Enhancing Healthy Behaviors Through Virtual Self: A Systematic Review of Health Interventions Using Avatars
Abstract
Objective: A systematic review of health interventions using avatars (N = 18) was conducted to provide comprehensive knowledge of the effectiveness of using avatars to promote healthy behaviors, specifically in relationship to healthy eating and exercising. Materials and Methods: Two researchers identified field or laboratory studies that had quantified study results, which were published in peer-reviewed journals in English from January 2000 to March 2019. Databases (PsychInfo, PubMed, and Web of Science), forward reference, and manual searches were used to identify the studies. Search terms included avatar, the Proteus effect, exercise, and diet, among others. Two field interventions and 16 laboratory studies were identified. Information on sample characteristics, technologies used, study design and conditions pertaining to avatars, outcome measures, results, and conclusion were extracted. Results: Six different avatar characteristics used to elicit health outcomes were identified, which are the similarity with the user, avatar body size, self-domain (e.g., ideal-self), customizability, body transformation, and avatar's behaviors. Only a few studies had a no-avatar control group; thus, it was not possible to conclude whether employing avatars in health interventions increases the effectiveness of the interventions in comparison to not using an avatar. Conclusion: The results indicate that using an avatar that is physically active, fit, and similar-looking (to the user) is effective in eliciting healthy behaviors.
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Cites
Self-discrepancy: A theory relating self and affect.
Higgins, E. T. (1987) · Psychological Review · doi:10.1037/0033-295x.94.3.319 · Cited by 7,219 · see citing works
Bem, D. J. (1972) · Advances in Experimental Social Psychology · doi:10.1016/s0065-2601(08)60024-6 · Cited by 5,241 · cited 2× · see citing works
“23 The Proteus effect argues that users behave in accordance with their avatar’s perceived traits.”
(1997) · Choice Reviews Online · doi:10.5860/choice.34-3702 · Cited by 4,870 · see citing works
The unbearable automaticity of being
Bargh, J. A., & Chartrand, T. L. (1999) · American Psychologist · doi:10.1037/0003-066x.54.7.462 · Cited by 3,699 · see citing works
The chameleon effect: the perception–behavior link and social interaction
Chartrand, T. L., & Bargh, J. A. (1999) · Journal of Personality and Social Psychology · doi:10.1037/0022-3514.76.6.893 · Cited by 3,674 · see citing works
Health promotion from the perspective of Social Cognitive Theory
Bandura, A. (1998) · Psychology & Health · doi:10.1080/08870449808407422 · Cited by 3,087 · see citing works
Bandura, A. (2008) · The International Encyclopedia of Communication · doi:10.1002/9781405186407.wbiecs053 · Cited by 1,902 · see citing works
The Cyborg's Dilemma: Progressive Embodiment in Virtual Environments [1]
Biocca, F. A. (2006) · Journal of Computer-Mediated Communication · doi:10.1111/j.1083-6101.1997.tb00070.x · Cited by 1,228 · see citing works
Playing Video Games : Motives, Responses, and Consequences
Vorderer, P., & Bryant, J. (2012) · Cited by 1,060 · see citing works
Yee, N., Bailenson, J. N., & Ducheneaut, N. (2009) · Communication Research · doi:10.1177/0093650208330254 · Cited by 819 · see citing works
Brave, S., Nass, C., & Hutchinson, K. (2005) · International Journal of Human-Computer Studies · doi:10.1016/j.ijhcs.2004.11.002 · Cited by 512 · see citing works
Fox, J., & Bailenson, J. N. (2009) · Media Psychology · doi:10.1080/15213260802669474 · Cited by 494 · see citing works
Anthropomorphic Interactions with a Robot and Robot–like Agent
Kiesler, S. B., Powers, A., Fussell, S. R., & Torrey, C. (2008) · Social Cognition · doi:10.1521/soco.2008.26.2.169 · Cited by 409 · see citing works
A review of the outcome expectancy construct in physical activity research
Williams, D. M., Anderson, E. S., & Winett, R. A. (2005) · Annals of Behavioral Medicine · doi:10.1207/s15324796abm2901_10 · Cited by 398 · see citing works
Embodiment and Presence in Virtual Worlds: A Review
Schultze, U. (2010) · Journal of Information Technology · doi:10.1057/jit.2010.25 · Cited by 298 · see citing works
Morrison, L. G., Yardley, L., Powell, J., & Michie, S. (2012) · Telemedicine and e-Health · doi:10.1089/tmj.2011.0062 · Cited by 290 · see citing works
(2006) · Cited by 283 · see citing works
Player Identification in Online Games: Validation of a Scale for Measuring Identification in MMOGs
LOOY, J. V., Courtois, C., Vocht, M. D., & Marez, L. D. (2012) · Media Psychology · doi:10.1080/15213269.2012.674917 · Cited by 280 · see citing works
Fox, J., Bailenson, J. N., & Tricase, L. (2013) · Computers in Human Behavior · doi:10.1016/j.chb.2012.12.027 · Cited by 274 · see citing works
Virtual Experiences, Physical Behaviors: The Effect of Presence on Imitation of an Eating Avatar
