Use Of Ecological Momentary Assessment Research Articles

Tailoring Individualized Evaluation of Pediatric Abdominal Pain Using Ecological Momentary Assessment (EMA): A Pilot Study Testing Feasibility and Acceptability.

The current study aimed to determine if it was feasible and acceptable to use ecological momentary assessment to assess individual associations between biopsychosocial contributors to chronic abdominal pain with 2 objective sensors and a mobile application. Specifically, we aimed to determine if it was possible to identify individualized associations between idiopathic pain associations. The goal was to determine if idiographic profiles have clinical value while the field works torward consensus about nomothetic trends. Participants included 30 pediatric chronic abdominal pain patients, aged 8 to 17, who wore a physiological monitor and accelerometer that measured sleep and physical activity and answered 4 surveys per day on an app over the course of a 14-day study period. Results indicated that participants were 96.2% and 95.5% compliant to the wrist-worn accelerometer measuring sleep and physical activity, respectively. Participants completed 76.3% of expected surveys and were least adherent to the physiological monitor (37.9%). In addition, it was possible to generate 24 (80%) personalized reports describing unique associations with pain for participants in the study. Findings provide initial support for the use of ecological momentary assessment over a 2-week period to inform and create personalized profiles for improved clinical care in this population.

“You Are Really at Their Mercy”: Examining the Relationship between Transportation Disadvantage and Social Exclusion among Older Adults through the Use of Innovative Technology

This study investigates transportation disadvantage (TD) and its impact on social exclusion among lower-income older adults ( n = 10) through the use of a custom-designed daily transportation diary app, MyAmble. The study utilized an ecological momentary assessment design using the Travel Buddy, which was the qualitative feature of MyAmble. The Travel Buddy allowed study participants to share their transportation experiences as they relate to the following domains of social exclusion: quality of life, participation, and resources. Conventional content analysis revealed five primary themes related to TD and social exclusion: constrained autononmy and flexibility, safety concerns, dimished emotional well-being, barriers to community engagement, and burdensome. The Travel Buddy produced qualitative data that contextualize lost opportunities and how characteristics of economic justice exacerbate the risk of TD, as well as how individuals manage within these intersections of disadvantage. Study findings provide insight for expanded conversations about how to transform transportation planning from mobility to equity. Finally, the use of ecological momentary assessment through digital platforms such as the Travel Buddy offer an innovative way to collect holistic data related to TD that will lead to better opportunities for transportation planners, engineers, and social service providers to work together to address the needs of environmental justice populations, including lower-income older adults.

When All Else Fails, Listen to the Patient: A Viewpoint on the Use of Ecological Momentary Assessment in Clinical Trials.

A major problem in mental health clinical trials, such as depression, is low assay sensitivity in primary outcome measures. This has contributed to clinical trial failures, resulting in the exodus of the pharmaceutical industry from the Central Nervous System space. This reduced assay sensitivity in psychiatry outcome measures stems from inappropriately broad measures, recall bias, and poor interrater reliability. Limitations in the ability of traditional measures to differentiate between the trait versus state-like nature of individual depressive symptoms also contributes to measurement error in clinical trials. In this viewpoint, we argue that ecological momentary assessment (EMA)—frequent, real time, in-the-moment assessments of outcomes, delivered via smartphone—can both overcome these psychometric challenges and reduce clinical trial failures by increasing assay sensitivity and minimizing recall and rater bias. Used in this manner, EMA has the potential to further our understanding of treatment response by allowing for the assessment of dynamic interactions between treatment and distinct symptom response.

Exploring modern trends and advances in mental health treatment in the 21st century-mobile mental health

Background: Mobile mental health (mHealth) has revolutionized mental health treatment by integrating technology into patient care, emphasizing patient-centered care (PCC). This shift has transformed patients from passive recipients to active participants in managing their health through technology. Telemental health (TMH) and e-mental health (eMH) are key components, leveraging the Internet and mobile technologies for mental health services. Aim: This review article explores modern trends and advancements in mental health treatment in the 21st century, focusing on the role of mobile technologies in enhancing mental health care. Methods: A comprehensive review of literature and current practices related to mHealth and eMH was conducted. The review included analysis of mobile health applications, telepsychiatry models, and emerging technologies in mental health treatment. Results: The article highlights significant advancements in mobile mental health, including the growth of mental health apps, the use of ecological momentary assessment (EMA) for real-time data collection, and the integration of mobile technologies into traditional mental health care. Trends indicate increased usage of mobile applications for mental health support, though challenges remain in app evaluation and integration into clinical practice. Conclusion: Mobile mental health technologies offer promising enhancements to traditional mental health care by providing accessible, flexible, and cost-effective solutions.

