Indexing stories for conversational health interventions
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Indexing stories for conversational health interventions
- 1. Indexing Stories for Conversational Health Interventions Ramesh Manuvinakurike, Barbara Barry, Timothy Bickmore College of Computer and Information Science, Northeastern University 360 Huntington Ave, WVH 202, Boston, MA-02120 AAAI Spring Symposium 2013, Data Driven Wellness Track
- 2. Motivation • 39% (PEW Report 2013) of people query online to find information about people with same health condition • 26% of people using internet have read/watched someone else’s experience in last 12 months • 16% of online health information seekers search specifically for someone sharing the same health condition • Millions of real patient stories available on the internet in specialized websites for patient experience stories (patientslikeme, experience project, webmd, Healthtalkonline etc.)
- 3. Motivation • Stories have tremendous potential to motivate health behavior changes. • Houston.T et.al painstakingly collected real patient stories (narrated and stored in D.V.Ds) for Hypertension intervention. • The stories were matched to the patients manually and delivered. • Can the process of matching and delivery be automated by using stories found online for successful health interventions?
- 4. Past Works • Used random stories, anecdotes, humor for awareness and long term engagement. (Velicer, Bickmore et.al, 2009) • Random storytelling for patient companionships in Hospitals. (Bickmore et.al 2012) • Situational Storytelling for pre-conception care and awareness and many more..
- 5. Example : For a Male, 24-25 looking for stories to lose weight STORY 1 STORY 2 I became pregnant with my second When you're doing shift work and child. But this time I gained around having lunch at nine in the morning it 80 pounds while carrying Tyson, my doesn't give you many options. The son. The extra weight took a huge toll only places open are fast food chains on me emotionally. I was so ashamed and kebab shops. The irregular hours to weigh 248 pounds. I had to lose also encouraged his soft drink habit weight for children and set a good ….. Set a goal. Find something to train example for them. I was also for like a race, party or trip away to diabetic…. keep you motivated. Do it yourself. You can eat the food you want…… This could get worse
- 6. Indexing Scheme Transtheoretical Model Change Tailoring Theory Quality Metrics (TTM) Get the stories Demographics Stage of change (Age, Gender, Model Profession, Emotions Index the stories education levels) Obtain information Processes of change Model Culture/Ethnicity Cohesion from users Match the stories Pros and Cons Celebrity Model storyteller Deliver the stories Health Conditions
- 7. Transtheoretical Model of Change(TTM) • Health behavior change as a continuum from not considering a health behavior to maintaining a health behavior. • Enumerates activities in which users engage to change Health Behavior (Called Processes of change).
- 8. Transtheoretical Model of Change(TTM) • Not considering a health behavior change • Health behavior Precontemplation • Ex : I don’t think I need to lose weight change as a continuum from not considering a health behavior to maintaining a health behavior. • Enumerates activities in which users engage to change Health Behavior (Called Processes of change).
- 9. Transtheoretical Model of Change(TTM) • Not considering a health behavior change • Health behavior Precontemplation • Ex : I don’t think I need to lose weight change as a continuum from not • Thinking about health behavior change considering a health Contemplation • Ex: May be I should lose weight because I get tired easily behavior to maintaining a health behavior. • Enumerates activities in which users engage to change Health Behavior (Called Processes of change).
- 10. Transtheoretical Model of Change(TTM) • Not considering a health behavior change • Health behavior Precontemplation • Ex : I don’t think I need to lose weight change as a continuum from not • Thinking about health behavior change considering a health Contemplation • Ex: May be I should lose weight because I get tired easily behavior to maintaining a health • Taking action in near future behavior. Preparation • Ex: I will join a weight loss program and start exercising regularly • Enumerates activities in which users engage to change Health Behavior (Called Processes of change).
- 11. Transtheoretical Model of Change(TTM) • Not considering a health behavior change • Health behavior Precontemplation • Ex : I don’t think I need to lose weight change as a continuum from not • Thinking about health behavior change considering a health Contemplation • Ex: May be I should lose weight because I get tired easily behavior to maintaining a health Preparation • Taking action in near future behavior. • Ex: I will join a weight loss program and start exercising regularly • Enumerates activities • Making Attempts Action • Ex: I exercise 3 days per week now. in which users engage to change Health Behavior (Called Processes of change).
- 12. Transtheoretical Model of Change(TTM) • Not considering a health behavior change • Health behavior Precontemplation • Ex : I don’t think I need to lose weight change as a continuum from not • Thinking about health behavior change considering a health Contemplation • Ex: May be I should lose weight because I get tired easily behavior to maintaining a health Preparation • Taking action in near future • Ex: I will join a weight loss program and behavior. start exercising regularly • Making Attempts • Enumerates activities Action • Ex: I exercise 3 days per week now. in which users engage to change Health • Avoiding relapse Behavior (Called Maintenance • Ex: I should keep exercising to avoid gaining more weight Processes of change).
