Compliance With Mobile Ecological Momentary Assessment of Self-Reported Health-Related Behaviors and Psychological Constructs in Adults: Systematic Review and Meta-analysis

Characterizing Patient-Reported Fatigue Using Electronic Diaries in Neurodegenerative and Immune-Mediated Inflammatory Diseases: Observational Study

Background

Fatigue is a prevalent and debilitating symptom in many chronic conditions, including immune-mediated inflammatory diseases (IMIDs) and neurodegenerative diseases (NDDs). Fatigue often fluctuates significantly within and between days, yet traditional patient-reported outcomes (PROs) typically rely on recall periods of a week or more, potentially missing these short-term variations. The development of digital tools, such as electronic diaries (eDiaries), offers a unique opportunity to collect granular, real-time data. However, the feasibility, adherence, and comparability of eDiary-based assessments to established PROs require further investigation.

Objective

This study aimed to evaluate the feasibility and acceptability of using a high-frequency eDiary to capture intraday variability in fatigue and to compare eDiary data with scores obtained from the Functional Assessment of Chronic Illness Therapy-Fatigue (FACIT-F), a validated weekly recall PRO.

Methods

Data were collected from 159 participants enrolled in the IDEA-FAST (Identifying Digital Endpoints to Assess Fatigue, Sleep and Activities in Daily Living in Neurodegenerative Disorders and Immune-Mediated Inflammatory Diseases) feasibility study; a 4-week prospective observational study conducted at 4 European centers. Participants included individuals with NDDs (n=39), IMIDs (n=78), and healthy volunteers (n=42). Participants used an eDiary to report their physical and mental fatigue levels up to 4 times daily on a 7-point Likert scale (0=low and 6=high). Adherence was calculated as the proportion of completed eDiary entries relative to the total expected entries. Correlations between averaged eDiary scores and weekly FACIT-F scores were analyzed.

Results

Adherence to the eDiary protocol was 5505/8880 (61.99%) overall, varying by cohort, with the highest adherence (1117/1200, 93.07%) observed in the primary Sjögren syndrome cohort and the lowest adherence in the Parkinson disease (410/960, 42.7%) and Huntington disease (320/720, 44.4%) cohorts. The average adherence was 430/1680 (43.45%) in the NDD cohorts and 3367/4560 (73.84%) in the IMID cohorts. Fatigue levels showed clear diurnal variation, with significantly higher fatigue reported in the evening compared to the morning (P<.001). A moderate correlation (Spearman=0.46, P<.001) was observed between eDiary fatigue scores and FACIT-F scores, with stronger cohort-specific associations for certain FACIT-F items. These results indicate that eDiaries provide complementary insights to weekly PROs by capturing intraday fluctuations in fatigue.

Conclusions

This study demonstrates the feasibility, acceptability, and validity of using high-frequency eDiaries to assess fatigue in chronic conditions. By effectively detecting intra- and interday fatigue variations, eDiaries complement traditional PROs such as FACIT-F, offering a more nuanced understanding of fatigue patterns. Future research should explore optimized eDiary protocols to balance participant burden with data granularity.

Sensor-triggered ecological momentary assessment in physical activity and sedentary behaviour research among Belgian community-dwelling elderly: lessons learnt from intensive longitudinal studies

OBJECTIVES

Regular physical activity (PA) and reduced sedentary behaviour (SB) have been associated with positive health outcomes, but many older adults do not comply with the current recommendations. Sensor-triggered ecological momentary assessment (EMA) studies allow capturing real-time data during or immediately after PA or SB, which can yield important insights into these behaviours. Despite the promising potential of sensor-triggered EMA, this methodology is still in its infancy. Addressing methodological challenges in sensor-triggered EMA studies is essential for improving protocol adherence and enhancing validity. Therefore, this study aimed to examine (1) the patterns in sensor-triggered EMA protocol adherence (eg, compliance rates), (2) the impact of specific settings (eg, event duration) on the number of prompted surveys, and (3) participants' experiences with engaging in a sensor-triggered EMA study.

DESIGN

Two longitudinal, sensor-triggered EMA studies-one focused on PA and the other on SB-were conducted using similar methodologies from February to October 2022. Participants' steps were monitored for seven days using a Fitbit activity tracker, which automatically prompted an EMA survey through the HealthReact smartphone application when specified (in)activity thresholds were reached. After the monitoring period, qualitative interviews were conducted. Data from both studies were merged.

SETTING

The studies were conducted among community-dwelling Belgian older adults.

PARTICIPANTS

The participants had a median age of 72 years, with 54.17% being females. The PA study included 88 participants (four dropped out), while the SB study included 76 participants (seven dropped out).

PRIMARY AND SECONDARY OUTCOME MEASURES

Descriptive methods and generalised logistic mixed models were employed to analyse EMA adherence patterns. Simulations were conducted to assess the impact of particular settings on the number of prompted EMA surveys. Additionally, qualitative interview data were transcribed verbatim and thematically analysed using NVivo.

RESULTS

Participants responded to 81.22% and 79.10% of the EMA surveys in the PA and SB study, respectively. The confirmation rate, defined as the percentage of EMA surveys in which participants confirmed the detected behaviour, was 94.16% for PA and 72.40% for SB. Logistic mixed models revealed that with each additional day in the study, the odds of responding to the EMA survey increased significantly by 1.59 times (OR=1.59, 95% CI: 1.36 to 1.86, p<0.01) in the SB study. This effect was not observed in the PA study. Furthermore, time in the study did not significantly impact the odds of participants confirming to be sedentary (OR=0.97, 95% CI: 0.92 to 1.02, p=0.28). However, it significantly influenced the odds of confirming PA (OR: 0.81, 95% CI: 0.68 to 0.97, p=0.02), with the likelihood of confirming decreasing by 19% with each additional day in the study. Furthermore, a one-minute increase in latency (ie, time between last syncing and starting the EMA survey) in the PA study decreased the odds of the participant confirming to be physically active by 20% (OR: 0.80, 95% CI: 0.72 to 0.89, p<0.01). Simulations of the specific EMA settings revealed that reducing the event duration and shorter minimum time intervals between prompts increased the number of EMA surveys. Overall, most participants found smartphone usage to be feasible and rated the HealthReact app as user-friendly. However, some reported issues, such as not hearing the notification, receiving prompts at an inappropriate time and encountering technical issues. While the majority reported that their behaviour remained unchanged due to study participation, some noted an increased awareness of their habits and felt more motivated to engage in PA.

CONCLUSIONS

This study demonstrates the potential of sensor-triggered EMA to capture real-time data on PA and SB among older adults, showing strong adherence potential with compliance rates of approximately 80%. The SB study had lower confirmation rates than the PA study, due to technical issues and discrepancies between self-perception and device-based measurements. Practical recommendations were provided for future studies, including improvements in survey timing, technical reliability and strategies to reduce latency.

A temporal investigation of the relationship between difficulty concentrating and perseverative thought

Perseverative thought (also known as repetitive thought) is an established transdiagnostic mechanism of internalizing psychopathology characterized primarily by its repetitive, difficult to control quality. Subjective difficulty concentrating frequently coincides with perseverative thought and may function as both mechanism and clinical consequence of perseverative thought. Although cognitive theories suggest a bidirectional relationship between perseverative thought and difficulty concentrating, experimental and longitudinal investigations provide mixed evidence. The current study addresses this gap by testing a bidirectional relationship between momentary perseverative thought and difficulty concentrating using ecological momentary assessment (EMA) (8 surveys per day for 14 days) with 200 adult community participants (N = 155 with compliance ≥ 70 %) oversampled for moderate/severe perseverative thought. Multilevel modeling tested concurrent and time-lagged associations. Difficulty concentrating and perseverative thought were concurrently and prospectively related within-person: higher difficulty concentrating at T-1 predicted higher perseverative thought at T, and higher perseverative thought at T-1 predicted higher difficulty concentrating at T (β =.19 -.20, p < .001). Findings held when controlling for the outcome at T-1 (β =.02 - .06, p < .001). These findings demonstrate covariation between difficulty concentrating and perseverative thought within-person in daily life consistent with theoretical models that predict bidirectional relationships. Findings suggest that intervening on difficulty concentrating and/or perseverative thought may reduce the "vicious cycle" of perseverative thought episodes.

Association of medication adherence with treatment preferences: incentivizing truthful self-reporting

OBJECTIVE

Self-reported medication adherence may be influenced by socially desirable answers and untruthful reporting. Misreporting of adherence behavior can bias estimations of treatment (cost)effectiveness. This study investigated how to induce truthful self-reported medication adherence and evaluated how self-reported (truth-induced vs. regularly reported) medication adherence and treatment preferences were associated.

METHODS

Medication adherence was measured after a discrete choice experiment eliciting stated preferences for Multiple Sclerosis (MS)-treatments. Data was collected among MS-patients in three Western countries. Half of the sample was randomized to 'choice-matching', a novel mechanism which induces truthfulness. It financially compensates respondents based on their self-reported adherence and guesses about other respondents' adherence. To investigate the impact of truth-incentivized adherence reporting on preference heterogeneity, interaction effects between medication adherence and treatment preferences were tested separately within the choice-matching and the 'standard' group.

RESULTS

The sample comprised 380 MS-patients (mean age 41y, 69% female). Respondents in the choice-matching group reported a lower medication adherence compared to the standard group (always adherent: 39.3% vs. 46.6%). Mixed logit models showed significant interaction effects: in the choice-matching group, higher medication adherence resulted in lower utility for pills twice/day compared to injections three times/week (p = 0.019), while in the standard group, respondents with higher medication adherence preferred pills once/day compared to injections three times/week (p = 0.005).

CONCLUSION

Choice-matching likely encouraged respondents to report their true medication adherence. Linking truthful behavior to patients' preferences allows for a better understanding of preference heterogeneity and helping to make decisions that fit patients' true preferences.

