Avatar customization, social presence, and eHealth literacy: understanding user adoption of virtual hospitals for public health innovation

These findings suggest that avatar-based design and users' eHealth literacy jointly shape key psychological processes underlying the adoption of virtual hospitals. The results are consistent with and extend prior work on avatar identification and social presence by demonstrating their combined mediating role in a virtual healthcare context. The study offers practical implications for designing virtual hospital systems that foster identification and social presence, and it highlights the importance of supporting users' eHealth literacy. Future research could further explore these mechanisms in different cultural settings and with longitudinal designs.