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Precise Evidence for Specific Problems
@ehekler
Dr. Eric Hekler
Arizona State University
August 4, 2016
Outline
• Motivations & perspective
• Precise solutions
• Precise evidence
• Agile science (v.2)
• Citizen-led science & PLM
@ehekler
Motivations & Perspective
Human Genome ProjectWalking on the Moon
Penicillin
Eric Hekler, @ehekler
theamazingworldofgumball.wikia.com
http://www.genome.gov/
http://youtu.be/QPKKQnijnsM
Flickr – just.Luc
Flickr-meanMrmustard
Precise Evidence for Specific Problems
Precise Evidence for Specific Problems
Behaviors explain most variability in health
Flickr – Stuck in Customs@ehekler
40
15
5
10
30
Sub-Optimal Health behaviors
Social Circumstances
Environmental Exposures
Healthcare
Genetics
McGinnis, et al. 2002 Health Affairs
Behavior at the center
Hovell M, Wahlgren D, Adams M. Emerging theories in health promotion practice and research. 2009;2:347-85.@ehekler
Core problem: Skeumorphisms
Schueller et al. 2013
Precise Solutions
Personal, pervasive, & powerful technologies
Flickr – Stuck in CustomsPatrick, Hekler, Estrin, Godino, Crane, Riper, & Mohr, Riley, Manuscript in Prep@ehekler
@ehekler http://www.nih.gov/precisionmedicine/
Just in Time Adaptive Interventions
@ehekler
Just in time: State of vulnerability
Flickr - Rob Marquardt
@ehekler Nahum-Shani, Hekler, & Spruijt-Metz, (2015) Health Psychology
Just in time: State of opportunity
Flickr - Miroslav Petrasko
@ehekler Nahum-Shani, Hekler, & Spruijt-Metz, (2015) Health Psychology
Just in time: Receptive
Flickr-Jonathan Powell
Nahum-Shani, Hekler, & Spruijt-Metz, (2015) Health Psychology@ehekler
Adaptive: Series of “just in time” moments
@ehekler Flickr - Dave Gray
System controlled
“Giving the fish”
NSF IIS-1449751: EAGER: Defining a Dynamical Behavioral
Model to Support a Just in Time Adaptive Intervention, PIs, Hekler & Rivera
@ehekler
Modeling behavior
Riley, Martin, Rivera, Hekler, et al. 2016; Martin, Riley, Rivera, Hekler, et al. 2014@ehekler
Three Example Individualized Computational Models via Black-Box
System ID: Goals-Expected Points-Granted Points model; B: Predicted
Busyness; S: Predicted Stress; T: Predicted Typical; W: Weekday-Weekend
Modeling differences
Future-oriented predictions
Hekler, et al. 2013 Health Education and Behavior@ehekler
Martin, Rivera, & Hekler Manuscript Submitted for Publication
Future-oriented decisions
@ehekler
Individual controlled
“Teaching to fish”
Eric Hekler, Jisoo Lee, Erin Walker, Winslow Burleson, Arizona State University; Bob Evans, Google
Flickr Juhan Sonin
@ehekler
Measure
success
towards
goal
Results
Self-experimentation
Plan
+ Implement for 1 week
@ehekler
MS Wearables 101 Course
Emil Chiauzzi, PatientsLikeMe
Eric Hekler, Arizona State University
Pronabesh DasMahapatra, PatientsLikeMe
Precise Evidence
Specific Solutions
for Specific Problems
Design &
Engineering
“On Average”
Science
“On Average” Evidence
for General Problems
Key
Traditional pathway
Emerging pathway
Product
Process
Professional-led
Specific Solutions
for Specific Problems
Design &
Engineering
“On Average”
Science
“On Average” Evidence
for General Problems
Key
Traditional pathway
Emerging pathway
Product
Process
Precise Evidence
for Specific Problems
Personalization
Algorithm
Science
Professional-led
Specific Solutions
for Specific Problems
Design &
Engineering
“On Average”
Science
“On Average” Evidence
for General Problems
Key
Traditional pathway
Emerging pathway
Product
Process
Precise Evidence
for Specific Problems
Personalization
Algorithm
Science
Professional-led
Citizen/Patient-led
Subjectivity matters
@ehekler
• Solving the “last mile” problem
• Requires a damn good designer
• AND(/OR?) patient empowerment
. Mullainathan S. Solving social problems with a nudge. TEDIndia.
