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Ecological Momentary Assessment of Adolescent Problems, Coping Efficacy, and Mood States Using a Mobile Phone App: An Exploratory Study.

ABSTRACT: BACKGROUND:Mobile technologies have the potential to be used as innovative tools for conducting research on the mental health and well-being of young people. In particular, they have utility for carrying out ecological momentary assessment (EMA) research by capturing data from participants in real time as they go about their daily lives. OBJECTIVE:The aim of this study was to explore the utility of a mobile phone app as a means of collecting EMA data pertaining to mood, problems, and coping efficacy in a school-based sample of Irish young people. METHODS:The study included a total of 208 participants who were aged 15-18 years, 64% female (113/208), recruited from second-level schools in Ireland, and who downloaded the CopeSmart mobile phone app as part of a randomized controlled trial. On the app, participants initially responded to 5 single-item measures of key protective factors in youth mental health (formal help-seeking, informal help-seeking, sleep, exercise, and sense of belonging). They were then encouraged to use the app daily to input data relating to mood states (happiness, sadness, anger, stress, and worry), daily problems, and coping self-efficacy. The app automatically collected data pertaining to user engagement over the course of the 28-day intervention period. Students also completed pen and paper questionnaires containing standardized measures of emotional distress (Depression, Anxiety, and Stress Scale; DASS-21), well-being (World Health Organization Well-Being Index; WHO-5), and coping (Coping Strategies Inventory; CSI). RESULTS:On average the participants completed 18% (5/28) of daily ratings, and engagement levels did not differ across gender, age, school, socioeconomic status, ethnicity, or nationality. On a scale of 1 to 10, happiness was consistently the highest rated mood state (overall mean 6.56), and anger was consistently the lowest (overall mean 2.11). Pearson correlations revealed that average daily ratings of emotional states were associated with standardized measures of emotional distress (rhappiness=-.45, rsadness=.51, ranger=.32, rstress=.41, rworry=.48) and well-being (rhappiness=.39, rsadness =-.43, ranger=-.27, rstress=-.35, rworry=-.33). Inferential statistics indicated that single-item indicators of key protective factors were related to emotional distress, well-being, and average daily mood states, as measured by EMA ratings. Hierarchical regressions revealed that greater daily problems were associated with more negative daily mood ratings (all at the P<.001 level); however, when coping efficacy was taken into account, the relationship between problems and happiness, sadness, and anger became negligible. CONCLUSIONS:While engagement with the app was low, overall the EMA data collected in this exploratory study appeared valid and provided useful insights into the relationships between daily problems, coping efficacy, and mood states. Future research should explore ways to increase engagement with EMA mobile phone apps in adolescent populations to maximize the amount of data captured by these tools. TRIAL REGISTRATION:Clinicaltrials.gov NCT02265978; http://clinicaltrials.gov/ct2/show/NCT02265978 (Archived by WebCite at http://www.webcitation.org/6mMeYqseA).

SUBMITTER: Kenny R

PROVIDER: S-EPMC5155083 | biostudies-literature | 2016 Nov

REPOSITORIES: biostudies-literature

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Ecological Momentary Assessment of Adolescent Problems, Coping Efficacy, and Mood States Using a Mobile Phone App: An Exploratory Study.

Kenny Rachel R Dooley Barbara B Fitzgerald Amanda A

JMIR mental health 20161129 4

<h4>Background</h4>Mobile technologies have the potential to be used as innovative tools for conducting research on the mental health and well-being of young people. In particular, they have utility for carrying out ecological momentary assessment (EMA) research by capturing data from participants in real time as they go about their daily lives.<h4>Objective</h4>The aim of this study was to explore the utility of a mobile phone app as a means of collecting EMA data pertaining to mood, problems, ...[more]

