Ecological Momentary Assessment Protocol Research Articles

Social Integration and Diurnal Cortisol Decline: The Role of Psychosocial and Behavioral Pathways.

A growing number of studies have associated various measures of social integration, the diversity of social roles in which one participates, with alterations in hypothalamic-pituitary-adrenocortical (HPA) functioning. The pathways through which social integration may be linked to HPA functioning, however, are as yet unknown. The present study examined whether daily social interactions, affective responses, health behaviors, and personality help explain the association between social integration and diurnal cortisol slope. A sample of 456 healthy, employed adults (53.9% female, 82.0% white, 72.2% bachelor's degree or greater, mean age of 42.86 years) completed a 4-day ecological momentary assessment protocol that measured cortisol, social interactions, affect, sleep, and physical activity at frequent intervals throughout the day. Social integration was measured at baseline. Regression results controlling for age, sex, race, and education indicated that more socially integrated individuals showed steeper cortisol slopes (B = -0.00253, p = .006). Exploratory analyses suggested that the consistency (i.e., reduced variability) in nightly sleep midpoint partially explained this association (B = -0.00042, 95% confidence interval = -0.00095 to -0.00001). Personality, mood, social interaction patterns, and nonsleep health behavior differences did not account for the association between social integration and HPA activity. This study replicates previous findings linking social integration and HPA functioning, and it examines patterns of nightly sleep as possible pathways through which the association may operate. Results have implications for understanding mechanisms for health risk and for development of future interventions.

Naturalistically assessed associations between physical activity, affective functioning, and binge eating among adults with binge-eating disorder

ABSTRACT Binge-eating disorder (BED) is associated with overweight/obesity, physical inactivity, and disturbances in affective functioning. While research suggests that physical activity (PA) may have beneficial effects on BED symptoms, little is known about the daily correlates of PA. As a first step in understanding the processes linking PA and binge eating, this study examined associations between PA (i.e., self-reported time engaged in moderate-to-vigorous PA), affective functioning (i.e., positive and negative affect, body satisfaction, emotion regulation), and eating-related cognitions and behaviors (i.e., craving, overeating, loss of control eating) measured via ecological momentary assessment (EMA). Adults with BED (N = 91) completed a seven-day EMA protocol during which they completed repeated measures of these variables. Results indicated individuals who reported greater time engaged in PA over the EMA protocol evidenced higher positive affect and body satisfaction, and lower overeating (between-subjects effects). No significant within-subjects effects were observed. Findings demonstrate that individual differences in PA levels were related to more adaptive affective functioning and eating regulation in daily life. Results highlight the relevance of PA in BED, and the need for future studies to identify the timescale of these relationships using objective measurements of PA.

Momentary Physical Activity Co-Occurs with Healthy and Unhealthy Dietary Intake in African American College Freshmen.

Background: Research investigating interrelations between physical activity and dietary intake has primarily used retrospective, summary-based measures of behavior subject to increased recall bias. This study used ecological momentary assessment (EMA) methods with accelerometry to determine within-day, momentary associations between physical activity and dietary intake behaviors in African American college freshmen. Methods: Participants (N = 50) completed a dietary EMA protocol that assessed food/fluids consumed over the past 2 h at five random times per day and wore an activPAL accelerometer for 7 days to measure physical activity. Physical activity was operationalized as step counts in the 2 h prior to the EMA prompt (matching the EMA recall window). Results: On occasions when participants took more steps than was typical for them in the 2 h prior to the EMA prompt, they were more likely to consume sugar-sweetened beverages (OR = 1.37, p < 0.001), water (OR = 1.28, p < 0.001), fruit (OR = 1.44, p < 0.001), vegetables (OR = 1.19, p = 0.02), and fried fast food (OR = 1.21, p = 0.04) over that same time. Conclusion: Momentary physical activity co-occurred with momentary consumption of both healthy and unhealthy dietary intake. These behavioral interrelations suggest potential implications for obesity risk and multiple health behavior change interventions in young adult African Americans.

