Enabling Precision Behavior Change via Agile Science

Enabling Precision Behavior Change

@ehekler

Dr. Eric HeklerArizona State University

April 30, 2015

We want behavioral interventions that are…

• Evidence-based

• Cost-effective

• Easy to deliver/disseminate

• Promote maintenance

• Personalized

• Fit into a person’s daily life

• Financially self-sustaining/

reimbursable

@ehekler

@ehekler

Behavior is complex…

Hovell M, Wahlgren D, Adams M. The logical and empirical basis for the behavioral ecological model. Emerging

theories in health promotion practice and research. 2009;2:347-85.

Outline

• Target

– Precision behavior-change interventions

• Problem

– Our science is not matched to the target

• Reasons

– Subject-Matter – Behavior change is wicked

– Methods – Evaluation not granular enough

• (Possible) Solution

– Agile ScienceFlickr -Espen_Faugstad@ehekler

Outline

• Target

– Precision behavior-change interventions

• Problem

– Our science is not matched to the target

• Reasons

– Subject-Matter – Behavior change is wicked

– Methods – Evaluation not granular enough

• (Possible) Solution

– Agile ScienceFlickr -Espen_Faugstad@ehekler

Why now for precision behavior-change interventions?

Flickr – Stuck in Customs

Digital health technologies

are pervasive, personal,

and (potentially) powerful.

@ehekler

Health behaviors explain

the most in individual

health variations.

40

155

10

30

Sub-Optimal Health behaviors

Social Circumstances

Environmental Exposures

Healthcare

Genetics

McGinnis, et al. 2002 Health Affairs

What is a precise behavioral intervention?

@ehekler

Just in time Adaptive

Flickr -Casgen

What are the pieces of precision?

Flickr -Eldeem@ehekler

The pieces

• Technologies to sense & provide feedback

• What’s my goal right now?

• When is “now?”

• What will help right now?

• How do I choose the right option for now?

@ehekler

Individualized recommendations

What’s my goal right now?

Hekler, et al. 2013 Health Education and Behavior@ehekler

Decision points

When is now?/ When is NOT now?

Nahum-Shani, Hekler, & Spruijt-Metz, under review.@ehekler

Intervention options

What will help right now?

Nahum-Shani, Hekler, & Spruijt-Metz, under review.@ehekler

Decision rules

How to choose the right option for now?

@ehekler Flickr-Gerry Dincher

Precision behavior change spectrum

Individual/User

Controlled

System

ControlledIndividual/System

Balanced Control

@ehekler

System controlled

JITAI approach – “giving the fish”

NSF IIS-1449751: EAGER: Defining a Dynamical Behavioral

Model to Support a Just in Time Adaptive Intervention, PIs, Hekler & Rivera@ehekler

Study designs to build controller

-100

100

300

500

700

900

1100

1300

1500

0

2000

4000

6000

8000

10000

12000

14000

1 8 15 22 29 36 43 50 57 64 71 78 85 92 99

Po

ints

Ste

ps

per

day

Days

Points Provided (100, 300, 500)

Fictionalized actual steps per day

Daily step goal ((Baseline Median) to (Baseline Median+100% Baseline Median))

NSF IIS-1449751: EAGER: Defining a Dynamical Behavioral Model to Support a Just in Time

Adaptive Intervention, PIs, Hekler & Rivera

Guiding the controller

Idiographic trajectory models

Hekler, et al. 2013 Health Education and Behavior@ehekler

Individual controlled

DIY approach - “teach to fish”

Eric Hekler, Jisoo Lee, Erin Walker, Winslow Burleson,

Arizona State University; Bob Evans, Google Flickr Juhan Sonin

GoalBehavior Change

Technique(s)

Create a plan

Plan = +

@ehekler

Measure

success

towards

goal

Results

Evaluate your plan

Plan

+Implement for 1 week

@ehekler

GoalBehavior Change

Technique(s)

Revise plan and repeat!

Plan = +

@ehekler

Precision behavior change spectrum

Individual/User

Controlled

System

ControlledIndividual/System

Balanced Control

@ehekler

Precision requires small “Lego” pieces

Flickr -Eldeem@ehekler

Outline

• Target

– Precision behavior-change interventions

• Problem

– Our science is not matched to the target

• Reasons

– Subject-Matter – Behavior Change is Wicked

– Methods – evaluation not granular enough

• (Possible) Solution

– Agile ScienceFlickr -Espen_Faugstad@ehekler

Classic evidence pipeline

Phase 1

Define &

Design

Phase 2

Pilot and

Proof of

Concept

Phase 3

Efficacy

Trial

(RCT)

Phase 4

Effectiveness

Trial

@ehekler

Flickr – Metrix X

2005 2006 2007 2008 2009 2010 2011 2012

Conceive

of a study

Gather

Pilot Data

Submit

Grant

Receive

Funding

Conduct the study

Submit publications

for review

500,000th App

Accepted on

App Store

@ehekler

What are useful “products” from science?

