A Randomized Trial of Incentivization to Maximize Retention For Real-Time Symptom and Activity Monitoring Using Ecological Momentary Assessment in Pediatric Concussion

Neurology ◽  
2021 ◽  
Vol 98 (1 Supplement 1) ◽  
pp. S7.2-S7
Author(s):  
Mr. Daniel Corwin ◽  
Julia Orchinik ◽  
Bernadette D'Alonzo ◽  
Christina Master ◽  
Anish K. Agarwal ◽  
...  
Keyword(s):  
Real Time ◽  
Ecological Momentary Assessment ◽  
Electronic Device ◽  
Cognitive Activity ◽  
Flat Rate ◽  
Symptom Resolution ◽  
Pediatric Concussion ◽  
Significant Difference ◽  
Ecological Momentary ◽  
Momentary Assessment

ObjectiveTo determine the incentivization strategy that maximizes patient adherence to report symptoms and activity via ecological momentary assessment (EMA) following pediatric concussion.BackgroundConcussion is a common pediatric injury. Traditionally, outcome assessment has occurred at discrete points-in-time, days or weeks apart, relying on patient's subjective recall of symptoms and activity. EMA is a behavioral measurement approach that allows for reporting of real-time symptoms and behaviors in real-life settings. While feasible in adolescents, the ideal strategy to maximize responsiveness from the emergency department (ED) setting is unknown.Design/MethodsThis was a randomized controlled trial of patients age 13–18 with concussion presenting to an urban, academic pediatric ED within 5 days of injury. Patients were randomized to one of 4 incentive-based arms: 2 dynamic (loss-based and streak) and 2 flat-rate (monetary and electronic device). Through the ReCoUPS app, patients reported symptoms 3 times per day and cognitive activity once each evening for 3 weeks. Physical activity (step count) and sleep were monitored using a FitBit (which was kept by the participant in the electronic device flat-rate arm). The primary outcome was proportion of prompts to which patients responded. Secondary outcomes included daily symptom change and time to symptom resolution.ResultsThirty participants were enrolled, median age 15.5 years, 60% female. Median proportion completed was 81% in the loss-based arm, 59% in the streak accrual arm, 50% in the FitBit-received arm, and 57% monetary flat rate arm. Retention was higher in the dynamic compared to the flat arms (68% v. 54%, p = 0.065). There was no significant difference between morning, afternoon, and evening symptoms. Sixty-four percent of participants had symptom resolution during the 3-week follow-up.ConclusionsDynamic incentivization showed higher rates of response to tri-daily symptom prompts compared with flat-fee incentivization. This data shows tracking concussed youth using EMA from ED is feasible using a dynamic incentivization strategy.

scholarly journals Possible Application of Ecological Momentary Assessment to Older Adults’ Daily Depressive Mood: Integrative Literature Review

10.2196/13247 ◽  
2020 ◽  
Vol 7 (6) ◽  
pp. e13247
Author(s):  
Heejung Kim ◽  
Sunah Kim ◽  
Seong Sook Kong ◽  
Yi-Rang Jeong ◽  
Hyein Kim ◽  
...  
Keyword(s):  
Older Adults ◽  
Literature Review ◽  
Real Time ◽  
Ecological Momentary Assessment ◽  
Compliance Rate ◽  
Depressive Mood ◽  
Age Difference ◽  
Technical Problems ◽  
Ecological Momentary ◽  
Momentary Assessment

