Mobile Ecological Momentary Assessment Research Articles

What is in a Day? Investigating the Relationship Between Sleep Quality and Quality of Life Among Caregivers of Children With Autism.

The purpose of this study was to investigate the relationship between sleep quality and quality of life (QOL), or overall level of well-being, in caregivers of children with autism spectrum disorder (ASD) on the daily level. This study utilizes mobile ecological momentary assessment (mEMA) to capture daily experiences of caregivers of children with ASD over a period of 14 days. Utilizing mEMA, this study examines relations between sleep quality and QOL and the role of mood and physical health as mediators on the daily level, specifically for caregivers of children with ASD (n = 51). The data were analyzed using multilevel modeling by MLMed macro. The results suggest that there is a significant positive relation between sleep quality and QOL across individuals. Surprisingly, there was a negative relation between sleep quality and QOL within individuals. The positive relationship between sleep quality and QOL across participants was explained through positive mood across individuals. Furthermore, this relationship also occurred through better physical health across and within individuals. For caregivers of children with ASD, daily positive mood and better physical health explain the relationship between daily sleep quality and QOL. Understanding daily experiences of caregivers of children with ASD may inform interventions and practices aimed at improving sleep and its associated outcomes to ultimately improve caregiver well-being.

Examining daily impact of mood and quality of social support for caregivers of children on the autism spectrum

BackgroundCaregivers of children on the autism spectrum often report elevated levels of perceived stress which may lead to poorer ratings of quality of life (QOL), though this relation has not yet been investigated at the daily level. Caregiver daily mood and quality of social support may buffer the relation of perceived stress to QOL. MethodThe current study utilizes mobile ecological momentary assessment (mEMA) to capture daily experiences to examine relations between perceived stress and QOL and the role of mood and quality of social support as mediators on the daily level specifically for caregivers of children on the autism spectrum (n = 52). ResultsResults suggest that there is a significant relation between perceived stress and QOL within and across individuals. Further, positive mood buffered this relation across and within individuals, while better quality of social support buffered this relation only across individuals. ConclusionsMood and quality of social support serve as buffers in the relation between perceived stress and QOL for caregivers of children on the autism spectrum. Interventions addressing perceived stress would benefit from specifically targeting daily mood and quality of social support to bolster caregiver QOL and well-being.

Impulsivity and Alcohol Use during Pregnancy and Postpartum: Insights from Novel Methodological Approaches within the Context of the COVID-19 Pandemic.

Impaired emotion regulation and impulsivity have been linked to substance use. This study evaluated the association between emotion regulation difficulties-specifically impulsivity-and substance use within the context of the COVID-19 pandemic among pregnant (n = 49) and postpartum (n = 20) women. Participants from a prospective cohort ENRICH-2 completed a baseline phone survey of COVID-19-related experiences and impulsivity followed by a 14-day (3x/day) mobile ecological momentary assessment (mEMA) of impulsivity and substance use. Between-subject (BS) and within-subject (WS) associations for baseline impulsivity and momentary impulsivity with respect to substance use were examined using mixed effects models. At the BS level, momentary impulsivity scores that were higher than the overall group average were positively associated with subsequent momentary reports of marijuana use (β = 1.25; p = 0.04) when controlling for pregnancy status and COVID-19-related stress. At the WS level, momentary impulsivity scores that were higher than an individual's average score were positively associated with subsequent reports of momentary alcohol use (β = 0.08; p = 0.04). This research supports the idea that impulsivity varies based on individual situations, such as stress associated with the COVID-19 pandemic, and may be an important correlate of substance use in pregnant and postpartum women. Future research might consider investigation of additional factors, which may serve to moderate or mediate the relationship between impulsivity and substance use.

The feasibility and acceptability of mobile ecological momentary assessment to evaluate sleep, family functioning, and affect in patients with pediatric craniopharyngioma

Purpose/Objectives We aimed to assess the feasibility and acceptability of mobile ecological momentary assessment (mEMA) for youth with craniopharyngioma and evaluate daily associations among family functioning, affect, and sleep difficulties. Design/Research Approach Youth completed two mEMA diaries per day for one week. Sample/Participants Thirty-nine youth who underwent surgery and proton radiotherapy (when indicated) for craniopharyngioma. Methods/Methodological Approach Descriptive statistics and multi-level modeling were used to examine feasibility and acceptability of mEMA and daily associations among family functioning, affect, and sleep. Findings Youth reported satisfaction and minimal burden from completing daily mEMA diaries. Poorer family functioning was not related to lower sleep efficiency. Conclusions/Interpretation mEMA is an acceptable and feasible method for evaluating sleep and related variables in children and adolescents with craniopharyngioma. Implications for Psychosocial Providers or Policy Results highlight the utility of gathering mEMA data in youth at elevated risk for sleep difficulties as a function of their illness/treatment.