Affective Dynamics Across Internalizing and Externalizing Dimensions of Psychopathology.

Little is known about pathogenic affective processes that cut across diverse mental disorders. The current study examines how dynamic features of positive and negative affect differ or converge across internalizing and externalizing disorders in a diagnostically diverse urban sample using bivariate dynamic structural equation modeling. One-hundred fifty-six young women completed semi-structured clinical interviews and a 21-day ecological momentary assessment protocol with seven assessments of affective states per day. Internalizing and externalizing dimensions of psychopathology were modeled using confirmatory factor analysis of mental disorders. After controlling for externalizing disorders, internalizing disorders were associated with higher negative affective mean intensity, higher negative affective variability (i.e., unique innovation variance), and lower positive affective variability. Conversely, externalizing disorders were associated with less persistent positive affect (i.e., lower inertia) and more variable positive emotionality. Results suggest internalizing and externalizing disorders have distinct affective dynamic signatures, which have implications for development of tailored interventions.

The use of ecological momentary assessment to evaluate real-world aided outcomes with children

Background Ecological momentary assessment (EMA) methods allow for real-time, real-world survey data collection. Studies with adults have reported EMA as a feasible and valid tool in the measurement of real-world listening experience. Research is needed to investigate the use of EMA with children who wear hearing aids. Objectives This study explored the implementation of EMA with children using a single-blinded repeated measures design to evaluate real-world aided outcome. Methods Twenty-nine children, aged 7–17, used manual program switching to access hearing aid programs, fitted according to Desired Sensation Level (DSL) version 5.0 child quiet and noise prescriptive targets. Aided outcome was measured using participant-triggered twice-daily EMA entries, across listening situations and hearing dimensions. Results Adherence to the EMA protocol by the children was high (82.4% compliance rate). Speech loudness, understanding and preference results were found to relate to both the hearing aid program and the listening situation. Aided outcomes related to prescription-based noise management were found to be highest in noisy situations. Conclusions Mobile device-based EMA methods can be used to inform daily life listening experience with children. Prescription-based noise management was found to decrease perceived loudness in noisy, non-school environments; this should be evaluated in combination with hearing aid noise reductions features.

The momentary interplay of affect, attention bias, and expectancies as predictors of binge eating in the natural environment.

Affect regulation, eating expectancies, and attention toward food-related cues are interrelated constructs that have been implicated in the maintenance of binge eating. While these processes show considerable temporal variability, the momentary associations between these domains have not been elucidated. This study examined a model that posited momentary fluctuations in affect, eating expectancies, and attention bias (AB) would interact to predict subsequent binge eating. Forty women who endorsed recurrent binge eating completed a 10-day ecological momentary assessment protocol with ambulatory measures of AB (i.e., dot-probe task with palatable food and neutral cues) and self-report assessments of positive and negative affect, eating expectancies (i.e., the belief that eating would improve one's mood), and binge-eating symptoms. Generalized linear mixed models indicated higher momentary AB toward palatable food was associated with increased risk of subsequent binge eating, and a two-way interaction showed that moments of higher eating expectancies and negative affect were associated with increased likelihood of subsequent binge eating. Also, a three-way interaction emerged, in that the association between eating expectancies and subsequent binge eating was strongest at lower levels of positive affect and higher AB. Together, findings partially supported hypotheses and demonstrate meaningful within-person fluctuations in AB that precede binge eating. Further, results demonstrate that the momentary influence of eating expectancies on binge eating depends on both affective state and attentional processes.

