Ecological Intervention Research Articles

Economic Analysis of Patient's Own Medication, Unit-Use and Ward Stock Utilization: Results of the First Pilot Study.

Background: Medication wastage is causing a cost burden to the healthcare system that is worth millions of dollars. An economic and ecological friendly intervention such as using a patient’s own medications (POM) has proven to reduce wastage and save the cost spent by the hospital. The potential benefits of using POM in inpatient settings have yet to be explored in a country with universal health coverage. This study aimed to pilot test the POM intervention in an adult ward setting and to perform the economic analysis of using POM and ward stock during hospitalization. Methods: A prospective cross-sectional observational study was conducted among the patients admitted to the medical and surgical wards in a public hospital located in Brunei Darussalam between February 2022 and April 2022. Hospitalized adults above 18 years old with regular medications with a minimum length of stay of 48 h and a maximum length of stay of 21 days were included in the study. These eligible patients were divided into a POM group and a non-POM group. The economic analysis of using POM was performed by calculating the direct cost per unit of medication used during admission (from unit-use, ward stock and POM) and comparing the cost spent for both groups. Expired ward stock deemed as medication wastage was determined. Medical research ethics were approved, and all participating patients had given their written informed consent before enrolling in this study. Results: A total of 112 patients aged 63.2 ± 15.8 years participated in this study. The average cost of medication supplied by the inpatient pharmacy for the non-POM group was USD 21.60 ± 34.20 per patient, whereas, for the POM group, it was approximately USD 13.00 ± 18.30 per patient, with a mean difference of USD 8.60 ± 5.17 per patient (95% CI: −3.95, 27.47, p ≥ 0.05). The use of POM minimized 54.03% (USD 625.04) of the total cost spent by the hospital for the POM group within the period of the study. Conclusion: The pilot study showed that the supplied medication cost per patient was not significantly different between the POM and non-POM groups. Nevertheless, the utilization of POM during hospitalization is capable of reducing at least 50% of the total cost spent on inpatient medications by the hospital. The use of POM during hospitalization also helped in reducing the total time spent on the medication process per patient.

Blue sheep strongly affect snow leopard relative abundance but not livestock depredation in the Annapurna Conservation Area, Nepal

Large carnivores play key roles in their ecosystems, but their protection is a major challenge in biodiversity conservation due to conflicts with human interests. The snow leopard ( Panthera uncia ) is the top predator of Asian high-altitude landscapes and faces various threats including wild prey depletion and illegal killings as a consequence of livestock depredation. As the interactions between snow leopards, wild prey, and livestock are still insufficiently understood, we studied the effects of 1) wild prey (blue sheep Pseudois nayaur and Himalayan marmots Marmota himalayana ) and domestic prey on snow leopard relative abundance, and of 2) these ecological parameters and intervention applications on livestock depredation by snow leopards. In the Annapurna Conservation Area, Nepal, we monitored wildlife populations and livestock along transects (490.8 km) in 82 grid cells (4 ×4 km) in 2019 and 2021 and conducted questionnaire surveys to determine livestock depredation between 2018 and 2021 (n = 479 households). We applied generalized linear models (GLMs) and sample comparison testing to examine the effects of prey densities and other environmental and anthropogenic predictors on snow leopard relative abundance and livestock depredation. Blue sheep density strongly positively affected snow leopard relative abundance, which also increased with terrain ruggedness and decreased with increasing densities of livestock and the human population. The size of livestock holdings shaped depredation events of large livestock (yak, cattle and horse), whereas depredation events of sheep and goats, which accounted for most (68.6%) depredated animals, decreased with increasing human population density and marmot presence. The strong impact of blue sheep on snow leopard relative abundance supports demands for integrating this ungulate into conservation and management plans, including wild prey recovery and translocation. The rather weak evidence for effects of blue sheep on depredation events suggests that conflicts over livestock depredation by snow leopards would neither be inflicted nor solved by increasing wild prey abundance. This demonstrates the need to improve intervention strategies in the Annapurna region, such as predator-proofing corrals and optimizing daytime herding practices. We suggest further exploring the effects of marmots and other secondary prey on livestock depredation rates, and testing the suitability of additional interventions, e.g., dogs and deterrents, as conflict mitigation tools. Our results will support wildlife managers in setting conservation priorities to promote the long-term co-existence of local people and snow leopards. • Blue sheep strongly shape snow leopard relative abundance in the Annapurna region. • Livestock losses in the Annapurna region are mainly associated with husbandry factors. • Wild prey restoration and improved husbandry practices should benefit snow leopards.

