Keywords

1 Introduction

1.1 Backgrounds

Many medical Augmented Reality (AR) applications attempt to help surgical processes; for example, projecting guidance with medical imaging to help develop physician’s intuitive abilities [1]. Also, medical AR have been applied for rehabilitation of various areas such as post-stroke rehabilitation and physical therapy [2, 3]. In addition, medical AR include psychological disorder treatments; while the AR technology allows patients to experience a phobic simulation, e.g., cockroach phobia, the patient may experience a reduction in the mental disorder because they can expose themselves to virtual cockroaches through the AR technology [4].

Exposing people to impossible experiences with augmented reality technology may have great benfit for attitude change but that effect has been relatively disregarded. Recently, communication technology scholars have attempted to demonstrate AR’s persuasive effects [2, 4,5,6,7,8,9].

This study is particularly focused on the effects of an anti-smoking message by turning the 3D objects in the message into embodied parts of the participants’ bodies. The purpose of this study is to gain better understanding of the persuasive effects of the projected health message through the SAR form by comparing the threedimensional human body and two-dimensional flat screen of an identical antismoking message.

Definition of Augmented Reality (AR) and Spatial Augmented Reality (SAR).

Based on the real, physical world, projecting and overlaying virtual images is the definition of augmented reality (AR) [10]. The projection mapping is known as a variation of spatial augmented reality (SAR), or a projection-based AR, that augments images based on the physical 3D objects or spaces in the real world [11]. Utilizing the real environment doesn’t require having the higher resolution of a hologram, which is solely depending on the lumens of projector. Instead, SAR uses the depth of threediemnsional effect and stereognostic perception to help perceivers’ simulation process [6]. Therefore, its strong affordnace based on three-dimensional depth has occured sense of immersion and presence [12].

1.2 SAR and Spatial Presence

The feeling of presence, “being there,” also known as spatial presence, has been discussed for the whole of a virtual environment; however, it could be extended to the virtual objected and mixed reality, which is rendered by augmented reality systems [6, 12]. When the virtual objects evoke the unconscious spatial cognition processes and check for the possibility of interaction with the AR, it enhances the affordances of the virtual objects. In the moment, the spatial presence is feedback of the potential interactivity from AR [12].

The feeling of “being-there” presence is developed by tele-communication scholarship to explain the experience of transcendence [13] that is beyond the physical place and being, existing in another place mediated by a medium, e.g., book, TV, movie, phone, or VR. The extended experiences, emergent through the new medium, have developed along with technological advancement.

The novel experience—an impossible visual representation in the physical world—created by SAR provides the feeling of spatial presence, which is a transcendent feeling of immersion; while the SAR projects anatomical images of lung and fetus onto the perceiver’s body.

The role of the feeling of spatial presence in the model here was how the perceivers were involved in the environment and how the participants were immersed in the projected AR.

The feeling of presence generally demonstrates that it results in better evaluation on content and system [6], and also shows attitude change [13]. However, the scholarship of theory of presence has attempted to explain the hidden meaning and relationship between presence and the dual model process in perception [12, 14]. According to Schubert [12], the presence is demonstrated as affective feeling associated with experiences. The presence occurs by experiencing a mediated situation; the involvement in the experience can then be applied to when a perceiver judges the information that is provided from the mediated situation. The feelings have also been considered as affective influence on information processing during persuasion process [15, 16].

Before making an affirmation on persuasion’s effect on the feeling of presence, we must retrace the information processing model for persuasion to systematically explicate how the heuristic-systematic model of information processing occurred when presence emerged.

1.3 Heuristic-Systematic Model (HSM) of Information Processing

In social psychology scholarship, it is understood that affective influence results better on persuasion than cognition [17,18,19]. This phenomenon can be explained with a unique peripheral persuasion process, which is known as the theory of persuasion heuristic-systematic model (HSM) [18, 20,21,22,23]. Chaiken attempts to explain that while people process persuasive information in one of two ways—a heuristic or systematic process—they tend to minimize their cognitive process so that they utilize their memory and experience to determine whether the information is valid. Thus, the processing of messages can be affected by pre-existing memory and experience in terms of “principle of least effort” (p. 269, Kluckhohn [31]).

