Ecological Momentary Assessment App Research Articles

Integrating Real-Time Air Quality Monitoring, Ecological Momentary Assessment, and Spirometry to Evaluate Asthma Symptoms: Usability Study.

Individuals are exposed to a variety of indoor residential toxins including volatile organic compounds and particulates. In adults with asthma, such exposures are associated with asthma symptoms, asthma exacerbations, and decreased lung function. However, data on these exposures and asthma-related outcomes are generally collected at different times and not in real time. The integration of multiple platforms to collect real-time data on environmental exposure, asthma symptoms, and lung function has rarely been explored. This paper describes how adults with asthma perceive the acceptability and usability of three integrated devices: (1) residential indoor air quality monitor, (2) ecological momentary assessment (EMA) surveys delivered via a smartphone app, and (3) home spirometry, over 14 days. Participants (N=40) with uncontrolled asthma were mailed the Awair Omni indoor air quality monitor, ZEPHYRx home spirometer, and detailed instructions required for the in-home monitoring. The air quality monitor, spirometer, and EMA app were set up and tested during a videoconference or phone orientation with a research team member. Midway through the 14-day data collection period, participants completed an interview about the acceptability of the study devices or apps, instructional materials provided, and the setup process. At the end of the 14-day data collection period, participants completed a modified System Usability Scale. A random sample of 20 participants also completed a phone interview regarding the acceptability of the study and the impact of the study on their asthma. Participants ranged in age from 26 to 77 (mean 45, SD 13.5) years and were primarily female (n=36, 90%), White (n=26, 67%), college graduates (n=25, 66%), and residing in a single-family home (n=30, 75%). Most indicated that the air quality monitor (n=23, 58%), the EMA (n=20, 50%), and the spirometer (n=17, 43%) were easy to set up and use. Challenges with the EMA included repetitive surveys, surveys arriving during the night, and technical issues. While the home spirometer was identified as a plausible means to evaluate lung function in real time, the interpretation of the readings was unclear, and several participants reported side effects from home spirometer use. Overall, the acceptability of the study and the System Usability Scale scores were high. The study devices were highly acceptable and usable. Participant feedback was instrumental in identifying technical challenges that should be addressed in future studies.

Feasibility of ecological momentary assessment in measuring physical activity and sedentary behaviour in shift and non-shift workers

BackgroundPrevious studies assessing shift workers’ behaviours have mainly used self-report recall questionnaires, however these measures don’t always account for variations in work schedules. Alternative methods that allow for real-time assessments tailored to capture variations in work patterns might provide more accurate measures of physical activity (PA) and sedentary behaviour (SB). Therefore, the aim of this study was to evaluate the feasibility of Ecological Momentary Assessment (EMA), which provides real-time evaluations of PA and SB in shift workers. A secondary aim was to compare shift workers and non-shift worker responses.MethodsParticipants (n = 120; 58% female, mean Mage=36.0), included 69 shift workers and 51 non-shift workers. After downloading the EMA app, shift workers received either interval-contingent tailored (SW-T) or standardized EMA prompts (SW-S) over 7–10 days, while non-shift workers received standardized prompts (NSW-S) for seven days. Prompts were scheduled five times daily, every three hours. The EMA survey asked participants to report their current activity, including type, duration, and location of physical activity and sitting. Feasibility was assessed by analysing recruitment, retention, and compliance rates (EMA surveys completed) across SW-T, SW-S, and NSW-S groups.ResultsApproximately 78% of invited workers enrolled, and all enrolled workers completed at least one prompt on 4 out 7 days in the NSW-S and 7 out of 10 days in the SW group. Workers who chose not to participate reported unwillingness to travel for meetings (n = 14), while others did not respond (n = 20). Participants completed an average of 24 surveys per day, each one taking less than 30 s to complete. Overall, 64% of EMA surveys were started and completed. SW-S completed the least prompts (57%), while SW-T and NSW-S completed 64% and 68%, respectively (p = 0.90). On average, workers missed 36% EMA surveys which was similar for SW and NSW (p = 0.05).ConclusionOur study represents one of the few studies that has used EMA in the shift work population with adaptation to shift schedules. The findings showed a modest compliance to EMA. Strategies are needed to enhance compliance rates. However, EMA shows promise for capturing real-time behaviours in shift workers’ natural work environments.

Perceived glucose levels matter more than CGM-based data in predicting diabetes distress in type 1 or type 2 diabetes: a precision mental health approach using n-of-1 analyses.