Adolescent suicide risk and experiences of dissociation in daily life

Dissociation is associated with risk for suicide in adults, but this link is not well studied in adolescents, in spite of their marked suicide risk. This study assessed adolescents’ dissociative experiences in daily life and evaluated the association between dissociative experiences and suicide risk, including the independence of this relationship from related affective and clinical states and demographic characteristics. Clinically referred early adolescents (N = 162; aged 11–13) were assessed via multi-informant clinical interview, questionnaires, and 4-day ecological momentary assessment protocol. Adolescents were classified as being at elevated suicide risk using multi-informant, multi-method reports of suicide risk behavior and/or at elevated proximal risk using the 4-day EMA only. Suicide risk was associated with daily dissociative experiences, and this relationship was independent of daily negative and positive affect and co-occurring borderline personality symptoms. Gender differences emerged, such that the relationship between daily dissociative experiences and suicide risk was only significant in adolescent girls. Overall, findings suggest dissociation may be independently relevant to adolescent suicide risk, above and beyond effects of psychopathology and affective disturbance, and especially in girls. Daily dissociative experiences may help understand and detect suicide risk among early adolescents and warrant further research.

The ecological validity of trait-level rumination measures among women with binge eating symptoms.

Cognitive rumination is a transdiagnostic construct that has been increasingly studied in the context of eating disorders (EDs). While this literature has consistently linked trait-level general and ED-specific forms of rumination to ED psychopathology, it is not clear whether trait-level measures are independently related to symptoms in daily life. Therefore, the present study used ecological momentary assessment (EMA) to assess the ecological validity of trait measures of general rumination and ED-specific rumination, and assess the degree to which ruminative brooding and reflection were differentially related to relevant momentary affective, cognitive, and behavioral processes. Forty women completed baseline measures (Ruminative Response Scale [RRS] and Ruminative Response Scale for Eating Disorders [RRSED]) followed by a 10-day EMA protocol. Generalized estimating equations indicated trait-level ED-specific rumination was related to momentary general and ED-specific rumination, and trait-level general and ED-specific rumination were related to momentary affect and concentration difficulties. Trait-level general rumination was related to momentary self-discrepancy, while higher trait-level ED-specific rumination was related to greater loss of control eating, overeating, and body dissatisfaction. Lastly, trait levels of ruminative brooding, compared to reflection, were more consistently related to maladaptive momentary symptoms (i.e., general rumination, negative affect, concentration problems, body dissatisfaction). Together these findings support the ecological validity of the RRSED and identify shared and unique momentary correlates of the RRS and RRSED. Results also highlight the importance of measuring and addressing trait- and state-level ruminative processes that are both general and specific to ED psychopathology in research and clinical work. Level V, observational descriptive study.

Using ecological momentary assessment to evaluate neuropathic pain experienced by adults with SCI: recommendations and participant perceptions

Purpose Neuropathic pain is a debilitating consequence of spinal cord injury. Ecological momentary assessment can be a valuable research tool for understanding temporal fluctuations in neuropathic pain and designing effective management strategies. The objectives of this study were to (a) describe strategies necessary to adapt ecological momentary assessment to measure neuropathic pain in adults with spinal cord injury, and (b) explore participant perceptions of using ecological momentary assessment to measure pain sensations. Methods End-users with spinal cord injury provided input to guide development of an ecological momentary assessment protocol. Six adults with spinal cord injury (ages 27–50 years, M = 39.33 ± 8.24) engaged in the six-day protocol and completed six daily neuropathic pain assessments. Upon finishing participants completed a semi-structured interview regarding their protocol experiences. A qualitative content analysis was used to analyze the interview data. Results Participants reported that this specific ecological momentary assessment protocol was unobtrusive to their daily routines, and effectively captured their neuropathic pain sensations. However, participants experienced increased neuropathic pain due to the repeated nature of assessments. Conclusion Ecological momentary assessment can capture the dynamic nature of neuropathic pain experienced by persons with spinal cord injury. However, caution should be taken when designing intensive pain-related protocols to minimize pain exacerbation. IMPLICATIONS FOR REHABILITATION Neuropathic pain affects up to 75% of people with spinal cord injury and is one of the most frequently occurring, debilitating forms of pain. Appropriate and feasible pain data collection methods are necessary to acquire a better understanding of how neuropathic pain manifests in people with spinal cord injury. Implementing ecological momentary assessment in a rehabilitation setting may help facilitate the monitoring of neuropathic pain for both rehabilitation professionals and persons with SCI. Using ecological momentary assessment may lead to a better understanding of individual temporal patterns of neuropathic pain that could inform the design of tailored neuropathic pain management techniques.