Mobile Assessments of Mood, Cognition, Smartphone-Based Sensor Activity, and Variability in Craving and Substance Use in Patients With Substance Use Disorders in Norway: Prospective Observational Feasibility Study.

Patients with substance use disorders (SUDs) are at increased risk for symptom deterioration following treatment, with up to 60% resuming substance use within the first year posttreatment. Substance use craving together with cognitive and mental health variables play important roles in the understanding of the trajectories from abstinence to substance use. This prospective observational feasibility study aims to improve our understanding of specific profiles of variables explaining SUD symptom deterioration, in particular, how individual variability in mental health, cognitive functioning, and smartphone use is associated with craving and substance use in a young adult clinical population. In this pilot study, 26 patients with SUDs were included at about 2 weeks prior to discharge from inpatient SUD treatment from 3 different treatment facilities in Norway. Patients underwent baseline neuropsychological and mental health assessments; they were equipped with smartwatches and they downloaded an app for mobile sensor data collection in their smartphones. Every 2 days for up to 8 weeks, the patients were administered mobile ecological momentary assessments (EMAs) to evaluate substance use, craving, mental health, cognition, and a mobile Go/NoGo performance task. Repeated EMAs as well as the smartphone's battery use data were averaged across all days per individual and used as candidate input variables together with the baseline measures in models of craving intensity and the occurrence of any substance use episodes. A total of 455 momentary assessments were completed out of a potential maximum of 728 assessments. Using EMA and baseline data as candidate input variables and craving and substance use as responses, model selection identified mean craving intensity as the most important predictor of having one or more substance use episodes and with variabilities in self-reported impulsivity, mental health, and battery use as significant explanatory variables of craving intensity. This prospective observational feasibility study adds novelty by collecting high-intensity data for a considerable period of time, including mental health data, mobile cognitive assessments, and mobile sensor data. Our study also contributes to our knowledge about a clinical population with the most severe SUD presentations in a vulnerable period during and after discharge from inpatient treatment. We confirmed the importance of variability in cognitive function and mood in explaining variability in craving and that smartphone usage may possibly add to this understanding. Further, we found that craving intensity is an important explanatory variable in understanding substance use episodes.

The effect of the COVID-19 pandemic on substance use patterns and physiological dysregulation in pregnant and postpartum women.

The SARS-CoV-2/COVID-19 pandemic has been associated with increased stress levels and higher alcohol use, including in pregnant and postpartum women. In the general population, alcohol use is associated with dysregulation in the autonomic nervous system (ANS), which is indexed by heart rate variability (HRV). The objectives of this study were to: (1) characterize changes in substance use during the SARS-CoV-2/COVID-19 pandemic via a baseline self-report survey followed by mobile ecological momentary assessment (mEMA) of substance use; and (2) examine the associations between momentary substance use and ambulatory HRV measures in pregnant and postpartum women. Pregnant and postpartum women were identified from the ENRICH-2 prospective cohort study. Participants were administered a baseline structured phone interview that included the Coronavirus Perinatal Experiences (COPE) survey and ascertained the prevalence of substance use. Over a 14-day period, momentary substance use was assessed three times daily, and HRV measurements were captured via wearable electronics. Associations between momentary substance use and HRV measures (root mean square of successive differences [RMSSD] and low frequency/high frequency [LF/HF] ratio) were examined using a mixed effects model that included within-subject (WS) and between-subject (BS) effects and adjusted for pregnancy status and participant age. The sample included 49 pregnant and 22 postpartum women. From a combination of a baseline and 14-day mEMA surveys, 21.2% reported alcohol use, 16.9% reported marijuana use, and 8.5% reported nicotine use. WS effects for momentary alcohol use were associated with the RMSSD (β = -0.14; p = 0.005) and LF/HF ratio (β = 0.14; p = 0.01) when controlling for pregnancy status and maternal age. No significant associations were observed between HRV measures and instances of marijuana or nicotine use. These findings highlight the negative effect of the SARS-CoV-2/COVID-19 pandemic on the psychological health of pregnant and postpartum women associated with substance use, and in turn, ANS dysregulation, which potentially puts some women at risk of developing a substance use disorder.