Use of Ecological Momentary Assessment and Intervention in Treatment With Adults.

This article reviews the use of ecological momentary assessment (EMA) and ecological momentary intervention (EMI) in clinical research applications. EMA refers to a method of data collection that attempts to capture respondents' activities, emotions, and thoughts in the moment, in their natural environment. It typically uses prompts administered through a personal electronic device, such as a smartphone or tablet. EMI extends this technique and includes the use of microlevel interventions administered through personal electronic devices. These technological developments hold promise for enhancing psychological treatments by prompting the patient outside of therapy sessions in his or her day-to-day environment. Research suggests that EMI may be beneficial to participants and that this effect is amplified when EMI is delivered in the context of ongoing psychotherapy. EMI may reflect a cost-effective mechanism to enhance therapeutic outcomes.

The use of ecological momentary assessment in hearing research and future clinical applications

To obtain real-world insights into the hearing difficulties of individuals, the field of hearing research has recently started to adopt ecological momentary assessment. Using this approach, study participants describe their experiences in real time, in their own natural environment.This paper describes the use of ecological momentary assessment in hearing research to date. Several studies have shown the approach is feasible and has good construct validity for use with adults with hearing impairment and/or tinnitus.Two recent studies conducted by the authors are described. The first study investigated the listening experiences of older adults with mild hearing impairment and concluded that ecological momentary assessment provided group and individual data which highlighted the between-subject variability in this clinical population. The second study investigated the difference that the provision of hearing aids could make for older adults with mild hearing impairment. The pilot study indicated that ecological momentary assessment could be successfully used in intervention studies to measure, for example, individual hearing aid benefit, which may extend beyond improved speech understanding. The study also revealed the potential for ecological momentary assessment as a tool for clinical practice and decision-making.Ecological momentary assessment can result in a rich array of research data if specific study design guidelines, presented in this paper, are followed. The development of a clinical ecological momentary assessment tool would provide clinicians an individualized outcome measure and facilitate the adoption of a greater degree of client- and family-centeredness, thereby improving rehabilitation outcomes.

Understanding Environmental and Contextual Influences of Physical Activity During First-Year University: The Feasibility of Using Ecological Momentary Assessment in the MovingU Study.

BackgroundIt is well established that drastic declines in physical activity (PA) occur during young adults’ transition into university; however, our understanding of contextual and environmental factors as it relates to young adults’ PA is limited.ObjectiveThe purpose of our study was to examine the feasibility of using wrist-worn accelerometers and the use of ecological momentary assessment (EMA) to assess the context and momentary correlates of PA on multiple occasions each day during first-year university.MethodsFirst-year university students were asked to participate in the study. The participants completed a brief questionnaire and were subsequently asked to wear an ActiGraph GT9X-Link accelerometer and respond to a series of EMA prompts (7/day) via their phones for 5 consecutive days.ResultsA total of 96 first-year university students with smartphones agreed to participate in the study (mean age 18.3 [SD 0.51]; n=45 females). Overall, there was good compliance for wearing the accelerometers, with 91% (78/86) of the participants having ≥2 days of ≥10 hours of wear time (mean=3.53 valid days). Students were generally active, averaging 10,895 steps/day (SD 3413) or 1123.23 activity counts/min (SD 356.10). Compliance to EMA prompts was less desirable, with 64% (55/86) of the participants having usable EMA data (responding to a minimum of ≥3 days of 3 prompts/day or ≥4 days of 2 prompts/day), and only 47% (26/55) of these participants were considered to have excellent EMA compliance (responding to ≥5 days of 4 prompts/day or ≥ 4 days of 5 prompts/day).ConclusionsThis study represents one of the first studies to use an intensive real-time data capture strategy to examine time-varying correlates of PA among first-year university students. These data will aim to describe the physical and social contexts in which PA occurs and examine the relationships between momentary correlates of PA among the first-year university students. Overall, current results suggest that wrist-worn accelerometers and EMA are feasible methods for data collection among the young adult population; however, more work is needed to understand how to improve upon compliance to a real-time data capture method such as EMA.

The effects of contingency contracts and performance feedback on completing data entries to self-monitor community participation of people with physical disabilities: An ecological momentary study

ABSTRACTThis article examines the use of ecological momentary assessment (EMA) to analyze the effect of contingent contracts and performance feedback in completing data entries to self-monitor community participation of people with mobility-related disabilities. Two participants with mobility-related disabilities were assigned to self-monitor their community participation activities using a personal digital assistant (PDA), which had been preprogrammed to signal four times a day throughout the entire study. At each prompt, participants were asked to complete a brief survey on a PDA. Participants received the monetary rewards based on their PDA completion rate. All participants maintained more than 95% completion and received the full monetary reward available.