P.445 Association between interoception and emotions in individuals with alcohol use disorder

Cognitive reappraisal has been discussed to dampen emotional experience and foster health and well-being. Recent theorizing suggests that the benefits of reappraisal might depend on the feasibility to exert control in a given situation and the ability of an individual to sensitively attend to organismic cues (interoception). This study examined the interplay of habitual reappraisal, interoceptive awareness and perceived control on psychological (self-esteem) and physiological (heart rate variability) adjustment in daily life. A sample of 111 participants was monitored throughout 12 h. Habitual reappraisal was assessed via the emotion regulation questionnaire and interoception via a heartbeat detection task (method of constant stimuli). An ecological momentary assessment protocol was used to record short-term heart rate variability (HRV) as an indicator of cardiac vagal tone, self-esteem and perceived control in daily life. Higher use of reappraisal was associated with higher self-esteem particularly in good heartbeat detectors when perceived control in daily life was low. Conversely, habitual reappraisal was unrelated to momentary self-esteem in poor heartbeat detectors. Moreover, habitual reappraisal predicted higher HRV in daily life when perceived control was low, and reappraisal tended to be positively related with HRV in good, but not in poor heartbeat detectors. Together the findings suggest that the benefits of habitual reappraisal in daily life may depend on perceived control and interoceptive accuracy, thus supporting the assumption that the effects of reappraisal in daily life are more complex.

AFFECTIONATE PHYSICAL TOUCH MITIGATES PAIN AND EMOTIONAL DISTRESS IN OLDER ADULTS

Although research suggests that social interactions can decrease pain and emotional distress, it is unclear what produces these salubrious effects. We examined whether older adults experienced lower pain and emotional distress after two types of social interactions (affectionate physical contact and non-physical pleasant interactions) using data from the Einstein Aging Study (N=193, age=70-92). Participants completed a 14-day ecological momentary assessment protocol via which they reported the quality of recent social interaction, types of physical touch, levels of current stress, negative affect, and pain intensity five times a day. Multilevel models indicated that, following affectionate physical contact, individuals reported low levels of current pain intensity, negative affect, and stress (ps<.05). Following a pleasant non-physical interaction, individuals reported low negative affect (p<.05); pleasant interactions did not predict current pain or stress. Results highlight the potential unique utility of affectionate physical contact versus mere pleasant social interactions in older adults’ daily lives.

Examining intra-individual variability in food-related inhibitory control and negative affect as predictors of binge eating using ecological momentary assessment

Binge eating presents in the context of several eating disorders (EDs) and has been shown to be associated with negative affectivity and inhibitory control deficits. While considerable ecological momentary assessment (EMA) work in EDs has demonstrated the importance of intra-individual variability in affect in predicting binge episodes, no research has considered how fluctuations in inhibitory control and negative affect together influence binge eating, or the extent to which these relationships may differ across ED diagnoses. Therefore, the present EMA study assessed the extent to which daily inhibitory control moderated momentary associations between negative affect and binge eating, and whether the presence of regular compensatory behaviors influenced these associations. Participants were 40 women reporting regular binge eating (anorexia nervosa binge-purge type [AN-BP], bulimia nervosa [BN], binge-eating disorder [BED]/subthreshold BED) who completed a 10-day EMA protocol that included measures of affect, eating, and a daily ambulatory Go/No-go task that included palatable food and neutral stimuli. Results of generalized estimating equations indicated greater between-person food-related inhibitory control deficits were associated with greater binge likelihood, and there was a three-way interaction between momentary negative affect, daily food-related inhibitory control, and compensatory behavior group. For individuals with BN or AN-BP, the relationship between momentary negative affect and subsequent binge eating was stronger on days characterized by reduced inhibitory control, whereas no main or interactive effects of negative affect or inhibitory control were observed for those with BED/subthreshold BED. Together these results demonstrate the importance of intra-individual variability in executive functioning and affective processes that underlie binge eating, as well as meaningful individual differences in these momentary associations.

