View
223
Download
3
Embed Size (px)
Citation preview
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
@eheklerFlickr- Tony Fischer