Ecological momentary assessment of physical and eating behaviours: The WEALTH feasibility and optimisation study with recommendations for large-scale data collection

Ecological Momentary Assessment (EMA) enables the real-time capture of health-related behaviours, their situational contexts, and associated subjective experiences. This study aimed to evaluate the feasibility of an EMA targeting physical and eating behaviours, optimise its protocol, and provide recommendations for future large-scale EMA data collections. The study involved 52 participants (age 31±9 years, 56% females) from Czechia, France, Germany, and Ireland completing a 9-day free-living EMA protocol using the HealthReact platform connected to a Fitbit tracker. The EMA protocol included time-based (7/day), event-based (up to 10/day), and self-initiated surveys, each containing 8 to 17 items assessing physical and eating behaviours and related contextual factors such as affective states, location, and company. Qualitative insights were gathered from post-EMA feedback interviews. Compliance was low (median 49%), particularly for event-based surveys (median 34%), and declined over time. Many participants were unable or unwilling to complete surveys in certain contexts (e.g., when with family), faced interference with their daily schedules, and encountered occasional technical issues, suggesting the need for thorough initial training, an individualised protocol, and systematic compliance monitoring. The number of event-based surveys was less than desired for the study, with a median of 2.4/day for sedentary events, when 4 were targeted, and 0.9/day for walking events, when 3 were targeted. Conducting simulations using participants' Fitbit data allowed for optimising the triggering rules, achieving the desired median number of sedentary and walking surveys (3.9/day for both) in similar populations. Self-initiated reports of meals and drinks yielded more reports than those prompted in time-based and event-based EMA surveys, suggesting that self-initiated surveys might better reflect actual eating behaviours. This study highlights the importance of assessing feasibility and optimising EMA protocols to enhance subsequent compliance and data quality. Conducting pre-tests to refine protocols and procedures, including simulations using participants' activity data for optimal event-based triggering rules, is crucial for successful large-scale data collection in EMA studies of physical and eating behaviours.

Participant Compliance With Ecological Momentary Assessment in Movement Behavior Research Among Adolescents and Emerging Adults: Systematic Review

BACKGROUND

Adolescence through emerging adulthood represents a critical period associated with changes in lifestyle behaviors. Understanding the dynamic relationships between cognitive, social, and environmental contexts is informative for the development of interventions aiming to help youth sustain physical activity and limit sedentary time during this life stage. Ecological momentary assessment (EMA) is an innovative method involving real-time assessment of individuals' experiences and behaviors in their naturalistic or everyday environments; however, EMA compliance can be problematic due to high participant burdens.

OBJECTIVE

This systematic review synthesized existing evidence pertaining to compliance in EMA studies that investigated wake-time movement behaviors among adolescent and emerging adult populations. Differences in EMA delivery scheme or protocol, EMA platforms, prompting schedules, and compensation methods-all of which can affect participant compliance and overall study quality-were examined.

METHODS

An electronic literature search was conducted in PubMed, PsycINFO, and Web of Science databases to select relevant papers that assessed movement behaviors among the population using EMA and reported compliance information for inclusion (n=52) in October 2022. Study quality was assessed using a modified version of the Checklist for Reporting of EMA Studies (CREMAS).

RESULTS

Synthesizing the existing evidence revealed several factors that influence compliance. The platform used for EMA studies could affect compliance and data quality in that studies using smartphones or apps might lessen additional burdens associated with delivering EMAs, yet most studies used web-based formats (n=18, 35%). Study length was not found to affect EMA compliance rates, but the timing and frequency of prompts may be critical factors associated with missingness. For example, studies that only prompted participants once per day had higher compliance (91% vs 77%), but more frequent prompts provided more comprehensive data for researchers at the expense of increased participant burden. Similarly, studies with frequent prompting within the day may provide more representative data but may also be perceived as more burdensome and result in lower compliance. Compensation type did not significantly affect compliance, but additional motivational strategies could be applied to encourage participant response.

CONCLUSIONS

Ultimately, researchers should consider the best strategies to limit burdens, balanced against requirements to answer the research question or phenomena being studied. Findings also highlight the need for greater consistency in reporting and more specificity when explaining procedures to understand how EMA compliance could be optimized in studies examining physical activity and sedentary time among youth.

TRIAL REGISTRATION

PROSPERO CRD42021282093; https://www.crd.york.ac.uk/prospero/display_record.php?RecordID=282093.

Day-to-day associations between pain intensity and sleep outcomes in an adult chronic musculoskeletal pain population: A systematic review

BACKGROUND

In individuals with chronic musculoskeletal pain, a reciprocal relationship between sleep and pain across short and long-term evaluations exists. Sleep influences pain levels, while the level of pain also impairs sleep. However, given the day-to-day variability of both sleep and pain intensity, assessing this relationship within a daily time frame should be considered.

OBJECTIVES

To systematically review the literature concerning the bidirectional day-to-day relationship between night-time sleep variables and day-time pain intensity in individuals with chronic musculoskeletal pain.

METHODS

A systematic search (final search on October 12, 2023) in four databases (PubMed, Web of Science, Embase, PsycInfo) identified eligible articles based on pre-defined criteria. Three independent reviewers executed data extraction and risk of bias assessment using the "Quality In Prognosis Studies" tool. The study findings were synthesized narratively.

RESULTS

Eleven articles (1014 study participants; 83 associations) were included. A bidirectional relationship between pain intensity and sleep was found. Nine articles indicated night-time sleep quality to be a more consistent predictor for next day pain intensity than vice versa.

CONCLUSION

Nonetheless the bidirectional day-to-day sleep-pain relationship in individuals with chronic musculoskeletal pain, results suggest that self-reported sleep quality has a stronger predictive value on pain intensity then vice versa.

Understanding Compliance Rates in Suicide Research During the Post-Discharge Period

INTRODUCTION

The period following discharge from psychiatric hospitalization is one of particularly elevated suicide risk. It is essential to better understand risk factors for suicide during this period; however, retention and compliance in longitudinal research can be a challenge with high-risk populations.

METHODS

We examined compliance rates in the six-month period following psychiatric hospital discharge among 174 adults (149 psychiatric patients and 25 healthy controls) across three data collection methods: ecological momentary assessment (EMA), weekly clinical assessment phone calls, and clinical follow-up assessments at two- and six-months post-discharge. We examined whether clinical and demographic characteristics influenced compliance rates.

RESULTS

Results suggested low rates of EMA compliance, but strong rates of completion of weekly phone calls and follow-up assessments. Compared to psychiatric patients, healthy controls completed more EMA and weekly phone calls, but not follow-up assessments. Participants who met current diagnostic criteria for a major depressive episode and who scored above the clinical threshold for borderline personality disorder symptoms had lower EMA compliance rates.

CONCLUSIONS

These findings have important implications for strategies to improve patient engagement in research during this high-risk period.

Completion Rates of Smart Technology Ecological Momentary Assessment (EMA) in Populations With a Higher Likelihood of Cognitive Impairment: A Systematic Review and Meta-Analysis

Ecological Momentary Assessment using smartphone technology (smart EMA) has grown substantially over the last decade. However, little is known about the factors associated with completion rates in populations who have a higher likelihood of cognitive impairment. A systematic review of Smart EMA studies in populations who have a higher likelihood of cognitive impairment was carried out (PROSPERO; ref no CRD42022375829). Smartphone EMA studies in neurological, neurodevelopmental and neurogenetic conditions were included. Six databases were searched, and bias was assessed using Egger's test. Completion rates and moderators were analyzed using meta-regression. Fifty-five cohorts were included with 18 cohorts reporting confirmed cognitive impairment. In the overall cohort, the completion rate was 74.4% and EMA protocol characteristics moderated completion rates. Participants with cognitive impairment had significantly lower completion rates compared with those without (p = .021). There were no significant moderators in the cognitive impairment group. Limitations included significant methodological issues in reporting of completion rates, sample characteristics, and associations with completion and dropout rates. These findings conclude that smart EMA is feasible for people with cognitive impairment. Future research should focus on the efficacy of using smart EMA within populations with cognitive impairment to develop an appropriate methodological evidence base.

Exploring emotions beyond the laboratory: A review of emotional and physiological ecological momentary assessment methods in children and youth

Recent advancements in methodologies such as ecological momentary assessment (EMA) and ambulatory physiology devices have enhanced our ability to measure emotions experienced in daily life. Despite the feasibility of EMA for assessing children's and youth's emotional self-reports, the feasibility of combining it with physiological measurements in a real-life context has yet to be established. Our scoping review evaluates the feasibility and usability of implementing emotional and physiological EMA in children and youth. Due to the complexities of physiological EMA data, this review also synthesized existing methodological and statistical practices of existing studies. Following the PRISMA-ScR guidelines, we searched and screened PsycINFO, PubMed, and Web of Science electronic databases for studies that assessed children's and youth's subjective emotions and cardiac or electrodermal physiological responses outside the laboratory. Our initial search resulted in 4174 studies, 13 of which were included in our review. Findings showed significant variability in the feasibility of physiological EMA, with physiology device wear-time averaging 58.77% of study periods and data loss due to quality issues ranging from 0.2% to 77% across signals. Compliance for emotional EMA was approximately 60% of study periods when combined with physiological EMA. The review points to a lack of standardized procedures in physiological EMA and suggests a need for guidelines in designing, processing, and analyzing such data collected in real-life contexts. We offer recommendations to enhance participant engagement and develop standard practices for employing physiological EMA with children and youth for emotion, developmental, and psychophysiology researchers.

Sexual Alcohol Expectancies, Alcohol Intoxication, and Sexual Behavior in MSM: An Experience Sampling Study

Despite advances in prevention and treatment, the transmission of human immunodeficiency virus remains a significant problem in the United States, especially among men who have sex with men (MSM). Alcohol use can promote risky sexual decisions, and alcohol expectancies may influence the role of alcohol in decision making. The present secondary analysis tests the moderating role of sexual alcohol expectancies (SAEs) in the relation between daily alcohol intoxication and sexual behavior in a sample of 248 moderate- to heavy-drinking MSM. SAEs were assessed with the Sexual Alcohol Expectancies Questionnaire at baseline, followed by two 23-day bursts of ecological momentary assessment including self-initiated morning assessments of sexual behavior and the prior night's perceived intoxication, as well as nine daily random alcohol assessments. Multilevel modeling showed that SAEs moderated a curvilinear association between intoxication and anal intercourse with a condom such that the relation between daily intoxication and anal intercourse with a condom is a more pronounced inverted u-shape among individuals with strong SAEs, and this moderation effect was not seen for condomless anal intercourse (CAI). While SAEs do appear to influence the association between intoxication and sexual behavior in MSM, they do not appear to moderate the association between alcohol intoxication and CAI.

A proof-of-concept trial of a smoking cessation and anxiety sensitivity reduction smartphone application for Black adults

Black persons who smoke are recognized as a smoking health disparity group and face higher rates of tobacco-related disease and morbidity. These disparities result from, in part, exposure to minority-related stress, which results in lower rates of quit success. Anxiety sensitivity (AS), which refers to the fear of stress, is associated with lower rates of cessation and impedes quit success among Black adults who smoke. The current study evaluated the feasibility, utilization, acceptability, and initial efficacy of a smoking cessation and AS reduction smartphone application for Black adults with elevated AS who smoke (The Mobile Anxiety Sensitivity Program for Smoking [MASP]). Participants (N = 24; 62.50% female; Mage = 47.83 years, SD = 9.32) participated in a 6-week trial of MASP. Retention was 83.33% at the 6-week follow-up and MASP utilization was high, with all features used by most participants. Participants reported that MASP was acceptable and 25% of participants reported 7-day point-prevalence abstinence, demonstrating strong utility and impact potential. Results also indicated a statistically significant reduction in AS from baseline to follow-up (p = .003, Cohen's d=.76). Black persons who smoke with AS may benefit from an accessible, adaptive app with culturally tailored treatment that addressed AS in the context of smoking cessation.

