Five questions for Vivien Zhou

Researcher finds path from virtual reality to healthier lifestyles

Vivien Zhou
Vivien Zhou

As an undergraduate majoring in broadcast journalism, Vivien Zhou met a lot of people with a variety of life experiences.

“I realized that (understanding) why they engaged in different, sometimes surprising behaviors was more interesting to me than it was to just record their experiences,” she said. “That led me to seek answers about why they were doing risky behaviors that could harm their lives and what influenced them.”

Zhou understood that she could use her knowledge of communication to develop strategies that would more effectively engage people to persuade or influence their behaviors. She also wanted to use her skills to develop ways to help improve the health provider/patient relationship.


For more information about participating in Zhou’s research studies, contact her at

In 2017, Zhou completed her Ph.D. in communications from Cornell University. She loved living in Ithaca, a quiet, scenic place, but didn’t like the winters.

“During the long, gray winters, the sun was reluctant to come out. I needed to live in a place where I could enjoy the sunshine. More importantly, working in academia and conducting research has always been my dream.”

She wanted to apply her knowledge and expertise in real health practices and in relatively large scales, and she was attracted to the University of Colorado Anschutz Medical Campus because of the resources available.

Zhou joined the Colorado School of Public Health as an assistant professor in the Department of Community and Behavioral Health in the fall of 2017.

“The School of Public Health, the Colorado Cancer Center, Children’s Hospital Colorado and University of Colorado Hospital can provide me with valuable opportunities to collaborate with scholars, clinicians and other health practitioners who share the same research interests or have the same goal of helping people in need using innovative methods to reduce health disparities and improve health conditions,” she said.

1. Much of your research revolves around digital technology, especially virtual reality. How is virtual reality used to accomplish behavioral change, and what is an example of your research?

Vivien Zhou and her avatar as seen in the virtual reality fitness center she created.
Vivien Zhou and her avatar as seen in the virtual reality fitness center she created.

Nowadays, we use virtual reality (VR) in different ways, but mostly in gaming. More and more people are able to purchase VR equipment for fun, but I think it is a good idea to use VR in more meaningful ways to benefit people. For instance, a lot of patients in a hospital spend time waiting or are worried about their health conditions or have anxiety or sleep problems. We can use VR to help patients spend more time in a happier way and provide useful information to them about changing a behavior or increasing adherence to behaviors like taking medications.

I currently have designed a virtual environment of a fitness center. This is an actual copy of a fitness center with equipment like weights, balls and machines. People put on headsets and immerse themselves in the virtual center by using controllers to pick up the weights or do different types of exercise. This is useful for those who may not visit a fitness center or who can’t do actual exercises because of their health conditions. Being immersed in that environment motivates them to engage in habitual exercise behavior.

2. Why is being in a virtual world an effective way to change behaviors?

Virtual reality works better than other strategies because of its capabilities to simulate the real world and create a feeling of presence for the users­, who perceive they are physically in the virtual world. Most often, we learn vicariously, observing the consequences of others’ behaviors.

Virtual reality provides us with opportunities to personally experience the life of others, or experience something you are unlikely to or that it is impossible to experience in real life. The immersive experience and active learning process increase the impacts of the VR experience. Other persuasion methods, like advertisements, have an explicit way of delivering a message. People can have a tendency to react to it with psychological resistance, and that may have unexpected effects. Virtual reality is not likely to have that effect. Immersing a person in a virtual environment allows him or her to reach a conclusion themselves and it is more effective than persuasion.

Virtual reality has shown great potential to be applied in health contexts. For example, it helps distract a patient’s attention from painful or fearful experiences, especially before and during the treatment process; provides a platform for medical or surgical training; and enables patients to better understand the process of treatment and the causes of their disease. We are collaborating with University of Colorado Hospital to see if we can use VR in the clinical setting. The hospital has strict rules and concerns, but if it can be applied here, it will open a door for patients and providers.

3. You have also used personal narratives in your research to alter behaviors. How does that work?

We all love stories. In fact, storytelling is a form of communication we are most familiar with. The narrative work was done prior to the VR research, but the two share some commonalities. They have the advantage of attracting people’s attention, engaging people with the storyline or virtual experience, and building a close relationship between the audience member and the story character or the avatar so that people are willing to accept the embedded persuasive message.

Another aspect is that stories help us to imagine and rehearse our behaviors. Sometimes readers will project themselves onto the story characters, imagining how things will happen if they were in the same scenario. Such rehearsals can better prepare us for the actual behaviors and help us make wiser decisions.

Stories are useful in the health setting. If people can foresee the outcome of a behavior, it will motivate them to engage in it more; if there is a negative consequence, it will prevent them from doing it. The stories can be more beneficial than just telling something to a person directly.

People with different cultural backgrounds or ethnicity have varying preferences for effective communication styles. Some prefer direct communication, while others prefer telling stories. We have found that using the narrative form to deliver health information is more effective among Mexican-Americans and African-Americans than Caucasians. If we can use stories, which are a natural way people learn, to expand people’s knowledge more effectively, it will be helpful in reducing health disparities.

4. What other research are you doing that focuses on healthy behavioral change?

One of my most interesting studies is about unconscious eating. People in the study see a clip from the movie “Harold and Kumar Go to White Castle.” In one condition, people see the characters continually eating burgers and fries; in another, people see the characters with full bellies and they have stopped eating.

What we find is that people eat more food if they see the characters continue to eat than if the characters have finished eating. We’ve also found that people are more likely to choose savory food after watching the eating clip and choose sweet food after watching the “full” clip.

Our speculation is that perhaps after eating, the possible next goal is to have something sweet for dessert. So the first goal was to eat and get full, and when that goal is accomplished, the brain unconsciously activates the next goal, which is to have dessert.

This has implications for both practitioners designing messages for people who need to lose or control their weight or for use in advertising.

I’m currently working on a smoking cessation project funded by the American Cancer Society Institutional Research Grant (ACS IRG). It is a pilot study with a goal of identifying environmental cues that may trigger smoking behavior. We usually frame smoking as a personal choice, but we shouldn’t neglect the environmental influences.

Especially these days, the smoking industry targets low-income communities with an increasing number of exposures to tobacco stores, promotions and ads that will have a significant effect on this population. We want to explore the major environmental risk factors for smokers who want to quit and the impact of those factors. The study also could contribute to future studies that would design mobile-based interventions. We are still in the recruitment process, targeting the Aurora area.

5. What are hobbies or leisure activities you enjoy outside of work?

Zhou says she gains knowledge of people by playing characters in dramatic performances during her free time.
Zhou says she gains knowledge of people by playing characters in dramatic performances during her free time.

One of my hobbies is watching and playing drama. Those experiences have really influenced me. I enjoy performing different characters on stage. Every time I perform a different character, I feel that I add a new dimension to my life. I learn a lot by trying to see how the character feels and thinks in different situations. You know you are not that person, but you gain a lot of knowledge by trying to imagine the life they lead. I want to expand that to different areas, not only in my life, but also to use this method to spread health information to people by allowing them to experience the message rather than being told about it or reading about it.

I also love hiking and swimming. I want to add skiing, but skiing in Colorado is a bit challenging now. I’ve skied in upstate New York, but the altitude is much lower. I only skied twice last year, but we’ll see this year.