Modeling Approaches for Health Coaching Interventions Holly Jimison, PhD, FACMI College of Computer & Information Science College of Health Sciences Director, Consortium on Technology for Proactive Care Northeastern University, Boston, MA, USA NSF International Workshop on Dynamic Modeling of Health Behavior Change and Maintenance, Sept 8-9, 2015, London, UK

Modeling for Coaching Overview Points Use theoretical frameworks that health coaches actually use (mix and match as needed) Use a decision theoretic framework (probabilities and utilities for any action taken (alerts, messaging) Integrate intervention into daily life Devices: smart phones, calendars Coordinate with other interventions (stress management, medications, exercise, etc.) Unobtrusive

What does this mean for Skyler? Integrate intervention into daily life Coordinate with other interventions (stress management, medications, exercise, sleep, etc.) Unobtrusive or minimally obtrusive sensors Smart phone for messaging, sensing voice quality, location for context, rough level of activity, EMA assessments Credit card, debit card reports of food purchases Computer interactions (cognitive games, mouse, keyboard interactions) for cognitive state Smart watch for EDA, HRV, SaO2, activity, messaging Bed sensor for HRV (stress recovery, sleep efficiency)

Theoretical frameworks that health coaches actually use: Backdrop: Collaborative, Tailored, Timely Develop a tailored shared action plan Monitor & provide feedback / encouragement Frameworks: Motivational Interviewing throughout Motivations, Barriers, Triggers Stages of Change for initial content & level of detail in later stage messaging Self efficacy for preparation/action/maintenance

Model Variables Monitored behaviors Baseline variables for all modules Eating behaviors Purchasing behaviors Physical exercise Socialization activities Sleep efficiency Monitored physiology HRV, EDA, SaO2 Context Variables Location Activity Inferred patient states Baseline variables for all modules Behavior goals Motivations Barriers Triggers Stage of change Self efficacy Literacy/numberacy level Contact info & preferences

Model Variables Possible actions Inferred Variables Tailored messaging Adherence to goals Stage of change Self efficacy Patient states Quality of diet Stress level Cognitive functioning Physical functioning Socialization level Sleep quality Possible actions Tailored messaging Reminders Encouragement Suggestions Information Alerts Coach, Family, Clinician Interventions Lighting to highlight good food choices Stress management …. other

When to use which type of computational model Sensor data models Sampling, filtering, summarization Data harmonization, representation, storage Sensor fusion models (not a simple average) Inference of patient state – statistical and process models Tailored messaging – production rules; active methods Alerting or assessment – decision theoretic overlay

Dynamic User Model to Support Health Coaching Intake Assessment Health Status Health Goals Motivations Barriers Stage of Change Social Support Preferred Name Contact Preferences Dynamic User Model Current Goals Current Motivations Current Barriers Current Triggers Current Self Efficacy Current Patient States Monitored Data Eating Behaviors Food Purchases Emotional Status Sleep Quality Cognitive Status Socialization EMA Self Report As needed Tailored Action Plan Data Summary Tailored Message Generator Message Database Greetings Feedback Messages Recommendations Closings General Interest News Family Interface Patient Interface Coach Interface

Use decision theory framework Probabilities Patient state Patient activity Utilities for any action taken Messaging Assessments Alerts to coach, family, clinician

Modeling for Alerts Decision Theory Framework Probabilities Utilities

Example: Medication Adherence Modeling for Alerts Decision Theory Framework Probabilities Utilities 11

Example: Medication Alerts Model Variables Importance of Drug Likelihood of remembering Cost of alert (nagging) Generate Alerts Patient Reminders Display to coach Display to family Display to clinician U=Utility, A=Alerting Action, C=Context, q=patient state

Summary: Use theoretical frameworks that health coaches actually use (mix and match as needed) Use computational models that fit the need Use a decision theoretic framework (probabilities and utilities for any action taken Integrate intervention into daily life Holistic multifaceted approaches Think long-term sustainability

Questions / Suggestions Holly Jimison, PhD, FACMI h.jimison@neu.edu