TY - JOUR AU - Cook, Diane AU - Walker, Aiden AU - Minor, Bryan AU - Luna, Catherine AU - Tomaszewski Farias, Sarah AU - Wiese, Lisa AU - Weaver, Raven AU - Schmitter-Edgecombe, Maureen PY - 2025/4/10 TI - Understanding the Relationship Between Ecological Momentary Assessment Methods, Sensed Behavior, and Responsiveness: Cross-Study Analysis JO - JMIR Mhealth Uhealth SP - e57018 VL - 13 KW - ecological momentary assessment KW - smart home KW - smartwatch KW - cognitive assessment KW - well-being KW - monitoring KW - monitoring behavior KW - machine learning KW - artificial intelligence KW - app KW - wearables KW - sensor KW - effectiveness KW - accuracy N2 - Background: Ecological momentary assessment (EMA) offers an effective method to collect frequent, real-time data on an individual?s well-being. However, challenges exist in response consistency, completeness, and accuracy. Objective: This study examines EMA response patterns and their relationship with sensed behavior for data collected from diverse studies. We hypothesize that EMA response rate (RR) will vary with prompt time of day, number of questions, and behavior context. In addition, we postulate that response quality will decrease over the study duration and that relationships will exist between EMA responses, participant demographics, behavior context, and study purpose. Methods: Data from 454 participants in 9 clinical studies were analyzed, comprising 146,753 EMA mobile prompts over study durations ranging from 2 weeks to 16 months. Concurrently, sensor data were collected using smartwatch or smart home sensors. Digital markers, such as activity level, time spent at home, and proximity to activity transitions (change points), were extracted to provide context for the EMA responses. All studies used the same data collection software and EMA interface but varied in participant groups, study length, and the number of EMA questions and tasks. We analyzed RR, completeness, quality, alignment with sensor-observed behavior, impact of study design, and ability to model the series of responses. Results: The average RR was 79.95%. Of those prompts that received a response, the proportion of fully completed response and task sessions was 88.37%. Participants were most responsive in the evening (82.31%) and on weekdays (80.43%), although results varied by study demographics. While overall RRs were similar for weekday and weekend prompts, older adults were more responsive during the week (an increase of 0.27), whereas younger adults responded less during the week (a decrease of 3.25). RR was negatively correlated with the number of EMA questions (r=?0.433, P<.001). Additional correlations were observed between RR and sensor-detected activity level (r=0.045, P<.001), time spent at home (r=0.174, P<.001), and proximity to change points (r=0.124, P<.001). Response quality showed a decline over time, with careless responses increasing by 0.022 (P<.001) and response variance decreasing by 0.363 (P<.001). The within-study dynamic time warping distance between response sequences averaged 14.141 (SD 11.957), compared with the 33.246 (SD 4.971) between-study average distance. ARIMA (Autoregressive Integrated Moving Average) models fit the aggregated time series with high log-likelihood values, indicating strong model fit with low complexity. Conclusions: EMA response patterns are significantly influenced by participant demographics and study parameters. Tailoring EMA prompt strategies to specific participant characteristics can improve RRs and quality. Findings from this analysis suggest that timing EMA prompts close to detected activity transitions and minimizing the duration of EMA interactions may improve RR. Similarly, strategies such as gamification may be introduced to maintain participant engagement and retain response variance. UR - https://mhealth.jmir.org/2025/1/e57018 UR - http://dx.doi.org/10.2196/57018 ID - info:doi/10.2196/57018 ER - TY - JOUR AU - Holmqvist, Sophia AU - Kaplan, Marina AU - Chaturvedi, Riya AU - Shou, Haochang AU - Giovannetti, Tania PY - 2025/4/8 TI - Longitudinal and Combined Smartwatch and Ecological Momentary Assessment in Racially Diverse Older Adults: Feasibility, Adherence, and Acceptability Study JO - JMIR Hum Factors SP - e69952 VL - 12 KW - cognitive impairment KW - smartwatch KW - longitudinal monitoring KW - ecological momentary assessment KW - aging N2 - Background: Due to the rising prevalence of Alzheimer disease and related dementias, easily deployable tools to quantify risk are needed. Smartphones and smartwatches enable unobtrusive and continuous monitoring, but there is limited information regarding the feasibility, adherence, and acceptability of digital data collection among racially diverse older adults. Objective: This paper examined the feasibility, adherence, and acceptability of a 4-week combined smartwatch monitoring and ecological momentary assessment (EMA) study in a racially diverse sample of older adults. Methods: A total of 44 older adults (aged ?55 y) with either mild cognitive impairment or healthy cognition completed an informed consent comprehension quiz, baseline cognitive testing, training regarding digital data collection, and questionnaires. Participants were instructed to wear a Garmin Vivosmart 4 smartwatch for 23 h/d for 4 weeks, sync 2 smartphone apps (Garmin and Labfront) daily, and complete a daily EMA survey with automated prompts for surveys and charging. Training time, smartwatch adherence (eg, wear time), daily EMA survey response rate, and performance on the consent quiz were quantified. Associations between feasibility and adherence metrics and participant factors were evaluated. Self-reported usability of the apps and smartwatch was collected at study end. Results: Consent comprehension quiz scores were high (mean 97.33%, SD 6.86% correct), and training sessions lasted on average 17.93 (SD 6.89) minutes. During the 4-week study, participants wore the smartwatch for an average of 21 h/d (SD 1.53) and showed an average response rate of 94% (SD 9.58%) to daily EMA surveys. In unadjusted bivariate analyses, age, race, and cognition were associated with feasibility and adherence measures, but only age and race remained significant in multivariate models. After accounting for all participant factors, older age was a significant predictor of longer training time, and Black race was a significant predictor of lower daily wear time. On the usability survey, all participants (45/45, 100%) indicated willingness to participate in future smartwatch studies, >80% (37/45) had a positive experience, and >90% (41/45) were satisfied with smartphone app syncing. Conclusions: Smartwatch monitoring, requiring daily wear, smartphone syncing, and daily EMA survey completion, is highly feasible in older adults because adherence to daily wear and EMA surveys was high, as was general satisfaction on usability surveys. Although older participants may require more training on smartwatch and smartphone procedures and automated prompting during the study period, longitudinal monitoring with the Garmin Vivosmart 4 smartwatch and Labfront app is acceptable and feasible for collecting nearly continuous data in Black and White older adults, including those with mild cognitive impairment and those without. UR - https://humanfactors.jmir.org/2025/1/e69952 UR - http://dx.doi.org/10.2196/69952 UR - http://www.ncbi.nlm.nih.gov/pubmed/ ID - info:doi/10.2196/69952 ER - TY - JOUR AU - Noh, Min Jung AU - Im, SongHyun AU - Park, JooYong AU - Kim, Myung Jae AU - Lee, Miyoung AU - Choi, Ji-Yeob PY - 2025/4/1 TI - Validation of Ecological Momentary Assessment With Reference to Accelerometer Data: Repeated-Measures Panel Study With Multilevel Modeling JO - J Med Internet Res SP - e59878 VL - 27 KW - telemedicine KW - wearable electronic devices KW - physical activity KW - mobile phone KW - wearables KW - smartphones KW - ecological momentary assessment KW - EMA KW - global physical activity questionnaire KW - GPAQ KW - Bouchard?s physical activity KW - multilevel modeling KW - females KW - women KW - males KW - men KW - sensors KW - evaluation KW - comparative KW - South Korea N2 - Background: There is growing interest in the real-time assessment of physical activity (PA) and physiological variables. Acceleration, particularly those collected through wearable sensors, has been increasingly adopted as an objective measure of physical activity. However, sensor-based measures often pose challenges for large-scale studies due to their associated costs, inability to capture contextual information, and restricted user populations. Smartphone-delivered ecological momentary assessment (EMA) offers an unobtrusive and undemanding means to measure PA to address these limitations. Objective: This study aimed to evaluate the usability of EMA by comparing its measurement outcomes with 2 self-report assessments of PA: Global Physical Activity Questionnaire (GPAQ) and a modified version of Bouchard Physical Activity Record (BAR). Methods: A total of 235 participants (137 female, 98 male, and 94 repeated) participated in one or more 7-day studies. Waist-worn sensors provided by ActiGraph captured accelerometer data while participants completed 3 self-report measures of PA. The multilevel modeling method was used with EMA, GPAQ, and BAR as separate measures, with 6 subdomains of physiological activity (overall PA, overall excluding occupational, transport, exercise, occupational, and sedentary) to model accelerometer data. In addition, EMA and GPAQ were further compared with 6 domains of PA from the BAR as outcome measures. Results: Among the 3 self-reporting instruments, EMA and BAR exhibited better overall performance in modeling the accelerometer data compared to GPAQ (eg EMA daily: ?