The New Technology Frontier in Health:

Lessons from Behavioral Science

Sherry Pagoto, PhDFounder, UMass Center for mHealth and Social MediaProfessor, Department of MedicineUniversity of Massachusetts Medical School

Obesity as a case study

Efficacy for behavioral strategies to manage obesity and prevent diabetes was established in 2001 via the landmark Diabetes Prevention Program Trial (DPP, 2001)

Over 16 years, this program is still not widely available to the public.

What are the problems?Too expensive/ burdensome (kitchen sink approach) for patients and providers (e.g., numerous visits over 1 year) leading to poor reach

Clinical trials move slowly, so testing new innovations has advanced slowly

Smaller effects when applied to real world samples, need to increase potency

How can technology help?

1. Reduce burden/cost of original intervention (i.e., make it cheaper and easier to implement)2. Speed up clinical testing of strategies that could increase potency (i.e., speed up science)3. Advance our understanding of process of behavior change (i.e., make it work better)

Make it easier and cheaper to deliver

Prevent by Omada Health (Sepah et al 2015)

Less burdensome due to no clinic visits

Noom Health (app w/ human coaching) (Michaelides et al 2016)

Provided by employers (not direct to individual)Less burdensome due to no clinic visits

So far tech is being used to automate, not innovate.

Speed up scienceClinical trials are the evidence gold standard They are slow due to…

Recruitment pace and diversity relies on local population Data collection is burdensomeInterventions are burdensome

` Research Kit –poor sample diversity, selection bias, drop off in participation at 5 weeks. (Dorsey et al 2016)

Need innovative platforms to solve theseproblems.

Make it work betterMobile apps and wearables for self-monitoring and goal setting

– Literature is mixed on whether apps improve diet tracking adherence– Passive diet tracking approaches must improve accuracy, wearables need to be

acceptable to patients– Large trial showed deleterious effect of wearable tracker on weight loss long-term

(Jakicic et al 2016)

Using online social networks to increase social support for behavior changes

– Too early to tell– Need data science to help us understand participant engagement

Make it work betterExamine how more sophisticated behavioralstrategies can be implemented with technology

Behavior change taxonomy identified 93 distinctevidence-based behavioral strategies(Michie et al 2015)

“Contextualized” Self

Shift from “What am I doing?” to “Why did I do it?”

Stress level is high You slept 4

hours

At a restaurant

You skipped breakfast

With guys from office

No exercise in 2 days.

Predictive models of contextual factors surrounding healthy and unhealthy choices

“Modified” SelfWhich specific habits have the biggest impact overall and for a specific patient?What is best time to implement a particular habit?Which habit combinations are sufficient to

produce weight loss?

A note on team science…

Greater collaboration during the conceptual phase Too many cases where an investigator has anidea and then brings in collaborators; not enoughcases where investigator brings in collaboratorsto generate an idea.

Collaborators ≠ service providers, technicians, content experts

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