Avatar-Based Health Education: Applying Self-determination Theory to Promote Preventative Care in U.S. Military Service Members

Cardiovascular diseases (CVD) remain the leading cause of death in the United States, disproportionately impacting veterans and posing significant risks to active duty service members (ADSMs). These challenges threaten both long-term health outcomes and operational readiness. In response, the Veterans Health Administration (VHA, often referred to as the VA) and the DoD launched an innovative initiative within the Veterans Affairs Virtual Medical Center (VMC): the Performance, Health, and Wellness Center (PHWC). Bringing subject matter experts together from the DoD and VA, the PHWC pilot leveraged the VMC's cutting-edge, avatar-interactive 3D platform to educate ADSMs and veterans about CVD through self-paced or professionally guided courses, deliver actionable prevention strategies, and provide centralized, comprehensive information on DoD and VA resources supporting CVD risk reduction. Although the VMC was decommissioned in March 2024, the PHWC pilot established a valuable framework for future research and educational initiatives. By utilizing virtual immersion, it offered geographically dispersed service members convenient access to health education and peer support in an interactive, engaging format. Notably, although the PHWC was not intentionally designed with self-determination theory in mind, it unintentionally embodied its core principles. Self-determination theory, a framework widely applied in health initiatives, emphasizes the importance of addressing psychological needs for autonomy, competence, and relatedness to enhance motivation. The PHWC supported autonomy by offering customizable learning options and empowering messaging that allowed users to take control of their health journeys. It promoted competence by providing lay-friendly, actionable educational content and practical guidance for modifying health risks. Additionally, it highlighted the value of social support and community, reinforcing the importance of connectedness in sustaining motivation. As the first of its kind, the PHWC offered a visionary model for supporting ADSMs and veterans on their journey toward Total Force Fitness. This article reflects on the PHWC, highlighting the compelling potential of virtual platforms to advance self-determination through more intentional design, and offers practical lessons for future programs aiming to promote lifelong health and wellness.