Diabetes distress is one of the most frequent mental health issues identified in people with type 1 and type 2 diabetes. Little is known about the role of glucose control as a potential contributor to diabetes distress and whether the subjective perception of glucose control or the objective glycaemic parameters are more important for the experience. With the emergence of continuous glucose monitoring (CGM), this is a relevant question as glucose values are now visible in real-time. We employed a precision monitoring approach to analyse the independent associations of perceived and measured glucose control with diabetes distress on a daily basis. By using n-of-1 analyses, we aimed to identify individual contributors to diabetes distress per person and analyse the associations of these individual contributors with mental health at a 3 month follow-up. In this prospective, observational study, perceived (hypoglycaemia/hyperglycaemia/glucose variability burden) and measured glucose control (time in hypoglycaemia and hyperglycaemia, CV) were assessed daily for 17 days using an ecological momentary assessment (EMA) approach with a special EMA app and CGM, respectively. Mixed-effect regression analysis was performed, with daily diabetes distress as the dependent variable and daily perceived and CGM-measured metrics of glucose control as random factors. Individual regression coefficients of daily distress with perceived and CGM-measured metrics were correlated with levels of psychosocial well-being at a 3 month follow-up. Data from 379 participants were analysed (50.9% type 1 diabetes; 49.6% female). Perceived glucose variability (t=14.360; p<0.0001) and perceived hyperglycaemia (t=13.637; p<0.0001) were the strongest predictors of daily diabetes distress, while CGM-based glucose variability was not significantly associated (t=1.070; p=0.285). There was great heterogeneity between individuals in the associations of perceived and measured glucose parameters with diabetes distress. Individuals with a stronger association between perceived glucose control and daily distress had more depressive symptoms (β=0.32), diabetes distress (β=0.39) and hypoglycaemia fear (β=0.34) at follow-up (all p<0.001). Individuals with a stronger association between CGM-measured glucose control and daily distress had higher levels of psychosocial well-being at follow-up (depressive symptoms: β=-0.31; diabetes distress: β=-0.33; hypoglycaemia fear: β=-0.27; all p<0.001) but also higher HbA1c (β=0.12; p<0.05). Overall, subjective perceptions of glucose seem to be more influential on diabetes distress than objective CGM parameters of glycaemic control. N-of-1 analyses showed that CGM-measured and perceived glucose control had differential associations with diabetes distress and psychosocial well-being 3 months later. The results highlight the need to understand the individual drivers of diabetes distress to develop personalised interventions within a precision mental health approach.

Feasibility and Acceptability of a Prospective Syphilis Sexual Network Study for Sexual Minority Men.

In preparation for a prospective syphilis network study of sexual minority men, we conducted a mixed-methods formative study with the following objectives: ( a ) assess acceptability of respondent-driven sampling, ( b ) assess acceptability of study procedures, ( c ) social network seed selection, and ( d ) pilot an ecological momentary assessment (EMA) study to assess social networking, sexual, and substance use behaviors. We conducted in-depth interviews with 8 providers serving sexual minority men and 5 focus group discussions with 34 sexual minority men, prioritizing 4 target populations: (1) young Black sexual minority men, (2) on preexposure prophylaxis, (3) living with HIV, and (4) not engaged in care. The 4-week EMA pilot was conducted with 40 sexual minority men. Ecological momentary assessment survey responses were analyzed to evaluate how different compensation levels influenced response rates. Brief exit surveys were used to assess EMA app acceptability. Primary themes identified through qualitative data collection: (1) importance of developing trust and maintaining confidentiality during proposed recruitment activities, (2) importance of compensating participants appropriately for study activities, and (3) cultural considerations for increasing visibility and participation of young Black sexual minority men. All EMA participants reported being "completely comfortable" reporting sexual behavior through the app. Most (78%) preferred the app to in-person interviews. Several participants identified technical issues with the app, including not receiving push notifications and spontaneous closure. This mixed-methods formative study allowed for adjustments to and tailoring of the planned network study, including recruitment protocols, compensation type and amount, and EMA survey wording and response items.