Beyond State of the Art: Digital psychiatry is coming of age!

Abstract Digital interventions for common mental disorders are coming of age. The uptake of evidence-based self-guided and guided (a-synchronic in time) cognitive behavioural digital interventions for depression and anxiety in routine care is however low. Blended treatment formats appear an attractive alternative for routine care settings as these combine face-to-face sessions with digital ones in integrated treatment protocols. Yet little is known about the clinical and cost-effectiveness of blended CBT (bCBT). In this presentation I will touch upon the current state of the art of digital interventions for depression and anxiety disorders, including blended formats in routine care and I will go beyond that state by addressing new developments. I will illustrate these new developments by virtue of several studies (RCT’s) we conducted on the clinical and cost-effectiveness of blended CBT interventions (and their implementation) in routine care settings. A specific focus will be put on blending digital phenotyping in CBT treatment which includes mobile ecological momentary assessment tools and AI algorithms. Conclusion While digital mental health for depression and anxiety in routine care was boosted through the Covid-19 pandemic, the question remains whether the current knowledge base will leveraging digital mental health research and services to the next level. Implications for future research on blended treatments and clinical applications in routine care will be discussed. Disclosure of Interest None Declared

Mobile assessment of experiential avoidance, mood, stress, and attendance in cardiopulmonary rehabilitation.

This study utilized mobile ecological momentary assessment (EMA) to examine the dynamic relationships among experiential avoidance (EA), mood, and cardiopulmonary rehabilitation (CVPR) attendance. Participants (n = 47; 40.4% female; 80.1% White; 85.1% Cardiac, 14.9% Pulmonary) were recruited from CVPR during their first 2 weeks of the program. They completed daily EMA prompts to assess momentary mood and EA for 2 weeks using a smartphone device. Multilevel modeling (MLM) was employed to investigate the impact of EA and mood on next-week attendance and the within-person within-prompt correlates, antecedents, and consequences of EA. Greater EA and negative mood significantly predicted worse next-week CVPR attendance rates. Within the same EMA prompt individuals with higher EA also reported greater negative affect and perceived stress, while individuals with lower EA reported greater positive mood. In addition, lagged analyses showed that EA was negatively related to next-day positive mood scores. EA appears to be an important targetable mechanism negatively related to CVPR program attendance and mood in CVPR patients. The present study builds upon previous research supporting EA as a dynamic and fluid emotion-regulation process, suggesting EA's impact on mood and behavior may be best understood through repeated real-time measurement methodology. (PsycInfo Database Record (c) 2022 APA, all rights reserved).

Descriptive Exploratory Study to Understand Postpartum Anxiety Using Multiple Measures

ObjectiveTo compare a general anxiety instrument plus a depression instrument with a specific postpartum anxiety instrument plus a depression instrument to detect postpartum anxiety and to explore trends in daily postpartum anxiety. DesignProspective, longitudinal cohort study. SettingAcademic tertiary center in the mid-Atlantic United States. Study activities were remote. ParticipantsPregnant women (N = 73) in the third trimester of pregnancy. MethodsWe administered the State–Trait Anxiety Inventory (STAI), Postpartum Specific Anxiety Scale (PSAS), and Edinburgh Postnatal Depression Scale (EPDS) at 1 and 8 weeks after birth. We used mobile ecological momentary assessment prompts to measure daily anxiety levels (0–10) from 1 to 8 weeks after birth. We defined the presence of anxiety and depression by using the established instrument cutoff scores. We used repeated-measures analysis of variance and dependent-samples t tests to determine the stability of the determined anxiety instruments during the study time frame. We used linear mixed modeling to explore mobile ecological momentary assessment anxiety trends. ResultsThe PSAS and EPDS detected more participants with anxiety and/or depression (26.8%, 19/71) than the STAI and EPDS (23.9%, 17/71) at 8 weeks after birth. PSAS scores increased from 1 to 8 weeks after birth (p = .003); STAI scores decreased (p = .01). Daily anxiety ratings changed nonlinearly during the study period, were greatest at 2 weeks, declined and stabilized, and then trended upward toward Week 8. ConclusionDetection of postpartum anxiety in clinical settings can be improved through addition of the PSAS in routine screening. Timing of anxiety assessment should be considered between 6 to 8 weeks after birth.