=.387, P<.001; BAR daily: ?=.394, P<.001; GPAQ: ?=.281, P<.001, based on repeated-only participants with step counts from accelerometer as dependent variables). Conclusions: Multilevel modeling on 3 self-report assessments of PA indicates that smartphone-delivered EMA is a valid and efficient method for assessing PA. UR - https://www.jmir.org/2025/1/e59878 UR - http://dx.doi.org/10.2196/59878 UR - http://www.ncbi.nlm.nih.gov/pubmed/40168069 ID - info:doi/10.2196/59878 ER - TY - JOUR AU - Stone, Chris AU - Adams, Sally AU - Wootton, E. Robyn AU - Skinner, Andy PY - 2025/3/25 TI - Smartwatch-Based Ecological Momentary Assessment for High-Temporal-Density, Longitudinal Measurement of Alcohol Use (AlcoWatch): Feasibility Evaluation JO - JMIR Form Res SP - e63184 VL - 9 KW - smartwatch KW - ecological momentary assessment KW - ?EMA KW - alcohol KW - ALSPAC N2 - Background: Ecological momentary assessment methods have recently been adapted for use on smartwatches. One particular class of these methods, developed to minimize participant burden and maximize engagement and compliance, is referred to as microinteraction-based ecological momentary assessment (?EMA). Objective: This study explores the feasibility of using these smartwatch-based ?EMA methods to capture longitudinal, high-temporal-density self-report data about alcohol consumption in a nonclinical population selected to represent high- and low-socioeconomic position (SEP) groups. Methods: A total of 32 participants from the Avon Longitudinal Study of Parents and Children (13 high and 19 low SEP) wore a smartwatch running a custom-developed ?EMA app for 3 months between October 2019 and June 2020. Every day over a 12-week period, participants were asked 5 times a day about any alcoholic drinks they had consumed in the previous 2 hours, and the context in which they were consumed. They were also asked if they had missed recording any alcoholic drinks the day before. As a comparison, participants also completed fortnightly online diaries of alcohol consumed using the Timeline Followback (TLFB) method. At the end of the study, participants completed a semistructured interview about their experiences. Results: The compliance rate for all participants who started the study for the smartwatch ?EMA method decreased from around 70% in week 1 to 45% in week 12, compared with the online TLFB method which was flatter at around 50% over the 12 weeks. The compliance for all participants still active for the smartwatch ?EMA method was much flatter, around 70% for the whole 12 weeks, while for the online TLFB method, it varied between 50% and 80% over the same period. The completion rate for the smartwatch ?EMA method varied around 80% across the 12 weeks. Within high- and low-SEP groups there was considerable variation in compliance and completion at each week of the study for both methods. However, almost all point estimates for both smartwatch ?EMA and online TLFB indicated lower levels of engagement for low-SEP participants. All participants scored ?experiences of using? the 2 methods equally highly, with ?willingness to use again? slightly higher for smartwatch ?EMA. Conclusions: Our findings demonstrate the acceptability and potential utility of smartwatch ?EMA methods for capturing data on alcohol consumption. These methods have the benefits of capturing higher-temporal-density longitudinal data on alcohol consumption, promoting greater participant engagement with less missing data, and potentially being less susceptible to recall errors than established methods such as TLFB. Future studies should explore the factors impacting participant attrition (the biggest reason for reduced engagement), latency issues, and the validity of alcohol data captured with these methods. The consistent pattern of lower engagement among low-SEP participants than high-SEP participants indicates that further work is warranted to explore the impact and causes of these differences. UR - https://formative.jmir.org/2025/1/e63184 UR - http://dx.doi.org/10.2196/63184 UR - http://www.ncbi.nlm.nih.gov/pubmed/40131326 ID - info:doi/10.2196/63184 ER - TY - JOUR AU - Eguchi, Kana AU - Kubota, Takeaki AU - Koyanagi, Tomoyoshi AU - Muto, Manabu PY - 2025/3/25 TI - Real-World Data on Alcohol Consumption Behavior Among Smartphone Health Care App Users in Japan: Retrospective Study JO - Online J Public Health Inform SP - e57084 VL - 17 KW - alcohol consumption KW - individual behavior KW - mobile health KW - mobile health app KW - mobile health care app log-based survey KW - real-world data KW - RWD KW - RWD analysis KW - smartphone health care app KW - surveillance system KW - health care app N2 - Background: Although many studies have used smartphone apps to examine alcohol consumption, none have clearly delineated long-term (>1 year) consumption among the general population. Objective: The objective of our study is to elucidate in detail the alcohol consumption behavior of alcohol drinkers in Japan using individual real-world data. During the state of emergency associated with the COVID-19 outbreak, the government requested that people restrict social gatherings and stay at home, so we hypothesize that alcohol consumption among Japanese working people decreased during this period due to the decrease in occasions for alcohol consumption. This analysis was only possible with individual real-world data. We also aimed to clarify the effects of digital interventions based on notifications about daily alcohol consumption. Methods: We conducted a retrospective study targeting 5-year log data from January 1, 2018, to December 31, 2022, obtained from a commercial smartphone health care app (CALO mama Plus). First, to investigate the possible size of the real-world data, we investigated the rate of active users of this commercial smartphone app. Second, to validate the individual real-world data recorded in the app, we compared individual real-world data from 9991 randomly selected users with government-provided open data on the number of daily confirmed COVID-19 cases in Japan and with nationwide alcohol consumption data. To clarify the effects of digital interventions, we investigated the relationship between 2 types of notification records (ie, ?good? and ?bad?) and a 3-day daily alcohol consumption log following the notification. The protocol of this retrospective study was approved by the Ethics Committee of the Kyoto University Graduate School and Faculty of Medicine (R4699). UR - https://ojphi.jmir.org/2025/1/e57084 UR - http://dx.doi.org/10.2196/57084 UR - http://www.ncbi.nlm.nih.gov/pubmed/40131328 ID - info:doi/10.2196/57084 ER - TY - JOUR AU - Bataineh, S. Bara AU - Marti, Nathan C. AU - Murthy, Dhiraj AU - Badillo, David AU - Chow, Sherman AU - Loukas, Alexandra AU - Wilkinson, V. Anna PY - 2025/3/24 TI - Vaping, Acculturation, and Social Media Use Among Mexican American College Students: Protocol for a Mixed Methods Web-Based Cohort Study JO - JMIR Res Protoc SP - e63584 VL - 14 KW - vaping KW - social media KW - Mexican American KW - college students KW - marketing KW - acculturation KW - protocol KW - artificial intelligence N2 - Background: The tobacco industry has a history of targeting minority communities, including Hispanic individuals, by promoting vaping through social media. This marketing increases the risk of vaping among Hispanic young adults, including college students. In Texas, college enrollment among Mexican Americans has significantly increased over recent years. However, little research exists on the link between social media and vaping and the underlying mechanisms (ie, outcome expectations, attitudes, and beliefs) explaining how vaping-related social media impacts vaping among Mexican American college students. Moreover, there is limited knowledge about how acculturation moderates the association between social media and vaping. Hispanic individuals, particularly Mexican Americans, are the largest ethnic group in Texas colleges; thus, it is crucial to understand the impact of social media and acculturation on their vaping behaviors. Objective: We outline the mixed methods used in Project Vaping, Acculturation, and Media Study (VAMoS). We present descriptive analyses of the participants enrolled in the study, highlight methodological strengths, and discuss lessons learned during the implementation of the study protocol related to recruitment and data collection and management. Methods: Project VAMoS is being conducted with Mexican American students attending 1 of 6 Texas-based colleges: University of Texas (UT) Arlington, UT Dallas, UT El Paso, UT Rio Grande Valley, UT San Antonio, and the University of Houston System. This project has 2 phases. Phase 1 included an ecological momentary assessment (EMA) study and qualitative one-on-one interviews (years 1-2), and phase 2 includes cognitive interviews and a 4-wave web-based survey study (years 2-4) with objective assessments of vaping-related social media content to which participants are exposed. Descriptive statistics summarized participants? characteristics in the EMA and web-based survey. Results: The EMA analytic sample comprised 51 participants who were primarily female (n=37, 73%), born in the United States (n=48, 94%), of middle socioeconomic status (n=38, 75%), and aged 21 years on average (SD 1.7 years). The web-based survey cohort comprised 1492 participants self-identifying as Mexican American; Tejano, Tejana, or Tejanx; or Chicano, Chicana, or Chicanx heritage who were primarily female (n=1042, 69.8%), born in the United States (n=1366, 91.6%), of middle socioeconomic status (n=1174, 78.7%), and aged 20.1 years on average at