Abstract
Care for chronic disease requires patient adherence to treatment advice. Nonadherence worsens health outcomes and increases healthcare costs. When healthcare professionals are in short supply, a virtual physician could serve as a persuasive technology to promote adherence. However, acceptance of advice may be hampered by the uncanny valley effect—a feeling of eeriness elicited by human simulations. In a hypothetical virtual doctor consultation, 441 participants assumed the patient’s role. Variables from the stereotype content model and the heuristic–systematic model were used to predict adherence intention and behavior change. This 2 × 5 between-groups experiment manipulated the doctor’s bedside manner—either good or poor—and virtual depiction at five levels of realism. These independent variables were designed to manipulate the doctor’s level of warmth and eeriness. In hypothesis testing, depiction had a nonsignificant effect on adherence intention and diet and exercise change, even though the 3-D computer-animated versions of the doctor (i.e., animation, swapped, and bigeye) were perceived as eerier than the others (i.e., real and cartoon). The low-warmth, high-eeriness doctor prompted heuristic processing of information, while the high-warmth doctor prompted systematic processing. This pattern contradicts evidence reported in the persuasion literature. For the stereotype content model, a path analysis found that good bedside manner increased the doctor’s perceived warmth significantly, which indirectly increased physical activity. For the heuristic–systematic model, the doctor’s eeriness, measured in a pretest, had no significant effect on adherence intention and physical activity, while good bedside manner increased both significantly. Surprisingly, cognitive perspective-taking was a stronger predictor of change in physical activity than adherence intention. Although virtual characters can elicit the uncanny valley effect, their effect on adherence intention and physical activity was comparable to a video of a real person. This finding supports the development of virtual consultations.
Highlights
There is growing interest in adopting virtual characters to persuade people to change their health-related behaviors
Our experiment manipulated a virtual doctor’s bedside manner and depiction to determine how these variables influence perceived warmth and eeriness, heuristic and systematic processing, adherence intention, and behavior change. We further explored these variables of the stereotype content model and the heuristic–systematic model in a path analysis to predict adherence intention and behavior change
We assumed that the effect of increasing eye size 50% on pretest Eeriness and Adherence Intention would be similar in magnitude to the effect of bedside manner on Warmth and Adherence Intention
Summary
There is growing interest in adopting virtual characters to persuade people to change their health-related behaviors. Strategies that people adopt to persuade others, such as arguments and social cues, could be employed in virtual characters (André et al, 2011). This could offer a novel and efficient way to increase adherence to treatment advice and improve health literacy more generally. Virtual characters, depending on their level of realism, could appear eerie—an effect called the uncanny valley (Mori, 2012). We must consider how eeriness influences persuasion in virtual characters
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