring and rating sheets to record the collected data manually. SPSS (version 22.0; IBM Corp) was applied to analyse the data quantitatively. First, a descriptive analysis of the results was conducted. The frequency and percentage were computed for the categorical variables, whereas the measures of central tendency and dispersion were determined for the quantitative variables. To determine the questionnaire’s structural validity, a factorial analysis was conducted through principal component analysis. The content validity index (CVI) of the instrument in this study was evaluated using Aiken’s formula. A measurement tool is considered adequately valid if its Aiken coefficient is greater than 0.5. 22 – 24 To examine the preliminary construct validity of the adapted instrument, a principal component analysis (PCA) was performed. PCA was selected as an initial dimensionality assessment appropriate for pilot data and aimed to identify the dominant components explaining variance in the responses. Prior to analysis, sampling adequacy and factorability were examined using the Kaiser–Meyer–Olkin (KMO) statistic and Bartlett’s Test of Sphericity. The assessment of internal consistency and reliability of the variables in this study was conducted through Cronbach’s alpha reliability analysis. Items with Cronbach’s alpha value above 0.70 were considered reliable. To evaluate the validity of the responses, the Pearson Correlation Coefficient (PCC) was calculated to assess the relationship between individual items and the overall scale. 25 – 28 Ethical considerations and consent to participate This study was conducted following the Declaration of Helsinki and was approved by the Ethics Committee of the Faculty of Medicine, Universitas Indonesia - Dr. Cipto Mangunkusumo Hospital with regards of the protection of human rights and welfare in medical research, with approval number 1146/UN2.F1/ETIK/PPM.00.02/2022, on October 31, 2022. All participants provided written informed consent before participation. No participant-identifying information was included in the study data. Data were managed by researchers and assistants who were not involved in any teaching roles, and only the ID codes were noted in the database. No personal data was accessible to the instructional team in the initial phase of the research; adjustments were made to the items in the original ISVS to suit the multiplayer VR environment. Results Content validity Aiken’s method was used to assess the content validity of the questionnaire in this study. Four senior anesthesiology consultants who were experts in MPVR simulation-based education evaluated each item based on its relevance to interprofessional collaboration within virtual environments. Consequently, in this investigation, each questionnaire item underwent scrutiny by the experts who evaluated its appropriateness and relevance. If a consensus (two or more experts) suggested that a specific item was unnecessary, it was subsequently removed from the questionnaire. The analysis of the content validity of the instrument used the Aiken coefficient V can be viewed in Table 1 . Table 1. Analysis table of Aiken's coefficient calculation results. No. Item V Self-perceived ability to work for others 1 Item 1 0.875 2 Item 2 0.938 3 Item 3 0.938 4 Item 4 0.813 5 Item 5 0.125 a 6 Item 6 0.875 7 Item 7 0.063 a 8 Item 8 0.688 9 Item 9 0.813 Value in working with others 10 Item 10 0.750 11 Item 11 0.875 12 Item 12 0.875 13 Item 13 0.938 14 Item 14 0.875 15 Item 15 0.750 16 Item 16 0.188 a 17 Item 17 0.750 18 Item 18 0.875 Comfort in working with others 19 Item 19 0.688 20 Item 20 0.875 21 Item 21 0.875 22 Item 22 0.750 23 Item 23 0.625 24 Item 24 0.750 Mean V 0.815 a Not valid, items were removed. Three items (item 5, 7, and 16) received Aiken’s V values ≤ 0.50 and were therefore excluded. These items were considered less compatible with the immersive characteristics of the MPVR context, particularly those referencing client or family-centered care, which were not applicable to the simulated clinical scenario. The removal of these items was based on low content validity indices (Aiken’s V ≤ 0.50) as assessed by four expert reviewers during Phase 2. These three items were excluded prior to Phase 3 and were therefore not tested further with study participants. The decision was made to ensure content relevance in the context of MPVR-based interprofessional learning. The three items that were removed are: 1. “I am comfortable engaging in shared decision-making with clients” (item 5) 2. “I have gained a better understanding of the client’s involvement in decision-making around their care” (item 7) 3. “I have gained an appreciation for the importance of having the client and family as members of a team” (item 16) Following this, twenty-one items with Aiken’s V values ≥ 0.5 were deemed valid and incorporated into the Multiplayer Virtual Reality Adapted Version of the Interprofessional Socialization and Valuing Scale. In addition, all experts agreed to make a slight change to item number 21 to ensure it is framed as a positive statement, changing it from “I believe that interprofessional practice is difficult to implement” to “I believe that interprofessional practice is easy to implement”. Participant characteristics Seventy-two participants total participated in the study, of which 40 were female (55.6%) and 32 were male (44.4%); 26 were anesthesiology residents (36.1%), 23 were general physicians (31.9%), and 23 were professional nurses (31.9%). The average age was 29.32 ± 2.54 years old ( Table 2 ). Table 2. Demographic characteristics of subjects. Characteristics Mean ± SD n (%) Age in years 29.32 ± 2.54 Sex Female 40 (55.6) Male 32 (44.4) Profession Anesthesiology resident 26 (36.1) General physician 23 (31.9) Nurse 23 (31.9) Consistency validity The questionnaire’s validity was verified through the computation of the Pearson correlation coefficient (PCC). The critical value was 0.232, according to the table of critical values. As shown in Table 3 , for all our variables, the r table was > 0.232 for p values of < 0.05. Table 3 displays the validity (Pearson’s correlation coefficient) for every item. Table 3. Pearson’s correlation coefficients for measuring the validity of the questionnaire’s internal consistency. Item No. Statement items PCC Mean SD Self-perceived ability to work for others 1 I feel comfortable in accepting responsibility delegated to me within a team 0.66 4.51 0.56 2 I feel able to act as a fully collaborative member of the team 0.75 4.64 0.48 3 I’ve gained a better understanding of my own approach to care within an interprofessional team 0.66 4.67 0.48 4 I feel comfortable in being accountable for responsibilities I have taken on 0.76 4.61 0.52 5 I am able to listen to other members of the team 0.69 4.58 0.52 6 I feel comfortable clarifying misconceptions with other members of the team about the role of someone in my profession 0.58 4.44 0.55 7 I more highly value open and honest communication with team members 0.72 4.67 0.51 Value in working with others 8 I have gained more realistic expectations of other professionals on a team 0.70 4.61 4.91 9 I have gained an enhanced awareness of the roles of other professionals on a team 0.77 4.60 0.62 10 I see myself as preferring to work on an interprofessional team 0.81 4.60 0.52 11 I have gained an appreciation for the benefits in interprofessional teamwork 0.74 4.65 0.51 12 I have gained greater appreciation of the importance of a team approach 0.81 4.58 0.52 13 I feel comfortable initiating discussions 0.78 4.43 0.67 14 I believe that interprofessional practice will give me the desire to remain in my profession 0.80 4.57 0.53 15 I believe that interprofessional practice is not a waste of time 0.66 4.68 0.47 Comfort in working with others 16 I feel comfortable debating issues in a team 0.79 4.56 0.55 17 I am comfortable being the leader in a team situation 0.79 4.42 0.62 18 I feel confident in taking on different roles in a team (i.e., leader, participant) 0.79 4.44 0.58 19 I am able to share and exchange ideas in a team discussion 0.87 4.50 0.53 20 I feel comfortable speaking out within the team when others are not keeping the best interest of the patient in mind 0.74 4.26 0.69 21 I believe that interprofessional practice is easy to implement 0.72 4.51 0.58 Exploratory Factor Analysis Before conducting the analysis, the distribution of item scores was examined. The Kolmogorov–Smirnov test indicated no significant deviation from normality (p > 0.05), and all skewness and kurtosis values fell within the acceptable range (−2 to +2). Sampling adequacy was confirmed by a Kaiser–Meyer–Olkin (KMO) value of 0.857, and Bartlett’s Test of Sphericity was significant (χ 2 (210) = 1193.762, p < 0.001), indicating that the data were suitable for factor analysis. An Exploratory Factor Analysis (EFA) was performed using Principal Component Analysis (PCA) as the extraction method, followed by Varimax rotation. Communalities ranged from 0.47 to 0.79, suggesting that the extracted components explained a substantial proportion of variance in each item. Based on Kaiser’s criterion (eigenvalues > 1), three components were retained, accounting for 66.88% of the total variance. Details of the retained components are presented in Table 4 . Although the first component accounted for the largest proportion of variance, the second and third components had eigenvalues above 1 and produced a coherent and interpretable loading pattern. This three-component structure aligns with the conceptual domains described in the original ISVS development study. Table 4. Total variance explained. Component Eigenvalue % of variance Cumulative % 1 11,912 56,726 56,726 2 1,106 5,266 61,992 3 1,027 4,891 66,883 The rotated solution demonstrated a clear and interpretable structure. All 21 items loaded above the threshold of 0.40 on at least one component. Rotated factor loadings for all items are shown in Table 5 . Table 5. Factor loadings of items. Item Factor 1 Factor 2 Factor 3 1 0.796 0.280 0.225 2 0.767 0.255 0.292 3 0.760 0.402 0.223 4 0.620 0.296 0.323 5 0.550 0.362 0.231 6 0.532 0.263 0.358 7 0.497 - 0.278 8 0.237 0.730 0.205 9 0.173 0.715 0.297 10 0.211 0.667 - 11 0.302 0.647 0.347 12 0.197 0.589 0.241 13 0.354 0.588 0.156 14 0.169 0.583 0.281 15 0.249 0.570 0.406 16 0.200 0.186 0.800 17 0.287 0.372 0.642 18 0.240 0.385 0.629 19 0.357 0.232 0.600 20 0.222 0.317 0.583 21 0.331 0.239 0.565 Item reliability test In this study, Cronbach’s alpha was used to measure the reliability of each item. Table 6 shows the Cronbach’s alpha result. The overall Cronbach’s alpha coefficient for the 21-item scale was 0.959. Table 6. Cronbach’s alpha. Sections Number of items Cronbach’s alpha Self perceived ability to work for others 7 (No. 1-7) 0.861 Value in working with others 8 (No. 8-15) 0.909 Comfort in working with others 6 (No. 16-21) 0.907 Overall 0.959 Discussion VR presents enormous potential for the future of medical education. Its applications range from surgical training and 3D visualization skills to teaching soft skills like empathy and communication. VR’s capacity for training technical competencies is well-recognized. 29 However, its role in enhancing interpersonal collaboration skills still requires further study. Recent study examines the effectiveness of immersive virtual reality simulation in interprofessional education, finding that it enhances cooperation and communication among students, promotes a team approach, and provides an immersive learning experience that benefits future healthcare team roles. 30 In line with this, there’s an increasing demand for instruments that evaluate interprofessional collaboration performance in a multiplayer VR setting. In this study, we adapted ISVS for multiplayer VR-based simulation education. Three items were removed based on a combination of contextual incompatibility and expert content review using Aiken’s V analysis. These items referred to shared decision-making with patients or families, which was not feasible in VR settings where non-player characters (NPCs) are standardized and not designed for complex reciprocal interaction. The removal of these items improved contextual fit and content validity. In most VR-based simulation programs for medical education, patients are represented by NPC. Complex human behaviours are challenging to replicate authentically in VR. As a result, interactions with NPC might feel limited and less realistic than with real humans. The inherent limitations of NPC constrain the possible interactions between learners and patients. However, with technological advancements, particularly integrating artificial intelligence with NPC, NPC might become more sophisticated, allowing more realistic interactions. 31 Despite these challenges, VR’s capability in facilitating interprofessional collaboration lies in its ability to offer both communication and information support, enhancing users’ information processing abilities. VR might help students in achieving collaborative skills crucial for problem-solving both in and outside the classroom. 31 – 33 The content validity analysis, using Aiken’s V method, resulted in a final adapted questionnaire consisting of 21 valid items, after excluding three items with Aiken’s V values below 0.5. Furthermore, slight modifications were made to ensure clarity and appropriateness of the remaining items, such as rephrasing item 21 to convey a positive perspective. The high agreement among experts highlights the rigor of the adaptation process and supports the relevance of the adapted items for a VR-based environment. The result showed a high internal consistency with an overall Cronbach’s alpha result of 0.959, which indicates that the adapted version of ISVS items’ were reliable. King et al. reported an alpha of 0.988 for the refined ISVS-21, concluding that it possessed excellent measurement properties and consistent performance across professional groups. 18 These findings reinforce the strong internal consistency and conceptual coherence of the adapted ISVS-24 when applied in MPVR-based interprofessional collaboration settings. Although future studies should supplement this with McDonald’s Omega to assess reliability more precisely, especially given potential item redundancy. Preliminary construct validity was supported by exploratory factor analysis, which retained three components aligning with the ISVS’s original subscales: self-perceived ability to work with others, value in collaboration, and comfort in working with others. The three retained components accounted for 66.88% of the total variance, and all items loaded above the 0.40 threshold, indicating strong item–component associations. The Kaiser-Meyer-Olkin (KMO = 0.857) and Bartlett’s test further confirmed the adequacy of the dataset for factor analysis. Although the total number of participants (n=72) was below the conventional recommendation for factor analysis, the adequacy of this sample was supported by the high KMO value (0.857) and strong factor loadings (≥0.4). Previous simulation studies have shown that exploratory factor analysis can still produce valid and stable solutions with small sample sizes when communalities and factor loadings are high. 34 These findings support the appropriateness of using 72 participants in this pilot validation. Our findings are consistent with earlier validation work on the ISVS-24. King et al., who developed the original instrument, reported a three-factor structure with strong internal consistency, although several items showed modest loadings and required further refinement. 21 Similar to their results, our adapted version demonstrated high reliability, but the factor structure differed, likely reflecting the distinct characteristics of a VR-based learning environment compared with traditional clinical or classroom settings. A comparison with the Spanish adaptation by González-Pascual et al. also shows parallels in translation challenges, particularly for items involving role clarity and team communication, although their study ultimately supported a unidimensional structure. 33 In the Indonesian context, prior validation of the ISVS-19 demonstrated strong psychometric performance and highlighted the influence of cultural and educational factors on item interpretation. 35 Our findings extend this evidence by showing that the instrument can be meaningfully adapted for use in multi-participant VR simulations while maintaining conceptual fidelity to the original scale. Other study validation of the Collaborative Practice Assessment Tool (CPAT) in Singapore followed rigorous COSMIN guidelines and demonstrated strong construct validity in a real-world healthcare environment. While the setting differs (clinical practice versus simulated VR education), both studies underscore the importance of robust methodology and contextual relevance when measuring interprofessional collaboration. 36 Our findings extend this evidence base by showing that even within a virtual environment, collaborative behaviors can be meaningfully assessed when using a well-adapted and validated instrument. However, this study has several limitations. The sample size in this pilot study was relatively small and drawn from a single institution, which may affect the robustness and generalizability of the factor analysis. Additionally, the content validation process involved only four expert reviewers, all of whom were anesthesiology consultants. This may limit the diversity of perspectives that are typically recommended for interprofessional instruments. Future studies should expand the participant pool and include a broader panel of experts from various health professions to strengthen content validity. In addition, while our simulation reflected real-world interprofessional scenarios, it relied on scripted interactions and NPCs, which may limit ecological validity. Future studies should test the adapted ISVS across diverse educational contexts, larger and more heterogeneous populations, and in simulations with varying levels of realism and interactivity. Despite these limitations, our findings support the use of the Multiplayer Virtual Reality Adapted Version of ISVS as a valid and reliable instrument for assessing interprofessional collaboration skills in VR-based education. By addressing the unique challenges of VR environments and adapting existing tools to fit this innovative learning modality, this study contributes to the growing body of research on VR’s role in advancing interprofessional education. Conclusion This study presents preliminary evidence that the Indonesian-adapted ISVS-24 is a valid and reliable instrument for assessing interprofessional collaboration in Multiplayer VR simulation-based education. The instrument demonstrated acceptable content validity, internal consistency, and construct structure when used in an immersive learning environment. While this study provides valuable insights into the adaptation and validation of ISVS-24 in a VR-based interprofessional collaboration setting, several limitations must be acknowledged. The relatively small sample size and single-institution focus may limit the generalizability of our findings. Additionally, future studies with larger and more diverse participant pools are needed to further validate the instrument. Future research should involve multiple institutions and a broader range of healthcare professionals to enhance the robustness of the findings. Data availability Underlying data Zenodo: Adaptation and Validation of the Interprofessional Socialization and Valuing Scale (ISVS-24) for Utilization in Multiplayer Virtual Reality Environments. https://doi.org/10.5281/zenodo.14637073 . 37 This project contains the following underlying data: • Aiken’s V Results.xlsx • Validity and Reliability Test Results.xlsx • Participants Feedback.xlsx Extended data Zenodo: Adaptation and Validation of the Interprofessional Socialization and Valuing Scale (ISVS-24) for Utilization in Multiplayer Virtual Reality Environments. https://doi.org/10.5281/zenodo.14637073 . 37 This project contains the following extended data: • Supplementary Table.docx • Final Questionnaire (Indonesia and English Version).docx Data are available under the terms of the Creative Commons Attribution 4.0 International license (CC-BY 4.0). Reporting guidelines STROBE checklist for adaptation and validation of the interprofessional socialization and valuing scale (ISVS-24) for utilization in multiplayer virtual reality environments. https://doi.org/10.5281/zenodo.14637073 . 37 Data are available under the terms of the Creative Commons Attribution 4.0 International license (CC-BY 4.0). References 1. Wong AH, Ruppel H, Gang M, et al. : “The safety dance”: a faculty development workshop partnering ipe and patient safety initiatives using simulation-based education. MedEdPORTAL. 2016; 12 : 10440. Publisher Full Text 2. Hur HK, Kim KK, Lim YM, et al. : Patient safety interprofessional education program using medical error scenarios for undergraduate nursing and medical students in korea. J. Interprof. Care. 2023; 37 (6): 944–953. PubMed Abstract | Publisher Full Text 3. 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Mahler C, Orchard C, Berger S, et al. : Translation and psychometric properties of the german version of the “interprofessional socialization and valuing scale” (isvs-21-d). J. Interprof. Care. 2023; 37 (4): 655–661. PubMed Abstract | Publisher Full Text 20. Wu Q, Wang Y, Lu L, et al. : Virtual simulation in undergraduate medical education: a scoping review of recent practice. Front. Med. (Lausanne). 2022 Mar; 9 : 855403. PubMed Abstract | Publisher Full Text | Free Full Text 21. King G, Shaw L, Orchard CA, et al. : The Iinterprofessional socialization and valuing scale: A tool for evaluating the shift toward collaborative care approaches in health caresettings. Work. 2010; 35 (1): 77–85. PubMed Abstract | Publisher Full Text 22. Bujang MA, Khee HY, Yee LK: A step-by-step guide to questionnaire validation research. Institute for clinical Research. 2022. 