A Patient-Centered Proposal for Bayesian Analysis of Self-Experiments for Health

The rise of affordable sensors and apps has enabled people to monitor various health indicators via self-tracking. This trend encourages self-experimentation, a subset of self-tracking in which a person systematically explores potential causal relationships to try to answer questions about their health. Although recent research has investigated how to support the data collection necessary for self-experiments, less research has considered the best way to analyze data resulting from these self-experiments. Most tools default to using traditional frequentist methods. However, the US Agency for Healthcare Research and Quality recommends using Bayesian analysis for n-of-1 studies, arguing from a statistical perspective. To develop a complementary patient-centered perspective on the potential benefits of Bayesian analysis, this paper describes types of questions people want to answer via self-experimentation, as informed by (1) our experiences engaging with irritable bowel syndrome patients and their healthcare providers and (2) a survey investigating what questions individuals want to answer about their health and wellness. We provide examples of how those questions might be answered using (1) frequentist null hypothesis significance testing, (2) frequentist estimation, and (3) Bayesian estimation and prediction. We then provide design recommendations for analyses and visualizations that could help people answer and interpret such questions. We find the majority of the questions people want to answer with self-experimentation data are better answered with Bayesian methods than with frequentist methods. Our results therefore provide patient-centered support for the use of Bayesian analysis for n-of-1 studies.

[1]  Sean A. Munson,et al.  Uncertainty Displays Using Quantile Dotplots or CDFs Improve Transit Decision-Making , 2018, CHI.

[2]  Andrew Gelman,et al.  Why We (Usually) Don't Have to Worry About Multiple Comparisons , 2009, 0907.2478.

[3]  Steven L. Scott,et al.  Predicting the Present with Bayesian Structural Time Series , 2013, Int. J. Math. Model. Numer. Optimisation.

[4]  Torrin M. Liddell,et al.  The Bayesian New Statistics: Hypothesis testing, estimation, meta-analysis, and power analysis from a Bayesian perspective , 2016, Psychonomic bulletin & review.

[5]  Eun Kyoung Choe,et al.  Understanding and designing computing technologies that convey concerning health news , 2010 .

[6]  D. Mitra,et al.  All-Cause Health Care Charges among Managed Care Patients with Constipation and Comorbid Irritable Bowel Syndrome , 2011, Postgraduate medicine.

[7]  Syed Monowar Hossain,et al.  mPuff: automated detection of cigarette smoking puffs from respiration measurements , 2012, IPSN.

[8]  Karthik Desingh,et al.  Lessons Learned from Two Cohorts of Personal Informatics Self-Experiments , 2017, Proc. ACM Interact. Mob. Wearable Ubiquitous Technol..

[9]  Margaret M Heitkemper,et al.  A Comprehensive Self-Management Irritable Bowel Syndrome Program Produces Sustainable Changes in Behavior After 1 Year. , 2016, Clinical gastroenterology and hepatology : the official clinical practice journal of the American Gastroenterological Association.

[10]  G. Gigerenzer Mindless statistics , 2004 .

[11]  Jeffrey N. Rouder,et al.  Robust misinterpretation of confidence intervals , 2013, Psychonomic bulletin & review.

[12]  Ulf Bengtsson,et al.  Food-Related Gastrointestinal Symptoms in the Irritable Bowel Syndrome , 2001, Digestion.

[13]  Erin Walker,et al.  Self-Experimentation for Behavior Change: Design and Formative Evaluation of Two Approaches , 2017, CHI.

[14]  P. Cummings,et al.  Arguments for and against standardized mean differences (effect sizes). , 2011, Archives of pediatrics & adolescent medicine.

[15]  Sean A. Munson,et al.  When (ish) is My Bus?: User-centered Visualizations of Uncertainty in Everyday, Mobile Predictive Systems , 2016, CHI.

[16]  Lena Mamykina,et al.  Investigating health management practices of individuals with diabetes , 2006, CHI.

[17]  Michael Betancourt,et al.  Calibrating Model-Based Inferences and Decisions , 2018, 1803.08393.

[18]  A. Gelman,et al.  Of Beauty, Sex and Power , 2009 .

