CP 4: Control Systems Engineering for Counteracting Notification Fatigue: An Examination of Health Behavior Change

In this paper we present BayesLDM, a system for Bayesian longitudinal data modeling consisting of a high-level modeling language with specific features for modeling complex multivariate time series data coupled with a compiler that can produce optimized probabilistic program code for performing inference in the specified model. BayesLDM supports modeling of Bayesian network models with a specific focus on the efficient, declarative specification of dynamic Bayesian Networks (DBNs). The BayesLDM compiler combines a model specification with inspection of available data and outputs code for performing Bayesian inference for unknown model parameters while simultaneously handling missing data. These capabilities have the potential to significantly accelerate iterative modeling workflows in domains that involve the analysis of complex longitudinal data by abstracting away the process of producing computationally efficient probabilistic inference code. We describe the BayesLDM system components, evaluate the efficiency of representation and inference optimizations and provide an illustrative example of the application of the system to analyzing heterogeneous and partially observed mobile health data.

Digital behavior change interventions (DBCIs) are feasibly effective tools for addressing physical activity. However, in-depth understanding of participants’ long-term engagement with DBCIs remains sparse. Since the effectiveness of DBCIs to impact behavior change depends, in part, upon participant engagement, there is a need to better understand engagement as a dynamic process in response to an individual’s ever-changing biological, psychological, social, and environmental context. The year-long micro-randomized trial (MRT) HeartSteps II provides an unprecedented opportunity to investigate DBCI engagement among ethnically diverse participants. We combined data streams from wearable sensors (Fitbit Versa, i.e., walking behavior), the HeartSteps II app (i.e. page views), and ecological momentary assessments (EMAs, i.e. perceived intrinsic and extrinsic motivation) to build the idiographic models. A system identification approach and a fluid analogy model were used to conduct autoregressive with exogenous input (ARX) analyses that tested hypothesized relationships between these variables inspired by Self-Determination Theory (SDT) with DBCI engagement through time.
Data from 11 HeartSteps II participants was used to test aspects of the hypothesized SDT dynamic model. Across individuals, the number of daily notification prompts received by the participant was positively associated with increased app page views. The weekend/weekday indicator and perceived daily busyness were also found to be key predictors of the number of daily application page views. This novel approach has significant implications for both personalized and adaptive DBCIs by identifying factors that foster or undermine engagement in an individual’s respective context. Once identified, these factors can be tailored to promote engagement and support sustained behavior change over time.

Digital behavior change interventions (DBCIs) such as “just-in-time” adaptive interventions (JITAIs) have demonstrated efficacy for increasing physical activity behavior. However, the effectiveness of these interventions is heavily dependent upon user engagement. Despite the inherent dynamic nature of engagement, as it varies over time based on an individual’s changing environment, context, and psychological state, the current understanding of engagement primarily comes from static snapshots of the behavior. The availability of intensive longitudinal data from JITAIs provides a unique opportunity to build and test dynamic models of behavior change from a process systems lens, relying on prediction-error methods from system identification. However, data missingness is a significant practical consideration in this process. Therefore, in this work we address missingness using a Bayesian imputation approach, which we evaluate using data from the HeartSteps II JITAI. Ultimately, the methods presented support the discovery of key factors that impact engagement behavior over time and can play an important role in the development of large-scale personalized interventions.

Behavioral health problems such as physical inactivity are among the main causes of mortality around the world. Mobile and wireless health (mHealth) interventions offer the opportunity for applying control engineering concepts in behavioral change settings. Social Cognitive Theory (SCT) is among the most influential theories of health behavior and has been used as the conceptual basis of many behavioral interventions. This dissertation examines adaptive behavioral interventions for physical inactivity problems based on SCT using system identification and control engineering principles. First, a dynamical model of SCT using fluid analogies is developed. The model is used throughout the dissertation to evaluate system identification approaches and to develop control strategies based on Hybrid Model Predictive Control (HMPC). An initial system identification informative experiment is designed to obtain basic insights about the system. Based on the informative experimental results, a second optimized experiment is developed as the solution of a formal constrained optimization problem. The concept of Identification Test Monitoring (ITM) is developed for determining experimental duration and adjustments to the input signals in real time. ITM relies on deterministic signals, such as multisines, and uncertainty regions resulting from frequency domain transfer function estimation that is performed during experimental execution. ITM is motivated by practical considerations in behavioral interventions; however, a generalized approach is presented for broad-based multivariable application settings such as process control. Stopping criteria for the experimental test utilizing ITM are developed using both open-loop and robust control considerations.

A closed-loop intensively adaptive intervention for physical activity is proposed relying on a controller formulation based on HMPC. The discrete and logical features of HMPC naturally address the categorical nature of the intervention components that include behavioral goals and reward points. The intervention incorporates online controller reconfiguration to manage the transition between the behavioral initiation and maintenance training stages. Simulation results are presented to illustrate the performance of the system using a model for a hypothetical participant under realistic conditions that include uncertainty. The contributions of this dissertation can ultimately impact novel applications of cyberphysical system in medical applications.