Can extended reality in the metaverse revolutionize health communication?

There is abundant evidence indicating that XR, in particular VR, can create realistic that produce genuine emotional, cognitive, social and behavioral reactions6.7. The content presented and experienced in XR can be modified in such a way that it is particularly useful for effective health communication, with three main application domains (Fig. 1). First, XR allows people to experience phenomena that they could not experience in the real world (eg, visualizing how otherwise unobservable viruses or bacteria spread)8. Second, XR can limitations of space and time by communicating the negative consequences of unhealthy behaviors that are temporarily distant from the present behavior, such as obesity or smoker’s lungs9.10. Third, XR makes it possible to experience the world from other perspectives, including those of vulnerable individuals, thereby eliciting empathy and compassion11.

Fig. 1: Extended reality (XR) in health communication.
figure 1

Note: The behavior figure X depicts three major application domains and affordances and shows how they can improve healthy by targeting self- and other-directed threat and coping appraisal.

According to Protection Motivation Theory (PMT)12a prominent and widely adopted theoretical framework for disease prevention and health promotion, successful health communication requires improving appraisal threat and coping appraisal. Threat appraisal encompasses two aspects: threat severity (ie, perceived level of severity of the threat to health) and vulnerability (ie, perceived level of susceptibility to the threat). Coping appraisal enclose response efficacy and self-efficacy. Response efficacy refers to an individual’s belief as to whether a recommended coping behavior will effectively reduce a health-related threat; self-efficacy describes the confidence that the individual has in his/her ability to perform the recommended behavior. Compared to cyberspace and social media accessed using standard media (ie, computers or mobile devices), which already play a crucial role in health communication13immersive XR has specific affordances of presence, agency and embodiment14. These affordances can be addressed in health communication via the metaverse, for instance, by providing immersive environments for patient support groups, expert-moderated health communities13 or health-aware pre-programmed agents and immersive health messages to facilitate health-related behavior change more effectively than standard media (Fig. 1)15. Although these XR affordances are empirically related16each affordance can conceptually be linked to specific health-related perceptions, that is, threat and coping appraisalwhich we discuss below.


According to PMT, low appraisal threat of temporally distant consequences of current unhealthy behaviors frequently explains people’s reluctance to adopt health-protective behaviours. This idea is supported by constructive level theory17, which states that events, including threats, that are temporally, spatially or socially distant, are perceived as abstract and therefore as less relevant. As compared to the standard text, image or video interventions, XR technology can elicit higher presence, a feeling of being ‘there’ in the simulated environment18. Presence is understood: place illusion of three sub-dimensions presence (ie, perceived self-presence (ie, perceived authenticity of self-representation in the environment) and social presence (ie, perceived realness of virtual others)19. Being highly present in the virtual environment makes scenarios, such as experiencing the consequences of unhealthy behaviors9feel more imminent and therefore increases appraisal threat20. Experiencing the consequences of behaviors is also crucial for coping appraisalparticularly response efficacyas it allows the individual to vividly experience the impacts of such behaviors from a first-person perspective instead of reading about them.

Furthermore, as we are social creatures, and others largely influence our behavior, high social presence, which results in increased social influence21, plays an important role in behavioral change. In health communication, avatars are often used to exemplify health consequences and influence our decisions. We can be affected by the presence of others via social norms and conformity22, such as the presence of ‘health-aware’ programmed agents (eg, interacting with an agent who engages in exercising and healthy eating could influence the user to do the same). In a similar vein, self-efficacywhich plays a major role in adopting new behavior and closing knowledge-behaviour gaps23can be enhanced not only by our past experience but also by observing others similar to ourselves succeeding in the desired action24.


According to Bandura, personal experience of success is the most influential source of self-efficacy24. As compared to immersive videos or more fixed scenarios that do not allow users to take their own courses of action, a highly interactive XR environment elicits the feeling of being in control of one’s actions (ie, a sense of agency). Agency provides the user with a first-person interactive experience of success, ie, mastery experience14.24and is crucial for promoting self-efficacy and, in turn, the intention to adopt healthy behavior. For example, Fox et al. showed that individuals who experienced positive effects of their own physical exercise on their virtual selves in an XR environment undertook more exercise in real life25.


Although PMT and similar theories focus on the protection of the actors themselves, the health behaviors of individuals can provide social externalities to others, for example, by indirectly protecting others by increasing herd immunity via vaccination26. The XR affordance embodiment refers to the illusion of ownership of the virtual body14. The embodiment allows users to experience the world from someone else’s perspective, including someone of a different gender, race or species, and, in turn, influences our attitudes towards them27. The successful embodiment can promote health-related decisions by making the experience more personal, increasing the user’s perceived positive own vulnerability but also the vulnerability of others. For example, being embodied as a vulnerable person and therefore experiencing health threats from that person’s perspective, as well as the impact of others’ behavior on the person’s health, can affect other-directed threat and coping appraisalmotivating the user to engage in behaviors that benefit not only their own health but that of others8. Due to such an embodied vivid perspective-taking experience, XR, particularly VR, has been labeled the ultimate ’empathy machine’11. In line with this perspective, studies have shown that embodying users in the body of a person who is vulnerable to COVID-19 increases their collective responsibility to get vaccinated and, in turn, vaccination intention8.28.

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