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An Ecological Momentary Assessment Study Investigating Self-efficacy and Outcome Expectancy as Mediators of Affective and Physiological Responses and Exercise Among Endometrial Cancer Survivors.

ABSTRACT: BACKGROUND:Previous studies have shown affective and physiological states in response to exercise as predictors of daily exercise, yet little is known about the mechanism underlying such effects. PURPOSE:To examine the mediating effects of self-efficacy and outcome expectancy on the relationships between affective and physiological responses to exercise and subsequent exercise levels in endometrial cancer survivors. METHODS:Ecological momentary assessment (EMA) surveys were delivered up to eight 5- to 7-day periods over 6 months. Participants (n = 100) rated their affective and physiological states before and after each exercise session (predictors) and recorded their self-efficacy and outcome expectancy each morning (mediators). Exercise (outcome) was based on self-reported EMA surveys and accelerometer measures. A 1-1-1 multilevel mediation model was used to disaggregate the within-subject (WS) and between-subject (BS) effects. RESULTS:At the WS level, a more positive affective state after exercise was associated with higher self-efficacy and positive outcome expectation the next day, which in turn was associated with higher subsequent exercise levels (ps < .05). At the BS level, participants who typically had more positive affective and experienced less intense physiological sensation after exercise had higher average self-efficacy, which was associated with higher average exercise levels (ps < .05). CONCLUSIONS:In endometrial cancer survivors, affective experience after exercise, daily self-efficacy and positive outcome expectation help explain the day-to-day differences in exercise levels within-person. Findings from this study highlight potentials for behavioral interventions that target affective experience after exercise and daily behavioral cognitions to promote physical activity in cancer survivors' everyday lives.

SUBMITTER: Liao Y

PROVIDER: S-EPMC7168577 | biostudies-literature | 2020 Apr

REPOSITORIES: biostudies-literature

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An Ecological Momentary Assessment Study Investigating Self-efficacy and Outcome Expectancy as Mediators of Affective and Physiological Responses and Exercise Among Endometrial Cancer Survivors.

Liao Yue Y Song Jaejoon J Robertson Michael C MC Cox-Martin Emily E Basen-Engquist Karen K

Annals of behavioral medicine : a publication of the Society of Behavioral Medicine 20200401 5

<h4>Background</h4>Previous studies have shown affective and physiological states in response to exercise as predictors of daily exercise, yet little is known about the mechanism underlying such effects.<h4>Purpose</h4>To examine the mediating effects of self-efficacy and outcome expectancy on the relationships between affective and physiological responses to exercise and subsequent exercise levels in endometrial cancer survivors.<h4>Methods</h4>Ecological momentary assessment (EMA) surveys were ...[more]

PMID: 31722394

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Project description:BackgroundEcological 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.ObjectiveThe 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.MethodsParticipants 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.ResultsParticipants (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.ConclusionsStudy results have broad implications for developing best practices guidelines for future studies that use EMA methodologies.Trial registrationClinicalTrials.gov number NCT05194228; https://clinicaltrials.gov/study/NCT05194228.

Project description:BackgroundHealthy behaviors are crucial for maintaining a person's health and well-being. The effects of health behavior interventions are mediated by individual and contextual factors that vary over time. Recently emerging smartphone-based ecological momentary interventions (EMIs) can use real-time user reports (ecological momentary assessments [EMAs]) to trigger appropriate support when needed in daily life.ObjectiveThis systematic review aims to assess the characteristics of smartphone-delivered EMIs using self-reported EMAs in relation to their effects on health behaviors, user engagement, and user perspectives.MethodsWe searched MEDLINE, Embase, PsycINFO, and CINAHL in June 2019 and updated the search in March 2020. We included experimental studies that incorporated EMIs based on EMAs delivered through smartphone apps to promote health behaviors in any health domain. Studies were independently screened. The PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) guidelines were followed. We performed a narrative synthesis of intervention effects, user perspectives and engagement, and intervention design and characteristics. Quality appraisal was conducted for all included studies.ResultsWe included 19 papers describing 17 unique studies and comprising 652 participants. Most studies were quasi-experimental (13/17, 76%), had small sample sizes, and great heterogeneity in intervention designs and measurements. EMIs were most popular in the mental health domain (8/17, 47%), followed by substance abuse (3/17, 18%), diet, weight loss, physical activity (4/17, 24%), and smoking (2/17, 12%). Of the 17 studies, the 4 (24%) included randomized controlled trials reported nonstatistically significant effects on health behaviors, and 4 (24%) quasi-experimental studies reported statistically significant pre-post improvements in self-reported primary outcomes, namely depressive (P<.001) and psychotic symptoms (P=.03), drinking frequency (P<.001), and eating patterns (P=.01). EMA was commonly used to capture subjective experiences as well as behaviors, whereas sensors were rarely used. Generally, users perceived EMIs to be helpful. Common suggestions for improvement included enhancing personalization, multimedia and interactive capabilities (eg, voice recording), and lowering the EMA reporting burden. EMI and EMA components were rarely reported and were not described in a standardized manner across studies, hampering progress in this field. A reporting checklist was developed to facilitate the interpretation and comparison of findings and enhance the transparency and replicability of future studies using EMAs and EMIs.ConclusionsThe use of smartphone-delivered EMIs using self-reported EMAs to promote behavior change is an emerging area of research, with few studies evaluating efficacy. Such interventions could present an opportunity to enhance health but need further assessment in larger participant cohorts and well-designed evaluations following reporting checklists. Future research should explore combining self-reported EMAs of subjective experiences with objective data passively collected via sensors to promote personalization while minimizing user burden, as well as explore different EMA data collection methods (eg, chatbots).Trial registrationPROSPERO CRD42019138739; https://www.crd.york.ac.uk/prospero/display_record.php?RecordID=138739.

Dataset Information

An Ecological Momentary Assessment Study Investigating Self-efficacy and Outcome Expectancy as Mediators of Affective and Physiological Responses and Exercise Among Endometrial Cancer Survivors.

Publications

An Ecological Momentary Assessment Study Investigating Self-efficacy and Outcome Expectancy as Mediators of Affective and Physiological Responses and Exercise Among Endometrial Cancer Survivors.

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