Momentary Well-being Research Articles

Association of Built Environment with Well-Being: An Experience Sampling Method

Abstract Background Well-being (WB) is important because it extends beyond physical health, as defined by the World Health Organization (WHO). From a temporal perspective, WB encompasses two aspects: long-term WB (LWB), such as overall life satisfaction, and momentary WB (MWB), such as immediate mood. While research has demonstrated a positive association between built environments such as urban land, grassland areas, and LWB, there is limited research exploring the association between the characteristics of built environments and MWB. Methods We applied the Experience Sampling Method (ESM) to collect data on the location, detailed environmental characteristics, and the MWB and LWB of adult participants living in Kashiwa City, Japan. Structural equation modeling was used to calculate the correlation coefficients between different built environments and both MWB and LWB. Results Nine hundred reports from 273 valid participants were obtained. In terms of types of locations, it was shown that cafes/restaurants/bars (coefficients = 0.85), culture/sport/education facilities (0.45), and public spaces (0.62) have a positive association with MWB. Additionally, environments perceived as natural (0.43), relaxing, and clean (2.31) have a positive association with MWB. Conversely, being on the move (-0.88) and vibrant environments (-0.58) have a negative association with MWB. Moreover, higher LWB levels were associated with higher MWB (0.64). Conclusions This study used the ESM to measure MWB and confirmed an association with various built environments. These findings provide guidance for city planning and policies that focus on enhancing urban well-being. This study highlights the benefits of places such as parks and cafes that promote happiness and the need for well-designed transportation and roads. These elements are important for developing urban areas that not only meet residents’ physical requirements but also support their emotional and psychological well-being. Key messages • Our findings show that public spaces, cafes, and cultural facilities are significantly associated with MWB, highlighting their role in urban planning as places that promote happiness. • ‘Being on the move’ is associated with lower MWB, indicating the need for well-designed transportation and road environments.

Investigating the effects of congruence between within-person associations: A comparison of two extensions of response surface analysis.

Response surface analysis (RSA) allows researchers to study whether the degree of congruence between two predictor variables is related to a potential psychological outcome. Here, we adapt RSA to the case in which the two predictor variables whose congruence is of interest refer to individual differences in within-person associations (WPAs) between variables that fluctuate over time. For example, a WPA-congruence hypothesis in research on romantic relationships could posit that partners are happier when they have similar social reactivities-that is, when they have similarly strong WPAs between the quantity of their social interactions and their momentary well-being. One method for testing a WPA-congruence hypothesis is a two-step approach in which the individuals' WPAs are first estimated as random slopes in respective multilevel models, and then these estimates are used as predictors in a regular RSA. As an alternative, we suggest combining RSA with multilevel structural equation modeling (MSEM) by specifying the WPAs as random slopes in the structural equation and using their latent second-order terms to predict the outcome on Level 2. We introduce both approaches and provide and explain their corresponding computer code templates. We also compared the two approaches with a simulation study and found that the MSEM model-despite its complexities (e.g., nonlinear functions of latent slopes)-has advantages over the two-step approach. We conclude that the MSEM approach should be used in practice. We demonstrate its application using data from a daily diary study and offer guidance for important decisions (e.g., about standardization). (PsycInfo Database Record (c) 2024 APA, all rights reserved).

How is momentary well-being and stress associated in persons with spinal cord injury and their romantic partners? A study protocol for a dyadic everyday life study

IntroductionVery little is known about daily life dynamics and mutual influences that tie together well-being and psychobiological stress responses in persons with spinal cord injury (SCI) and their romantic partners...

Estimating nonlinear effects of random slopes: A comparison of multilevel structural equation modeling with a two-step, a single-indicator, and a plausible values approach

Multilevel structural equation modeling (MSEM) is a statistical framework of major relevance for research concerned with people’s intrapersonal dynamics. An application domain that is rapidly gaining relevance is the study of individual differences in the within-person association (WPA) of variables that fluctuate over time. For instance, an individual’s social reactivity – their emotional response to social situations – can be represented as the association between repeated measurements of the individual’s social interaction quantity and momentary well-being. MSEM allows researchers to investigate the associations between WPAs and person-level outcome variables (e.g., life satisfaction) by specifying the WPAs as random slopes in the structural equation on level 1 and using the latent representations of the slopes to predict outcomes on level 2. Here, we are concerned with the case in which a researcher is interested in nonlinear effects of WPAs on person-level outcomes – a U-shaped effect of a WPA, a moderation effect of two WPAs, or an effect of congruence between two WPAs – such that the corresponding MSEM includes latent interactions between random slopes. We evaluate the nonlinear MSEM approach for the three classes of nonlinear effects (U-shaped, moderation, congruence) and compare it with three simpler approaches: a simple two-step approach, a single-indicator approach, and a plausible values approach. We use a simulation study to compare the approaches on accuracy of parameter estimates and inference. We derive recommendations for practice and provide code templates and an illustrative example to help researchers implement the approaches.