PMID: 27899340

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Project description:BackgroundMany mental disorders are preceded by a prodromal phase consisting of various attenuated and unspecific symptoms and functional impairment. Electronic health records are generally used to capture these symptoms during medical consultation. Internet and mobile technologies provide the opportunity to monitor symptoms emerging in patients' environments using ecological momentary assessment techniques to support preventive therapeutic decision making.ObjectiveThe objective of this study was to assess the acceptability of a Web-based app designed to collect medical data during appointments and provide ecological momentary assessment features.MethodsWe recruited clinicians at 4 community psychiatry departments in France to participate. They used the app to assess patients and to collect data after viewing a video of a young patient's emerging psychiatric consultation. We then asked them to answer a short anonymous self-administered questionnaire that evaluated their experience, the acceptability of the app, and their habit of using new technologies.ResultsOf 24 practitioners invited, 21 (88%) agreed to participate. Most of them were between 25 and 45 years old, and greater age was not associated with poorer acceptability. Most of the practitioners regularly used new technologies, and 95% (20/21) connected daily to the internet, with 70% (15/21) connecting 3 times a day or more. However, only 57% (12/21) reported feeling comfortable with computers. Of the clinicians, 86% (18/21) would recommend the tool to their colleagues and 67% (14/21) stated that they would be interested in daily use of the app. Most of the clinicians (16/21, 76%) found the interface easy to use and useful. However, several clinicians noted the lack of readability (8/21, 38%) and the need to improve ergonometric features (4/21, 19%), in particular to facilitate browsing through various subsections. Some participants (5/21, 24%) were concerned about the storage of medical data and most of them (11/21, 52%) seemed to be uncomfortable with this.ConclusionsWe describe the first step of the development of a Web app combining an electronic health record and ecological momentary assessment features. This online tool offers the possibility to assess patients and to integrate medical data easily into face-to-face conditions. The acceptability of this app supports the feasibility of its broader implementation. This app could help to standardize assessment and to build up a strong database. Used in conjunction with robust data mining analytic techniques, such a database would allow exploration of risk factors, patterns of symptom evolution, and identification of distinct risk subgroups.

Project description:BackgroundUndergraduate studies are challenging, and mental health issues can frequently occur in undergraduate students, straining campus resources that are already in demand for somatic problems. Cost-effective measures with ubiquitous devices, such as smartphones, offer the potential to deliver targeted interventions to monitor and affect lifestyle, which may result in improvements to student mental health. However, the avenues by which this can be done are not particularly well understood, especially in the Canadian context.ObjectiveThe aim of this study is to deploy an initial version of the Smart Healthy Campus app at Western University, Canada, and to analyze corresponding data for associations between psychosocial factors (measured by a questionnaire) and behaviors associated with lifestyle (measured by smartphone sensors).MethodsThis preliminary study was conducted as an observational app-based ecological momentary assessment. Undergraduate students were recruited over email, and sampling using a custom 7-item questionnaire occurred on a weekly basis.ResultsFirst, the 7-item Smart Healthy Campus questionnaire, derived from fully validated questionnaires-such as the Brief Resilience Scale; General Anxiety Disorder-7; and Depression, Anxiety, and Stress Scale-21-was shown to significantly correlate with the mental health domains of these validated questionnaires, illustrating that it is a viable tool for a momentary assessment of an overview of undergraduate mental health. Second, data collected through the app were analyzed. There were 312 weekly responses and 813 sensor samples from 139 participants from March 2019 to March 2020; data collection concluded when COVID-19 was declared a pandemic. Demographic information was not collected in this preliminary study because of technical limitations. Approximately 69.8% (97/139) of participants only completed one survey, possibly because of the absence of any incentive. Given the limited amount of data, analysis was not conducted with respect to time, so all data were analyzed as a single collection. On the basis of mean rank, students showing more positive mental health through higher questionnaire scores tended to spend more time completing questionnaires, showed more signs of physical activity based on pedometers, and had their devices running less and plugged in charging less when sampled. In addition, based on mean rank, students on campus tended to report more positive mental health through higher questionnaire scores compared with those who were sampled off campus. Some data from students found in or near residences were also briefly examined.ConclusionsGiven these limited data, participants tended to report a more positive overview of mental health when on campus and when showing signs of higher levels of physical activity. These early findings suggest that device sensors related to physical activity and location are useful for monitoring undergraduate students and designing interventions. However, much more sensor data are needed going forward, especially given the sweeping changes in undergraduate studies due to COVID-19.

