África Periáñez

Aditya Rastogi, Juan Francisco Garamendi, Ana Fernández del Río et al.

Artificial Intelligence and digital health have the potential to transform global health. However, having access to representative data to test and validate algorithms in realistic production environments is essential. We introduce HealthSyn, an open-source synthetic data generator of user behavior for testing reinforcement learning algorithms in the context of mobile health interventions. The generator utilizes Markov processes to generate diverse user actions, with individual user behavioral patterns that can change in reaction to personalized interventions (i.e., reminders, recommendations, and incentives). These actions are translated into actual logs using an ML-purposed data schema specific to the mobile health application functionality included with HealthKit, and open-source SDK. The logs can be fed to pipelines to obtain user metrics. The generated data, which is based on real-world behaviors and simulation techniques, can be used to develop, test, and evaluate, both ML algorithms in research and end-to-end operational RL-based intervention delivery frameworks.

África Periáñez, Ana Fernández del Río, Ivan Nazarov et al.

Mobile health has the potential to revolutionize health care delivery and patient engagement. In this work, we discuss how integrating Artificial Intelligence into digital health applications-focused on supply chain, patient management, and capacity building, among other use cases-can improve the health system and public health performance. We present an Artificial Intelligence and Reinforcement Learning platform that allows the delivery of adaptive interventions whose impact can be optimized through experimentation and real-time monitoring. The system can integrate multiple data sources and digital health applications. The flexibility of this platform to connect to various mobile health applications and digital devices and send personalized recommendations based on past data and predictions can significantly improve the impact of digital tools on health system outcomes. The potential for resource-poor settings, where the impact of this approach on health outcomes could be more decisive, is discussed specifically. This framework is, however, similarly applicable to improving efficiency in health systems where scarcity is not an issue.

Babaniyi Yusuf Olaniyi, Ana Fernández del Río, África Periáñez et al.

Mobile health apps are revolutionizing the healthcare ecosystem by improving communication, efficiency, and quality of service. In low- and middle-income countries, they also play a unique role as a source of information about health outcomes and behaviors of patients and healthcare workers, while providing a suitable channel to deliver both personalized and collective policy interventions. We propose a framework to study user engagement with mobile health, focusing on healthcare workers and digital health apps designed to support them in resource-poor settings. The behavioral logs produced by these apps can be transformed into daily time series characterizing each user's activity. We use probabilistic and survival analysis to build multiple personalized measures of meaningful engagement, which could serve to tailor content and digital interventions suiting each health worker's specific needs. Special attention is given to the problem of detecting churn, understood as a marker of complete disengagement. We discuss the application of our methods to the Indian and Ethiopian users of the Safe Delivery App, a capacity-building tool for skilled birth attendants. This work represents an important step towards a full characterization of user engagement in mobile health applications, which can significantly enhance the abilities of health workers and, ultimately, save lives.

África Periáñez, Andrew Trister, Madhav Nekkar et al.

Malaria can be prevented, diagnosed, and treated; however, every year, there are more than 200 million cases and 200.000 preventable deaths. Malaria remains a pressing public health concern in low- and middle-income countries, especially in sub-Saharan Africa. We describe how by means of mobile health applications, machine-learning-based adaptive interventions can strengthen malaria surveillance and treatment adherence, increase testing, measure provider skills and quality of care, improve public health by supporting front-line workers and patients (e.g., by capacity building and encouraging behavioral changes, like using bed nets), reduce test stockouts in pharmacies and clinics and informing public health for policy intervention.

Ana Fernández del Río, Michael Brennan Leong, Paulo Saraiva et al.

Pharmacies are critical in healthcare systems, particularly in low- and middle-income countries. Procuring pharmacists with the right behavioral interventions or nudges can enhance their skills, public health awareness, and pharmacy inventory management, ensuring access to essential medicines that ultimately benefit their patients. We introduce a reinforcement learning operational system to deliver personalized behavioral interventions through mobile health applications. We illustrate its potential by discussing a series of initial experiments run with SwipeRx, an all-in-one app for pharmacists, including B2B e-commerce, in Indonesia. The proposed method has broader applications extending beyond pharmacy operations to optimize healthcare delivery.

