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 Modeling Approaches for Health Coaching Interventions

Northeastern University 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

Northeastern University 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, SaO 2, activity, messaging  Bed sensor for HRV (stress recovery, sleep efficiency)

Northeastern University 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

Northeastern University Model Variables Baseline variables for all modules –Behavior goals –Motivations –Barriers –Triggers –Stage of change –Self efficacy –Literacy/numberacy level –Contact info & preferences 5 Monitored behaviors –Eating behaviors –Purchasing behaviors –Physical exercise –Socialization activities –Sleep efficiency Monitored physiology –HRV, EDA, SaO 2 Context Variables –Location –Activity –Inferred patient states

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

Northeastern University 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

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

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

Northeastern University Modeling for Alerts Decision Theory Framework Probabilities Utilities

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

Northeastern University Example: Medication Alerts Model Variables –Importance of Drug –Likelihood of remembering –Cost of alert (nagging) 12 Generate Alerts –Patient Reminders –Display to coach –Display to family –Display to clinician U=Utility, A=Alerting Action, C=Context, q=patient state

Northeastern University 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