23. Shrotiya VK, Dhanda U: Content validity of Assessment Instrument for Employee Engagement. SAGE Open. 2019; 9 : 1–7. Publisher Full Text 24. Aiken LR: Three coefficients for analyzing the reliability and validity of ratings. Educ. Psychol. Meas. 1985; 45 (1): 131–142. Publisher Full Text 25. Retnawati H: Proving content validity of self-regulated learning scale (the comparison of aiken index and expanded gregiry index). REiD (Res. Eval. Educ). 2016; 2 (2): 155–164. Publisher Full Text 26. Paranhos R, Figueiredo-Filho D, Rocha E, et al. : Unveiling the mysteries of pearson’s correlation coefficient: the return. Leviathan. 2014; 8 : 66–95. Publisher Full Text 27. Taber KS: The use of cronbach’s alpha when developing and reporting research instruments in science education. Res. Sci. Educ. 2018; 48 : 1273–1296. Publisher Full Text 28. Tavakol M, Dennick R: Making sense of Cronbach’s alpha. Int. J. Med. Educ. 2011 Jun; 2 : 53–55. PubMed Abstract | Publisher Full Text | Free Full Text 29. Schultz KS, Whitney DJ: Measurement theory in action: case studies and exercises. Thousand Oaks, CA: Sage; 2005. 9781452224749. 30. Qiao J, Xu J, Li L, et al. : The integration of immersive virtual reality simulation in interprofessional education: A scoping review. Nurse. Educ. Today. 2021 Mar; 98 : 104773. PubMed Abstract | Publisher Full Text 31. McGrath JL, Taekman JM, Dev P, et al. : Using virtual reality simulation environments to assess competence for emergency medicine learners. Acad. Emerg. Med. 2018 Feb; 25 (2): 186–195. PubMed Abstract | Publisher Full Text 32. Aithal A, Aithal PS: Development and validation of survey questionnaire & experimental data – a systematical review-based statistical approach. IJMTS. 2020; 5 (2): 233–251. Publisher Full Text 33. González-Pascual JL, Márquez MG, Rodríguez-Rey R, et al. : Adaptation and validation of the interprofessional socialization and valuing scale (isvs) in spanish university health sciences students. J. Interprof. Care. 2022 Nov-Dec; 36 (6): 916–922. Publisher Full Text 34. de Winter JC , Dodou D, Wieringa PA: Exploratory factor analysis with small sample sizes. Multivariate Behav. Res. 2009 Mar-Apr; 44 (2): 147–181. Publisher Full Text 35. Ardyansyah BD, Cordier R, Brewer ML, et al. : Psychometric evaluation of the culturally adapted interprofessional socialisation and valuing scale (ISVS)-19 for health practitioners and students in Indonesia. J. Interprof. Care. 2024 Mar-Apr; 38 (2): 283–293. PubMed Abstract | Publisher Full Text 36. Quek GSM, Kwan YH, Chan CQH, et al. : Validation of the Collaborative Practice Assessment Tool (CPAT) to assess the degree of inter-professional collaboration (IPC) in a Community Hospital in Singapore. J. Interprof. Ed. Practice. 2022; 27 : 100504. Publisher Full Text 37. Firdaus R, Tantri AR, Atan RB, et al. : Adaptation and validation of the interprofessional socialization and valuing scale (isvs-24) for utilization in multiplayer virtual reality environments. Dataset. Zenodo. 2025. Publisher Full Text Comments on this article Comments (0) Version 3 VERSION 3 PUBLISHED 06 Feb 2025 ADD YOUR COMMENT Comment Author details Author details 1 Department of Anesthesiology and Intensive Care, Faculty of Medicine, Universitas Indonesia, Central Jakarta, Jakarta, 10430, Indonesia 2 Simulation-Based Medical Education and Research Center Cluster, Indonesia Medical Education and Research Institute (IMERI), Faculty of Medicine, Universitas Indonesia, Central Jakarta, Jakarta, 10430, Indonesia 3 Department of Anesthesiology, Faculty of Medicine, Malaya University, Kuala Lumpur, Kuala Lumpur, 50603, Malaysia 4 Medical Technology Cluster, Indonesia Medical Education and Research Institute (IMERI), Faculty of Medicine, Universitas Indonesia, Central Jakarta, Jakarta, 10430, Indonesia Riyadh Firdaus Roles: Conceptualization, Methodology, Supervision, Writing – Original Draft Preparation Aida Rosita Tantri Roles: Conceptualization, Formal Analysis, Project Administration, Writing – Original Draft Preparation Rafidah Binti Atan Roles: Conceptualization Sidharta Kusuma Manggala Roles: Conceptualization, Methodology, Software Anggara Gilang Dwiputra Roles: Conceptualization, Methodology, Software Andy Omega Roles: Conceptualization, Methodology, Software Imelda Rosalyn Sianipar Roles: Resources, Software, Writing – Original Draft Preparation Dina Muktiarti Roles: Resources, Software, Writing – Original Draft Preparation Adisti Dwijayanti Roles: Resources, Software, Writing – Original Draft Preparation Rima Maulida Hidayati Roles: Project Administration, Resources, Supervision, Writing – Review & Editing Tasya Claudia Roles: Data Curation, Formal Analysis, Writing – Original Draft Preparation Dewi Anggraeni Kusumoningrum Roles: Conceptualization, Methodology, Software Luthfi Saiful Arif Roles: Conceptualization, Methodology, Software Competing interests No competing interests were disclosed. Grant information This work was supported by the Universitas Indonesia under the Publikasi Terindex Internasional (PUTI) Q2 Tahun 2022-2023 grant scheme [grant number: NKB-1217/UN2.RST/HKP.05.00/2022]. The funders had no role in study design, data collection and analysis, decision to publish, or preparation of the manuscript. Article Versions (3) version 3 Revised Published: 21 Jan 2026, 14:169 https://doi.org/10.12688/f1000research.160939.3 version 2 Revised Published: 17 Jul 2025, 14:169 https://doi.org/10.12688/f1000research.160939.2 version 1 Published: 06 Feb 2025, 14:169 https://doi.org/10.12688/f1000research.160939.1 Copyright © 2026 Firdaus R et al . This is an open access article distributed under the terms of the Creative Commons Attribution License , which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited. Download Export To Sciwheel Bibtex EndNote ProCite Ref. Manager (RIS) Sente metrics Views Downloads F1000Research - - PubMed Central info_outline Data from PMC are received and updated monthly. - - Citations open_in_new 0 open_in_new 0 open_in_new SEE MORE DETAILS CITE how to cite this article Firdaus R, Tantri AR, Atan RB et al. Adaptation and Validation of the Interprofessional Socialization and Valuing Scale (ISVS-24) for Utilization in Multiplayer Virtual Reality Environments [version 3; peer review: 4 approved with reservations] . F1000Research 2026, 14 :169 ( https://doi.org/10.12688/f1000research.160939.3 ) NOTE: If applicable, it is important to ensure the information in square brackets after the title is included in all citations of this article. COPY CITATION DETAILS track receive updates on this article Track an article to receive email alerts on any updates to this article. TRACK THIS ARTICLE Share Open Peer Review Current Reviewer Status: ? Key to Reviewer Statuses VIEW HIDE Approved The paper is scientifically sound in its current form and only minor, if any, improvements are suggested Approved with reservations A number of small changes, sometimes more significant revisions are required to address specific details and improve the papers academic merit. Not approved Fundamental flaws in the paper seriously undermine the findings and conclusions Version 3 VERSION 3 PUBLISHED 21 Jan 2026 Revised Views 0 Cite How to cite this report: Ardyansyah BD. Reviewer Report For: Adaptation and Validation of the Interprofessional Socialization and Valuing Scale (ISVS-24) for Utilization in Multiplayer Virtual Reality Environments [version 3; peer review: 4 approved with reservations] . F1000Research 2026, 14 :169 ( https://doi.org/10.5256/f1000research.194649.r451848 ) The direct URL for this report is: https://f1000research.com/articles/14-169/v3#referee-response-451848 NOTE: it is important to ensure the information in square brackets after the title is included in this citation. Close Copy Citation Details Reviewer Report 26 Mar 2026 Bau Dilam Ardyansyah , Medical Education, Universitas Hasanuddin, Makassar, South Sulawesi, Indonesia; Hasanuddin University Teaching Hospital, Hasanuddin University, Makassar, South Sulawesi, Indonesia; Curtin School of Allied Health, Curtin University, Perth, Western Australia, Australia Approved with Reservations VIEWS 0 https://doi.org/10.5256/f1000research.194649.r451848 I would like to commend the authors for the thoughtful revisions and the improvements made throughout the manuscript. The overall structure is now more coherent, and the description of the translation and adaptation process is much clearer. The enhanced reporting ... Continue reading READ ALL I would like to commend the authors for the thoughtful revisions and the improvements made throughout the manuscript. The overall structure is now more coherent, and the description of the translation and adaptation process is much clearer. The enhanced reporting of statistical analyses also strengthens the transparency of the study. Importantly, the work addresses a highly relevant and innovative area, adapting an interprofessional instrument for use in multiplayer virtual reality (MPVR) environments, which represents a meaningful contribution to the field of interprofessional education. I would encourage the authors to refine the framing of the study to more clearly reflect its pilot nature, rather than presenting it as a full validation study. In its current form, the use of the term “validation” may overstate the strength of the evidence. Describing the work as a “preliminary validation” or “initial psychometric evaluation” would more accurately align the claims with the level of evidence provided. This reframing is important in light of several methodological considerations: The content validity process, while involving experienced experts, does not yet include representation from multiple interprofessional groups. Given that the instrument is intended for interprofessional use, this may limit the comprehensiveness of the construct coverage. The relatively small sample size, as acknowledged by the authors, constrains the robustness of factor analytic findings and their generalizability. The study presents useful preliminary evidence related to internal structure (i.e., structural validity through factor analysis). However, structural and construct validity require multiple complementary sources of evidence. At present, the manuscript does not include evidence based on relationships with other variables, such as convergent or discriminant validity. Therefore, the current evidence may be more appropriately interpreted as partial and preliminary, rather than sufficient to support a full validation claim. With this reframing as a pilot or preliminary study, the manuscript is already adequate and makes a meaningful contribution. In this context, the authors may focus on strengthening the current presentation through the following refinements: Consider reporting McDonald’s omega to complement Cronbach’s alpha. A brief discussion of dimensionality would be valuable, as several indicators suggest the presence of one strong general factor (unidimensional instrument): the proportion of variance explained by the first factor, and the first eigenvalue is substantially larger than the second. The discussion would help clarify how the scale should be interpreted. Cronbach’s alpha (> 0.95), while indicating very high internal consistency, does not necessarily reflect optimal scale performance and may instead suggest potential item overlap or redundancy. Explicitly acknowledging this possibility would provide a more balanced interpretation of the reliability findings. As a preliminary validation, these refinements would further enhance the rigor and interpretability of the findings while remaining fully achievable within the scope of the current study. Competing Interests: No competing interests were disclosed. Reviewer Expertise: The reviewer is a senior academic and medical doctor specializing in the development and implementation of interprofessional education and collaborative practice for health practitioners and students. Her expertise includes learning, teaching, and assessment in medical education, interprofessional education and collaborative practice, instrument development, and psychometric properties evaluation. She has led studies on adapting assessment tools for Indonesian and Australian contexts, including tuberculosis care through a Delphi study. Her research ensures culturally relevant and reliable instruments for evaluating interprofessional education and practice, enhancing collaboration among healthcare professionals and students. I confirm that I have read this submission and believe that I have an appropriate level of expertise to confirm that it is of an acceptable scientific standard, however I have significant reservations, as outlined above. Close READ LESS CITE CITE HOW TO CITE THIS REPORT Ardyansyah BD. Reviewer Report For: Adaptation and Validation of the Interprofessional Socialization and Valuing Scale (ISVS-24) for Utilization in Multiplayer Virtual Reality Environments [version 3; peer review: 4 approved with reservations] . F1000Research 2026, 14 :169 ( https://doi.org/10.5256/f1000research.194649.r451848 ) The direct URL for this report is: https://f1000research.com/articles/14-169/v3#referee-response-451848 NOTE: it is important to ensure the information in square brackets after the title is included in all citations of this article. COPY CITATION DETAILS Report a concern Respond or Comment COMMENT ON THIS REPORT Version 2 VERSION 2 PUBLISHED 17 Jul 2025 Revised Views 0 Cite How to cite this report: Titus-Dawson S. Reviewer Report For: Adaptation and Validation of the Interprofessional Socialization and Valuing Scale (ISVS-24) for Utilization in Multiplayer Virtual Reality Environments [version 3; peer review: 4 approved with reservations] . F1000Research 2026, 14 :169 ( https://doi.org/10.5256/f1000research.184902.r435741 ) The direct URL for this report is: https://f1000research.com/articles/14-169/v2#referee-response-435741 NOTE: it is important to ensure the information in square brackets after the title is included in this citation. Close Copy Citation Details Reviewer Report 08 Jan 2026 Simone Titus-Dawson , Stellenbosch University, Stellenbosch, South Africa Approved with Reservations VIEWS 0 https://doi.org/10.5256/f1000research.184902.r435741 Dear Editor and Authors, Thank you for inviting me to review this body of work. The article reports on the adaptation and pilot validation of the Interprofessional Socialization and Valuing Scale (ISVS-24) for use ... Continue reading READ ALL Dear Editor and Authors, Thank you for inviting me to review this body of work. The article reports on the adaptation and pilot validation of the Interprofessional Socialization and Valuing Scale (ISVS-24) for use in multiplayer virtual reality (MPVR)–based interprofessional education where the authors translated the original ISVS-24 into Indonesian, conducted expert content validation, and administered a reduced 21-item version to 72 participants who are health professionals following participation in a VR simulation scenario. The overall study design is appropriate at a pilot and exploratory level. The phased approach to translation the instrument in order to do the content validation, and preliminary psychometric testing is well considered, particularly in a novel educational context such as MPVR based simulations. The ethical procedures are clearly documented, and the authors appropriately situate their work within the growing literature on VR-based IPE. However, the work is not fully technically sound as a validation study and it would appear to be better interpreted as a feasibility study or a form of preliminary exploration rather than a robust validation. For instance, the methods are really well explained, and are conceptually sound, and the study can be replicated. I found that this was a strength of this body of work, and the authors made the datasets available. However, some aspects of the translation process are insufficiently detailed, particularly which items require substantive rewording or contextual adaptation for VR, as well as for your context. The manuscript does not report what was extracted and why, what were, the commonalities etc. This would be important for others who may want to repeat this study for their own context. This is easily remedied as the authors can include the items and the justification for their choices more clearly. ​​​​​​The findings do justify claims regarding the feasibility, contextual relevance, and internal consistency of the adapted instrument in an MPVR setting. However, conclusions may come across as being overstated given the limitations in construct validation, sample size, and analytic approach. It would also be interesting to understand what the IPE simulation scenario was in order to understand which of the IPE competencies were being enacted. It is often useful for context. ​​​​​​Overall, this manuscript addresses an important and emerging area in HPE and particularly IPE. This work has several strengths, particularly in relevance, transparency, and feasibility testing. However the article requires clearer positioning as a pilot study, more cautious interpretation of validity claims, and substantially improved reporting and justification of psychometric analyses, especially factor analysis. Is the work clearly and accurately presented and does it cite the current literature? Yes Is the study design appropriate and is the work technically sound? Partly Are sufficient details of methods and analysis provided to allow replication by others? Partly If applicable, is the statistical analysis and its interpretation appropriate? I cannot comment. A qualified statistician is required. Are all the source data underlying the results available to ensure full reproducibility? Yes Are the conclusions drawn adequately supported by the results? No Competing Interests: No competing interests were disclosed. Reviewer Expertise: Digital Education and Innovation, Health Professions Education, Interprofessional Education, VR and AR I confirm that I have read this submission and believe that I have an appropriate level of expertise to confirm that it is of an acceptable scientific standard, however I have significant reservations, as outlined above. Close READ LESS CITE CITE HOW TO CITE THIS REPORT Titus-Dawson S. Reviewer Report For: Adaptation and Validation of the Interprofessional Socialization and Valuing Scale (ISVS-24) for Utilization in Multiplayer Virtual Reality Environments [version 3; peer review: 4 approved with reservations] . F1000Research 2026, 14 :169 ( https://doi.org/10.5256/f1000research.184902.r435741 ) The direct URL for this report is: https://f1000research.com/articles/14-169/v2#referee-response-435741 NOTE: it is important to ensure the information in square brackets after the title is included in all citations of this article. COPY CITATION DETAILS Report a concern Respond or Comment COMMENT ON THIS REPORT Views 0 Cite How to cite this report: Munawaroh S. Reviewer Report For: Adaptation and Validation of the Interprofessional Socialization and Valuing Scale (ISVS-24) for Utilization in Multiplayer Virtual Reality Environments [version 3; peer review: 4 approved with reservations] . F1000Research 2026, 14 :169 ( https://doi.org/10.5256/f1000research.184902.r433777 ) The direct URL for this report is: https://f1000research.com/articles/14-169/v2#referee-response-433777 NOTE: it is important to ensure the information in square brackets after the title is included in this citation. Close Copy Citation Details Reviewer Report 24 Nov 2025 Siti Munawaroh , Universitas Sebelas Maret, Surakarta, Indonesia Approved with Reservations VIEWS 0 https://doi.org/10.5256/f1000research.184902.r433777 Thank you for the opportunity to review this manuscript. I appreciate the authors’ efforts in adapting and validating the ISVS-24 instrument for use in a Multiplayer Virtual Reality (MPVR)–based interprofessional education setting. This topic is timely and highly relevant, ... Continue reading READ ALL Thank you for the opportunity to review this manuscript. I appreciate the authors’ efforts in adapting and validating the ISVS-24 instrument for use in a Multiplayer Virtual Reality (MPVR)–based interprofessional education setting. This topic is timely and highly relevant, given the increasing adoption of immersive VR in health professions education and the lack of validated instruments specifically tailored for VR-based interprofessional learning. This study therefore has the potential to make a meaningful contribution to the field. That said, several aspects of the manuscript require clarification and further refinement to enhance its methodological rigor and interpretability: Clarity and depth of methodological reporting The translation and back-translation procedures are described at a general level. The manuscript would benefit from specifying which items required significant modification or discussion during the adaptation process, as this information is important to support content validity. Additionally, the expert review process involved only anesthesiology specialists, whereas interprofessional instruments ideally require input from experts representing multiple professions. This limitation should be clearly acknowledged in the Discussion section rather than integrated into the Methods. Sample size justification for factor analysis The sample size (N=72) is relatively small for conducting a stable exploratory factor analysis. Many methodological guidelines recommend a minimum of 5–10 participants per item or at least 100–200 participants for reliable factor extraction. A clear justification referencing the psychometric literature is needed to support the adequacy of the current sample. Clarification of factor-analytic approach (PCA vs EFA) Although the manuscript states that an Exploratory Factor Analysis (EFA) was conducted, the analytical procedures described—specifically the use of Principal Component Analysis (PCA) as the extraction method—do not align with the requirements of a true EFA. PCA is a data-reduction technique that does not model latent constructs. The authors should clarify