Comparing recalled versus experienced symptoms of breathlessness ratings: An ecological assessment study using mobile phone technology.

Background and objectiveRecall of breathlessness is important for clinical care but might differ from the experienced (momentary) symptoms. This study aimed to characterize the relationship between momentary breathlessness ratings and the recall of the experience. It is hypothesized that recall is influenced by the peak (worst) and end (most recent) ratings of momentary breathlessness (peak‐end rule).MethodsThis study used mobile ecological momentary assessment (mEMA) for assessing breathlessness in daily life through an application installed on participants' mobile phones. Breathlessness ratings (0–10 numerical rating scale) were recorded throughout the day and recalled each night and at the end of the week. Analyses were performed using regular and mixed linear regression.ResultsEighty‐four people participated. Their mean age was 64.4 years, 60% were female and 98% had modified Medical Research Council (mMRC) ≥ 1. The mean number of momentary ratings of breathlessness provided was 7.7 ratings/participant/day. Recalled breathlessness was associated with the mean, peak and end values of the day. The mean was most closely associated with the daily recall. Associations were strong for weekly values: peak breathlessness (beta = 0.95, r 2 = 0.57); mean (beta = 0.91, r 2 = 0.53); and end (beta = 0.67, r 2 = 0.48); p < 0.001 for all. Multivariate analysis showed that peak breathlessness had the strongest influence on the breathlessness recalled at the end of the week.ConclusionOver 1 week, recalled breathlessness is most strongly influenced by the peak breathlessness; over 1 day, it is mean breathlessness that participants most readily recalled.

Ecological Momentary Assessment: A Systematic Review of Validity Research.

Ecological momentary assessment (EMA) is a self-report method that involves intensive longitudinal assessment of behavior and environmental conditions during everyday activities. EMA has been used extensively in health and clinical psychology to investigate a variety of health behaviors, including substance use, eating, medication adherence, sleep, and physical activity. However, it has not been widely implemented in behavior analytic research. This is likely an example of the empirically based skepticism with which behavioral scientists view self-report measures. We reviewed studies comparing electronic, mobile EMA (mEMA) to more objective measures of health behavior to explore the validity of mEMA as a measurement tool, and to identify procedures and factors that may promote the accuracy of mEMA. We identified 32 studies that compared mEMA to more objective measures of health behavior or environmental events (e.g., biochemical measures or automated devices such as accelerometers). Results showed that the correspondence rates varied considerably across individuals, behavior, and studies (agreement rates ranged from 1.8%-100%), and no unifying variables could be identified across the studies that found high correspondence. The findings suggest that mEMA can be an accurate measurement tool, but further research should be conducted to identify procedures and variables that promote accurate responding.

Automaticity and depression: Daily mood-reactive rumination in people with and without depression history.

Depressive rumination has been conceptualized as a mental habit that is initiated automatically without conscious awareness, intent, or control in response to negative mood. However, it is unknown whether depression vulnerability is characterized by elevated levels of mood-reactive rumination at the level of short-term dynamics. Using mobile ecological momentary assessment, formerly depressed individuals with a recurrent history of depression (n = 94) and nonclinical controls (n = 55) recorded in-the-moment affect and rumination 10 times daily over 6 days, after completing baseline measures of trait ruminative brooding, early life stress, and habitual characteristics of negative thinking (e.g., automaticity, lack of conscious awareness, intent, and control). Momentary fluctuations in negative affect were prospectively associated with greater rumination at the next sampling occasion in formerly depressed participants whereas this pattern of mood-reactive rumination was not observed in nonclinical controls. In formerly depressed participants, habitual characteristics of negative thinking was associated with greater mood-reactivity of rumination, particularly among those with a history of early life stress. Mood-reactive rumination was not, however, associated with depression course nor with the frequency of trait ruminative brooding. Rumination may be triggered in response to negative affect with a high degree of automaticity, making it difficult to control. Greater mood-reactivity of rumination might be associated with increased depression risk, independent of the depressive course and may be exacerbated by early life stress. Future studies may need to go beyond frequency and focus on the role of mood-reactivity and automaticity of ruminative thinking in depression vulnerability. (PsycInfo Database Record (c) 2022 APA, all rights reserved).