Association Between Self-Reported Protective Behavior and Heat-Associated Health Complaints Among Patients With Chronic Diseases in Primary Care: Results of the CLIMATE Pilot Cohort Study

BACKGROUND

As a result of climate change, exposure to high temperatures is becoming more common, even in countries with temperate climates. For patients with chronic diseases, heat poses significant health risks. Empowering patients is a crucial element in protecting the population from the adverse effects of heat. In this context, self-reports of protective behavior are often used to gain a mutual understanding of patients' issues. However, the extent to which self-reported behavior is associated with health complaints remains unclear.

OBJECTIVE

This study aims to describe the association between light to moderate heat and health complaints in everyday life, and to analyze whether self-reported protective behavior and related psychosocial factors are linked to these complaints.

METHODS

We conducted a pilot cohort study using internet climate data merged with an online survey of patients with chronic diseases recruited through general practitioner practices. Patients were eligible if they were 18 years or older and had at least one chronic disease. The heat was modeled using temperature and humidity data. Health complaints were assessed through up to 7 follow-up evaluations on the hottest day of each week during the observation period. Data were analyzed using 3 nested models with mixed effects multivariable linear regression, adjusting for random effects at the climate measuring station and participant levels. Model 1 included heat exposure, sociodemographic data, and chronic diseases. Model 2 added protective behavior and health literacy, while model 3 incorporated self-efficacy and somatosensory amplification (ie, the tendency to catastrophize normal bodily sensations such as insect bites).

RESULTS

Of the 291 eligible patients, 61 (21.0%) participated in the study, providing 294 observations. On average, participants were 61 (SD 14) years old, and 31 (51%) were men. The most prevalent conditions were cardiovascular diseases (n=23, 38%) and diabetes mellitus (n=20, 33%). The most commonly reported symptoms were tiredness/fatigue (232/294 observations, 78.9%) and shortness of breath (142/294 observations, 48.3%). Compared with temperatures of 27°C or lower, a heat index between over 27°C and 32°C (β=1.02, 95% CI 0.08-1.96, P=.03) and over 32°C (β=1.35, 95% CI 0.35-2.35, P=.008) were associated with a higher symptom burden. Lower health literacy (β=-0.25, 95% CI -0.49 to -0.01, P=.04) and better self-reported protective behavior (β=0.65, 95% CI 0.29-1.00, P<.001) were also linked to increased symptom burden but lost statistical significance in model 3. Instead, lower self-efficacy (β=-0.39, 95% CI -0.54 to -0.23, P<.001) and higher somatosensory amplification (β=0.18, 95% CI 0.07-0.28, P=.001) were associated with a higher symptom burden.

CONCLUSIONS

Compared with colder weather, light and moderate heat were associated with more severe health complaints. Symptom burden was lower in participants with higher self-efficacy and less somatosensory amplification. Self-reported protective behavior was not linked to a lower symptom burden. Instead, we found that patients who tended to catastrophize normal bodily sensations reported both better protective behavior and a higher symptom burden simultaneously.

TRIAL REGISTRATION

ClinicalTrials.gov NCT05961163; https://clinicaltrials.gov/ct2/show/NCT05961163.

Sexual Victimization History and Emotion Regulation in Daily Life: A Role for Stress Sensitization

Relative to other types of traumatic experiences, a lifetime history of sexual violence (SV) has been linked with more persistent and severe mental health outcomes, but the reasons for this discrepancy have not been clearly established. Stress sensitization, or the amplification of responses to daily stressors as a function of trauma history, offers one possible explanation. Using ecological momentary assessment, the current study tested stress sensitization effects in daily life for individuals with a history of SV, focusing on emotion regulation as an outcome. Smartphone surveys were delivered four times per day over a 2-week period to assess relationships between prior SV exposure, daily stressors, and emotion regulation in an undergraduate sample (N = 122). As expected, individuals with lifetime exposure to SV evidenced increased emotion dysregulation and maladaptive emotion regulation in response to daily stressors relative to nonexposed peers, even after accounting for cumulative trauma. However, the SV and non-SV groups did not differ significantly on state adaptive emotion regulation. Instead, experiencing daily stressors was associated with increased adaptive emotion regulation for individuals in both groups. Broadly, results suggest that SV is uniquely associated with increased sensitivity to daily stressors, manifested as emotion dysregulation and use of maladaptive emotion regulation strategies to regulate emotions. These findings are consistent with emerging research on the neurobiology of trauma and with an emphasis on emotion regulation skills in leading interventions for SV-exposed individuals. Stress sensitization warrants additional attention as a factor linking SV and mental health problems.

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

BACKGROUND

Previous studies assessing shift workers' behaviours have mainly used self-report recall questionnaires, however these measures don't always account for variations in work schedules. Alternative methods that allow for real-time assessments tailored to capture variations in work patterns might provide more accurate measures of physical activity (PA) and sedentary behaviour (SB). Therefore, the aim of this study was to evaluate the feasibility of Ecological Momentary Assessment (EMA), which provides real-time evaluations of PA and SB in shift workers. A secondary aim was to compare shift workers and non-shift worker responses.

METHODS

Participants (n = 120; 58% female, mean Mage=36.0), included 69 shift workers and 51 non-shift workers. After downloading the EMA app, shift workers received either interval-contingent tailored (SW-T) or standardized EMA prompts (SW-S) over 7-10 days, while non-shift workers received standardized prompts (NSW-S) for seven days. Prompts were scheduled five times daily, every three hours. The EMA survey asked participants to report their current activity, including type, duration, and location of physical activity and sitting. Feasibility was assessed by analysing recruitment, retention, and compliance rates (EMA surveys completed) across SW-T, SW-S, and NSW-S groups.

RESULTS

Approximately 78% of invited workers enrolled, and all enrolled workers completed at least one prompt on 4 out 7 days in the NSW-S and 7 out of 10 days in the SW group. Workers who chose not to participate reported unwillingness to travel for meetings (n = 14), while others did not respond (n = 20). Participants completed an average of 24 surveys per day, each one taking less than 30 s to complete. Overall, 64% of EMA surveys were started and completed. SW-S completed the least prompts (57%), while SW-T and NSW-S completed 64% and 68%, respectively (p = 0.90). On average, workers missed 36% EMA surveys which was similar for SW and NSW (p = 0.05).

CONCLUSION

Our study represents one of the few studies that has used EMA in the shift work population with adaptation to shift schedules. The findings showed a modest compliance to EMA. Strategies are needed to enhance compliance rates. However, EMA shows promise for capturing real-time behaviours in shift workers' natural work environments.

Adherence to high-frequency ecological momentary assessment in persons with moderate-to-severe traumatic brain injury

OBJECTIVE

Ecological momentary assessment (EMA) involves repeated collection of real-time self-report data, often multiple times per day, nearly always delivered electronically by smartphone. While EMA has shown promise for researching internal states, behaviors, and experiences in multiple populations, concerns remain regarding its feasibility in samples with cognitive impairments, like those associated with chronic moderate-to-severe traumatic brain injury (TBI).

METHODS

This study examines adherence to a 7-week high-frequency (5x daily) EMA protocol in individuals with moderate-to-severe TBI, considering changes in response rate over time, as well as individual participant characteristics (memory function, education, injury severity, and age).

RESULTS

In the sample of 39 participants, the average overall response rate was 65% (range: 5%-100%). Linear mixed-effects modeling revealed a small but statistically significant linear decay in response rate over 7 weeks of participation. Individual trajectories were variable, as evidenced by the significant effect of random slope. A better response rate was positively associated with greater educational attainment and better episodic memory function (statistical trend), whereas the effects of age and injury severity were not significant.

CONCLUSIONS

These findings shed light on the potential of EMA in TBI studies but underscore the need for tailored strategies to address individual barriers to adherence.

Examining missingness at the momentary level in clinical research using ecological momentary assessment: Implications for suicide research

The use of intensive time sampling methods, such as ecological momentary assessment (EMA), has increased in clinical, and specifically suicide, research during the past decade. While EMA can capture dynamic intraindividual processes, repeated assessments increase participant burden, potentially resulting in low compliance. This study aimed to shed light on study-level and psychological variables, including suicidal ideation (SI), that may predict momentary prompt (i.e., prompt-to-prompt) completion. We combined data from three EMA studies examining mental health difficulties (N = 103; 10,656 prompts; 7144 completed), using multilevel models and machine learning to determine how well we can predict prompt-to-prompt completion and which variables are most important. The two most important variables in prompt-to-prompt completion were hours since the last prompt and time in study. Psychological variables added little predictive validity; similarly, trait-level SI demonstrated a small effect on prompt-to-prompt completion. Our study showed how study-level characteristics can be used to explain prompt-to-prompt compliance rates in EMA research, highlighting the potential for developing adaptive assessment schedules to improve compliance.

Linking social reward responsiveness and affective responses to the social environment: An ecological momentary assessment study

Social support is a key predictor of well-being, but not everyone experiences mental health benefits from receiving it. However, given that a growing number of interventions are based on social support, it is crucial to identify the features that make individuals more likely to benefit from social ties. Emerging evidence suggests that neural responses to positive social feedback (i.e., social reward) might relate to individual differences in social functioning, but potential mechanisms linking these neural responses to psychological outcomes are yet unclear. This study examined whether neural correlates of social reward processing, indexed by the reward positivity (RewP), relate to individuals' affective experience following self-reported real-world positive social support events. To this aim, 193 university students (71% females) underwent an EEG assessment during the Island Getaway task and completed a 10-day ecological momentary assessment where participants reported their positive and negative affects (PA, NA) nine times a day and the count of daily positive and negative events. Experiencing a higher number of social support positive events was associated with higher PA. The RewP moderated this association, such that individuals with greater neural response to social feedback at baseline had a stronger positive association between social support positive events count and PA. Individual differences in the RewP to social feedback might be one indicator of the likelihood of experiencing positive affect when receiving social support.

Ecological Momentary Assessment of Alcohol Marketing Exposure, Alcohol Use, and Purchases Among University Students: Prospective Cohort Study

BACKGROUND

The relationships between alcohol marketing exposure, alcohol use, and purchase have been widely studied. However, prospective studies examining the causal relationships in real-world settings using mobile health tools are limited.

OBJECTIVE

We used ecological momentary assessment (EMA) to examine both the within-person- and between-person-level effects of alcohol marketing exposure on any alcohol use, amount of alcohol use, any alcohol purchase, and frequency of alcohol purchase among university students.