Acceptability and feasibility of mobile phone-based ecological momentary assessment and intervention in Uganda: A pilot randomized controlled trial.

Valid, reliable behavioral data and contextually meaningful interventions are necessary for improved health outcomes. Ecological Momentary Assessment and Intervention (EMAI), which collects data as behaviors occur to deliver real-time interventions, may be more accurate and reliable than retrospective methods. The rapid expansion of mobile technologies in low-and-middle-income countries allows for unprecedented remote data collection and intervention opportunities. However, no previous studies have trialed EMAI in sub-Saharan Africa. We assessed EMAI acceptability and feasibility, including participant retention and response rate, in a prospective, parallel group, randomized pilot trial in Rakai, Uganda comparing behavioral outcomes among adults submitting ecological momentary assessments (EMA) versus EMAI. After training, participants submitted EMA data on five nutrition and health risk behaviors over a 90-day period using a smartphone-based application utilizing prompt-based, participant-initiated, and geospatial coordinate data collection, with study coordinator support and incentives for >50% completion. Included behaviors and associated EMAI-arm intervention messages were selected to pilot a range of EMAI applications. Acceptability was measured on questionnaires. We estimated the association between high response rate and participant characteristics and conducted thematic analysis characterizing participant experiences. Study completion was 48/50 participants. Median prompt response rate was 66.5% (IQR: 60.0%-78.6%). Prior smartphone app use at baseline (aPR 3.76, 95%CI: 1.16–12.17, p = 0.03) and being in the intervention arm (aPR 2.55, 95% CI: 1.01–6.44, p = 0.05) were significantly associated with the top response rate quartile (response to >78.6% of prompts). All participants submitted self-initiated reports, covering all behaviors of interest, including potentially sensitive behaviors. Inconsistent phone charging was the most reported feasibility challenge. In this pilot, EMAI was acceptable and feasible. Response rates were good; additional strategies to improve compliance should be investigated. EMAI using mobile technologies may support improved behavioral data collection and intervention approaches in low and middle-income settings. This approach should be tested in larger studies.

Acceptability and satisfaction with emma, a smartphone application dedicated to suicide ecological assessment and prevention.

BackgroundAs mHealth may contribute to suicide prevention, we developed emma, an application using Ecological Momentary Assessment and Intervention (EMA/EMI).ObjectiveThis study evaluated emma usage rate and acceptability during the first month and satisfaction after 1 and 6 months of use.MethodsNinety-nine patients at high risk of suicide used emma for 6 months. The acceptability and usage rate of the EMA and EMI modules were monitored during the first month. Satisfaction was assessed by questions in the monthly EMA (Likert scale from 0 to 10) and the Mobile App Rating Scale (MARS; score: 0–5) completed at month 6. After inclusion, three follow-up visits (months 1, 3, and 6) took place.ResultsSeventy-five patients completed at least one of the proposed EMAs. Completion rates were lower for the daily than weekly EMAs (60 and 82%, respectively). The daily completion rates varied according to the question position in the questionnaire (lower for the last questions, LRT = 604.26, df = 1, p-value < 0.0001). Completion rates for the daily EMA were higher in patients with suicidal ideation and/or depression than in those without. The most used EMI was the emergency call module (n = 12). Many users said that they would recommend this application (mean satisfaction score of 6.92 ± 2.78) and the MARS score at month 6 was relatively high (overall rating: 3.3 ± 0.87).ConclusionEmma can target and involve patients at high risk of suicide. Given the promising users’ satisfaction level, emma could rapidly evolve into a complementary tool for suicide prevention.