Abstract P222: The Psychological Predictors Of Recovery After Acute Cardiac Events Study: Rationale And Design

Objective: To estimate the prospective association of cardiac anxiety at cardiac arrest (CA) discharge with subsequent risk for cardiovascular disease (CVD)/mortality after adjusting for general psychological distress and test its independent association with health-related quality of life (HRQoL). Our second objective is to test whether cardiac anxiety after CA is associated with low physical activity (PA) and/or short sleep shortly after discharge. Our third objective will test if low PA and/or short sleep mediate the association between cardiac anxiety and 12-month CVD/mortality post-discharge for CA. Further, the study will test the associations of general psychological distress with cardiac vagal control assessed by activity-adjusted heart rate variability. Background: Survivorship after CA is on the rise. However, survivors remain at markedly elevated risk for CVD, and many report poor HRQoL in the year after CA. Cardiac anxiety (i.e., cardiac specific-fear, avoidance behavior, and excessive cardiac symptom monitoring) has been shown in non-CA CVD patients to be associated with higher rates of psychological distress, avoidance of PA and poor sleep, patient-reported disability, and poor perceived health. Further, despite the association of low PA and poor sleep in CVD risk, no study has assessed those health behaviors in CA survivors. Design/Methods: This observational cohort study (anticipated n = 246) will evaluate CVD prognosis, HRQoL in the first year of survivorship of neurologically intact CA survivors admitted to New York Presbyterian Hospital between May 2021 and April 2026. At hospital discharge, 1, 6, and 12 months, study participants will be assessed for cardiac anxiety, and general psychological distress (screening measures for depression, posttraumatic stress, generalized anxiety symptoms), positive psychological factors (optimism, positive affect, purpose in life), functional (modified Rankin Scale) and telephone-based cognitive assessments. For 1-week post-discharge, and 1 week at 6-months post-discharge we will assess the level of PA and sleep duration using wrist-worn actigraphy, daily psychological factors using mobile ecological momentary assessment, and heart rate/heart rate variability using chest-worn patches. Results: Of the 21 patients enrolled to date (mean age 57 years, 10 women). The presentation will describe patterns of physical activity, sleep, both negative and positive psychological factors at 1-month post-discharge relative to discharge status. Conclusions: This is the first major prospective cohort study of CA survivorship, and the first to objectively assess health behaviors. By identifying malleable intervention targets for improving both CVD/mortality risk and post-CA HRQoL, this study could ignite the development of the first generation of CA survivorship interventions.

Negative Parenting, Adolescents' Emotion Regulation, Self-Efficacy in Emotion Regulation, and Psychological Adjustment.

This study examines associations between parents’ rejection and control, adolescents’ self-efficacy in their regulation of negative emotions, and maladjustment. Path analyses were employed to test (a) whether adolescents’ dysregulation and self-efficacy regarding anger/sadness regulation mediate the relationship between parental rejection/control and adolescent maladjustment; (b) whether adolescent adjustment mediates the association between parental rejection/control and dysregulation and self-efficacy regarding anger/sadness regulation. Participants included 103 Italian adolescents (Time 1: M age = 15.57; 53% male), their mothers (n = 103), and their fathers (n = 79). Follow up data were assessed one year later (Time 2). At Time 1, adolescent reports of the frequency of mothers’ and fathers’ rejection and control were examined. At Time 2, adolescent-reports of their beliefs about self-efficacy in regulating anger and sadness, as well as anger and sadness dysregulation, were assessed by two methods: questionnaire and mobile ecological momentary assessment. At Time 2, mothers’, fathers’, and adolescents’ reports of adolescents’ aggressive behaviors and depressive problems were also assessed. Maternal rejection was associated with higher one year later aggressive problems, which in turn were associated with higher dysregulation of sadness, and lower self-efficacy in dealing with both anger and sadness. In addition, maternal rejection was associated with higher depressive symptoms one year later, which in turn were associated with lower self-efficacy in dealing with sadness and higher dysregulation of both anger and sadness. Finally, maternal control was associated with higher depressive symptoms, whereas paternal control was associated with lower depressive symptoms.

