Structured Exploration vs. Generative Flexibility: A Field Study Comparing Bandit and LLM Architectures for Personalised Health Behaviour Interventions

We study Contextual Multi-Armed Bandits (CMABs) for non-episodic decision-making problems where the context includes both textual and numerical information (e.g., recommendation systems, dynamic portfolio adjustments, offer selection; all frequent problems in finance). While Large Language Models (LLMs) are increasingly applied to these settings, utilizing LLMs for reasoning at every decision step is computationally expensive, and uncertainty estimates are difficult to obtain. To address this, we introduce LLMP-UCB, a bandit algorithm that derives uncertainty estimates from LLMs via repeated inference. However, our experiments demonstrate that lightweight numerical bandits operating on text embeddings (dense or Matryoshka) match or exceed the accuracy of LLM-based solutions at a fraction of their cost. We further show that embedding dimensionality is a practical lever on the exploration-exploitation balance, enabling cost-performance tradeoffs without prompt complexity. Finally, to guide practitioners, we propose a geometric diagnostic based on the arms' embeddings to decide when to use LLM-driven reasoning versus a lightweight numerical bandit. Our results provide a principled deployment framework for cost-effective, uncertainty-aware decision systems with broad applicability across AI use cases.

Large language models (LLMs) show potential as simulators of human behavior, offering a scalable way to study responses to interventions. However, because LLMs are trained largely on observational data, interventions in experiments with LLM-simulated synthetic users can induce unintended shifts in latent user attributes, causing user drift where the implicit simulated population differs across treatment conditions, potentially distorting effect estimates. We formalize the confounding or selection bias that can arise due to user drift and show how intervention-dependent shifts can inflate or attenuate observed differences in user responses under intervention. To diagnose confounding, we propose using negative control outcomes--attributes that should remain invariant under intervention--to identify distribution shifts across intervention conditions, providing evidence of user drift. To mitigate drift, we study adjusting the persona specification by eliciting additional confounders, finding that targeted, setting-relevant confounders can substantially reduce bias across survey-style and multi-turn agent evaluations.

Perceived message effectiveness (PME) by potential intervention end-users is important for selecting and optimizing personalized smoking cessation intervention messages for mobile health (mHealth) platform delivery. This study evaluates whether large language models (LLMs) can accurately predict PME for smoking cessation messages. We evaluated multiple models for predicting PME across three domains: content quality, coping support, and quitting support. The dataset comprised 3010 message ratings (5-point Likert scale) from 301 young adult smokers. We compared (1) supervised learning models trained on labeled data, (2) zero and few-shot LLMs prompted without task-specific fine-tuning, and (3) LLM-based digital twins that incorporate individual characteristics and prior PME histories to generate personalized predictions. Model performance was assessed on three held-out messages per participant using accuracy, Cohen's kappa, and F1. LLM-based digital twins outperformed zero and few-shot LLMs (12 percentage points on average) and supervised baselines (13 percentage points), achieving accuracies of 0.49 (content), 0.45 (coping), and 0.49 (quitting), with directional accuracies of 0.75, 0.66, and 0.70 on a simplified 3-point scale. Digital twin predictions showed greater dispersion across rating categories, indicating improved sensitivity to individual differences. Integrating personal profiles with LLMs captures person-specific differences in PME and outperforms supervised and zero and few-shot approaches. Improved PME prediction may enable more tailored intervention content in mHealth. LLM-based digital twins show potential for supporting personalization of mobile smoking cessation and other health behavior change interventions.