‘Meeting them where they are at’: A practice note on implementation of the Child and Family Traumatic Stress Intervention in an emergency family homeless shelter

Families experiencing homelessness report higher rates of traumatic exposure than the general population, and traumatic experiences can often be precipitating factors for entrance into a homeless shelter. Emergency shelter is meant to be a brief, temporary housing intervention to support families toward more stable and permanent living arrangements. Beyond this ecological intervention, there is a frequently unmet need for trauma-specific mental health services. Further still, psychosocial interventions to support sheltered families should be sensitive to both the trauma-specific needs of this population and the constraints of the shelter setting. The Child and Family Traumatic Stress Intervention (CFTSI) is a brief, secondary prevention protocol that aims to prevent PTSD after exposure to a traumatic event, with research demonstrating its effectiveness in acute care settings such as child advocacy centres and emergency departments. This case study illustrates the implementation of CFTSI in an emergency family shelter in a large urban area, highlighting the appropriateness of the intervention for the setting, its adaptability to client needs and its generalizability to other non-traditional intervention settings.

Can different physical education programs produce specific developments in psychological responses and cognitive functions? An ecological intervention in school-age children.

The aim of this study was to investigate the effects of physical education (PE) class contents on 6-8 years school-age children's perceived exertion, psychological responses and cognitive functions. These dimensions were measured in 135 children (6.61 ± 0.58 years) before and after an 8-week different PE intervention programs [i.e. balance intervention program (BIP), game based program (GBP) or drama learning program (DLP)]. With regard to the physical exertion, higher perceived exertion was found in BIP than in GBP and DLP (p < .01, ES=-0.5 to -1.0, small to moderate). Regarding cognitive functions, children of the GBP and the DLP significantly improved some of the cognitive functions test scores (p < .01 or 0.05, ES=0.5 to 1.5, small to large). These results lead us to think that physical activity could be an effective tool for improving children's cognitive functions.

An Evolutionary Model of "Sexual Conflict" Over Women's Age at Marriage: Implications for Child Mortality and Undernutrition.

BackgroundEarly women's marriage is associated with adverse outcomes for mothers and their offspring, including reduced human capital and increased child undernutrition and mortality. Despite preventive efforts, it remains common in many populations and is often favored by cultural norms. A key question is why it remains common, given such penalties. Using an evolutionary perspective, a simple mathematical model was developed to explore women's optimal marriage age under different circumstances, if the sole aim were to maximize maternal or paternal lifetime reproductive fitness (surviving offspring).MethodsThe model was based on several assumptions, supported by empirical evidence, regarding relationships between women's marital age and parental and offspring outcomes. It assumes that later marriage promotes women's autonomy, enhancing control over fertility and childcare, but increases paternity uncertainty. Given these assumptions, optimal marriage ages for maximizing maternal and paternal fitness were calculated. The basic model was then used to simulate environmental changes or public health interventions, including shifts in child mortality, suppression of women's autonomy, or promoting women's contraception or education.ResultsIn the basic model, paternal fitness is maximized at lower women's marriage age than is maternal fitness, with the paternal optimum worsening child undernutrition and mortality. A family planning intervention delays marriage age and reduces child mortality and undernutrition, at a cost to paternal but not maternal fitness. Reductions in child mortality favor earlier marriage but increase child undernutrition, whereas ecological shocks that increase child mortality favor later marriage but reduce fitness of both parents. An education intervention favors later marriage and reduces child mortality and undernutrition, but at a cost to paternal fitness. Efforts to suppress maternal autonomy substantially increase fitness of both parents, but only if other members of the household provide compensatory childcare.ConclusionEarly women's marriage maximizes paternal fitness despite relatively high child mortality and undernutrition, by increasing fertility and reducing paternity uncertainty. This tension between the sexes over the optimal marriage age is sensitive to ecological stresses or interventions. Education interventions seem most likely to improve maternal and child outcomes, but may be resisted by males and their kin as they may reduce paternal fitness.

