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Combining ecological momentary assessment with objective, ambulatory measures of behavior and physiology in substance-use research.

ABSTRACT: Whereas substance-use researchers have long combined self-report with objective measures of behavior and physiology inside the laboratory, developments in mobile/wearable electronic technology are increasingly allowing for the collection of both subjective and objective information in participants' daily lives. For self-report, ecological momentary assessment (EMA), as implemented on contemporary smartphones or personal digital assistants, can provide researchers with near-real-time information on participants' behavior and mood in their natural environments. Data from portable/wearable electronic sensors measuring participants' internal and external environments can be combined with EMA (e.g., by timestamps recorded on questionnaires) to provide objective information useful in determining the momentary context of behavior and mood and/or validating participants' self-reports. Here, we review three objective ambulatory monitoring techniques that have been combined with EMA, with a focus on detecting drug use and/or measuring the behavioral or physiological correlates of mental events (i.e., emotions, cognitions): (1) collection and processing of biological samples in the field to measure drug use or participants' physiological activity (e.g., hypothalamic-pituitary-adrenal axis activity); (2) global positioning system (GPS) location information to link environmental characteristics (disorder/disadvantage, retail drug outlets) to drug use and affect; (3) ambulatory electronic physiological monitoring (e.g., electrocardiography) to detect drug use and mental events, as advances in machine learning algorithms make it possible to distinguish target changes from confounds (e.g., physical activity). Finally, we consider several other mobile/wearable technologies that hold promise to be combined with EMA, as well as potential challenges faced by researchers working with multiple mobile/wearable technologies simultaneously in the field.

SUBMITTER: Bertz JW

PROVIDER: S-EPMC5955807 | biostudies-literature | 2018 Aug

REPOSITORIES: biostudies-literature

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Combining ecological momentary assessment with objective, ambulatory measures of behavior and physiology in substance-use research.

Bertz Jeremiah W JW Epstein David H DH Preston Kenzie L KL

Addictive behaviors 20171116

Whereas substance-use researchers have long combined self-report with objective measures of behavior and physiology inside the laboratory, developments in mobile/wearable electronic technology are increasingly allowing for the collection of both subjective and objective information in participants' daily lives. For self-report, ecological momentary assessment (EMA), as implemented on contemporary smartphones or personal digital assistants, can provide researchers with near-real-time information ...[more]

PMID: 29174666

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Project description:BackgroundEcological 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.ObjectiveThis 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.MethodsA 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.ResultsCompliance 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).ConclusionsThis 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 registrationClinicalTrials.gov NCT03262662; https://clinicaltrials.gov/ct2/show/NCT03262662.

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.

Project description:Context: Stroke has several consequences on survivors' daily life even for those who experience short-lasting neurological symptoms with no functional disability. Depression and anxiety are common psychological disorders occurring after a stroke. They affect long-term outcomes and quality of life but they are difficult to diagnose because of the neurobiological consequences of brain lesions. Current research priority is given to the improvement of the detection and prevention of those post-stroke psychological disorders. Although previous studies have brought promising perspectives, their designs based on retrospective tools involve some limits regarding their ecological validity. Ecological Momentary Assessment (EMA) is an alternative to conventional instruments that could be a key in research for understanding processes that underlined post-stroke depression and anxiety onset. We aim to evaluate the feasibility and validity of anxiety, depression and coping EMA for minor stroke patients. Methods: Patients hospitalized in an Intensive Neuro-vascular Care Unit between April 2016 and January 2017 for a minor stroke is involved in a study based on an EMA methodology. We use a smartphone application in order to assess anxiety and depression symptoms and coping strategies four times a day during 1 week at three different times after stroke (hospital discharge, 2 and 4 months). Participants' self-reports and clinician-rates of anxiety, depression and coping are collected simultaneously using conventional and standard instruments. Feasibility of the EMA method will be assessed considering the participation and compliance rate. Validity will be the assessed by comparing EMA and conventional self-report and clinician-rated measures. Discussion: We expect this study to contribute to the development of EMA using smartphone in minor stroke population. EMA method offers promising research perspective in the assessment and understanding of post-stroke psychological disorders. The development of EMA in stroke population could lead to clinical implications such as remotely psychological follow-ups during early supported discharge. Trial registration: European Clinical Trials Database Number 2014-A01937-40.

