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Amplifying humanity via
precision behavior change
Dr. Eric Hekler
Director
Designing Health Lab
Arizona State University
@...
Amplifying creativity
www.apple.com
http://youtu.be/QPKKQnijnsM
Flickr – just.Luc
Flickr-meanMrmustard
Behavior is complex…
Hovell M, Wahlgren D, Adams M. The logical and empirical basis for the behavioral ecological model. E...
@ehekler
Flickr – Stuck in Customs@ehekler
40
15
5
10
30
Sub-Optimal Health behaviors
Social Circumstances
Environmental Exposures
...
Open science
@ehekler
We need help…
friko-diamondsdesigns.blogspot.com
Flickr – Stuck in Customs@ehekler
Personal, powerful, & pervasive
https://www.apple.com/iwatch/
What is precision behavior change?
@ehekler
Just in time Adaptive
Flickr -Casgen
Meaningful moments
https://www.google.com/culturalinstitute/u/0/asset-viewer/luncheon-of-the-boating-
party/mgHsTKDNJVzPAg...
Ping pollution
Flickr_Eric_Longstaff Flickr_Alex_Valentinehttp://globalmoxie.com/blog/smart-watches-wearables-data-rash.sh...
Design silence
http://www.123posters.com/images/f-mdavis.jpg
Meaningful moments
Flickr - Dave Gray
Flickr - Rob Marquardt@ehekler
Opportunity
Receptivity
0
1
2
3
4
5
6
7
8
9
10
1 4 7 10 13 16 19 22
Value/Burden(10=high)
Interactions with the system
Value/burden ra...
Eric Hekler (ASU)Aaron Coleman (Fitabase) Sayali Phatak (ASU)
Exploring Strategies to Improve Acceptability and Usability ...
Why Context Matters
(fictitious hourly activity graph)
Why Context Matters
Nightstand
Nightstand
Nightstand
Nightstand
Nightstand
Nightstand
Nightstand
Nightstand
Nightstand
Nig...
The honeybee is nature’s
best collector and
communicator of data.
Project HoneyBee explores
the transformational promise
o...
Precision adaptation
Individual/User
Controlled
System
Controlled
Individual/System
Balanced Control
@ehekler
www.agilesci...
System-controlled – “Giving a fish”
NSF IIS-1449751: EAGER: Defining a Dynamical Behavioral
Model to Support a Just in Tim...
0
2000
4000
6000
8000
10000
12000
14000
1000 3000 5000 7000 9000 11000 13000 15000
ActualDailySteps
Recommended Goal
Dynam...
Impacting the sweet spot
@ehekler
Personal trajectory predictions
Hekler, et al. 2013 Health Education and Behavior
@ehekler
Message selection based on:
- time of day
- location
- weather
- current activity
Two types of messages:
- promote activit...
Eric Hekler, Jisoo Lee, Erin Walker, Winslow Burleson,
Arizona State University; Bob Evans, Google Flickr Juhan Sonin
Indi...
Goal
Behavior Change
Technique(s)
Create a plan
Plan = +
@ehekler
Measure
success
towards
goal
Results
Evaluate your plan
Plan
+ Implement for 1 week
@ehekler
Technology support
http://commons.wikimedia.org/wiki/File:Symptoms_of_multiple_sclerosis.svg
Dynamic "Sweet Spot"
Chiauzzi (PI), Hekler (Co-I...
Enabling precision behavior change
https://www.apple.com/iwatch/
Building the ecosystem of precision
https://www.apple.com/ios/whats-new/health/ http://researchkit.github.io/
Academia now
Flickr-alsotop
What we should be
Flickr-Stuck in Customs
Classic evidence pipeline
Phase 1
Define &
Design
Phase 2
Pilot and
Proof of
Concept
Phase 3
Efficacy
Trial
(RCT)
Phase 4
...
What do we get from RCTs?
Stead LF, Lancaster T. Group behaviour therapy programmes for smoking cessation. Cochrane Databa...
What do we get from RCTs?
Mohr DC, Ho J, Hart TL, Baron KG, Berendsen M, Beckner V, et al. Translational Behavioral Medici...
What do we get from RCTs?
@ehekler
@ehekler
What are useful products from science?
What are useful products from science?
Flickr – Metrix X
2005 2006 2007 2008 2009 2010 2011 2012
Conceive
of a study
Gather
Pilot Data
Submit
Grant
Receive
Fundi...
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
Smaller meaningful tools of precision
@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 de...