Project description:BACKGROUND:Smoking is one of the most significant factors contributing to low life expectancy, health inequalities, and illness at the worldwide scale. Smoking cessation attempts benefit from social support. Mobile phones have changed the way we communicate through the use of freely available message-oriented apps. Mobile app-based interventions for smoking cessation programs can provide interactive, supportive, and individually tailored interventions. OBJECTIVE:This study aimed to identify emotions, coping strategies, beliefs, values, and cognitive evaluations of smokers who are in the process of quitting, and to analyze online social support provided through the analysis of messages posted to a chat function integrated into a mobile app. METHODS:In this descriptive qualitative study, informants were smokers who participated in the chat of Tobbstop. The technique to generate information was documentary through messages collected from September 2014 through June 2016, specifically designed to support a smoking cessation intervention. A thematic content analysis of the messages applied 2 conceptual models: the Lazarus and Folkman model to assess participant's experiences and perceptions and the Cutrona model to evaluate online social support. RESULTS:During the study period, 11,788 text messages were posted to the chat by 101 users. The most frequent messages offered information and emotional support, and all the basic emotions were reported in the chat. The 3 most frequent coping strategies identified were physical activity, different types of treatment such as nicotine replacement, and humor. Beliefs about quitting smoking included the inevitability of weight gain and the notion that not using any type of medications is better for smoking cessation. Health and family were the values more frequently described, followed by freedom. A smoke-free environment was perceived as important to successful smoking cessation. The social support group that was developed with the app offered mainly emotional and informational support. CONCLUSIONS:Our analysis suggests that a chat integrated into a mobile app focused on supporting smoking cessation provides a useful tool for smokers who are in the process of quitting, by offering social support and a space to share concerns, information, or strategies.

Project description:Valid, reliable behavioral data and contextually meaningful interventions are necessary for improved health outcomes. Ecological Momentary Assessment and Intervention (EMAI), which collects data as behaviors occur to deliver real-time interventions, may be more accurate and reliable than retrospective methods. The rapid expansion of mobile technologies in low-and-middle-income countries allows for unprecedented remote data collection and intervention opportunities. However, no previous studies have trialed EMAI in sub-Saharan Africa. We assessed EMAI acceptability and feasibility, including participant retention and response rate, in a prospective, parallel group, randomized pilot trial in Rakai, Uganda comparing behavioral outcomes among adults submitting ecological momentary assessments (EMA) versus EMAI. After training, participants submitted EMA data on five nutrition and health risk behaviors over a 90-day period using a smartphone-based application utilizing prompt-based, participant-initiated, and geospatial coordinate data collection, with study coordinator support and incentives for >50% completion. Included behaviors and associated EMAI-arm intervention messages were selected to pilot a range of EMAI applications. Acceptability was measured on questionnaires. We estimated the association between high response rate and participant characteristics and conducted thematic analysis characterizing participant experiences. Study completion was 48/50 participants. Median prompt response rate was 66.5% (IQR: 60.0%-78.6%). Prior smartphone app use at baseline (aPR 3.76, 95%CI: 1.16-12.17, p = 0.03) and being in the intervention arm (aPR 2.55, 95% CI: 1.01-6.44, p = 0.05) were significantly associated with the top response rate quartile (response to >78.6% of prompts). All participants submitted self-initiated reports, covering all behaviors of interest, including potentially sensitive behaviors. Inconsistent phone charging was the most reported feasibility challenge. In this pilot, EMAI was acceptable and feasible. Response rates were good; additional strategies to improve compliance should be investigated. EMAI using mobile technologies may support improved behavioral data collection and intervention approaches in low and middle-income settings. This approach should be tested in larger studies.