Ana Fernández del Río, Michael Brennan Leong, Paulo Saraiva et al.

This paper introduces a reinforcement learning (RL) platform that enhances end-to-end user journeys in healthcare digital tools through personalization. We explore a case study with SwipeRx, the most popular all-in-one app for pharmacists in Southeast Asia, demonstrating how the platform can be used to personalize and adapt user experiences. Our RL framework is tested through a series of experiments with product recommendations tailored to each pharmacy based on real-time information on their purchasing history and in-app engagement, showing a significant increase in basket size. By integrating adaptive interventions into existing mobile health solutions and enriching user journeys, our platform offers a scalable solution to improve pharmaceutical supply chain management, health worker capacity building, and clinical decision and patient care, ultimately contributing to better healthcare outcomes.

África Periáñez, Kathrin Schmitz, Lazola Makhupula et al.

By providing evidence-based clinical decision support, digital tools and electronic health records can revolutionize patient management, especially in resource-poor settings where fewer health workers are available and often need more training. When these tools are integrated with AI, they can offer personalized support and adaptive interventions, effectively connecting community health workers (CHWs) and healthcare facilities. The CHARM (Community Health Access & Resource Management) app is an AI-native mobile app for CHWs. Developed through a joint partnership of Causal Foundry (CF) and mothers2mothers (m2m), CHARM empowers CHWs, mainly local women, by streamlining case management, enhancing learning, and improving communication. This paper details CHARM's development, integration, and upcoming reinforcement learning-based adaptive interventions, all aimed at enhancing health worker engagement, efficiency, and patient outcomes, thereby enhancing CHWs' capabilities and community health.

Babaniyi Olaniyi, Ina Kalisa, Ana Fernández del Río et al.

As part of Rwanda's transition toward universal health coverage, the national Community-Based Health Insurance (CBHI) scheme is moving from retrospective fee-for-service reimbursements to prospective capitation payments for public primary healthcare providers. This report outlines a data-driven approach to designing, calibrating, and monitoring the capitation model using individual-level claims data from the Intelligent Health Benefits System (IHBS). We introduce a transparent, interpretable formula for allocating payments to Health Centers and their affiliated Health Posts. The formula is based on catchment population, service utilization patterns, and patient inflows, with parameters estimated via regression models calibrated on national claims data. Repeated validation exercises show the payment scheme closely aligns with historical spending while promoting fairness and adaptability across diverse facilities. In addition to payment design, the same dataset enables actionable behavioral insights. We highlight the use case of monitoring antibiotic prescribing patterns, particularly in pediatric care, to flag potential overuse and guideline deviations. Together, these capabilities lay the groundwork for a learning health financing system: one that connects digital infrastructure, resource allocation, and service quality to support continuous improvement and evidence-informed policy reform.

Jiamin Xu, Ivan Nazarov, Aditya Rastogi et al.

This paper addresses the poor finite-horizon performance of existing online \emph{restless bandit} (RB) algorithms, which stems from the prohibitive sample complexity of learning a full \emph{Markov decision process} (MDP) for each agent. We argue that superior finite-horizon performance requires \emph{rapid convergence} to a \emph{high-quality} policy. Thus motivated, we introduce a reformulation of online RBs as a \emph{budgeted thresholding contextual bandit}, which simplifies the learning problem by encoding long-term state transitions into a scalar reward. We prove the first non-asymptotic optimality of an oracle policy for a simplified finite-horizon setting. We propose a practical learning policy under a heterogeneous-agent, multi-state setting, and show that it achieves a sublinear regret, achieving \emph{faster convergence} than existing methods. This directly translates to higher cumulative reward, as empirically validated by significant gains over state-of-the-art algorithms in large-scale heterogeneous environments. Our work provides a new pathway for achieving practical, sample-efficient learning in finite-horizon RBs.