[19]  Amy P Abernethy,et al.  Rapid, responsive, relevant (R3) research: a call for a rapid learning health research enterprise , 2013, Clinical and Translational Medicine.

[20]  Jodi Forlizzi,et al.  A stage-based model of personal informatics systems , 2010, CHI.

[21]  Jessica S. Ancker,et al.  The Practice of Informatics: Design Features of Graphs in Health Risk Communication: A Systematic Review , 2006, J. Am. Medical Informatics Assoc..

[22]  Christopher D. Chambers,et al.  Redefine statistical significance , 2017, Nature Human Behaviour.

[23]  Sean A. Munson,et al.  A lived informatics model of personal informatics , 2015, UbiComp.

[24]  Lesley Roberts,et al.  Treatments for irritable bowel syndrome: patients' attitudes and acceptability , 2008, BMC complementary and alternative medicine.

[25]  Jiqiang Guo,et al.  Stan: A Probabilistic Programming Language. , 2017, Journal of statistical software.

[26]  Kenton T. Unruh,et al.  Patient-driven N-of-1 in Parkinson’s Disease , 2017, Methods of Information in Medicine.

[27]  P. Vandvik,et al.  Perceived food intolerance in subjects with irritable bowel syndrome – etiology, prevalence and consequences , 2006, European Journal of Clinical Nutrition.

[28]  Andrew Gelman,et al.  Of beauty, sex, and power: Statistical challenges in estimating small eects , 2008 .

[29]  S. Hayes,et al.  Alternating treatments design: one strategy for comparing the effects of two treatments in a single subject. , 1979, Journal of applied behavior analysis.

[30]  Matthew Kay,et al.  Researcher-Centered Design of Statistics: Why Bayesian Statistics Better Fit the Culture and Incentives of HCI , 2016, CHI.

[31]  R. Kravitz,et al.  The PREEMPT study - evaluating smartphone-assisted n-of-1 trials in patients with chronic pain: study protocol for a randomized controlled trial , 2015, Trials.

[32]  David Gal,et al.  Abandon Statistical Significance , 2017, The American Statistician.

[33]  Sun Young Park,et al.  Individual and Social Recognition: Challenges and Opportunities in Migraine Management , 2015, CSCW.

[34]  Sean A. Munson,et al.  Tu1422 Inter-rater Reliability of Healthcare Provider Interpretations of Food and Gastrointestinal Symptom Paper Diaries of Patients with Irritable Bowel Syndrome , 2016 .

[35]  M. Swan Emerging Patient-Driven Health Care Models: An Examination of Health Social Networks, Consumer Personalized Medicine and Quantified Self-Tracking , 2009, International journal of environmental research and public health.

[36]  Elizabeth M. Heitkemper,et al.  Personal discovery in diabetes self-management: Discovering cause and effect using self-monitoring data , 2017, J. Biomed. Informatics.

[37]  Lena Mamykina,et al.  MAHI: investigation of social scaffolding for reflective thinking in diabetes management , 2008, CHI.

[38]  Jeffrey N. Rouder,et al.  The fallacy of placing confidence in confidence intervals , 2015, Psychonomic bulletin & review.

[39]  Sean A. Munson,et al.  TummyTrials: A Feasibility Study of Using Self-Experimentation to Detect Individualized Food Triggers , 2017, CHI.

[40]  A. Ford,et al.  Effect of Gender on Prevalence of Irritable Bowel Syndrome in the Community: Systematic Review and Meta-Analysis , 2012, The American Journal of Gastroenterology.

[41]  Sunny Consolvo,et al.  Lullaby: a capture & access system for understanding the sleep environment , 2012, UbiComp.

[42]  Silvia Lindtner,et al.  Fish'n'Steps: Encouraging Physical Activity with an Interactive Computer Game , 2006, UbiComp.

[43]  J. T. Jørgensen,et al.  New era of personalized medicine: a 10-year anniversary. , 2009, The oncologist.

[44]  E. Larson,et al.  N-of-1 Clinical Trials: A Technique for Improving Medical Therapeutics , 1990 .

[45]  N. Schork,et al.  The n-of-1 clinical trial: the ultimate strategy for individualizing medicine? , 2011, Personalized medicine.