Ecological Momentary Assessment in Eating Disorder and Obesity Research: a Review of the Recent Literature.

Our current understanding of the etiology and maintenance of eating disorders and obesity continues to be far from complete. Similarly, our understanding of determinants of both successful and unsuccessful weight loss surgery is also quite limited. While a number of research methodologies have been applied to these areas, one methodology that has recently seen a rise in popularity is the use of ecological momentary assessment (EMA). EMA allows one to study a variety of variables of interest in the natural environment. The study of eating disorders, obesity, and bariatric surgery has all been conducted using EMA recently. The current study is a review of these areas and summarizes the recent literature (past 3 years) in eating disorders, obesity, and bariatric surgery using EMA methodology.

Pickles and ice cream! Food cravings in pregnancy: hypotheses, preliminary evidence, and directions for future research.

Women in the United States experience an increase in food cravings at two specific times during their life, (1) perimenstrually and (2) prenatally. The prevalence of excess gestational weight gain (GWG) is a growing concern due to its association with adverse health outcomes in both mothers and children. To the extent that prenatal food cravings may be a determinant of energy intake in pregnancy, a better understanding of craving etiology could be crucial in addressing the issue of excessive GWG. This paper reviews the available literature to corroborate and/or dispute some of the most commonly accepted hypotheses regarding the causes of food cravings during pregnancy, including a role of (1) hormonal changes, (2) nutritional deficits, (3) pharmacologically active ingredients in the desired foods, and (4) cultural and psychosocial factors. An existing model of perimenstrual chocolate craving etiology serves to structure the discussion of these hypotheses. The main hypotheses discussed receive little support, with the notable exception of a postulated role of cultural and psychosocial factors. The presence of cravings during pregnancy is a common phenomenon across different cultures, but the types of foods desired and the adverse impact of cravings on health may be culture-specific. Various psychosocial factors appear to correlate with excess GWG, including the presence of restrained eating. Findings strongly suggest that more research be conducted in this area. We propose that future investigations fall into one of the four following categories: (1) validation of food craving and eating-related measures specifically in pregnant populations, (2) use of ecological momentary assessment to obtain real time data on cravings during pregnancy, (3) implementation of longitudinal studies to address causality between eating disorder symptoms, food cravings, and GWG, and (4) development of interventions to ensure proper prenatal nutrition and prevent excess GWG.

Feasibility of text messaging for ecological momentary assessment of marijuana use in college students.

Measuring self-reported substance use behavior is challenging due to issues related to memory recall and patterns of bias in estimating behavior. Limited research has focused on the use of ecological momentary assessment (EMA) to evaluate marijuana use. This study assessed the feasibility of using short message service (SMS) texting as a method of EMA with college-age marijuana users. Our goals were to evaluate overall response/compliance rates and trends of data missingness, response time, baseline measures (e.g., problematic use) associated with compliance rates and response times, and differences between EMA responses of marijuana use compared to timeline followback (TLFB) recall. Nine questions were texted to participants on their personal cell phones 3 times a day over a 2-week period. Overall response rate was high (89%). When examining predictors of the probability of data missingness with a hierarchical logistic regression model, we found evidence of a higher propensity for missingness for Week 2 of the study compared to Week 1. Self-regulated learning was significantly associated with an increase in mean response time. A model fit at the participant level to explore response time found that more time spent smoking marijuana related to higher response times, while more time spent studying and greater "in the moment" academic motivation and craving were associated with lower response times. Significant differences were found between the TLFB and EMA, with greater reports of marijuana use reported through EMA. Overall, results support the feasibility of using SMS text messaging as an EMA method for college-age marijuana users.

Feasibility and validity of ecological momentary assessment in the investigation of suicide risk

Ecological Momentary Assessment has been used to investigate a wide range of behaviors and psychiatric conditions. Previous investigations have consistently obtained promising results with high acceptance and compliance rates, and with only minor reactive effects for specific variables. Despite the promise of this methodology for the study of severe psychiatric populations, little is known about its feasibility in samples at risk for suicide. In the present study, four samples at varying risk for suicide completed an Ecological Momentary Assessment study by responding to five electronic assessments per day over a one-week period. Samples included healthy controls (n=13), affective controls (n=21), past suicide attempters (n=20), and recent suicide attempters (n=42). The results demonstrate satisfactory participation rates and high compliance with daily life repeated assessments across all groups. Importantly, negative thoughts or suicidal ideation were not reactive to the duration of the study, indicating that the repeated assessment of such cognitions in daily life have little or no effect on their frequency. The findings provide support for the use of Ecological Momentary Assessment in the study of suicidal ideation and suggest that mobile technologies represent new opportunities for the assessment of high-risk cognitive states experienced by patients in daily life.