From neuroimaging to daily functioning: A multimethod analysis of reward anticipation in people with schizophrenia.

Negative symptoms are a core clinical feature of schizophrenia that are only marginally responsive to current treatments. Recent work suggests that deficits in reinforcement learning and anticipatory responses to reward may be two mechanisms that help explain impairments in motivation in those with schizophrenia. The present study utilized a reinforcement-learning paradigm, which allowed us to examine both reward anticipation and reinforcement learning. Twenty-eight people with schizophrenia and 30 healthy controls completed a reinforcement-learning task while undergoing functional MRI. Participants with schizophrenia also completed a weeklong ecological momentary assessment protocol reporting anticipated motivation and pleasure in their daily activities. Unexpectedly, we found no significant group differences in performance or neural response in reinforcement learning. However, we found that poorer reward learning was associated with greater clinician ratings of negative symptoms and daily reports of anticipatory motivation and pleasure negative symptoms. In regards to anticipatory responses, we found that people with schizophrenia showed blunted activation in the anterior cingulate, insula, caudate, and putamen while anticipating reward. Further, blood oxygen level-dependent (BOLD) response in reward related regions during anticipation of reward was significantly related to both clinician-rated motivation and pleasure deficits as well as daily reports of motivation and pleasure. Our results provide further evidence of deficits during reward anticipation in individuals with schizophrenia, particularly for those with severe negative symptoms, and some evidence for worse reward learning among those with greater negative symptoms. Moreover, our findings suggest that these deficits show important relationships with emotional and motivational functioning in everyday life. (PsycINFO Database Record (c) 2019 APA, all rights reserved).

Application of an Ecological Momentary Assessment Protocol in a Workplace Intervention: Assessing Compliance, Criterion Validity, and Reactivity.

Ecological momentary assessment (EMA) is a method of collecting behavioral data in real time. The purpose of this study was to examine EMA compliance, identify factors predicting compliance, assess criterion validity of, and reactivity to, using EMA in a workplace intervention study. Forty-five adults (91.1% female, 39.7 [9.6]y) were recruited for a workplace standing desk intervention. Participants received 5 surveys each day for 5 workdays via smartphone application. EMA items assessed current position (sitting/standing/stepping). EMA responses were time matched to objectively measured time in each position before and after each prompt. Multilevel logistic regression models estimated factors influencing EMA response. Cohen kappa measured interrater agreement between EMA-reported and device-measured position. Reactivity was assessed by comparing objectively measured sitting/standing/stepping in the 15minutes before and after each EMA prompt using multilevel repeated-measures models. Participants answered 81.4% of EMA prompts. Differences in compliance differed by position. There was substantial agreement between EMA-reported and device-measured position (κ = .713; P < .001). Following the EMA prompt, participants sat 0.87minutes more than before the prompt (P < .01). The use of EMA is a valid assessment of position when used in an intervention to reduce occupational sitting and did not appear to disrupt sitting in favor of the targeted outcome.

Alexithymia – Not autism – is associated with frequency of social interactions in adults

ObjectiveWhile much is known about the quality of social behavior among neurotypical individuals and those with autism spectrum disorder (ASD), little work has evaluated quantity of social interactions. This study used ecological momentary assessment (EMA) to quantify in vivo daily patterns of social interaction in adults as a function of demographic and clinical factors. MethodAdults with and without ASD (NASD = 23, NNeurotypical = 52) were trained in an EMA protocol to report their social interactions via smartphone over one week. Participants completed measures of IQ, ASD symptom severity and alexithymia symptom severity. ResultsCyclical multilevel models were used to account for nesting of observations. Results suggest a daily cyclical pattern of social interaction that was robust to ASD and alexithymia symptoms. Adults with ASD did not have fewer social interactions than neurotypical peers; however, severity of alexithymia symptoms predicted fewer social interactions regardless of ASD status. ConclusionsThese findings suggest that alexithymia, not ASD severity, may drive social isolation and highlight the need to reevaluate previously accepted notions regarding differences in social behavior utilizing modern methods.

