In this Spotlight feature we focus on Karina Davidson, PhD, MASc, the Principal Investigator on the grant for the SOBC Resource and Coordinating Center at Columbia University. Dr. Davidson has a wealth of varied experience and knowledge with respect to behavioral research and systems organization. She is Vice Dean of Organizational Effectiveness at the College of Physicians and Surgeons, Chief Academic Officer at New York Presbyterian Hospital, Executive Director of the Center for Behavioral & Cardiovascular Health (CBCH), and Professor of Medicine and Psychiatry at Columbia College of Physicians and Surgeons. In this interview Dr. Davidson offers her expert perspective on differing approaches to studying how behaviors change.
Q: Research on behavior change often takes a between-subjects approach to understanding which groups of people may benefit most from an intervention (e.g., men, older adults). You have suggested that a within-subjects approach is important to understand the extent to which individuals alter their behavior in response to an intervention. How do you think SOBC might best integrate these between- and within-subject approaches to understand mechanisms of behavior change?
Within-subject tests of basic behavioral science mechanisms allow us to test the theory and the mechanism as intended. That is, engaging a target for one person and determining the response in that same person is how most psychological theories are formulated. It offers the added benefit that we then can aggregate similar responders to understand a basic behavioral mechanism more thoroughly. Both between- and within-subject designs have a role to play in understanding behavioral change mechanisms, but we should be more thoughtful as to which design is employed for which question.
Q: The group at Columbia recently received an NIH Director’s Transformative Research Award, a high-risk/high-reward grant that will be used to study N-of-1 trials run by physicians in their offices with individual patients. Can you tell us about the science behind the grant?
This interesting NIH mechanism requires a team of scientists to articulate an area, discipline, or methodology in need of disruption. We proposed that the use of a single-subject, within-subject-design, personalized trial would be a disruptive methodology to bring to bear on the outpatient clinical encounter. For those patients having difficulty changing a behavior, such as increasing exercise, improving their sleep duration, or managing their blood pressure, we will be deploying a digital health care platform to conduct a personalized trial to manage these behaviors and symptoms. We look forward to being able to add validated basic behavioral science mechanisms to these trials once our platform is developed.
Q: The SOBC measures repository has grown to include over 100 assays as 2018 begins. We are at the stage of the larger initiative where many of the measures will soon have information at the influenced and validated stages of the process. This organized approach holds promise for understanding which interventions work, by what mechanisms, for which behaviors, and for whom. What is your vision for the next steps of the measures repository with respect to the systematic advancement of SOBC?
I think the availability of validated and influenced measures will revolutionize the way we understand how behavior change interventions work. Once we can start using a standardized set of measures across different types of behavior interventions, we will have an entirely new domain of information about what truly works to improve behavior. For many researchers, they propose a theory and mechanisms, but they have no validated measure of that mechanism, and so the theory as to why their intervention did or did not work remains hypothetical. This measures repository will allow all researchers to locate the correct measure for their framework or approach and systematically add to the body of knowledge as to whether their intervention worked as intended. This is different than our current state. We have the ironic problem that if an intervention worked, it’s possible it did so because the mechanism hypothesized was correct and operated as intended. It’s also possible that the intervention worked but in no way engaged or influenced the hypothesized mechanism. So, even at the end of a successful behavior change intervention, we are sometimes left not knowing why it worked. The measures repository will fix this problem.
Q: Those are great points. Do you have anything to add about the usefulness of the measures repository for future SOBC scientists?
The other advantage of a measures repository is the ability to identify where gaps remain. We hope this will invigorate new scientists to propose measure development work where we do not yet have validated and influenced mechanisms. We also believe that the entire SOBC approach of the experimental medicine method is a great framework for new scientists interested in behavior change to use as they develop their own programs of research.