Pilot Testing in the Wild: Feasibility, Acceptability, Usage Patterns, and Efficacy of an Integrated Web and Smartphone Platform for Bipolar II Disorder.

BackgroundBipolar II disorder (BD-II) is associated with significant burden, disability, and mortality; however, there continues to be a dearth of evidence-based psychological interventions for this condition. Technology-mediated interventions incorporating self-management have untapped potential to help meet this need as an adjunct to usual clinical care.ObjectiveThe objective of this pilot study is to assess the feasibility, acceptability, and clinical utility of a novel intervention for BD-II (Tailored Recovery-oriented Intervention for Bipolar II Experiences; TRIBE), in which mindfulness-based psychological content is delivered via an integrated web and smartphone platform. The focus of the study is evaluation of the dynamic use patterns emerging from ecological momentary assessment and intervention to assist the real-world application of mindfulness skills learned from web-delivered modules.MethodsAn open trial design using pretest and posttest assessments with nested qualitative evaluation was used. Individuals (aged 18-65 years) with a diagnosis of BD-II were recruited worldwide and invited to use a prototype of the TRIBE intervention over a 3-week period. Data were collected via web-based questionnaires and phone interviews at baseline and 3-week follow-up.ResultsA total of 25 participants completed baseline and follow-up assessments. Adherence rates (daily app use) were 65.6% across the 3-week study, with up to 88% (22/25) of participants using the app synergistically alongside the web-based program. Despite technical challenges with the prototype intervention (from user, hardware, and software standpoints), acceptability was adequate, and most participants rated the intervention positively in terms of concept (companion app with website: 19/25, 76%), content (19/25, 76%), and credibility and utility in supporting their management of bipolar disorder (17/25, 68%). Evaluation using behavioral archetypes identified important use pathways and a provisional model to inform platform refinement. As hypothesized, depression scores significantly decreased after the intervention (Montgomery-Asberg Depression Rating Scale baseline mean 8.60, SD 6.86, vs follow-up mean 6.16, SD 5.11; t24=2.63; P=.01; Cohen d=0.53, 95% CI 0.52-4.36).ConclusionsOur findings suggest that TRIBE is feasible and represents an appropriate and acceptable self-management program for patients with BD-II. Preliminary efficacy results are promising and support full development of TRIBE informed by the present behavioral archetype analysis. Modifications suggested by the pilot study include increasing the duration of the intervention and increasing technical support.

SandplayAR: Evaluation of psychometric game for people with generalized anxiety disorder

In the context of the rapid development of the Internet, there has been a paradigm shift in psychotherapy practice. The current study develops an online psychometric game: SandplayAR. The experiment primarily evaluates the differences in the effects of SandplayAR and traditional sandplay on the young with generalized anxiety disorder and examines the operational usability of SandplayAR. A total of 20 participants with mild anxiety and above were screened, who were randomly and equally allocated to experimental and control groups for the experiment. Sandplay Image Healing Experience Questionnaire scores as the primary judgment basis, pre/post skin conductance levels and systolic blood pressure levels are collected as additional indexes. The results revealed that the participants using SandplayAR exhibited better performance in both the unconscious emergence and the conscious perception activation, and the product met usability needs. The skin conductance data further demonstrated that AR could achieve more effective ecological intervention through sensory stimulation. This study provides a reference for innovative design in online psychometric tools, and in future research, SandplayAR has the potential to develop into a complete psychotherapy tool.