A clinical case study of the use of ecological momentary assessment in obsessive compulsive disorder

Accurate assessment of obsessions and compulsions is a crucial step in treatment planning for Obsessive-Compulsive Disorder (OCD). In this clinical case study, we sought to determine if the use of Ecological Momentary Assessment (EMA) could provide additional symptom information beyond that captured during standard assessment of OCD. We studied three adults diagnosed with OCD and compared the number and types of obsessions and compulsions captured using the Yale-Brown Obsessive-Compulsive Scale (Y-BOCS) compared to EMA. Following completion of the Y-BOCS interview, participants then recorded their OCD symptoms into a digital voice recorder across a 12-h period in reply to randomly sent mobile phone SMS prompts. The EMA approach yielded a lower number of symptoms of obsessions and compulsions than the Y-BOCS but produced additional types of obsessions and compulsions not previously identified by the Y-BOCS. We conclude that the EMA-OCD procedure may represent a worthy addition to the suite of assessment tools used when working with clients who have OCD. Further research with larger samples is required to strengthen this conclusion.

New Methods for Advancing Research on Tobacco Dependence Using Ecological Momentary Assessments

New Methods for Advancing Research on Tobacco Dependence Using Ecological Momentary Assessments

Assessment of parental discipline in daily life.

The use of ecological momentary assessment (EMA) for studying parenting has been rare. We examined the psychometric properties and structural validity of an EMA Parenting Scale based on 32 mothers' reports of their parenting over a period of 10 consecutive days, and explored the acceptance of the scale and compliance with the procedure. The results suggested that the EMA Parenting Scale was well accepted for the assessment of daily parenting, and that it consistently captured the overreactive and lax dimensions of parenting across different episodes of child misbehavior. Moreover, multilevel analyses suggested that the scale was sensitive to change across different parenting episodes, and that it reliably assessed the dimensions at both the personal and situational levels.

Ecological Momentary Assessment in Borderline Personality Disorder: A Review of Recent Findings and Methodological Challenges

The use of Ecological Momentary Assessment (EMA) has led to increased insight into borderline personality disorder (BPD) symptoms, especially regarding affective instability. EMA is characterized by a series of repeated assessments of current affective, behavioral, and contextual experiences or physiological processes while participants engage in normal daily activities. EMA has several advantages. It enables researchers to avoid biased recollection, to investigate within-person processes, and to enhance real-life generalizability. This review is dedicated to four main objectives: (1) to discuss the characteristics of EMA in studying BPD symptomatology; (2) to provide an extensive overview of EMA findings in BPD structured into findings regarding DSM-IV criteria and findings regarding emotional dysregulation as stated in the biosocial theory of Linehan; (3) to discuss challenges of EMA and to give recommendations for the proper use of it; and (4) to highlight prospects and promising applications that should be addressed.

Use of ecological momentary assessment to determine which structural factors impact perceived teaching quality of attending rounds.

Providing high-quality teaching to residents during attending rounds is challenging. Reasons include structural factors that affect rounds, which are beyond the attending's teaching style and control. To develop a new evaluation tool to identify the structural components of ward rounds that most affect teaching quality in an internal medicine (IM) residency program. The authors developed a 10-item Ecological Momentary Assessment (EMA) tool and collected daily evaluations for 18months from IM residents rotating on inpatient services. Residents ranked the quality of teaching on rounds that day, and questions related to their service (general medicine, medical intensive care unit, and subspecialty services), patient census, absenteeism of team members, call status, and number of teaching methods used by the attending. Residents completed 488 evaluation cards over 18months. This found no association between perceived teaching quality and training level, team absenteeism, and call status. We observed differences by service (P < .001) and patient census (P = .009). After adjusting for type of service, census was no longer significant. Use of a larger variety of teaching methods was associated with higher perceived teaching quality, regardless of service or census (P for trend < .001). The EMA tool successfully identified that higher patient census was associated with lower perceived teaching quality, but the results were also influenced by the type of teaching service. We found that, regardless of census or teaching service, attendings can improve their teaching by diversifying the number of methods used in daily rounds.