Project description:BACKGROUND:Ecological momentary assessment (EMA) has utility for measuring psychological properties in daily life. EMA has also allowed researchers to collect data on diverse experiences and symptoms from various subjects. OBJECTIVE:The aim of this study was to review methodological strategies and useful related information for EMA using mobile phones to capture changes of mood and stress in adult patients seeking health care. METHODS:We searched PubMed, Cumulative Index to Nursing and Allied Health Literature (CINAHL), Embase, the Cochrane Library, PsycINFO, and Web of Science. This review included studies published in peer-reviewed journals in English between January 2008 and November 2017 that used basic- or advanced-feature mobile phones to measure momentary mood or stress in adult patients seeking health care in outpatient departments. We excluded studies of smoking and substance addictions and studies of mental disorder patients who had been diagnosed by physicians. RESULTS:We reviewed 12 selected articles that used EMA via mobile phones to measure momentary mood and stress and other related variables from various patients with chronic fatigue syndrome, breast cancer, migraine, HIV, tinnitus, temporomandibular disorder, end-stage kidney disease, and traumatic brain injury. Most of the selected studies (11/12, 92%) used signal contingency and in 8 of the 12 studies (67%) alarms were sent at random or semirandom intervals to prompt the momentary measurement. Out of 12 studies, 7 (58%) used specific apps directly installed on mobile phones, 3 (25%) used mobile phones to link to Web-based survey programs, and 2 (17%) used an interactive voice-response system. CONCLUSIONS:This study provides researchers with useful information regarding methodological details for utilizing EMA to measure mood and stress in adult patients. This review shows that EMA methods could be effective and reasonable for measuring momentary mood and stress, given that basic- and advanced-feature mobile phones are ubiquitous, familiar, and easy to approach. Therefore, researchers could adopt and utilize EMA methods using mobile phones to measure psychological health outcomes, such as mood and stress, in adult patients.

Project description:BACKGROUND: The use of mobile phones, and specifically smartphones, in the last decade has become more and more prevalent. The latest mobile phones are equipped with comprehensive features that can be used in health care, such as providing rapid access to up-to-date evidence-based information, provision of instant communications, and improvements in organization. The estimated number of health care apps for mobile phones is increasing tremendously, but previous research has highlighted the lack of critical appraisal of new apps. This lack of appraisal of apps has largely been due to the lack of clinicians with technical knowledge of how to create an evidence-based app. OBJECTIVE: We discuss two freely available methodologies for developing Web-based mobile phone apps: a website builder and an app builder. With these, users can program not just a Web-based app, but also integrate multimedia features within their app, without needing to know any programming language. METHODS: We present techniques for creating a mobile Web-based app using two well-established online mobile app websites. We illustrate how to integrate text-based content within the app, as well as integration of interactive videos and rich site summary (RSS) feed information. We will also briefly discuss how to integrate a simple questionnaire survey into the mobile-based app. A questionnaire survey was administered to students to collate their perceptions towards the app. RESULTS: These two methodologies for developing apps have been used to convert an online electronic psychiatry textbook into two Web-based mobile phone apps for medical students rotating through psychiatry in Singapore. Since the inception of our mobile Web-based app, a total of 21,991 unique users have used the mobile app and online portal provided by WordPress, and another 717 users have accessed the app via a Web-based link. The user perspective survey results (n=185) showed that a high proportion of students valued the textbook and objective structured clinical examination videos featured in the app. A high proportion of students concurred that a self-designed mobile phone app would be helpful for psychiatry education. CONCLUSIONS: These methodologies can enable busy clinicians to develop simple mobile Web-based apps for academic, educational, and research purposes, without any prior knowledge of programming. This will be beneficial for both clinicians and users at large, as there will then be more evidence-based mobile phone apps, or at least apps that have been appraised by a clinician.

