Background Each year, patient nonadherence to treatment advice costs the US healthcare system more than $300 billion and results in 250,000 deaths. Developing virtual consultations to promote adherence could improve public health while cutting healthcare costs and usage. However, inconsistencies in the realism of computer-animated humans may cause them to appear eerie, a phenomenon termed the uncanny valley. Eeriness could reduce a virtual doctor’s credibility and patients’ adherence. Methods In a 2 × 2 × 2 between-groups posttest-only experiment, 738 participants played the role of a patient in a hypothetical virtual consultation with a doctor. The consultation varied in the doctor’s Character (good or poor bedside manner), Outcome (received a fellowship or sued for malpractice), and Depiction (a recorded video of a real human actor or of his 3D computer-animated double). Character, Outcome, and Depiction were designed to manipulate the doctor’s level of warmth, competence, and realism, respectively. Results Warmth and competence increased adherence intention and consultation enjoyment, but realism did not. On the contrary, the computer-animated doctor increased adherence intention and consultation enjoyment significantly more than the doctor portrayed by a human actor. We propose that enjoyment of the animated consultation caused the doctor to appear warmer and more real, compensating for his realism inconsistency. Expressed as a path model, this explanation fit the data. Discussion The acceptance and effectiveness of the animation should encourage the development of virtual consultations, which have advantages over creating content with human actors including ease of scenario revision, internationalization, localization, personalization, and web distribution.

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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.