baseline (SD 2.2 years). Of the baseline cohort, the retention rate in wave 2 was 74.7% (1114/1492). Conclusions: Project VAMoS is one of the first longitudinal mixed methods studies exploring the impact of social media and acculturation on vaping behaviors specifically targeting Mexican American college students. Its innovative approach to objectively measuring social media exposure and engagement related to vaping enhances the validity of self-reported data beyond what national surveys can achieve. The results can be used to develop evidence-based, culturally relevant interventions to prevent vaping among this rapidly growing minority population. International Registered Report Identifier (IRRID): DERR1-10.2196/63584 UR - https://www.researchprotocols.org/2025/1/e63584 UR - http://dx.doi.org/10.2196/63584 UR - http://www.ncbi.nlm.nih.gov/pubmed/ ID - info:doi/10.2196/63584 ER - TY - JOUR AU - Morgan, Tucker AU - He, Michelle AU - Nicholson, Andrew AU - El Shahawy, Omar AU - Sherman, E. Scott AU - Stevens, R. Elizabeth PY - 2025/3/21 TI - Using Text Messaging Ecological Momentary Assessment to Record Changes in e-Cigarette and Combustible Cigarette Use: Pilot Randomized Clinical Trial JO - JMIR Form Res SP - e66709 VL - 9 KW - smoking KW - electronic cigarette KW - smoking cessation KW - ecological momentary assessment KW - EMA KW - adherence KW - real-time data KW - mobile phone KW - cigarette KW - smoker KW - e-cigarettes KW - pilot randomized clinical trial KW - clinical trial KW - pilot study KW - adult smoker KW - chronic condition N2 - Background: Ecological momentary assessment (EMA) provides insight into the effectiveness and feasibility of smoking-related interventions. Objective: The objective of this paper was to assess adherence to an EMA protocol and compare EMA-derived responses with measures collected through multiple surveys. Methods: A subanalysis was conducted using data from a 12-week, open-label, and 2-arm pilot randomized clinical trial among adult smokers with chronic obstructive pulmonary disease, coronary artery disease, peripheral vascular disease, or asthma in the last 12 months (n=109). Participants were randomized to either electronic cigarette (EC) or nicotine replacement therapy (NRT) treatment arms. We compared EMA data collected through automated SMS text message prompts sent to participants 4 times daily for 12 weeks, including cigarettes smoked per day (CPD), craving, and satisfaction, to survey data collected at 12 weeks. Convergent validity between survey- and EMA-reported measures was evaluated using Pearson correlation and paired t tests. CPD was modeled using negative binomial regression. Relative rates (RRs) of reaching at least 50%, 75%, and 100% CPD reduction between two arms were calculated using both EMA and survey data. Results: The majority of participants were non-Hispanic White (63/109, 58%) and female (60/109, 55%), and had a median age of 60 (IQR 54?65) years. Among the 109 participants, 59.6% (n=65) were consistently adherent to the EMA protocol over the 12-week period. Median weekly EMA response rate remained high over the 12-week study period even though a modest decline was observed (week 1, 97.8% and week 12, 89.4%). The mean CPD declined significantly (week 1, mean 14.2, SD 9.9 and week 12, mean 4.6, SD 6.7; P<.001). EMA-derived and survey-based CPD measurements were positively correlated (r=0.73, 95% CI 0.6-0.82) as were measures of craving (r=0.38, 95% CI 0.17-0.56). No significant paired difference in CPD was observed between EMA measurements and surveys. A significant effect of time on CPD EMA data (incidence rate ratio [IRR] 1-week change 0.93; P<.01) and survey data was found (IRR 12-week change 0.36; P<.01). However, the treatment effect was not significant, which aligned with the RR results. An increase in the EC consumption was observed over time in the EC arm, with 12.1% (7/58) fully switched to EC (defined as CPD=0 and EC use>0) and 20.7% (12/58) mostly switched (defined as a reduction in CPD>75% and EC use>0) in week 12. Conclusions: EMA is a suitable method to collect recall-based smoking-related data. Though results from mixed effect modeling and RR comparisons were similar using EMA or survey data, EMA provides unique advantages, namely greater granularity in the time and the capability to detect switching patterns in near real time. These findings provide the feasibility of using EMA in developing smoking cessation interventions in future tobacco harm reduction research. Trial Registration: ClinicalTrials.gov NCT04465318; https://clinicaltrials.gov/study/NCT04465318 International Registered Report Identifier (IRRID): RR2-10.1186/s13722-021-00284-0 UR - https://formative.jmir.org/2025/1/e66709 UR - http://dx.doi.org/10.2196/66709 ID - info:doi/10.2196/66709 ER - TY - JOUR AU - Pickard, Abigail AU - Edwards, Katie AU - Farrow, Claire AU - Haycraft, Emma AU - Blissett, Jacqueline PY - 2025/2/27 TI - Capturing Everyday Parental Feeding Practices and Eating Behaviors of 3- to 5-Year-Old Children With Avid Eating Behavior: Ecological Momentary Assessment Feasibility and Acceptability Study JO - JMIR Form Res SP - e66807 VL - 9 KW - pediatric KW - paediatric KW - child KW - child eating KW - parent feeding KW - parent KW - ecological momentary assessment KW - mHealth KW - mobile health KW - mobile app KW - application KW - smartphone KW - digital KW - digital health KW - digital technology KW - digital intervention N2 - Background: The wide use of smartphones offers large-scale opportunities for real-time data collection methods such as ecological momentary assessment (EMA) to assess how fluctuations in contextual and psychosocial factors influence parents? feeding practices and feeding goals, particularly when feeding children with high food approaches. Objective: The main objectives of this study were to (1) assess parents/caregivers? compliance with EMA procedures administered through a smartphone app and (2) estimate the criterion validity of the EMA to capture children?s eating occasions and parents? feeding practices. Participant adherence, technological challenges, and data quality were used to provide an overview of the real-time dynamics of parental mood, feeding goals, and contextual factors during eating occasions. Methods: Parents in the United Kingdom with a child aged 3 to 5 years who exhibit avid eating behavior were invited to participate in a 10-day EMA study using a smartphone app. Of the 312 invited participants, 122 (39%) parents initiated the EMA study, of which 118 (96.7%) completed the full EMA period and the follow-up feasibility and acceptability survey. Results: Of those parents who completed the EMA study, 104 (87.4%) parents provided at least 7 ?full? days of data (2 signal surveys and 1 event survey), despite 51 parents (43.2%) experiencing technical difficulties. The parents received notifications for morning surveys (69.9% response rate), 3 daily mood surveys (78.7% response rate), and an end-of-day survey (84.6% response rate) on each of the 10 days. Over the EMA period, a total of 2524 child eating/food request surveys were self-initiated by the participants on their smartphones, an average of 2.1 times per day per parent (SD 0.18; min=1.7, max=2.3). The majority of parents felt that the surveys made them more aware of their feelings (105/118, 89%) and activities (93/118, 79%). The frequency of daily food requests estimated by parents at baseline was significantly correlated with the frequency of food requests reported daily during the EMA period (r=0.483, P<.001). However, the number of daily food requests per day estimated at baseline (mean 4.5, SD 1.5) was significantly higher than the number of food requests reported per day during the EMA period (mean 3.7, SD 1.1), (t116=18.8, P<.001). Conclusions: This paper demonstrates the feasibility of employing EMA to investigate the intricate interplay between parental mood, feeding goals, contextual factors, and feeding practices with children exhibiting an avid eating behavior profile. However, the use of EMA needs to be carefully developed and tested with parents? involvement to ensure successful data collection. International Registered Report Identifier (IRRID): RR2-10.2196/55193 UR - https://formative.jmir.org/2025/1/e66807 UR - http://dx.doi.org/10.2196/66807 ID - info:doi/10.2196/66807 ER - TY - JOUR AU - Prochnow, Tyler AU - Dunton, F. Genevieve AU - de la Haye, Kayla AU - Pollack Porter, M. Keshia AU - Lee, Chanam PY - 2025/2/21 TI - Combining Ecological Momentary Assessment and Social Network Analysis to Study Youth Physical Activity and Environmental Influences: Protocol for a Mixed Methods Feasibility Study JO - JMIR Res Protoc SP - e68667 VL - 14 KW - physical activity KW - youth KW - social environment KW - built environment KW - ecological momentary assessment KW - social network analysis KW - phenotypes KW - accelerometry KW - GPS N2 - Background: Physical activity (PA) is crucial for youth health, but up to 74% of adolescents fail to meet recommended levels, especially during summer when structured supports associated with school are not available. The social and built environments significantly influence youth PA; yet, their complex interactions remain poorly understood. This study aims to evaluate the feasibility of combining ecological momentary assessment (EMA) and social network analysis to examine bidirectional influences among youth PA, built environments, and social networks during summer. Objective: The objectives are to (1) evaluate the feasibility and acceptability of the combined EMA and Social Network Analysis protocol, and (2) identify phenotypes using person-level, microtemporal, and dynamic overlap between social