whether their intention was to conduct a genuine EFA, and if so, justify the use of PCA or consider reanalyzing the data using appropriate factor-extraction methods such as Principal Axis Factoring (PAF) or Maximum Likelihood (ML). Clear reporting of communalities, factor loadings, rotation methods, and rationale for factor retention (e.g., scree plot, parallel analysis) is also needed. Manuscript structure and placement of information Several statements about study limitations appear within the Methods and Results sections. These should be relocated to the Discussion section to improve structural coherence and to distinguish descriptive procedures from interpretive commentary. Strengthening the Discussion through comparison with prior ISVS validations The Discussion section would benefit from a deeper comparison with ISVS validation studies from other countries or educational contexts. Highlighting similarities or differences in item performance, factor structures, and reliability indices would help situate the findings within the broader literature. Overall, this manuscript addresses an important and emerging area in health professions education. With clearer methodological reporting, appropriate factor-analytic procedures, and a more structured presentation of findings, the study has the potential to make a valuable contribution to the development of assessment tools for VR-based interprofessional education. Is the work clearly and accurately presented and does it cite the current literature? Partly Is the study design appropriate and is the work technically sound? No Are sufficient details of methods and analysis provided to allow replication by others? Partly If applicable, is the statistical analysis and its interpretation appropriate? Partly Are all the source data underlying the results available to ensure full reproducibility? Yes Are the conclusions drawn adequately supported by the results? Partly Competing Interests: No competing interests were disclosed. Reviewer Expertise: Anatomy education, health professions education, curriculum development, faculty development, learning environment, and assessment in medical education. I confirm that I have read this submission and believe that I have an appropriate level of expertise to confirm that it is of an acceptable scientific standard, however I have significant reservations, as outlined above. Close READ LESS CITE CITE HOW TO CITE THIS REPORT Munawaroh S. Reviewer Report For: Adaptation and Validation of the Interprofessional Socialization and Valuing Scale (ISVS-24) for Utilization in Multiplayer Virtual Reality Environments [version 3; peer review: 4 approved with reservations] . F1000Research 2026, 14 :169 ( https://doi.org/10.5256/f1000research.184902.r433777 ) The direct URL for this report is: https://f1000research.com/articles/14-169/v2#referee-response-433777 NOTE: it is important to ensure the information in square brackets after the title is included in all citations of this article. COPY CITATION DETAILS Report a concern Author Response 21 Jan 2026 Aida Tantri , Department of Anesthesiology and Intensive Care, Faculty of Medicine, Universitas Indonesia, Central Jakarta, 10430, Indonesia 21 Jan 2026 Author Response 1. Thank you for the helpful comment. We have clarified in the Methods Phase 1 section which items required discussion during translation and have revised the manuscript accordingly. As suggested, we ... Continue reading 1. Thank you for the helpful comment. We have clarified in the Methods Phase 1 section which items required discussion during translation and have revised the manuscript accordingly. As suggested, we have relocated the statement about the composition of the expert panel for content validity, who were all anesthesiology specialists to the Discussion section. This limitation has now been clearly acknowledged as it may reduce the diversity of perspectives typically expected for interprofessional instruments. 2. Thank you for this important comment. We have strengthened our justification for the sample size by drawing on simulation-based evidence demonstrating that exploratory factor analysis can yield stable and valid results with small samples when communalities and factor loadings are high. We have also added a referencing de Winter et al. (2009) to clarify the appropriateness of using 72 participants in this pilot validation. 3. Thank you for your comment. We have clarified the factor-analytic approach by explaining the use of PCA as the extraction method within the exploratory phase and providing the rationale for this choice. Reporting of communalities, factor loadings, rotation method, and factor-retention criteria has also been updated in the revised Methods and Results sections 4. Thank you for the helpful suggestion. We have revised the manuscript to remove limitation-related statements from the Methods and Results sections. All limitations are now presented in the Discussion section 5. Thank you for the valuable feedback. In response, we have strengthened the Discussion section with a deeper comparison to prior ISVS validations conducted in different countries and contexts. These comparisons help situate our findings within the broader literature and clarify the unique contribution of our VR-based adaptation 1. Thank you for the helpful comment. We have clarified in the Methods Phase 1 section which items required discussion during translation and have revised the manuscript accordingly. As suggested, we have relocated the statement about the composition of the expert panel for content validity, who were all anesthesiology specialists to the Discussion section. This limitation has now been clearly acknowledged as it may reduce the diversity of perspectives typically expected for interprofessional instruments. 2. Thank you for this important comment. We have strengthened our justification for the sample size by drawing on simulation-based evidence demonstrating that exploratory factor analysis can yield stable and valid results with small samples when communalities and factor loadings are high. We have also added a referencing de Winter et al. (2009) to clarify the appropriateness of using 72 participants in this pilot validation. 3. Thank you for your comment. We have clarified the factor-analytic approach by explaining the use of PCA as the extraction method within the exploratory phase and providing the rationale for this choice. Reporting of communalities, factor loadings, rotation method, and factor-retention criteria has also been updated in the revised Methods and Results sections 4. Thank you for the helpful suggestion. We have revised the manuscript to remove limitation-related statements from the Methods and Results sections. All limitations are now presented in the Discussion section 5. Thank you for the valuable feedback. In response, we have strengthened the Discussion section with a deeper comparison to prior ISVS validations conducted in different countries and contexts. These comparisons help situate our findings within the broader literature and clarify the unique contribution of our VR-based adaptation Competing Interests: No competing interests were disclosed. Close Report a concern Respond or Comment COMMENTS ON THIS REPORT Author Response 21 Jan 2026 Aida Tantri , Department of Anesthesiology and Intensive Care, Faculty of Medicine, Universitas Indonesia, Central Jakarta, 10430, Indonesia 21 Jan 2026 Author Response 1. Thank you for the helpful comment. We have clarified in the Methods Phase 1 section which items required discussion during translation and have revised the manuscript accordingly. As suggested, we ... Continue reading 1. Thank you for the helpful comment. We have clarified in the Methods Phase 1 section which items required discussion during translation and have revised the manuscript accordingly. As suggested, we have relocated the statement about the composition of the expert panel for content validity, who were all anesthesiology specialists to the Discussion section. This limitation has now been clearly acknowledged as it may reduce the diversity of perspectives typically expected for interprofessional instruments. 2. Thank you for this important comment. We have strengthened our justification for the sample size by drawing on simulation-based evidence demonstrating that exploratory factor analysis can yield stable and valid results with small samples when communalities and factor loadings are high. We have also added a referencing de Winter et al. (2009) to clarify the appropriateness of using 72 participants in this pilot validation. 3. Thank you for your comment. We have clarified the factor-analytic approach by explaining the use of PCA as the extraction method within the exploratory phase and providing the rationale for this choice. Reporting of communalities, factor loadings, rotation method, and factor-retention criteria has also been updated in the revised Methods and Results sections 4. Thank you for the helpful suggestion. We have revised the manuscript to remove limitation-related statements from the Methods and Results sections. All limitations are now presented in the Discussion section 5. Thank you for the valuable feedback. In response, we have strengthened the Discussion section with a deeper comparison to prior ISVS validations conducted in different countries and contexts. These comparisons help situate our findings within the broader literature and clarify the unique contribution of our VR-based adaptation 1. Thank you for the helpful comment. We have clarified in the Methods Phase 1 section which items required discussion during translation and have revised the manuscript accordingly. As suggested, we have relocated the statement about the composition of the expert panel for content validity, who were all anesthesiology specialists to the Discussion section. This limitation has now been clearly acknowledged as it may reduce the diversity of perspectives typically expected for interprofessional instruments. 2. Thank you for this important comment. We have strengthened our justification for the sample size by drawing on simulation-based evidence demonstrating that exploratory factor analysis can yield stable and valid results with small samples when communalities and factor loadings are high. We have also added a referencing de Winter et al. (2009) to clarify the appropriateness of using 72 participants in this pilot validation. 3. Thank you for your comment. We have clarified the factor-analytic approach by explaining the use of PCA as the extraction method within the exploratory phase and providing the rationale for this choice. Reporting of communalities, factor loadings, rotation method, and factor-retention criteria has also been updated in the revised Methods and Results sections 4. Thank you for the helpful suggestion. We have revised the manuscript to remove limitation-related statements from the Methods and Results sections. All limitations are now presented in the Discussion section 5. Thank you for the valuable feedback. In response, we have strengthened the Discussion section with a deeper comparison to prior ISVS validations conducted in different countries and contexts. These comparisons help situate our findings within the broader literature and clarify the unique contribution of our VR-based adaptation Competing Interests: No competing interests were disclosed. Close Report a concern COMMENT ON THIS REPORT Views 0 Cite How to cite this report: Ardyansyah BD. Reviewer Report For: Adaptation and Validation of the Interprofessional Socialization and Valuing Scale (ISVS-24) for Utilization in Multiplayer Virtual Reality Environments [version 3; peer review: 4 approved with reservations] . F1000Research 2026, 14 :169 ( https://doi.org/10.5256/f1000research.184902.r398929 ) The direct URL for this report is: https://f1000research.com/articles/14-169/v2#referee-response-398929 NOTE: it is important to ensure the information in square brackets after the title is included in this citation. Close Copy Citation Details Reviewer Report 02 Sep 2025 Bau Dilam Ardyansyah , Medical Education, Universitas Hasanuddin, Makassar, South Sulawesi, Indonesia; Hasanuddin University Teaching Hospital, Hasanuddin University, Makassar, South Sulawesi, Indonesia; Curtin School of Allied Health, Curtin University, Perth, Western Australia, Australia Approved with Reservations VIEWS 0 https://doi.org/10.5256/f1000research.184902.r398929 I appreciate the authors’ efforts to revise the manuscript in response to the previous comments. The overall clarity of the paper has improved, and several earlier concerns have been addressed. However, several important issues remain that should be considered further: ... Continue reading READ ALL I appreciate the authors’ efforts to revise the manuscript in response to the previous comments. The overall clarity of the paper has improved, and several earlier concerns have been addressed. However, several important issues remain that should be considered further: The current version of the Methods includes several statements describing the limitations of the study. The Methods should focus exclusively on what was done , in sufficient detail to allow replication. A clearer justification is needed for key methodological decisions. The study involved factor analysis but included only 72 participants. Because sample size is a critical consideration in factor analysis, the rationale for this choice should be explicitly explained and supported by references or methodological guidelines. The description of the translation procedure, particularly backward translation, remains insufficient. It is not clear whether backward translation was conducted, and Figure 1 does not show this step. A more detailed summary of the forward and backward translation processes would strengthen transparency. In particular, were there any items that required significant discussion to reach consensus, or did all 24 items proceed smoothly? How many items were reworded? Which items were they? Identification of problematic words, sentences, or phrases encountered during the translation would enrich the discussion of content validity The description of factor analysis in the Methods and Results remains limited. It is not clear whether exploratory factor analysis (EFA) or confirmatory factor analysis (CFA) was conducted. The manuscript currently refers only to the use of principal component analysis. This distinction should be clarified and described in line with standard reporting practices. There is no statement regarding the assessment of data normality. Table 4 currently contains a large amount of information, much of which does not appear essential. It could be streamlined to present only the data directly relevant to determining the dimensional structure of the instrument. In addition, a table showing the factor loadings for each item, along with other results typically reported in factor analysis, would be more informative. Although the eigenvalue criterion (>1) suggests three domains, the results in Table 4 more strongly support a unidimensional structure rather than a three-dimensional one. A more convincing and methodologically robust justification of the factorial structure could be achieved by triangulating with alternative approaches rather than relying solely on the Kaiser criterion. The manuscript presents statements of limitation throughout the text, including in the Methods, Results, and Discussion sections. This is not conventional. Limitations should generally be reported only in the Discussion section, where they can be appropriately contextualised. The Discussion could be further strengthened by comparing and contrasting the findings with previous ISVS-24 validation studies conducted in other languages and contexts. Highlighting similarities (e.g., factor structure, reliability, problematic items) and differences (e.g., cultural or contextual variations) would clarify how this study contributes to the broader evidence base. Thank you. Competing Interests: No competing interests were disclosed. Reviewer Expertise: The reviewer is a senior academic and medical doctor specializing in the development and implementation of interprofessional education and collaborative practice for health practitioners and students. Her expertise includes learning, teaching, and assessment in medical education, interprofessional education and collaborative practice, instrument development, and psychometric properties evaluation. She has led studies on adapting assessment tools for Indonesian and Australian contexts, including tuberculosis care through a Delphi study. Her research ensures culturally relevant and reliable instruments for evaluating interprofessional education and practice, enhancing collaboration among healthcare professionals and students. I confirm that I have read this submission and believe that I have an appropriate level of expertise to confirm that it is of an acceptable scientific standard, however I have significant reservations, as outlined above. Close READ LESS CITE CITE HOW TO CITE THIS REPORT Ardyansyah BD. Reviewer Report For: Adaptation and Validation of the Interprofessional Socialization and Valuing Scale (ISVS-24) for Utilization in Multiplayer Virtual Reality Environments [version 3; peer review: 4 approved with reservations] . F1000Research 2026, 14 :169 ( https://doi.org/10.5256/f1000research.184902.r398929 ) The direct URL for this report is: https://f1000research.com/articles/14-169/v2#referee-response-398929 NOTE: it is important to ensure the information in square brackets after the title is included in all citations of this article. COPY CITATION DETAILS Report a concern Author Response 21 Jan 2026 Aida Tantri , Department of Anesthesiology and Intensive Care, Faculty of Medicine, Universitas Indonesia, Central Jakarta, 10430, Indonesia 21 Jan 2026 Author Response 1. Thank you for your valuable feedback. We have removed the statements describing study limitations from the Methods section to maintain focus on the procedures conducted 2. Thank you for the comment. ... Continue reading 1. Thank you for your valuable feedback. We have removed the statements describing study limitations from the Methods section to maintain focus on the procedures conducted 2. Thank you for the comment. We have added an explanation in the Discussion section to justify the sample size, citing de Winter et al. (2009) to support that EFA can yield valid results with small samples when communalities and factor loadings are high 3. Thank you for the insightful comment. We have expanded the description of the translation process, providing clearer details on the forward and backward translation steps. We also identified several items that required clarification during the review, and we have described how these were discussed and refined through consensus meetings. 4. Thank you for your comment. We have clarified the analytical approach by explicitly stating that an Exploratory Factor Analysis (EFA) was conducted using PCA as the extraction method. Details of the procedure and justification have been added to both the Methods and Results sections. 5. Thank you for pointing this out. We have added a description of the normality assessment to the Results section 6. Thank you for the suggestion. Table 4 has been simplified to present only the eigenvalues, percentage of variance, and cumulative variance for the retained factors. In addition, a new table (Table 5) presenting the rotated factor loadings for all items has been added to enhance clarity and provide essential information related to the factor structure 7. Thank you for your comment. We have strengthened the justification for retaining three components by incorporating additional explanation based on the interpretability of the loading structure and the alignment of the three-component solution with the conceptual subscales of the original ISVS. We have also acknowledged the limitations of relying solely on the Kaiser criterion and clarified that the decision was supported by theoretical considerations in addition to statistical outputs. These revisions have been added to the Results sections 8. Thank you for the helpful suggestion. We have removed all limitation statements from the Methods and Results sections and relocated them to the Discussion 9. Thank you for this helpful suggestion. We have expanded the Discussion section by adding comparisons with previous ISVS-24 validation studies, including the original validation by King et al. (2010) and a recent Spanish adaptation 1. Thank you for your valuable feedback. We have removed the statements describing study limitations from the Methods section to maintain focus on the procedures conducted 2. Thank you for the comment. We have added an explanation in the Discussion section to justify the sample size, citing de Winter et al. (2009) to support that EFA can yield valid results with small samples when communalities and factor loadings are high 3. Thank you for the insightful comment. We have expanded the description of the translation process, providing clearer details on the forward and backward translation steps. We also identified several items that required clarification during the review, and we have described how these were discussed and refined through consensus meetings. 4. Thank you for your comment. We have clarified the analytical approach by explicitly stating that an Exploratory Factor Analysis (EFA) was conducted using PCA as the extraction method. Details of the procedure and justification have been added to both the Methods and Results sections. 