Playing with the Anthropocene: Board game imaginaries of islands, nature, and empire

The figure of the island as a metonym for the planet is central to many allegories of the Anthropocene. These allegories build upon pre-existing discourses of islands as remote, vulnerable, and timeless, and often portray contemporary island nations as helpless, doomed, and disposable. This article focuses on one allegorical terrain that has received limited discursive and cultural analysis: analogue board games. Board game representations of islands are relevant to island studies both due to the popularity of island themes and because of the resonances between common island imaginaries and the form of board game play itself. Looking at three explicitly island-themed board games (Taluva, Vanuatu, and Spirit Island), I explore the extent to which these games reiterate or contest discourses of islands as sites of ahistorical insularity and alterity. I investigate the presence and absence of islanders in these fictional landscapes, the relationship between these ludic cartographies and imaginaries of ecological collapse and environmental intervention, and the articulations of nature, humanity, and empire that are literally at play. Particularly in the case of Spirit Island, these board game representations reflect the potential for the figure of the island to be reconfigured in order to imagine the Anthropocene otherwise.

The Faith, Activity, and Nutrition (FAN) dissemination and implementation study: changes in and maintenance of organizational practices over 24 months in a statewide initiative

BackgroundFew studies have examined the impact of ecological health promotion interventions on organizational practices over time, especially in faith-based settings. This statewide dissemination and implementation study examined change in organizational practices and their predictors across a 24-month period, as well as maintenance of change.MethodsUsing a pre-post quasi-experimental design, church coordinators from 92 United Methodist Churches in South Carolina (42% predominantly African American congregations) completed surveys at baseline, and immediate, 12-, and 24-months post-training regarding physical activity (PA) and healthy eating (HE) organizational practices consistent with the Faith, Activity, and Nutrition (FAN) program (opportunities, policies, pastor support, messages) and possible predictors. The study was guided by the RE-AIM framework and the Consolidated Framework for Implementation Research (CFIR). Mixed model repeated measures analyses examined change in organizational practices over time. Regression models examined CFIR predictors of 24-month PA and HE organizational practices, controlling for baseline practices. Churches were also classified as maintainers (implemented at 12 and 24 months), non-sustained implementers (implemented at 12 but not 24 months), delayed implementers (implemented at 24 but not 12 months), and low implementers (implemented at neither 12 nor 24 months) for each FAN component.ResultsPA and HE organizational practices increased over time (p < .0001). CFIR domains (and constructs within) of intervention characteristics (adaptability, relative advantage, cost/time), inner setting (relative priority, organizational rewards, readiness, congregant needs), characteristics of the implementer (self-efficacy, perceived benefits), and implementation process (engaging opinion leaders, engaging champions) were important predictors of 24-month PA and HE organizational practices. Over half of churches implementing PA policies, PA messages, HE policies, and HE opportunities at 12 months were maintainers at 24 months, and one-third were maintainers for PA opportunities, HE messages, and PA and HE pastor support. Furthermore, 16% of 12-month non-implementers were delayed implementers at 24 months for PA policies and 31% were delayed implementers for HE policies.ConclusionsThis study makes important contributions to the faith-based health promotion literature by including a large sample of churches, testing an ecological intervention approach, and assessing organizational practices over a 24-month period. Study findings can guide technical assistance and program adaptations over time.Trial registrationThis study was registered in clinicaltrials.gov NCT02868866 on August 16, 2016.

Use of selective gut decontamination in critically ill children: protocol for the Paediatric Intensive Care and Infection Control (PICnIC) pilot study

IntroductionHealthcare-associated infections (HCAIs) are a major cause of morbidity and mortality in critically ill children. In critically ill adults, there are data that suggest the use of Selective Decontamination of...

