Leveraging Machine Learning to Develop Digital Engagement Phenotypes of Users in a Digital Diabetes Prevention Program: Evaluation Study
Authors: Rodriguez Danissa V , Chen Ji , Viswanadham Ratnalekha V N , Lawrence Katharine , Mann Devin 
Published: January 2024

Background
Digital diabetes prevention programs (dDPPs) are effective “digital prescriptions” but have high attrition rates and program noncompletion. To address this, we developed a personalized automatic messaging system (PAMS) that leverages SMS text messaging and data integration into clinical workflows to increase dDPP engagement via enhanced patient-provider communication. Preliminary data showed positive results. However, further investigation is needed to determine how to optimize the tailoring of support technology such as PAMS based on a user’s preferences to boost their dDPP engagement.

Objective
This study evaluates leveraging machine learning (ML) to develop digital engagement phenotypes of dDPP users and assess ML’s accuracy in predicting engagement with dDPP activities. This research will be used in a PAMS optimization process to improve PAMS personalization by incorporating engagement prediction and digital phenotyping. This study aims (1) to prove the feasibility of using dDPP user-collected data to build an ML model that predicts engagement and contributes to identifying digital engagement phenotypes, (2) to describe methods for developing ML models with dDPP data sets and present preliminary results, and (3) to present preliminary data on user profiling based on ML model outputs.

Methods
Using the gradient-boosted forest model, we predicted engagement in 4 dDPP individual activities (physical activity, lessons, social activity, and weigh-ins) and general activity (engagement in any activity) based on previous short- and long-term activity in the app. The area under the receiver operating characteristic curve, the area under the precision-recall curve, and the Brier score metrics determined the performance of the model. Shapley values reflected the feature importance of the models and determined what variables informed user profiling through latent profile analysis.

Results
We developed 2 models using weekly and daily DPP data sets (328,821 and 704,242 records, respectively), which yielded predictive accuracies above 90%. Although both models were highly accurate, the daily model better fitted our research plan because it predicted daily changes in individual activities, which was crucial for creating the “digital phenotypes.” To better understand the variables contributing to the model predictor, we calculated the Shapley values for both models to identify the features with the highest contribution to model fit; engagement with any activity in the dDPP in the last 7 days had the most predictive power. We profiled users with latent profile analysis after 2 weeks of engagement (Bayesian information criterion=−3222.46) with the dDPP and identified 6 profiles of users, including those with high engagement, minimal engagement, and attrition.

Conclusions
Preliminary results demonstrate that applying ML methods with predicting power is an acceptable mechanism to tailor and optimize messaging interventions to support patient engagement and adherence to digital prescriptions. The results enable future optimization of our existing messaging platform and expansion of this methodology to other clinical domains.

Trial Registration
ClinicalTrials.gov NCT04773834; https://www.clinicaltrials.gov/ct2/show/NCT04773834

International Registered Report Identifier (IRRID)
RR2-10.2196/26750