Objective Neighborhood-Level Disorder Versus Subjective Safety as Predictors of HIV Transmission Risk and Momentary Well-Being

Mental health and HIV risk behavior have been studied with ecological momentary assessment (EMA), but this approach has not been combined with tracking of activity space (where people go and what they encounter there) in people with HIV and their social relations, who may be HIV+ or HIV−. Activity space represents a modifiable risk or protective factor for behavior related to health status and quality of life, in both clinical and nonclinical populations. We conducted an observational study with 286 participants (243 HIV+ and 43 HIV−), roughly matched for socioeconomic status and neighborhood of residence via three waves of snowball sampling. Each participant carried a smartphone for up to 4 weeks, making 5 randomly prompted entries and 1 end-of-day entry each day, plus self-initiated event-contingent entries for sexual activity and drug use. Responses to randomly prompted items provided subjective evaluations of the safety of the participant’s current social and physical environment (the place they were and the people they were with). GPS-based location tracking—coupled with publicly available statistic indicating neighborhood-level physical disorder and socioeconomic disadvantage—provided an indicator of each participant’s exposure to objective psychosocial hazard. We examined possible relationships of these objective and subjective environmental exposures with risky sexual and intravenous drug-use behavior, knowledge and utilization of antiretroviral treatment and prophylaxis, and momentary mental health (mood and stress, which relate to risky behavior and overall well-being). We found that both risky behavior and mental health were more related to participants’ subjective evaluations of their activity space than to objective measures of neighborhood-level disorder, suggesting that, even within an objectively hazardous neighborhood, people who find a niche they perceive as socially and physically safe may engage in less risky behavior and have better well-being.Trial registration Clinicaltrials.gov Identifier NCT01571752.

Aging in Place: Toward Understanding Momentary Well-Being and Daily Satisfaction of Older People

Few studies have investigated how older people’s daily activities and characteristics of the surrounding urban environment affect their emotions and daily satisfaction. This study fills the research gap by using a paper-based survey and a smartphone ecological momentary assessment (EMA) application (with GPS tracking and pop-up surveys about activities) to study older people’s well-being in Hong Kong. Three hundred and two older adults completed the paper survey and forty-two of them further completed a six- to seven-day EMA survey. Based on a total of 1,530 activity episodes, generalized estimating equation models were developed to examine the relationship between older people’s socioeconomic background, activity participation, urban environment characteristics, and their feelings of happiness and calmness. Results show that older people’s daily life satisfaction is affected by the emotions they experienced throughout the day. In particular, a higher level of happiness was associated with socializing, leisure, and recreation activities taking place outside of the immediate neighborhood, and calmness was best achieved during passive relaxation and resting activities within the residential neighborhood. Furthermore, characteristics of the environment at activity locations are statistically significant in explaining momentary well-being. The findings support the planning for age-friendly cities and communities through encouraging older people to engage in activities outside their residential neighborhoods and designing activity locations with more leisure facilities, lower road density, and higher exposure to water bodies.

Meaningful Peer Social Interactions and Momentary Well-Being in Context

Using three large-scale longitudinal datasets collected from a cohort of university students over the span of 3 years (total N = 2,896 participants; ecological momentary assessments = 129,414), we found that engagement in meaningful social interactions with peers was associated with lower momentary loneliness and greater affective well-being. We also examined the role of four contextual factors (interaction partners, communication channels, places, and co-occurring activities) in explaining the relationships between meaningful social interactions and momentary well-being. Across samples, we found (a) participants reported experiencing greater loneliness and lower affective well-being after engaging in meaningful social interaction via computer-mediated channels (and via direct messaging in particular), compared to face-to-face, and (b) participants reported experiencing lower affective well-being after engaging in meaningful social interactions while dining and studying or working, compared to while resting. Taken together, our findings provide insight into the relationships between meaningful social interactions, momentary well-being, and contextual factors.