and built environments. Methods: This mixed methods feasibility study with an exploratory observational component will recruit 120 youth aged 12 years to 15 years from an urban school district in Central Texas, US. Participants will first complete a baseline survey to report their general social network patterns and environmental perceptions. Then participants will wear an ActiGraph LEAP accelerometer and respond to EMA prompts via smartphone for 7 days. EMA will assess real-time perceptions of social networks and surrounding built environments, which will be time-matched with accelerometer-assessed PA data. GPS coordinates will be collected with each EMA prompt to assess features of the built environment. Follow-up semistructured interviews will assess protocol acceptability. Results: This study has been funded by the National Heart, Lung, and Blood Institute. Data collection is expected in the summers of 2025, 2026, and 2027. Conclusions: This innovative approach combines EMA, SNA, accelerometry, and GPS data to provide unprecedented insights into the dynamic interplay between social networks, built environments, and youth PA during summer. Findings will inform the development of more targeted, effective interventions to promote PA among youth. While limitations include potential participant burden and generalizability, the study?s strengths in capturing real-time, contextualized data make it a valuable contribution to understanding youth PA determinants. International Registered Report Identifier (IRRID): PRR1-10.2196/68667 UR - https://www.researchprotocols.org/2025/1/e68667 UR - http://dx.doi.org/10.2196/68667 UR - http://www.ncbi.nlm.nih.gov/pubmed/ ID - info:doi/10.2196/68667 ER - TY - JOUR AU - Allen, D. K. J. AU - Elliott, V. Matthew AU - Ronold, Haga Eivind AU - Mason, Liam AU - Rajgopal, Nandini AU - Hammar, Åsa AU - Johnson, L. Sheri PY - 2025/2/19 TI - Cognitive Training for Emotion-Related Impulsivity and Rumination: Protocol for a Pilot Randomized Waitlist-Controlled Trial JO - JMIR Res Protoc SP - e54221 VL - 14 KW - cognitive control KW - cognitive training KW - emotion regulation KW - emotional response inhibition KW - emotional working memory KW - executive function KW - impulsivity KW - rumination KW - transdiagnostic KW - urgency N2 - Background: Inhibitory deficits are common in psychopathology. Emotion-related impulsivity (ERI) and rumination are general risk factors for psychiatric distress that are similarly associated with dysfunctional inhibition?particularly in affective contexts. A number of cognitive remediation procedures have been developed to improve inhibitory control; however, most remediation programs focus on ?cold? cognition independent of affective processing. This pilot trial will gather preliminary evidence for a new cognitive training intervention targeting ?hot? affective control (ie, inhibitory functions during elevated emotional arousal) in a transdiagnostic sample of adults who report heightened emotion dysregulation. Objective: This manuscript describes a protocol for a pilot randomized waitlist-controlled trial to assess changes in ERI and rumination after neurobehavioral affective control training (N-ACT), an 8-week cognitive training intervention designed to improve emotional response inhibition and emotional working memory. Our primary aim is to evaluate the efficacy, feasibility, and acceptability of N-ACT in reducing rumination and ERI, which we respectively conceptualize as complementary cognitive and behavioral consequences of emotion dysregulation. Secondarily, we will examine whether N-ACT leads to improvements in inhibitory control and, more distally, psychopathology symptoms. Methods: The final sample will comprise 80 adults who report high ERI or rumination. Participants will be randomized to (1) begin the N-ACT program without delay or (2) join a waitlist condition and then complete N-ACT. Exclusion criteria include active alcohol or substance use disorders, psychosis, and suicide risk. At the baseline and postintervention time points, participants will complete measures of emotion dysregulation and psychiatric symptoms, as well as a neuropsychological assessment of inhibitory control. Individuals assigned to the control group will undergo an identical assessment before joining the waitlist, followed by parallel assessments before and after N-ACT. Results: This trial is funded by support from the University of California Board of Regents and the Peder Sather Foundation (funding period: October 2022-September 2025). Recruitment is scheduled to begin in spring 2025. We will begin data analysis once data collection is complete, which is planned to occur in fall 2025. Conclusions: This pilot randomized waitlist-controlled trial is designed to assess the initial efficacy, feasibility, and acceptability of N-ACT, a novel cognitive remediation approach developed to address 2 key contributors to psychopathology: ERI and rumination. The N-ACT program uses computerized adaptive behavioral tasks to strengthen the affective control processes theoretically and empirically linked to ERI and rumination. We hope this work will help inform future studies with sufficient statistical power to ascertain whether enhancing affective control through cognitive training (N-ACT) produces downstream reductions in psychiatric symptoms via improved emotion regulation. Trial Registration: ClinicalTrials.gov NCT06226467; https://www.clinicaltrials.gov/study/NCT06226467; Open Science Framework Registry rak5z; https://osf.io/rak5z International Registered Report Identifier (IRRID): PRR1-10.2196/54221 UR - https://www.researchprotocols.org/2025/1/e54221 UR - http://dx.doi.org/10.2196/54221 UR - http://www.ncbi.nlm.nih.gov/pubmed/ ID - info:doi/10.2196/54221 ER - TY - JOUR AU - Hietbrink, G. Eclaire A. AU - Middelweerd, Anouk AU - d?Hollosy, Wendy AU - Schrijver, K. Laura AU - Laverman, D. Gozewijn AU - Vollenbroek-Hutten, R. Miriam M. PY - 2025/2/19 TI - Exploring the Acceptance of Just-in-Time Adaptive Lifestyle Support for People With Type 2 Diabetes: Qualitative Acceptability Study JO - JMIR Form Res SP - e65026 VL - 9 KW - eHealth KW - just-in-time adaptive intervention KW - ecological momentary assessment KW - type 2 diabetes KW - behavior change KW - physical activity KW - nutrition KW - acceptability KW - formative evaluation KW - mobile phone N2 - Background: The management of type 2 diabetes (T2D) requires individuals to adopt and maintain a healthy lifestyle. Personalized eHealth interventions can help individuals change their lifestyle behavior. Specifically, just-in-time adaptive interventions (JITAIs) offer a promising approach to provide tailored support to encourage healthy behaviors. Low-effort self-reporting via ecological momentary assessment (EMA) can provide insights into individuals? experiences and environmental factors and thus improve JITAI support, particularly for conditions that cannot be measured by sensors. We developed an EMA-driven JITAI to offer tailored support for various personal and environmental factors influencing healthy behavior in individuals with T2D. Objective: This study aimed to assess the acceptability of EMA-driven, just-in-time adaptive lifestyle support in individuals with T2D. Methods: In total, 8 individuals with T2D used the JITAI for 2 weeks. Participants completed daily EMAs about their activity, location, mood, overall condition, weather, and cravings and received tailored support via SMS text messaging. The acceptability of the JITAI was assessed through telephone-conducted, semistructured interviews. Interview topics included the acceptability of the EMA content and prompts, the intervention options, and the overall use of the JITAI. Data were analyzed using a hybrid approach of thematic analysis. Results: Participants with a mean age of 70.5 (SD 9) years, BMI of 32.1 (SD 5.3) kg/m², and T2D duration of 15.6 (SD 7.7) years had high self-efficacy scores in physical activity (ie, 32) and nutrition (ie, 29) and were mainly initiating or maintaining behavior changes. The identified themes were related to the intervention design, decision points, tailoring variables, intervention options, and mechanisms underlying adherence and retention. Participants provided positive feedback on several aspects of the JITAI, such as the motivating and enjoyable messages that appeared well tailored to some individuals. However, there were notable differences in individual experiences with the JITAI, particularly regarding intervention intensity and the perceived personalization of the EMA and messages. The EMA was perceived as easy to use and low in burden, but participants felt it provided too much of a snapshot and too little context, reducing the perceived tailoring of the intervention options. Challenges with the timing and frequency of prompts and the relevance of some tailoring variables were also observed. While some participants found the support relevant and motivating, others were less inclined to follow the advice. Participants expressed the need for even more personalized support tailored to their specific characteristics and circumstances. Conclusions: This study showed that an EMA-driven JITAI can provide motivating and tailored support, but more personalization is needed to ensure that the lifestyle support more closely fits each individual?s unique needs. Key areas for improvement include developing more individually tailored interventions, improving assessment methods to balance active and passive data collection, and integrating JITAIs within comprehensive lifestyle interventions. UR - https://formative.jmir.org/2025/1/e65026 UR - http://dx.doi.org/10.2196/65026 UR - http://www.ncbi.nlm.nih.gov/pubmed/39969969 