METHODS

From January to June 2020, we conducted a prospective cohort study via EMA among university students in Hong Kong who reported current drinking. Over 14 consecutive days, each participant completed 5 fixed-interval, signal-contingent EMAs daily via a smartphone app. Each EMA asked about the number and types of alcohol marketing exposures, the amount and types of alcohol used, and whether any alcohol was purchased, all within the past 3 hours. We used 2-part models, including multilevel logistic regressions and multilevel gamma regressions, to examine if the number of alcohol marketing exposure was associated with subsequent alcohol use and alcohol purchase.

RESULTS

A total of 49 students participated, with 33% (16/49) being male. The mean age was 22.6 (SD 2.6) years. They completed 2360 EMAs (completion rate: 2360/3430, 68.8%). Participants reported exposure to alcohol marketing in 5.9% (140/2360), alcohol use in 6.1% (145/2360), and alcohol purchase in 2.4% (56/2360) of all the EMAs. At the between-person level, exposure to more alcohol marketing predicted a higher likelihood of alcohol use (adjusted odd ratio [AOR]=3.51, 95% CI 1.29-9.54) and a higher likelihood of alcohol purchase (AOR=4.59, 95% CI 1.46-14.49) the following day. Exposure to more alcohol marketing did not increase the amount of alcohol use or frequency of alcohol purchases the following day in participants who used or purchased alcohol. At the within-person level, exposure to more alcohol marketing was not associated with a higher likelihood of alcohol use, amount of alcohol use, higher likelihood of alcohol purchase, or frequency of alcohol purchases the following day (all Ps>.05). Each additional exposure to alcohol marketing within 1 week predicted an increase of 0.85 alcoholic drinks consumed in the following week (adjusted B=0.85, 95% CI 0.09-1.61). On days of reporting alcohol use, the 3 measures for alcohol marketing receptivity were not associated with more alcohol use or purchase (all Ps>.05).

CONCLUSIONS

By using EMA, we provided the first evidence for the effect of alcohol marketing exposure on initiating alcohol use and purchase in current-drinking university students. Our findings provide evidence of the regulation of alcohol marketing for the reduction of alcohol use and purchase among young adults.

Using mHealth Technology to Evaluate Daily Symptom Burden among Adult Survivors of Childhood Cancer: A Feasibility Study

BACKGROUND

Cancer therapies predispose survivors to a high symptom burden. This study utilized mobile health (mHealth) technology to assess the feasibility of collecting daily symptoms from adult survivors of childhood cancer to evaluate symptom fluctuation and associations with future health-related quality-of-life (HRQOL).

METHODS

This prospective study used an mHealth platform to distribute a 20-item cancer-related symptom survey (5 consecutive days each month) and an HRQOL survey (the day after the symptom survey) over 3 consecutive months to participants from the Childhood Cancer Survivor Study. These surveys comprised a PROMIS-29 Profile and Neuro-QOL assessed HRQOL. Daily symptom burden was calculated by summing the severity (mild, moderate, or severe) of 20 symptoms. Univariate linear mixed-effects models were used to analyze total, person-to-person, day-to-day, and month-to-month variability for the burden of 20 individual symptoms. Multivariable linear regression was used to analyze the association between daily symptom burden in the first month and HRQOL in the third month, adjusted for covariates.

RESULTS

Out of the 60 survivors invited, 41 participated in this study (68% enrollment rate); 83% reported their symptoms ≥3 times and 95% reported HRQOL in each study week across 3 months. Variability of daily symptom burden differed from person-to-person (74%), day-to-day (18%), and month-to-month (8%). Higher first-month symptom burden was associated with poorer HRQOL related to anxiety (regression coefficient: 6.56; 95% CI: 4.10-9.02), depression (6.32; 95% CI: 3.18-9.47), fatigue (7.93; 95% CI: 5.11-10.80), sleep (6.07; 95% CI: 3.43-8.70), pain (5.16; 95% CI: 2.11-8.22), and cognitive function (-6.89; 95% CI: -10.00 to -3.79) in the third month.

CONCLUSIONS

Daily assessment revealed fluctuations in symptomology, and higher symptom burden was associated with poorer HRQOL in the future. Utilizing mHealth technology for daily symptom assessment improves our understanding of symptom dynamics and sources of variability.

Older adults' compliance with mobile ecological momentary assessments in behavioral nutrition and physical activity research: pooled results of four intensive longitudinal studies and recommendations for future research

BACKGROUND

Mobile Ecological Momentary Assessment (EMA) is increasingly used to gather intensive, longitudinal data on behavioral nutrition, physical activity and sedentary behavior and their underlying determinants. However, a relevant concern is the risk of non-random non-compliance with mobile EMA protocols, especially in older adults. This study aimed to examine older adults' compliance with mobile EMA in health behavior studies according to participant characteristics, and prompt timing, and to provide recommendations for future EMA research.

METHODS

Data of four intensive longitudinal observational studies employing mobile EMA to understand health behavior, involving 271 community-dwelling older adults (M = 71.8 years, SD = 6.8; 52% female) in Flanders, were pooled. EMA questionnaires were prompted by a smartphone application during specific time slots or events. Data on compliance (i.e. information whether a participant answered at least one item following the prompt), time slot (morning, afternoon or evening) and day (week or weekend day) of each prompt were extracted from the EMA applications. Participant characteristics, including demographics, body mass index, and smartphone ownership, were collected via self-report. Descriptive statistics of compliance were computed, and logistic mixed models were run to examine inter- and intrapersonal variability in compliance.

RESULTS

EMA compliance averaged 77.5%, varying from 70.0 to 86.1% across studies. Compliance differed among subgroups and throughout the day. Age was associated with lower compliance (OR = 0.96, 95%CI = 0.93-0.99), while marital/cohabiting status and smartphone ownership were associated with higher compliance (OR = 1.83, 95%CI = 1.21-2.77, and OR = 4.43, 95%CI = 2.22-8.83, respectively). Compliance was lower in the evening than in the morning (OR = 0.82, 95%CI = 0.69-0.97), indicating non-random patterns that could impact study validity.

CONCLUSIONS

The findings of this study shed light on the complexities surrounding compliance with mobile EMA protocols among older adults in health behavior studies. Our analysis revealed that non-compliance within our pooled dataset was not completely random. This non-randomness could introduce bias into study findings, potentially compromising the validity of research findings. To address these challenges, we recommend adopting tailored approaches that take into account individual characteristics and temporal dynamics. Additionally, the utilization of Directed Acyclic Graphs, and advanced statistical techniques can help mitigate the impact of non-compliance on study validity.

Investigating Best Practices for Ecological Momentary Assessment: Nationwide Factorial Experiment

BACKGROUND

Ecological momentary assessment (EMA) is a measurement methodology that involves the repeated collection of real-time data on participants' behavior and experience in their natural environment. While EMA allows researchers to gain valuable insights into dynamic behavioral processes, the need for frequent self-reporting can be burdensome and disruptive. Compliance with EMA protocols is important for accurate, unbiased sampling; yet, there is no "gold standard" for EMA study design to promote compliance.

OBJECTIVE

The purpose of this study was to use a factorial design to identify optimal study design factors, or combinations of factors, for achieving the highest completion rates for smartphone-based EMAs.

METHODS

Participants recruited from across the United States were randomized to 1 of 2 levels on each of 5 design factors in a 2×2×2×2×2 design (32 conditions): factor 1-number of questions per EMA survey (15 vs 25); factor 2-number of EMAs per day (2 vs 4); factor 3-EMA prompting schedule (random vs fixed times); factor 4-payment type (US $1 paid per EMA vs payment based on the percentage of EMAs completed); and factor 5-EMA response scale type (ie, slider-type response scale vs Likert-type response scale; this is the only within-person factor; each participant was randomized to complete slider- or Likert-type questions for the first 14 days or second 14 days of the study period). All participants were asked to complete prompted EMAs for 28 days. The effect of each factor on EMA completion was examined, as well as the effects of factor interactions on EMA completion. Finally, relations between demographic and socioenvironmental factors and EMA completion were examined.

RESULTS

Participants (N=411) were aged 48.4 (SD 12.1) years; 75.7% (311/411) were female, 72.5% (298/411) were White, 18.0% (74/411) were Black or African American, 2.7% (11/411) were Asian, 1.5% (6/411) were American Indian or Alaska Native, 5.4% (22/411) belonged to more than one race, and 9.6% (38/396) were Hispanic/Latino. On average, participants completed 83.8% (28,948/34,552) of scheduled EMAs, and 96.6% (397/411) of participants completed the follow-up survey. Results indicated that there were no significant main effects of the design factors on compliance and no significant interactions. Analyses also indicated that older adults, those without a history of substance use problems, and those without current depression tended to complete more EMAs than their counterparts. No other demographic or socioenvironmental factors were related to EMA completion rates. Finally, the app was well liked (ie, system usability scale score=82.7), and there was a statistically significant positive association between liking the app and EMA compliance.

CONCLUSIONS

Study results have broad implications for developing best practices guidelines for future studies that use EMA methodologies.

TRIAL REGISTRATION

ClinicalTrials.gov number NCT05194228; https://clinicaltrials.gov/study/NCT05194228.

Examining early adherence measures as predictors of subsequent adherence in an intensive longitudinal study of individuals in mutual help groups: One day at a time

BACKGROUND

Individuals with a substance use disorder complete ecological momentary assessments (EMA) at lower rates than community samples. Previous research in tobacco users indicates that early log-in counts to smoking cessation websites predicted subsequent smoking cessation website usage. We extended this line of research to examine individuals who are seeking to change their drinking behaviors through mutual support groups. We examined whether adherence in the first 7 days (1487 observations) of an intensive longitudinal study design could predict subsequent EMA protocol adherence (50% and 80% adherence separately) at 30 (5700 observations) and 60 days (10,750 observations).

METHODS

Participants (n = 132) attending mutual-help groups for alcohol use completed two assessments per day for 6 months. We trained four classification models (logistic regression, recursive partitioning, support vector machines, and neural networks) using a training dataset (80% of the data) with each of the first 7 days' cumulative EMA assessment completion. We then tested these models to predict the remaining 20% of the data and evaluated model classification accuracy. We also used univariate receiver operating characteristic curves to examine the minimal combination of days and completion percentage to best predict subsequent adherence.

RESULTS

Different modeling techniques can be used with early assessment completion as predictors to accurately classify individuals that will meet minimal and optimal adherence rates later in the study. Models ranged in their performance from poor to outstanding classification, with no single model clearly outperforming other models.

CONCLUSIONS

Traditional and machine learning approaches can be used concurrently to examine several methods of predicting EMA adherence based on early assessment completion. Future studies could investigate the use of several algorithms in real time to help improve participant adherence rates by monitoring early adherence and using early assessment completion as features in predictive modeling.