Feasibility, Acceptability, and Design of a Mobile Ecological Momentary Assessment for High-Risk Men Who Have Sex With Men in Hanoi, Vietnam: Qualitative Study.

BackgroundMen who have sex with men (MSM) are at a disproportionate risk for HIV infection and common mental disorders worldwide. In the context of HIV, common mental disorders are important and are frequent drivers of suboptimal prevention and treatment outcomes. Mobile ecological momentary assessments (EMAs), or the repeated sampling of people’s behaviors and psychological states in their daily lives using mobile phones, can clarify the triggers and HIV-related sequelae of depressive-anxious symptoms and contribute toward the design of ecological momentary interventions (EMIs) that cater to the contextually varying needs of individuals to optimize prevention and treatment outcomes.ObjectiveThis study aims to characterize the feasibility and acceptability of mobile EMA among high-risk MSM in Hanoi, Vietnam. It aims to evaluate the perceived relevance, usability, and concerns of this group with regard to the content and delivery of mobile EMA and the potential of leveraging such platforms in the future to deliver EMIs.MethodsBetween January and April 2018, a total of 46 participants were recruited. The participants completed 6 to 8 mobile EMA surveys daily for 7 days. Surveys occurred once upon waking, 4 to 6 times throughout the day, and once before sleeping. All surveys queried participants’ perceived safety, social interactions, psychological state, and mental health symptoms. The morning survey further queried on sleep and medication use within the past 24 hours, whereas the night survey queried on sexual activity and substance use and allowed participants to share an audio recording of a stressful experience they had that day. At the end of the week, participants were interviewed about their experiences with using the app.ResultsParticipants completed an average of 21.7 (SD 12.7) prompts over the 7-day period. Excluding nonresponders, the average compliance rate was 61.8% (SD 26.6%). A thematic analysis of qualitative interviews suggested an overall positive reception of the app and 5 recurring themes, which were centered on the relevance of psychological and behavioral items to daily experiences (eg, mental health symptoms and audio recording), benefits of using the app (eg, increased self-understanding), worries and concerns (eg, privacy), usability (eg, confusion about the interface), and recommendations for future design (eg, integrating more open-ended questions).ConclusionsMobile EMA is feasible and acceptable among young MSM in Vietnam; however, more research is needed to adapt EMA protocols to this context and enhance compliance. Most participants eagerly provided information about their mental health status and daily activities. As several participants looked toward the app for further mental health and psychosocial support, EMIs have the potential to reduce HIV and mental health comorbidity among MSM.

Daily park use, physical activity, and psychological stress: A study using smartphone-based ecological momentary assessment amongst a multi-ethnic Asian cohort

ObjectiveTo investigate a) daily patterns of park use, leisure-time physical activity and stress, b) relationship of daily park use and leisure-time physical activity with stress; and c) the combined effects of daily park use and leisure-time physical activity on stress, and whether associations of daily park use and leisure-time physical activity with stress are independent. MethodsSingapore citizens/permanent residents 21-75 years-of-age from the Multi-Ethnic Cohort were enrolled into this study. Participants received mobile Ecological Momentary Assessment (mEMA) mini-surveys for up to nine days via their smartphone, with daily questions on park use and leisure-time physical activity, and perceived stress level in the evening. Descriptive statistics summarized demographics, day-to-day variation in park use, leisure-time physical activity and stress. Logistic regression models using generalized estimating equations assessed relationships of daily park use and leisure time physical activity with stress. ResultsA total of 605 participants providing 4678 EMA responses to mini-surveys were included in the analyses. Participants who visited parks during a day were less stressed on the same evening than those who did not visit parks (OR = 0.67; 95% CI = 0.58–0.77). Likewise, participants who were physically active during a day were less stressed on the same evening than those who were not physically active (OR = 0.73; 95% CI = 0.64–0.82). Daily park use and leisure-time physical activity on the same day was also associated with less stress (OR = 0.58; 95% CI = 0.49–0.69), and this measure of association was lower than those comparing daily engagement in only 1 of the 2 activities. The effects of park use and physical activity on lower perceived stress were independent. ConclusionsBoth daily park use and leisure time physical activity during the day were associated with reduced evening stress. These relationships were independent of one another, suggesting that each activity on its own is beneficial to reducing stress amongst adults in urban settings.

