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We calculated an index of the negative engagement modes (sum of scores for the frustration/anxiety and hesitation/avoidance modes), as described by Hedman and Sharafi [36], because they may be associated with lower self-efficacy. Negative engagement modes were assessed before each session from a 15-item questionnaire using a 5-point Likert-type scale.
We assumed that very high mental strain could be another factor that may jeopardize perceived self-efficacy.
J Med Internet Res 2013;15(1):e9
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This has previously been described in detail by Hedman et al [28]. In order to also control for different individual coping strategies during the two sessions, we administered a validated questionnaire described by Carver [29] before the scenarios, in which each of 21 items gave indications of a particular way of coping.
In the virtual world simulation, the subjects interacted in real time with each other, a victim, and paramedics, by use of their avatars.
J Med Internet Res 2010;12(3):e38
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