ID - info:doi/10.2196/65026 ER - TY - JOUR AU - Smith, R. Abigail AU - Mueller, R. Elizabeth AU - Lewis, E. Cora AU - Markland, Alayne AU - Smerdon, Caroline AU - Smith, L. Ariana AU - Sutcliffe, Siobhan AU - Wyman, F. Jean AU - Low, Kane Lisa AU - Miller, M. Janis AU - PY - 2025/2/12 TI - Assessment of Environmental, Sociocultural, and Physiological Influences on Women?s Toileting Decisions and Behaviors Using ?Where I Go?: Pilot Study of a Mobile App JO - JMIR Mhealth Uhealth SP - e56533 VL - 13 KW - ecological momentary assessment KW - time location factors KW - voiding diary KW - voiding behaviors KW - population studies KW - mobile application KW - app KW - bladder health KW - data collection tool KW - decision support N2 - Background: Little is known about women?s decisions around toileting for urination and how those decisions influence moment-to-moment behaviors to manage bladder needs. The new smartphone app ?Where I Go? captures such nuanced and granular data in real-world environments. Objective: This study aims to describe participant engagement with ?Where I Go?, variation in novel parameters collected, and readiness for the data collection tool?s use in population-based studies. Methods: ?Where I Go? has three components: (1) real-time data, (2) short look-back periods (3?4 h), and (3) event location (GPS recorded at each interaction). The sample size was 44 women. Recording of real-time toileting events and responding to look-back questions was measured over 2 days of data collection. The participant?s self-entered location descriptions and the automatic GPS recordings were compared. Results: A total of 44 women with an average age of 44 (range 21-85) years interacted with the app. Real-time reporting of at least 1 toileting event per day was high (38/44, 86%, on day 1 and 40/44, 91%, on day 2) with a median of 5 (IQR 3-7 on day 1 and IQR 3-8 on day 2) toileting events recorded each day. Toileting most commonly occurred at home (85/140, 61%, on day 1 and 129/171, 75%, on day 2) due to a need to go (114/140, 66%, on day 1 and 153/171, 74%, on day 2). The most common reasons for delaying toileting were ?work duties? (33/140, 21%, on day 1 and 21/171, 11%, on day 2) and ?errands or traveling? (19/140, 12%, on day 1 and 19/171, 10%, on day 2). Response to at least 1 look-back notification was similarly high (41/44, 93%, on day 1 and 42/44, 95%, on day 2), with number of responses higher on average on day 2 compared with day 1 (mean on day 1=3.2, 95% CI 3.0-3.5; mean on day 2=4.3, 95% CI 3.9-4.7; P<.001). Median additional toileting events reported on the look-back survey were 1 (IQR 1-2) and 2 (IQR 1-2) on days 1 and 2, respectively. Overall concordance between self-reported location recording and GPS was 76% (188/247). Participants reported lower urge ratings when at home versus away when reporting real-time toileting (median rating 61, IQR 41-84 vs 72, IQR 56-98), and daily fluid intake showed a small to medium positive correlation with toileting frequency (day 1 r=0.3, day 2 r=0.24). Toileting frequency reported in ?Where I Go? showed a small positive correlation with the frequency item from the International Consultation on Incontinence Questionnaire (r=0.31 with day 1 toileting frequency and r=0.21 with day 2 toileting frequency). Conclusions: ?Where I Go? has potential to increase the understanding of factors that affect women?s toileting decisions and long-term bladder health. We anticipate its use as a data collection tool in population-based studies. International Registered Report Identifier (IRRID): RR2-10.2196/54046 UR - https://mhealth.jmir.org/2025/1/e56533 UR - http://dx.doi.org/10.2196/56533 ID - info:doi/10.2196/56533 ER - TY - JOUR AU - Wang, Shirlene AU - Yang, Chih-Hsiang AU - Brown, Denver AU - Cheng, Alan AU - Kwan, W. Matthew Y. PY - 2025/2/11 TI - Participant Compliance With Ecological Momentary Assessment in Movement Behavior Research Among Adolescents and Emerging Adults: Systematic Review JO - JMIR Mhealth Uhealth SP - e52887 VL - 13 KW - compliance KW - ecological momentary assessment KW - mobile health KW - adolescents KW - emerging adults KW - physical activity KW - movement behavior KW - systematic review KW - cognitive KW - social KW - development KW - youth KW - literature search KW - inclusion KW - data quality KW - mobile phone N2 - 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 UR - https://mhealth.jmir.org/2025/1/e52887 UR - http://dx.doi.org/10.2196/52887 UR - http://www.ncbi.nlm.nih.gov/pubmed/ ID - info:doi/10.2196/52887 ER - TY - JOUR AU - Astill Wright, Laurence AU - Moore, Matthew AU - Reeves, Stuart AU - Vallejos, Perez Elvira AU - Morriss, Richard PY - 2025/2/7 TI - Improving the Utility, Safety, and Ethical Use of a Passive Mood-Tracking App for People With Bipolar Disorder Using Coproduction: Qualitative Focus Group Study JO - JMIR Form Res SP - e65140 VL - 9 KW - mood monitoring KW - ecological momentary assessment KW - EMA KW - passive ecological momentary assessment KW - passive EMA KW - bipolar disorder KW - implementation KW - qualitative KW - mobile phone N2 - Background: Coproduction with users of new digital technology, such as passive mood monitoring, is likely to improve its utility, safety, and successful implementation via improved design and consideration of how such technology fits with their daily lives. Mood-monitoring interventions are commonly used by people with bipolar disorder (BD) and have promising potential for digitization using novel technological methods. Objective: This study aims to explore how a passive behavioral monitoring platform, Remote Assessment of Disease and Relapse, would meet the needs of people with BD by specifically considering purpose and function, diversity of need, personal preference, essential components and potential risks, and harms and mitigation strategies through an iterative coproduction process. Methods: A total of 17 people with BD were recruited via national charities. We conducted 3 web-based focus groups as a part of an iterative coproduction process in line with responsible research and innovation principles and with consideration of clinical challenges associated with BD. Data were analyzed thematically. Results were cross-checked by someone with lived experience of BD. Results: Focus groups were transcribed and analyzed using thematic analysis. Six themes were identified as follows: (1) the purpose of using the app, (2) desired features, (3) when to use the app, (4) risks of using the app, (5) sharing with family and friends, and (6) sharing with health care professionals. Conclusions: People with BD who are interested in using passive technology to monitor their mood wish to do so for a wide variety of purposes, identifying several preferences and potential risks. Principally, people with BD wished to use this novel technology to aid them in self-managing their BD with greater insight and a better understanding of potential triggers. We discuss key features that may aid this functionality and purpose, including crisis plans and sharing with others. Future development of passive mood-monitoring technologies should not assume that the involvement of formal mental health services is desired. UR - https://formative.jmir.org/2025/1/e65140 UR - http://dx.doi.org/10.2196/65140 UR - http://www.ncbi.nlm.nih.gov/pubmed/39918865 ID - info:doi/10.2196/65140 ER - TY - JOUR AU - Ahn, Seon Ji AU - Jeong, InJi AU - Park, Sehwan AU - Lee, Jooho AU - Jeon, Minjeong AU - Lee, Sangil AU - Do, Gangho AU - Jung, Dooyoung AU - Park, Young Jin PY - 2025/2/5 TI - App-Based Ecological Momentary Assessment of Problematic Smartphone Use During Examination Weeks in University Students: 6-Week Observational Study JO - J Med Internet Res SP - e69320 VL - 27 KW - problematic smartphone use KW - PSU KW - ecological momentary assessment KW - EMA KW - GPS tracking KW - digital phenotypes KW - psychosocial measures KW - university students KW - academic stress KW - mobile health KW - mHealth KW - mobile phone N2 - Background: The increasing prevalence of problematic smartphone use (PSU) among university students is raising concerns, particularly as excessive smartphone engagement is linked to negative outcomes such as mental health issues, academic underperformance, and sleep disruption. Despite the severity of PSU, its association with behaviors such as physical activity, mobility, and sociability has received limited research attention. Ecological momentary assessment (EMA), including passive data collection through digital phenotyping indicators, offers an objective approach to explore these behavioral patterns. Objective: This study aimed to examine associations between self-reported psychosocial measures; app-based EMA data, including daily behavioral indicators from GPS location tracking; and PSU in university students during the examination period. Methods: A 6-week observational study involving 243 university students was conducted using app-based EMA on personal smartphones to collect data on daily behaviors and psychosocial factors related to smartphone overuse. PSU was assessed using the Korean Smartphone Addiction Proneness Scale. Data collected from the Big4+ app, including self-reports on mood, sleep, and appetite, as well as passive sensor data (GPS location, acceleration, and steps) were used to evaluate overall health. Logistic regression analysis was conducted to identify factors that significantly influenced smartphone overuse, providing insights into daily behavior and mental health patterns. Results: In total, 23% (56/243) of the students exhibited PSU. The regression analysis revealed significant positive associations between PSU and several factors, including