Sleepless Nights, Sugary Days: Creating Synthetic Users with Health Conditions for Realistic Coaching Agent Interactions

We present an end-to-end framework for generating synthetic users for evaluating interactive agents designed to encourage positive behavior changes, such as in health and lifestyle coaching. The synthetic users are grounded in health and lifestyle conditions, specifically sleep and diabetes management in this study, to ensure realistic interactions with the health coaching agent. Synthetic users are created in two stages: first, structured data are generated grounded in real-world health and lifestyle factors in addition to basic demographics and behavioral attributes; second, full profiles of the synthetic users are developed conditioned on the structured data. Interactions between synthetic users and the coaching agent are simulated using generative agent-based models such as Concordia, or directly by prompting a language model. Using two independently-developed agents for sleep and diabetes coaching as case studies, the validity of this framework is demonstrated by analyzing the coaching agent's understanding of the synthetic users' needs and challenges. Finally, through multiple blinded evaluations of user-coach interactions by human experts, we demonstrate that our synthetic users with health and behavioral attributes more accurately portray real human users with the same attributes, compared to generic synthetic users not grounded in such attributes. The proposed framework lays the foundation for efficient development of conversational agents through extensive, realistic, and grounded simulated interactions.

From Barriers to Tactics: A Behavioral Science-Informed Agentic Workflow for Personalized Nutrition Coaching

Effective management of cardiometabolic conditions requires sustained positive nutrition habits, often hindered by complex and individualized barriers. Direct human management is simply not scalable, while previous attempts aimed at automating nutrition coaching lack the personalization needed to address these diverse challenges. This paper introduces a novel LLM-powered agentic workflow designed to provide personalized nutrition coaching by directly targeting and mitigating patient-specific barriers. Grounded in behavioral science principles, the workflow leverages a comprehensive mapping of nutrition-related barriers to corresponding evidence-based strategies. A specialized LLM agent intentionally probes for and identifies the root cause of a patient's dietary struggles. Subsequently, a separate LLM agent delivers tailored tactics designed to overcome those specific barriers with patient context. We designed and validated our approach through a user study with individuals with cardiometabolic conditions, demonstrating the system's ability to accurately identify barriers and provide personalized guidance. Furthermore, we conducted a large-scale simulation study, grounding on real patient vignettes and expert-validated metrics, to evaluate the system's performance across a wide range of scenarios. Our findings demonstrate the potential of this LLM-powered agentic workflow to improve nutrition coaching by providing personalized, scalable, and behaviorally-informed interventions.

The Geometry of Queries: Query-Based Innovations in Retrieval-Augmented Generation

Digital health chatbots powered by Large Language Models (LLMs) have the potential to significantly improve personal health management for chronic conditions by providing accessible and on-demand health coaching and question-answering. However, these chatbots risk providing unverified and inaccurate information because LLMs generate responses based on patterns learned from diverse internet data. Retrieval Augmented Generation (RAG) can help mitigate hallucinations and inaccuracies in LLM responses by grounding it on reliable content. However, efficiently and accurately retrieving most relevant set of content for real-time user questions remains a challenge. In this work, we introduce Query-Based Retrieval Augmented Generation (QB-RAG), a novel approach that pre-computes a database of potential queries from a content base using LLMs. For an incoming patient question, QB-RAG efficiently matches it against this pre-generated query database using vector search, improving alignment between user questions and the content. We establish a theoretical foundation for QB-RAG and provide a comparative analysis of existing retrieval enhancement techniques for RAG systems. Finally, our empirical evaluation demonstrates that QB-RAG significantly improves the accuracy of healthcare question answering, paving the way for robust and trustworthy LLM applications in digital health.

Selective Fine-tuning on LLM-labeled Data May Reduce Reliance on Human Annotation: A Case Study Using Schedule-of-Event Table Detection

Large Language Models (LLMs) have demonstrated their efficacy across a broad spectrum of tasks in healthcare applications. However, often LLMs need to be fine-tuned on task-specific expert annotated data to achieve optimal performance, which can be expensive and time consuming. In this study, we fine-tune PaLM-2 with parameter efficient fine-tuning (PEFT) using noisy labels obtained from gemini-pro 1.0 for the detection of Schedule-of-Event (SoE) tables, which specify care plan in clinical trial protocols. We introduce a filtering mechanism to select high-confidence labels for this table classification task, thereby reducing the noise in the auto-generated labels. We show that fine-tuned PaLM-2 with those labels achieves performance that exceeds the gemini-pro 1.0 and other LLMs. Furthermore, its performance is close to a PaLM-2 fine-tuned on labels obtained from non-expert annotators. Our results show that leveraging LLM-generated labels through powerful models like gemini-pro can potentially serve as a viable strategy for improving LLM performance through fine-tuning in specialized tasks, particularly in domains where expert annotations are scarce, expensive, or time-consuming to obtain.

Equitable Restless Multi-Armed Bandits: A General Framework Inspired By Digital Health

Restless multi-armed bandits (RMABs) are a popular framework for algorithmic decision making in sequential settings with limited resources. RMABs are increasingly being used for sensitive decisions such as in public health, treatment scheduling, anti-poaching, and -- the motivation for this work -- digital health. For such high stakes settings, decisions must both improve outcomes and prevent disparities between groups (e.g., ensure health equity). We study equitable objectives for RMABs (ERMABs) for the first time. We consider two equity-aligned objectives from the fairness literature, minimax reward and max Nash welfare. We develop efficient algorithms for solving each -- a water filling algorithm for the former, and a greedy algorithm with theoretically motivated nuance to balance disparate group sizes for the latter. Finally, we demonstrate across three simulation domains, including a new digital health model, that our approaches can be multiple times more equitable than the current state of the art without drastic sacrifices to utility. Our findings underscore our work's urgency as RMABs permeate into systems that impact human and wildlife outcomes. Code is available at https://github.com/google-research/socialgood/tree/equitable-rmab