May I Help You? The Relationship Between Interpersonal Emotion Regulation and Emotional and Relational Wellbeing in Daily Life

People often get support from others in regulating their emotions, a phenomenon known as interpersonal emotion regulation (IER). However, the relative effectiveness of specific IER strategies for improving emotional and relational wellbeing in daily life is unclear. Here, we report two preregistered, ecological momentary assessment studies, in which we examined how the use of six key IER strategies relates to emotional and relational wellbeing among romantic couples in daily life. Study 1 focused on enacted IER as reported by the regulator, whereas Study 2 focused on perceived IER as reported by the regulated partner. Using a dyadic experience sampling design (6 beeps/day for 7 days), Study 1 (N = 136) showed that when people reported to have given advice or encouraged their partner to suppress their emotions, their partners experienced impaired emotional wellbeing. When people reported to have distracted their partner, their partner experienced enhanced positive affect and felt closer to their partner. The use of interpersonal reappraisal, acceptance and ignoring was unrelated to partners’ momentary wellbeing. Using a dyadic daily diary design (1 beep/day for 12 days), Study 2 (N = 361) showed that perceptions of one’s emotions being ignored by the partner were associated with impaired emotional and relational wellbeing on the same day. The perceived use of other IER strategies was unrelated to momentary wellbeing. Taken together, the present set of studies illuminates how IER processes shape people’s emotions and relationships in ecologically valid settings. Our findings indicate that enacted and perceived regulatory behaviors are associated with differential outcomes, highlighting the complex nature of interpersonal emotion dynamics.

The use of audio-biographical cues in dementia care: a four-year evaluation in Swiss hospitals, care, and domestic homes.

In dementia care, the integration of innovative interventions is essential to enhancing the wellbeing and quality of life of people with dementia. Among these interventions, the Music Mirror intervention has emerged as a promising tool to provide personalized audio-biographical cues aimed at soothing, motivating, and engaging people with dementia. This study examined the effects of a Music Mirror intervention on the (a) wellbeing, emotions, and behavioral and psychological symptoms of 155 individuals with dementia, (b) perceived burden, relationship quality, and gains of their informal/formal caregivers, and (c) momentary closeness, wellbeing and stress of caregivers. This four-year study employed a quasi-experimental waiting-control group design, utilizing before-after measurements in Swiss hospitals, care homes, and domestic homes. For four 6-week intervention phases, Music Mirrors, i.e., brief written resources of acoustic material, associated with practical activities of daily life, were applied at least twice a week by the caregivers during critical moments such as staff handover. Repeated measures' analysis of variance and other tests were used to analyze the data. Individuals with dementia had a higher wellbeing after the Music Mirror use across different care situations. While the Music Mirrors were played, individuals with dementia showed more positive than negative emotions at each measurement occasion, but emotion scores did not significantly change over time. After the MM use, caregivers felt better, closer to the person with dementia, and less stressed. Caregivers also reported significant gains at the end of the intervention. However, there were no significant changes in the frequency of the behavioral and psychological symptoms of dementia, care-related burden and relationship quality over time, regardless of the treatment condition. By incorporating personalized audio-biographical cues into their care routines, the wellbeing of people with dementia was improved as well as it had positive momentary effects on their caregivers. The Music Mirror intervention addresses the preferences and needs of people with dementia and helps build bonds between care-recipients and caregivers. Therefore, Music Mirrors can be seen as a highly adaptive and individualized instrument to improve momentary wellbeing of people with dementia in various care situations during daily life.

Unlocking the muse - Developing arts-based approaches for people with Parkinson’s disease

Interventions considering the arts are increasingly gaining acceptance in the clinical-methodological repertoire, and in supporting people with diseases. However, current approaches are often limited considering the variety of offered creative activities and are neglecting the influence of the artistic context. Furthermore, there is often a focus on momentary well-being primarily and not on the impact on quality of life, missing centralization around the transferability of creative engagement and art-based interventions into daily life issues. The goal of our study is the implementation of a person-centered, art-based program. 
 We offer people with Parkinson’s a program wherein they participate in orientation sessions (playgrounds) to find preferred activities, and in specialization sessions (artist studio’s) to develop deep engagement/flow in the preferred activities. Self-direction by participants and a psychological safe environment, are the cornerstones of this program. The first group of participants (n=5) took part in a pilot study. A second pilot and full trial will take place early 2023.
 The activities can address both instrumental (practical utilization) and non-instrumental (existential) creativity, with the upper goal to increase the individuum’s quality of life as the main outcome variable. Besides these three quantitative measures (pre/post), individual open interviews (pre/peri/post) are held and analyzed using thematic and grounded methodologies. We aim to distil the active ingredients to transform a person’s mindset and skill-set to learn that engaging with creativity is a tool for enhancing individual quality of life in a self-empowered manner. We will present the first outcomes of our study in this poster.

