1. Virtual Patient Character Transformation

2. Avatar Creation
Virtual patients made to mimic real patients in primary care setting
Two of six virtual patient characters preferred
Developed to transform as staff refer more patients to an online tobacco cessation intervention
Characters were made to mimic patients in the primary care setting. Using descriptors of “typical” primary care patients, a professional artist sketched six characters. Healthcare providers were asked their opinion on the characters drawn in order to eliminate unconvincing or offensive characters. Two of the six characters were strongly preferred and considered believable of the six created. We will show examples of the characters’ transformation as clinic staff participate in a quality improvement program, where staff refer patients to an online tobacco cessation program.

3. Susie and Bob
These two characters were most popular and were used for the program. Meet Susie and Bob.  
Susie is a young woman who is pregnant with her first child and is a current smoker.
She says, “Here's my story. I'm 27 years old and I just recently found out I'm pregnant. My husband and I are really happy about this, but I know I have to quit smoking for my health and for my baby. I'm ready to quit, almost, and I need your expert help.”
Bob is a middle-aged man with coronary artery disease and is a current smoker.
He says, “Here's my story. I'm 52 years old and I've been smoking for years. I just had stents placed. I'm a pretty mellow guy but I need to quit smoking. I'm not sure I'm ready.”

4. Several referrals
When the clinic has started the program and has referred several patients to the online intervention, Susie the avatar changes her facial expression and narrative at varrying milestones. This can happen 16 times throughout the program. For example, after 3 referrals, she frowns and says “If I stop smoking now, will I be able to prevent some of the risks to my baby? I am concerned about having a low birth-weight baby.”

5. Small Amount of Referrals
After a small number of referrals by the clinic, Susie says: My sister told me that if I just cut back on smoking, it will be much better for the baby. I'm not so sure about that, but I have cut back to about half what I was smoking before. I think I'm afraid to take the next step. I'm worried about managing without smoking.

6. Moderate amount of referrals
After a moderate amount of referrals, Susie says “I know my risk for going into premature labor is increased because of my smoking. I think I'm ready to develop a quit plan.”

7. Met referral goal
After meeting the referral goal, Susie states, “I took your advice and talked with all my family and friends top make sure everyone knows I am quitting and I need their help and support.”

8. High Number of Referrals
When the clinic staff have made a high number of referrals, Susie smiles and says, “Well, I've made it one whole month. Can you believe it? I feel better and better everyday. I am so glad I made the decision to quit - I could not have done this without your help!”

9. Several referrals
Now we will look at several examples of Bob’s transformation during the program. If a clinical staff member selected Bob as their virtual patient and had made several referrals to the intervention, Bob would look thoughtful and say “I think I could taper my smoking, or cut back a bit. What do you think about that?”

10. Small Amount of Referrals
After a small number of referrals, he would quip, “ Can you tell me about the medicines that can help me? I think I might need a patch or something.”

11. Moderate Amount of Referrals
Once the clinic staff made a moderate number of referrals, Bob would reveal his struggle with quitting. He says “Boy I really had a hard time this weekend. We had a backyard get-together and I could just taste a smoke. I didn’t cheat, but it was a struggle. Maybe it was the beer?”

12. Met referral goal
After the clinic staff member meets the referral goal for the program, Bob appears optimistic. He reports, “Hey Doc, I am actually starting to feel a little better. It's been 3 weeks now. I feel like I have more energy. My wife says that's not possible. What do you say about it?

13. High Number of Referrals
After a high number of referrals, Bob exclaims, “Hey Doc! I am quit and staying quit! I am really making it work. Thanks for all your help. I am sending a buddy of mine to see you. I told him if I can do it, anyone can. I told him you were the best, so see what you can do for him. Thanks again, Doc!

14. Thank you.