5. Thank you for pointing this out. We have added a description of the normality assessment to the Results section 6. Thank you for the suggestion. Table 4 has been simplified to present only the eigenvalues, percentage of variance, and cumulative variance for the retained factors. In addition, a new table (Table 5) presenting the rotated factor loadings for all items has been added to enhance clarity and provide essential information related to the factor structure 7. Thank you for your comment. We have strengthened the justification for retaining three components by incorporating additional explanation based on the interpretability of the loading structure and the alignment of the three-component solution with the conceptual subscales of the original ISVS. We have also acknowledged the limitations of relying solely on the Kaiser criterion and clarified that the decision was supported by theoretical considerations in addition to statistical outputs. These revisions have been added to the Results sections 8. Thank you for the helpful suggestion. We have removed all limitation statements from the Methods and Results sections and relocated them to the Discussion 9. Thank you for this helpful suggestion. We have expanded the Discussion section by adding comparisons with previous ISVS-24 validation studies, including the original validation by King et al. (2010) and a recent Spanish adaptation Competing Interests: No competing interests were disclosed. Close Report a concern Respond or Comment COMMENTS ON THIS REPORT Author Response 21 Jan 2026 Aida Tantri , Department of Anesthesiology and Intensive Care, Faculty of Medicine, Universitas Indonesia, Central Jakarta, 10430, Indonesia 21 Jan 2026 Author Response 1. Thank you for your valuable feedback. We have removed the statements describing study limitations from the Methods section to maintain focus on the procedures conducted 2. Thank you for the comment. ... Continue reading 1. Thank you for your valuable feedback. We have removed the statements describing study limitations from the Methods section to maintain focus on the procedures conducted 2. Thank you for the comment. We have added an explanation in the Discussion section to justify the sample size, citing de Winter et al. (2009) to support that EFA can yield valid results with small samples when communalities and factor loadings are high 3. Thank you for the insightful comment. We have expanded the description of the translation process, providing clearer details on the forward and backward translation steps. We also identified several items that required clarification during the review, and we have described how these were discussed and refined through consensus meetings. 4. Thank you for your comment. We have clarified the analytical approach by explicitly stating that an Exploratory Factor Analysis (EFA) was conducted using PCA as the extraction method. Details of the procedure and justification have been added to both the Methods and Results sections. 5. Thank you for pointing this out. We have added a description of the normality assessment to the Results section 6. Thank you for the suggestion. Table 4 has been simplified to present only the eigenvalues, percentage of variance, and cumulative variance for the retained factors. In addition, a new table (Table 5) presenting the rotated factor loadings for all items has been added to enhance clarity and provide essential information related to the factor structure 7. Thank you for your comment. We have strengthened the justification for retaining three components by incorporating additional explanation based on the interpretability of the loading structure and the alignment of the three-component solution with the conceptual subscales of the original ISVS. We have also acknowledged the limitations of relying solely on the Kaiser criterion and clarified that the decision was supported by theoretical considerations in addition to statistical outputs. These revisions have been added to the Results sections 8. Thank you for the helpful suggestion. We have removed all limitation statements from the Methods and Results sections and relocated them to the Discussion 9. Thank you for this helpful suggestion. We have expanded the Discussion section by adding comparisons with previous ISVS-24 validation studies, including the original validation by King et al. (2010) and a recent Spanish adaptation 1. Thank you for your valuable feedback. We have removed the statements describing study limitations from the Methods section to maintain focus on the procedures conducted 2. Thank you for the comment. We have added an explanation in the Discussion section to justify the sample size, citing de Winter et al. (2009) to support that EFA can yield valid results with small samples when communalities and factor loadings are high 3. Thank you for the insightful comment. We have expanded the description of the translation process, providing clearer details on the forward and backward translation steps. We also identified several items that required clarification during the review, and we have described how these were discussed and refined through consensus meetings. 4. Thank you for your comment. We have clarified the analytical approach by explicitly stating that an Exploratory Factor Analysis (EFA) was conducted using PCA as the extraction method. Details of the procedure and justification have been added to both the Methods and Results sections. 5. Thank you for pointing this out. We have added a description of the normality assessment to the Results section 6. Thank you for the suggestion. Table 4 has been simplified to present only the eigenvalues, percentage of variance, and cumulative variance for the retained factors. In addition, a new table (Table 5) presenting the rotated factor loadings for all items has been added to enhance clarity and provide essential information related to the factor structure 7. Thank you for your comment. We have strengthened the justification for retaining three components by incorporating additional explanation based on the interpretability of the loading structure and the alignment of the three-component solution with the conceptual subscales of the original ISVS. We have also acknowledged the limitations of relying solely on the Kaiser criterion and clarified that the decision was supported by theoretical considerations in addition to statistical outputs. These revisions have been added to the Results sections 8. Thank you for the helpful suggestion. We have removed all limitation statements from the Methods and Results sections and relocated them to the Discussion 9. Thank you for this helpful suggestion. We have expanded the Discussion section by adding comparisons with previous ISVS-24 validation studies, including the original validation by King et al. (2010) and a recent Spanish adaptation Competing Interests: No competing interests were disclosed. Close Report a concern COMMENT ON THIS REPORT Version 1 VERSION 1 PUBLISHED 06 Feb 2025 Views 0 Cite How to cite this report: Rulli D. Reviewer Report For: Adaptation and Validation of the Interprofessional Socialization and Valuing Scale (ISVS-24) for Utilization in Multiplayer Virtual Reality Environments [version 3; peer review: 4 approved with reservations] . F1000Research 2026, 14 :169 ( https://doi.org/10.5256/f1000research.176903.r379678 ) The direct URL for this report is: https://f1000research.com/articles/14-169/v1#referee-response-379678 NOTE: it is important to ensure the information in square brackets after the title is included in this citation. Close Copy Citation Details Reviewer Report 06 Jun 2025 Danielle Rulli , The Ohio State University, Columbus, Ohio, USA Approved with Reservations VIEWS 0 https://doi.org/10.5256/f1000research.176903.r379678 Thank you for the opportunity to review this manuscript. TITLE Appropriately descriptive of the study and manuscript contents. INTRODUCTION There are a number of statements that need citation support. For example: "IPE seeks to ... Continue reading READ ALL Thank you for the opportunity to review this manuscript. TITLE Appropriately descriptive of the study and manuscript contents. INTRODUCTION There are a number of statements that need citation support. For example: "IPE seeks to impart clinical knowledge engagingly and dynamically. The benefits of IPE are clear to the students. When it comes to overcoming the limits of healthcare professionals, students who have been exposed to IPE in the curriculum have developed interprofessional partnerships throughout their practices, boosted team spirit, and fostered competencies." This sentence needs clarification as the ISVS does indeed measure these things - "Although MPVR-based simulation is a rapidly developing simulation in medical education, there is not yet a suitable measuring instrument that fully measures interprofessional socialization outcomes, which captures changes in attitudes, actions, and beliefs of participants." Needs citation - Effective interprofessional socialization is essential as it will enhance the utilization of each individual’s skills during collaborative practice, promote efficient patient care, and enhance patient safety. More background in the use of MPVR-based simulation in health professions education is needed to provide the foundation for this study. There needs to be a more robust relation of the significance of interprofessional socialization and identity to convey why this is relevant to the study. Additionally, further exploration of the ISVS (there are multiple versions) and comparator evaluations are needed to understand the selection for this study. METHODS ISVS-24 has already been revised,shortened, and validated by the original authors. Why was this older version chosen? More clarity is needed on participants, as well as inclusion and exclusion criteria. Clearer description of the intervention is needed, including how it was developed and piloted. The authors state, "This study utilised virtual reality simulations that were played by three individuals."How were the three calibrated and how were participants oriented to using the the VR? In the Phase 2 component, other than expertise in MPVR simulation-based education, was anyone involved that is an expert in IPE evaluation/assessment? In Phase 3, it does not appear that all professions/students who would be involved were part of the pilot, making this component of validation questionable. RESULTS Regarding the content validity, why was question removal based on a handful of experts instead of being guided by a wider pilot assessment? A further explanation as to why these were removed should be in the methods in the Phase 3 section. This is assuming the final ISVS used did not include those 3 questions. RESULTS There is a lack of clarity on the factor analysis of individual questions to demonstrate validity. The statements on the results of individual tests should be in the discussion. Only the results should be presented, not their interpretation. The item reliability test data states the Cronbach alpha of 0.959 "indicates that the adapted version of ISVS items' [sic] were reliable." Please reassess this. Again, this statement should also be in the discussion, not the results. DISCUSSION The discussion needs to tie back to the literature in the introduction, and/or with the minimal introduction of additional literature, whether it agrees or differs with similar evidence. Consider addressing additional limitations of the study. CONCLUSION Consider revising. In its current form it is somewhat reaching based on the limitations of the study design. Is the work clearly and accurately presented and does it cite the current literature? Partly Is the study design appropriate and is the work technically sound? Partly Are sufficient details of methods and analysis provided to allow replication by others? Partly If applicable, is the statistical analysis and its interpretation appropriate? Partly Are all the source data underlying the results available to ensure full reproducibility? Partly Are the conclusions drawn adequately supported by the results? Partly Competing Interests: No competing interests were disclosed. Reviewer Expertise: Interprofessional education, educational methodologies, medical/dental integration. I confirm that I have read this submission and believe that I have an appropriate level of expertise to confirm that it is of an acceptable scientific standard, however I have significant reservations, as outlined above. Close READ LESS CITE CITE HOW TO CITE THIS REPORT Rulli D. Reviewer Report For: Adaptation and Validation of the Interprofessional Socialization and Valuing Scale (ISVS-24) for Utilization in Multiplayer Virtual Reality Environments [version 3; peer review: 4 approved with reservations] . F1000Research 2026, 14 :169 ( https://doi.org/10.5256/f1000research.176903.r379678 ) The direct URL for this report is: https://f1000research.com/articles/14-169/v1#referee-response-379678 NOTE: it is important to ensure the information in square brackets after the title is included in all citations of this article. COPY CITATION DETAILS Report a concern Author Response 09 Aug 2025 Aida Tantri , Department of Anesthesiology and Intensive Care, Faculty of Medicine, Universitas Indonesia, Central Jakarta, 10430, Indonesia 09 Aug 2025 Author Response We appreciate the reviewer thoughtful comments and suggestions. Please find our detailed responses below. 1. Introduction a. We have revised the paragraph to improve clarity and accuracy, and to ensure ... Continue reading We appreciate the reviewer thoughtful comments and suggestions. Please find our detailed responses below. 1. Introduction a. We have revised the paragraph to improve clarity and accuracy, and to ensure that each claim is appropriately supported by literature. Specifically, we rephrased the original sentences and placed the citation numbers directly after the relevant claims b. We acknowledge that the ISVS is indeed a validated instrument that measures changes in attitudes, actions, and beliefs related to interprofessional socialization. To address this, we have revised the sentence to clarify that the gap lies not in the existence of such instruments, but in the lack of validation and adaptation of these tools for use specifically in immersive MPVR-based educational environments. c. A reference has been added to support the role of effective interprofessional socialization in improving collaborative practice and patient safety. d. We have expanded the background section to provide more context and examples of how MPVR has been applied in health professions education. e. We have expanded our explanation regarding the significance of interprofessional socialization and identity formation in collaborative practice, particularly in virtual learning environments. Additionally, we elaborated on the rationale for selecting ISVS-24 over other versions and alternative instruments. 2. Methods a. We chose to adapt the original ISVS-24, as the full and unrevised version developed by the original authors because it allows for more controlled and context-specific refinement. This ensures the instrument appropriately captures interprofessional socialisation within immersive VR settings. The explanation has been add to the method – instrument and introduction part. b. We have added more clarity about participant c. We have added a clearer description of the VR-LAST development process and included a brief explanation of its pilot testing by the research team. Please see the revised Methods section. d. We have added details on how participants were oriented and briefed prior to the simulation. All participants attended a standard orientation session before each simulation that included a demonstration of the VR interface, headset usage, scenario overview, and simulation flow. e. We acknowledge that while all panelists were highly experienced in simulation-based interprofessional education, none held formal training in IPE assessment. This is a limitation of this study and should be addressed in future validation efforts f. We have clarified that Phase 3 involved participants from all professional groups engaged in the VR-LAST simulation, including anesthesiology residents, general physicians, and professional nurses. To avoid confusion with the earlier pilot testing of the VR intervention, we have also revised the heading of Phase 3 to better reflect the focus on instrument validation. 3. Results a. We have clarified in the Methods – Phase 3 that three items were removed based on expert judgment in Phase 2 (content validation), and the final 21-item version was used for construct validation. No data were collected for the removed items during Phase 3 b. We have clarified the purpose and procedures of the exploratory factor analysis in the Results section to better demonstrate the construct validity of the instrument. c. We have revised the Results section to present only the statistical outcomes and moved all interpretations to the Discussion. d. We have corrected the grammatical error and moved the interpretation of the Cronbach’s alpha result to the Discussion section. 4. Discussion We have revised the Discussion to clearly relate our findings back to key literature mentioned in the Introduction. Furthermore, we have expanded the Limitations section to address issues such as ecological validity and sample generalizability. 5. Conclusion We have revised the conclusion to better reflect the study’s limitations. We appreciate the reviewer thoughtful comments and suggestions. Please find our detailed responses below. 1. Introduction a. We have revised the paragraph to improve clarity and accuracy, and to ensure that each claim is appropriately supported by literature. Specifically, we rephrased the original sentences and placed the citation numbers directly after the relevant claims b. We acknowledge that the ISVS is indeed a validated instrument that measures changes in attitudes, actions, and beliefs related to interprofessional socialization. To address this, we have revised the sentence to clarify that the gap lies not in the existence of such instruments, but in the lack of validation and adaptation of these tools for use specifically in immersive MPVR-based educational environments. c. A reference has been added to support the role of effective interprofessional socialization in improving collaborative practice and patient safety. d. We have expanded the background section to provide more context and examples of how MPVR has been applied in health professions education. e. We have expanded our explanation regarding the significance of interprofessional socialization and identity formation in collaborative practice, particularly in virtual learning environments. Additionally, we elaborated on the rationale for selecting ISVS-24 over other versions and alternative instruments. 2. Methods a. We chose to adapt the original ISVS-24, as the full and unrevised version developed by the original authors because it allows for more controlled and context-specific refinement. This ensures the instrument appropriately captures interprofessional socialisation within immersive VR settings. The explanation has been add to the method – instrument and introduction part. b. We have added more clarity about participant c. We have added a clearer description of the VR-LAST development process and included a brief explanation of its pilot testing by the research team. Please see the revised Methods section. d. We have added details on how participants were oriented and briefed prior to the simulation. All participants attended a standard orientation session before each simulation that included a demonstration of the VR interface, headset usage, scenario overview, and simulation flow. e. We acknowledge that while all panelists were highly experienced in simulation-based interprofessional education, none held formal training in IPE assessment. This is a limitation of this study and should be addressed in future validation efforts f. We have clarified that Phase 3 involved participants from all professional groups engaged in the VR-LAST simulation, including anesthesiology residents, general physicians, and professional nurses. To avoid confusion with the earlier pilot testing of the VR intervention, we have also revised the heading of Phase 3 to better reflect the focus on instrument validation. 3. Results a. We have clarified in the Methods – Phase 3 that three items were removed based on expert judgment in Phase 2 (content validation), and the final 21-item version was used for construct validation. No data were collected for the removed items during Phase 3 b. We have clarified the purpose and procedures of the exploratory factor analysis in the Results section to better demonstrate the construct validity of the instrument. c. We have revised the Results section to present only the statistical outcomes and moved all interpretations to the Discussion. d. We have corrected the grammatical error and moved the interpretation of the Cronbach’s alpha result to the Discussion section. 4. Discussion We have revised the Discussion to clearly relate our findings back to key literature mentioned in the Introduction. Furthermore, we have expanded the Limitations section to address issues such as ecological validity and sample generalizability. 5. Conclusion We have revised the conclusion to better reflect the study’s limitations. Competing Interests: No competing interests were disclosed. Close Report a concern Respond or Comment COMMENTS ON THIS REPORT Author Response 09 Aug 2025 Aida Tantri , Department of Anesthesiology and Intensive Care, Faculty of Medicine, Universitas Indonesia, Central Jakarta, 10430, Indonesia 09 Aug 2025 Author Response We appreciate the reviewer thoughtful comments and suggestions. Please find our detailed responses below. 1. Introduction a. We have revised the paragraph to improve clarity and accuracy, and to ensure ... Continue reading We appreciate the reviewer thoughtful comments and suggestions. Please find our detailed responses below. 