2009. http://www.ted.com/talks/sendhil_mullainathan.
From “on average” to algorithms
@ehekler
• From generally true to true for me
• Requires acknowledging variance
“On Average”
~50%
“Personalization/Matchma
king”
~35%
Idiosyncratic/
Subjective
~15%
Role of the professional may change
@ehekler
• From solving to empowering
• Professional can support
– Education
– Tool building
– Communication
– Curation
Agile Science
friko-diamondsdesigns.blogspot.com
HealthFoo, December 2013:
https://www.youtube.com/watch?v=wY-stOXqmuw
Watch this video on being a “thought leader”:
https://www.youtube.com/watch?v=_ZBKX-6Gz6A
Agile science products
• Modules
• Computational models
• Personalization algorithms
@ehekler
Modules
Smallest, meaningful, self-contained,& repurposable
“Perfect” intervention package Components
Flickr - Paul Swansen Flickr - Benjamin Esham
@ehekler
Modules
@ehekler
Inputs Process Output
Proximity sensor module
@ehekler
Inputs
iBeacons
Phone
Meta-data
Process
Transform
tagged data
into a time-
stamped db
Output
Time-
stamped csv
of indoor
location
Modules
APIs
www.yelp.com@ehekler
IFTTT
http://www.ifttt.com
Modules
Templates
www.ifttt.com@ehekler
Modules
http://www.ifttt.comwww.ifttt.com@ehekler
Computational models
Riley, Martin, Rivera, Hekler, et al. 2016; Martin, Riley, Rivera, Hekler, et al. 2014@ehekler
Computational models: Ontologies
Larsen, Michie, Hekler, et el. 2016, Journal of Behavioral Medicine@ehekler
Personalization algorithms
www.netflix.com@ehekler
Martin, Rivera, & Hekler Am. Control Conference (2015)
Personalization algorithms
@ehekler
Agile Science Process v0.2
@ehekler
Agile Science
Process
Generate
Design & engineer specific solutions for
specific problems
@ehekler
Formative research
• Defining a “niche”
• Defining constraints
• Generating solutions
IDEO
“Niche” specification
IDEO: Human-Centered Design Kit
Design constraints
DesignWhat fits in time &
budget constraints
What does your
target audience
think they need?
What do the
“experts” think your
target audience
needs?
How might policy
impact what is
possible?
What does your
target audience
ACTUALLY need?
What’s fundable?
What’s feasible to
build?
What ideas can be
evaluated?
What’s something
that can be
sustained during &
after the study?
What can you
actually build with
your tech partner?
Generating solutions
Stanford d.School, Bootleg Bootcamp
Complexity mapping
• Finding assumptions
• Defining causal
pathways
• Defining a research
agenda
Finding assumptions via simulation
Martin, Rivera, & Hekler (In preparation)
Finding assumptions via simulation
Martin, Rivera, & Hekler (In preparation)
Causal pathways
Antecedents
Body
Movement ConsequencesContext (People, place,
time)
Time
scale
Year
Month
Day
Hour
Min
Bouts of MVPA
Min/day MVPADaily min/day
goal of MVPA
Cardiovascular
Fitness (vO2)
Self-
Management
Skills
Self-Identity as
an “exerciser”
Atherosclerotic
Plaque
Prevention
Research agenda
Prototyping
• Testing “hunches”
• Testing assumptions
• Examining feasibility
Amy Luginbill; Samantha Quagliano; Sepideh Zohreh
S=Stop
M=Move
I= I statement; I can do it!
L=Love (positivity)
E=Exhale
SMS: “If you are stressed
today, try one of the
following options, Deep
breathing, Stretching, get
up move around.”
MOBILECAR
MAIDSERVICES
GREEN CLEAN
Prototype 1: S.M.I.L.E.