Project description:Objective:To systematically review the publications on ecological momentary assessment (EMA) relating to physical activity (PA) behavior in order to classify the methodologies, and to identify the main mHealth technology-based tools and procedures that have been applied during the first 10 years since the emergence of smartphones. As a result of this review, we want to ask if there is enough evidence to propose the use of the term "mEMA" (mobile-based EMA). Design:A systematic review according to PRISMA Statement (PROSPERO registration: CRD42018088136). Method:Four databases (PsycINFO, CINALH, Medline and Web of Science Core Collection) were searched electronically from 2008 to February 2018. Results:A total of 76 studies from 297 potential articles on the use of EMA and PA were included in this review. It was found that 71% of studies specifically used "EMA" for assessing PA behaviors but the rest used other terminology that also adjusted to the inclusion criteria. Just over half (51.3%) of studies (39) used mHealth technology, mainly smartphones, for collecting EMA data. The majority (79.5%) of these studies (31 out of 39) were published during the last 4 years. On the other hand, 58.8% of studies that only used paper-and-pencil were published during the first 3 years of the 10-year period analyzed. An accelerometer was the main built-in sensor used for collecting PA behavior by means of mHealth (69%). Most of the studies were carried out on young-adult samples, with only three studies in older adults. Women were included in 60% of studies, and healthy people in 82%. The studies lasted between 1 and 7 days in 57.9%, and between three and seven assessments per day were carried out in 37%. The most popular topics evaluated together with PA were psychological state and social and environmental context. Conclusions:We have classified the EMA methodologies used for assessing PA behaviors. A total of 71% of studies used the term "EMA" and 51.3% used mHealth technology. Accelerometers have been the main built-in sensor used for collecting PA. The change of trend in the use of tools for EMA in PA coincides with the technological advances of the last decade due to the emergence of smartphones and mHealth technology. There is enough evidence to use the term mEMA when mHealth technology is being used for monitoring real-time lifestyle behaviors in natural situations. We define mEMA as the use of mobile computing and communication technologies for the EMA of health and lifestyle behaviors. It is clear that the use of mHealth is increasing, but there is still a lot to be gained from taking advantage of all the capabilities of this technology in order to apply EMA to PA behavior. Thus, mEMA methodology can help in the monitoring of healthy lifestyles under both subjective and objective perspectives. The tendency for future research should be the automatic recognition of the PA of the user without interrupting their behavior. The ecological information could be completed with voice messages, image captures or brief text selections on the touch screen made in real time, all managed through smartphone apps. This methodology could be extended when EMA combined with mHealth are used to evaluate other lifestyle behaviors.

Project description:Background:Dialysis patients have reduced moderate to vigorous physical activity, and light physical activity. This has been shown in self-reported surveys and objective accelerometer studies. Less attention has been directed toward sedentary behavior, which is characterized by low energy expenditure (?1.5 metabolic equivalents). Furthermore, locations where physical activity and sedentary behavior occur are largely unknown for dialysis patients. Objectives:The objectives of this study were (1) to determine the minutes per day of moderate to vigorous physical activity, light physical activity, and sedentary behavior for hemodialysis patients; (2) to describe differences in moderate to vigorous physical activity, light physical activity, and sedentary behavior comparing dialysis versus nondialysis days; and (3) to describe the locations where moderate to vigorous physical activity, light physical activity, and sedentary behavior occur using global positioning system (GPS) data. Design:Cross-sectional study. Setting:The study was performed at a tertiary care hospital in Nova Scotia, Canada. Patients:A total of 50 adult in-center hemodialysis patients consented to the study. Measurements:Physical activity and sedentary behavior were measured with an Actigraph-GT3X accelerometer. Location was determined using a Qstarz BT-Q1000X GPS receiver. Methods:Minutes of daily activity were described as was percentage of wear time for each activity level across different locations during waking hours. Physical activity intensity, quantity, and location were also analyzed according to dialysis vs nondialysis days. Results:Forty-three patients met requirements for accelerometer analysis, of whom 42 had GPS data. Median wear time was 836.5 min/day (interquartile range [IQR]: 788.3-918.3). Median minutes of daily wear time spent in sedentary behavior, light physical activity, and moderate to vigorous physical activity was 636 minutes (IQR: 594.1-730.1), 178 minutes (IQR: 144-222.1), and 1.6 minutes (IQR: 0.6-7.7), respectively. Proportion of daily wear time spent in sedentary behavior, light physical activity, and moderate to vigorous physical activity was 78.4% (IQR: 70.7-84.0), 21.5% (IQR: 16.0-26.9), and 0.2% (IQR: 0.1-1.1), respectively. Home was the dominant location for total linked accelerometer-GPS time (59.4%, IQR: 46.9-69.5) as well as for each prespecified level of activity. Significantly more sedentary behavior and less light physical activity occurred on dialysis days compared with nondialysis days (P ? .01, respectively). Moderate to vigorous physical activity did not differ significantly between dialysis and nondialysis days. Limitations:Small sample size from a single academic center may limit generalizability. Difficult to engage population as less than half of eligible dialysis patients provided consent. Physical activity may have been underestimated as devices were not worn for all waking hours or aquatic activities, and hip-based accelerometers may not capture stationary exercise. Conclusions:Ambulatory, in-center hemodialysis patients exhibit substantial sedentary behavior and minimal physical activity across a limited range of locations. Given the sedentary tendencies of this population, focus should be directed on increasing physical activity at any location frequented. Home-based exercise programs may serve as a potential adjunct to established intradialytic-based therapies given the amount of time spent in the home environment.

Dataset Information

Combining ecological momentary assessment with objective, ambulatory measures of behavior and physiology in substance-use research.

Publications

Combining ecological momentary assessment with objective, ambulatory measures of behavior and physiology in substance-use research.

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