Development and use of a co-produced short mood survey to collect ground truth in digital footprints research

Introduction &amp; BackgroundTo use digital footprint data for mental health and well-being research we often need to collect concurrent, high-quality measures of ground truth. Delivering frequent surveys to participants using an ecological momentary assessment (EMA) methodology is one way to collect such data. However, existing surveys tend to be long, not focused on momentary states or rely on rating images which are not platform agnostic. Here we present a five-item test-based survey designed with participants and validated for use in EMA studies to collect data about momentary changes in mood. We describe its methodological development and how it has been used to investigate music listening on Spotify as a digital footprint of mood. Objectives &amp; ApproachThe survey is based on the circumplex model of affect. It was co-produced with a participant advisory group (N=5), who gave feedback on the length, content and delivery of the survey. It was then piloted in a group of N=98 participants to assess statistical validity, and congruence with the 20-item Positive and Negative Affect Schedule (PANAS). Following this it was delivered in a wider sample (N=150) four times a day over a two-week period using an EMA app on participant’s phones. Relevance to Digital FootprintsEMA is an increasingly popular method for collecting ground truth to support the interpretation of digital footprint data. This newly developed and tested mood survey offers an opportunity to reduce participant burden for collecting mood data in EMA studies which will support the collection of high quality and high time-resolution ground truth for digital footprints research. ResultsTogether with participants we selected four emotions across the axes of arousal and valence, as well as rumination which participants considered important in their music listening behaviors. Factor analysis of pilot data showed that the questions represented two factors of positive and negative affect. The ratings on a 0-10 scale of the emotions ‘cheerful’ and ‘relaxed’ explained 44% of the variance in positive affect, and ratings of ‘worried’, ‘sad’ and ‘frustrated’ explained 40% of the variance in negative affect. Delivery of the questionnaire in a wider student sample (N=150) four times per day for two weeks allowed for the opportunity to assess typical response rates in a realistic EMA setting. On average participants completed 3 out of the 4 surveys a day. Conclusions &amp; ImplicationsThe co-created, short mood survey for the collection of ground truth in digital footprint studies was validated across two independent samples, and shown to allow for good response rates in a two week study. Future testing on wider samples will provide opportunities to validate the survey and assess its effectiveness across demographic groups and different sample types.

Ecological momentary assessment of physical activity and sedentary behaviour in shift workers and non-shift workers: Validation study

ABSTRACT This study examined the criterion validity of an ecological momentary assessment (EMA)-reported physical activity and sedentary time compared with accelerometry in shift workers and non-shift workers. Australian workers (n = 102) received prompts through a mobile EMA app and wore the Actigraph accelerometer on the right hip for 7–10 days. Participants received five EMA prompts per day at 3-hour intervals on their mobile phones. EMA prompts sent to shift workers (SW-T) were tailored according to their work schedule. Non-shift workers (NSW-S) received prompts at standardised times. To assess criterion validity, the association of EMA-reported activities and the Actigraph accelerometer activity counts and number of steps were used. Participants were 36 ± 11 years and 58% were female. On occasions where participants reported physical activity, acceleration counts per minute (CPM) and steps were significantly higher (β = 1184 CPM, CI 95%: 1034, 1334; β = 20.9 steps, CI 95%: 18.2, 23.6) than each of the other EMA activities. Acceleration counts and steps were lower when sitting was reported than when no sitting was reported by EMA. Our study showed that EMA-reported physical activity and sedentary time was significantly associated with accelerometer-derived data. Therefore, EMA can be considered to assess shift workers’ movement-related behaviours with accelerometers to provide rich contextual data.

Where does stress happen? Ecological momentary assessment of daily stressors using a mobile phone app

AbstractDespite the importance of daily stress to individuals' health and wellbeing, few studies have explored where stress happens in real time, that is, dynamic stress processes in different spaces. As such, stress interventions rarely account for the environment in which stress occurs. We used mobile phone based ecological momentary assessment (EMA) to collect daily stress data. Thirty‐three participants utilized a mobile‐phone‐based EMA app to self‐report stressors as they went about their daily lives. Geographic coordinates were automatically collected with each stress report. Data from thematic analysis of stressors by location (home, work, work from home, other) were used to determine whether certain stressors were more prevalent in certain environments. Nine daily stressors significantly differed by location. Work‐related stress was reported more often at work. Pets, household chores, sleep, and media‐related stressors were reported most at home. Physical illnesses, vehicle issues, and safety/security stressors occurred most often while participants were “working from home.” Traffic‐related stress was experienced more commonly in “other” environments. Other 18 stressors were generated regardless of location, suggesting that these stressors were persistent and without respect to location. Study findings expand the understanding of environments in which specific stressors occur, providing baseline data for potential targeted “just‐in‐time” stress interventions tailored to unique stressors in specific environments. We also provide findings related to the “work from home” phenomenon. Further work is needed to better understand the unique stressors among the large number of individuals who transitioned to working from home during and after the COVID‐19 pandemic.