Prototype 2:
Facial Wave
Prototype 3:
SMS
Intervention
Prototype 4:
De-stress your carTesting hunches
@ehekler
Testing assumptions
John Harlow, Erik Johnston, Zoe Yeh@ehekler
Phoenix Proposition 104
John Harlow, Erik Johnston, Zoe Yeh@ehekler http://movephx.org/get-the-facts/maps/
Examining feasibility
https://www.youtube.com/watch?v=xy9nSnalvPc
Evaluate
Determine the “boundary conditions” on when,
where, for whom, and in what state a tool
produces its desired outcome.
@ehekler
Linda M. Collins
The Methodology Center
Penn State
methodology.psu.edu@ehekler
Micro-randomization design
• Sequential, full factorial designs
• Randomize intervention component
• Each time we might deliver component
• Multiple components can be randomized
• Randomized 100s or 1000s of times
Klasnja, Hekler, Shiffman, Boruvka, Almirall, Tewari, Murphy, Health Psych, 2015@ehekler
Dynamic hypotheses- “sweet spot”
Hekler (PI), Rivera (Co-PI), NSF IIS-1449751
-15
-10
-5
0
5
10
15
20
0
2000
4000
6000
8000
10000
12000
14000
AveChangeSelfEffficacy
ActualDailySteps
Recommended Goal
Actual Steps Δ Self-Efficacy
@ehekler
System identification experiments
-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
Points
Stepsperday
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: Defining a Dynamical Behavioral Model to Support
a Just in Time Adaptive Intervention, PIs, Hekler & Rivera@ehekler
Curate
Evidence-based insights for match-making of
specific solutions to specific problems
@ehekler
Precise Evidence for Specific Problems
Ontologies
Larsen, Michie, Hekler et al. in press
Shared test-beds
@ehekler
PatientsLikeMe
@ehekler
Research Kit
https://www.apple.com/ios/whats-new/health/ http://researchkit.github.io/ http://sagebase.org/
Paco
www.pacoapp.com@ehekler
Open Humans
@ehekler
eEcosphere
@ehekler DISCLAIMER: On scientific advisory board w/ equity stakes in the company
Patient-led science @PLM
PLM is a true pioneer (as you know ;)
Specific Solutions
for Specific Problems
Design &
Engineering
“On Average”
Science
“On Average” Evidence
for General Problems
Key
Traditional pathway
Emerging pathway
Product
Process
Precise Evidence
for Specific Problems
Personalization
Algorithm
Science
Professional-led
Citizen/Patient-led
OpenAPS
OpenAPS
End-User design, engineering, & science
• Target: empowering systematic patient “hacking”
– Disease management (e.g., MS “sweet spot” study)
– Next gen drugs (e.g., Lithium study v2.0)
– Next gen medical devices (e.g., OpenAPS)
• Courses on patient-led design, engineering & science
• End-user programming tools (e.g., Paco) to empower
patient-led design, engineering & science
What you get?
• Insights on the “last mile” problem
• Highly marketable (?)
• Strong value back to your patients
Advocating for culture change
• Target: shifting social, ethical, methodological, and
regulatory change to embrace patient-led design,
engineering, and science
• Devise a pathway through the FDA
– OpenAPS
• Build communication pathways between patient-
innovators and professionals
– OpenAPS
Specific Solutions
for Specific Problems
Design &
Engineering
“On Average”
Science
“On Average” Evidence
for General Problems
Key
Traditional pathway
Emerging pathway
Product
Process
Precise Evidence
for Specific Problems
Personalization
Algorithm
Science
Professional-led
Citizen/Patient-led
Thanks! What can we build together?