1. Introduction a. We have revised the paragraph to improve clarity and accuracy, and to ensure that each claim is appropriately supported by literature. Specifically, we rephrased the original sentences and placed the citation numbers directly after the relevant claims b. We acknowledge that the ISVS is indeed a validated instrument that measures changes in attitudes, actions, and beliefs related to interprofessional socialization. To address this, we have revised the sentence to clarify that the gap lies not in the existence of such instruments, but in the lack of validation and adaptation of these tools for use specifically in immersive MPVR-based educational environments. c. A reference has been added to support the role of effective interprofessional socialization in improving collaborative practice and patient safety. d. We have expanded the background section to provide more context and examples of how MPVR has been applied in health professions education. e. We have expanded our explanation regarding the significance of interprofessional socialization and identity formation in collaborative practice, particularly in virtual learning environments. Additionally, we elaborated on the rationale for selecting ISVS-24 over other versions and alternative instruments. 2. Methods a. We chose to adapt the original ISVS-24, as the full and unrevised version developed by the original authors because it allows for more controlled and context-specific refinement. This ensures the instrument appropriately captures interprofessional socialisation within immersive VR settings. The explanation has been add to the method – instrument and introduction part. b. We have added more clarity about participant c. We have added a clearer description of the VR-LAST development process and included a brief explanation of its pilot testing by the research team. Please see the revised Methods section. d. We have added details on how participants were oriented and briefed prior to the simulation. All participants attended a standard orientation session before each simulation that included a demonstration of the VR interface, headset usage, scenario overview, and simulation flow. e. We acknowledge that while all panelists were highly experienced in simulation-based interprofessional education, none held formal training in IPE assessment. This is a limitation of this study and should be addressed in future validation efforts f. We have clarified that Phase 3 involved participants from all professional groups engaged in the VR-LAST simulation, including anesthesiology residents, general physicians, and professional nurses. To avoid confusion with the earlier pilot testing of the VR intervention, we have also revised the heading of Phase 3 to better reflect the focus on instrument validation. 3. Results a. We have clarified in the Methods – Phase 3 that three items were removed based on expert judgment in Phase 2 (content validation), and the final 21-item version was used for construct validation. No data were collected for the removed items during Phase 3 b. We have clarified the purpose and procedures of the exploratory factor analysis in the Results section to better demonstrate the construct validity of the instrument. c. We have revised the Results section to present only the statistical outcomes and moved all interpretations to the Discussion. d. We have corrected the grammatical error and moved the interpretation of the Cronbach’s alpha result to the Discussion section. 4. Discussion We have revised the Discussion to clearly relate our findings back to key literature mentioned in the Introduction. Furthermore, we have expanded the Limitations section to address issues such as ecological validity and sample generalizability. 5. Conclusion We have revised the conclusion to better reflect the study’s limitations. We appreciate the reviewer thoughtful comments and suggestions. Please find our detailed responses below. 1. Introduction a. We have revised the paragraph to improve clarity and accuracy, and to ensure that each claim is appropriately supported by literature. Specifically, we rephrased the original sentences and placed the citation numbers directly after the relevant claims b. We acknowledge that the ISVS is indeed a validated instrument that measures changes in attitudes, actions, and beliefs related to interprofessional socialization. To address this, we have revised the sentence to clarify that the gap lies not in the existence of such instruments, but in the lack of validation and adaptation of these tools for use specifically in immersive MPVR-based educational environments. c. A reference has been added to support the role of effective interprofessional socialization in improving collaborative practice and patient safety. d. We have expanded the background section to provide more context and examples of how MPVR has been applied in health professions education. e. We have expanded our explanation regarding the significance of interprofessional socialization and identity formation in collaborative practice, particularly in virtual learning environments. Additionally, we elaborated on the rationale for selecting ISVS-24 over other versions and alternative instruments. 2. Methods a. We chose to adapt the original ISVS-24, as the full and unrevised version developed by the original authors because it allows for more controlled and context-specific refinement. This ensures the instrument appropriately captures interprofessional socialisation within immersive VR settings. The explanation has been add to the method – instrument and introduction part. b. We have added more clarity about participant c. We have added a clearer description of the VR-LAST development process and included a brief explanation of its pilot testing by the research team. Please see the revised Methods section. d. We have added details on how participants were oriented and briefed prior to the simulation. All participants attended a standard orientation session before each simulation that included a demonstration of the VR interface, headset usage, scenario overview, and simulation flow. e. We acknowledge that while all panelists were highly experienced in simulation-based interprofessional education, none held formal training in IPE assessment. This is a limitation of this study and should be addressed in future validation efforts f. We have clarified that Phase 3 involved participants from all professional groups engaged in the VR-LAST simulation, including anesthesiology residents, general physicians, and professional nurses. To avoid confusion with the earlier pilot testing of the VR intervention, we have also revised the heading of Phase 3 to better reflect the focus on instrument validation. 3. Results a. We have clarified in the Methods – Phase 3 that three items were removed based on expert judgment in Phase 2 (content validation), and the final 21-item version was used for construct validation. No data were collected for the removed items during Phase 3 b. We have clarified the purpose and procedures of the exploratory factor analysis in the Results section to better demonstrate the construct validity of the instrument. c. We have revised the Results section to present only the statistical outcomes and moved all interpretations to the Discussion. d. We have corrected the grammatical error and moved the interpretation of the Cronbach’s alpha result to the Discussion section. 4. Discussion We have revised the Discussion to clearly relate our findings back to key literature mentioned in the Introduction. Furthermore, we have expanded the Limitations section to address issues such as ecological validity and sample generalizability. 5. Conclusion We have revised the conclusion to better reflect the study’s limitations. Competing Interests: No competing interests were disclosed. Close Report a concern COMMENT ON THIS REPORT Views 0 Cite How to cite this report: Ardyansyah BD. Reviewer Report For: Adaptation and Validation of the Interprofessional Socialization and Valuing Scale (ISVS-24) for Utilization in Multiplayer Virtual Reality Environments [version 3; peer review: 4 approved with reservations] . F1000Research 2026, 14 :169 ( https://doi.org/10.5256/f1000research.176903.r366123 ) The direct URL for this report is: https://f1000research.com/articles/14-169/v1#referee-response-366123 NOTE: it is important to ensure the information in square brackets after the title is included in this citation. Close Copy Citation Details Reviewer Report 27 Feb 2025 Bau Dilam Ardyansyah , Medical Education, Universitas Hasanuddin, Makassar, South Sulawesi, Indonesia; Hasanuddin University Teaching Hospital, Hasanuddin University, Makassar, South Sulawesi, Indonesia; Curtin School of Allied Health, Curtin University, Perth, Western Australia, Australia Approved with Reservations VIEWS 0 https://doi.org/10.5256/f1000research.176903.r366123 Thank you for allowing me the opportunity to review this paper. The study aims to adapt and validate an interprofessional outcome measure for assessing the Multiplayer Virtual Reality Environments. This manuscript has implemented several instrument development standards. ... Continue reading READ ALL Thank you for allowing me the opportunity to review this paper. The study aims to adapt and validate an interprofessional outcome measure for assessing the Multiplayer Virtual Reality Environments. This manuscript has implemented several instrument development standards. However, I have several concerns regarding this manuscript, which I have detailed below. Introduction: Regarding the Statement: These interactive virtual experiences have been shown to outperform traditional or other digital educational methods in terms of knowledge retention and skill development among health professionals. To strengthen this claim, consider citing specific studies or providing empirical evidence demonstrating interactive virtual experiences' superiority over traditional or other digital learning methods. A well-supported reference would enhance the credibility of the argument. Regarding the Instrument, ISVS-24: For adaptation and validation studies in a new cultural and linguistic context, best practices recommend utilising existing validated instruments in the target language whenever possible. Several IPE outcome measures have already been adapted and validated in Indonesian, including RIPLS, CICS-29, CPAT, EPIS-RI, and even an Indonesian version of ISVS (ISVS-19), which has undergone thorough adaptation and validation. This leads to an important question: Why not use one of these existing scales? What are their limitations? A thorough discussion of the shortcomings of these previously validated instruments is necessary to justify the adaptation of ISVS-24. Summarising the key findings from earlier outcome measure studies would provide a stronger contextual foundation for the research. Additionally, ISVS-24 has been refined by its original developers into ISVS-21, which has improved psychometric properties. This raises a question: Why use ISVS-24 instead of ISVS-21? Clarifying what specific aspects of ISVS-24 make it more suitable for Multi-Participant Virtual Reality (MPVR)-based simulations compared to ISVS-21 would strengthen the rationale for this choice. Since this study focuses on the adaptation and validation of an instrument from one language (English) to another (Indonesian), it is essential to discuss the psychometric properties of ISVS-24 to establish its reliability and validity within this new context. Methods - Participants. A total of 72 anesthesiology residents, general physicians, and nurses from the Faculty of Medicine, Universitas Indonesia. Are the participants nurses or nursing students? Inclusion criteria: no information was provided about how participants were recruited. Since the ISVS-24 assesses interprofessional socialisation within the simulation, it is unclear whether participants were required to have prior experience working in interprofessional teams or, with or without previous exposure to VR training, were included. Methods – Instruments. This study utilised virtual reality simulations that were played by three individuals. Who are these individuals? A clear layout of the participants and their roles in the simulation is needed. Seeking permission from the original author (King et al., 2016) is highly recommended when adapting an instrument to a new context, especially if it involves translation, cultural adaptation, or modifications. Has the author obtained permission from the original author of the instrument to adapt it? Methods – Procedure Phase 1: Translation of the ISVS-24. The translation process of an instrument is crucial in adapting it to a new cultural context. Therefore, the translation methodology must be clearly explained. Who conducted the translation? What were their qualifications to be designated as translators? The translation process described in this article did not mention whether a back-translation was performed. Briefly explain the dynamics of the translation process and how consensus was reached. Methods – Phase 2 and Phase 3. The methodology provides a structured approach to instrument adaptation, pilot testing, and validation. However, a clearer separation between pilot testing and validation is needed. A panel of experts made up of 4 senior anaesthesiology consultants who were experts in MPVR simulation-based education. This step is crucial to content validation for an interprofessional outcome measure. Provide elaboration on the expertise of the reviewers and whether their backgrounds cover relevant fields of interprofessional education. Why not include practitioners from diverse healthcare backgrounds, who are also the intended end users of the instrument, such as nurses? Four reviewers are relatively small to be considered sufficient for a content validity study. The target users of this instrument, such as anaesthesiology residents and nurses, were not involved in assessing content validity in phase 2 (should be part of a pilot study). Phase 3 (should be part of the validation study?) used only 72 respondents, which is too small for robust psychometric analysis (factor analysis and reliability testing) of 21 items. Results The pilot study should primarily focus on the instrument’s items comprehensibility, feasibility, and usability. However, three items were removed solely based on the opinions of four-panel reviewers during phase 2. Why not consider removing the item based on the factor analysis? Please justify the items’ removal at this stage. A more detailed description of the factor analysis method employed, including the type of factor analysis (e.g., exploratory or confirmatory), extraction method, rotation technique, and criteria for factor retention. Many important indices for factor analysis results are not reported; for example, the item and factor loadings and how the factor loadings were interpreted (e.g., items retained if factor loading >0.40). Provide the McDonald’s Omega to compliment the internal consistency reliability evaluation for each subscale (factor/domain) and the total for the scale. A very high Cronbach alpha (> 0.95) is undesirable for a subscale or total scale. The structural validity of the instrument, after being tested with 72 participants, was not adequately evaluated. Discussions It would be helpful to clarify the criteria used for removing the three items beyond just the VR setting. Consider providing a comparison and contrast of relevant publications with the findings of this study. The Discussion section needs improvement, as some of the narratives repeat the results presented in the Results section. Conclusion Consider tempering the statement by acknowledging the study's limitations, such as the small sample size, single-institution focus, and some methodology limitations. References to instrument adaptation, standards, and validation processes need to be strengthened to ensure the incorporation of the best practices in the adaptation and validation process, including the latest statistical methods for validation. Is the work clearly and accurately presented and does it cite the current literature? Partly Is the study design appropriate and is the work technically sound? No Are sufficient details of methods and analysis provided to allow replication by others? Partly If applicable, is the statistical analysis and its interpretation appropriate? Partly Are all the source data underlying the results available to ensure full reproducibility? Partly Are the conclusions drawn adequately supported by the results? Partly Competing Interests: No competing interests were disclosed. Reviewer Expertise: The reviewer is a senior academic and medical doctor specializing in the development and implementation of interprofessional education and collaborative practice for health practitioners and students. Her expertise includes learning, teaching, and assessment in medical education, interprofessional education and collaborative practice, instrument development, and psychometric properties evaluation. She has led studies on adapting assessment tools for Indonesian and Australian contexts, including tuberculosis care through a Delphi study. Her research ensures culturally relevant and reliable instruments for evaluating interprofessional education and practice, enhancing collaboration among healthcare professionals and students. I confirm that I have read this submission and believe that I have an appropriate level of expertise to confirm that it is of an acceptable scientific standard, however I have significant reservations, as outlined above. Close READ LESS CITE CITE HOW TO CITE THIS REPORT Ardyansyah BD. Reviewer Report For: Adaptation and Validation of the Interprofessional Socialization and Valuing Scale (ISVS-24) for Utilization in Multiplayer Virtual Reality Environments [version 3; peer review: 4 approved with reservations] . F1000Research 2026, 14 :169 ( https://doi.org/10.5256/f1000research.176903.r366123 ) The direct URL for this report is: https://f1000research.com/articles/14-169/v1#referee-response-366123 NOTE: it is important to ensure the information in square brackets after the title is included in all citations of this article. COPY CITATION DETAILS Report a concern Author Response 09 Aug 2025 Aida Tantri , Department of Anesthesiology and Intensive Care, Faculty of Medicine, Universitas Indonesia, Central Jakarta, 10430, Indonesia 09 Aug 2025 Author Response We appreciate the reviewer thoughtful comments and suggestions. Please find our detailed responses below. 1. Introduction In response, we have strengthened the justification for using virtual reality by adding ... Continue reading We appreciate the reviewer thoughtful comments and suggestions. Please find our detailed responses below. 1. Introduction In response, we have strengthened the justification for using virtual reality by adding previous studies demonstrating VR’s superiority over traditional methods in improving knowledge retention and skill development. We clarified the rationale for adapting the ISVS-24 from the original version rather than using translated instruments such as RIPLS, CPAT or ISVS-19. We also justified the selection of ISVS-24 over ISVS-21 by emphasizing the need for item-level adaptation from the source to preserve content relevance and theoretical integrity within immersive VR settings. 2. Methods - Participants We have clarified that the participants were professional nurses, not students, and provided additional details on the inclusion criteria and recruitment process. We have clarified in the revised manuscript that participants were not required to have prior experience working in interprofessional teams or with VR training. However, their professional backgrounds ensured exposure to interprofessional collaboration in clinical settings. We also noted that previous VR experience was not a prerequisite, as the study aimed to assess interprofessional socialization within a simulated VR setting, regardless of participants’ prior VR exposure 3. Methods – Instruments We have clarified the composition and roles of the participants in the VR simulation, specifying that each team consisted of an anesthesiology resident, a general physician, and a professional nurse assigned to interprofessional roles. We also confirm that permission to adapt and translate the ISVS-24 was obtained from the original author to use in this study. 4. Methods – Procedure Phase 1 We have clarified the qualifications of the translators, included the back-translation process, and elaborated on how consensus was reached during the translation phase to ensure cultural and contextual relevance of the adapted instrument. 5. Methods – Phase 2 and Phase 3 We have clarified the expertise of the content reviewers, acknowledged the absence of other health professions in the expert panel, and addressed this as a limitation. We also revised the manuscript to clearly distinguish between pilot testing and construct validation in Phase 3. Additionally, we acknowledged the limited sample size for factor analysis and recommended future studies to include larger and more diverse samples and expert panels. 6. Results We have clarified that the three items were removed based on low Aiken’s V scores and expert consensus due to incompatibility with the MPVR context, and we acknowledged the limitation of not basing removal on factor analysis. We have also added a more detailed explanation of the factor analysis. While Cronbach’s alpha was used to assess internal consistency, we acknowledge in the discussion that the use of McDonald’s Omega would provide a more robust reliability estimate; however, this analysis was not conducted due to limitations in the statistical software used. 7. Discussions We have clarified the rationale for removing three items. We have included a comparison of our findings with previous studies using ISVS or similar interprofessional education tools. We revised the Discussion section to focus more on interpretation and implications, and removed redundant restatements of the Results section to enhance clarity and purpose. 8. Conclusion We have revised the conclusion to acknowledge the study’s limitations, including the small sample size, single-institution focus, and the need for further validation through broader future studies We appreciate the reviewer thoughtful comments and suggestions. Please find our detailed responses below. 