- 13. Transtheoretical Model of Change (Weight loss Example) Examples : (Processes of change) (1) “ I read an article in my husband's health STAGES Precontemplation Contemplation Preparation Action Maintanence magazine about BMI and life expectancy PR0CESSES Consciousness Raising it said that being obese can shorten your Counter Conditioning life by five to 10 years. That was scary. I didn't want to miss out on any moments with my son just because of poor eating patterns. … ‘Consciousness Raising’ (2) “ Do it yourself. You can eat the food you like but just make it yourself instead. Instead of buying a kebab, cook some chicken and put it in a wrap with lettuce and chilli sauce.” – ‘Counter Conditioning • Stories obtained from experienceproject.com and healthtalkonline.org (substituting)’ to progress through stages.
- 14. Transtheoretical Model of Change (Weight loss Example) Examples : (Processes of change) (1) “ I read an article in my husband's health STAGES Precontemplation Contemplation Preparation Action Maintanence magazine about BMI and life expectancy Consciousness Raising it said that being obese can shorten your Environmental Reevaluation life by five to 10 years. That was scary. I Dramatic Relief didn't want to miss out on any moments Helping Relationships with my son just because of poor eating Social Liberation patterns. … ‘Consciousness Raising’ PROCESSES Self Liberation Self Reevaluation (2) “ Do it yourself. You can eat the food you Stimulus control like but just make it yourself instead. Substance Use Instead of buying a kebab, cook some Counter Conditioning chicken and put it in a wrap with lettuce Reinforcement Management and chilli sauce.” – ‘Counter Conditioning (substituting)’ to progress through stages.
- 15. Index Construction Algorithms Indexes Algorithms Processes of Change (TTM) Classification Algorithms (Machine Learning) Age Regular Expressions/Pattern matching Gender Gender Detection Algorithm (Cheng et.al, 2011) Geography, Race, Ethnicity, Profession, Keywords Stigmatized Groups, Health Condition Emotions Sentiment Analysis Cohesion Coh-Metrix
- 16. Preliminary Results • Processes of Change classification (Boosting with weak learners) Correctly Classified Instances : 87.6923 % Incorrectly Classified Instances : 12.3077 % (Decision Trees using Decision Stumps) Correctly Classified Instances : 88.4615 % Incorrectly Classified Instances : 11.5385 % • Gender Detection Accuracy : 72.7 %
- 17. Future Work • 2 X 2 randomized evaluation of the algorithms. Agent + Indexing Agent + Random No Agent + Indexing No Agent + Random • Integrate this capability into a counseling agent for longitudinal health behavior changes. • Evaluate indexes • Automate story crawling
- 18. THANK YOU Special thanks to : Prof Timothy Bickmore, Barabara Barry, Takashi Kido, Lazlo Ring, Kathleen Totzke, Zack and rest of Relational Agents Group
Editor's Notes
- Recent PEW studies also indicated that nearly 21 – 26% of the people tried to find stories of someone who had the same health condition. Effectiveness of stories in health intervention kept aside, there are people who voluntarily search for the experiences of people someone similar to them. There is also an interest from organizations such as experienceproject, patientslikeme, healthtalkonline etc. who provide a platform for sharing stories with others. With potentially millions of real patient experiences on the web, can we build a system that indexes these stories and help people get the right story that they were looking for ? In this work we attempt to answer the question “Can this process of matching the stories be done automatically ?”
- Recent studies have showed that stories hold tremendous potential to motivate health behavior changes. One such example is a study by Thomas Houston. The study involved collecting stories of Hypertensions patients in DVDs as narrative videos. Randomized trials were conducted where these recorded narratives were matched to subjects manually and distributed for viewing. The subjects who received matched narratives recorded reduction in the blood pressures against those who received just information videos. But, the important point here is that large amounts of stories were matched manually by the research assistants using a predefined standard.Focus on manual matching is painful.
- Our recent works at Northeastern University have looked at Agent based storytelling intervention systems. The storytelling by these systems have either been random or pre scripted such that users listen to only a certain number of stories. Random stories, anecdotes and humor have been used successfully used for various purposes such as companionship, long tem health intervention and awareness. The results from these works have looked promising and have demonstrated a need for more relevant and personalized storytelling systems.
- The previous works on storytelling systems, such as the work of Houston, use Transtheoretical Model of Change and cultural parameters to match the stories to individuals. Tailoring theory has successfully used the idea of tailoring the stories to individuals based on demographics to achieve relevancy. Works by Pennebaker demonstrate the importance of quality of the stories to get the maximum benefits. Similarly many works demonstrate importance of different indexes used in our work. The list of indexes are constructed based on these previous studies. The prominent of these were transtheoretical model of health behavior change and tailoring theory. Lets take a look at TTM.