Dr. Eric Hekler, Arizona State University
ehekler@asu.edu, @ehekler
TARGET: Precision behavior change
Individual/User
Controlled
System
Controlled
Individual/System
Balanced Control
@ehekler
Why now? Behavioral meteorology
Flickr-Bart Everson
Patrick, Riley, Estrin, Hekler, Godino, Crane, Riper, & Mohr, Manuscript in Prep@ehekler
Why now? The world needs us…
Flickr – Stuck in Customs
http://youtu.be/QPKKQnijnsM
Flickr – just.Luc
Flickr-meanMrmustard
First step…
@ehekler
Stop building “perfect”
packages…
Start building interoperable
modules
Flickr - Paul Swansen Flickr - Benjamin Esham
www.agilescience.org
Interoperable systems
@ehekler
LeadSecondary
Secondary
Secondary
SecondarySecondary
Interoperable systems
www.openmhealth.org
Ecologically-valid data streams
@ehekler
Lead Secondary
Secondary
Co-Lead
Turning “noise” into information
https://ubicomplab.cs.washington.edu/
Data standardization
@ehekler
LeadCo-Lead
Secondary
Secondary
Secondary
Data standardization
www.openmhealth.org

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Precise Evidence for Specific Problems

Editor's Notes

  • #2: The talk will briefly set up the current context for mHealth / UbiComp / digital health research efforts as seen from various disciplinary lenses. Following this, the precision medicine initiative will be discussed followed by a discussion on one subclass of prevention interventions, labeled precision behavior change, which could fit well within the precision medicine initiative. Following the definition of precision behavior change, transdisciplinary research questions, with a particular focus on attempting to articulate intellectual merit and contributions for each discipline when exploring the research questions, will be discussed. The talk will conclude with plausible next steps to spur conversation among the webinar participants and later viewers on ways to refine this transdisciplinary research agenda to see if it is viable and, if so, how best to more actively enable it as an organizing “moon shot” agenda for the mHealth research community.
  • #3:  The talk will briefly set up the current context for mHealth / UbiComp / digital health research efforts as seen from various disciplinary lenses. Following this, the precision medicine initiative will be discussed followed by a discussion on one subclass of prevention interventions, labeled precision behavior change, which could fit well within the precision medicine initiative. Following the definition of precision behavior change, transdisciplinary research questions, with a particular focus on attempting to articulate intellectual merit and contributions for each discipline when exploring the research questions, will be discussed. The talk will conclude with plausible next steps to spur conversation among the webinar participants and later viewers on ways to refine this transdisciplinary research agenda to see if it is viable and, if so, how best to more actively enable it as an organizing “moon shot” agenda for the mHealth research community.
  • #10: Discuss the lack of understanding from behavioral scientists on how to really deal with big data and opportunities for setting up “in the wild” studies that could later be harnessed for A/B testing. Nice melding of behavioral science knowledge of randomized controlled trials and HCI’s knowledge on the systems to automate those types of systems in the real-world.
  • #16: Based on this, we need to move more into an open discussion in which we explore lots and lots of different ideas if we really want to understand which ones are best. Sadly, science, particularly behavioral science doesn’t really have the sort of “maker” culture that would allow us. As such, a key emphasis.
  • #17: Based on this, we need to move more into an open discussion in which we explore lots and lots of different ideas if we really want to understand which ones are best. Sadly, science, particularly behavioral science doesn’t really have the sort of “maker” culture that would allow us. As such, a key emphasis.
  • #24: Based on this, we need to move more into an open discussion in which we explore lots and lots of different ideas if we really want to understand which ones are best. Sadly, science, particularly behavioral science doesn’t really have the sort of “maker” culture that would allow us. As such, a key emphasis.
  • #25: NOTE, this current draft is just to get a sense of timing and flow on key points to discuss. Formatting on almost all slides will not remain (e.g., likely will NOT have the titles at the top like that).
  • #26: - OK, now you’re creating a plan for your problem. For a successful plan, you should set an appropriate goal, and come up with ways to apply behavior change techniques.
  • #29: Decision Policies – we are talking about what this is supposed to do Citizens= Patients, Providers, and anyone else driven to solve a problem that the individual has first-hand experience with.
  • #30: Decision Policies – we are talking about what this is supposed to do Citizens= Patients, Providers, and anyone else driven to solve a problem that the individual has first-hand experience with.
  • #31: Decision Policies – we are talking about what this is supposed to do Citizens= Patients, Providers, and anyone else driven to solve a problem that the individual has first-hand experience with.
  • #33: Professionals still focus on “on average” science (even, it appears, with many precision medicine efforts) Professionals need to move towards studying the utility of personalization algorithms
  • #34: Professionals need to continually enable more “end-user” design, engineering, and Science
  • #35: FIND THE VIDEO MAKING FUN OF TED TALKS AND PUT IN A LINK HERE.
