Virtual Reality for Caregiver Assembly, Relief, Empowerment, and Support (VR-CARES)

System Usability Scale (SUS) Score

A 10-item questionnaire measuring subjective usability of the VR technology platforms. To gain more nuanced meaning from the data, items are rated using a numerical response scale with ratio properties and finite anchors, the Global Hedonic Intensity Scale (GHIS), in place of a 5-point categorical scale. The GHIS is a bipolar 100-point sliding scale with -100 representing the most unpleasant personal experience, 0 neutral, and +100 representing the most pleasurable personal experience (Bartoshuk et al., 2004; Lim et al., 2009). Scores of each item are averaged for a total score. To score it traditionally for direct comparison in the literature, scores of each item will be divided back into the 5-point categorical scores, totaled, and multiplied by 2.5 to range from 0 to 100 (Lewis \& Sauro, 2020). Higher scores indicate better usability. A traditionally scored value above 68 is considered above average usability.

Mean Change in Caregiver Job Satisfaction

Job satisfaction will be assessed with the Centers for Medicare and Medicaid Services' (CMS) Nursing Home Employee Satisfaction Survey adapted for home care workers. 34 items make up 4 subsections: job satisfaction, team building and communication, scheduling and staffing, and management and leadership. For more sensitive measurmment of change over time, a bipolar 100-point slider scale is provided to indicate the degree to which one 100% disagrees or 100% agrees with each statement instead of the 5-item Likert response scale typically provided. The total score is the mean of items (range: -100 to +100). To score it traditionally for direct comparison in the literature, scores of each item are divided back into the 5-point Likert scale and averaged. The total score and scores of each subsection will be calculated and analyzed. Higher scores indicate greater job satisfaction. This measure aligns with CMS quality metrics and workforce sustainability priorities for long-term care.

Mean Change in Caregiver Empowerment

Caregiver empowerment is assessed with the 13-item Personal Self-Efficacy (PSE) and the 7-item Caregiver Self-Efficacy (CSE) subsections of the Caregiver Empowerment Scale. For more accurate detection of significance and measure of change over time, items are rated using the GHIS bipolar 100-point sliding response scale (-100 labeled as the most unpleasant personal experience, 0 neutral, and +100 representing the most pleasurable personal experience (Bartoshuk et al., 2004; Lim et al., 2009)) in place of a 5-point categorical scale of low to high. Item's scores are averaged for a total score. To score it traditionally for direct comparison in the literature, items' scores are divided back into the 5-point categorical scores, totaled, and multiplied by 2.5 (range: 0-100) (Lewis \& Sauro, 2020). Higher scores indicate greater empowerment and confidence as a caregiver. Caregiver empowerment is a key outcome valued in social engagement interventions.

Adherence to VR-CARES Intervention

Adherence will be defined as the average number of group activities attended during the 8-week VR-CARES intervention period. Attendance will be recorded automatically via the VR-CARES platform for each session. Higher values indicate greater adherence to the VR-CARES intervention.

Mean Change in Study-Specific Caregiver Job Satisfaction Items

Three study-specific items assess caregivers' experiential and emotional dimensions of job satisfaction, complementing the structural job satisfaction domains captured by the CMS Employee Satisfaction Survey (primary outcome), providing a 2-dimensional view of job satisfaction. Items are rated on the Global Hedonic Intensity Scale (GHIS) bipolar 100-point sliding scale (-100 = most unpleasant personal experience, 0 = neutral, +100 = most pleasurable personal experience). The three items are: (1) Overall, how do you feel about the work you do? (2) How would you rate the level of care you provide to clients? (3) How positive, neutral, or negative do you feel about continuing to work at your current home care provider office? Scores are averaged across the three items. Higher scores indicate more positive feelings about caregiving work.

Technology Acceptance Model (TAM) Score

Technology acceptance is indicated with the 6-item Perceived Usefulness subset of the TAM, one item from the TAM Perceived Ease of Use subset (How pleasant or unpleasant was learning how to use the technology?) and one item from the TAM Attitude of Use subset (All things considered, how do you feel about using the technology?). The numerical GHIS, -100 (most unpleasant experience of your life) to 0 (neutral) to +100 (most pleasant experience of your life) is provided as the response scale (Lim et al., 2009), in place of a 7-point Likert scale. Scores of each item are averaged for a total score. To score it traditionally for direct comparison in the literature, scores of each item are divided back into the 7-point Likert scale scores and averaged. Higher scores indicate better acceptance, perceived usefulness, and adoption likelihood by the target population. TAM provides the adoption and sustainability narrative that complements usability data from the SUS.

User Experience Questionnaire Short Form (UEQ-S) Score

The UEQ-S measures the overall appeal of the technology in two domains and 6 dimensions of user experience: pragmatic quality and hedonic quality. Pragmatic quality refers to the usability, efficiency, and clarity of the technology, while hedonic quality refers to the stimulation, interest, and novelty of it. Each of the 8 items consists of a pair of contrasting attributes (e.g., boring vs. exciting) rated on a 7-point semantic differential scale from -3 to +3. Two additional study-specific items were added: at T2 only, 'confusing for my clients vs. reassuring for my clients'; and at T2 and T3, 'creating more work for me vs. providing relief for me.' These study-specific items capture caregiver-relevant dimensions absent from the standard UEQ-S. Scores for each dimension are averaged. Values between -0.8 and 0.8 represent a neutral evaluation, while values \> 0.8 indicate a positive user experience.