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

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Abstract

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.

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Notes

  1. So long as one makes use of informed priors (as we advocate here) and/or applies a hierarchical modeling approach.

  2. The widespread use of this null ritual in scientific fields is not without criticism [78]. Most pointedly, Gigerenzer went so far as to declare it a symptom of “mindless statistics” [69]. We will describe why we believe it is not applicable to small self-experiments but leave aside the question of its broader applicability to science.

  3. Readers familiar with standardized effect sizes (like Cohen’s d) might ask why we do not use them here. Like Cummings [79], we believe that unstandardized effect sizes (e.g., mean differences) are easier to interpret, particularly for individual decision-making (a person should know what one point on a pain scale that they have used means to them; they are less likely to know what a difference of 1 standard deviation means).

  4. We do not discuss the use of Bayes factors—one approach to Bayesian hypothesis testing—in this paper, as the sensitivity of Bayes factors to irrelevant details of the prior make them difficult even for experienced analysts to use in practice [80]. Instead, if hypothesis testing is desired, we prefer estimation-based approaches, such as regions of practical equivalence, which we believe are also easier to interpret. Regions of practical equivalence answer questions like “how likely is the effect to be 0 (or close enough to 0 that I will not care)?” [46, 80].

  5. We used a variant of our Bayesian regression model with flat priors (i.e., priors in which all possible outcomes are equally likely, which is the implicit assumption a frequentist analysis makes) on the parameters to simulate the frequentist regression.

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Acknowledgements

We thank Eric B. Heckler and Roger Vilardaga for conversations that informed this research.

Funding

This research was funded in part by a University of Washington Innovation Research Award, the National Science Foundation under awards IIS-1553167 and SCH-1344613, and the Agency for Healthcare Research Quality under award 1R21HS023654.

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Authors and Affiliations

  1. University of Washington, Seattle, WA, USA

    Jessica Schroeder, Ravi Karkar, James Fogarty, Julie A. Kientz & Sean A. Munson

  2. University of Michigan, Ann Arbor, MI, USA

    Matthew Kay

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  1. Jessica Schroeder
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Correspondence to Jessica Schroeder.

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Schroeder, J., Karkar, R., Fogarty, J. et al. A Patient-Centered Proposal for Bayesian Analysis of Self-Experiments for Health. J Healthc Inform Res 3, 124–155 (2019). https://doi.org/10.1007/s41666-018-0033-x

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