1. Introduction In response, we have strengthened the justification for using virtual reality by adding previous studies demonstrating VR’s superiority over traditional methods in improving knowledge retention and skill development. We clarified the rationale for adapting the ISVS-24 from the original version rather than using translated instruments such as RIPLS, CPAT or ISVS-19. We also justified the selection of ISVS-24 over ISVS-21 by emphasizing the need for item-level adaptation from the source to preserve content relevance and theoretical integrity within immersive VR settings. 2. Methods - Participants We have clarified that the participants were professional nurses, not students, and provided additional details on the inclusion criteria and recruitment process. We have clarified in the revised manuscript that participants were not required to have prior experience working in interprofessional teams or with VR training. However, their professional backgrounds ensured exposure to interprofessional collaboration in clinical settings. We also noted that previous VR experience was not a prerequisite, as the study aimed to assess interprofessional socialization within a simulated VR setting, regardless of participants’ prior VR exposure 3. Methods – Instruments We have clarified the composition and roles of the participants in the VR simulation, specifying that each team consisted of an anesthesiology resident, a general physician, and a professional nurse assigned to interprofessional roles. We also confirm that permission to adapt and translate the ISVS-24 was obtained from the original author to use in this study. 4. Methods – Procedure Phase 1 We have clarified the qualifications of the translators, included the back-translation process, and elaborated on how consensus was reached during the translation phase to ensure cultural and contextual relevance of the adapted instrument. 5. Methods – Phase 2 and Phase 3 We have clarified the expertise of the content reviewers, acknowledged the absence of other health professions in the expert panel, and addressed this as a limitation. We also revised the manuscript to clearly distinguish between pilot testing and construct validation in Phase 3. Additionally, we acknowledged the limited sample size for factor analysis and recommended future studies to include larger and more diverse samples and expert panels. 6. Results We have clarified that the three items were removed based on low Aiken’s V scores and expert consensus due to incompatibility with the MPVR context, and we acknowledged the limitation of not basing removal on factor analysis. We have also added a more detailed explanation of the factor analysis. While Cronbach’s alpha was used to assess internal consistency, we acknowledge in the discussion that the use of McDonald’s Omega would provide a more robust reliability estimate; however, this analysis was not conducted due to limitations in the statistical software used. 7. Discussions We have clarified the rationale for removing three items. We have included a comparison of our findings with previous studies using ISVS or similar interprofessional education tools. We revised the Discussion section to focus more on interpretation and implications, and removed redundant restatements of the Results section to enhance clarity and purpose. 8. Conclusion We have revised the conclusion to acknowledge the study’s limitations, including the small sample size, single-institution focus, and the need for further validation through broader future studies Competing Interests: No competing interests were disclosed. Close Report a concern Respond or Comment COMMENTS ON THIS REPORT Author Response 09 Aug 2025 Aida Tantri , Department of Anesthesiology and Intensive Care, Faculty of Medicine, Universitas Indonesia, Central Jakarta, 10430, Indonesia 09 Aug 2025 Author Response We appreciate the reviewer thoughtful comments and suggestions. Please find our detailed responses below. 1. Introduction In response, we have strengthened the justification for using virtual reality by adding ... Continue reading We appreciate the reviewer thoughtful comments and suggestions. Please find our detailed responses below. 1. Introduction In response, we have strengthened the justification for using virtual reality by adding previous studies demonstrating VR’s superiority over traditional methods in improving knowledge retention and skill development. We clarified the rationale for adapting the ISVS-24 from the original version rather than using translated instruments such as RIPLS, CPAT or ISVS-19. We also justified the selection of ISVS-24 over ISVS-21 by emphasizing the need for item-level adaptation from the source to preserve content relevance and theoretical integrity within immersive VR settings. 2. Methods - Participants We have clarified that the participants were professional nurses, not students, and provided additional details on the inclusion criteria and recruitment process. We have clarified in the revised manuscript that participants were not required to have prior experience working in interprofessional teams or with VR training. However, their professional backgrounds ensured exposure to interprofessional collaboration in clinical settings. We also noted that previous VR experience was not a prerequisite, as the study aimed to assess interprofessional socialization within a simulated VR setting, regardless of participants’ prior VR exposure 3. Methods – Instruments We have clarified the composition and roles of the participants in the VR simulation, specifying that each team consisted of an anesthesiology resident, a general physician, and a professional nurse assigned to interprofessional roles. We also confirm that permission to adapt and translate the ISVS-24 was obtained from the original author to use in this study. 4. Methods – Procedure Phase 1 We have clarified the qualifications of the translators, included the back-translation process, and elaborated on how consensus was reached during the translation phase to ensure cultural and contextual relevance of the adapted instrument. 5. Methods – Phase 2 and Phase 3 We have clarified the expertise of the content reviewers, acknowledged the absence of other health professions in the expert panel, and addressed this as a limitation. We also revised the manuscript to clearly distinguish between pilot testing and construct validation in Phase 3. Additionally, we acknowledged the limited sample size for factor analysis and recommended future studies to include larger and more diverse samples and expert panels. 6. Results We have clarified that the three items were removed based on low Aiken’s V scores and expert consensus due to incompatibility with the MPVR context, and we acknowledged the limitation of not basing removal on factor analysis. We have also added a more detailed explanation of the factor analysis. While Cronbach’s alpha was used to assess internal consistency, we acknowledge in the discussion that the use of McDonald’s Omega would provide a more robust reliability estimate; however, this analysis was not conducted due to limitations in the statistical software used. 7. Discussions We have clarified the rationale for removing three items. We have included a comparison of our findings with previous studies using ISVS or similar interprofessional education tools. We revised the Discussion section to focus more on interpretation and implications, and removed redundant restatements of the Results section to enhance clarity and purpose. 8. Conclusion We have revised the conclusion to acknowledge the study’s limitations, including the small sample size, single-institution focus, and the need for further validation through broader future studies We appreciate the reviewer thoughtful comments and suggestions. Please find our detailed responses below. 1. Introduction In response, we have strengthened the justification for using virtual reality by adding previous studies demonstrating VR’s superiority over traditional methods in improving knowledge retention and skill development. We clarified the rationale for adapting the ISVS-24 from the original version rather than using translated instruments such as RIPLS, CPAT or ISVS-19. We also justified the selection of ISVS-24 over ISVS-21 by emphasizing the need for item-level adaptation from the source to preserve content relevance and theoretical integrity within immersive VR settings. 2. Methods - Participants We have clarified that the participants were professional nurses, not students, and provided additional details on the inclusion criteria and recruitment process. We have clarified in the revised manuscript that participants were not required to have prior experience working in interprofessional teams or with VR training. However, their professional backgrounds ensured exposure to interprofessional collaboration in clinical settings. We also noted that previous VR experience was not a prerequisite, as the study aimed to assess interprofessional socialization within a simulated VR setting, regardless of participants’ prior VR exposure 3. Methods – Instruments We have clarified the composition and roles of the participants in the VR simulation, specifying that each team consisted of an anesthesiology resident, a general physician, and a professional nurse assigned to interprofessional roles. We also confirm that permission to adapt and translate the ISVS-24 was obtained from the original author to use in this study. 4. Methods – Procedure Phase 1 We have clarified the qualifications of the translators, included the back-translation process, and elaborated on how consensus was reached during the translation phase to ensure cultural and contextual relevance of the adapted instrument. 5. Methods – Phase 2 and Phase 3 We have clarified the expertise of the content reviewers, acknowledged the absence of other health professions in the expert panel, and addressed this as a limitation. We also revised the manuscript to clearly distinguish between pilot testing and construct validation in Phase 3. Additionally, we acknowledged the limited sample size for factor analysis and recommended future studies to include larger and more diverse samples and expert panels. 6. Results We have clarified that the three items were removed based on low Aiken’s V scores and expert consensus due to incompatibility with the MPVR context, and we acknowledged the limitation of not basing removal on factor analysis. We have also added a more detailed explanation of the factor analysis. While Cronbach’s alpha was used to assess internal consistency, we acknowledge in the discussion that the use of McDonald’s Omega would provide a more robust reliability estimate; however, this analysis was not conducted due to limitations in the statistical software used. 7. Discussions We have clarified the rationale for removing three items. We have included a comparison of our findings with previous studies using ISVS or similar interprofessional education tools. We revised the Discussion section to focus more on interpretation and implications, and removed redundant restatements of the Results section to enhance clarity and purpose. 8. Conclusion We have revised the conclusion to acknowledge the study’s limitations, including the small sample size, single-institution focus, and the need for further validation through broader future studies Competing Interests: No competing interests were disclosed. Close Report a concern COMMENT ON THIS REPORT Comments on this article Comments (0) Version 3 VERSION 3 PUBLISHED 06 Feb 2025 ADD YOUR COMMENT Comment keyboard_arrow_left keyboard_arrow_right Open Peer Review Reviewer Status info_outline Alongside their report, reviewers assign a status to the article: Approved The paper is scientifically sound in its current form and only minor, if any, improvements are suggested Approved with reservations A number of small changes, sometimes more significant revisions are required to address specific details and improve the papers academic merit. Not approved Fundamental flaws in the paper seriously undermine the findings and conclusions Reviewer Reports Invited Reviewers 1 2 3 4 Version 3 (revision) 21 Jan 26 read Version 2 (revision) 17 Jul 25 read read read Version 1 06 Feb 25 read read Bau Dilam Ardyansyah , Universitas Hasanuddin, Makassar, Indonesia; Hasanuddin University, Makassar, Indonesia; Curtin University, Perth, Australia Danielle Rulli , The Ohio State University, Columbus, USA Siti Munawaroh , Universitas Sebelas Maret, Surakarta, Indonesia Simone Titus-Dawson , Stellenbosch University, Stellenbosch, South Africa Comments on this article All Comments (0) Add a comment Sign up for content alerts Sign Up You are now signed up to receive this alert Browse by related subjects keyboard_arrow_left Back to all reports Reviewer Report 0 Views copyright © 2026 Ardyansyah B. This is an open access peer review report distributed under the terms of the Creative Commons Attribution License , which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited. 26 Mar 2026 | for Version 3 Bau Dilam Ardyansyah , Medical Education, Universitas Hasanuddin, Makassar, South Sulawesi, Indonesia; Hasanuddin University Teaching Hospital, Hasanuddin University, Makassar, South Sulawesi, Indonesia; Curtin School of Allied Health, Curtin University, Perth, Western Australia, Australia 0 Views copyright © 2026 Ardyansyah B. This is an open access peer review report distributed under the terms of the Creative Commons Attribution License , which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited. format_quote Cite this report speaker_notes Responses (0) Approved With Reservations info_outline Alongside their report, reviewers assign a status to the article: Approved The paper is scientifically sound in its current form and only minor, if any, improvements are suggested Approved with reservations A number of small changes, sometimes more significant revisions are required to address specific details and improve the papers academic merit. Not approved Fundamental flaws in the paper seriously undermine the findings and conclusions I would like to commend the authors for the thoughtful revisions and the improvements made throughout the manuscript. The overall structure is now more coherent, and the description of the translation and adaptation process is much clearer. The enhanced reporting of statistical analyses also strengthens the transparency of the study. Importantly, the work addresses a highly relevant and innovative area, adapting an interprofessional instrument for use in multiplayer virtual reality (MPVR) environments, which represents a meaningful contribution to the field of interprofessional education. I would encourage the authors to refine the framing of the study to more clearly reflect its pilot nature, rather than presenting it as a full validation study. In its current form, the use of the term “validation” may overstate the strength of the evidence. Describing the work as a “preliminary validation” or “initial psychometric evaluation” would more accurately align the claims with the level of evidence provided. This reframing is important in light of several methodological considerations: The content validity process, while involving experienced experts, does not yet include representation from multiple interprofessional groups. Given that the instrument is intended for interprofessional use, this may limit the comprehensiveness of the construct coverage. The relatively small sample size, as acknowledged by the authors, constrains the robustness of factor analytic findings and their generalizability. The study presents useful preliminary evidence related to internal structure (i.e., structural validity through factor analysis). However, structural and construct validity require multiple complementary sources of evidence. At present, the manuscript does not include evidence based on relationships with other variables, such as convergent or discriminant validity. Therefore, the current evidence may be more appropriately interpreted as partial and preliminary, rather than sufficient to support a full validation claim. With this reframing as a pilot or preliminary study, the manuscript is already adequate and makes a meaningful contribution. In this context, the authors may focus on strengthening the current presentation through the following refinements: Consider reporting McDonald’s omega to complement Cronbach’s alpha. A brief discussion of dimensionality would be valuable, as several indicators suggest the presence of one strong general factor (unidimensional instrument): the proportion of variance explained by the first factor, and the first eigenvalue is substantially larger than the second. The discussion would help clarify how the scale should be interpreted. Cronbach’s alpha (> 0.95), while indicating very high internal consistency, does not necessarily reflect optimal scale performance and may instead suggest potential item overlap or redundancy. Explicitly acknowledging this possibility would provide a more balanced interpretation of the reliability findings. As a preliminary validation, these refinements would further enhance the rigor and interpretability of the findings while remaining fully achievable within the scope of the current study. Competing Interests No competing interests were disclosed. Reviewer Expertise The reviewer is a senior academic and medical doctor specializing in the development and implementation of interprofessional education and collaborative practice for health practitioners and students. Her expertise includes learning, teaching, and assessment in medical education, interprofessional education and collaborative practice, instrument development, and psychometric properties evaluation. She has led studies on adapting assessment tools for Indonesian and Australian contexts, including tuberculosis care through a Delphi study. Her research ensures culturally relevant and reliable instruments for evaluating interprofessional education and practice, enhancing collaboration among healthcare professionals and students. I confirm that I have read this submission and believe that I have an appropriate level of expertise to confirm that it is of an acceptable scientific standard, however I have significant reservations, as outlined above. reply Respond to this report Responses (0) Ardyansyah BD. Peer Review Report For: Adaptation and Validation of the Interprofessional Socialization and Valuing Scale (ISVS-24) for Utilization in Multiplayer Virtual Reality Environments [version 3; peer review: 4 approved with reservations] . F1000Research 2026, 14 :169 ( https://doi.org/10.5256/f1000research.194649.r451848) NOTE: it is important to ensure the information in square brackets after the title is included in this citation. The direct URL for this report is: https://f1000research.com/articles/14-169/v3#referee-response-451848 keyboard_arrow_left Back to all reports Reviewer Report 0 Views copyright © 2026 Titus-Dawson S. This is an open access peer review report distributed under the terms of the Creative Commons Attribution License , which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited. 08 Jan 2026 | for Version 2 Simone Titus-Dawson , Stellenbosch University, Stellenbosch, South Africa 0 Views copyright © 2026 Titus-Dawson S. This is an open access peer review report distributed under the terms of the Creative Commons Attribution License , which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited. format_quote Cite this report speaker_notes Responses (0) Approved With Reservations info_outline Alongside their report, reviewers assign a status to the article: Approved The paper is scientifically sound in its current form and only minor, if any, improvements are suggested Approved with reservations A number of small changes, sometimes more significant revisions are required to address specific details and improve the papers academic merit. Not approved Fundamental flaws in the paper seriously undermine the findings and conclusions Dear Editor and Authors, Thank you for inviting me to review this body of work. The article reports on the adaptation and pilot validation of the Interprofessional Socialization and Valuing Scale (ISVS-24) for use in multiplayer virtual reality (MPVR)–based interprofessional education where the authors translated the original ISVS-24 into Indonesian, conducted expert content validation, and administered a reduced 21-item version to 72 participants who are health professionals following participation in a VR simulation scenario. The overall study design is appropriate at a pilot and exploratory level. The phased approach to translation the instrument in order to do the content validation, and preliminary psychometric testing is well considered, particularly in a novel educational context such as MPVR based simulations. The ethical procedures are clearly documented, and the authors appropriately situate their work within the growing literature on VR-based IPE. However, the work is not fully technically sound as a validation study and it would appear to be better interpreted as a feasibility study or a form of preliminary exploration rather than a robust validation. For instance, the methods are really well explained, and are conceptually sound, and the study can be replicated. I found that this was a strength of this body of work, and the authors made the datasets available. However, some aspects of the translation process are insufficiently detailed, particularly which items require substantive rewording or contextual adaptation for VR, as well as for your context. The manuscript does not report what was extracted and why, what were, the commonalities etc. This would be important for others who may want to repeat this study for their own context. This is easily remedied as the authors can include the items and the justification for their choices more clearly. ​​​​​​The findings do justify claims regarding the feasibility, contextual relevance, and internal consistency of the adapted instrument in an MPVR setting. However, conclusions may come