Assessing Sleep Quality Using Mobile EMAs: Opportunities, Practical Consideration, and Challenges

Sleep is one of the most important factors in maintaining both physical and mental health. There are many causes of sleep problems, it is generally necessary to maintain a healthy lifestyle to avoid them. In the medical field, information related to sleep problems including lifestyle information is obtained through interviews, but this approach is limited because it is dependent on the patient’s memory. Thus, there are many studies adopting ecological momentary assessments (EMAs) to collect patient’s lifestyles. Some of them also use smart devices to collect data effectively. However, these studies focused on specific factors such as smoking, exercising so that they have limits to reflect complex narrative of lifestyle patterns. Therefore, we proposed indicators consist of EMAs data for assessing everyday sleep quality and these indicators contain the complex lifestyle contexts in a quantitative manner. First, we collected real-life data using a smartphone through a 4-week data collection experiment. Second, we develop a method of generating daily indexes reflecting geospatial and social habits, social condition, activity level, and emotional condition using self-report data. Third, we evaluated daily indexes whether could use to supplement indicators comprising features using EMAs from conventional sleep questionnaires. The goal of analysis consists of five metrics of sleep quality that explain perceived sleep quality. The result of analysis indicates that features using both daily indexes and sleep questionnaires lead to better prediction of sleep quality. Additionally, it also shows the potential to generate indicators identifying complex human behaviors with the help of mobile devices and EMAs. Further research on user-friendly data acquisition methods and more diverse lifestyle information should be useful to support behavior decisions for better sleep in well-being services and in specialized medical fields.

Healthy diet and lifestyles assessment using a mEMA approach: protocol of the HEALTHY-UNICT study

Abstract Background Dietary intake, physical activity and other lifestyle factors, behaviors known to change in college students, may affect long-term health outcomes. The mobile Ecological Momentary Assessment (mEMA) methods represent an innovative, detailed and valid approach to capture the complexity of food intake and behaviors and to overcome limitations of traditional dietary assessment methods. The main aim of the HEALTHY-UNICT study is to characterize heating habits, including Mediterranean Diet adherence, and others lifestyle factors, and their relationship with anthropometrics and emotions in a sample of college students of the University of Catania, using real-time mEMA methods and an innovative custom mEMA application. Methods Data will be collected using a mEMA tool administered via a web-based application. mEMA data collection will be carried out in two waves during the second semester of the academic year. During each wave, participants will receive prompts via the text messages to complete the surveys during four selected days, eight times per day. Results This abstract describes the protocol of the study. The HEALTHY-UNICT study aims to follow university students from a large university. A total of 100 students will be enrolled in the pilot phase. Expected results are the characterization of dietary behaviors, including Mediterranean diet adherence, food choices and others lifestyle factors, including smoking habits and physical activity and their relationship with anthropometrics and emotions in the sample of college students of the University of Catania. Conclusions The project idea should be relevant since results of the study could be useful to identify targets for the improvement of health and the promotion of healthy lifestyles in young adults. The HEALTHY-UNICT project will contribute to Sustainable Development Goals (SDGs) in the area of food and nutrition, to improve nutrition and lifestyle, through actions that combine tradition and innovation. Key messages The study will provide a better understanding of the food choices that college students make and insights for individual and population level prevention interventions. Findings of this study could be used to develop targeted interventions that encourage healthy food choices and healthy habit and ultimately reduce the risk of overweight and others adverse outcomes.

Mobile Ecological Momentary Assessment and Intervention and Health Behavior Change Among Adults in Rakai, Uganda: Pilot Randomized Controlled Trial.