Dexian Tang, Guillem Francès, África Periáñez

Providing front-line health workers in low- and middle- income countries with recommendations and predictions to improve health outcomes can have a tremendous impact on reducing healthcare inequalities, for instance by helping to prevent the thousands of maternal and newborn deaths that occur every day. To that end, we are developing a data-centric machine learning platform that leverages the behavioral logs from a wide range of mobile health applications running in those countries. Here we describe the platform architecture, focusing on the details that help us to maximize the quality and organization of the data throughout the whole process, from the data ingestion with a data-science purposed software development kit to the data pipelines, feature engineering and model management.

Anna Guitart, Afsaneh Heydari, Eniola Olaleye et al.

Maternal and child mortality is a public health problem that disproportionately affects low- and middle-income countries. Every day, 800 women and 6,700 newborns die from complications related to pregnancy or childbirth. And for every maternal death, about 20 women suffer serious birth injuries. However, nearly all of these deaths and negative health outcomes are preventable. Midwives are key to revert this situation, and thus it is essential to strengthen their capacities and the quality of their education. This is the aim of the Safe Delivery App, a digital job aid and learning tool to enhance the knowledge, confidence and skills of health practitioners. Here, we use the behavioral logs of the App to implement a recommendation system that presents each midwife with suitable contents to continue gaining expertise. We focus on predicting the click-through rate, the probability that a given user will click on a recommended content. We evaluate four deep learning models and show that all of them produce highly accurate predictions.

Anna Guitart, Ana Fernández del Río, África Periáñez et al.

Every day, 800 women and 6,700 newborns die from complications related to pregnancy or childbirth. A well-trained midwife can prevent most of these maternal and newborn deaths. Data science models together with logs generated by users of online learning applications for midwives can help to improve their learning competencies. The goal is to use these rich behavioral data to push digital learning towards personalized content and to provide an adaptive learning journey. In this work, we evaluate various forecasting methods to determine the interest of future users on the different kind of contents available in the app, broken down by profession and region.

Ana Fernández del Río, Anna Guitart, África Periáñez

Players of a free-to-play game are divided into three main groups: non-paying active users, paying active users and inactive users. A State Space time series approach is then used to model the daily conversion rates between the different groups, i.e., the probability of transitioning from one group to another. This allows, not only for predictions on how these rates are to evolve, but also for a deeper understanding of the impact that in-game planning and calendar effects have. It is also used in this work for the detection of marketing and promotion campaigns about which no information is available. In particular, two different State Space formulations are considered and compared: an Autoregressive Integrated Moving Average process and an Unobserved Components approach, in both cases with a linear regression to explanatory variables. Both yield very close estimations for covariate parameters, producing forecasts with similar performances for most transition rates. While the Unobserved Components approach is more robust and needs less human intervention in regards to model definition, it produces significantly worse forecasts for non-paying user abandonment probability. More critically, it also fails to detect a plausible marketing and promotion campaign scenario.

Anna Guitart, Ana Fernández del Río, África Periáñez

As video games attract more and more players, the major challenge for game studios is to retain them. We present a deep behavioral analysis of churn (game abandonment) and what we called "purchase churn" (the transition from paying to non-paying user). A series of churning behavior profiles are identified, which allows a classification of churners in terms of whether they eventually return to the game (false churners)--or start purchasing again (false purchase churners)--and their subsequent behavior. The impact of excluding some or all of these churners from the training sample is then explored in several churn and purchase churn prediction models. Our results suggest that discarding certain combinations of "zombies" (players whose activity is extremely sporadic) and false churners has a significant positive impact in all models considered.

Ana Fernández del Río, Pei Pei Chen, África Periáñez

The possibility of using player engagement predictions to profile high spending video game users is explored. In particular, individual-player survival curves in terms of days after first login, game level reached and accumulated playtime are used to classify players into different groups. Lifetime value predictions for each player---generated using a deep learning method based on long short-term memory---are also included in the analysis, and the relations between all these variables are thoroughly investigated. Our results suggest this constitutes a promising approach to user profiling.

Anna Guitart, Shi Hui Tan, Ana Fernández del Río et al.