Thursday, May 2, 14:00-15:20 | Mind the Theoretical Gap: Interpreting, Using, and Developing Behavioral Theory in HCI Research

@ehekler

What are useful “products” from science?

Thursday, May 2, 14:00-15:20 | Mind the Theoretical Gap: Interpreting, Using, and Developing Behavioral Theory in HCI Research

Outline

• Target

– Precision behavior-change interventions

• Problem

– Our science is not matched to the target

• Reasons

– Subject-Matter – Behavior change is wicked

– Methods – Evaluation not granular enough

• (Possible) Solution

– Agile ScienceFlickr -Espen_Faugstad@ehekler

Horst Rittel’s “wicked problems”

Rith C, Dubberly H. Why Horst WJ Rittel matters. Design Issues. 2007;23(1):72-91.

@ehekler

Wicked problems reformulated

@ehekler

Flickr – just.Luc Flickr -darkwood67

@ehekler

Is behavior change a wicked problem?

Yes@ehekler

“Taming” a wicked problem

• ill-defined problems

– Stakeholder interaction

• Mutating problems

– Rapid iteration

• Context-dependent problems

– “Match” between solution and context

Chambers et al. 2013; Riley, et al, 2013; Rittel & Webber, 1973; van Gemert-Pijnen et al. 2011; Hekler et al. under review

What do we get from RCTs?

Stead LF, Lancaster T. Group behaviour therapy programmes for smoking cessation. Cochrane Database of

Systematic Reviews 2005, Issue 2. Art. No.: CD001007. DOI: 10.1002/14651858.CD001007.pub2. @ehekler

What do we get from RCTs?

Mohr DC, Ho J, Hart TL, Baron KG, Berendsen M, Beckner V, et al. Translational Behavioral Medicine. 2014:1-17.@ehekler

What do we get from RCTs?

@ehekler

Smaller meaningful “Lego” pieces

@ehekler

Linda M. Collins

The Methodology Center

Penn State

methodology.psu.edu@ehekler

Evaluation of decision rules

SMART

Example

Adaptive

Example

http://methodology.psu.edu/ra/smart/projects@ehekler

Outline

• Target

– Precision behavior-change interventions

• Problem

– Science is not matched to the target

• Reasons

– Subject-Matter – Behavior change is wicked

– Methods – Evaluation not granular enough

• (Possible) Solution

– Agile ScienceFlickr -Espen_Faugstad@ehekler

Agile science

www.agilescience.org@ehekler

Agile science - products

• Modules

• System architectures

• Algorithms

@ehekler www.agilescience.org

Just in Time “Meaningful Moments”

• State of opportunity or vulnerability

• Receptive

• Behavior does not have to happen now

@ehekler Nahum-Shani, Hekler, & Spruijt-Metz, under review

State of vulnerability

Flickr - Rob Marquardt@ehekler www.agilescience.org

Receptive

0

2

4

6

8

10

1 4 7 10 13 16 19 22

Valu

e/B

urd

en (10

=hig

h)

Interactions with the system

Value/burden ratio

Value

Burden

ModulesSmallest, meaningful, repurposable, and concrete

Flickr - Benjamin Esham@ehekler www.agilescience.org

Theory vs. system architecture

Martin, Riley, Rivera, Hekler, et al. 2014@ehekler

Theory vs. system architecture

Hekler et al. Manuscript Submitted for Publication, 2015@ehekler

Predictive matchmaking algorithms

@ehekler www.agilescience.org

What evidence do we need for

matchmaking algorithms?

@ehekler

“Perfect” intervention

package?

Pieces for meaningful moments

with insights on how to recombine?

Flickr - Paul Swansen Flickr - Benjamin Esham

www.agilescience.org

Agile science

Process

@ehekler

“Sprint” phase

Formative work

@ehekler www.agilescience.org

“Sprint” phase

Concrete prototypes

@ehekler www.agilescience.org

“Sprint” phase

Rapid testing w/ concrete criterion

@ehekler

methodology.psu.edu

“Optimization” phaseValidate the three products

@ehekler

Product release

www.agilescience.org

Product release:

Individuals/

Practitioners

www.agilescience.org

Product release:

Scientists/engineers

& funders

www.agilescience.org

Paco – open source tool

Build, iterate, & share together

www.agilescience.org@ehekler

Agile science

Process

@ehekler

Precision behavior change spectrum

Individual/User

Controlled

System

ControlledIndividual/System

Balanced Control

@ehekler

Enabling precision behavior change

@ehekler

Move from building and evaluating…

@ehekler

this, to this.

Flickr - Paul Swansen Flickr - Benjamin Esham

To enable practitioners and individuals to

build this…

Flickr- Tony Fischer@ehekler

Thank you!

Dr. Eric Hekler

Arizona State University

ehekler@asu.edu

@eheklerFlickr- Tony Fischer