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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: 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