Medication adherence is critical for the recovery of adolescents and young adults (AYAs) who have undergone hematopoietic cell transplantation (HCT). However, maintaining adherence is challenging for AYAs after hospital discharge, who experience both individual (e.g. physical and emotional symptoms) and interpersonal barriers (e.g., relational difficulties with their care partner, who is often involved in medication management). To optimize the effectiveness of a three-component digital intervention targeting both members of the dyad as well as their relationship, we propose a novel Multi-Agent Reinforcement Learning (MARL) approach to personalize the delivery of interventions. By incorporating the domain knowledge, the MARL framework, where each agent is responsible for the delivery of one intervention component, allows for faster learning compared with a flattened agent. Evaluation using a dyadic simulator environment, based on real clinical data, shows a significant improvement in medication adherence (approximately 3%) compared to purely random intervention delivery. The effectiveness of this approach will be further evaluated in an upcoming trial.

The escalating prevalence of cannabis use, and associated cannabis-use disorder (CUD), poses a significant public health challenge globally. With a notably wide treatment gap, especially among emerging adults (EAs; ages 18-25), addressing cannabis use and CUD remains a pivotal objective within the 2030 United Nations Agenda for Sustainable Development Goals (SDG). In this work, we develop an online reinforcement learning (RL) algorithm called reBandit which will be utilized in a mobile health study to deliver personalized mobile health interventions aimed at reducing cannabis use among EAs. reBandit utilizes random effects and informative Bayesian priors to learn quickly and efficiently in noisy mobile health environments. Moreover, reBandit employs Empirical Bayes and optimization techniques to autonomously update its hyper-parameters online. To evaluate the performance of our algorithm, we construct a simulation testbed using data from a prior study, and compare against commonly used algorithms in mobile health studies. We show that reBandit performs equally well or better than all the baseline algorithms, and the performance gap widens as population heterogeneity increases in the simulation environment, proving its adeptness to adapt to diverse population of study participants.

In digital health, the strategy of allocating a limited treatment budget across available risk times is crucial to reduce user fatigue. This strategy, however, encounters a significant obstacle due to the unknown actual number of risk times, a factor not adequately addressed by existing methods lacking theoretical guarantees. This paper introduces, for the first time, the online uniform risk times sampling problem within the approximation algorithm framework. We propose two online approximation algorithms for this problem, one with and one without learning augmentation, and provide rigorous theoretical performance guarantees for them using competitive ratio analysis. We assess the performance of our algorithms using both synthetic experiments and a real-world case study on HeartSteps mobile applications.

Many important behavior changes are frictionful; they require individuals to expend effort over a long period with little immediate gratification. Here, an artificial intelligence (AI) agent can provide personalized interventions to help individuals stick to their goals. In these settings, the AI agent must personalize rapidly (before the individual disengages) and interpretably, to help us understand the behavioral interventions. In this paper, we introduce Behavior Model Reinforcement Learning (BMRL), a framework in which an AI agent intervenes on the parameters of a Markov Decision Process (MDP) belonging to a boundedly rational human agent. Our formulation of the human decision-maker as a planning agent allows us to attribute undesirable human policies (ones that do not lead to the goal) to their maladapted MDP parameters, such as an extremely low discount factor. Furthermore, we propose a class of tractable human models that captures fundamental behaviors in frictionful tasks. Introducing a notion of MDP equivalence specific to BMRL, we theoretically and empirically show that AI planning with our human models can lead to helpful policies on a wide range of more complex, ground-truth humans.

Mobile health aims to enhance health outcomes by delivering interventions to individuals as they go about their daily life. The involvement of care partners and social support networks often proves crucial in helping individuals managing burdensome medical conditions. This presents opportunities in mobile health to design interventions that target the dyadic relationship -- the relationship between a target person and their care partner -- with the aim of enhancing social support. In this paper, we develop dyadic RL, an online reinforcement learning algorithm designed to personalize intervention delivery based on contextual factors and past responses of a target person and their care partner. Here, multiple sets of interventions impact the dyad across multiple time intervals. The developed dyadic RL is Bayesian and hierarchical. We formally introduce the problem setup, develop dyadic RL and establish a regret bound. We demonstrate dyadic RL's empirical performance through simulation studies on both toy scenarios and on a realistic test bed constructed from data collected in a mobile health study.