System identification “informative” experiment
-100
100
300
500
700
900
1100
1300
1500
0
2000
4000
6000
8000
10000
12000
1...
Agile science
www.agilescience.org@ehekler
Agile science products
• Modules
• System architectures
• Matchmaking algorithms
@ehekler www.agilescience.org
Modules
Smallest, meaningful, repurposable, and concrete
Flickr - Benjamin Esham@ehekler www.agilescience.org
System architecture
wwww.agilescience.org@ehekler
Matchmaking algorithms
@ehekler www.agilescience.org
Getting scientists to amplify creativity
@ehekler
“Perfect” intervention Tools for meaningful moments
Flickr - Paul Swanse...
Agile science process
@ehekler
Sprint phase
@ehekler
methodology.psu.edu
Optimization phase
@ehekler
Product release
www.agilescience.org
Build & iterate together
www.pacoapp.com@ehekler
Ecosystem of precision
https://www.apple.com/ios/whats-new/health/ http://researchkit.github.io/
Enabling precision behavior change
@ehekler
Move scientists from building & evaluating
@ehekler
this, to this.
Flickr - Paul Swansen Flickr - Benjamin Esham
To amplify creativity of individuals to create this
Flickr- Tony Fischer@ehekler
Thank you!
Dr. Eric Hekler
Arizona State University
ehekler@asu.edu
@ehekler
Flickr- Tony Fischer
Amplifying Humanity via Precision Behavior Change
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Amplifying Humanity via Precision Behavior Change

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The purpose of this talk is to suggest concepts about behavior change that Apple could further enable with the Apple Watch, HealthKit, and ResearchKit. Concepts in this talk include: precision behavior change, designing silence to support meaningful moments to ensure technology is appropriately used in life, and building an research frameworks that match the pace of technology and enable better collective action for enhancing humanity.

Published in: Health & Medicine
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Amplifying Humanity via Precision Behavior Change

  1. 1. Amplifying humanity via precision behavior change Dr. Eric Hekler Director Designing Health Lab Arizona State University @ehekler Talk @ Apple 5/19/2015 Flickr -B.S. Wise
  2. 2. Amplifying creativity www.apple.com
  3. 3. http://youtu.be/QPKKQnijnsM Flickr – just.Luc Flickr-meanMrmustard
  4. 4. 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.
  5. 5. @ehekler
  6. 6. 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
  7. 7. Open science @ehekler
  8. 8. We need help… friko-diamondsdesigns.blogspot.com
  9. 9. Flickr – Stuck in Customs@ehekler Personal, powerful, & pervasive https://www.apple.com/iwatch/
  10. 10. What is precision behavior change? @ehekler Just in time Adaptive Flickr -Casgen
  11. 11. Meaningful moments https://www.google.com/culturalinstitute/u/0/asset-viewer/luncheon-of-the-boating- party/mgHsTKDNJVzPAg?utm_source=google&utm_medium=kp&hl=en&projectId=art-project
  12. 12. Ping pollution Flickr_Eric_Longstaff Flickr_Alex_Valentinehttp://globalmoxie.com/blog/smart-watches-wearables-data-rash.shtml
  13. 13. Design silence http://www.123posters.com/images/f-mdavis.jpg
  14. 14. Meaningful moments Flickr - Dave Gray
  15. 15. Flickr - Rob Marquardt@ehekler Opportunity
  16. 16. Receptivity 0 1 2 3 4 5 6 7 8 9 10 1 4 7 10 13 16 19 22 Value/Burden(10=high) Interactions with the system Value/burden ratio Value Burden
  17. 17. Eric Hekler (ASU)Aaron Coleman (Fitabase) Sayali Phatak (ASU) Exploring Strategies to Improve Acceptability and Usability of a Just In Time Adaptive Intervention via Incorporation of Proximity Sensors and a Smartwatch
  18. 18. Why Context Matters (fictitious hourly activity graph)
  19. 19. Why Context Matters Nightstand Nightstand Nightstand Nightstand Nightstand Nightstand Nightstand Nightstand Nightstand Nightstand Desk Desk Desk Desk Desk Desk Desk Desk Desk Desk Home Home Home Home Home Home Home Home HomeHome Home
  20. 20. The honeybee is nature’s best collector and communicator of data. Project HoneyBee explores the transformational promise of continuous physiological measurement to sustain health through the prevention and early detection of disease. HoneyBee’s Clinical Validation Network for Observational Clinical Trials (OCTs)