[46]  David W. McDonald,et al.  Activity sensing in the wild: a field trial of ubifit garden , 2008, CHI.

[47]  James Fogarty,et al.  Rethinking the Mobile Food Journal: Exploring Opportunities for Lightweight Photo-Based Capture , 2015, CHI.

[48]  Sean A. Munson,et al.  Examining Self-Tracking by People with Migraine: Goals, Needs, and Opportunities in a Chronic Health Condition , 2018, Conference on Designing Interactive Systems.

[49]  Jeff Huang,et al.  SleepCoacher: A Personalized Automated Self-Experimentation System for Sleep Recommendations , 2016, UIST.

[50]  Martin Steinert,et al.  Displayed Uncertainty Improves Driving Experience and Behavior: The Case of Range Anxiety in an Electric Car , 2015, CHI.

[51]  Edward T. Cokely,et al.  Science Current Directions in Psychological , 2010 .

[52]  Matthew Chalmers,et al.  Personal tracking as lived informatics , 2014, CHI.

[53]  Andrew Gelman,et al.  Measurement error and the replication crisis , 2017, Science.

[54]  Gurkirpal Singh,et al.  Diagnosis, comorbidities, and management of irritable bowel syndrome in patients in a large health maintenance organization. , 2012, Clinical gastroenterology and hepatology : the official clinical practice journal of the American Gastroenterological Association.

[55]  Margaret E. Morris,et al.  Mobile Heart Health: Project Highlight , 2009, IEEE Pervasive Computing.

[56]  A. Riordan,et al.  Management of patients with food intolerance in irritable bowel syndrome: the development and use of an exclusion diet , 1995 .

[57]  Eric Carter,et al.  Women With Irritable Bowel Syndrome: Differences in Patients’ and Physicians’ Perceptions , 2002, Gastroenterology nursing : the official journal of the Society of Gastroenterology Nurses and Associates.

[58]  Jan Tack,et al.  Food: the forgotten factor in the irritable bowel syndrome. , 2011, Gastroenterology clinics of North America.

[59]  M Soledad Cepeda,et al.  An N-of-1 trial as an aid to decision-making prior to implanting a permanent spinal cord stimulator. , 2008, Pain medicine.

[60]  Sean A. Munson,et al.  Supporting Patient-Provider Collaboration to Identify Individual Triggers using Food and Symptom Journals , 2017, CSCW.

[61]  David M. Rothschild,et al.  Lay understanding of probability distributions , 2014, Judgment and Decision Making.

[62]  Sean A Munson,et al.  More Than Telemonitoring: Health Provider Use and Nonuse of Life-Log Data in Irritable Bowel Syndrome and Weight Management , 2015, Journal of medical Internet research.

[63]  David B. Dunson,et al.  Bayesian Data Analysis , 2010 .

[64]  Wanda Pratt,et al.  Understanding quantified-selfers' practices in collecting and exploring personal data , 2014, CHI.

[65]  Eric Baumer,et al.  Prescriptive persuasion and open-ended social awareness: expanding the design space of mobile health , 2012, CSCW.

[66]  Lena Mamykina,et al.  Adopting the sensemaking perspective for chronic disease self-management , 2015, J. Biomed. Informatics.

[67]  M. E. Boyle Single Case Experimental Designs: Strategies for Studying Behavior Change , 1983 .

[68]  A. Nowacki,et al.  Understanding Equivalence and Noninferiority Testing , 2011, Journal of General Internal Medicine.

[69]  J. Carlin,et al.  Beyond Power Calculations , 2014, Perspectives on psychological science : a journal of the Association for Psychological Science.

[70]  N. Lazar,et al.  The ASA Statement on p-Values: Context, Process, and Purpose , 2016 .

[71]  Sean A. Munson,et al.  A framework for self-experimentation in personalized health , 2016, J. Am. Medical Informatics Assoc..

[72]  Sigrid Elsenbruch,et al.  Abdominal pain in Irritable Bowel Syndrome: A review of putative psychological, neural and neuro-immune mechanisms , 2011, Brain, Behavior, and Immunity.

[73]  Amitava Banerjee,et al.  Tracking global funding for the prevention and control of noncommunicable diseases. , 2012, Bulletin of the World Health Organization.