Digital Twins for Just-in-Time Adaptive Interventions (JITAIs): Framework for Optimizing and Continually Improving JITAIs

In the context of digital health, just-in-time adaptive interventions (JITAIs) are nascent precision medicine systems that can extend personalized health care support to everyday life. A challenge in designing JITAIs is that personalized support often involves sophisticated decision-making algorithms. These decision-making algorithms can require numerous nontrivial design decisions that must be made between successive JITAI deployments (eg, hyperparameter selection for an artificial intelligence algorithm). Making design decisions between deployments-rather than during deployment-ensures intervention fidelity and enhances the ability to replicate results. Yet, each deployment can be costly, precluding the use of A/B testing for every design decision. How should design decisions be made strategically between JITAI deployments? This paper introduces "digital twins for just-in-time adaptive interventions (JITAI-Twins)" to address this question. JITAI-Twins are "digital twins of a subpopulation" (term used in the 2023 National Academies workshop proceedings on digital twins). JITAI-Twins are used to virtually simulate the potential outcomes of a JITAI's design decisions for an upcoming deployment. Based on simulation results, design decisions are made for the deployed JITAI. To continually improve the JITAI, data collected during deployment are used to update the JITAI-Twin-and this bidirectional feedback between deployments and simulation environments continues. JITAI-Twins are thus "fit-for-purpose" (term used in the National Academies 2024 consensus report on digital twins) instantiations of the digital twin concept. In this paper, we elucidate the specifics and design process of JITAI-Twins, with examples of prior use in clinical settings. JITAI-Twins highlight continuity over the course of a JITAI's optimization and continual improvement, emphasizing the need for bidirectional feedback between versions of a simulation environment and a JITAI's deployments.