  21. 21. Precision adaptation Individual/User Controlled System Controlled Individual/System Balanced Control @ehekler www.agilescience.orgHeartSteps NIH-Funded (PI, Klasnja)
  22. 22. System-controlled – “Giving a fish” NSF IIS-1449751: EAGER: Defining a Dynamical Behavioral Model to Support a Just in Time Adaptive Intervention, PIs, Hekler & Rivera @ehekler
  23. 23. 0 2000 4000 6000 8000 10000 12000 14000 1000 3000 5000 7000 9000 11000 13000 15000 ActualDailySteps Recommended Goal Dynamic "Sweet Spot"
  24. 24. Impacting the sweet spot @ehekler
  25. 25. Personal trajectory predictions Hekler, et al. 2013 Health Education and Behavior @ehekler
  26. 26. Message selection based on: - time of day - location - weather - current activity Two types of messages: - promote activity - interrupt sedentary behavior Klasnja, P. (PI), Hekler, E.B., (Co-I), Tewari, A., (Co-I), Jackson, E., (Co-I)), Murphy, S., (Co-I)) NHLBI, R01HL125440
  27. 27. Eric Hekler, Jisoo Lee, Erin Walker, Winslow Burleson, Arizona State University; Bob Evans, Google Flickr Juhan Sonin Individual-controlled – “Teach to Fish”
  28. 28. Goal Behavior Change Technique(s) Create a plan Plan = + @ehekler
  29. 29. Measure success towards goal Results Evaluate your plan Plan + Implement for 1 week @ehekler
  30. 30. Technology support
  31. 31. http://commons.wikimedia.org/wiki/File:Symptoms_of_multiple_sclerosis.svg Dynamic "Sweet Spot" Chiauzzi (PI), Hekler (Co-I), Rodarte(Co-I),
  32. 32. Enabling precision behavior change https://www.apple.com/iwatch/
  33. 33. Building the ecosystem of precision https://www.apple.com/ios/whats-new/health/ http://researchkit.github.io/
  34. 34. Academia now Flickr-alsotop What we should be Flickr-Stuck in Customs
  35. 35. Classic evidence pipeline Phase 1 Define & Design Phase 2 Pilot and Proof of Concept Phase 3 Efficacy Trial (RCT) Phase 4 Effectiveness Trial @ehekler
  36. 36. 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
  37. 37. 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
  38. 38. What do we get from RCTs? @ehekler
  39. 39. @ehekler What are useful products from science?
  40. 40. What are useful products from science?
  41. 41. 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
  42. 42. Horst Rittel’s “wicked problems” Rith C, Dubberly H. Why Horst WJ Rittel matters. Design Issues. 2007;23(1):72-91. @ehekler
  43. 43. Wicked problems reformulated @ehekler
  44. 44. Smaller meaningful tools of precision @ehekler
  45. 45. Linda M. Collins The Methodology Center Penn State methodology.psu.edu@ehekler
  46. 46. 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, under review
  47. 47. System identification “informative” experiment -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: EAGER: Defining a Dynamical Behavioral Model to Support a Just in Time Adaptive Intervention, PIs, Hekler & Rivera
  48. 48. Agile science www.agilescience.org@ehekler
  49. 49. Agile science products • Modules • System architectures • Matchmaking algorithms @ehekler www.agilescience.org
  50. 50. Modules Smallest, meaningful, repurposable, and concrete Flickr - Benjamin Esham@ehekler www.agilescience.org
  51. 51. System architecture wwww.agilescience.org@ehekler
  52. 52. Matchmaking algorithms @ehekler www.agilescience.org
  53. 53. Getting scientists to amplify creativity @ehekler “Perfect” intervention Tools for meaningful moments Flickr - Paul Swansen Flickr - Benjamin Esham www.agilescience.org
  54. 54. Agile science process @ehekler
  55. 55. Sprint phase @ehekler
  56. 56. methodology.psu.edu Optimization phase @ehekler
  57. 57. Product release www.agilescience.org
  58. 58. Build & iterate together www.pacoapp.com@ehekler
  59. 59. Ecosystem of precision https://www.apple.com/ios/whats-new/health/ http://researchkit.github.io/
  60. 60. Enabling precision behavior change @ehekler
  61. 61. Move scientists from building & evaluating @ehekler this, to this. Flickr - Paul Swansen Flickr - Benjamin Esham
  62. 62. To amplify creativity of individuals to create this Flickr- Tony Fischer@ehekler
  63. 63. Thank you! Dr. Eric Hekler Arizona State University ehekler@asu.edu @ehekler Flickr- Tony Fischer

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