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Table 3 Key changes to acceptance-inhibiting cues to promote perceptions of VHA acceptability

From: Key changes to improve social presence of a virtual health assistant promoting colorectal cancer screening informed by a technology acceptance model

Cue Key themes Key changes Version
Clothing Not professional (e.g., scrubs) Updated the VHA so she was dressed in business casual clothing rather than scrubs Print to V1
Real/Fake Low quality, animated, robotic looking Changed lighting to introduce depth in visual features V.1 to V.2
Scary/Creepy Looked like a vampire (e.g., "fangs") Added shading to mouth and teeth V.1 to V.2
Expertise Preference for doctor vs. nurse or lay health worker Added white coat (e.g., business casual was too casual) V.1 to V.2
Authority Preference for middle age (e.g., too young = not enough knowledge vs. too old = not enough current knowledge) Removed gray hair V.1 to V.2
Trustworthiness Desire for accurate, relevant information, desire to not feel targeted Removed color-coded response options (e.g. red = “no”) to prevent perception of judgment when answering questions V.1 to V.2
Navigability Perceptions of how easy it is to use and navigate through the app Added pause button with ability to tap to pause. Updated text size of subtitles. Removed user transition from waiting room to clinic room V.1 to V.2
Movement Unnatural movements, excessive hand gestures and rocking Used motion capture suits to update motion to correspond with script (e.g. breathing animation) V.2 to V.3
Appearance More feminine, more dignified Changed hairstyle, added jewelry V.2 to V.3
Friendliness/likability Angry looking, stressed out, not approachable Added smile, removed furrowed brow V.2 to V.3
Interactivity Poor eye contact, low interactivity, limited opportunity to ask questions or have responses tailored to personal needs Focused eye gaze, added randomness in eye movements (e.g., static to dynamic), new response option for health behavior questions (e.g., “yes, occasionally”), reduced extra info in VHA script V.2 to V.3
Voice Reading from a script, too fast/ loud, persuasive intent, subtitles not synched with audio Selected race and gender concordant voice, adjusted subtitle speed, hired professional voice actors to record script, presented options to users All