depression (Patient Health Questionnaire-9; odds ratio [OR] 8.48, 95% CI 1.95-36.87; P=.004), social interaction anxiety (Social Interaction Anxiety Scale; OR 4.40, 95% CI 1.59-12.15; P=.004), sleep disturbances (General Sleep Disturbance Scale; OR 3.44, 95% CI 1.15-10.30; P=.03), and longer sleep duration (OR 3.11, 95% CI 1.14-8.48; P=.03). Conversely, a significant negative association was found between PSU and time spent at home (OR 0.35, 95% CI 0.13-0.94; P=.04). Conclusions: This study suggests that negative self-perceptions of mood and sleep, along with patterns of increased mobility identified through GPS data, increase the risk of PSU, particularly during periods of academic stress. Combining psychosocial assessments with EMA data offers valuable insights for managing PSU during high-stress periods, such as examinations, and provides new directions for future research. UR - https://www.jmir.org/2025/1/e69320 UR - http://dx.doi.org/10.2196/69320 UR - http://www.ncbi.nlm.nih.gov/pubmed/ ID - info:doi/10.2196/69320 ER - TY - JOUR AU - Amo, Victoria AU - Lieder, Falk PY - 2025/2/4 TI - Evaluating the Effectiveness of InsightApp for Anxiety, Valued Action, and Psychological Resilience: Longitudinal Randomized Controlled Trial JO - JMIR Ment Health SP - e57201 VL - 12 KW - ecological momentary intervention KW - serious game KW - mindfulness-based intervention KW - acceptance and commitment therapy KW - cognitive behavioral therapy KW - metacognition KW - stress KW - anxiety KW - mobile phone N2 - Background: Anxiety disorders are among the most prevalent mental disorders, and stress plays a significant role in their development. Ecological momentary interventions (EMIs) hold great potential to help people manage stress and anxiety by training emotion regulation and coping skills in real-life settings. InsightApp is a gamified EMI and research tool that incorporates elements from evidence-based therapeutic approaches. It is designed to strengthen people?s metacognitive skills for coping with challenging real-life situations and embracing anxiety and other emotions. Objective: This randomized controlled trial aims to examine the effectiveness of InsightApp in (1) improving individuals? metacognitive strategies for coping with stress and anxiety and (2) promoting value-congruent action. It also evaluates how long these effects are retained. This experiment advances our understanding of the role of metacognition in emotional and behavioral reactivity to stress. Methods: We conducted a randomized controlled trial with 228 participants (completion rate: n=197, 86.4%; mean age 38, SD 11.50 years; age range 20-80 years; female: n=101, 52.6%; and White: n=175, 91.1%), who were randomly assigned to either the treatment or the active placebo control group. During the 1-week intervention phase, the treatment group engaged with InsightApp, while participants in the control group interacted with a placebo version of the app that delivered executive function training. We assessed the differences between the 2 groups in posttest and follow-up assessments of mental health and well-being while controlling for preexisting differences. Moreover, we used a multilevel model to analyze the longitudinal data, focusing on the within-participant causal effects of the intervention on emotional and behavioral reactivity to daily stressors. Specifically, we measured daily anxiety, struggle with anxiety, and value-congruent action. Results: The intervention delivered by InsightApp yielded mixed results. On one hand, we found no significant posttest scores on mental health and well-being measures directly after the intervention or 7 days later (all P>.22). In contrast, when confronted with real-life stress, the treatment group experienced a 15% lower increase in anxiety (1-tailed t test, t197=?2.4; P=.009) and a 12% lower increase in the struggle with anxiety (t197=?1.87; P=.031) than the control group. Furthermore, individuals in the treatment group demonstrated a 7% higher tendency to align their actions with their values compared to the control group (t197=3.23; P=.002). After the intervention period, InsightApp?s positive effects on the struggle with anxiety in reaction to stress were sustained, and increased to an 18% lower reactivity to stress (t197=?2.84; P=.002). Conclusions: As our study yielded mixed results, further studies are needed to obtain an accurate and reliable understanding of the effectiveness of InsightApp. Overall, our findings tentatively suggest that guiding people to apply adaptive metacognitive strategies for coping with real-life stress daily with a gamified EMI is a promising approach that deserves further evaluation. Trial Registration: OSF Registries osf.io/k3b5d; https://osf.io/k3b5d UR - https://mental.jmir.org/2025/1/e57201 UR - http://dx.doi.org/10.2196/57201 UR - http://www.ncbi.nlm.nih.gov/pubmed/ ID - info:doi/10.2196/57201 ER - TY - JOUR AU - Terhorst, Yannik AU - Messner, Eva-Maria AU - Opoku Asare, Kennedy AU - Montag, Christian AU - Kannen, Christopher AU - Baumeister, Harald PY - 2025/1/30 TI - Investigating Smartphone-Based Sensing Features for Depression Severity Prediction: Observation Study JO - J Med Internet Res SP - e55308 VL - 27 KW - smart sensing KW - digital phenotyping KW - depression KW - observation study KW - smartphone KW - mHealth KW - mobile health KW - app KW - mental health KW - symptoms KW - assessments N2 - Background: Unobtrusively collected objective sensor data from everyday devices like smartphones provide a novel paradigm to infer mental health symptoms. This process, called smart sensing, allows a fine-grained assessment of various features (eg, time spent at home based on the GPS sensor). Based on its prevalence and impact, depression is a promising target for smart sensing. However, currently, it is unclear which sensor-based features should be used in depression severity prediction and if they hold an incremental benefit over established fine-grained assessments like the ecological momentary assessment (EMA). Objective: The aim of this study was to investigate various features based on the smartphone screen, app usage, and call sensor alongside EMA to infer depression severity. Bivariate, cluster-wise, and cluster-combined analyses were conducted to determine the incremental benefit of smart sensing features compared to each other and EMA in parsimonious regression models for depression severity. Methods: In this exploratory observational study, participants were recruited from the general population. Participants needed to be 18 years of age, provide written informed consent, and own an Android-based smartphone. Sensor data and EMA were collected via the INSIGHTS app. Depression severity was assessed using the 8-item Patient Health Questionnaire. Missing data were handled by multiple imputations. Correlation analyses were conducted for bivariate associations; stepwise linear regression analyses were used to find the best prediction models for depression severity. Models were compared by adjusted R2. All analyses were pooled across the imputed datasets according to Rubin?s rule. Results: A total of 107 participants were included in the study. Ages ranged from 18 to 56 (mean 22.81, SD 7.32) years, and 78% of the participants identified as female. Depression severity was subclinical on average (mean 5.82, SD 4.44; Patient Health Questionnaire score ?10: 18.7%). Small to medium correlations were found for depression severity and EMA (eg, valence: r=?0.55, 95% CI ?0.67 to ?0.41), and there were small correlations with sensing features (eg, screen duration: r=0.37, 95% CI 0.20 to 0.53). EMA features could explain 35.28% (95% CI 20.73% to 49.64%) of variance and sensing features (adjusted R2=20.45%, 95% CI 7.81% to 35.59%). The best regression model contained EMA and sensing features (R2=45.15%, 95% CI 30.39% to 58.53%). Conclusions: Our findings underline the potential of smart sensing and EMA to infer depression severity as isolated paradigms and when combined. Although these could become important parts of clinical decision support systems for depression diagnostics and treatment in the future, confirmatory studies are needed before they can be applied to routine care. Furthermore, privacy, ethical, and acceptance issues need to be addressed. UR - https://www.jmir.org/2025/1/e55308 UR - http://dx.doi.org/10.2196/55308 UR - http://www.ncbi.nlm.nih.gov/pubmed/39883512 ID - info:doi/10.2196/55308 ER - TY - JOUR AU - de Vries, Jaap Herman AU - Delahaij, Roos AU - van Zwieten, Marianne AU - Verhoef, Helen AU - Kamphuis, Wim PY - 2025/1/28 TI - The Effects of Self-Monitoring Using a Smartwatch and Smartphone App on Stress Awareness, Self-Efficacy, and Well-Being?Related Outcomes in Police Officers: Longitudinal Mixed Design Study JO - JMIR Mhealth Uhealth SP - e60708 VL - 13 KW - wearable electronic devices KW - ecological momentary assessment KW - psychological stress KW - psychological well-being KW - awareness KW - self-efficacy KW - occupational medicine KW - emergency responders KW - well-being KW - psychological KW - efficacy KW - stress KW - wearables KW - wearable device KW - smartwatch KW - smartphone app KW - app KW - sensor KW - sensor technology KW - police officers KW - questionnaire KW - stress awareness KW - stress management N2 - Background: Wearable sensor technologies, often referred to as ?wearables,? have seen a rapid rise in consumer interest in recent years. Initially often seen as ?activity trackers,? wearables have gradually expanded to also estimate sleep, stress, and physiological recovery. In occupational settings, there is a growing interest in applying this technology to promote health and well-being, especially in professions