Also, when forming an attitude, people carefully consider any available information to determine whether the information is accurate or valid. However, this systematic process requires more time and is a cognitively effortful process. According to the heuristic-systematic model, when people developed and changed their attitude by utilizing their knowledge based on memory and experiences, this demonstrated that people used a simplified form of attitude judgment—e.g., heuristic processing—and it is likely to be less stable and less resistant information [24]. Hence, the source of information is cue for the judgement, e.g., when a doctor or specialist endorses the information, people use the credibility of the source to judge whether the information is credible or not.

In addition, feeling is an important influential factor on information processing [16, 25]. Consistent with logic of feeling as information theory, Krishna and Schwarz [25] argued that bodily experience is a source of information and is used for judgement [26].

Therefore, three-dimensionally mapped out onto body images can give a novel experience to see one’s organs—which is impossible to see in the physical world—and demonstrate significant effect on anti-smoking. This novel experience provides affective feeling while perceivers experience feeling of presence, and it results in a better persuasive effect [27], e.g., information sharing intention or intention to engage the campaign with PSA video rather than cognitive feelings.

In sum, what is the persuasion effect of SAR on anti-smoking messages which is projecting anatomical images directly onto perceiver’s body by examining how the perceiver’s overall impressions of and the negative attitudes toward cigarette smoking have changed and how the affective feeling is and with this persuasion process.

The role of spatial presence, and its affective feeling, enhanced negative attitude toward cigarette smoking, and lead to better motivation to engage the cigarette cessation campaign.

2 Methodology

In this study, the two conditions were compared: projecting health information onto a two-dimensional flat screen versus projecting health information onto the three-dimensional body of the participant. The embodied augmented message has greater persuasive effect on health messages than a two-dimensional flat screen. The imbedded video is edited with the existing cigarette cessation campaign Public Service Announcement (PSA) video, which contains anatomical moving images of a polluted lung and fetus by cigarette smoking.

2.1 Procedure

For this study, we hired college students (n = 58) from one of the Northern East college. The recruited students were rewarded with class extra credit. When they entered the experiment room, they were told about the experiment and were randomly assigned to either the flat screen or body mapping condition. Before they were exposed to the stimulus video, they were asked to start the survey questionnaire to measure their backgrounds, i.e., age, gender, education, pre-existing attitude toward cigarette smoking, and technology usage. The two-minute long identical video was played for them two times for each condition in the dark room. Both conditions were prepared as an identical situation—the same size of images and the same distance between projector and image of 6 feet. The body condition was shown to the participants through a mirror.

2.2 Participants

All 58 participants (men = 37, women = 21) were recruited at a university in the Northeastern U.S. The mean age was 19.17 (SD = 2.93). Most of them were Caucasians (74.1%), the next dominant group was Asian/Pacific Islanders (10%), 6.9% were Hispanic/Latino, 5.2% were African and 3.4% were other racial/ethnic groups.

3 Measures

Spatial Presence and Immersion.

Spatial presence and immersion were measured by the ITC-SOPI multidimensional scale [26], which was developed for measuring virtual reality. The original scale consists of four subfactors—spatial presence, immersion, ecological validity, and negative effects. We adopted the two primary factors of spatial presence and immersion to measure the variables of interest. Hence, in the present study, the questionnaire was comprised of 33 items on a 7-point scale (1 = never, 7 = very much). First, to measure spatial presence, 20 items were employed (e.g., “I felt like the content was live,” “I had a sense of being in the scenes displayed,” “I had the sensation that parts of the displayed environment [e.g. characters or objects] were responding to me”), M = 3.09, SD = 1.20, Cronbach’s α = .95. Next, to measure immersion, 13 items were employed (e.g., “I felt involved [in the displayed environment],” “I paid more attention to the displayed environment than I did to my thoughts,” “I lost track of time”), M = 3.79, SD = 1.06, Cronbach’s α = .89. The items were averaged to create each of the scales.

Change in Negative Emotions Toward Smoking.