Reactive and proactive aggression in children with and without ADHD and negative emotional lability

AbstractChildren with attention‐deficit/hyperactivity disorder (ADHD) exhibit marked difficulty with frequent and intense shifts in negative or positive emotions, referred to as emotional lability. This study examines the relationships between negative emotional lability (NEL), ADHD, and reactive and proactive aggression. A community sample of 96 children (53 with ADHD, 43 control) ages 8–12 and their parents completed a baseline session include a diagnostic structured interview and the Reactive–Proactive Aggression Questionnaire (RPAQ). Parents then rated their child's NEL using the Positive and Negative Affect Scale as part of an Ecological Momentary Assessment protocol 3 times a day for 28 days. Seventy‐three participants (37 with ADHD, 36 control) completed the RPAQ at follow‐up. Hierarchical regression analyses indicated that NEL significantly and independently estimates reactive aggression at baseline and follow‐up, regardless of ADHD status. NEL and ADHD status significantly estimates concurrent proactive aggression, but not at follow‐up. Results of this study suggest that NEL accounts for a significant amount of the variability in reactive aggression, a common difficulty in children with ADHD. Further, individuals that are reportedly emotionally labile become more reactively aggressive over time. Both ADHD diagnostic and NEL are predictors of proactive aggression at baseline, although no interaction occurred.

Associations between affect and alcohol consumption in adults: an ecological momentary assessment study

ABSTRACT Background: Consuming alcohol for coping with negative affect (NA) or enhancing positive affect (PA) may lead to risky drinking patterns. Previous research has yielded mixed findings regarding these affective drinking associations. Objectives: To examine support for the self-medication and expectancy models of alcohol use in an adult community sample, by examining reciprocal associations between alcohol consumption and NA and PA within and between persons. Methods: During seven consecutive days, 162 adults from the community (109 female) reported their affective experiences and alcohol consumption, following a signal contingent ecological momentary assessment protocol on their smartphones. Results: Within-person daily NA preceding the first drinking event was associated with increased likelihood of same-day alcohol consumption. Within-person momentary NA was associated with a decrease in the amount of next-moment alcohol consumption. Within-person momentary PA was positively associated with likelihood of next-moment alcohol consumption. Between persons, levels of daily and momentary NA and PA were not associated with any index of alcohol consumption. The intercepts and slopes of NA were not significantly different before and after alcohol consumption. The intercept of PA was higher after alcohol consumption, whereas the slope of PA decreased after alcohol consumption. Conclusion: In the current sample affective drinking was a within-person process (i.e. persons were sensitive to their varying levels of affect). Some support was found for the self-medication and expectancy models. People may drink for coping with NA, but may also be at risk for developing affective drinking patterns in response to PA.

Suicidal Ideation Among Anxious Youth: A Preliminary Investigation of the Role of Neural Processing of Social Rejection in Interaction with Real World Negative Social Experiences.

Suicidal ideation increases in adolescence, especially for anxious youth, and is a frequent precursor to suicide. This study examined whether neural processing of social rejection interacted with negative social experiences to predict suicidal ideation. Thus, to our knowledge this is the first study to examine how brain function may interact with the environment to contribute to suicidal ideation in youth, consistent with a developmental psychopathology perspective. Thirty-six anxious youth (ages 11 to 16) completed diagnostic interviews and questionnaires, an ecological momentary assessment (EMA) protocol, and a functional magnetic resonance imaging paradigm. Results showed that youth experienced greater severity of suicidal ideation when they exhibited heightened activation to social rejection in the right anterior insula and also experienced high levels of peer victimization or EMA-measured daily negative social experiences. Findings provide preliminary evidence that alterations in neural processing of social rejection interacts with exposure to negative social experiences to contribute to suicidal ideation.

