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Technical Research Centre
of Finland
International Workshop on New Computationally-Enabled Theoretical Models
to Support Health Behavior Change and Maintenance, Brussels, Belgium, October
16-17, 2012
Computationally-modelling health decision making
processes, especially the dynamic nature of such
processes, in a way that cross-cuts health behavior
change silos and incorporates “irrationality.”
Cristina Botella. Universitat Jaume I (Spain)
...health decision making processes…..
…made
by a very complex organism… a
human being.
CONCEPT OF HUMAN BEING
We actively contribute to the
building of our own experience:
“Participatory Universe”
John Archibald Wheeler
• “OPEN” SYSTEM
• “LIVING” SYSTEM
“Black hole”
Model of health-related behavior
Series of research studies to test the different parts of the model and provide
data regarding the role of each factor and variable:
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Which genes?
Which theoretical approaches?
Which personality dimensions?
Which cultural contexts?
Which values and beliefs?
Which health habit/s?
Which specific behaviors?
Which legal contexts?
Which is the role of variables such as sex, age, educational level or socioeconomical level?
 Which ICTs devices could be used?
 Which assessment procedures and instruments are suitable for the defined
factors and variables.
General Theory of Systems
Ludwig von Bertalanffy
There are common principles of organization in various disciplines, such as physics,
chemistry, biology, and sociology.
He developed a set of universal principles applying to systems in general and
emphasized that real systems are open to, and interact with their environments.
Systems and Systems Thinking
 A system is a group of elements that operate in unison to
form a larger distinct entity that is subject to analysis.
 These entities, or metasystems, are so ubiquitous in our
environment that we take them for granted (we refer to a wide
variety of systems such as the air conditioning system, the
computer system, the electrical system, the transportation
system, the economic system, and the healthcare system).
 Rarely do we consider the complexity of these systems, their
interactivity, or their global effect on our environment.
 Bertalanffy emphasizes that real systems are open to, and
interact with their environments so that they acquire new
properties resulting in continued evolution and increased
complexity of the systems.
Selye (1956):
“The secret of health and happiness lies in successful
adaptation to the ever-changing conditions of the globe; the
penalties for failure in this great process of adaptation are
disease and unhappiness.”
Different people in different environments,
with different cultures and values
Frederick H. Kanfer
His seminal research on
self-control and applications
to the therapeutic process
provided the foundation for
modern theories of selfmanagement and cognitivebehavior therapy methods
widely practiced today.
Temporal gradient of self-control
Self-regulatory techniques have been examined as primary interventions
with adult problem behaviors with generally favorable results.
(Bandura,1986, 1991; Kanfer, 1970; Kanfer & Hagerman, 1981; Kanfer & Karoly, 1972; Kanfer
& Schefft, 1988).
Temporal gradient of self-control
It is a problem of the effects of different behaviors
 Physical exercise
 Overeating
 Smoking
- short term
- long term
Show the person the consequences in the short
and long term,
and make him/her aware of them now
Self-Determination Theory Applied to
Health Contexts
Self-determination theory (SDT) maintains that an understanding of human motivation requires a
consideration of psychological needs for competence, autonomy, and relatedness.
The SDT emphasizes that needs specify the necessary conditions for psychological growth,
integrity, and well-being.
Different regulatory processes underlying goal pursuits are differentially associated with effective
functioning and well-being, and also that different goal contents have different relations to the
quality of behavior and mental health, specifically because different regulatory processes and
different goal contents are associated with differing degrees of need satisfaction.
Social contexts and individual differences that support satisfaction of the basic needs facilitate
natural growth processes including intrinsically motivated behavior and integration of extrinsic
motivations, whereas those that forestall autonomy, competence, or relatedness are associated
with poorer motivation, performance, and well-being.
Self-Determination Theory Applied to
Health Contexts
The Self-Determination Theory Model for maintained behavior change. Model presents key constructs of
health behavior change and the expected relationships among them. Autonomy is central to maintained behavior
change through is effects on competence and self-regulation. Silva et al. BMC Public Health 2008 8:234
Self-Determination Theory Applied to
Health Contexts
 When patients have their psychological needs for autonomy, competence, and
relatedness supported in the process of their health care, they experience more
volitional engagement in treatment and maintain outcomes better over time.
 This pattern of findings appears to hold for broad lifestyle changes such as
smoking cessation or dietary regulation, as well as discrete behaviors such as the
adherent use of medications.
“Irrationality”
Self-control
dilemmas
Which simple heuristic are people using
in these situations?
Ecological Rationality: Intelligence
in the World
Gerd Gigerenzer
Simple Heuristics That Make Us Smart (1999)
Bounded Rationality: The Adaptive Toolbox (2001)
Reckoning with Risk: Learning to Live with Uncertainty (2002)
Gut Feelings: The Intelligence of the Unconscious (2007)
Rationality for Mortals (2012) investigates decisions under limited time and information
Ecological Rationality: Intelligence in the World
Explores how people can be effective decision makers by using simple
heuristics that fit well into the structure of the environment.
When we wield the right tool from the mind’s adaptive toolbox for a particular
situation, we can make good choices with little information or computation.
Heuristics are not good or bad, “biased” or “unbiased,” on their own, but only
in relation to the setting in which they are used.