Associations of clinical, psychological, and sociodemographic characteristics and ecological momentary assessment completion in the 10-week Hypo-METRICS study: Hypoglycaemia MEasurements ThResholds and ImpaCtS

INTRODUCTION

Reporting of hypoglycaemia and its impact in clinical studies is often retrospective and subject to recall bias. We developed the Hypo-METRICS app to measure the daily physical, psychological, and social impact of hypoglycaemia in adults with type 1 and insulin-treated type 2 diabetes in real-time using ecological momentary assessment (EMA). To help assess its utility, we aimed to determine Hypo-METRICS app completion rates and factors associated with completion.

METHODS

Adults with diabetes recruited into the Hypo-METRICS study were given validated patient-reported outcome measures (PROMs) at baseline. Over 10 weeks, they wore a blinded continuous glucose monitor (CGM), and were asked to complete three daily EMAs about hypoglycaemia and aspects of daily functioning, and two weekly sleep and productivity PROMs on the bespoke Hypo-METRICS app. We conducted linear regression to determine factors associated with app engagement, assessed by EMA and PROM completion rates and CGM metrics.

RESULTS

In 602 participants (55% men; 54% type 2 diabetes; median(IQR) age 56 (45-66) years; diabetes duration 19 (11-27) years; HbA1c 57 (51-65) mmol/mol), median(IQR) overall app completion rate was 91 (84-96)%, ranging from 90 (81-96)%, 89 (80-94)% and 94(87-97)% for morning, afternoon and evening check-ins, respectively. Older age, routine CGM use, greater time below 3.0 mmol/L, and active sensor time were positively associated with app completion.

DISCUSSION

High app completion across all app domains and participant characteristics indicates the Hypo-METRICS app is an acceptable research tool for collecting detailed data on hypoglycaemia frequency and impact in real-time.

Reduced approach disposition in familial risk for depression: Evidence from time-frequency alpha asymmetries

Despite the promising role of alpha and delta power in reflecting reduced approach disposition in depression, to date, it is unclear whether these measures can be employed to identify at-risk individuals. Hence, the present study investigated affective disposition in 32 unaffected individuals with a family history of depression (23 F) and 30 individuals without a family history of depression (21 F) through a data-driven analysis of alpha and delta time-frequency power during the viewing of pleasant, neutral, and unpleasant pictures. Different patterns of posterior alpha asymmetry emerged within each group. Particularly, controls showed greater right posterior alpha desynchronization ~ 600 ms following emotional relative to neutral pictures presentation. Conversely, the group with a family history of depression showed greater posterior left alpha desynchronization only to unpleasant relative to neutral images in a later time window (> 900 ms). Hence, depression vulnerability seems to be characterized by a blunted reactivity to pleasant and delayed reactivity to unpleasant stimuli with a distinct posterior distribution relative to the controls. Finally, the two groups showed a comparable pattern of greater delta power to emotional relative to neutral cues. Overall, initial support was provided for the employment of time-frequency alpha power changes during affective processing in identifying blunted approach disposition in unaffected at-risk individuals.

Implementation of an Ecological Momentary Assessment (EMA) in Naturalistic Psychotherapy Settings: Qualitative Insights from Patients, Therapists, and Supervisors Perspectives

Ecological momentary assessment (EMA) allows measuring intra-individual processes moment by moment, identifying and modeling, in a naturalistic way, individual levels and changes in different psychological processes. However, active EMA requires a high degree of adherence, as it implies a significant burden for patients. Moreover, there is still no consensus on standardized procedures for implementation. There have been few results in detecting desirable characteristics for the design and implementation of an EMA device. Studies that address these issues from the perspectives of participants in psychotherapeutic processes are needed. To analyze the perspectives of patients, therapists and supervisors on the implementation of an EMA device in a psychotherapeutic treatment for depression. The sample will include eight patients, eleven therapists and five supervisors, taken from a research project that implemented an EMA system for monitoring the dynamics of affectivity at the beginning of psychotherapies for depression. Semi-structured interviews specific to each group are being conducted and analyzed from a qualitative approach based on consensual qualitative research (CQR). Participants reported having a positive evaluation of the study's informational resources and implementation. Difficulties were expressed in responding in the morning hours and the importance of having a customized EMA that is tailored to the needs of the patients was expressed. Furthermore, patients and therapists agreed that the impact of the use of the monitoring system on treatment was neutral or positive. In contrast, patients considered the EMA to be positive for their daily life.

Early adverse physiological event detection using commercial wearables: challenges and opportunities

Data from commercial off-the-shelf (COTS) wearables leveraged with machine learning algorithms provide an unprecedented potential for the early detection of adverse physiological events. However, several challenges inhibit this potential, including (1) heterogeneity among and within participants that make scaling detection algorithms to a general population less precise, (2) confounders that lead to incorrect assumptions regarding a participant's healthy state, (3) noise in the data at the sensor level that limits the sensitivity of detection algorithms, and (4) imprecision in self-reported labels that misrepresent the true data values associated with a given physiological event. The goal of this study was two-fold: (1) to characterize the performance of such algorithms in the presence of these challenges and provide insights to researchers on limitations and opportunities, and (2) to subsequently devise algorithms to address each challenge and offer insights on future opportunities for advancement. Our proposed algorithms include techniques that build on determining suitable baselines for each participant to capture important physiological changes and label correction techniques as it pertains to participant-reported identifiers. Our work is validated on potentially one of the largest datasets available, obtained with 8000+ participants and 1.3+ million hours of wearable data captured from Oura smart rings. Leveraging this extensive dataset, we achieve pre-symptomatic detection of COVID-19 with a performance receiver operator characteristic (ROC) area under the curve (AUC) of 0.725 without correction techniques, 0.739 with baseline correction, 0.740 with baseline correction and label correction on the training set, and 0.777 with baseline correction and label correction on both the training and the test set. Using the same respective paradigms, we achieve ROC AUCs of 0.919, 0.938, 0.943 and 0.994 for the detection of self-reported fever, and 0.574, 0.611, 0.601, and 0.635 for detection of self-reported shortness of breath. These techniques offer improvements across almost all metrics and events, including PR AUC, sensitivity at 75% specificity, and precision at 75% recall. The ring allows continuous monitoring for detection of event onset, and we further demonstrate an improvement in the early detection of COVID-19 from an average of 3.5 days to an average of 4.1 days before a reported positive test result.

The emotional support plan: Feasibility trials of a brief, telehealth-based mobile intervention to support coping for autistic adults

LAY ABSTRACT

Autistic adults may have difficulty coping during stressful periods, which could make them more vulnerable to depression and anxiety. We designed the emotional support plan (ESP) to help autistic people find ways to cope in stressful situations. Thirty-six autistic adults created an ESP and answered questions about their opinions of the ESP. Most autistic adults found the ESP to have a positive impact on them and many would recommend the ESP to another person. Feedback from autistic adults suggested ways that we might test the ESP in future studies. Overall, autistic adults in this study found the ESP to be useful and a worthwhile intervention to study more in the future. While more research is clearly needed, we hope that the brief nature of the ESP will make it helpful for autistic people who are trying to handle negative feelings during stressful life events.

Inner speech in the daily lives of people with aphasia

Introduction

This exploratory, preliminary, feasibility study evaluated the extent to which adults with chronic aphasia (N = 23) report experiencing inner speech in their daily lives by leveraging experience sampling and survey methodology.

Methods

The presence of inner speech was assessed at 30 time-points and themes of inner speech at three time-points, over the course of three weeks. The relationship of inner speech to aphasia severity, demographic information (age, sex, years post-stroke), and insight into language impairment was evaluated.

Results

There was low attrition (<8%) and high compliance (>94%) for the study procedures, and inner speech was experienced in most sampled instances (>78%). The most common themes of inner speech experience across the weeks were 'when remembering', 'to plan', and 'to motivate oneself'. There was no significant relationship identified between inner speech and aphasia severity, insight into language impairment, or demographic information. In conclusion, adults with aphasia tend to report experiencing inner speech often, with some shared themes (e.g., remembering, planning), and use inner speech to explore themes that are uncommon in young adults in other studies (e.g., to talk to themselves about health).

Discussion

High compliance and low attrition suggest design feasibility, and results emphasize the importance of collecting data in age-similar, non-brain-damaged peers as well as in adults with other neurogenic communication disorders to fully understand the experience and use of inner speech in daily life. Clinical implications and future directions are discussed.

Methodological Characteristics and Feasibility of Ecological Momentary Assessment Studies in Psychosis: a Systematic Review and Meta-Analysis

BACKGROUND

Ecological momentary assessment (EMA) involves completing multiple surveys over time in daily life, capturing in-the-moment experiences in real-world contexts. EMA use in psychosis studies has surged over several decades. To critically examine EMA use in psychosis research and assist future researchers in designing new EMA studies, this systematic review aimed to summarize the methodological approaches used for positive symptoms in psychosis populations and evaluate feasibility with a focus on completion rates.

METHODS

A systematic review of PubMed, PsycINFO, MEDLINE, Web of Science, EBSCOhost, and Embase databases using search terms related to EMA and psychosis was conducted. Excluding duplicate samples, a meta-analysis was conducted of EMA survey completion rates and meta-regression to examine predictors of completion.

RESULTS

Sixty-eight studies were included in the review. Characteristics and reporting of EMA methodologies were variable across studies. The meta-mean EMA survey completion computed from the 39 unique studies that reported a mean completion rate was 67.15% (95% CI = 62.3, 71.9), with an average of 86.25% of the sample meeting a one-third EMA completion criterion. No significant predictors of completion were found in the meta-regression. A variety of EMA items were used to measure psychotic experiences, of which few were validated.

CONCLUSIONS

EMA methods have been widely applied in psychosis studies using a range of protocols. Completion rates are high, providing clear evidence of feasibility in psychosis populations. Recommendations for reporting in future studies are provided.

Compliance Trends in a 14-Week Ecological Momentary Assessment Study of Undergraduate Alcohol Drinkers

High compliance is a priority for successful ecological momentary assessment (EMA) research, but meta-analyses of between-study differences show that reasons for missed prompts remain unclear. We examined compliance data from a 14-week, 182-survey EMA study of undergraduate alcohol use to test differences over time and across survey types between participants with better and worse compliance rates, and to evaluate the impact of incentives on ongoing participation. Participants were N = 196 students (65.8% female; Mage = 20.6). Overall compliance was 76.5%, declining gradually from 88.9% to 70% over 14 weeks. Declines were faster in participants with lower overall compliance, but we found no demographic, personality, mental health, or substance use differences between participants with better versus worse compliance rates. Compliance varied by survey type, and unannounced bonus incentives did not impact compliance rates. Participants completed fewer surveys the week after winning a gift card. We offer recommendations for designing future EMA studies.