Assessment of cochlear implant hearing outcomes using ecological momentary assessment in both controlled and real-world settings

Laboratory tests of speech understanding demonstrate high effectiveness of cochlear implants (CIs) for individuals with severe-to-profound hearing loss. However, understanding real-world benefits remains challenging. Retrospective questionnaires may be unreliable due to recall bias and limited acoustic information. To address this, we used an Ecological Momentary Assessment (EMA) smartphone app to collect subjective feedback and acoustic data from CI recipients in lab and real-world settings. We characterised challenging acoustic environments for CI users and the influence of internal factors on self-ratings of environmental noisiness, device benefit, and speech understanding. Twenty adults underwent cognitive tests, questionnaires, EMA, and the NAL Dynamic Conversation Test in the lab. Acoustic scenes were reproduced in an anechoic chamber to assess comprehension, familiarise participants with EMA, and establish benchmarks for real-world EMA data. Over four weeks, participants recorded experiences using the EMA app. Analysis of real-world EMA data revealed perceived noisiness was influenced by spectro-temporal properties and sound level. Self-reported communication factors were associated with environmental sound level and predictive of self-reported CI device benefit. Communication factors were also correlated with CI experience and cognitive performance. EMA offers valuable insights into CI recipients' real-world experiences, aiding customization and efficacy evaluation.

A Proof of Concept Study on Individual Trends in Suicidal Ideation: An Ecological Momentary Assessment Study of 5 Patients Over Three Months.

Suicidal ideation (SI) is a significant and long-lasting mental health problem, with a third of individuals still experiencing SI after two years. To date, most Ecological Momentary Assessment (EMA) studies of SI have assessed its day-to-day course over one to four consecutive weeks and found no consistent trends in average SI severity over time. The current proof of concept study assessed daily fluctuations of SI over a time span of 3 to 6 months to explore whether individual trends in SI severity could be detected, and if so, if the trajectory of changes were gradual or sudden. The secondary aim was to explore whether changes in SI severity could be detected at an early stage. Five adult outpatients with depression and SI used an EMA app on their smartphone in addition to their regular treatment for 3 to 6 months, where SI was assessed 3 times a day. To detect trends in SI for each patient, three models were tested: a null model, a gradual change model and a sudden change model. To detect changes in SI before a new plateau was reached, Early Warning Signals and Exponentially Weighted Moving Average control charts were used. In each patient, average SI severity had a unique trajectory of sudden and/or gradual changes. Additionally, in some patients, increases in both sudden and gradual SI could be detected at an early stage. The study presents a first indication of unique individual trends in SI severity over a 3 to 6 months period. Though replication in a larger sample is needed to test how well results generalize, a first proof-of-concept is provided that both sudden and gradual changes in SI severity may be detectable at an early stage using the dynamics of time-series data.

Wearable-Measured Sleep and Resting Heart Rate Variability as an Outcome of and Predictor for Subjective Stress Measures: A Multiple N-of-1 Observational Study.

The effects of stress may be alleviated when its impact or a decreased stress-resilience are detected early. This study explores whether wearable-measured sleep and resting HRV in police officers can be predicted by stress-related Ecological Momentary Assessment (EMA) measures in preceding days and predict stress-related EMA outcomes in subsequent days. Eight police officers used an Oura ring to collect daily Total Sleep Time (TST) and resting Heart Rate Variability (HRV) and an EMA app for measuring demands, stress, mental exhaustion, and vigor during 15-55 weeks. Vector Autoregression (VAR) models were created and complemented by Granger causation tests and Impulse Response Function visualizations. Demands negatively predicted TST and HRV in one participant. TST negatively predicted demands, stress, and mental exhaustion in two, three, and five participants, respectively, and positively predicted vigor in five participants. HRV negatively predicted demands in two participants, and stress and mental exhaustion in one participant. Changes in HRV lasted longer than those in TST. Bidirectional associations of TST and resting HRV with stress-related outcomes were observed at a weak-to-moderate strength, but not consistently across participants. TST and resting HRV are more consistent predictors of stress-resilience in upcoming days than indicators of stress-related measures in prior days.