- Transtheoretical Model of Change or TTM has been successfully used in various health intervention studies. This model observes health behavior change as a continuum from a stage where a person is not considering a health behavior to a stage where he successfully maintains the behavior. These stages are listed here. As shown in the figure a person moves from the initial stage of precontemplation, where a person is not considering a health behavior progresses through contemplating, preparing, taking action and maintaining the behavior. He progresses using events or activities called processes of change.The person can go back and forth in TTM stages.
- Transtheoretical Model of Change or TTM has been successfully used in various health intervention studies. This model observes health behavior change as a continuum from a stage where a person is not considering a health behavior to a stage where he successfully maintains the behavior. These stages are listed here. As shown in the figure a person moves from the initial stage of precontemplation, where a person is not considering a health behavior progresses through contemplating, preparing, taking action and maintaining the behavior. He progresses using events or activities called processes of change.The person can go back and forth in TTM stages.
- Transtheoretical Model of Change or TTM has been successfully used in various health intervention studies. This model observes health behavior change as a continuum from a stage where a person is not considering a health behavior to a stage where he successfully maintains the behavior. These stages are listed here. As shown in the figure a person moves from the initial stage of precontemplation, where a person is not considering a health behavior progresses through contemplating, preparing, taking action and maintaining the behavior. He progresses using events or activities called processes of change.The person can go back and forth in TTM stages.
- Transtheoretical Model of Change or TTM has been successfully used in various health intervention studies. This model observes health behavior change as a continuum from a stage where a person is not considering a health behavior to a stage where he successfully maintains the behavior. These stages are listed here. As shown in the figure a person moves from the initial stage of precontemplation, where a person is not considering a health behavior progresses through contemplating, preparing, taking action and maintaining the behavior. He progresses using events or activities called processes of change.The person can go back and forth in TTM stages.
- Transtheoretical Model of Change or TTM has been successfully used in various health intervention studies. This model observes health behavior change as a continuum from a stage where a person is not considering a health behavior to a stage where he successfully maintains the behavior. These stages are listed here. As shown in the figure a person moves from the initial stage of precontemplation, where a person is not considering a health behavior progresses through contemplating, preparing, taking action and maintaining the behavior. He progresses using events or activities called processes of change.The person can go back and forth in TTM stages.
- Transtheoretical Model of Change or TTM has been successfully used in various health intervention studies. This model observes health behavior change as a continuum from a stage where a person is not considering a health behavior to a stage where he successfully maintains the behavior. These stages are listed here. As shown in the figure a person moves from the initial stage of precontemplation, where a person is not considering a health behavior progresses through contemplating, preparing, taking action and maintaining the behavior. He progresses using events or activities called processes of change.The person can go back and forth in TTM stages.
- Lets look at an example to gain a better understand the relation between the stages and processes. In the story <read (1)>, the lady learns about the dangers of being obese by reading an article. Learning about a health behavior is achieved using a process called consciousness raising. This is predominantly used by people in precontemplation and contemplation stages. From a stage of not considering (or probably not considering seriously) she moves to a stage of preparation. Similarly, the second person substitutes his old unhealthy eating habits with new ones. This predominantly used by people in the preparation or action stages. TTM defines this process as Counter Conditioning. The figure in the left defines the relation between the all stages and all the processes in TTM.Explicitly state that the person reads what stories. !
- Lets look at an example to gain a better understand the relation between the stages and processes. In the story <read (1)>, the lady learns about the dangers of being obese by reading an article. Learning about a health behavior is achieved using a process called consciousness raising. This is predominantly used by people in precontemplation and contemplation stages. From a stage of not considering (or probably not considering seriously) she moves to a stage of preparation. Similarly, the second person substitutes his old unhealthy eating habits with new ones. This predominantly used by people in the preparation or action stages. TTM defines this process as Counter Conditioning. The figure in the left defines the relation between the all stages and all the processes in TTM.Explicitly state that the person reads what stories. !
- Tailoring theory uses demographics matching to achieve the goal of relevant storytelling.We use these algorithms to construct the indexes automatically. These indexes can be constructed or predicted from any given story. We have implemented these algorithms and lets take a look at the preliminary results for processes of change and gender detection.We gathered these algorithms from various works ! Where I got these algorithms from.
- The preliminary results for processes of change have looked promising. For an initial dataset containing 260 weight loss stories we extracted a set of features and categorized the stories into processes. Then we do stage matching as shown earlier. This stage matching has produced an accuracy of around 87-88%. Gender detection performs with an accuracy of ~72%. We plan publish these results in detail in future.
- Going into the future we plan to do a 2 X 2 randomized evaluation of the algorithms. We plan to deliver the stories through agents, indexed and random. We also plan to provide only the story text, random and indexed and see how well the algorithm performs. We plan to integrate the ability of relevant storytelling by indexing large amounts of stories and using them in counseling agents for longitudinal health behaviors.