Retaining premium players is key to the success of free-to-play games, but most of them do not start purchasing right after joining the game. By exploiting the exceptionally rich datasets recorded by modern video games--which provide information on the individual behavior of each and every player--survival analysis techniques can be used to predict what players are more likely to become paying (or even premium) users and when, both in terms of time and game level, the conversion will take place. Here we show that a traditional semi-parametric model (Cox regression), a random survival forest (RSF) technique and a method based on conditional inference survival ensembles all yield very promising results. However, the last approach has the advantage of being able to correct the inherent bias in RSF models by dividing the procedure into two steps: first selecting the best predictor to perform the splitting and then the best split point for that covariate. The proposed conditional inference survival ensembles method could be readily used in operational environments for early identification of premium players and the parts of the game that may prompt them to become paying users. Such knowledge would allow developers to induce their conversion and, more generally, to better understand the needs of their players and provide them with a personalized experience, thereby increasing their engagement and paving the way to higher monetization.

Anna Guitart, Pei Pei Chen, África Periáñez

Machine learning competitions such as those organized by Kaggle or KDD represent a useful benchmark for data science research. In this work, we present our winning solution to the Game Data Mining competition hosted at the 2017 IEEE Conference on Computational Intelligence and Games (CIG 2017). The contest consisted of two tracks, and participants (more than 250, belonging to both industry and academia) were to predict which players would stop playing the game, as well as their remaining lifetime. The data were provided by a major worldwide video game company, NCSoft, and came from their successful massively multiplayer online game Blade and Soul. Here, we describe the long short-term memory approach and conditional inference survival ensemble model that made us win both tracks of the contest, as well as the validation procedure that we followed in order to prevent overfitting. In particular, choosing a survival method able to deal with censored data was crucial to accurately predict the moment in which each player would leave the game, as censoring is inherent in churn. The selected models proved to be robust against evolving conditions---since there was a change in the business model of the game (from subscription-based to free-to-play) between the two sample datasets provided---and efficient in terms of time cost. Thanks to these features and also to their a ability to scale to large datasets, our models could be readily implemented in real business settings.

Pei Pei Chen, Anna Guitart, Ana Fernández del Río et al.

Nowadays, video game developers record every virtual action performed by their players. As each player can remain in the game for years, this results in an exceptionally rich dataset that can be used to understand and predict player behavior. In particular, this information may serve to identify the most valuable players and foresee the amount of money they will spend in in-app purchases during their lifetime. This is crucial in free-to-play games, where up to 50% of the revenue is generated by just around 2% of the players, the so-called whales. To address this challenge, we explore how deep neural networks can be used to predict customer lifetime value in video games, and compare their performance to parametric models such as Pareto/NBD. Our results suggest that convolutional neural network structures are the most efficient in predicting the economic value of individual players. They not only perform better in terms of accuracy, but also scale to big data and significantly reduce computational time, as they can work directly with raw sequential data and thus do not require any feature engineering process. This becomes important when datasets are very large, as is often the case with video game logs. Moreover, convolutional neural networks are particularly well suited to identify potential whales. Such an early identification is of paramount importance for business purposes, as it would allow developers to implement in-game actions aimed at retaining big spenders and maximizing their lifetime, which would ultimately translate into increased revenue.

Paul Bertens, Anna Guitart, Pei Pei Chen et al.

Video-game players generate huge amounts of data, as everything they do within a game is recorded. In particular, among all the stored actions and behaviors, there is information on the in-game purchases of virtual products. Such information is of critical importance in modern free-to-play titles, where gamers can select or buy a profusion of items during the game in order to progress and fully enjoy their experience. To try to maximize these kind of purchases, one can use a recommendation system so as to present players with items that might be interesting for them. Such systems can better achieve their goal by employing machine learning algorithms that are able to predict the rating of an item or product by a particular user. In this paper we evaluate and compare two of these algorithms, an ensemble-based model (extremely randomized trees) and a deep neural network, both of which are promising candidates for operational video-game recommender engines. Item recommenders can help developers improve the game. But, more importantly, it should be possible to integrate them into the game, so that users automatically get personalized recommendations while playing. The presented models are not only able to meet this challenge, providing accurate predictions of the items that a particular player will find attractive, but also sufficiently fast and robust to be used in operational settings.