  • #36: Central to agile science is a focus on products that will be immediately useful for non-scientists.
  • #40: Based on this, we need to move more into an open discussion in which we explore lots and lots of different ideas if we really want to understand which ones are best. Sadly, science, particularly behavioral science doesn’t really have the sort of “maker” culture that would allow us. As such, a key emphasis.
  • #45: Based on this, we need to move more into an open discussion in which we explore lots and lots of different ideas if we really want to understand which ones are best. Sadly, science, particularly behavioral science doesn’t really have the sort of “maker” culture that would allow us. As such, a key emphasis.
  • #46: Based on this, we need to move more into an open discussion in which we explore lots and lots of different ideas if we really want to understand which ones are best. Sadly, science, particularly behavioral science doesn’t really have the sort of “maker” culture that would allow us. As such, a key emphasis.
  • #48: I’ve been calling this alternative process agile science, which I’ll jump into briefly here.
  • #60: The group studies were where the most interesting things happened. In particular, this was when the groups really took advantage of “crummy trials” for better understanding when an idea was working. For example, Amy, Sam, and Sepideh’s group was trying to reduce stress. They did a lot of empathizing work and looking into the previous literature to find the importance of breathing and stress management techniques. Sadly though, whenever they tested some of their ideas, which included mantras and other ideas to help simple triggers for relaxing, they all failed. This was particularly fascinating because in their initial brainstorming, they really loved their “S.M.I.L.E.” accronym that they came up with. When they tested it, comparing it to a control, it simply didn’t work. They perceived but ultimately found that they needed to pivot and instead ended up focusing on figuring out ways to de-stress a person’s environment. So they went and started cleaning cars and got great responses.
  • #65: Thankfully, there has been great movement away from that classic pipeline and particularly the use of a randomized trial of interventions with multiple components in it, to other strategies that are more mirrored on strategies from engineering. Central to this work is a careful understanding of how to develop the evidence around the components of the intervention, with the assumption being htat the components will be more repurposable. SO, for example, Linda Collins has been pioneering the use of fractional factorial study designs to run interventions with multiple components but with a methodology that supports understanding of how the components and how they interact might function.
  • #66: Indeed, my colleagues and I have ben extending this logic to what we’ve been calling a micor-randomization study, which is atype of factorial design but that is done within a single person. The idea is to randomize intervention componetns with a person at each time when it might help. The design allows multiple of these to work and there is great power on a single person because it is plausible to randomize hundreds and even thousands of times within person.
  • #68: Myc olleauge, Daniel Rivera, and I have been extending this further using methods fromcontrol systems engineering to develop experimental designs that take more advantage of a priori knowledge than the micro-randomization study. In the discussion section, I’d be happy to get into details on these experimental designsbut for the focus of this, the main point is to realize that this is a huge shift in the behavioral science community away from ideas like RCTs nad instead towards methods that embrace and map out idiosyncracy.
  • #70: Beyond just the difficulty of the complexity of behavior and the behavioral problems we are trying to solve, there are a lot of demands on behavior change technologies themselves and different points that tend to thought about from different disciplines. Indeed, we want behavior change technologies that are evidence-based, cost-effective, personalized, easy to disseminate, promote maintenance, fit into a person’s life, and can, hopefully be financially self-sustained in sustaining. As can be seen just from this list, this can’t be achieved through the class disciplinary silo model of creation.
  • #71: Flipping to the second half of this talk now though, in my view, this will only be achieved by carefully building an ecosystem that supports precision behavior change and I think your HealthKit and ResearchKit are great starting points for this. To set up why though, allow me to briefly take a step back and discuss how behavioral scientists like me were told that we were supposed to do our science.
  • #72:  The talk will briefly set up the current context for mHealth / UbiComp / digital health research efforts as seen from various disciplinary lenses. Following this, the precision medicine initiative will be discussed followed by a discussion on one subclass of prevention interventions, labeled precision behavior change, which could fit well within the precision medicine initiative. Following the definition of precision behavior change, transdisciplinary research questions, with a particular focus on attempting to articulate intellectual merit and contributions for each discipline when exploring the research questions, will be discussed. The talk will conclude with plausible next steps to spur conversation among the webinar participants and later viewers on ways to refine this transdisciplinary research agenda to see if it is viable and, if so, how best to more actively enable it as an organizing “moon shot” agenda for the mHealth research community.