Effectiveness of psychosocial school interventions in Finnish schools for refugee and immigrant children, \u201cRefugees Well School\u201d in Finland (RWS-FI): a protocol for a cluster randomized controlled trial

BackgroundSchools are natural environments in which to enhance young people’s social and emotional skills, mental health, and contact between diverse groups, including students from refugee and immigrant backgrounds. A layered or tiered provision of services is recommended as it can be effective to meet the needs of war-affected adolescents who variably show mental health problems (such as posttraumatic stress disorder (PTSD)). The current protocol describes the study design for a multi-layered intervention model. The study will test the effectiveness of two interventions: a teacher-training intervention In-Service Teacher Training (INSETT) combined with targeted cognitive-behavioral treatment-based Teaching Recovery Techniques (TRT) and a classroom-focused preventive intervention Peer Integration and Enhancement Resources (PIER). We analyze, first, whether the interventions are effective in decreasing psychological distress and increasing positive resources, i.e., prosocial behavior and resilience among refugee and immigrant students. Second, we analyze which student-, school-, and parent-related factors mediate the possible beneficial changes. Third, we look at which groups the interventions are most beneficial to.MethodsA three-arm cluster RCT with parallel assignment, with a 1:1:1 allocation ratio, is applied in 16 schools that agreed to participate in the Refugees Well School interventions and effectiveness study. Schools were randomized to three conditions of two active interventions and a waiting list control condition. Students, their parents, and teachers in intervention and control schools participated in the study at baseline before the interventions, after the interventions, and at 6 to 12 months after the interventions. The primary effectiveness criterion variables are psychological distress (SDQ) symptoms, resilience (CYRM-12), and prosocial behavior (SDQ).DiscussionThe current study presents a recommended universal approach of layered interventions aiming to reduce psychological distress and increase resilience among refugee and immigrant students. A combination of promotive, preventive, and targeted interventions may offer a holistic, ecological intervention package for schools to better address the needs of the whole group.Trial registrationISRCTN ISRCTN64245549. Retrospectively registered on 10 June 2020

Remote Delivery of Service: A Survey of Occupational Therapists' Perceptions.

Background:Telehealth has been declared an accepted method of occupational therapy (OT) service delivery and has been shown to be effective. However, studies done before the outbreak of coronavirus disease (COVID-19) show that most occupational therapists didn’t use it.Aim:The aim of this exploratory study was to examine the perceptions of occupational therapists regarding remote delivery of service following the COVID-19 outbreak.Material and methods:An online survey, including 11-item five-point Likert scale, and 2 open-ended questions were distributed to occupational therapists.Results:Responses were received from 245 Israeli occupational therapists. The majority of the participants (60%) strongly agreed that remote delivery allows an ecological and effective intervention, while 76% strongly agreed that an ideal treatment is one that would combine telehealth with in-person intervention. Qualitative findings indicated that the most significant advantage was providing care in the natural environment and improving accessibility to the service. The most salient barriers were limitations of the therapeutic relationship and threats on clinical reasoning.Conclusion:The study results highlight the complexity of telehealth. Findings indicate that overall occupational therapists perceive remote care as an effective and legitimate service delivery method that cannot be used as an alternative to in-person treatment. These findings can help in developing intervention programs for remote treatment, and their implementation.

Topological Transmutation of the Urban Heat Island: Experimenting Ecological Urbanistic Intervention of Public Space in Toledo

Topological Transmutation of the Urban Heat Island: Experimenting Ecological Urbanistic Intervention of Public Space in Toledo

How Remote Sensing Choices Influence Monitoring and Evaluation Results of Ecological Restoration Interventions

How Remote Sensing Choices Influence Monitoring and Evaluation Results of Ecological Restoration Interventions

EVALUATION OF THE TRIAL IMPLEMENTATION OF A PROTOCOL FOR ASSESSING AND SUPPORTING CHILDREN WITH DEVELOPMENTAL DELAYS AND DISABILITIES AT RURAL CHILD AND YOUTH CARE CENTRES