Using smartphone-based ecological momentary assessment and personalized feedback for patients with chronic cancer-related fatigue: A proof-of-concept study

IntroductionChronic cancer-related fatigue (CCRF) is a complex multidimensional problem warranting person-centered care. Providing patients and therapists personalized feedback based on network analysis applied to ecological momentary assessment (EMA) data could facilitate case conceptualization in psycho-oncological care. The aim was to explore patients' and therapists' experiences of using an EMA app and personalized feedback based on network theory to aid case conceptualization in psycho-oncological care. MethodsA n = 5 proof-of-concept study was implemented in routine psycho-oncological care. We purposively selected adult cancer patients suffering from severe CCRF who were on the waitlist for psycho-oncological care. During a 3-week period participants filled out the EMA app Energy InSight (fatigue, mood, activity, responding, and context) five times a day. Participants received a descriptive and network feedback report, which they reflected upon during the first therapy sessions. Thematic analysis was used to analyze user experiences. ResultsPatients experienced that filling out the Energy InSight app, as well as receiving descriptive and network-based personalized feedback provided them with insight into their CCRF. Although therapists experienced the discussion of network feedback as challenging, it facilitated the case conceptualization. DiscussionUsing EMA during waitlist for psychological care seemed feasible. Patients experienced beneficial effects from filling out the EMA app and talking over the personalized feedback reports, which in turn aided case conceptualization and personalized care. Based on this evaluation, an improved version of the Energy InSight app and a therapist training for providing network feedback is developed for implementation in psycho-oncological care.

Smartphone App-Based Noncontact Ecological Momentary Assessment With Experienced and Naïve Older Participants: Feasibility Study.

BackgroundSmartphone app–based ecological momentary assessment (EMA) without face-to-face contact between researcher and participant (app-based noncontact EMA) potentially provides a valuable data collection tool when geographic, time, and situational factors (eg, COVID-19 restrictions) place constraints on in-person research. Nevertheless, little is known about the feasibility of this method, particularly in older and naïve EMA participants.ObjectiveThis study aims to assess the feasibility of app-based noncontact EMA as a function of previous EMA experience, by recruiting and comparing a group of participants who had never participated in EMA before against a group of participants who had been part of an earlier in-person EMA study, and age, by recruiting middle-aged to older adults.MethodsOverall, 151 potential participants were invited via email; 46.4% (70/151) enrolled in the study by completing the baseline questionnaire set and were emailed instructions for the EMA phase. Of these participants, 67% (47/70) downloaded an EMA app and ran the survey sequence for 1 week. In total, 5 daytime surveys and 1 evening survey, each day, assessed participants’ listening environment, social activity, and conversational engagement. A semistructured exit telephone interview probed the acceptability of the method. As markers of feasibility, we assessed the enrollment rate, study completion rate, reason for noncompletion, EMA survey response rate, and likelihood of reporting an issue with survey alerts and requested assistance from researchers, family, or friends.ResultsEnrollment rates among invitees (63.3% vs 38.2%; P=.004) and completion rates among enrollees (83.9% vs 53.8%; P<.001) were higher in the experienced than in the naïve EMA group. On average, experienced participants responded to 64.1% (SD 30.2%) of the daytime EMA surveys, and naïve participants responded to 54.3% (SD 29.5%) of the daytime EMA surveys (P=.27). Among participants who retrospectively reported issues with survey alerts, only 19% (3/16) requested researcher assistance during data collection. Older participants were more likely to report not being alerted to EMA surveys (P=.008), but age was unrelated to all other markers of feasibility. Post hoc analyses of the effect of the phone operating system on markers of feasibility revealed that response rates were higher among iOS users (mean 74.8%, SD 20.25%) than among Android users (mean 48.5%, SD 31.35%; P=.002).ConclusionsSmartphone app–based noncontact EMA appears to be feasible, although participants with previous EMA experience, younger participants, and iOS users performed better on certain markers of feasibility. Measures to increase feasibility may include extensive testing of the app with different phone types, encouraging participants to seek timely assistance for any issues experienced, and recruiting participants who have some previous EMA experience where possible. The limitations of this study include participants’ varying levels of existing relationship with the researcher and the implications of collecting data during the COVID-19 social restrictions.

Personal Characteristics Associated with Ecological Momentary Assessment Compliance in Adult Cochlear Implant Candidates and Users.