Negative emotions toward smoking were measured by 6 items adopted [26]. These items include, “I am afraid of the effects of smoking on health,” “I am frightened by the effects of smoking on health,” “I feel tense when I think about the effects of smoking on health,” “I am worried about the effects of smoking on health.” All items were rated on a 7-point scale (1 = strongly disagree, 7 = strongly agree). Negative emotions were measured two times in the pre- and post-test (pre-test: M = 5.54, SD = 1.12, Cronbach’s α = .87; post-test: M = 5.55, SD = 1.34, Cronbach’s α = .89. Change in negative emotions was calculated by subtracting pre-test ratings from post-test ratings, M = .003, SD = 1.05.

Cognitive and affective attitudes toward the message.

Attitudes toward the smoking cessation message were assessed in the two dimensions—cognitive and affective attitudes—based on previous research by Yoo and MacInnis [28]. First, cognitive attitude toward the message was measured using a 7-point semantic differential scale with 3 pairs of adjectives (unpersuasive/persuasive, uninformative/informative, unbelievable/believable), M = 5.59, SD = .85, Cronbach’s α = .71. Similarly, affective attitude toward the message was measured using a 7-point semantic differential scale with 3 pairs of adjectives (negative/positive, bad/good, unfavorable/favorable), M = 4.31, SD = 1.19, Cronbach’s α = .81. The items were averaged to create each of the attitude scales.

Intentions to Engage in Smoking Cessation Campaign.

Intentions to engage in a smoking cessation campaign were measured using a 7point scale (1 = strongly disagree, 7 = strongly agree) modified from Alhabash, McAlister, Lou, and Hagerstrom [29]. The wordings of the items were modified specifically to smoking cessation campaigns. Items for online behavioral intentions (8 items) include, “Smoking cessation campaigns are worth sharing with others through online media,” “I would recommend smoking cessation campaigns to others through online media,” and “I would “SHARE” online smoking cessation campaigns on my social media pages (e.g., Facebook, Twitter, Instagram, etc.).” Items for offline behavioral intentions (5 items) include, “Smoking cessation campaigns make me want to volunteer for an organization that manages smoking problems, “Smoking cessation campaign makes me want to attend a community or neighborhood meeting dealing with the issue of smoking,” and “Smoking cessation campaign makes me want to sign a petition for governments to design more campaigns to decrease smoking rates.” All items were averaged to create a single scale of behavioral intentions, M = 3.82, SD = 1.23, Cronbach’s α = .93.

4 Results

Therefore, this finding gives interesting insights into AR and health related message delivery; first, the mapping out the body gives novel and personalized experience. Second, it raises higher spatial presence and higher affective attitude than flat and normal images. Third, only the spatial presence and affective attitude results in persuasive effects, e.g., enhancing negative attitude toward cigarette smoking and willingness to engage the cigarette cessation campaign (Fig. 1).

Fig. 1.
figure 1

Proposed model

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The path model was performed with WarpPLS [30]; its model fit, average path coefficient (APC) = 0.21, p = 0.008, average R-squared (ARS) = 0.136, p = 0.044 and average adjusted R-squared (AARS) = .119, p = 0.061 support significant results. The average block VIF (AVIF) <= 5 is acceptable; if AVIF <3.3 is ideally acceptable but the path model’s AVIF = 1.237, it shows ideal acceptable AVIF value (Fig. 2).

Fig. 2.
figure 2

Model analysis

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5 Discussion

The judgement process of humans has been considered a logical and objective process; however, social psychology scholarship has introduced that how information judgement process is how affective process when people make judgement. In other words, when people perceive the certain information, they use their heuristic experience from their memory [24]. The current research has implications for the impact of an SAR experience on change, enhancement, or persistence in opinion. In fact, that an SAR experience exerted no direct effect on opinion change. However, the cognitive and affective feeling analysis, which argues that greater spatial presence heightens the participants’ negative attitude on cigarette smoking and heighten their behavior intention to engage the cessation campaign. The feeling of spatial presence resulted when the message was projected on to the recipient’s body directly. This result can be explained with feeling as information theory [25] that emphasizes the embodiment is important input sensory system for judgment on information processing. The embodied message on cigarette cessation has shown significant effect. Therefore, the results of this study suggest that applying a health message with SAR technology to a patient’s body directly would have a positive persuasive effect on enhancing attitude and engagement of health-related information, such as sharing the health campaign information.