Periodicity and Variability in Daily Activity Satisfaction: Toward a Space-Time Modeling of Subjective Well-Being

Understanding how geographical environments influence peoples’ subjective experiences of daily activities is of great potential for improving subjective well-being (SWB), a subject that is presently limited by a lack of available data and proper statistical methods. Focusing on Beijing and using a unique data set that linked residents’ seven-day mobility trajectories at a fine spatiotemporal resolution to their complete activity participation and momentary well-being, this article investigates the temporal dynamics of and geographical contextual effects on SWB of daily activities. We developed a unified spatial multilevel stochastic process model to simultaneously capture periodicity, stochastic dynamics, and individual heterogeneity effects. Results show that momentary SWB has a twenty-four-hour periodicity and evolves stochastically around individual equilibrium states depending on key life-circumstance variables. Migrants and low-income residents tend to have lower equilibrium states than their counterparts. Real-time air pollution exposure significantly lowers daily activity satisfaction levels, and an inverted-U-shaped relationship exists between city vibrancy and satisfaction.

The importance of high quality real-life social interactions during the COVID-19 pandemic

The coronavirus pandemic has brought about dramatic restrictions to real-life social interactions and a shift towards more online social encounters. Positive social interactions have been highlighted as an important protective factor, with previous studies suggesting an involvement of the amygdala in the relationship between social embeddedness and well-being. The present study investigated the effect of the quality of real-life and online social interactions on mood, and explored whether this association is affected by an individual’s amygdala activity. Sixty-two participants of a longitudinal study took part in a one-week ecological momentary assessment (EMA) during the first lockdown, reporting their momentary well-being and their engagement in real-life and online social interactions eight times per day (N ~ 3000 observations). Amygdala activity was assessed before the pandemic during an emotion-processing task. Mixed models were calculated to estimate the association between social interactions and well-being, including two-way interactions to test for the moderating effect of amygdala activity. We found a positive relationship between real-life interactions and momentary well-being. In contrast, online interactions had no effect on well-being. Moreover, positive real-life social interactions augmented this social affective benefit, especially in individuals with higher amygdala being more sensitive to the interaction quality. Our findings demonstrate a mood-lifting effect of positive real-life social interactions during the pandemic, which was dependent on amygdala activity before the pandemic. As no corresponding effect was found between online social interactions and well-being, it can be concluded that increased online social interactions may not compensate for the absence of real-life social interactions.

Comparing Mobility-Based PM2.5 Concentrations and Activity Satisfaction in Beijing between 2012 and 2017.

Although the negative effect of air pollution on life satisfaction has been examined in many studies, comparative analyses of mobility-based exposures to air pollution and momentary wellbeing have been rare to date, despite the fact that they are essential to improve wellbeing. Drawing on individuals' space-time trajectories of two surveys conducted in 2012 and 2017 in Beijing, we investigate the temporal variations in activity satisfaction and mobility-based air pollution from monitoring stations and real-time air pollutant sensors, respectively. Furthermore, we explore how mobility-based air pollution dynamically influences activity satisfaction. The results show that air quality in Beijing improved from 2012 to 2017, and activity satisfaction increased as well. The negative relationship between them is more significant on workdays but insignificant on weekends. Moreover, real-time air pollution data show higher accuracy than monitor-based data, which suggests that future studies should pay more attention to real-time air pollution assessments.

Paradoxical Impacts of Social Relationship on Well-Being During the COVID-19 Pandemic.