across as being overstated given the limitations in construct validation, sample size, and analytic approach. It would also be interesting to understand what the IPE simulation scenario was in order to understand which of the IPE competencies were being enacted. It is often useful for context. ​​​​​​Overall, this manuscript addresses an important and emerging area in HPE and particularly IPE. This work has several strengths, particularly in relevance, transparency, and feasibility testing. However the article requires clearer positioning as a pilot study, more cautious interpretation of validity claims, and substantially improved reporting and justification of psychometric analyses, especially factor analysis. Is the work clearly and accurately presented and does it cite the current literature? Yes Is the study design appropriate and is the work technically sound? Partly Are sufficient details of methods and analysis provided to allow replication by others? Partly If applicable, is the statistical analysis and its interpretation appropriate? I cannot comment. A qualified statistician is required. Are all the source data underlying the results available to ensure full reproducibility? Yes Are the conclusions drawn adequately supported by the results? No Competing Interests No competing interests were disclosed. Reviewer Expertise Digital Education and Innovation, Health Professions Education, Interprofessional Education, VR and AR I confirm that I have read this submission and believe that I have an appropriate level of expertise to confirm that it is of an acceptable scientific standard, however I have significant reservations, as outlined above. reply Respond to this report Responses (0) Titus-Dawson S. Peer Review Report For: Adaptation and Validation of the Interprofessional Socialization and Valuing Scale (ISVS-24) for Utilization in Multiplayer Virtual Reality Environments [version 3; peer review: 4 approved with reservations] . F1000Research 2026, 14 :169 ( https://doi.org/10.5256/f1000research.184902.r435741) NOTE: it is important to ensure the information in square brackets after the title is included in this citation. The direct URL for this report is: https://f1000research.com/articles/14-169/v2#referee-response-435741 keyboard_arrow_left Back to all reports Reviewer Report 0 Views copyright © 2025 Munawaroh S. This is an open access peer review report distributed under the terms of the Creative Commons Attribution License , which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited. 24 Nov 2025 | for Version 2 Siti Munawaroh , Universitas Sebelas Maret, Surakarta, Indonesia 0 Views copyright © 2025 Munawaroh S. This is an open access peer review report distributed under the terms of the Creative Commons Attribution License , which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited. format_quote Cite this report speaker_notes Responses (1) Approved With Reservations info_outline Alongside their report, reviewers assign a status to the article: Approved The paper is scientifically sound in its current form and only minor, if any, improvements are suggested Approved with reservations A number of small changes, sometimes more significant revisions are required to address specific details and improve the papers academic merit. Not approved Fundamental flaws in the paper seriously undermine the findings and conclusions Thank you for the opportunity to review this manuscript. I appreciate the authors’ efforts in adapting and validating the ISVS-24 instrument for use in a Multiplayer Virtual Reality (MPVR)–based interprofessional education setting. This topic is timely and highly relevant, given the increasing adoption of immersive VR in health professions education and the lack of validated instruments specifically tailored for VR-based interprofessional learning. This study therefore has the potential to make a meaningful contribution to the field. That said, several aspects of the manuscript require clarification and further refinement to enhance its methodological rigor and interpretability: Clarity and depth of methodological reporting The translation and back-translation procedures are described at a general level. The manuscript would benefit from specifying which items required significant modification or discussion during the adaptation process, as this information is important to support content validity. Additionally, the expert review process involved only anesthesiology specialists, whereas interprofessional instruments ideally require input from experts representing multiple professions. This limitation should be clearly acknowledged in the Discussion section rather than integrated into the Methods. Sample size justification for factor analysis The sample size (N=72) is relatively small for conducting a stable exploratory factor analysis. Many methodological guidelines recommend a minimum of 5–10 participants per item or at least 100–200 participants for reliable factor extraction. A clear justification referencing the psychometric literature is needed to support the adequacy of the current sample. Clarification of factor-analytic approach (PCA vs EFA) Although the manuscript states that an Exploratory Factor Analysis (EFA) was conducted, the analytical procedures described—specifically the use of Principal Component Analysis (PCA) as the extraction method—do not align with the requirements of a true EFA. PCA is a data-reduction technique that does not model latent constructs. The authors should clarify whether their intention was to conduct a genuine EFA, and if so, justify the use of PCA or consider reanalyzing the data using appropriate factor-extraction methods such as Principal Axis Factoring (PAF) or Maximum Likelihood (ML). Clear reporting of communalities, factor loadings, rotation methods, and rationale for factor retention (e.g., scree plot, parallel analysis) is also needed. Manuscript structure and placement of information Several statements about study limitations appear within the Methods and Results sections. These should be relocated to the Discussion section to improve structural coherence and to distinguish descriptive procedures from interpretive commentary. Strengthening the Discussion through comparison with prior ISVS validations The Discussion section would benefit from a deeper comparison with ISVS validation studies from other countries or educational contexts. Highlighting similarities or differences in item performance, factor structures, and reliability indices would help situate the findings within the broader literature. Overall, this manuscript addresses an important and emerging area in health professions education. With clearer methodological reporting, appropriate factor-analytic procedures, and a more structured presentation of findings, the study has the potential to make a valuable contribution to the development of assessment tools for VR-based interprofessional education. Is the work clearly and accurately presented and does it cite the current literature? Partly Is the study design appropriate and is the work technically sound? No Are sufficient details of methods and analysis provided to allow replication by others? Partly If applicable, is the statistical analysis and its interpretation appropriate? Partly Are all the source data underlying the results available to ensure full reproducibility? Yes Are the conclusions drawn adequately supported by the results? Partly Competing Interests No competing interests were disclosed. Reviewer Expertise Anatomy education, health professions education, curriculum development, faculty development, learning environment, and assessment in medical education. I confirm that I have read this submission and believe that I have an appropriate level of expertise to confirm that it is of an acceptable scientific standard, however I have significant reservations, as outlined above. reply Respond to this report Responses (1) Author Response 21 Jan 2026 Aida Tantri, Department of Anesthesiology and Intensive Care, Faculty of Medicine, Universitas Indonesia, Central Jakarta, 10430, Indonesia 1. Thank you for the helpful comment. We have clarified in the Methods Phase 1 section which items required discussion during translation and have revised the manuscript accordingly. As suggested, we have relocated the statement about the composition of the expert panel for content validity, who were all anesthesiology specialists to the Discussion section. This limitation has now been clearly acknowledged as it may reduce the diversity of perspectives typically expected for interprofessional instruments. 2. Thank you for this important comment. We have strengthened our justification for the sample size by drawing on simulation-based evidence demonstrating that exploratory factor analysis can yield stable and valid results with small samples when communalities and factor loadings are high. We have also added a referencing de Winter et al. (2009) to clarify the appropriateness of using 72 participants in this pilot validation. 3. Thank you for your comment. We have clarified the factor-analytic approach by explaining the use of PCA as the extraction method within the exploratory phase and providing the rationale for this choice. Reporting of communalities, factor loadings, rotation method, and factor-retention criteria has also been updated in the revised Methods and Results sections 4. Thank you for the helpful suggestion. We have revised the manuscript to remove limitation-related statements from the Methods and Results sections. All limitations are now presented in the Discussion section 5. Thank you for the valuable feedback. In response, we have strengthened the Discussion section with a deeper comparison to prior ISVS validations conducted in different countries and contexts. These comparisons help situate our findings within the broader literature and clarify the unique contribution of our VR-based adaptation View more View less Competing Interests No competing interests were disclosed. reply Respond Report a concern Munawaroh S. Peer Review Report For: Adaptation and Validation of the Interprofessional Socialization and Valuing Scale (ISVS-24) for Utilization in Multiplayer Virtual Reality Environments [version 3; peer review: 4 approved with reservations] . F1000Research 2026, 14 :169 ( https://doi.org/10.5256/f1000research.184902.r433777) NOTE: it is important to ensure the information in square brackets after the title is included in this citation. The direct URL for this report is: https://f1000research.com/articles/14-169/v2#referee-response-433777 keyboard_arrow_left Back to all reports Reviewer Report 0 Views copyright © 2025 Ardyansyah B. This is an open access peer review report distributed under the terms of the Creative Commons Attribution License , which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited. 02 Sep 2025 | for Version 2 Bau Dilam Ardyansyah , Medical Education, Universitas Hasanuddin, Makassar, South Sulawesi, Indonesia; Hasanuddin University Teaching Hospital, Hasanuddin University, Makassar, South Sulawesi, Indonesia; Curtin School of Allied Health, Curtin University, Perth, Western Australia, Australia 0 Views copyright © 2025 Ardyansyah B. This is an open access peer review report distributed under the terms of the Creative Commons Attribution License , which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited. format_quote Cite this report speaker_notes Responses (1) Approved With Reservations info_outline Alongside their report, reviewers assign a status to the article: Approved The paper is scientifically sound in its current form and only minor, if any, improvements are suggested Approved with reservations A number of small changes, sometimes more significant revisions are required to address specific details and improve the papers academic merit. Not approved Fundamental flaws in the paper seriously undermine the findings and conclusions I appreciate the authors’ efforts to revise the manuscript in response to the previous comments. The overall clarity of the paper has improved, and several earlier concerns have been addressed. However, several important issues remain that should be considered further: The current version of the Methods includes several statements describing the limitations of the study. The Methods should focus exclusively on what was done , in sufficient detail to allow replication. A clearer justification is needed for key methodological decisions. The study involved factor analysis but included only 72 participants. Because sample size is a critical consideration in factor analysis, the rationale for this choice should be explicitly explained and supported by references or methodological guidelines. The description of the translation procedure, particularly backward translation, remains insufficient. It is not clear whether backward translation was conducted, and Figure 1 does not show this step. A more detailed summary of the forward and backward translation processes would strengthen transparency. In particular, were there any items that required significant discussion to reach consensus, or did all 24 items proceed smoothly? How many items were reworded? Which items were they? Identification of problematic words, sentences, or phrases encountered during the translation would enrich the discussion of content validity The description of factor analysis in the Methods and Results remains limited. It is not clear whether exploratory factor analysis (EFA) or confirmatory factor analysis (CFA) was conducted. The manuscript currently refers only to the use of principal component analysis. This distinction should be clarified and described in line with standard reporting practices. There is no statement regarding the assessment of data normality. Table 4 currently contains a large amount of information, much of which does not appear essential. It could be streamlined to present only the data directly relevant to determining the dimensional structure of the instrument. In addition, a table showing the factor loadings for each item, along with other results typically reported in factor analysis, would be more informative. Although the eigenvalue criterion (>1) suggests three domains, the results in Table 4 more strongly support a unidimensional structure rather than a three-dimensional one. A more convincing and methodologically robust justification of the factorial structure could be achieved by triangulating with alternative approaches rather than relying solely on the Kaiser criterion. The manuscript presents statements of limitation throughout the text, including in the Methods, Results, and Discussion sections. This is not conventional. Limitations should generally be reported only in the Discussion section, where they can be appropriately contextualised. The Discussion could be further strengthened by comparing and contrasting the findings with previous ISVS-24 validation studies conducted in other languages and contexts. Highlighting similarities (e.g., factor structure, reliability, problematic items) and differences (e.g., cultural or contextual variations) would clarify how this study contributes to the broader evidence base. Thank you. Competing Interests No competing interests were disclosed. Reviewer Expertise The reviewer is a senior academic and medical doctor specializing in the development and implementation of interprofessional education and collaborative practice for health practitioners and students. Her expertise includes learning, teaching, and assessment in medical education, interprofessional education and collaborative practice, instrument development, and psychometric properties evaluation. She has led studies on adapting assessment tools for Indonesian and Australian contexts, including tuberculosis care through a Delphi study. Her research ensures culturally relevant and reliable instruments for evaluating interprofessional education and practice, enhancing collaboration among healthcare professionals and students. I confirm that I have read this submission and believe that I have an appropriate level of expertise to confirm that it is of an acceptable scientific standard, however I have significant reservations, as outlined above. reply Respond to this report Responses (1) Author Response 21 Jan 2026 Aida Tantri, Department of Anesthesiology and Intensive Care, Faculty of Medicine, Universitas Indonesia, Central Jakarta, 10430, Indonesia 1. Thank you for your valuable feedback. We have removed the statements describing study limitations from the Methods section to maintain focus on the procedures conducted 2. Thank you for the comment. We have added an explanation in the Discussion section to justify the sample size, citing de Winter et al. (2009) to support that EFA can yield valid results with small samples when communalities and factor loadings are high 3. Thank you for the insightful comment. We have expanded the description of the translation process, providing clearer details on the forward and backward translation steps. We also identified several items that required clarification during the review, and we have described how these were discussed and refined through consensus meetings. 4. Thank you for your comment. We have clarified the analytical approach by explicitly stating that an Exploratory Factor Analysis (EFA) was conducted using PCA as the extraction method. Details of the procedure and justification have been added to both the Methods and Results sections. 5. Thank you for pointing this out. We have added a description of the normality assessment to the Results section 6. Thank you for the suggestion. Table 4 has been simplified to present only the eigenvalues, percentage of variance, and cumulative variance for the retained factors. In addition, a new table (Table 5) presenting the rotated factor loadings for all items has been added to enhance clarity and provide essential information related to the factor structure 7. Thank you for your comment. We have strengthened the justification for retaining three components by incorporating additional explanation based on the interpretability of the loading structure and the alignment of the three-component solution with the conceptual subscales of the original ISVS. We have also acknowledged the limitations of relying solely on the Kaiser criterion and clarified that the decision was supported by theoretical considerations in addition to statistical outputs. These revisions have been added to the Results sections 8. Thank you for the helpful suggestion. We have removed all limitation statements from the Methods and Results sections and relocated them to the Discussion 9. Thank you for this helpful suggestion. We have expanded the Discussion section by adding comparisons with previous ISVS-24 validation studies, including the original validation by King et al. (2010) and a recent Spanish adaptation View more View less Competing Interests No competing interests were disclosed. reply Respond Report a concern Ardyansyah BD. Peer Review Report For: Adaptation and Validation of the Interprofessional Socialization and Valuing Scale (ISVS-24) for Utilization in Multiplayer Virtual Reality Environments [version 3; peer review: 4 approved with reservations] . F1000Research 2026, 14 :169 ( https://doi.org/10.5256/f1000research.184902.r398929) NOTE: it is important to ensure the information in square brackets after the title is included in this citation. The direct URL for this report is: https://f1000research.com/articles/14-169/v2#referee-response-398929 keyboard_arrow_left Back to all reports Reviewer Report 0 Views copyright © 2025 Rulli D. This is an open access peer review report distributed under the terms of the Creative Commons Attribution License , which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited. 06 Jun 2025 | for Version 1 Danielle Rulli , The Ohio State University, Columbus, Ohio, USA 0 Views copyright © 2025 Rulli D. This is an open access peer review report distributed under the terms of the Creative Commons Attribution License , which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited. format_quote Cite this report speaker_notes Responses (1) Approved With Reservations info_outline Alongside their report, reviewers assign a status to the article: Approved The paper is scientifically sound in its current form and only minor, if any, improvements are suggested Approved with reservations A number of small changes, sometimes more significant revisions are required to address specific details and improve the papers academic merit. Not approved Fundamental flaws in the paper seriously undermine the findings and conclusions Thank you for the opportunity to review this manuscript. TITLE Appropriately descriptive of the study and manuscript contents. INTRODUCTION There are a number of statements that need citation support. For example: "IPE seeks to impart clinical knowledge engagingly and dynamically. The benefits of IPE are clear to the students. When it comes to overcoming the limits of healthcare professionals, students who have been exposed to IPE in the curriculum have developed interprofessional partnerships throughout their practices, boosted team spirit, and fostered competencies." This sentence needs clarification as the ISVS does indeed measure these things - "Although MPVR-based simulation is a rapidly developing simulation in medical education, there is not yet a suitable measuring instrument that fully measures interprofessional socialization outcomes, which captures changes in attitudes, actions, and beliefs of participants." Needs citation - Effective interprofessional socialization is essential as it will enhance the utilization of each individual’s skills during collaborative practice, promote efficient patient care, and enhance patient safety. More background in the use of MPVR-based simulation in health professions education is needed to provide the foundation for this study. There needs to be a more robust relation of the significance of interprofessional socialization and identity to convey why this is relevant