BackgroundAn extraordinary increase in mobile phone ownership has revolutionized the opportunities to use mobile health approaches in lower- and middle-income countries (LMICs). Ecological momentary assessment and intervention (EMAI) uses mobile technology to gather data and deliver timely, personalized behavior change interventions in an individual’s natural setting. To our knowledge, there have been no previous trials of EMAI in sub-Saharan Africa.ObjectiveTo advance the evidence base for mobile health (mHealth) interventions in LMICs, we conduct a pilot randomized trial to assess the feasibility of EMAI and establish estimates of the potential effect of EMAI on a range of health-related behaviors in Rakai, Uganda.MethodsThis prospective, parallel-group, randomized pilot trial compared health behaviors between adult participants submitting ecological momentary assessment (EMA) data and receiving behaviorally responsive interventional health messaging (EMAI) with those submitting EMA data alone. Using a fully automated mobile phone app, participants submitted daily reports on 5 different health behaviors (fruit consumption, vegetable consumption, alcohol intake, cigarette smoking, and condomless sex with a non–long-term partner) during a 30-day period before randomization (P1). Participants were then block randomized to the control arm, continuing EMA reporting through exit, or the intervention arm, EMA reporting and behavioral health messaging receipt. Participants exited after 90 days of follow-up, divided into study periods 2 (P2: randomization + 29 days) and 3 (P3: 30 days postrandomization to exit). We used descriptive statistics to assess the feasibility of EMAI through the completeness of data and differences in reported behaviors between periods and study arms.ResultsThe study included 48 participants (24 per arm; 23/48, 48% women; median age 31 years). EMA data collection was feasible, with 85.5% (3777/4418) of the combined days reporting behavioral data. There was a decrease in the mean proportion of days when alcohol was consumed in both arms over time (control: P1, 9.6% of days to P2, 4.3% of days; intervention: P1, 7.2% of days to P3, 2.4% of days). Decreases in sex with a non–long-term partner without a condom were also reported in both arms (P1 to P3 control: 1.9% of days to 1% of days; intervention: 6.6% of days to 1.3% of days). An increase in vegetable consumption was found in the intervention (vegetable: 65.6% of days to 76.6% of days) but not in the control arm. Between arms, there was a significant difference in the change in reported vegetable consumption between P1 and P3 (control: 8% decrease in the mean proportion of days vegetables consumed; intervention: 11.1% increase; P=.01).ConclusionsPreliminary estimates suggest that EMAI may be a promising strategy for promoting behavior change across a range of behaviors. Larger trials examining the effectiveness of EMAI in LMICs are warranted.Trial RegistrationClinicalTrials.gov NCT04375423; https://www.clinicaltrials.gov/ct2/show/NCT04375423

587-P: Adherence, Acceptability, and Feasibility of Mobile Ecological Momentary Assessments (mEMA) in Young Adults (YA) with Type 1 Diabetes (T1D) of Racial-Ethnic Minority Status

Background: YA with T1D of racial-ethnic minority disproportionately experience stress related to social determinants of health (SDOH), which may be associated with hyperglycemia, glycemic variability, and poorer emotional well-being. Mobile EMA methodology uses mobile technology to assess contextually relevant, real-time behavioral and self-report data. Methods: Coupled with real-time CGM for two weeks, we employed mEMA methodology with three times daily cell phone-delivered surveys to study the association of momentary variations in SDOH-related stress with glycemia in YA with T1D from the Bronx, NY. We report our preliminary findings on acceptability, feasibility, and adherence of mEMA methodology in this ongoing study. We evaluated adherence by real-time app tracking of mEMA survey completion, and evaluated acceptability and feasibility by post-study questionnaires and qualitative interviews. Results: Thus far, 18 participants have completed the study: (mean age 23 yrs, 11 Hispanic, 7 non-Hispanic Black, mean HbA1c 8.0%). Adherence to assigned daily surveys was high at 85% (753/887 surveys). There were no differences in survey adherence across timepoints. Acceptability was high: participants reported good understanding of mEMA procedures (mean score 4/5 on Likert scale), high satisfaction (mean score 5/5), high willingness to participate again (mean score 5/5), and were very likely to recommend participation to others (mean score 5/5). For feasibility, the most common barrier cited was mEMA app issues (40%, n=7), specifically dropped survey notifications, which interfered with adherence. Conclusions: YA with T1D of racial-ethnic minority demonstrated high adherence, feasibility, and acceptability of mEMA methods, however there were app-related issues that need closer monitoring. mEMA is a viable tool to study real-time contextual and behavioral factors in minority YA with T1D. Disclosure S. Leung: None. G. Crespo-ramos: None. M. Finnan: None. J. S. Gonzalez: None. S. Agarwal: None. Funding National Institute of Diabetes and Digestive and Kidney Diseases (5P30DK111022, K23DK115896)