Ecological momentary assessment (EMA) often places high physical and mental burden on research participants compared with retrospective self-reports. The high burden could result in noncompliance with the EMA sampling scheme protocol. It has been a concern that certain types of participants could be more likely to have low compliance, such as those who have severe hearing loss and poor speech recognition performance, are employed, are not familiar with technologies used to implement EMA (e.g., smartphones), and have poorer cognitive abilities. Noncompliance dependent on personal characteristics could negatively impact the generalizability of EMA research. This article aims to determine personal characteristics associated with EMA compliance in a group of adult cochlear implant (CI) candidates and users. An observational study. Fifty-eight adults who were either scheduled to received CIs or were experienced CI users completed the study. Participants conducted smartphone-based EMA designed to assess an individual's daily auditory ecology for 1 week. EMA compliance was quantified using two metrics: the number of completed surveys and the response rate to the notification delivered by the EMA app. Personal characteristics (i.e., predictors) included age, gender, CI status (candidate or user), employment status (employed or not employed), smartphone ownership, speech recognition performance, social network size, level of depressive symptoms, and neurocognitive abilities. A word recognition test, questionnaires, and a test battery of neurocognitive assessments were used to measure the predictors. We used negative binomial regression and logistic mixed models to determine the factors associated with the number of completed surveys and the response rate, respectively. We hypothesized that, for example, employed participants with poorer speech recognition performance would have lower compliance. Contrary to the hypothesis, word recognition score was negatively associated with the number of completed surveys (p = 0.022). Holding all other variables constant, a 10-point (i.e., 10%) word recognition score decrease was associated with an 11% increase in the number of completed surveys. For the response rate, employment status was the only significant predictor (p < 0.0001). Consistent with our hypothesis, the odds of responding to EMA notifications for those who are not employed are 82% higher than the odds for those who are employed. No other studied personal characteristic was associated with compliance. For CI candidates and users, EMA compliance could be affected by personal characteristics such as speech recognition performance and employment status. Because (1) participants with poorer speech recognition performance do not necessarily have lower compliance and (2) most personal characteristics investigated in the present study (e.g., age, gender, smartphone ownership, and neurocognitive abilities) do not predict compliance, a wide range of participants could successfully conduct smartphone-based EMA.

Advancing understanding of dietary and movement behaviours in an Asian population through real-time monitoring: Protocol of the Continuous Observations of Behavioural Risk Factors in Asia study (COBRA).

BackgroundModifiable risk factors for non-communicable diseases, including eating an unhealthy diet and being physically inactive, are influenced by complex and dynamic interactions between people and their social and physical environment. Therefore, understanding patterns and determinants of these risk factors as they occur in real life is essential to enable the design of precision public health interventions.ObjectiveThis paper describes the protocol for the Continuous Observations of Behavioural Risk Factors in Asia study (COBRA). The study uses real-time data capture methods to gain a comprehensive understanding of eating and movement behaviours, including how these differ by socio-demographic characteristics and are shaped by people's interaction with their social and physical environment.MethodsCOBRA is an observational study in free-living conditions. We will recruit 1500 adults aged 21–69 years from a large prospective cohort study. Real-time data capture methods will be used for nine consecutive days: an ecological momentary assessment app with a global positioning system enabled to collect location data, accelerometers to measure movement, and wearable sensors to monitor blood glucose levels. Participants receive six EMA surveys per day between 8 a.m. and 9.30 p.m. to capture information on behavioural risk factors including eating behaviours and diet composition movement behaviours (physical activity, sedentary behaviour, sleep), and related contextual factors. The second wave of ecological momentary assessment surveys with a global positioning system enabled will be sent 6 months later. Data will be analysed using generalised linear models to examine associations between behavioural risk factors and contextual determinants.DiscussionFindings from this study will advance our understanding of dietary and movement behaviours as they occur in real-life and inform the development of personalised interventions to prevent chronic diseases.

Perceived Impacts, Acceptability, and Recommendations for Ecological Momentary Assessment Among Youth Experiencing Homelessness: Qualitative Study.

BackgroundThe use of ecological momentary assessment (EMA) to study youth experiencing homelessness (YEH) behaviors is an emerging area of research. Despite high rates of participation and potential clinical utility, few studies have investigated the acceptability and recommendations for EMA from the YEH perspective.ObjectiveThis study aimed to describe the perceived benefits, usability, acceptability, and barriers to the use of EMA from the homeless youth perspective.MethodsYEH were recruited from a larger EMA study. Semistructured exit interviews were performed using an interview guide that focused on the YEH experience with the EMA app, and included perceived barriers and recommendations for future studies. Data analyses used an inductive approach with thematic analysis to identify major themes and subthemes.ResultsA total of 18 YEH aged 19-24 years participated in individual and group exit interviews. The EMA was highly acceptable to YEH and they found the app and EMA surveys easy to navigate. Perceived benefits included increased behavioral and emotional awareness with some YEH reporting a decrease in their high-risk behaviors as a result of participation. Another significant perceived benefit was the ability to use the phones for social support and make connections to family, friends, and potential employers. Barriers were primarily survey and technology related. Survey-related barriers included the redundancy of questions, the lack of customizable responses, and the timing of survey prompts. Technology-related barriers included the “freezing” of the app, battery charge, and connectivity issues. Recommendations for future studies included the need to provide real-time mental health support for symptomatic youth, to create individually customized questions, and to test the use of personalized motivational messages that respond to the EMA data in real time.ConclusionsYEH are highly receptive to the use of EMA in studies. Further studies are warranted to understand the impact of EMA on YEH behaviors. Incorporating the YEH perspective into the design and implementation of EMA studies may help minimize barriers, increase acceptability, and improve participation rates in this hard-to-reach, disconnected population.