The impact of measurement on clinical trials: Comparison of preliminary outcomes of a brief mobile intervention for autistic adults using multiple measurement approaches

Initial studies of the emotional safety plan (ESP), a new, brief telehealth and mobile intervention to support autistic adults to cope with periods of distress, have reported feasibility and acceptability (Bal et al., 2023, Autism, 1-13). Herein we report the preliminary clinical outcomes of thirty-six autistic adults who developed a personalized ESP, with a specific interest in comparing "outcomes" demonstrated by different instruments and assessment frequencies in order to inform outcome measurement in future clinical trials. Comparison of pre-intervention baseline to post-monitoring outcome (pre-post) anxiety symptoms (Generalized Anxiety Disorder-7 [GAD-7]) and depressive symptoms (Patient Health Questionnaire-9 [PHQ-9]) revealed medium effect sizes for reduction in symptoms, though, low effect sizes were observed for pre-post Adult Self-report Anxiety and Depressive Problems scales and the Emotion Dysregulation Inventory Reactivity and Dysphoria scales. Weekly assessments showed an initial decrease in GAD-7 anxiety symptoms but no effect on weekly PHQ-9 depressive ratings. Ecological momentary assessment (EMA) data suggested that, when participants reported feeling sad or agitated and used the ESP, reduced negative feelings and increased positive states were reported in subsequent EMA. Perhaps not surprisingly, preliminary outcomes of these feasibility trials differed depending on measure chosen. Implications for the design of clinical trials are discussed.

SOMAScience: A Novel Platform for Multidimensional, Longitudinal Pain Assessment

Chronic pain is one of the most significant health issues in the United States, affecting more than 20% of the population. Despite its contribution to the increasing health crisis, reliable predictors of disease development, progression, or treatment outcomes are lacking. Self-report remains the most effective way to assess pain, but measures are often acquired in sparse settings over short time windows, limiting their predictive ability. In this paper, we present a new mobile health platform called SOMAScience. SOMAScience serves as an easy-to-use research tool for scientists and clinicians, enabling the collection of large-scale pain datasets in single- and multicenter studies by facilitating the acquisition, transfer, and analysis of longitudinal, multidimensional, self-report pain data. Data acquisition for SOMAScience is done through a user-friendly smartphone app, SOMA, that uses experience sampling methodology to capture momentary and daily assessments of pain intensity, unpleasantness, interference, location, mood, activities, and predictions about the next day that provide personal insights into daily pain dynamics. The visualization of data and its trends over time is meant to empower individual users' self-management of their pain. This paper outlines the scientific, clinical, technological, and user considerations involved in the development of SOMAScience and how it can be used in clinical studies or for pain self-management purposes. Our goal is for SOMAScience to provide a much-needed platform for individual users to gain insight into the multidimensional features of their pain while lowering the barrier for researchers and clinicians to obtain the type of pain data that will ultimately lead to improved prevention, diagnosis, and treatment of chronic pain.

A novel self-rating instrument designed for long-term, app-based monitoring of ADHD symptoms: A mixed-methods development and validation study

Background

Regular outcome monitoring is essential for effective attention deficit hyperactivity disorder (ADHD) treatment, yet routine care often limits long-term contacts to annual visits. Smartphone apps can complement current practice by offering low-threshold, long-term sustainable monitoring capabilities. However, special considerations apply for such measurement which should be anchored in stakeholder preferences.

Methods

This mixed-methods study engaged 13 experienced clinicians from Region Stockholm in iterative qualitative interviews to inform development of an instrument for app-based ADHD monitoring: the mHealth scale for Continuous ADHD Symptom Self-monitoring (mCASS). A subsequent survey, including the mCASS and addressing app-based monitoring preferences, was administered to 397 individuals with self-reported ADHD. Psychometric properties of the mCASS were explored through exploratory factor analysis and examinations of internal consistency. Concurrent validity was calculated between the mCASS and the Adult ADHD Self-Report Scale-V1.1 (ASRS-V1.1). Additional quantitative analyses included summary statistics and repeated-measures ANOVAs.

Results

Clinicians identified properties influencing willingness to use and adherence including content validity, clinical relevance, respondent burden, tone, wording and preferences for in-app results presentation. The final 12-item mCASS version demonstrated four factors covering everyday tasks, productivity, rest and recovery and interactions with others, explaining 47.4% of variance. Preliminary psychometric assessment indicated satisfactory concurrent validity (r = .595) and internal consistency (α = .826).

Conclusions

The mCASS, informed by clinician and patient experiences, appears to be valid for app-based assessment of ADHD symptoms. Furthermore, insights are presented regarding important considerations when developing mobile health (mHealth) instruments for ADHD individuals. These can be of value for future, similar endeavours.

The Role of a Smart Health Ecosystem in Transforming the Management of Chronic Health Conditions

The effective management of chronic conditions requires an approach that promotes a shift in care from the clinic to the home, improves the efficiency of health care systems, and benefits all users irrespective of their needs and preferences. Digital health can provide a solution to this challenge, and in this paper, we provide our vision for a smart health ecosystem. A smart health ecosystem leverages the interoperability of digital health technologies and advancements in big data and artificial intelligence for data collection and analysis and the provision of support. We envisage that this approach will allow a comprehensive picture of health, personalization, and tailoring of behavioral and clinical support; drive theoretical advancements; and empower people to manage their own health with support from health care professionals. We illustrate the concept with 2 use cases and discuss topics for further consideration and research, concluding with a message to encourage people with chronic conditions, their caregivers, health care professionals, policy and decision makers, and technology experts to join their efforts and work toward adopting a smart health ecosystem.

Evaluating the Effects of Rewards and Schedule Length on Response Rates to Ecological Momentary Assessment Surveys: Randomized Controlled Trials

BACKGROUND

Ecological momentary assessments (EMAs) are short, repeated surveys designed to collect information on experiences in real-time, real-life contexts. Embedding periodic bursts of EMAs within cohort studies enables the study of experiences on multiple timescales and could greatly enhance the accuracy of self-reported information. However, the burden on participants may be high and should be minimized to optimize EMA response rates.

OBJECTIVE

We aimed to evaluate the effects of study design features on EMA response rates.

METHODS

Embedded within an ongoing cohort study (Health@NUS), 3 bursts of EMAs were implemented over a 7-month period (April to October 2021). The response rate (percentage of completed EMA surveys from all sent EMA surveys; 30-42 individual EMA surveys sent/burst) for each burst was examined. Following a low response rate in burst 1, changes were made to the subsequent implementation strategy (SMS text message announcements instead of emails). In addition, 2 consecutive randomized controlled trials were conducted to evaluate the efficacy of 4 different reward structures (with fixed and bonus components) and 2 different schedule lengths (7 or 14 d) on changes to the EMA response rate. Analyses were conducted from 2021 to 2022 using ANOVA and analysis of covariance to examine group differences and mixed models to assess changes across all 3 bursts.

RESULTS

Participants (N=384) were university students (n=232, 60.4% female; mean age 23, SD 1.3 y) in Singapore. Changing the reward structure did not significantly change the response rate (F3,380=1.75; P=.16). Changing the schedule length did significantly change the response rate (F1,382=6.23; P=.01); the response rate was higher for the longer schedule (14 d; mean 48.34%, SD 33.17%) than the shorter schedule (7 d; mean 38.52%, SD 33.44%). The average response rate was higher in burst 2 and burst 3 (mean 50.56, SD 33.61 and mean 48.34, SD 33.17, respectively) than in burst 1 (mean 25.78, SD 30.12), and the difference was statistically significant (F2,766=93.83; P<.001).

CONCLUSIONS

Small changes to the implementation strategy (SMS text messages instead of emails) may have contributed to increasing the response rate over time. Changing the available rewards did not lead to a significant difference in the response rate, whereas changing the schedule length did lead to a significant difference in the response rate. Our study provides novel insights on how to implement EMA surveys in ongoing cohort studies. This knowledge is essential for conducting high-quality studies using EMA surveys.

TRIAL REGISTRATION

ClinicalTrials.gov NCT05154227; https://clinicaltrials.gov/ct2/show/NCT05154227.

Decision Trade-Offs in Ecological Momentary Assessments and Digital Wearables Uptake: Protocol for a Discrete Choice Experiment

BACKGROUND

Ecological momentary assessments (EMAs) and digital wearables (DW) are commonly used remote monitoring technologies that capture real-time data in people's natural environments. Real-time data are core to personalized medical care and intensively adaptive health interventions. The utility of such personalized care is contingent on user uptake and continued use of EMA and DW. Consequently, it is critical to understand user preferences that may increase the uptake of EMA and DW.

OBJECTIVE

The study aims to quantify users' preferences of EMA and DW, examine variations in users' preferences across demographic and behavioral subgroups, and assess the association between users' preferences and intentions to use EMA and DW.

METHODS

We will administer 2 discrete choice experiments (DCEs) paired with self-report surveys on the internet to a total of 3260 US adults through Qualtrics. The first DCE will assess participants' EMA preferences using a choice-based conjoint design that will ask participants to compare the relative importance of prompt frequency, number of questions per prompt, prompt type, health topic, and assessment duration. The second DCE will measure participants' DW preferences using a maximum difference scaling design that will quantify the relative importance of device characteristics, effort expectancy, social influence, and facilitating technical, health care, and market factors. Hierarchical Bayesian multinomial logistic regression models will be used to generate subject-specific preference utilities. Preference utilities will be compared across demographic (ie, sex, age, race, and ethnicity) and behavioral (ie, substance use, physical activity, dietary behavior, and sleep duration) subgroups. Regression models will determine whether specific utilities are associated with attitudes toward or intentions to use EMA and DW. Mixture models will determine the associations of attitudes toward and intentions to use EMA and DW with latent profiles of user preferences.

RESULTS

The institutional review board approved the study on December 19, 2022. Data collection started on January 20, 2023, and concluded on May 4, 2023. Data analysis is currently underway.

CONCLUSIONS

The study will provide evidence on users' preferences of EMA and DW features that can improve initial uptake and potentially continued use of these remote monitoring tools. The sample size and composition allow for subgroup analysis by demographics and health behaviors and will provide evidence on associations between users' preferences and intentions to uptake EMA and DW. Limitations include the cross-sectional nature of the study, which limits our ability to measure direct behavior. Rather, we capture behavioral intentions for EMA and DW uptake. The nonprobability sample limits the generalizability of the results and introduces self-selection bias related to the demographic and behavioral characteristics of participants who belong to web-based survey panels.

INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID)

DERR1-10.2196/47567.