  • #74: Flipping to the second half of this talk now though, in my view, this will only be achieved by carefully building an ecosystem that supports precision behavior change and I think your HealthKit and ResearchKit are great starting points for this. To set up why though, allow me to briefly take a step back and discuss how behavioral scientists like me were told that we were supposed to do our science.
  • #79: Flipping to the second half of this talk now though, in my view, this will only be achieved by carefully building an ecosystem that supports precision behavior change and I think your HealthKit and ResearchKit are great starting points for this. To set up why though, allow me to briefly take a step back and discuss how behavioral scientists like me were told that we were supposed to do our science.
  • #80: Decision Policies – we are talking about what this is supposed to do Citizens= Patients, Providers, and anyone else driven to solve a problem that the individual has first-hand experience with.
  • #83: Flipping to the second half of this talk now though, in my view, this will only be achieved by carefully building an ecosystem that supports precision behavior change and I think your HealthKit and ResearchKit are great starting points for this. To set up why though, allow me to briefly take a step back and discuss how behavioral scientists like me were told that we were supposed to do our science.
  • #84: Flipping to the second half of this talk now though, in my view, this will only be achieved by carefully building an ecosystem that supports precision behavior change and I think your HealthKit and ResearchKit are great starting points for this. To set up why though, allow me to briefly take a step back and discuss how behavioral scientists like me were told that we were supposed to do our science.
  • #85: Flipping to the second half of this talk now though, in my view, this will only be achieved by carefully building an ecosystem that supports precision behavior change and I think your HealthKit and ResearchKit are great starting points for this. To set up why though, allow me to briefly take a step back and discuss how behavioral scientists like me were told that we were supposed to do our science.
  • #86: Decision Policies – we are talking about what this is supposed to do Citizens= Patients, Providers, and anyone else driven to solve a problem that the individual has first-hand experience with.
  • #92:  The talk will briefly set up the current context for mHealth / UbiComp / digital health research efforts as seen from various disciplinary lenses. Following this, the precision medicine initiative will be discussed followed by a discussion on one subclass of prevention interventions, labeled precision behavior change, which could fit well within the precision medicine initiative. Following the definition of precision behavior change, transdisciplinary research questions, with a particular focus on attempting to articulate intellectual merit and contributions for each discipline when exploring the research questions, will be discussed. The talk will conclude with plausible next steps to spur conversation among the webinar participants and later viewers on ways to refine this transdisciplinary research agenda to see if it is viable and, if so, how best to more actively enable it as an organizing “moon shot” agenda for the mHealth research community.
  • #94:  The talk will briefly set up the current context for mHealth / UbiComp / digital health research efforts as seen from various disciplinary lenses. Following this, the precision medicine initiative will be discussed followed by a discussion on one subclass of prevention interventions, labeled precision behavior change, which could fit well within the precision medicine initiative. Following the definition of precision behavior change, transdisciplinary research questions, with a particular focus on attempting to articulate intellectual merit and contributions for each discipline when exploring the research questions, will be discussed. The talk will conclude with plausible next steps to spur conversation among the webinar participants and later viewers on ways to refine this transdisciplinary research agenda to see if it is viable and, if so, how best to more actively enable it as an organizing “moon shot” agenda for the mHealth research community.
  • #96:  The talk will briefly set up the current context for mHealth / UbiComp / digital health research efforts as seen from various disciplinary lenses. Following this, the precision medicine initiative will be discussed followed by a discussion on one subclass of prevention interventions, labeled precision behavior change, which could fit well within the precision medicine initiative. Following the definition of precision behavior change, transdisciplinary research questions, with a particular focus on attempting to articulate intellectual merit and contributions for each discipline when exploring the research questions, will be discussed. The talk will conclude with plausible next steps to spur conversation among the webinar participants and later viewers on ways to refine this transdisciplinary research agenda to see if it is viable and, if so, how best to more actively enable it as an organizing “moon shot” agenda for the mHealth research community.