Project description:BackgroundReal-time ecological momentary interventions have shown promising effects in domains other than alcohol use; however, only few studies regarding ecological momentary interventions for alcohol use have been conducted thus far. The increasing popularity of smartphones offers new avenues for intervention and innovation in data collection.ObjectiveWe aimed to test the efficacy of an ecological momentary intervention, comprising mobile Web-based ecological momentary assessments (EMAs) and text messaging (short message service, SMS) brief interventions, delivered during drinking events using participants' mobile phones.MethodsWe conducted a three-armed randomized controlled trial to assess the effect of a mobile Web-based ecological momentary assessment with texting feedback on self-reported alcohol consumption and alcohol-related harms in young adults. Participants were enrolled from an existing observational cohort study of young adults screened for risky drinking behavior. The intervention group (ecological momentary intervention group) completed repeated ecological momentary assessments during 6 drinking events and received immediate texting-based feedback in response to each ecological momentary assessment. The second group (ecological momentary assessment group) completed ecological momentary assessments without the brief intervention, and the third did not receive any contact during the trial period. Recent peak risky single-occasion drinking was assessed at the baseline and follow-up using telephone interviews. We used a random effects mixed modeling approach using maximum likelihood estimation to provide estimates of differences in mean drinking levels between groups between baseline and 12-week follow-up.ResultsA total of 269 participants were randomized into the 3 groups. The ecological momentary intervention group exhibited a small and nonsignificant increase between baseline and follow-up in (geometric) the mean number of standard drinks consumed at the most recent heavy drinking occasion (mean 12.5 vs 12.7). Both ecological momentary assessment and control groups exhibited a nonsignificant decrease (ecological momentary assessment: mean 13.8 vs 11.8; control: mean 12.3 vs 11.6); these changes did not differ significantly between groups (Wald ?22 1.6; P=.437) and the magnitude of the effects of the intervention were markedly small. No other significant differences between groups on measures of alcohol consumption or related harms were observed. The intervention acceptability was high despite the technical problems in delivery.ConclusionsWith a small number of participants, this study showed few effects of an SMS-based brief intervention on peak risky single-occasion drinking. Nevertheless, the study highlights areas for further investigation into the effects of EMI on young adults with heavy alcohol consumption.Trial registrationAustralian New Zealand Clinical Trials Registry ACTRN12616001323415; https://www.anzctr.org.au/Trial/Registration/TrialReview.aspx?id=369534 (Archived by WebCite at http://www.webcitation.org/7074mqwcs).

Project description:BackgroundNew methods for assessing diet in research are being developed to address the limitations of traditional dietary assessment methods. Mobile device-assisted ecological momentary diet assessment (mEMDA) is a new dietary assessment method that has not yet been optimized and has the potential to minimize recall biases and participant burden while maximizing ecological validity. There have been limited efforts to characterize the use of mEMDA in behavioral research settings.ObjectiveThe aims of this study were to summarize mEMDA protocols used in research to date, to characterize key aspects of these assessment approaches, and to discuss the advantages and disadvantages of mEMDA compared with the traditional dietary assessment methods as well as implications for future mEMDA research.MethodsStudies that used mobile devices and described mEMDA protocols to assess dietary intake were included. Data were extracted according to Preferred Reporting of Systematic Reviews and Meta-Analyses and Cochrane guidelines and then synthesized narratively.ResultsThe review included 20 studies with unique mEMDA protocols. Of these, 50% (10/20) used participant-initiated reports of intake at eating events (event-contingent mEMDA), and 50% (10/20) used researcher-initiated prompts requesting that participants report recent dietary intake (signal-contingent mEMDA). A majority of the study protocols (60%, 12/20) enabled participants to use mobile phones to report dietary data. Event-contingent mEMDA protocols most commonly assessed diet in real time, used dietary records for data collection (60%, 6/10), and provided estimates of energy and nutrient intake (60%, 6/10). All signal-contingent mEMDA protocols used a near real-time recall approach with unannounced (ie, random) abbreviated diet surveys. Most signal-contingent protocols (70%, 7/10) assessed the frequency with which (targeted) foods or food groups were consumed. Relatively few (30%, 6/20) studies compared mEMDA with the traditional dietary assessment methods.ConclusionsThis review demonstrates that mEMDA has the potential to reduce participant burden and recall bias, thus advancing the field beyond current dietary assessment methods while maximizing ecological validity.

Dataset Information

Ecological Momentary Assessment of Adolescent Problems, Coping Efficacy, and Mood States Using a Mobile Phone App: An Exploratory Study.

Publications

Ecological Momentary Assessment of Adolescent Problems, Coping Efficacy, and Mood States Using a Mobile Phone App: An Exploratory Study.

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