A scoping review of intensive longitudinal methods in informal caregivers of people with dementia

BACKGROUND

The daily life of informal caregivers assisting individuals with dementia widely varies throughout the day and week. As an answer, an increasing number of researchers have used intensive longitudinal methods (ILMs) such as diary studies, experience sampling methods, or ecological momentary assessment.

OBJECTIVES AND METHODS

The present scoping review aims at synthesizing the use of ILMs in informal dementia caregivers to clarify what is currently done and how, as well as what remains unaddressed.

RESULTS

The screening process identified 48 studies from 22 different datasets. Synthesis of these studies showed the diversity of devices and uses of ILMs in informal care, including the exploration of associations between variables or accompanying an intervention. ILMs showed the important variability of caregiving phenomena, as well as the important association of momentary stress and well-being. Gaps were nevertheless identified, such as transparency in the construction of the tool or the absence of focus on emotions and dyads.

CONCLUSIONS

For now, this field of research remains in its infancy and does not seem to have reached its full potential as it has in other fields. Nevertheless, it appears that ILMs are promising tools for informal dementia caregivers as they contribute to understanding the complexity of their daily life, with changing resources and challenges. Future directions include focusing more on (emotion) regulation, temporal lags, and the use of ILMs in interventional designs.

TRIAL REGISTRATION

The present review was registered on OSF (osf.io/b2qr4).

Compliance with ecological momentary assessment programmes in the elderly: a systematic review and meta-analysis

OBJECTIVE

Ecological momentary assessment (EMA) refers to the repeated sampling of information about an individual's symptoms and behaviours, enabling the capture of ecologically meaningful real-time information in a timely manner. Compliance with EMA is critical in determining the validity of an assessment. However, there is limited evidence related to how the elderly comply with EMA programmes or the factors that are associated with compliance.

DESIGN

Systematic review and meta-analysis.

DATA SOURCES

PubMed, Embase, the Cochrane Library and Web of Science were searched up to 17 July 2022.

ELIGIBILITY CRITERIA

We included observational studies on EMA in the elderly reported in English.

DATA EXTRACTION AND SYNTHESIS

Two investigators independently performed screening and data extraction. Discrepancies were resolved by discussion or a third investigator. A systematic review was carried out to characterise the basic characteristics of the participants and EMA programmes. Random-effects meta-analysis was conducted to assess overall compliance and to explore factors associated with differences in compliance among the elderly.

RESULTS

A total of 20 studies with 2047 participants were included in the systematic review and meta-analysis. Meta-analysis showed that the combined compliance rate was 86.41% (95% CI: 77.38% to 92.20%; I²=96.4%; p<0.001). Subgroup analysis revealed high levels of heterogeneity in terms of the methods used to assess population classification, assessment method and assessment frequency, although these may not be the sources of heterogeneity. Meta-regression analysis showed that population classification and assessment period might have a significant impact on heterogeneity (p<0.05). Egger's test indicated significant publication bias (p<0.001).

CONCLUSIONS

Compliance with EMA programmes is high in the elderly. It is recommended that scholars design reasonable EMA programmes according to the health status of the elderly in the future.

Use of Electronic Ecological Momentary Assessment Methodologies in Physical Activity, Sedentary Behavior, and Sleep Research in Young Adults: Systematic Review

BACKGROUND

Recent technological advances allow for the repeated sampling of real-time data in natural settings using electronic ecological momentary assessment (eEMA). These advances are particularly meaningful for investigating physical activity, sedentary behavior, and sleep in young adults who are in a critical life stage for the development of healthy lifestyle behaviors.

OBJECTIVE

This study aims to describe the use of eEMA methodologies in physical activity, sedentary behavior, and sleep research in young adults.

METHODS

The PubMed, CINAHL, PsycINFO, Embase, and Web of Science electronic databases were searched through August 2022. Inclusion criteria were use of eEMA; sample of young adults aged 18 to 25 years; at least 1 measurement of physical activity, sedentary behavior, or sleep; English language; and a peer-reviewed report of original research. Study reports were excluded if they were abstracts, protocols, or reviews. The risk of bias assessment was conducted using the National Heart, Lung, and Blood Institute's Quality Assessment Tool for Observational Cohort and Cross-Sectional Studies. Screening, data extraction, and risk of bias assessments were conducted by independent authors, with discrepancies resolved by consensus. Descriptive statistics and narrative synthesis were used to identify overarching patterns within the following categories guided by the Checklist for Reporting Ecological Momentary Assessments Studies: study characteristics, outcomes and measures, eEMA procedures, and compliance.

RESULTS

The search resulted in 1221 citations with a final sample of 37 reports describing 35 unique studies. Most reports (28/37, 76%) were published in the last 5 years (2017-2022), used observational designs (35/37, 95%), consisted of samples of college students or apprentices (28/35, 80%), and were conducted in the United States (22/37, 60%). The sample sizes ranged from 14 to 1584 young adults. Physical activity was measured more frequently (28/37, 76%) than sleep (16/37, 43%) or sedentary behavior (4/37, 11%). Of the 37 studies, 11 (30%) reports included 2 movement behaviors and no reports included 3 movement behaviors. eEMA was frequently used to measure potential correlates of movement behaviors, such as emotional states or feelings (25/37, 68%), cognitive processes (7/37, 19%), and contextual factors (9/37, 24%). There was wide variability in the implementation and reporting of eEMA procedures, measures, missing data, analysis, and compliance.

CONCLUSIONS

The use of eEMA methodologies in physical activity, sedentary behavior, and sleep research in young adults has greatly increased in recent years; however, reports continue to lack standardized reporting of features unique to the eEMA methodology. Additional areas in need of future research include the use of eEMA with more diverse populations and the incorporation of all 3 movement behaviors within a 24-hour period. The findings are intended to assist investigators in the design, implementation, and reporting of physical activity, sedentary behavior, and sleep research using eEMA in young adults.

TRIAL REGISTRATION

PROSPERO CRD42021279156; https://www.crd.york.ac.uk/prospero/display_record.php?ID=CRD42021279156.

Evaluating Declines in Compliance With Ecological Momentary Assessment in Longitudinal Health Behavior Research: Analyses From a Clinical Trial

BACKGROUND

Ecological momentary assessment (EMA) is increasingly used to evaluate behavioral health processes over extended time periods. The validity of EMA for providing representative, real-world data with high temporal precision is threatened to the extent that EMA compliance drops over time.

OBJECTIVE

This research builds on prior short-term studies by evaluating the time course of EMA compliance over 9 weeks and examines predictors of weekly compliance rates among cigarette-using adults.

METHODS

A total of 257 daily cigarette-using adults participating in a randomized controlled trial for smoking cessation completed daily smartphone EMA assessments, including 1 scheduled morning assessment and 4 random assessments per day. Weekly EMA compliance was calculated and multilevel modeling assessed the rate of change in compliance over the 9-week assessment period. Participant and study characteristics were examined as predictors of overall compliance and changes in compliance rates over time.

RESULTS

Compliance was higher for scheduled morning assessments (86%) than for random assessments (58%) at the beginning of the EMA period (P<.001). EMA compliance declined linearly across weeks, and the rate of decline was greater for morning assessments (2% per week) than for random assessments (1% per week; P<.001). Declines in compliance were stronger for younger participants (P<.001), participants who were employed full-time (P=.03), and participants who subsequently dropped out of the study (P<.001). Overall compliance was higher among White participants compared to Black or African American participants (P=.001).

CONCLUSIONS

This study suggests that EMA compliance declines linearly but modestly across lengthy EMA protocols. In general, these data support the validity of EMA for tracking health behavior and hypothesized treatment mechanisms over the course of several months. Future work should target improving compliance among subgroups of participants and investigate the extent to which rapid declines in EMA compliance might prove useful for triggering interventions to prevent study dropout.

TRIAL REGISTRATION

ClinicalTrials.gov NCT03262662; https://clinicaltrials.gov/ct2/show/NCT03262662.

Assessing Emotion Polyregulation in Daily Life: Who Uses It, When Is It Used, and How Effective Is It?

Most research on emotion regulation has focused on understanding individual emotion regulation strategies. Preliminary research, however, suggests that people often use several strategies to regulate their emotions in a given emotional scenario (polyregulation). The present research examined who uses polyregulation, when polyregulation is used, and how effective polyregulation is when it is used. College students (N = 128; 65.6% female; 54.7% White) completed an in-person lab visit followed by a 2-week ecological momentary assessment protocol with six randomly timed survey prompts per day for up 2 weeks. At baseline, participants completed measures assessing past-week depression symptoms, social anxiety-related traits, and trait emotion dysregulation. During each randomly timed prompt, participants reported up to eight strategies used to change their thoughts or feelings, negative and positive affect, motivation to change emotions, their social context, and how well they felt they were managing their emotions. In pre-registered analyses examining the 1,423 survey responses collected, polyregulation was more likely when participants were feeling more intensely negative and when their motivation to change their emotions was stronger. Neither sex, psychopathology-related symptoms and traits, social context, nor subjective effectiveness was associated with polyregulation, and state affect did not moderate these associations. This study helps address a key gap in the literature by assessing emotion polyregulation in daily life.

Supplementary Information

The online version contains supplementary material available at 10.1007/s42761-022-00166-x.

Introducing a Real-Time Method for Identifying the Predictors of Noncompliance with Event-Based Reporting of Tobacco Use in Ecological Momentary Assessment

BACKGROUND

Little is known about the factors that bias event-based (i.e., self-initiated) reporting of health behaviors in ecological momentary assessment (EMA) due to the difficulty inherent to tracking failures to self-initiate reports.

PURPOSE

To introduce a real-time method for identifying the predictors of noncompliance with event-based reporting.

METHODS

N = 410 adults who used both cigarettes and e-cigarettes completed a 1-week EMA protocol that combined random reporting of current contexts with event-based reporting of tobacco use. Each random assessment first asked if participants were currently using tobacco and, if so, the assessment converted into a "randomly captured" event report-indicating failure to self-initiate that report. Multilevel modeling tested predictors of failing to complete random reports and failing to self-initiate event reports.

RESULTS

On the person level, male sex, higher average cigarette rate, and higher average cigarette urge each predicted missing random reports. The person-level predictors of failing to self-initiate event reports were older age, higher average cigarette and e-cigarette rates, higher average cigarette urge, and being alone more on average; the moment-level predictors were lower cigarette urge, lower positive affect, alcohol use, and cannabis use. Strikingly, the randomly captured events comprised more of the total EMA reports (28%) than did the self-initiated event reports (24%). These report types were similar across most variables, with some exceptions, such as momentary cannabis use predicting the random capture of tobacco events.

CONCLUSIONS

This study demonstrated a method of identifying predictors of noncompliance with event-based reporting of tobacco use and enhancing the real-time capture of events.