Social interaction is an important source of psychological and physical well-being during normal times. However, following the COVID-19 outbreak, which spreads rapidly from person to person, social interaction poses a fatal threat to one's health and life. Therefore, several countries including South Korea implemented an intense social distancing mandate to prevent the spread of the virus. During these unique times of pandemic, the current research investigated whether and how an individual's well-being varies as a function of their interaction with various relationship partners using experience sampling data (Study 1) and online longitudinal data (Study 2). The results indicated that being alone was more detrimental to well-being during the pandemic than before it. Specifically, interaction with close relationship partners (e.g., romantic partner, spouse, or friend) was positively related to well-being, whereas interaction with formal relationship partners (e.g., coworker, boss) was negatively linked to momentary well-being during the pandemic. Furthermore, our study showed that the association between social supports from close relationships and well-being was temporally strengthened during COVID-19 pandemic. In sum, the benefits of close relationships on well-being were stronger during the COVID-19 pandemic than before it.

Clarifying the Relationship Between Self-Compassion and Mindfulness: An Ecological Momentary Assessment Study.

Self-compassion entails relating to one's negative experiences with awareness, acceptance, and kindness, and it is associated with greater well-being. The Self-Compassion Scale (SCS) includes mindfulness, which is theorized as a necessary precursor to a self-compassionate response. The present study examined associations of the SCS and its subscales with mindfulness and decentering at baseline and in daily life to clarify the measure's construct validity. We also tested whether self-compassion moderates the association between mindfulness and eudaimonic well-being in daily life during occasions of increased negative affect. The sample of 172 community adults completed the SCS at baseline and a 7-day ecological momentary assessment. The SCS's construct validity was tested with multilevel correlations and regressions. We tested the interaction of momentary mindfulness, momentary negative affect, and dispositional self-compassion in predicting momentary well-being. Results generally supported the construct validity of the SCS, but SCS mindfulness subscales were most closely associated with decentering scales in daily life. Higher dispositional self-compassion, higher momentary mindful awareness, and lower momentary negative affect predicted higher momentary eudaimonic well-being. However, self-compassion did not interact with momentary mindful awareness and negative affect. The SCS generally related to measures of mindfulness and decentering as expected, but further work should be done to clarify subscale construct validity. Self-compassion was predictive of higher momentary eudaimonic well-being in people's daily lives, supportive of ecological validity, but trait levels of self-compassion did not affect the relationship between momentary mindfulness and eudaimonic well-being.

Does catching more fish increase the subjective well-being of fishers? Insights from Bangladesh

Small-scale fisheries have been associated with the subjective well-being of coastal communities through their links with culture, identity, and social cohesion. But although fish catches are usually considered the primary ecosystem service that benefits fishers, little is known about how subjective well-being is influenced by the fishing activity itself. Here, we applied the experience sampling method in two small-scale fisheries in Bangladesh to assess the effects of fishing on fishers’ occurrence of positive and negative affect, two measures of subjective well-being. We found that fishing activities were not directly associated with increased momentary affect and that the frequency of positive affect actually decreased as the fishing trip progressed. Furthermore, although very low catches were associated with less positive affect, the highest frequency of positive affect was achieved with relatively small catches. Our results imply that the benefits provided by small-scale fisheries to the momentary subjective well-being of fishers are not strongly related to the actual catching of fish.

Real-time individual benefit from social interactions before and during the lockdown: the crucial role of personality, neurobiology and genes

Social integration is a major resilience factor for staying healthy. However, the COVID-19-pandemic led to unprecedented restrictions in social life. The consequences of these social lockdowns on momentary well-being are yet not fully understood. We investigated the affective benefit from social interactions in a longitudinal birth cohort. We used two real-time, real-life ecological momentary assessments once before and once during the initial lockdown of the pandemic (N = 70 participants; n~6800 observations) capturing the protective role of social interactions on well-being. Moreover, we used a multimethod approach to analyze ecological assessment data with individual risk and resilience factors, which are promising moderators in the relationship of social behavior, stress reactivity, and affective states (i.e., amygdala volume, neuroticism, polygenic risk for schizophrenia). Social contacts were linked to higher positive affect both during normal times and during the COVID-19-pandemic (beta coefficient = 0.1035), highlighting the beneficial role of social embedding. Interestingly, this relationship was differentially moderated by individual risk and resilience factors. In detail, participants with a larger left amygdala volume (beta coefficient = −0.0793) and higher neuroticism (beta coefficient = −0.0958) exhibited an affective benefit from more social interactions prior to the pandemic. This pattern changed during the pandemic with participants with smaller amygdala volumes and lower neurotic traits showing an affective gain during the pandemic. Moreover, participants with low genetic risk for schizophrenia showed an affective benefit (beta coefficient = −0.0528) from social interactions irrespective of the time point. Our results highlight the protective role of social integration on momentary well-being. Thereby, we offer new insights into how this relationship is differently affected by a person’s neurobiology, personality, and genes under adverse circumstances.

