title: Design of Mobile Augmented Reality in Health Care Education: A Theory-Driven Framework.
abstract: BACKGROUND
  Augmented reality (AR) is increasingly used across a range of subject areas in health care education as health care settings partner to bridge the gap between knowledge and practice. As the first contact with patients, general practitioners (GPs) are important in the battle against a global health threat, the spread of antibiotic resistance. AR has potential as a practical tool for GPs to combine learning and practice in the rational use of antibiotics.
  
  
  OBJECTIVE
  This paper was driven by learning theory to develop a mobile augmented reality education (MARE) design framework. The primary goal of the framework is to guide the development of AR educational apps. This study focuses on (1) identifying suitable learning theories for guiding the design of AR education apps, (2) integrating learning outcomes and learning theories to support health care education through AR, and (3) applying the design framework in the context of improving GPs' rational use of antibiotics.
  
  
  METHODS
  The design framework was first constructed with the conceptual framework analysis method. Data were collected from multidisciplinary publications and reference materials and were analyzed with directed content analysis to identify key concepts and their relationships. Then the design framework was applied to a health care educational challenge.
  
  
  RESULTS
  The proposed MARE framework consists of three hierarchical layers: the foundation, function, and outcome layers. Three learning theories-situated, experiential, and transformative learning-provide foundational support based on differing views of the relationships among learning, practice, and the environment. The function layer depends upon the learners' personal paradigms and indicates how health care learning could be achieved with MARE. The outcome layer analyzes different learning abilities, from knowledge to the practice level, to clarify learning objectives and expectations and to avoid teaching pitched at the wrong level. Suggestions for learning activities and the requirements of the learning environment form the foundation for AR to fill the gap between learning outcomes and medical learners' personal paradigms. With the design framework, the expected rational use of antibiotics by GPs is described and is easy to execute and evaluate. The comparison of specific expected abilities with the GP personal paradigm helps solidify the GP practical learning objectives and helps design the learning environment and activities. The learning environment and activities were supported by learning theories.
  
  
  CONCLUSIONS
  This paper describes a framework for guiding the design, development, and application of mobile AR for medical education in the health care setting. The framework is theory driven with an understanding of the characteristics of AR and specific medical disciplines toward helping medical education improve professional development from knowledge to practice. Future research will use the framework as a guide for developing AR apps in practice to validate and improve the design framework.
authors.affiliation: Centre for Learning and Knowledge, Department of Learning, Informatics, Management and Ethics, Karolinska Institutet, Stockholm, Sweden. egui.zhu@ki.se.
authors.forename: Egui
authors.identifier: http://orcid.org/0000-0002-0861-4811
authors.initials: E
authors.lastname: Zhu
authors.forename: Anneliese
authors.identifier: http://orcid.org/0000-0001-5298-3289
authors.initials: A
authors.lastname: Lilienthal
authors.forename: Lauren Aquino
authors.identifier: http://orcid.org/0000-0003-3937-9751
authors.initials: LA
authors.lastname: Shluzas
authors.forename: Italo
authors.identifier: http://orcid.org/0000-0002-3738-7945
authors.initials: I
authors.lastname: Masiello
authors.forename: Nabil
authors.identifier: http://orcid.org/0000-0001-8999-6999
authors.initials: N
authors.lastname: Zary
keywords: antibiotics; augmented reality; general practitioners; health care education; learning environment; learning theory; mobile technology