Fox, J., Bailenson, J. N., & Binney, J. (2009) · PRESENCE Virtual and Augmented Reality · doi:10.1162/pres.18.4.294 · Cited by 197 · see citing works
Jin, S. A. (2009) · CyberPsychology & Behavior · doi:10.1089/cpb.2009.0130 · Cited by 158 · see citing works
Visualizing ideal self vs. actual self through avatars: Impact on preventive health outcomes
Kim, Y., & Sundar, S. S. (2012) · Computers in Human Behavior · doi:10.1016/j.chb.2012.02.021 · Cited by 151 · see citing works
Ahn, S. J. (2014) · Health Communication · doi:10.1080/10410236.2013.869650 · Cited by 132 · see citing works
Increasing exergame physical activity through self and opponent avatar appearance
Peña, J. F., & Kim, E. (2014) · Computers in Human Behavior · doi:10.1016/j.chb.2014.09.038 · Cited by 101 · see citing works
Peng, W. (2008) · CyberPsychology & Behavior · doi:10.1089/cpb.2007.0229 · Cited by 92 · see citing works
Ratan, R. (2012) · IGI Global eBooks · doi:10.4018/978-1-4666-2211-1.ch018 · Cited by 86 · see citing works
Li, B. J., Lwin, M. O., & Jung, Y. (2014) · Games for Health Journal · doi:10.1089/g4h.2013.0081 · Cited by 84 · see citing works
Peña, J. F., Khan, S., & Alexopoulos, C. (2016) · Journal of Computer-Mediated Communication · doi:10.1111/jcc4.12151 · Cited by 81 · see citing works
Kuo, H., Lee, C., & Chiou, W. (2015) · Cyberpsychology Behavior and Social Networking · doi:10.1089/cyber.2015.0203 · Cited by 54 · see citing works
Behm‐Morawitz, E., Lewallen, J., & Choi, G. Y. (2016) · Cyberpsychology Behavior and Social Networking · doi:10.1089/cyber.2015.0317 · Cited by 51 · see citing works
Anti-smoking educational game using avatars as visualized possible selves
Song, H., Kim, J., Kwon, J.-H., & Jung, Y. (2013) · Computers in Human Behavior · doi:10.1016/j.chb.2013.04.008 · Cited by 50 · see citing works
Are You What Your Avatar Eats? Health-Behavior Effects of Avatar-Manifested Self-Concept
Sah, Y. J., Ratan, R., Tsai, H.-Y. S., Peng, W., & Sarinopoulos, I. C. (2016) · Media Psychology · doi:10.1080/15213269.2016.1234397 · Cited by 47 · see citing works
Self-citationVirtual Social Identity and Consumer Behavior
Schee, B. A. V. (2010) · Journal of Consumer Marketing · doi:10.1108/07363761011078307 · Cited by 45 · see citing works
Verhulst, A., Normand, J., Lombart, C., Sugimoto, M., & Moreau, G. (2018) · Frontiers in Robotics and AI · doi:10.3389/frobt.2018.00113 · Cited by 37 · see citing works
Waddell, T. F., Sundar, S. S., & Auriemma, J. (2015) · Cyberpsychology Behavior and Social Networking · doi:10.1089/cyber.2014.0356 · Cited by 33 · see citing works
Joo, Y. K., & Kim, K. (2017) · Interacting with Computers · doi:10.1093/iwc/iwx003 · Cited by 19 · see citing works
Self-Discrepancy and Regulatory Fit in Avatar-Based Exergames
Jin, S. A. (2012) · Psychological Reports · doi:10.2466/06.07.21.pr0.111.6.697-710 · Cited by 17 · see citing works
Ruiz, J. G., Andrade, A. D., Anam, R., Aguiar, R., Sun, H., & Roos, B. A. (2012) · PubMed · Cited by 13 · see citing works
Playing Exergames and Sporting Activity
Kastenmüller, A., Greitemeyer, T., Fairclough, S. H., Waite, D., & Fischer, P. (2012) · Social Psychology · doi:10.1027/1864-9335/a000111 · Cited by 12 · see citing works
Avatars for Health Behavior Change
Fox, J. (2012) · Routledge eBooks · doi:10.4324/9780203149096-14 · Cited by 4 · see citing works
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Healy, D., Flynn, A., Conlan, O., McSharry, J., & Walsh, J. (2022) · JMIR Serious Games · doi:10.2196/35802 · Cited by 77 · see citing works
“The search terms were informed by previous systematic review search strategies with similar research questions [13,24-30] as well as input from the review team.”
Method
- Authors
- Rheu, M. (., Jang, Y., & Peng, W.
- Affiliations
- Michigan State University (US)
- Corresponding author
- Rheu, Minjin (MJ)
- Peng, Wei
- Venue
- Games for Health Journal
- Publisher
- SAGE Publications
- Published
- 2020-04-01
- Volume
- 9
- Issue
- 2
- Pages
- 85-94
- ISSN
- 2161-783X (ISSN-L)
- 2161-7856
- OpenAlex
- W2985644047
- Cited by
- 49
- References
- 40
- Citations by year
- 2026: 9 · 2025: 13 · 2024: 6 · 2023: 9 · 2022: 7 · 2021: 4 · 2019: 1
- FWCI
- 0.27
- Type
- journal article
- Language
- en
- Open access
- closed
- Locations
- Games for Health Journal (publishedVersion)
- PubMed (publishedVersion)
- Topics
- Physical Sciences › Computer Science › Human-Computer Interaction › Virtual Reality Applications and Impacts
- Social Sciences › Psychology › Social Psychology › Social Robot Interaction and HRI
- Social Sciences › Arts and Humanities › Literature and Literary Theory › Media Influence and Health
- Keywords
- avatars, virtual self, health interventions, healthy eating, physical activity, Proteus effect, ideal self, avatar behavior, health behavior promotion
- MeSH terms
- Healthy Lifestyle, Humans, Health Behavior, Video Games
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