Alain Saas, Anna Guitart, África Periáñez

The classification of time series data is a challenge common to all data-driven fields. However, there is no agreement about which are the most efficient techniques to group unlabeled time-ordered data. This is because a successful classification of time series patterns depends on the goal and the domain of interest, i.e. it is application-dependent. In this article, we study free-to-play game data. In this domain, clustering similar time series information is increasingly important due to the large amount of data collected by current mobile and web applications. We evaluate which methods cluster accurately time series of mobile games, focusing on player behavior data. We identify and validate several aspects of the clustering: the similarity measures and the representation techniques to reduce the high dimensionality of time series. As a robustness test, we compare various temporal datasets of player activity from two free-to-play video-games. With these techniques we extract temporal patterns of player behavior relevant for the evaluation of game events and game-business diagnosis. Our experiments provide intuitive visualizations to validate the results of the clustering and to determine the optimal number of clusters. Additionally, we assess the common characteristics of the players belonging to the same group. This study allows us to improve the understanding of player dynamics and churn behavior.

África Periáñez, Alain Saas, Anna Guitart et al.

Reducing user attrition, i.e. churn, is a broad challenge faced by several industries. In mobile social games, decreasing churn is decisive to increase player retention and rise revenues. Churn prediction models allow to understand player loyalty and to anticipate when they will stop playing a game. Thanks to these predictions, several initiatives can be taken to retain those players who are more likely to churn. Survival analysis focuses on predicting the time of occurrence of a certain event, churn in our case. Classical methods, like regressions, could be applied only when all players have left the game. The challenge arises for datasets with incomplete churning information for all players, as most of them still connect to the game. This is called a censored data problem and is in the nature of churn. Censoring is commonly dealt with survival analysis techniques, but due to the inflexibility of the survival statistical algorithms, the accuracy achieved is often poor. In contrast, novel ensemble learning techniques, increasingly popular in a variety of scientific fields, provide high-class prediction results. In this work, we develop, for the first time in the social games domain, a survival ensemble model which provides a comprehensive analysis together with an accurate prediction of churn. For each player, we predict the probability of churning as function of time, which permits to distinguish various levels of loyalty profiles. Additionally, we assess the risk factors that explain the predicted player survival times. Our results show that churn prediction by survival ensembles significantly improves the accuracy and robustness of traditional analyses, like Cox regression.

Paul Bertens, Anna Guitart, África Periáñez

The emergence of mobile games has caused a paradigm shift in the video-game industry. Game developers now have at their disposal a plethora of information on their players, and thus can take advantage of reliable models that can accurately predict player behavior and scale to huge datasets. Churn prediction, a challenge common to a variety of sectors, is particularly relevant for the mobile game industry, as player retention is crucial for the successful monetization of a game. In this article, we present an approach to predicting game abandon based on survival ensembles. Our method provides accurate predictions on both the level at which each player will leave the game and their accumulated playtime until that moment. Further, it is robust to different data distributions and applicable to a wide range of response variables, while also allowing for efficient parallelization of the algorithm. This makes our model well suited to perform real-time analyses of churners, even for games with millions of daily active users.

Anna Guitart, Pei Pei Chen, Paul Bertens et al.

Understanding player behavior is fundamental in game data science. Video games evolve as players interact with the game, so being able to foresee player experience would help to ensure a successful game development. In particular, game developers need to evaluate beforehand the impact of in-game events. Simulation optimization of these events is crucial to increase player engagement and maximize monetization. We present an experimental analysis of several methods to forecast game-related variables, with two main aims: to obtain accurate predictions of in-app purchases and playtime in an operational production environment, and to perform simulations of in-game events in order to maximize sales and playtime. Our ultimate purpose is to take a step towards the data-driven development of games. The results suggest that, even though the performance of traditional approaches such as ARIMA is still better, the outcomes of state-of-the-art techniques like deep learning are promising. Deep learning comes up as a well-suited general model that could be used to forecast a variety of time series with different dynamic behaviors.