Heuristics and environments fitting together to produce good decisions, in
situations including doctor/patient interactions.
To study mind and environment in tandem.
Ecological Rationality: Intelligence
in the World
Rationality:
 "More information is always better, and full information is best. More computation
is always better, and optimization is best."
 More-is-better ideals such as these have long shaped our vision of rationality.
Ecological Rationality:
 Humans and other animals typically rely on simple heuristics to solve adaptive
problems, focusing on one or a few important cues and ignoring the rest, and
shortcutting computation rather than striving for as much as possible.
 In an uncertain world, more information and computation are not always better,
the important point is to know when, and why, less can be more.
 ¿How we are able to achieve intelligence in the world by using simple heuristics
matched to the environments we face, exploiting the structures inherent in our
physical, biological, social, and cultural surroundings?
Antonio Damasio
- Descartes' Error
- The Feeling of What Happens: Body and Emotion in the
Making of Consciousness
- Looking for Spinoza: Joy, Sorrow, and the Feeling Brain
- Self Comes to Mind: Constructing the Conscious Brain
 Emotions are part of homeostatic regulation and are
rooted in reward/punishment mechanisms.
Emotions
 His research has helped to elucidate the neural basis for the emotions and has
shown that emotions play a central role in social cognition and decisionmaking.
Emotions
Positive emotions increase the number
of potential behavioral options,
promote cognitive flexibility and
psychological resources and
strengths that become very useful
for us over time.
Barbara L. Fredrickson
Broaden-and-build theory
ICT and Health
Computers
Persuasion
PDAs
Web sites
Videogames
Mobile phones
Smart
environments
Virtual Reality
CAPTOLOGY
Behavior change
Motivation
Attitudes change
Change in world
view
Compliance
Serious Games
Persuasives Tecnologies
ICTs and Health
Internet based self-applied interventions
The Smartphone Manifesto (Miller, 2012)
“Smartphone research will require new
skills in app development and data
analysis and will raise tough new ethical
issues, but smartphones could transform
psychology even more profoundly than
PCs and brain imaging did”.
Ecological Momentary Assessment (EMA)
 EMA involves repeated sampling of subjects’ current behaviors and experiences in real time, in subjects’
natural environments.
 EMA aims to minimize recall bias, maximize ecological validity, and allow study of micro-processes that
influence behavior in real-world contexts.
 EMA studies assess particular events in subjects’ lives or assess subjects at periodic intervals, often by
random time sampling, using technologies ranging from written diaries and telephones to electronic diaries
and physiological sensors.
 EMA holds unique promise to advance the science and practice of clinical psychology by shedding light on
the dynamics of behavior in real-world settings.
Ecological Momentary Assessment (EMA)
Ecological Momentary Motivation
iPhone
How could we provide people the key information at the key moment, helping them to
do the “right” choices?
That is, how could we use ICTs tools in order to provide people with useful and “nonirrational” heuristics?
ICTs pervasive tools embedded in the environment to serve people as guides and
motivational devices helping them to achieve “savvy decisions”.
The Smartphone Manifesto (Miller, 2012)
• We can use these devices in order to
provide the person with key information
and motivation at key moments.
• The new ICT based “heuristic” can
promote a new and useful “irrationality”
Marketing viral strategies
Viral marketing refers to marketing techniques that use pre-existing social
networks and other technologies to produce increases in brand awareness or
to achieve other marketing objectives (such as product sales) through selfreplicating viral processes, analogous to the spread of viruses or computer
viruses.
Huge Data Base
Huge data base: changing the way science is done, enabling new kinds of applications, furthering
citizen involvement, spawning a new class of software for processing big data and new
interdisciplinary class of “data scientists” to help utilize all this data.
Much of the potential value of data is to society at large: more data has the potential to facilitate
enhanced scientific collaboration and reproducibility, useful for speeding discovery and
understanding of solutions to planetary and societal needs.
Concept of “Crowd-sourcing” (Travis, 2008) and “Crowdfunding” (Gaggioli & Riva, 2008) captured in the power of all
and every person who make up humankind (at least, those
with access to the sophisticated ICTs).
Crowd Researching
Show people that they can get a healthier society
A place for people interested in
self-tracking to gather, share
knowledge and experiences,
and discover resources.
Nuevas ayudas
para el ser humano
Avatars
Robots
Virtual asistents
Sensors
Some ethical cautions
I “need” to be conected
Some ethical cautions
 We do not know the long term effects
this may have on the functioning of
the human being as a social being,
and even to its development from a
physical standpoint.
 It is possible that new digital natives
(Marc Prensky), our descendants no
longer need legs.
 Maybe they don’t need to go
anywhere because all the information,
all the fun, all they need and may
require can be brought to them.
 Much of life becomes digital.
Some ethical cautions
Kurzweil (2005)
•
To what extent the modification of the world could
bring out a different consciousness in a human being
living in mixed physical and virtual realities?
•
The merger between humans and technology is only
the precursor stage, as is increasingly become more
important non-biological intelligence.
•
This new intelligence is here yet and undoubtedly
occupies and governs much of our lives.
•
It can redesign itself, it can get better and better, and
also at increasingly accelerated pace.
•
The really dangerous aspect is that human
intelligence has not progressed sufficiently, perhaps
not even come to realize what is happening, or that it
can not even come to understand.
The future depends on us