The Ecological Assessment and Intervention Protocol (ECO-AIP) was designed by Heyns and Roestenburg (2021) to address inadequate service rendering to children with developmental delays and disabilities (DDDs) at rural Child and Youth Care Centres (CYCCs). This article presents the results of a trial implementation of the ECO-AIP at two rural CYCCs to ascertain whether the protocol made any difference to the care practices of the staff and the developmental health of the children. Qualitative focus groups were conducted using a semi-structured interview schedule and thematic analysis. This research study found that the ECO-AIP added substantially to the staff’s knowledge and skills base, leading to a general improvement in the quality and sophistication of service rendering. The ECO-AIP guided multidisciplinary CYCC teams in identifying DDDs in rural children and in supporting them to reach developmental milestones. Keywords: Child and Youth Care Centre (CYCC, child development, developmental delays and disabilities (DDDs), developmental milestones, protocol, Ecosystemic Assessment and Intervention Protocol (ECO-AIP)

Acceptability and feasibility of mobile phone-based ecological momentary assessment and intervention in Uganda: A pilot randomized controlled trial

Acceptability and feasibility of mobile phone-based ecological momentary assessment and intervention in Uganda: A pilot randomized controlled trial

The Agricultural Settlement of the Arabah and the Political Ecology of Zionism

AbstractAgricultural settlement geared to capitalist commodity production and accompanied by massive ecological interventions has historically been central to the Zionist colonial project of creating a permanent Jewish presence in the “Land of Israel.” The hyperarid southern region known as the Central Arabah is an instructive edge-case: in the 1960s, after the expulsion of the bedouin population, cooperative settlements were established here and vegetables produced through “Hebrew self-labor,” with generous assistance from the state. In the 1990s the region was again transformed as the importation of migrant workers from Thailand enabled farmers to expand cultivation of bell peppers for global markets. But today ecological destruction, depletion of water resources, and global warming cast doubt over the viability of settlement in this climatically extreme region. I locate the settlements of the Arabah within the historical political ecology of the Zionist movement, arguing that their current fragility exposes the essential precarity of capitalist colonization.

Normative Values of Client-Reported Outcome Measures and Self-Ratings of Six Voice Parameters via the VoiceEvalU8 App

Ecological momentary assessments (EMA) and interventions (EMI) have the potential to assess and offer interventions repeatedly within the client's daily life through mobile app technology. Considering the development of the EMA VoiceEvalU8, the current work provided normative data by comparing traditional (i.e., paper and pencil) and electronic (i.e., VoiceEvalU8 app) administration modalities of client-reported outcome measures and client self-ratings of six voice parameters twice a day in their functional environment. In Experiment 1, 50 vocally healthy cisgender women and men completed the Voice Handicap Index (VHI)-30, VHI-10, and Vocal Fatigue Index (VFI) with paper and pencil and the VoiceEvalU8 app. The order of administration modality and perceptual scales was randomized for each participant. In Experiment 2, 104 vocally healthy cisgender women and men used the VoiceEvalU8 app across five days in the morning before talking all day and in the evening after talking all day to self-rate six voice parameters (i.e., overall quality, roughness, breathiness, strain, pitch, and loudness) on a scale from 0 - 100. Mann Whitney U tests were run for all measures. Means and standard deviations are reported for descriptive analysis and normative values. In Experiment 1, results showed no significant differences between paper and pencil and VoiceEValU8 app administration for the VHI-30, VHI-10, and VFI for vocally healthy adults. Normative values in the current study were consistent with previous literature for the VHI-10 and VFI factor 1 and 2, but slightly higher for the VHI-30 and slightly lower for the VFI factor 3. In Experiment 2, results demonstrated significant differences for all six voice parameters between the morning and evening log sessions. Normative values demonstrated higher self-ratings in the morning as compared to the evening. For vocally healthy adults, completing the VHI-30, VHI-10, and VFI via paper and pencil and the VoiceEvalU8 app yielded the same results. Client self-ratings of six voice parameters on a scale from 0 - 100 twice a day demonstrated that vocally healthy adults perceived voice to be worse in the morning before talking all day as compared to the evening after talking all day. The results from the current work are promising for EMA via the VoiceEvalU8 app and support the need for continued investigations with clients with voice differences, problems, and/or disorders.