Need-Supportive Immersive Learning Design Based on Self-Determination Theory: Effects on Learning Outcomes in a High-Stress Learning Context

Immersive learning environments are increasingly being implemented in high-stress contexts; however, many designs emphasize technological affordances rather than theoretically grounded motivational support. Guided by self-determination theory (SDT), this study developed a need-supportive immersive learning design model, referred to as self-determination theory–based virtual reality learning (VR-SDT), that intentionally integrates autonomy, competence, and relatedness into interactive, scenario-driven experiences. A randomized controlled study involving 84 ICU patients with coronary heart disease compared an immersive SDT-based VR learning condition (VR-SDT) with a non-immersive app-based SDT-informed instructional condition (App-SDT). Results indicated that participants in the VR-SDT condition achieved significantly higher knowledge ( F = 84.23, p < .001) and self-efficacy ( t = 7.96, p < .001) than those in the App-SDT condition. Anxiety reduction was also significantly greater in the VR-SDT condition (t = −8.86, p < .001). These findings suggest that an immersive learning design informed by SDT principles may support improvements in disease-related knowledge, self-efficacy, and anxiety in high-stress learning contexts, while providing theoretically grounded guidance for the design of immersive learning systems.