Creation and validation of the pictorial ecological momentary well-being instrument (EMOWI) for adolescents.

PurposeAdolescence is characterized by the ongoing maturation of emotion-regulation skills and increased emotional reactivity. There is a need for a measurement tool suitable to the Ecological Momentary Assessment methodology, to better capture within-day variations in well-being, and provide fine-grained data that can help understand how environments, behaviors, and health intersect. This paper presents the development and evaluation of the Ecological MOmentary Well-Being Instrument for adolescents, designed for use in EMA.MethodsA mixed-methods study was conducted, using both qualitative and quantitative approaches, to develop and assess the EMOWI. A literature review, pictorial production by graphic designers, and qualitative interviews with French and Canadian professionals and adolescents helped design and evaluate the scale face validity. Quantitative evaluation of dimensionality, reliability, and validity was conducted in two samples of French 8th graders.ResultsThe resulting 8-item EMOWI showed excellent face validity. Confirmatory factor analysis supported a single factor hypothesis (RMSEA = 0.072). Internal consistency (Cronbach’s alpha = 0.85) and intraday test–retest reliability (ICC = 0.83) were high. Correlations with existing scales were consistent with preset hypotheses. Ceiling effects were evidenced for all items, yet not on the global score. Quantitative estimations were similar for the verbal and pictorial versions, but qualitative findings argued in favor of the pictorial version.ConclusionThe 8-item pictorial EMOWI is a short and innovative instrument to measure momentary well-being in adolescents aged 12 to 17 years. Its strong psychometric properties and its acceptability among adolescents make it an excellent candidate instrument for the Ecological Momentary Assessment of well-being in this population.Supplementary InformationThe online version contains supplementary material available at 10.1007/s11136-021-03077-9.

From Wellbeing to Social Media and Back: A Multi-Method Approach to Assessing the Bi-Directional Relationship Between Wellbeing and Social Media Use.

Literature concerning the relationship between social media use and wellbeing is inconsistent in its findings, and most research has focused on time spent on social media rather than on what emerging adults do there, with whom and why. Here, we investigated whether momentary social stress affects emerging adults’ social media use, and whether this social media use relates to subsequent changes in wellbeing. We implemented a multi-method paradigm utilising objective and self-report data to investigate how social stress relates to how (much) and why emerging adults use social media. We report on findings based on 114 17–25-year-old emerging adults recruited on university campus. Our findings suggest that social stress does not affect adolescents’ subsequent social media use and that there is no relationship between social media use after stress and changes in momentary wellbeing. Our work illustrates the need for detailed approaches in social media and psychological wellbeing research.

Assessing Momentary Well-Being in People Living With Dementia: A Systematic Review of Observational Instruments.

Optimizing the possibility to lead good lives is at the core of treatment and care for people with dementia. This may be monitored by assessing well-being and quality of life. However, cognitive impairment following dementia may complicate recall-based assessment with questionnaires, and proxy-ratings from family-caregivers do not correspond well to self-reports. Thus, using observational measures represents a potentially advanced option. Systematic reviews evaluating measurement properties, interpretability and feasibility of observational instruments assessing well-being in people living with dementia are lacking. Thus, this review performed systematic searches to find peer reviewed validated instruments of relevance in the databases MEDLINE, EMBASE, PsycINFO, Web of Science, CINAHL and ProQuest. Twenty-two instruments assessing well-being were included for evaluation of measurement properties based on the systematic approach of the COnsensus-based Standards for the selection of health Measurement INstruments (COSMIN). The evaluation included risk of bias on study level, and assessment of measurement properties on instrument level including content validity, construct validity, structural validity, internal consistency, measurement invariance, cross-cultural validity, measurement error and inter-rater/intra-rater/test–retest reliability and responsiveness. Additionally, the feasibility and interpretability of the measures were evaluated. No single instrument could be recommended based on existing publications. Thus, we provide general recommendations about further assessment and development of these instruments. Finally, we describe the most promising instruments and offer guidance with respect to their implementation and use in clinical and research contexts.