The Behavioral Assessment Screening Tool for Mobile Health (BASTmHealth): Development and Compliance in 2 Weeks of Daily Reporting in Chronic Traumatic Brain Injury

OBJECTIVES

To develop and evaluate the feasibility of a short form of the Behavioral Assessment Screening Tool (BASTmHealth) for high frequency in situ self-reported assessment of neurobehavioral symptoms using mobile health technology for community-dwelling adults with traumatic brain injury (TBI).

DESIGN

Prospective, repeated-measures study of mHealth assessment of self-reported neurobehavioral symptoms in adults with and without a lifetime history of TBI over a 2-week period.

SETTING

Community.

PARTICIPANTS

Community-dwelling adults with (n=52) and without (n=12) a lifetime TBI history consented to the study (N=64).

INTERVENTIONS

Not applicable.

MAIN OUTCOME MEASURES

BASTmHealth subscales (2-items each): negative affect, fatigue, executive function, substance abuse, impulsivity; feasibility measured via compliance (assessments assigned/assessments completed) and participant-reported usability.

RESULTS

We developed the 10-item BASTmHealth as a screener for high frequency in situ self-reported assessment of neurobehavioral symptoms leveraging mHealth. Compliance for 2 weeks of BASTmHealth supports its feasibility. Fifty-six of 64 participants (87.5%) who completed baseline assessments completed the 2 weeks of daily assessments; all 8 participants who did not complete ecological momentary assessment had a history of TBI. Overall compliance was 81.4% (496 completed of 609 assigned assessments) among all 52 participants with TBI and 96.7% (494 completed of 511 assigned assessments) among the 44 who completed any daily measures, compared with 91.8% (135 completed of 147 assigned assessments) among those with no TBI history. Participants thought the daily surveys were easy to understand and complete and the number of prompts were reasonable.

CONCLUSIONS

Conducting daily high-frequency in situ self-reported assessment of neurobehavioral symptoms using the BASTmHealth is feasible among individuals with and without a lifetime history of TBI. Developing and evaluating self-reported assessments for community-based assessment is a critical step toward expanding remote clinical monitoring systems to improve post-TBI outcomes.

Prompt-level predictors of compliance in an ecological momentary assessment study of young adults' mental health

BACKGROUND

Ecological momentary assessment (EMA) has become a popular method of gathering information about participants as they go about their daily lives. However, participant non-compliance, especially non-random compliance, in EMA is a concern. Better knowledge of the moment-to-moment factors that predict prompt non-response can inform the design of strategies to mitigate it.

METHOD

We used data from a general population young adult (n = 260) EMA study, 'decades-to-minutes' (D2M) and fitted dynamic structural equation models (DSEMs) to explore a range of candidate momentary predictors of missing the next prompt.

RESULTS

We found that higher levels of stress, overall negative affect, and the specific negative affective state of 'upset' at a given prompt predicted a greater likelihood of missing the next prompt. However, no other specific affective states, alcohol use, experiencing social provocations nor aggressive behaviour predicted missing the next prompt.

LIMITATIONS

The primary limitation of the present study was a lack of information on predictors concurrent with missed prompts.

CONCLUSIONS

Findings point to the potential value of gathering information on momentary negative affect (especially feeling upset) and stress to help inform strategies that intervene to prevent application disengagement at optimal moments and to feed into strategies to mitigate bias due to non-random non-response in EMA studies.

Glycemic Variability and Fluctuations in Cognitive Status in Adults With Type 1 Diabetes (GluCog): Observational Study Using Ecological Momentary Assessment of Cognition

BACKGROUND

Individuals with type 1 diabetes represent a population with important vulnerabilities to dynamic physiological, behavioral, and psychological interactions, as well as cognitive processes. Ecological momentary assessment (EMA), a methodological approach used to study intraindividual variation over time, has only recently been used to deliver cognitive assessments in daily life, and many methodological questions remain. The Glycemic Variability and Fluctuations in Cognitive Status in Adults with Type 1 Diabetes (GluCog) study uses EMA to deliver cognitive and self-report measures while simultaneously collecting passive interstitial glucose in adults with type 1 diabetes.

OBJECTIVE

We aimed to report the results of an EMA optimization pilot and how these data were used to refine the study design of the GluCog study. An optimization pilot was designed to determine whether low-frequency EMA (3 EMAs per day) over more days or high-frequency EMA (6 EMAs per day) for fewer days would result in a better EMA completion rate and capture more hypoglycemia episodes. The secondary aim was to reduce the number of cognitive EMA tasks from 6 to 3.

METHODS

Baseline cognitive tasks and psychological questionnaires were completed by all the participants (N=20), followed by EMA delivery of brief cognitive and self-report measures for 15 days while wearing a blinded continuous glucose monitor. These data were coded for the presence of hypoglycemia (<70 mg/dL) within 60 minutes of each EMA. The participants were randomized into group A (n=10 for group A and B; starting with 3 EMAs per day for 10 days and then switching to 6 EMAs per day for an additional 5 days) or group B (N=10; starting with 6 EMAs per day for 5 days and then switching to 3 EMAs per day for an additional 10 days).

RESULTS

A paired samples 2-tailed t test found no significant difference in the completion rate between the 2 schedules (t17=1.16; P=.26; Cohen dz=0.27), with both schedules producing >80% EMA completion. However, more hypoglycemia episodes were captured during the schedule with the 3 EMAs per day than during the schedule with 6 EMAs per day.

CONCLUSIONS

The results from this EMA optimization pilot guided key design decisions regarding the EMA frequency and study duration for the main GluCog study. The present report responds to the urgent need for systematic and detailed information on EMA study designs, particularly those using cognitive assessments coupled with physiological measures. Given the complexity of EMA studies, choosing the right instruments and assessment schedules is an important aspect of study design and subsequent data interpretation.

Understanding health behaviours in context: A systematic review and meta-analysis of ecological momentary assessment studies of five key health behaviours

Ecological Momentary Assessment (EMA) involves repeated, real-time sampling of health behaviours in context. We present the state-of-knowledge in EMA research focused on five key health behaviours (physical activity and sedentary behaviour, dietary behaviour, alcohol consumption, tobacco smoking, sexual health), summarising theoretical (e.g., psychological and contextual predictors) and methodological aspects (e.g., study characteristics, EMA adherence). We searched Ovid MEDLINE, Embase, PsycINFO and Web of Science until February 2021. We included studies focused on any of the aforementioned health behaviours in adult, non-clinical populations that assessed ≥1 psychological/contextual predictor and reported a predictor-behaviour association. A narrative synthesis and random-effects meta-analyses of EMA adherence were conducted. We included 633 studies. The median study duration was 14 days. The most frequently assessed predictors were 'negative feeling states' (21%) and 'motivation and goals' (16.5%). The pooled percentage of EMA adherence was high at 81.4% (95% CI = 80.0%, 82.8%, k = 348) and did not differ by target behaviour but was somewhat higher in student (vs. general population) samples, when EMAs were delivered via mobile phones/smartphones (vs. handheld devices), and when event contingent (vs. fixed) sampling was used. This review showcases how the EMA method has been applied to improve understanding and prediction of health behaviours in context.

Wearable Sensor and Mobile App-based mHealth Approach for Investigating Substance Use and Related Factors in Daily Life: Protocol for an Ecological Momentary Assessment Study (Preprint)

BACKGROUND

Digital health technologies using mobile apps and wearable devices are a promising approach to the investigation of substance use in the real world and for the analysis of predictive factors or harms from substance use. Moreover, consecutive repeated data collection enables the development of predictive algorithms for substance use by machine learning methods.

OBJECTIVE

We developed a new self-monitoring mobile app to record daily substance use, triggers, and cravings. Additionally, a wearable activity tracker (Fitbit) was used to collect objective biological and behavioral data before, during, and after substance use. This study aims to describe a model using machine learning methods to determine substance use.

METHODS

This study is an ongoing observational study using a Fitbit and a self-monitoring app. Participants of this study were people with health risks due to alcohol or methamphetamine use. They were required to record their daily substance use and related factors on the self-monitoring app and to always wear a Fitbit for 8 weeks, which collected the following data: (1) heart rate per minute, (2) sleep duration per day, (3) sleep stages per day, (4) the number of steps per day, and (5) the amount of physical activity per day. Fitbit data will first be visualized for data analysis to confirm typical Fitbit data patterns for individual users. Next, machine learning and statistical analysis methods will be performed to create a detection model for substance use based on the combined Fitbit and self-monitoring data. The model will be tested based on 5-fold cross-validation, and further preprocessing and machine learning methods will be conducted based on the preliminary results. The usability and feasibility of this approach will also be evaluated.

RESULTS

Enrollment for the trial began in September 2020, and the data collection finished in April 2021. In total, 13 people with methamphetamine use disorder and 36 with alcohol problems participated in this study. The severity of methamphetamine or alcohol use disorder assessed by the Drug Abuse Screening Test-10 or the Alcohol Use Disorders Identification Test-10 was moderate to severe. The anticipated results of this study include understanding the physiological and behavioral data before, during, and after alcohol or methamphetamine use and identifying individual patterns of behavior.

CONCLUSIONS

Real-time data on daily life among people with substance use problems were collected in this study. This new approach to data collection might be helpful because of its high confidentiality and convenience. The findings of this study will provide data to support the development of interventions to reduce alcohol and methamphetamine use and associated negative consequences.

INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID)

DERR1-10.2196/44275.

Feasibility of Passive ECG Bio-sensing and EMA Emotion Reporting Technologies and Acceptability of Just-in-Time Content in a Well-being Intervention, Considerations for Scalability and Improved Uptake

Researchers increasingly use passive sensing data and frequent self-report to implement personalized mobile health (mHealth) interventions. Yet, we know that certain populations may find these technical protocols burdensome and intervention uptake as well as treatment efficacy may be affected as a result. In the present study, we predicted feasibility (participant adherence to protocol) and acceptability (participant engagement with intervention content) as a function of baseline sociodemographic, mental health, and well-being characteristics of 99 women randomized in the personalized preventive intervention Wellness-for-Two (W-4-2), a randomized trial evaluating stress-related alterations during pregnancy and their effect on infant neurodevelopmental trajectories. The W-4-2 study used ecological momentary assessment (EMA) and wearable electrocardiograph (ECG) sensors to detect physiological stress and personalize the intervention. Participant adherence to protocols was 67% for EMAs and 52% for ECG bio-sensors. Higher baseline negative affect significantly predicted lower adherence to both protocols. Women assigned to the intervention group engaged on average with 42% of content they received. Women with higher annual household income were more likely to engage with more of the intervention content. Researchers should carefully consider tailoring of the intensity of technical intervention protocols to reduce fatigue, especially among participants with higher baseline negative affect, which may improve intervention uptake and efficacy findings at scale.