Refugee-centered framework for design of digital health interventions: a qualitative study with Ukrainian refugee women in Norway.

Autism Spectrum Disorder (ASD) is a neurodevelopmental disorder characterized by limitations in social communication and interaction, repetitive behaviors, and restricted interests (). The prevalence of ASD, which typically emerges in the first years of life, has increased significantly over the past two decades. Data from the Autism and Developmental Disabilities Monitoring (ADDM) Network, funded by the U.S. Centers for Disease Control and Prevention (CDC), revealed that the estimated prevalence increased from 1 in 150 children in 2000 to 1 in 44 in 2018 (), with the most recent CDC report indicating that 1 in 36 children is affected by ASD (). This upward trend is attributed to multiple factors, including the broadening of diagnostic criteria, heightened public awareness, and more frequent diagnoses among women and adults () highlighting ASD as a growing public health concern that requires effective intervention strategies. A core feature of ASD is persistent deficits in social communication and interaction across multiple contexts (). Children with ASD often experience difficulties initiating and maintaining conversations, sustaining joint attention, and responding appropriately to social cues, which limits their ability to form meaningful relationships (). Social skills, defined as both verbal and nonverbal behaviors that facilitate mutually beneficial interactions or as abilities that enable independent functioning and enhance quality of life (–), are thus critical targets in interventions for this population. Historically, interventions for social skills have included methods such as video modeling, behavioral skills training, social stories, peer- and sibling-mediated interventions, antecedent interventions, manualized curricula, pivotal response training, milieu teaching, naturalistic interventions, reinforcement strategies, script fading, discrete trial training, and self-management (). However, these approaches face challenges, including the time-intensive creation of diverse instructional scenarios and the difficulty in replicating certain naturalistic situations (). Research has highlighted that individuals with ASD often demonstrate a strong preference for structured, visually supported content, along with strengths in visual memory and detail-oriented processing (–). This receptiveness to digital media has prompted the development of technology-assisted instruction and intervention (TAII), which encompasses the use of common technologies such as computers and mobile devices, as well as advanced tools including virtual reality (VR), augmented reality (AR), mixed reality (MR), and robots (, ). VR enables the creation of immersive, interactive, and repeatable environments where distractions can be minimized and scenarios can be carefully controlled. Compared with traditional interventions, VR allows not only the safe simulation of real-life contexts but also the collection of rich behavioral and physiological data—such as gaze patterns, emotion recognition, and affective responses—that are difficult to capture in naturalistic settings (). VR systems used in autism research range from desktop-based applications and Cave Automatic Virtual Environments (CAVE) to wearable immersive VR devices such as head-mounted displays (HMDs) and VR glasses (). Wearable devices are particularly promising because they provide high levels of immersion and ecological validity, while remaining relatively portable and accessible. Advances in display technologies have made these devices increasingly affordable and adaptable, allowing for individualized interventions across developmental needs (, ). Despite the growing interest in wearable VR interventions for ASD, the evidence base remains fragmented. Existing studies vary widely in their targeted skills, methodological protocols, and device characteristics, making it difficult to establish standardized guidelines or identify the most effective approaches. Therefore, this systematic narrative review aims to map and synthesize the literature on wearable immersive VR devices (including HMDs and VR glasses) used with individuals with ASD. In this review wearable immersive virtual reality was operationally defined as any head-worn technology system that provides users with an immersive or semi-immersive digital experience through a device physically worn on the head, including head-mounted displays (HMDs), smart glasses, and mixed-reality headsets. These systems may deliver fully virtual environments or digitally overlaid content within the real world (augmented/mixed reality), provided that the primary interaction occurs through an embodied, head-mounted interface. Eligible systems were required to enable real-time interaction within the environment using sensory modalities such as head tracking, gaze, hand controllers, or integrated eye-tracking, thereby allowing user engagement with dynamic stimuli in controlled or semi-controlled environments. Non-wearable systems (e.g.