Background Ecological momentary assessment is a method of investigating individuals’ real-time experiences, behaviors, and moods in their natural environment over time. Despite its general usability and clinical value for evaluating daily depressive mood, there are several methodological challenges when applying ecological momentary assessment to older adults. Objective The aims of this integrative literature review were to examine possible uses of the ecological momentary assessment methodology with older adults and to suggest strategies to increase the feasibility of its application in geriatric depression research and practice. Methods We searched 4 electronic databases (MEDLINE, CINAHL, PsycINFO, and EMBASE) and gray literature; we also hand searched the retrieved articles’ references. We limited all database searches to articles published in peer-reviewed journals from 2009 to 2019. Search terms were “ecological momentary assessment,” “smartphone assessment,” “real time assessment,” “electronic daily diary,” “mHealth momentary assessment,” “mobile-based app,” and “experience sampling method,” combined with the relevant terms of depression. We included any studies that enrolled older adults even as a subgroup and that reported depressive mood at least once a day for more than 2 days. Results Of the 38 studies that met the inclusion criteria, only 1 study enrolled adults aged 65 years or older as the entire sample; the remainder of the reviewed studies used mixed samples of both younger and older adults. Most of the analyzed studies (18/38, 47%) were quantitative, exploratory (descriptive, correlational, and predictive), and cohort in design. Ecological momentary assessment was used to describe the fluctuating pattern of participants’ depressive moods primarily and to examine the correlation between mood patterns and other health outcomes as a concurrent symptom. We found 3 key methodological issues: (1) heterogeneity in study design and protocol, (2) issues with definitions of dropout and adherence, and (3) variation in how depressive symptoms were measured with ecological momentary assessment. Some studies (8/38, 21%) examined the age difference of participants with respect to dropout or poor compliance rate. Detailed participant burden was reported, such as technical problems, aging-related health problems, or discomfort while using the device. Conclusions Ecological momentary assessment has been used for comprehensive assessment of multiple mental health indicators in relation to depressive mood. Our findings provide methodological considerations for further studies that may be implemented using ecological momentary assessment to assess daily depressive mood in older adults. Conducting more feasibility studies focusing on older adults with standardized data collection protocols and mixed-methods research is required to reflect users’ experiences. Further telepsychiatric evaluation and diagnosis based on ecological momentary assessment data should involve standardized and sophisticated strategies to maximize the potential of ecological momentary assessment for older adults with depression in the community setting.

scholarly journals mHealth technology for ecological momentary assessment in physical activity research: a systematic review

PeerJ ◽  
2020 ◽  
Vol 8 ◽  
pp. e8848 ◽  
Author(s):  
Rafael Zapata-Lamana ◽  
Jaume F. Lalanza ◽  
Josep-Maria Losilla ◽  
Eva Parrado ◽  
Lluis Capdevila
Keyword(s):  
Physical Activity ◽  
Systematic Review ◽  
Real Time ◽  
Ecological Momentary Assessment ◽  
Psychological State ◽  
Future Research ◽  
Lifestyle Behaviors ◽  
Mhealth Technology ◽  
Ecological Momentary ◽  
Momentary Assessment

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.

scholarly journals Behavioral Impacts, Acceptability, and Recommendations for Ecological Momentary Assessment among Youth Experiencing Homelessness: A Qualitative Study (Preprint)

2020 ◽  
Author(s):  
Darlene Acorda ◽  
Michael Businelle ◽  
Diane Santa Maria
Keyword(s):  
Real Time ◽  
Ecological Momentary Assessment ◽  
Homeless Youth ◽  
Emotional Awareness ◽  
Perceived Benefits ◽  
Future Studies ◽  
Exit Interviews ◽  
Ecological Momentary ◽  
The Impact ◽  
Momentary Assessment

BACKGROUND Background: The use of ecological momentary assessment (EMA) to study youth experiencing homelessness (YEH) behaviors is an emerging area of research. Despite high rates of participation and potential clinical utility, few studies have investigated best practices and recommendations for EMA from the YEH perspective. OBJECTIVE This study aimed to describe the perceived benefits, usability, acceptability, and barriers to the use of EMA from the homeless youth perspective. METHODS YEH were recruited from a larger EMA study. Semi-structured exit interviews were performed using an interview guide that focused on the YEH experience with the EMA app, including perceived barriers and recommendations for future studies. Data analyses employed an inductive approach with thematic analysis to identify major themes and subthemes. RESULTS A total of 18 YEH aged 19-24 participated in individual and group exit interviews. EMA was highly acceptable to YEH and they found the app and survey easy to navigate. Perceived benefits included increased behavioral and emotional awareness with some YEH reporting a decrease in their high-risk behaviors as a result of participation. Another significant perceived benefit was the ability to use the phones for social support and make connections to family, friends, and potential employers. Barriers were primarily survey and technology related. Survey-related barriers included the redundancy of questions, the lack of customizable responses, and the timing of survey administration. Technology-related barriers included the “freezing” of the app, battery problems, and connectivity issues. Recommendations for future studies included the need to provide real-time mental health support for symptomatic youth, creating individually customized questions, and testing the use of personalized motivational messages that respond to the EMA data in real-time. CONCLUSIONS YEH are highly receptive to the use of EMA methodology. Further studies are warranted to assess whether participation improves behavior change. More research is needed to understand the impact of EMA on YEH behaviors. Incorporating the YEH perspective in the design and implementation of EMA studies may help minimize barriers, increase acceptability, and improve participation rates in this hard-to-reach, disconnected population.

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