Colorectal cancer (CRC) is the third most common type of cancer and second most common cause of cancer-related deaths worldwide [1]. The incidence and mortality associated with late-onset CRC, which occurs in people aged 50 years or older, have shown a decreasing tendency owing to the implementation of various cancer screening programs [2]. By contrast, the incidence of early onset CRC (EOCRC), which develops before the age of 50 years, has dramatically increased over the past several decades, especially in high-income countries [3, 4]. According to a recent study, Korea has the highest incidence of CRC worldwide, with 12.9 cases per 100,000 people and an average annual percentage change of 4.2% among individuals aged between 20 and 49 years diagnosed in 2008–2012 [5].

The incidence of CRC has been reduced through screening and early detection [6]. In addition, preventing CRC through screening is highly recommended as a standard practice [7]. To increase awareness of the importance of early diagnosis of CRC, the cancer awareness campaign called “Be Clear on Cancer” has been held in the United Kingdom since January 2011 to improve public awareness on CRC and encourage the public to seek urgent medical attention [8]. Moreover, March has been designated as the “National Colorectal Cancer Awareness Month” in the United States since 2000 under the slogan “Getting screened could save your life” [9]. The Korean Society of Coloproctology (KSCP) has designated September as the month of annual colorectal cancer awareness since 2007 [10]. These campaigns are collectively called the Gold Ribbon Campaign to raise awareness on CRC and to encourage screening through colonoscopy. Specifically, the 2022 event was held through a metaverse platform to enable active participation under the slogan “Colorectal Cancer? Also in the young! Even the Generation MZ should not feel safe,” targeting the younger age groups. The Generation MZ is a casual neologism in Korea that collectively refers to millennials (born between 1980 and 1994) and Generation Z (born between 1995 and 2015) [11, 12].

The metaverse is a network of 3-dimensional (3D) virtual world that emphasizes social interaction and is a combination of virtual reality (VR) and augmented reality (AR) [13]. The COVID-19 has made it challenging to interact physically; hence, the Generation MZ, which values virtual world immersion, has become the primary metaverse user [14]. Therefore, the 2022 campaign held in the metaverse was more effective as it encouraged participants to explore the event and promote awareness of EOCRC, mainly among the younger generation. This study aimed to assess the impact of the 2022 Gold Ribbon Campaign held on a metaverse platform.

This is the first study to analyze the statistical effect of a CRC awareness campaign which was conducted on a novel metaverse platform for the first time. Various studies have been conducted worldwide to promote cancer awareness. However, the 2022 Gold Ribbon Campaign in Korea was conducted using a metaverse platform, a new emerging technology, and participants were surveyed using various questions, including on their level of satisfaction, to measure the campaign’s effectiveness.

When designing the Gold Ribbon Campaign using a metaverse platform, the age of the participants should be significantly considered. Users comfortable with 3D games can easily navigate through the metaverse platform. However, if the campaign primarily involves people in their late 40s, individual differences play a significant role in achieving the campaign’s purpose. The participants may not be able to deliver content included in the Gold Ribbon Campaign effectively. However, raising awareness on EOCRC was the catchphrase of the 2022 Gold Ribbon Campaign. Therefore, although people of all ages were welcome to participate, a metaverse campaign was conducted to educate the Generation MZ on CRC.

With the development of virtual convergence technology (extended reality, XR), which includes AR and VR, the idea of a metaverse and its applied model is gaining interest [15]. This is an emerging technology in various medical fields [16–18]. Patients with posttraumatic stress disorder can use XR projected on data glasses in order to immerse in the metaverse environment and relieve traumatic events without the risk of physical harm [19]. This approach enables clinicians to assist patients in isolating triggers and building resistance to prevent future attacks. The metaverse can also be a powerful environmental tool for providing education and training [20, 21]. Medical students can learn to perform life-saving surgery in the metaverse at a virtual university before attempting it on actual patients [22]. Students can also participate in metaverse activities after setting up their avatars and entering a virtual classroom where they can attend lectures about surgery techniques [23].

Awareness campaigns have been conducted worldwide, and their effectiveness has been analyzed [24–26]. The World Gynecologic Oncology Day was promoted and analyzed on Twitter [27]. In addition, our previous study conducted in 2014 indicated how often the Gold Ribbon Campaign was mentioned on Twitter to assess the improvements in CRC awareness after the campaign [28].

The 2022 Gold Ribbon Campaign has achieved a significant effect that has met the expectations. The satisfaction score for the information provided through the campaign was higher in the younger age groups. This score distribution was particularly noticeable when asked if they recognized the severity of EOCRC and the necessity for screening and prevention, with variations in the distributions of answers corresponding to EOCRC among participants aged <50 and >50 years. The satisfaction score for the metaverse platform and the structural arrangement of the metaverse showed a decreasing tendency among teenagers; this finding suggests that the graphics on the metaverse map did not meet the expectations of young individuals who enjoy playing 3D games with high-level graphics. In addition, the higher the satisfaction with the CRC information provided through the campaign, the higher the cognitive score for the severity of EOCRC. The high-quality image content of CRC significantly conveyed the severity of EOCRC, which was the primary purpose of the campaign. Thus, the high-quality video content has played a significant role in conveying the subject, apart from the metaverse’s overall content layout.

This study has some limitations. First, it has a small sample size. Many people visited the metaverse campaign website, although the number of people who responded to the survey after the campaign was lower than the rate expected. As this study assessed the first campaign conducted on a metaverse platform, it was difficult to predict the campaign’s promotional effect and the survey’s response rate. Compared with the number of advertisement exposures through social network sites, such as Facebook and Instagram, the number of metaverse link clicks exceeded 1%, which was lower than the expected rate. Second, a more satisfactory tool should be used for measuring people’s level of satisfaction with the campaigns. The Likert scale is a widely used and excellent indicator for evaluating human satisfaction. However, only 6 questions were asked regarding satisfaction; the scope of the questions could have been more extensive.

In conclusion, most of the 2022 Gold Ribbon Campaign participants seemed to be satisfied with the metaverse campaign according to the post-campaign survey. The goal of raising awareness and conveying accurate knowledge of EOCRC to the younger group, with a focus on the Generation MZ, was successful. Similar to this campaign using a novel metaverse platform, the medical society should pay attention to increasing participation in and satisfaction with future public campaigns.