Just-In-Time, Adaptive Intervention framework for lifelong healthy dietary habits

1. Just-In-Time, Adaptive Intervention frameworkfor lifelong healthy dietary habits Donna Spruijt-Metz, MFA PhD Research Professor, Psychology Director, USC mHealth Collaboratory University of Southern California dmetz@usc.edu @metzlab @ NSF International Workshop on Dynamic Modeling of Health Behavior Change and Maintenance, Sept 8-9, 2015, London, UK

2. What, when, where and how • Skyler lives within a system of embedded systems (family, workplace, community, etc.) • Given how little we know of the dynamics of these systems in real time, choose 1 (family) • Use current behavioral evidence • Using food as reward or self medication • Stress & stressful interactions • Modeling • Availability • & Theories of choice • Self-regulation/self-control strength model (Muraven & BaumesiterPsyc Bull 2000) • Some form of family Systems Theory (McHale, Amato, Booth 2014) • To inform development of a learning sensor system to collect data describe eating behaviors in time and context • Wearable & deployable sensors that have pull as well as push capabilities. NSF SCH 1521722, Spruijt-Metz, Stancovic, Lach & De LaHaye

3. What, when, where and how • Using data accrued, develop dynamic models of selected and discovered behaviors to understand behavior (interactions, loops) in system in real time • Conceptually seeded with current behavioral theories & behavioral evidence • ‘Cycle out’ constructs when they no longer appear to contribute to the model, • Cycle in new ones as they are ‘discovered’ in an iterative fashion • This is a transdisciplinary effort • Use these models to inform choices on what, when and where to intervene on these models • Base “how” on theory and iterative user-centered design. NSF SCH 1521722, Spruijt-Metz, Stancovic, Lach & De LaHaye

4. Self-Regulation of Eating in real-time & in context FED System Dynamic Model + A1 angry tone Duration C1: EE-4 + + + A1 speed of eating + C1: EE-4 C1 speed of Eating A1 mimic C1 + + + A1 Stress C1 Stress A1: EE-4 + + + - + + C1 Self Regulation C2: EE-3 Social Facilitation - - + C2 mimic C1 A1 self-regulation Legend Family Members C1 = Child 1 C2 = Child 2 A1 = Adult 1 A2 = Adult 2 Eating Event Categories Hunger No Hunger Meal EE-1 EE-2 Snack EE-3 EE-4 NSF SCH 1521722, Spruijt-Metz, Stancovic, Lach & De LaHaye

5. Current knowledge on behavior & theory breaks here: Multilevel & Multisystem Time System Within-Individual Family Momentary Self-Control strength Modeling eating sweets Within a day Self-Control depletion Stressful interactions Availability of sweets Over a week Self-Control replenishing Months Ability to self-regulate mood System of dinner table stressors Spruijt-Metz, Hekler, Saranummi, Intille, Korhonen, Nilsen, Rivera, Spring, Michie, Asch, Sanna, Salcedo, Kukafka, Pavel, Trans Beh Med 2015 Parent Child-feeding practices Years Develop healthy eating habits

6. Not just when in need: Learning algorithms • Meaningful moments • Receptivity1 • Availability2 • Opportune moments3 • In need and/or vulnerable • Receptive and/or available • Motivated and/or able 1 Nahum-Shani, Hekler, Spruijt-Metz, Health Psyc in press 2 Sharmin, Ali, Rahman, Bari, Hossain, Kumar, UbiComp’14 3Poppinga, Heuten, Boll, Pervasive Computing 2014

7. Baseline data: What and how long?Combining sensing & Self-report Momentary level • Eating episodes (with whom, quality of interactions, where, when, speed, duration, stress, external cues/temptation – if possible, what) • Antecedents (physical activity, proximity to others, satiety, hunger, mood, access) • Outcomes (stress relief, self-control depletion) Dynamic models to determine • Meaningful moments • How momentary behavior, emotion, cognition and environment interact • And how they interact with past behavior, emotion, cognition

8. Baseline data: What and how long?Combining sensing & Self-report Periodically • Impulsivity • Chronic stressors • Pantry inventory & shopping habits • Whatever else choices of theory/behavior dictate These get fed into the multilevel models.

9. Framework: prompting, pulling and pushing information, decision rules • Prompts via phone, via deployable and wearable sensors, via network members – at meaningful moments • Models will inform choices of data to acquire, sensors, platforms, types of messages, when/where to intervene, decision rules • Models will need to be run in an ongoing fashion (decision rule needed here too) in order to continue adaptation ‘on the fly’ – the intervention targets and messaging will evolve as person changes. • One can’t model everything all the time. Choices will need to be made to achieve some kind of parsimony