Using Smartphone-Based Ecological Momentary Assessment in Audiology Research: The Participants' Perspective.

Purpose The article's purpose was to examine participants' impressions and experiences with smartphone-based ecological momentary assessment (EMA) to inform future EMA study design. Method Adults with hearing impairment (HI, n = 9) and with normal hearing (NH, n = 10) participated in a study using a smartphone-based EMA system to measure their auditory lifestyles. A 14-item survey was scheduled to deliver every 45 min by an EMA app. After a 1-week trial, participants were interviewed regarding their study experiences. The app log files were analyzed to understand how the participants interacted with the app. Results Across the two groups, 1,295 surveys were completed (compliance rate 74.4%). On average, HI participants completed 10.0 and NH participants completed 9.1 surveys per day. The mean survey completion time for HI and NH groups were 72 s and 51 s, respectively. For both groups, about 90% of the participants reported the app as easy to use; about 60% of the participants reported that repetitive surveys interrupted or somewhat interrupted their activities. Participants reported surveys disrupting situations, for example, working, driving, and social events, and that they were more likely to skip surveys in these situations. Additionally, 50% of NH and 30% of HI participants indicated that the survey was not delivered too frequently and none indicated that the survey was too long. Conclusion Overall, the app and EMA design seem to be appropriate. Insights from this study can help researchers design their studies to adequately assess listeners' experience in the field with optimal compliance and data quality.

Daily-Life Fatigue in Mild to Moderate Hearing Impairment: An Ecological Momentary Assessment Study.

Objectives:Previous research has indicated an association between hearing impairment (HI) and daily-life fatigue. However, the temporal and contextual correlates of such fatigue are largely unexplored. The present study used ecological momentary assessment (EMA) to examine (1) whether people with HI are more fatigued than people with normal hearing, (2) whether individuals with HI and normal hearing (NH) show similar diurnal patterns of fatigue, (3) whether people with HI spend less time in challenging listening situations compared with NH controls, and (4) whether more challenging listening situations are associated with more fatigue and whether hearing ability influences any observed association.Design:After excluding 22 participants with self-reported fatiguing health conditions from analyses, the participant sample consisted of 24 adults with HI and 20 adults with NH, aged 44 to 77 years (M = 65.4, SD = 7.5). Data were collected using smartphones and a commercially available EMA app, which ran the specified EMA protocol for this study. Participants responded to six smartphone surveys per day for two weeks. “In-the-moment” questions asked participants to report on their listening situation and to rate their current level of fatigue (“momentary fatigue”) at quasi-random time points throughout the day. Data were analyzed using multilevel modeling.Results:Hearing group (HI versus NH) was unrelated to trait, daily, and momentary fatigue; both participants with HI and NH became increasingly fatigued throughout the day and at a similar rate. Challenging listening situations occurred infrequently both for HI and NH groups. Participants with NH were more likely to report that there were people speaking in the background whom they were trying to ignore, but participants with HI were more likely to report a greater number of background speakers. No associations were found between within-person listening situations and momentary fatigue, but person-mean listening activity and conversational status were related to momentary fatigue. Notably, having tinnitus was positively related to momentary fatigue, after controlling for other covariates. Finally, having a fatiguing health condition was a strong predictor of both trait and momentary fatigue.Conclusions:This is the first study to explore and compare fatigue across HI and NH groups using EMA. Contrary to expectations, the groups showed similar levels and diurnal patterns of fatigue, and fatigue was mostly unrelated to aspects of the listening environment. Between-person differences, although statistically significant, produced small effect sizes and therefore must be accepted cautiously. Issues with group matching, the measurement of fatigue, and perceived hearing-related difficulties among participants with NH are notable limitations. However, this study makes a novel contribution to both EMA and hearing research and demonstrates the importance of screening for fatiguing health conditions. Further research is warranted, particularly with individuals with more severe HI.

Development and Acceptability of a Method to Investigate Prescription Drug Misuse in Daily Life: Ecological Momentary Assessment Study.

