Experiences of Nature Through Immersive Virtual Reality Among People with Type 2 Diabetes Mellitus

Round 1

Reviewer 1 Report

Comments and Suggestions for Authors

This is a somewhat strange paper about a virtual reality intervention for people with type 2 diabetes. The paper contains no control or contrast group, the outcomes reported had nothing to do with diabetes and no analyses are provided. The authors assume that periods of tranquility and peacefulness and free flowing reflection somehow are helpful to individuals diagnosed with diabetes. All of the 17 subjects who completed the program were recruited from a dedicated diabetes educational problem for patients in Sweden. Clearly, the virtual reality program did promote the feelings and thoughts that the authors expected. However, these expected responses were never linked to the diabetes of the patients in any fashion. 

Because this paper is really more about a therapeutic intervention delivered via virtual reality, perhaps a journal focused on treatment approaches might be more appropriate. As a therapeutic paper, it is well written, nicely organized, interesting to read and potentially helpful to providers desirous of developing highly focused, short-term interventions. 

Author Response

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Author Response File: Author Response.pdf

Reviewer 2 Report

Comments and Suggestions for Authors

The incorporation of immersive virtual reality in the field of diabetes represents an innovative opportunity that can create unforgettable and memorable experiences. However, it is necessary to have clear objectives for its use, to ensure that these tools truly contribute to improving quality of life and are not merely an attractive technological resource or an attempt to replace outdoor walks in nature.

The title is indicative of the study’s content.

The abstract allows for a quick identification of the basic content, describing the objective, methodology, results, and conclusions. Remove acronyms. Include numerical data related to the categories obtained in the results.

The what and the why of the research are presented, and the appropriate theoretical framework for the problem is described.

Section 2.4 should explain the reason or the theories on which the authors base their choice to use the glasses for 30 minutes, three times a week, for six months. It is unclear how people with diabetes choose the natural environments and whether the type of environment influences well-being.

It is not clear how many patients attend the diabetes education program, how they are invited to participate in this study, why only 17 people sign up, and some characteristics of these 17.

There is a lack of description of the follow-up interview—the topics and questions are unknown. It is striking that some participants take 17 minutes and others 46 minutes.

In section 2.6 (Data Analysis), it should be explained what the basis was for choosing the categories—was any qualitative data analysis software used?

The data are analyzed in relation to the study objective.

The type of images chosen seems to influence the participants; however, it is unclear how these images were selected and how the participants choose which images to view.

The conclusions are mixed with limitations and future directions. Besides stress reduction and general well-being improvement, clear and concrete conclusions in response to the objectives are missing.

The references are adequate. On line 196, the reference Krippendorff (2013) is not correct; this reference does not appear in the final list.

Add references from the last two years.

Author Response

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Author Response File: Author Response.pdf

Reviewer 3 Report

Comments and Suggestions for Authors

Experiences of Nature Through Immersive Virtual Reality 2 Among People with Type 2 Diabetes Mellitus

 

This manuscript presents a qualitative study exploring experiences of immersive virtual reality nature exposure among individuals with type 2 diabetes. The topic is novel, relevant, and timely, particularly given the increasing interest in digital health interventions and psychological support in chronic disease management.

The study contributes meaningful insights into patient experiences and highlights the potential of IVR as a complementary intervention for well-being. However, several points should be addressed to strengthen the manuscript.

 

The authors state that there is limited research on IVR-N in T2D, but the specific novelty of this study is not sufficiently emphasized.

Clarify: What new knowledge this qualitative study adds beyond existing IVR or nature-based intervention literature. Why qualitative insights are particularly needed in this context.

 

The qualitative approach is appropriate; however, more detail is needed:

How was data saturation determined?

Were researcher reflexivity and potential biases addressed?

What was the role/background of interviewers?

 

The sample (n = 17) is relatively small and drawn from a specific lifestyle program in Sweden, which may limit generalizability.

 

The IVR intervention is described, but some important aspects are unclear:

Were participants monitored for adherence?

Was usage objectively recorded or self-reported?

Were there any standardization procedures?

 

 

 Limitations Section

The limitations are briefly mentioned but should be expanded.

Missing aspects:

Small sample size

Cultural/geographical context

Lack of control/comparison group

Potential novelty effect of VR

Provide a more comprehensive and critical limitations discussion.

 

Comments on the Quality of English Language

Need Proofreading minor English mistake

Author Response

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Reviewer 4 Report

Comments and Suggestions for Authors

This manuscript explores the use of immersive virtual reality nature exposure in individuals with type 2 diabetes, addressing a timely and increasingly relevant topic in the context of digital health and non-pharmacological interventions. The study offers valuable qualitative insights into how virtual nature experiences may influence psychological well-being, particularly in relation to relaxation, stress reduction, and emotional regulation. Overall, the manuscript is clearly structured and addresses an important research gap, and the qualitative data presented are rich and informative. However, several aspects of the manuscript would benefit from further refinement in order to strengthen its methodological rigor, analytical depth, and overall coherence.

The qualitative design is appropriate for the research aim, but some key methodological details require further clarification. In particular, it would be helpful to provide more information on the sampling strategy, the rationale for the selected sample size, and whether data saturation was achieved. Additionally, a brief reflection on the role of the researchers in the data collection and analysis process would enhance transparency and align the study with established qualitative research standards. The description of the virtual reality intervention is notably detailed, particularly with regard to technical aspects, and while this information is useful, it currently feels disproportionate compared to other sections. A more concise presentation focusing on elements directly relevant to the research question would improve the flow and balance of the Methods section.

The Results section presents meaningful findings supported by participant quotations, which add depth and credibility to the analysis. However, there is a degree of repetition across themes, especially in relation to experiences of calmness, relaxation, and escape from everyday demands. Streamlining these sections and reducing redundancy would enhance readability and allow the key messages to emerge more clearly. In the Discussion, the manuscript tends to reiterate findings rather than engage in deeper interpretation. Strengthening the analytical component by more explicitly discussing the implications of the findings, as well as situating them more critically within the existing literature, would significantly improve the impact of this section.

Minor revisions are also recommended. Some sections of the Introduction could be slightly condensed to reduce repetition, and a light language edit would improve clarity in certain parts of the text. It would also be helpful to ensure consistency in the use of abbreviations and to consider shortening some participant quotations where similar points are repeated.

In conclusion, this is a promising and relevant study that has the potential to make a meaningful contribution to the field. The conclusions are generally supported by the findings and appropriately frame virtual nature as a complementary rather than substitutive intervention. However, given the qualitative design and sample size, the broader implications should be presented with appropriate caution.

Author Response

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Author Response File: Author Response.pdf

Round 2

Reviewer 2 Report

Comments and Suggestions for Authors

The article has improved considerably. Although not enough current references have been added, the authors have followed the suggestions offered, so the article could be published.

Author Response

We have acknowledged the reviewer’s comment and revised the Introduction accordingly, including ten additional references.