Contextual bandits (Auer, 2002; Langford and Zhang, 2007) represent a classical sequential decisionmaking problem where an agent aims to maximize cumulative reward based on context information. At each round t, the agent observes a context and must choose one of K available actions based on both the current context and previous observations. Once the agent selects an action, she observes the associated reward, which is then used to refine future decision-making. Contextual bandits are typical examples of reinforcement learning problems where a balance between exploring new actions and exploiting previously acquired information is necessary to achieve optimal long-term rewards. It has numerous real-world applications including personalized recommendation systems (Li et al., 2010; Bouneffouf et al., 2012), healthcare (Yom-Tov et al., 2017; Liao et al., 2020), and online education (Liu et al., 2014; Shaikh et al., 2019). Despite the extensive existing literature on contextual bandits, in many real-world applications, the agent never observes the context exactly.

There is a growing interest in using reinforcement learning (RL) to personalize sequences of treatments in digital health to support users in adopting healthier behaviors. Such sequential decision-making problems involve decisions about when to treat and how to treat based on the user's context (e.g., prior activity level, location, etc.). Online RL is a promising data-driven approach for this problem as it learns based on each user's historical responses and uses that knowledge to personalize these decisions. However, to decide whether the RL algorithm should be included in an ``optimized'' intervention for real-world deployment, we must assess the data evidence indicating that the RL algorithm is actually personalizing the treatments to its users. Due to the stochasticity in the RL algorithm, one may get a false impression that it is learning in certain states and using this learning to provide specific treatments. We use a working definition of personalization and introduce a resampling-based methodology for investigating whether the personalization exhibited by the RL algorithm is an artifact of the RL algorithm stochasticity. We illustrate our methodology with a case study by analyzing the data from a physical activity clinical trial called HeartSteps, which included the use of an online RL algorithm. We demonstrate how our approach enhances data-driven truth-in-advertising of algorithm personalization both across all users as well as within specific users in the study.

Policy learning is an important component of many real-world learning systems. A major challenge in policy learning is how to adapt efficiently to unseen environments or tasks. Recently, it has been suggested to exploit invariant conditional distributions to learn models that generalize better to unseen environments. However, assuming invariance of entire conditional distributions (which we call full invariance) may be too strong of an assumption in practice. In this paper, we introduce a relaxation of full invariance called effect-invariance (e-invariance for short) and prove that it is sufficient, under suitable assumptions, for zero-shot policy generalization. We also discuss an extension that exploits e-invariance when we have a small sample from the test environment, enabling few-shot policy generalization. Our work does not assume an underlying causal graph or that the data are generated by a structural causal model; instead, we develop testing procedures to test e-invariance directly from data. We present empirical results using simulated data and a mobile health intervention dataset to demonstrate the effectiveness of our approach.

Contextual bandit algorithms are commonly used in digital health to recommend personalized treatments. However, to ensure the effectiveness of the treatments, patients are often requested to take actions that have no immediate benefit to them, which we refer to as pro-treatment actions. In practice, clinicians have a limited budget to encourage patients to take these actions and collect additional information. We introduce a novel optimization and learning algorithm to address this problem. This algorithm effectively combines the strengths of two algorithmic approaches in a seamless manner, including 1) an online primal-dual algorithm for deciding the optimal timing to reach out to patients, and 2) a contextual bandit learning algorithm to deliver personalized treatment to the patient. We prove that this algorithm admits a sub-linear regret bound. We illustrate the usefulness of this algorithm on both synthetic and real-world data.

Mobile health (mHealth) technologies empower patients to adopt/maintain healthy behaviors in their daily lives, by providing interventions (e.g. push notifications) tailored to the user's needs. In these settings, without intervention, human decision making may be impaired (e.g. valuing near term pleasure over own long term goals). In this work, we formalize this relationship with a framework in which the user optimizes a (potentially impaired) Markov Decision Process (MDP) and the mHealth agent intervenes on the user's MDP parameters. We show that different types of impairments imply different types of optimal intervention. We also provide analytical and empirical explorations of these differences.