Paper ID: 2402.08658

The Last JITAI? The Unreasonable Effectiveness of Large Language Models in Issuing Just-in-Time Adaptive Interventions: Fostering Physical Activity in a Prospective Cardiac Rehabilitation Setting

David Haag, Devender Kumar, Sebastian Gruber, Mahdi Sareban, Gunnar Treff, Josef Niebauer, Christopher Bull, Jan David Smeddinck

We investigated the viability of using Large Language Models (LLMs) for triggering and personalizing content for Just-in-Time Adaptive Interventions (JITAIs) in digital health. JITAIs are being explored as a key mechanism for sustainable behavior change, adapting interventions to an individual's current context and needs. However, traditional rule-based and machine learning models for JITAI implementation face scalability and flexibility limitations, such as lack of personalization, difficulty in managing multi-parametric systems, and issues with data sparsity. To investigate JITAI implementation via LLMs, we tested the contemporary overall performance-leading model 'GPT-4' with examples grounded in the use case of fostering heart-healthy physical activity in outpatient cardiac rehabilitation. Three personas and five sets of context information per persona were used as a basis of triggering and personalizing JITAIs. Subsequently, we generated a total of 450 proposed JITAI decisions and message content, divided equally into JITAIs generated by 10 iterations with GPT-4, a baseline provided by 10 laypersons (LayPs), and a gold standard set by 10 healthcare professionals (HCPs). Ratings from 27 LayPs and 11 HCPs indicated that JITAIs generated by GPT-4 were superior to those by HCPs and LayPs over all assessed scales: i.e., appropriateness, engagement, effectiveness, and professionality. This study indicates that LLMs have significant potential for implementing JITAIs as a building block of personalized or "precision" health, offering scalability, effective personalization based on opportunistically sampled information, and good acceptability.

Submitted: Feb 13, 2024