BackgroundPrescription drug misuse and abuse is an established public health challenge, and young adults are particularly affected. There is a striking lack of real-time, naturalistic data collection assessing intentions to misuse and other precipitating factors at the time of actual misuse, leaving the conditions under which individuals are most likely to misuse prescription medications unknown. Ecological momentary assessment (EMA) apps and protocols designed to capture this information would accelerate and expand the knowledge base and could directly contribute to prevention and treatment efforts.ObjectiveThe objectives of this study are to describe the development and administration of a mobile app and the EMA protocol designed to collect real-time factors associated with college students’ prescription drug misuse intentions and behaviors in daily life; present completion rates, compliance, acceptability, and reactivity associated with the EMA protocol for participants who endorsed recent prescription drug misuse at screening (ie, risk group; n=300) and those who did not (ie, nonrisk group; n=55); and establish initial construct validity by linking the reports of misuse behaviors in daily life collected via the EMA app to prescription drug misuse reported on a standard survey.MethodsAn EMA data collection app and protocol were designed specifically to capture hypothesized contextual factors along with prescription drug misuse intentions and behaviors in daily life. Using this protocol, young adult college students (N=352) completed signal- and event-contingent reports over a 28-day period. When the intention to misuse a prescription drug was endorsed, a brief follow-up prompt was sent 15 min later to collect participants’ indications of whether or not misuse had occurred.ResultsRisk-group participants were significantly more likely than nonrisk counterparts to endorse any prescription drug misuse intentions in daily life (P<.001), to complete one or more follow-up reports (P<.001), and to endorse any prescription drug misuse behavior in daily life on the follow-ups (P<.001). Overall, participants demonstrated consistent engagement with the EMA procedures and returned an average of 74.5 (SD 23.82; range 10-122) reports. Participants in the risk and nonrisk groups did not differ in the number of reports they completed (P=.12), the number of their reporting days (P=.32), or their average completion rates (P=.14). The results indicated some evidence of reactivity to the momentary reporting procedure. Participants reported uniformly positive experiences and remained highly engaged throughout the reporting protocol and broader study.ConclusionsThe novel EMA app and protocol provide an effective way to assess real-time factors associated with prescription drug misuse intentions and behaviors in daily life. The resulting investigations offer the potential to provide highly translatable information for research and prevention efforts.

Associations between affect, craving, and smoking in Korean smokers: An ecological momentary assessment study

Cigarette smoking remains the largest cause of preventable death in the United States and worldwide. In South Korea and other Asian countries, a large proportion of males smoke, increasing the need to examine cigarette smoking in these populations. Research suggests that the association between positive affect and negative affect, and between affect and craving, may differ across cultures, and that it is useful to examine these associations using Ecological Momentary Assessment (EMA). South Korean smokers (N = 20, Mean Age = 21.15, 25% female) completed baseline questionnaires and downloaded an EMA app which prompted 4 random assessments (RAs) each day for 1-week. At each assessment, participants responded to items assessing momentary negative affect (NA) and positive affect (PA), craving, and number of cigarettes smoked since the previous EMA assessment. Linear mixed models (LMMs) were used to analyze EMA data (544 assessments), separating out between- and within- subject associations. There was a significant positive association between positive affect and negative affect at the between-subjects level. Both positive affect and negative affect were significantly positively associated with craving at between-subjects and within-subject levels. Craving was associated with subsequent smoking behavior at the within-subjects level. Overall, results suggest that associations between positive affect and negative affect may be different in South Korean smokers than in Western smokers, and that there are robust associations between both negative and positive affect and craving.

A pilot study using ecological momentary assessment via smartphone application to identify adolescent problematic internet use

For some youth, pathologic Internet use can cause significant distress and dysfunction, a phenomenon known as Problematic Internet Use (PIU). PIU has been associated with poorer health outcomes in adolescents with existing psychiatric illness but understanding PIU has been challenging due to research methodologies using cross-sectional, self-report data. This study assessed the feasibility of using app-based ecological momentary assessment (EMA) to provide more ecologically-valid data to identify and characterize the relationship between mood symptoms and PIU in adolescents in active mental health treatment. 25 youth (aged 12–23) were recruited to use an EMA app for 6 weeks. 96% of participants completed the study and the majority of participants completed surveys at least once weekly. Youth with anxiety disorders endorsed significantly greater benefit from using the app to monitor PIU. While PIU severity was positively correlated with worsened anxiety and depression, analyses of the temporal relationships between PIU and mood symptoms showed that anxiety symptoms were significantly improved after episodes of PIU. Overall results suggest that app-based EMA may be both acceptable and feasible to understand PIU in this population. Follow-up studies should consider personalization of study protocols and use of digital phenotyping methodology to collect more objective measurements of behavior.