to the study. Additionally, further exploration of the ISVS (there are multiple versions) and comparator evaluations are needed to understand the selection for this study. METHODS ISVS-24 has already been revised,shortened, and validated by the original authors. Why was this older version chosen? More clarity is needed on participants, as well as inclusion and exclusion criteria. Clearer description of the intervention is needed, including how it was developed and piloted. The authors state, "This study utilised virtual reality simulations that were played by three individuals."How were the three calibrated and how were participants oriented to using the the VR? In the Phase 2 component, other than expertise in MPVR simulation-based education, was anyone involved that is an expert in IPE evaluation/assessment? In Phase 3, it does not appear that all professions/students who would be involved were part of the pilot, making this component of validation questionable. RESULTS Regarding the content validity, why was question removal based on a handful of experts instead of being guided by a wider pilot assessment? A further explanation as to why these were removed should be in the methods in the Phase 3 section. This is assuming the final ISVS used did not include those 3 questions. RESULTS There is a lack of clarity on the factor analysis of individual questions to demonstrate validity. The statements on the results of individual tests should be in the discussion. Only the results should be presented, not their interpretation. The item reliability test data states the Cronbach alpha of 0.959 "indicates that the adapted version of ISVS items' [sic] were reliable." Please reassess this. Again, this statement should also be in the discussion, not the results. DISCUSSION The discussion needs to tie back to the literature in the introduction, and/or with the minimal introduction of additional literature, whether it agrees or differs with similar evidence. Consider addressing additional limitations of the study. CONCLUSION Consider revising. In its current form it is somewhat reaching based on the limitations of the study design. Is the work clearly and accurately presented and does it cite the current literature? Partly Is the study design appropriate and is the work technically sound? Partly Are sufficient details of methods and analysis provided to allow replication by others? Partly If applicable, is the statistical analysis and its interpretation appropriate? Partly Are all the source data underlying the results available to ensure full reproducibility? Partly Are the conclusions drawn adequately supported by the results? Partly Competing Interests No competing interests were disclosed. Reviewer Expertise Interprofessional education, educational methodologies, medical/dental integration. I confirm that I have read this submission and believe that I have an appropriate level of expertise to confirm that it is of an acceptable scientific standard, however I have significant reservations, as outlined above. reply Respond to this report Responses (1) Author Response 09 Aug 2025 Aida Tantri, Department of Anesthesiology and Intensive Care, Faculty of Medicine, Universitas Indonesia, Central Jakarta, 10430, Indonesia We appreciate the reviewer thoughtful comments and suggestions. Please find our detailed responses below. 1. Introduction a. We have revised the paragraph to improve clarity and accuracy, and to ensure that each claim is appropriately supported by literature. Specifically, we rephrased the original sentences and placed the citation numbers directly after the relevant claims b. We acknowledge that the ISVS is indeed a validated instrument that measures changes in attitudes, actions, and beliefs related to interprofessional socialization. To address this, we have revised the sentence to clarify that the gap lies not in the existence of such instruments, but in the lack of validation and adaptation of these tools for use specifically in immersive MPVR-based educational environments. c. A reference has been added to support the role of effective interprofessional socialization in improving collaborative practice and patient safety. d. We have expanded the background section to provide more context and examples of how MPVR has been applied in health professions education. e. We have expanded our explanation regarding the significance of interprofessional socialization and identity formation in collaborative practice, particularly in virtual learning environments. Additionally, we elaborated on the rationale for selecting ISVS-24 over other versions and alternative instruments. 2. Methods a. We chose to adapt the original ISVS-24, as the full and unrevised version developed by the original authors because it allows for more controlled and context-specific refinement. This ensures the instrument appropriately captures interprofessional socialisation within immersive VR settings. The explanation has been add to the method – instrument and introduction part. b. We have added more clarity about participant c. We have added a clearer description of the VR-LAST development process and included a brief explanation of its pilot testing by the research team. Please see the revised Methods section. d. We have added details on how participants were oriented and briefed prior to the simulation. All participants attended a standard orientation session before each simulation that included a demonstration of the VR interface, headset usage, scenario overview, and simulation flow. e. We acknowledge that while all panelists were highly experienced in simulation-based interprofessional education, none held formal training in IPE assessment. This is a limitation of this study and should be addressed in future validation efforts f. We have clarified that Phase 3 involved participants from all professional groups engaged in the VR-LAST simulation, including anesthesiology residents, general physicians, and professional nurses. To avoid confusion with the earlier pilot testing of the VR intervention, we have also revised the heading of Phase 3 to better reflect the focus on instrument validation. 3. Results a. We have clarified in the Methods – Phase 3 that three items were removed based on expert judgment in Phase 2 (content validation), and the final 21-item version was used for construct validation. No data were collected for the removed items during Phase 3 b. We have clarified the purpose and procedures of the exploratory factor analysis in the Results section to better demonstrate the construct validity of the instrument. c. We have revised the Results section to present only the statistical outcomes and moved all interpretations to the Discussion. d. We have corrected the grammatical error and moved the interpretation of the Cronbach’s alpha result to the Discussion section. 4. Discussion We have revised the Discussion to clearly relate our findings back to key literature mentioned in the Introduction. Furthermore, we have expanded the Limitations section to address issues such as ecological validity and sample generalizability. 5. Conclusion We have revised the conclusion to better reflect the study’s limitations. View more View less Competing Interests No competing interests were disclosed. reply Respond Report a concern Rulli D. Peer Review Report For: Adaptation and Validation of the Interprofessional Socialization and Valuing Scale (ISVS-24) for Utilization in Multiplayer Virtual Reality Environments [version 3; peer review: 4 approved with reservations] . F1000Research 2026, 14 :169 ( https://doi.org/10.5256/f1000research.176903.r379678) NOTE: it is important to ensure the information in square brackets after the title is included in this citation. The direct URL for this report is: https://f1000research.com/articles/14-169/v1#referee-response-379678 keyboard_arrow_left Back to all reports Reviewer Report 0 Views copyright © 2025 Ardyansyah B. This is an open access peer review report distributed under the terms of the Creative Commons Attribution License , which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited. 27 Feb 2025 | for Version 1 Bau Dilam Ardyansyah , Medical Education, Universitas Hasanuddin, Makassar, South Sulawesi, Indonesia; Hasanuddin University Teaching Hospital, Hasanuddin University, Makassar, South Sulawesi, Indonesia; Curtin School of Allied Health, Curtin University, Perth, Western Australia, Australia 0 Views copyright © 2025 Ardyansyah B. This is an open access peer review report distributed under the terms of the Creative Commons Attribution License , which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited. format_quote Cite this report speaker_notes Responses (1) Approved With Reservations info_outline Alongside their report, reviewers assign a status to the article: Approved The paper is scientifically sound in its current form and only minor, if any, improvements are suggested Approved with reservations A number of small changes, sometimes more significant revisions are required to address specific details and improve the papers academic merit. Not approved Fundamental flaws in the paper seriously undermine the findings and conclusions Thank you for allowing me the opportunity to review this paper. The study aims to adapt and validate an interprofessional outcome measure for assessing the Multiplayer Virtual Reality Environments. This manuscript has implemented several instrument development standards. However, I have several concerns regarding this manuscript, which I have detailed below. Introduction: Regarding the Statement: These interactive virtual experiences have been shown to outperform traditional or other digital educational methods in terms of knowledge retention and skill development among health professionals. To strengthen this claim, consider citing specific studies or providing empirical evidence demonstrating interactive virtual experiences' superiority over traditional or other digital learning methods. A well-supported reference would enhance the credibility of the argument. Regarding the Instrument, ISVS-24: For adaptation and validation studies in a new cultural and linguistic context, best practices recommend utilising existing validated instruments in the target language whenever possible. Several IPE outcome measures have already been adapted and validated in Indonesian, including RIPLS, CICS-29, CPAT, EPIS-RI, and even an Indonesian version of ISVS (ISVS-19), which has undergone thorough adaptation and validation. This leads to an important question: Why not use one of these existing scales? What are their limitations? A thorough discussion of the shortcomings of these previously validated instruments is necessary to justify the adaptation of ISVS-24. Summarising the key findings from earlier outcome measure studies would provide a stronger contextual foundation for the research. Additionally, ISVS-24 has been refined by its original developers into ISVS-21, which has improved psychometric properties. This raises a question: Why use ISVS-24 instead of ISVS-21? Clarifying what specific aspects of ISVS-24 make it more suitable for Multi-Participant Virtual Reality (MPVR)-based simulations compared to ISVS-21 would strengthen the rationale for this choice. Since this study focuses on the adaptation and validation of an instrument from one language (English) to another (Indonesian), it is essential to discuss the psychometric properties of ISVS-24 to establish its reliability and validity within this new context. Methods - Participants. A total of 72 anesthesiology residents, general physicians, and nurses from the Faculty of Medicine, Universitas Indonesia. Are the participants nurses or nursing students? Inclusion criteria: no information was provided about how participants were recruited. Since the ISVS-24 assesses interprofessional socialisation within the simulation, it is unclear whether participants were required to have prior experience working in interprofessional teams or, with or without previous exposure to VR training, were included. Methods – Instruments. This study utilised virtual reality simulations that were played by three individuals. Who are these individuals? A clear layout of the participants and their roles in the simulation is needed. Seeking permission from the original author (King et al., 2016) is highly recommended when adapting an instrument to a new context, especially if it involves translation, cultural adaptation, or modifications. Has the author obtained permission from the original author of the instrument to adapt it? Methods – Procedure Phase 1: Translation of the ISVS-24. The translation process of an instrument is crucial in adapting it to a new cultural context. Therefore, the translation methodology must be clearly explained. Who conducted the translation? What were their qualifications to be designated as translators? The translation process described in this article did not mention whether a back-translation was performed. Briefly explain the dynamics of the translation process and how consensus was reached. Methods – Phase 2 and Phase 3. The methodology provides a structured approach to instrument adaptation, pilot testing, and validation. However, a clearer separation between pilot testing and validation is needed. A panel of experts made up of 4 senior anaesthesiology consultants who were experts in MPVR simulation-based education. This step is crucial to content validation for an interprofessional outcome measure. Provide elaboration on the expertise of the reviewers and whether their backgrounds cover relevant fields of interprofessional education. Why not include practitioners from diverse healthcare backgrounds, who are also the intended end users of the instrument, such as nurses? Four reviewers are relatively small to be considered sufficient for a content validity study. The target users of this instrument, such as anaesthesiology residents and nurses, were not involved in assessing content validity in phase 2 (should be part of a pilot study). Phase 3 (should be part of the validation study?) used only 72 respondents, which is too small for robust psychometric analysis (factor analysis and reliability testing) of 21 items. Results The pilot study should primarily focus on the instrument’s items comprehensibility, feasibility, and usability. However, three items were removed solely based on the opinions of four-panel reviewers during phase 2. Why not consider removing the item based on the factor analysis? Please justify the items’ removal at this stage. A more detailed description of the factor analysis method employed, including the type of factor analysis (e.g., exploratory or confirmatory), extraction method, rotation technique, and criteria for factor retention. Many important indices for factor analysis results are not reported; for example, the item and factor loadings and how the factor loadings were interpreted (e.g., items retained if factor loading >0.40). Provide the McDonald’s Omega to compliment the internal consistency reliability evaluation for each subscale (factor/domain) and the total for the scale. A very high Cronbach alpha (> 0.95) is undesirable for a subscale or total scale. The structural validity of the instrument, after being tested with 72 participants, was not adequately evaluated. Discussions It would be helpful to clarify the criteria used for removing the three items beyond just the VR setting. Consider providing a comparison and contrast of relevant publications with the findings of this study. The Discussion section needs improvement, as some of the narratives repeat the results presented in the Results section. Conclusion Consider tempering the statement by acknowledging the study's limitations, such as the small sample size, single-institution focus, and some methodology limitations. References to instrument adaptation, standards, and validation processes need to be strengthened to ensure the incorporation of the best practices in the adaptation and validation process, including the latest statistical methods for validation. Is the work clearly and accurately presented and does it cite the current literature? Partly Is the study design appropriate and is the work technically sound? No Are sufficient details of methods and analysis provided to allow replication by others? Partly If applicable, is the statistical analysis and its interpretation appropriate? Partly Are all the source data underlying the results available to ensure full reproducibility? Partly Are the conclusions drawn adequately supported by the results? Partly Competing Interests No competing interests were disclosed. Reviewer Expertise The reviewer is a senior academic and medical doctor specializing in the development and implementation of interprofessional education and collaborative practice for health practitioners and students. Her expertise includes learning, teaching, and assessment in medical education, interprofessional education and collaborative practice, instrument development, and psychometric properties evaluation. She has led studies on adapting assessment tools for Indonesian and Australian contexts, including tuberculosis care through a Delphi study. Her research ensures culturally relevant and reliable instruments for evaluating interprofessional education and practice, enhancing collaboration among healthcare professionals and students. I confirm that I have read this submission and believe that I have an appropriate level of expertise to confirm that it is of an acceptable scientific standard, however I have significant reservations, as outlined above. reply Respond to this report Responses (1) Author Response 09 Aug 2025 Aida Tantri, Department of Anesthesiology and Intensive Care, Faculty of Medicine, Universitas Indonesia, Central Jakarta, 10430, Indonesia We appreciate the reviewer thoughtful comments and suggestions. Please find our detailed responses below. 1. Introduction In response, we have strengthened the justification for using virtual reality by adding previous studies demonstrating VR’s superiority over traditional methods in improving knowledge retention and skill development. We clarified the rationale for adapting the ISVS-24 from the original version rather than using translated instruments such as RIPLS, CPAT or ISVS-19. We also justified the selection of ISVS-24 over ISVS-21 by emphasizing the need for item-level adaptation from the source to preserve content relevance and theoretical integrity within immersive VR settings. 2. Methods - Participants We have clarified that the participants were professional nurses, not students, and provided additional details on the inclusion criteria and recruitment process. We have clarified in the revised manuscript that participants were not required to have prior experience working in interprofessional teams or with VR training. However, their professional backgrounds ensured exposure to interprofessional collaboration in clinical settings. We also noted that previous VR experience was not a prerequisite, as the study aimed to assess interprofessional socialization within a simulated VR setting, regardless of participants’ prior VR exposure 3. Methods – Instruments We have clarified the composition and roles of the participants in the VR simulation, specifying that each team consisted of an anesthesiology resident, a general physician, and a professional nurse assigned to interprofessional roles. We also confirm that permission to adapt and translate the ISVS-24 was obtained from the original author to use in this study. 4. Methods – Procedure Phase 1 We have clarified the qualifications of the translators, included the back-translation process, and elaborated on how consensus was reached during the translation phase to ensure cultural and contextual relevance of the adapted instrument. 5. Methods – Phase 2 and Phase 3 We have clarified the expertise of the content reviewers, acknowledged the absence of other health professions in the expert panel, and addressed this as a limitation. We also revised the manuscript to clearly distinguish between pilot testing and construct validation in Phase 3. Additionally, we acknowledged the limited sample size for factor analysis and recommended future studies to include larger and more diverse samples and expert panels. 6. Results We have clarified that the three items were removed based on low Aiken’s V scores and expert consensus due to incompatibility with the MPVR context, and we acknowledged the limitation of not basing removal on factor analysis. We have also added a more detailed explanation of the factor analysis. While Cronbach’s alpha was used to assess internal consistency, we acknowledge in the discussion that the use of McDonald’s Omega would provide a more robust reliability estimate; however, this analysis was not conducted due to limitations in the statistical software used. 7. Discussions We have clarified the rationale for removing three items. We have included a comparison of our findings with previous studies using ISVS or similar interprofessional education tools. We revised the Discussion section to focus more on interpretation and implications, and removed redundant restatements of the Results section to enhance clarity and purpose. 8. Conclusion We have revised the conclusion to acknowledge the study’s limitations, including the small sample size, single-institution focus, and the need for further validation through broader future studies View more View less Competing Interests No competing interests were disclosed. reply Respond Report a concern Ardyansyah BD. Peer Review Report For: Adaptation and Validation of the Interprofessional Socialization and Valuing Scale (ISVS-24) for Utilization in Multiplayer Virtual Reality Environments [version 3; peer review: 4 approved with reservations] . F1000Research 2026, 14 :169 ( https://doi.org/10.5256/f1000research.176903.r366123) NOTE: it is important to ensure the information in square brackets after the title is included in this citation. 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