Conceptualizing and Estimating Process Speed in Studies Employing Ecological Momentary Assessment Designs: A Multilevel Variance Decomposition Approach

Researchers have been making use of ecological momentary assessment (EMA) and other study designs that sample feelings and behaviors in real time and in naturalistic settings to study temporal dynamics and contextual factors of a wide variety of psychological, physiological, and behavioral processes. As EMA designs become more widespread, questions are arising about the frequency of data sampling, with direct implications for participants' burden and researchers' ability to capture and study dynamic processes. Traditionally, spectral analytic techniques are used for time series data to identify process speed. However, the nature of EMA data, often collected with fewer than 100 measurements per person, sampled at randomly spaced intervals, and replete with planned and unplanned missingness, precludes application of traditional spectral analytic techniques. Building on principles of variance partitioning used in the generalizability theory of measurement and spectral analysis, we illustrate the utility of multilevel variance decompositions for isolating process speed in EMA-type data. Simulation and empirical data from a smoking-cessation study are used to demonstrate the method and to evaluate the process speed of smoking urges and quitting self-efficacy. Results of the multilevel variance decomposition approach can inform process-oriented theory and future EMA study designs.

Use of Ecological Momentary Assessment to Guide Curricular Change in Graduate Medical Education

To assess whether a novel evaluation tool could guide curricular change in an internal medicine residency program. The authors developed an 8-item Ecological Momentary Assessment tool and collected daily evaluations from residents of the relative educational value of 3 differing ambulatory morning report formats (scale: 8 = best, 0 = worst). From the evaluations, they made a targeted curricular change and used the tool to assess its impact. Residents completed 1388 evaluation cards for 223 sessions over 32months, with a response rate of 75.3%. At baseline, there was a decline in perceived educational value with advancing postgraduate (PGY) year for the overall mean score (PGY-1, 7.4; PGY-2, 7.2; PGY-3, 7.0; P < .01) and for percentage reporting greater than 2 new things learned (PGY-1, 77%; PGY-2, 66%; PGY-3, 50%; P < .001). The authors replaced the format of a lower scoring session with one of higher cognitive content to target upper-level residents. The new session's mean score improved (7.1 to 7.4; P = .03); the adjusted odds ratios before and after the change for percentage answering, "Yes, definitely" to "Area I need to improve" was 2.53 (95% confidence interval [CI], 1.45-4.42; P = .001) and to "Would recommend to others," it was 2.08 (95% CI, 1.12-3.89; P = .05). The Ecological Momentary Assessment tool successfully guided ambulatory morning report curricular changes and confirmed successful curricular impact. Ecological Momentary Assessment concepts of multiple, frequent, timely evaluations can be successfully applied in residency curriculum redesign.

Use of Ecological Momentary Assessment to Monitor Fibromyalgia

ISSN 1758-1869 10.2217/PMT.11.15 © 2011 Future Medicine Ltd Pain Manage. (2011) 1(3), 195–197 Fibromyalgia syndrome (FMS) is a chronic musculoskeletal pain disorder characterized by widespread, diffuse pain and hyperalge­ sic responses. Various pain, functional and mood problems are also associated with FMS [1]. The exact cause or pathophysio­ logy of FMS continues to elude us. In the absence of specific biomarkers, the evalu­ ation of FMS patients must rely on self­ reported symptoms. Patients are typically asked to rate the severity of their symptoms over some period of time (e.g., past week or month). This requires patients to recall retrospectively the occurrence, nature and magnitude of their symptoms, and then to aggregate and average this information to arrive at a summary rating. Heavy reliance on recall, unfortunately, is known to lead to erroneous assessment. For example, the validity of pain recall is quite fragile [2–6], and it is easily influenced by various fac­ tors including pain severity at the time of recall [4], emotional status [7] and the patient’s beliefs about their conditions [8]. Another concern is related to ecological validity of in­clinic/laboratory assessment. Owing to this concern, many have tried to use home assessment methods where symp­ toms can be assessed in real­life settings. The most common method is to use a paper diary format and to record symptoms on a daily basis. Patients are typically asked to record their symptoms at the end of the day, thereby reducing recall bias to some extent. However, the validity still largely depends upon patients’ willingness to adhere with the required procedure, which is typically quite low [9]. Recent advances in hand­held computer technology has enabled clinical research­ ers to develop an electronically managed, real­time experience sampling method to assess symptoms. Typically, a patient is asked to carry a hand­held device, which prompts him/her several times a day. Upon the prompt, the device becomes an electric questionnaire, requesting the person to rate the severity of their symptoms. The method, termed ecological momentary assessment (EMA), makes use of real­time sampling strategies to assess phenomena as they occur in natural settings. The method works particularly well for track­ ing symptoms associated with FMS and various comorbidities. Ecological momentary assessment also overcomes many of the methodological flaws from which the paper diary format suf­ fers. The EMA device can be programmed in a way that limits the time frame for a