Practical Approaches in Evaluating Validation and Biases of Machine Learning Applied to Mobile Health Studies

Background: Machine learning (ML) models are evaluated in a test set to estimate model performance after deployment. The design of the test set is therefore of importance because if the data distribution after deployment differs too much, the model performance decreases. At the same time, the data often contains undetected groups. For example, multiple assessments from one user may constitute a group, which is usually the case in mHealth scenarios.

Methods: In this work, we evaluate a model's performance using several cross-validation train-test-split approaches, in some cases deliberately ignoring the groups. By sorting the groups (in our case: Users) by time, we additionally simulate a concept drift scenario for better external validity. For this evaluation, we use 7 longitudinal mHealth datasets, all containing Ecological Momentary Assessments (EMA). Further, we compared the model performance with baseline heuristics, questioning the essential utility of a complex ML model.

Results: Hidden groups in the dataset leads to overestimation of ML performance after deployment. For prediction, a user's last completed questionnaire is a reasonable heuristic for the next response, and potentially outperforms a complex ML model. Because we included 7 studies, low variance appears to be a more fundamental phenomenon of mHealth datasets.

Conclusions: The way mHealth-based data are generated by EMA leads to questions of user and assessment level and appropriate validation of ML models. Our analysis shows that further research needs to follow to obtain robust ML models. In addition, simple heuristics can be considered as an alternative for ML. Domain experts should be consulted to find potentially hidden groups in the data.