Affective Instability and Alcohol Consumption: Ecological Momentary Assessment in an Adult Sample

The purpose of this study was to examine associations between three measures of affective instability (total affective instability [i.e., the sum of negative and positive affective instability], negative affective instability, and positive affective instability) and the likelihood and quantity of alcohol consumption in an adult community sample, within and between subjects. Following an ecological momentary assessment protocol, 162 adults from the community (109 women, ages 20-50 years old, M = 36.07, SD = 9.23) reported their affect and alcohol consumption 10 times a day for 7 consecutive days on their smartphones. Within subjects, total affective instability was positively associated with likelihood and quantity of alcohol consumption. Separately, negative and positive affective instability were not associated with likelihood or quantity of alcohol consumption at the within-subject level. Total, negative, and positive affective instability were associated with neither likelihood nor quantity of alcohol consumption at the between-subject level. The results suggest that consuming alcohol in response to affective instability was a within-person process, and that higher than a person's average levels of negative and positive affective instability may have a cumulative effect. Personalized interventions should identify days when affective instability is elevated and provide alternative, adaptive strategies for coping with emotional dysregulation. These interventions need to target instability in both negative and positive affect to counter their cumulative effect on alcohol consumption.

Understanding Pregnancy and Postpartum Health Using Ecological Momentary Assessment and Mobile Technology: Protocol for the Postpartum Mothers Mobile Study.

BackgroundThere are significant racial disparities in pregnancy and postpartum health outcomes, including postpartum weight retention and cardiometabolic risk. These racial disparities are a result of a complex interplay between contextual, environmental, behavioral, and psychosocial factors.ObjectiveThis protocol provides a description of the development and infrastructure for the Postpartum Mothers Mobile Study (PMOMS), designed to better capture women’s daily experiences and exposures from late pregnancy through 1 year postpartum. The primary aims of PMOMS are to understand the contextual, psychosocial, and behavioral factors contributing to racial disparities in postpartum weight and cardiometabolic health, with a focus on the daily experiences of stress and racism, as well as contextual forms of stress (eg, neighborhood stress and structural racism).MethodsPMOMS is a longitudinal observation study that is ancillary to an existing randomized control trial, GDM2 (Comparison of Two Screening Strategies for Gestational Diabetes). PMOMS uses an efficient and cost-effective approach for recruitment by leveraging the infrastructure of GDM2, facilitating enrollment of participants while consolidating staff support from both studies. The primary data collection method is ecological momentary assessment (EMA) and through smart technology (ie, smartphones and scales). The development of the study includes: (1) the pilot phase and development of the smartphone app; (2) feedback and further development of the app including selection of key measures; and (3) implementation, recruitment, and retention.ResultsPMOMS aims to recruit 350 participants during pregnancy, to be followed through the first year after delivery. Recruitment and data collection started in December 2017 and are expected to continue through September 2020. Initial results are expected in December 2020. As of early May 2019, PMOMS recruited a total of 305 participants. Key strengths and features of PMOMS have included data collection via smartphone technology to reduce the burden of multiple on-site visits, low attrition rate because of participation in an ongoing trial in which women are already motivated and enrolled, high EMA survey completion and the use of EMA as a unique data collection method to understand daily experiences, and shorter than expected timeframe for enrollment because of the infrastructure of the GDM2 trial.ConclusionsThis protocol outlines the development of the PMOMS, one of the first published studies to use an ongoing EMA and mobile technology protocol during pregnancy and throughout 1 year postpartum to understand the health of childbearing populations and enduring racial disparities in postpartum weight and cardiometabolic health. Our findings will contribute to the improvement of data collection methods, particularly the role of EMA in capturing multiple exposures and knowledge in real time. Furthermore, the results of the study will inform future studies investigating weight and cardiometabolic health during pregnancy and the postpartum period, including how social determinants produce population disparities in these outcomes.International Registered Report Identifier (IRRID)DERR1-10.2196/13569