with highly demanding working conditions such as first responders. However, it is not clear to what extent self-monitoring with wearables can positively influence stress- and well-being?related outcomes in real-life conditions and how wearable-based interventions should be designed for high-risk professionals. Objective: The aim of this study was to investigate (1) whether offering a 5-week wearable-based intervention improves stress- and well-being?related outcomes in police officers and (2) whether extending a basic ?off-the-shelf? wearable-based intervention with ecological momentary assessment (EMA) questionnaires, weekly personalized feedback reports, and peer support groups improves its effectiveness. Methods: A total of 95 police officers from 5 offices participated in the study. The data of 79 participants were included for analysis. During the first 5 weeks, participants used no self-monitoring technology (control period). During the following 5 weeks (intervention period), 41 participants used a Garmin Forerunner 255 smartwatch with a custom-built app (comparable to that of the consumer-available wearable), whereas the other 38 participants used the same system, but complemented by daily EMA questionnaires, weekly personalized feedback reports, and access to peer support groups. At baseline (T0) and after the control (T1) and intervention (T2) periods, questionnaires were administered to measure 15 outcomes relating to stress awareness, stress management self-efficacy, and outcomes related to stress and general well-being. Linear mixed models that accounted for repeated measures within subjects, the control and intervention periods, and between-group differences were used to address both research questions. Results: The results of the first analysis showed that the intervention had a small (absolute Hedges g=0.25?0.46) but consistent effect on 8 of 15 of the stress- and well-being?related outcomes in comparison to the control group. The second analysis provided mixed results; the extended intervention was more effective than the basic intervention at improving recovery after work but less effective at improving self-efficacy in behavior change and sleep issues, and similarly effective in the remaining 12 outcomes. Conclusions: Offering a 5-week wearable-based intervention to police officers can positively contribute to optimizing their stress-related, self-efficacy, and well-being?related outcomes. Complementing the basic ?off-the-shelf? wearable-based intervention with additional EMA questionnaires, weekly personalized feedback reports, and peer support groups did not appear to improve the effectiveness of the intervention. Future work is needed to investigate how different aspects of these interventions can be tailored to specific characteristics and needs of employees to optimize these effects. UR - https://mhealth.jmir.org/2025/1/e60708 UR - http://dx.doi.org/10.2196/60708 ID - info:doi/10.2196/60708 ER - TY - JOUR AU - Sahandi Far, Mehran AU - Fischer, M. Jona AU - Senge, Svea AU - Rathmakers, Robin AU - Meissner, Thomas AU - Schneble, Dominik AU - Narava, Mamaka AU - Eickhoff, B. Simon AU - Dukart, Juergen PY - 2025/1/28 TI - Cross-Platform Ecological Momentary Assessment App (JTrack-EMA+): Development and Usability Study JO - J Med Internet Res SP - e51689 VL - 27 KW - digital biomarkers KW - mobile health KW - remote monitoring KW - smartphone KW - mobile phone KW - monitoring KW - biomarker KW - ecological momentary assessment KW - application KW - costly KW - user experience KW - data management KW - mobility N2 - Background: Traditional in-clinic methods of collecting self-reported information are costly, time-consuming, subjective, and often limited in the quality and quantity of observation. However, smartphone-based ecological momentary assessments (EMAs) provide complementary information to in-clinic visits by collecting real-time, frequent, and longitudinal data that are ecologically valid. While these methods are promising, they are often prone to various technical obstacles. However, despite the potential of smartphone-based EMAs, they face technical obstacles that impact adaptability, availability, and interoperability across devices and operating systems. Deficiencies in these areas can contribute to selection bias by excluding participants with unsupported devices or limited digital literacy, increase development and maintenance costs, and extend deployment timelines. Moreover, these limitations not only impede the configurability of existing solutions but also hinder their adoption for addressing diverse clinical challenges. Objective: The primary aim of this research was to develop a cross-platform EMA app that ensures a uniform user experience and core features across various operating systems. Emphasis was placed on maximizing the integration and adaptability to various study designs, all while maintaining strict adherence to security and privacy protocols. JTrack-EMA+ was designed and implemented per the FAIR (findable, accessible, interpretable, and reusable) principles in both its architecture and data management layers, thereby reducing the burden of integration for clinicians and researchers. Methods: JTrack-EMA+ was built using the Flutter framework, enabling it to run seamlessly across different platforms. This platform comprises two main components. JDash (Research Centre Jülich, Institute of Neuroscience and Medicine, Brain and Behaviour [INM-7]) is an online management tool created using Python (Python Software Foundation) with the Django (Django Software Foundation) framework. This online dashboard offers comprehensive study management tools, including assessment design, user administration, data quality control, and a reminder casting center. The JTrack-EMA+ app supports a wide range of question types, allowing flexibility in assessment design. It also has configurable assessment logic and the ability to include supplementary materials for a richer user experience. It strongly commits to security and privacy and complies with the General Data Protection Regulations to safeguard user data and ensure confidentiality. Results: We investigated our platform in a pilot study with 480 days of follow-up to assess participants? compliance. The 6-month average compliance was 49.3%, significantly declining (P=.004) from 66.7% in the first month to 42% in the sixth month. Conclusions: The JTrack-EMA+ platform prioritizes platform-independent architecture, providing an easy entry point for clinical researchers to deploy EMA in their respective clinical studies. Remote and home-based assessments of EMA using this platform can provide valuable insights into patients? daily lives, particularly in a population with limited mobility or inconsistent access to health care services. UR - https://www.jmir.org/2025/1/e51689 UR - http://dx.doi.org/10.2196/51689 UR - http://www.ncbi.nlm.nih.gov/pubmed/ ID - info:doi/10.2196/51689 ER - TY - JOUR AU - Kezbers, M. Krista AU - Robertson, C. Michael AU - Hébert, T. Emily AU - Montgomery, Audrey AU - Businelle, S. Michael PY - 2025/1/28 TI - Detecting Deception and Ensuring Data Integrity in a Nationwide mHealth Randomized Controlled Trial: Factorial Design Survey Study JO - J Med Internet Res SP - e66384 VL - 27 KW - ecological momentary assessment KW - enrollment KW - fraud KW - mHealth KW - randomized controlled trial KW - recruitment KW - deception KW - data integrity KW - behavior KW - social KW - RCT KW - factorial design KW - mobile phone N2 - Background: Social behavioral research studies have increasingly shifted to remote recruitment and enrollment procedures. This shifting landscape necessitates evolving best practices to help mitigate the negative impacts of deceptive attempts (eg, fake profiles and bots) at enrolling in behavioral research. Objective: This study aimed to develop and implement robust deception detection procedures during the enrollment period of a remotely conducted randomized controlled trial. Methods: A 32-group (2×2×2×2×2) factorial design study was conducted from November 2021 to September 2022 to identify mobile health (mHealth) survey design features associated with the highest completion rates of smartphone-based ecological momentary assessments (n=485). Participants were required to be at least 18 years old, live in the United States, and own an Android smartphone that was compatible with the Insight app that was used in the study. Recruitment was conducted remotely through Facebook advertisements, a 5-minute REDCap (Research Electronic Data Capture) prescreener, and a screening and enrollment phone call. The research team created and implemented a 12-step checklist (eg, address verification and texting a copy of picture identification) to identify and prevent potentially deceptive attempts to enroll in the study. Descriptive statistics were calculated to understand the prevalence of various types of deceptive attempts at study enrollment. Results: Facebook advertisements resulted in 5236 initiations of the REDCap prescreener. A digital deception detection procedure was implemented for those who were deemed pre-eligible (n=1928). This procedure resulted in 26% (501/1928) of prescreeners being flagged as potentially deceptive. Completing multiple prescreeners (301/501, 60.1%) and providing invalid addresses (156/501, 31.1%) were the most common reasons prescreeners were flagged. An additional 1% (18/1928) of prescreeners were flagged as potentially deceptive during the subsequent study screening and enrollment phone call. Reasons for exclusion at the screening and enrollment phone call level included having an invalid phone type (6/18, 33.3%), completing multiple prescreeners (6/18, 33.3%), and providing an invalid address (5/18, 27.7%). This resulted in 1409 individuals being eligible after all deception checks were completed. Postenrollment social security number checks revealed that 3 (0.6%) fully enrolled participants out of 485 provided erroneous social security numbers during the screening process. Conclusions: Implementation of a deception detection procedure in a remotely conducted randomized controlled trial resulted in a substantial proportion of cases being flagged as potentially engaging in deceptive attempts at study enrollment. The results of the deception detection procedures in this study confirmed the need for vigilance in conducting remote behavioral research in order to maintain data integrity. Implementing systematic deception detection procedures may support study administration, data quality, and participant safety in remotely conducted behavioral research. Trial Registration: ClinicalTrials.gov NCT05194228; https://clinicaltrials.gov/study/NCT05194228 UR - https://www.jmir.org/2025/1/e66384 UR - http://dx.doi.org/10.2196/66384 UR - http://www.ncbi.nlm.nih.gov/pubmed/ ID - info:doi/10.2196/66384 ER - TY - JOUR AU - Kumar, Devender AU - Haag, David AU - Blechert, Jens AU - Niebauer, Josef AU - Smeddinck, David Jan PY - 2025/1/24 TI - Feature Selection for Physical Activity Prediction Using Ecological Momentary Assessments to Personalize Intervention Timing: Longitudinal Observational Study JO - JMIR Mhealth Uhealth SP - e57255 VL - 13 KW - digital health KW - behavior change KW - tailoring KW - personalization KW - adaptive systems KW - ecological momentary assessments KW - sensing KW - questionnaires KW - machine learning KW - feature selection KW - situated research KW - physical activity KW - implementation intentions KW - barriers KW - intention-behavior gap KW - artificial intelligence KW - AI KW - well-being KW - user assessment KW - survey KW - self-efficacy KW - stress KW - mood KW - emotions KW - mobile phone N2 - Background: There has been a surge in the development of apps that aim to improve health, physical activity (PA), and well-being through behavior change. These apps often focus on creating a long-term and sustainable impact on the user. Just-in-time adaptive interventions (JITAIs) that are based on passive sensing of the user?s current context (eg, via smartphones and wearables) have been devised to enhance the effectiveness of these apps and foster PA. JITAIs aim to provide personalized support and interventions such as encouraging messages in a context-aware manner. However, the limited range of passive sensing capabilities often make it challenging to determine the timing and context for delivering well-accepted and effective interventions. Ecological momentary assessment (EMA) can provide personal context by directly capturing user assessments (eg, moods and emotions). Thus, EMA might be a useful complement to passive sensing in determining when JITAIs are triggered. However, extensive EMA schedules need to be scrutinized, as they can increase user burden. Objective: The aim of the study was to use machine learning to balance the feature set size of EMA questions with the prediction accuracy regarding of enacting PA. Methods: A total of 43 healthy participants (aged 19?67 years) completed 4 EMA surveys daily over 3 weeks. These surveys prospectively assessed various states, including both motivational and volitional variables related to PA preparation (eg, intrinsic motivation, self-efficacy, and perceived barriers) alongside stress and mood or emotions. PA enactment was assessed retrospectively via EMA and served as the outcome variable. Results: The best-performing machine learning models predicted PA engagement with a mean area under the curve score of 0.87 (SD 0.02) in 5-fold cross-validation and 0.87 on the test set. Particularly strong predictors included self-efficacy, stress, planning, and perceived barriers, indicating that a small set of EMA predictors can yield accurate PA prediction for these participants. Conclusions: A small set of EMA-based features like self-efficacy, stress, planning, and perceived barriers can be enough to predict PA reasonably well and can thus be used to meaningfully tailor JITAIs such as sending well-timed and context-aware support messages. UR - https://mhealth.jmir.org/2025/1/e57255 UR - http://dx.doi.org/10.2196/57255 ID - info:doi/10.2196/57255 ER - TY - JOUR AU - Hartnagel, Lisa-Marie AU - Emden, Daniel AU - Foo, C. Jerome AU - Streit, Fabian AU - Witt, H. Stephanie AU - Frank, Josef AU - Limberger, F. Matthias AU - Schmitz, E. Sara AU - Gilles, Maria AU - Rietschel, Marcella AU - Hahn, Tim AU - Ebner-Priemer, W. Ulrich AU - Sirignano, Lea PY - 2024/12/23 TI - Momentary Depression Severity Prediction in Patients With Acute Depression Who Undergo Sleep Deprivation Therapy: Speech-Based Machine Learning Approach JO - JMIR Ment Health SP - e64578 VL - 11 KW - ambulatory assessment KW - depression KW - speech features KW - openSMILE KW - machine learning KW - sleep deprivation therapy KW - remote monitoring KW - depressive disorder KW - mobile phone KW - digital health KW - mobile health KW - mHealth KW - mental health N2 - Background: Mobile devices for remote monitoring are inevitable tools to support treatment and patient care, especially in recurrent diseases such as major depressive disorder. The aim of this study was to learn if machine learning (ML) models based on longitudinal speech data are helpful in predicting momentary depression severity. Data analyses were based on a dataset including 30 inpatients during an acute depressive episode receiving sleep deprivation therapy in stationary care, an intervention inducing a rapid change in depressive symptoms in a relatively short period of time. Using an ambulatory assessment approach, we captured speech samples and assessed concomitant depression severity via self-report questionnaire over the course of 3 weeks (before, during, and after therapy). We extracted 89 speech features from the speech samples using the Extended Geneva Minimalistic Acoustic Parameter Set from the Open-Source Speech and Music Interpretation by Large-Space Extraction (audEERING) toolkit and the additional parameter speech rate. Objective: We aimed to understand if a multiparameter ML approach would significantly improve the prediction compared to previous statistical analyses, and, in addition, which mechanism for splitting training and test data was most successful, especially focusing on the idea of personalized prediction. Methods: To do so, we trained and evaluated a set of >500 ML pipelines including random forest, linear regression, support vector regression, and Extreme Gradient Boosting regression models and tested them on 5 different train-test split scenarios: a group 5-fold nested cross-validation at the subject level, a leave-one-subject-out approach, a chronological split, an odd-even split, and a random split. Results: In the 5-fold cross-validation, the leave-one-subject-out, and the chronological split approaches, none of the models were statistically different from random chance. The other two approaches produced significant results for at least one of the models tested, with similar performance. In total, the superior model was an Extreme Gradient Boosting in the odd-even split approach (R²=0.339, mean absolute error=0.38; both P<.001), indicating that 33.9% of the variance in depression severity could be predicted by the speech features. Conclusions: Overall, our analyses highlight that ML fails to predict depression scores of unseen patients, but prediction performance increased strongly compared to our previous analyses with multilevel models. We conclude that future personalized ML models might improve prediction performance even more, leading to better patient management and care. UR - https://mental.jmir.org/2024/1/e64578 UR - http://dx.doi.org/10.2196/64578 ID - info:doi/10.2196/64578 ER - TY - JOUR AU - Meisel, N. Samuel AU - Hogue, Aaron AU - Kelly, F. John AU - McQuaid, Elizabeth AU - Miranda Jr, Robert PY - 2024/12/20 TI - Examining Caregiver Practices During Adolescent Outpatient Alcohol Use and Co-Occurring Mental Health Treatment: Protocol for a Dyadic Ecological Momentary Assessment Study JO - JMIR Res Protoc SP - e63399 VL - 13 KW - adolescent KW - caregiver KW - ecological momentary assessment KW - alcohol KW - co-occurring disorders treatment KW - treatment KW - older adult KW - aging KW - alcohol use KW - mental health KW - assessment KW - protocol KW - alcohol use disorder KW - drinking KW - substance use KW - data collection N2 - Background: Caregiver-involved treatments for adolescents with alcohol use disorder and co-occurring disorders (AUD+CODs) are associated with the best treatment outcomes. Understanding what caregiving practices during treatment improve core adolescent treatment targets may facilitate the refinement and scalability of caregiver-involved interventions. Caregiving is dynamic, varying by context, affect, and adolescent behavior. Caregiver-involved treatments seek to change momentary interactions between caregivers and their adolescents. Accordingly, this protocol outlines a dyadic ecological momentary assessment (EMA) study to examine caregiving practices during AUD+CODs treatment and their associations with adolescent core treatment targets (eg, alcohol craving and use, motivation to reduce or stop drinking, and internalizing and externalizing symptoms). Objective: This paper aims to describe the methods for examining momentary caregiving practices and adolescent core treatment targets during adolescent outpatient AUD+CODs treatment. Methods: We will recruit 75 caregiver-adolescent dyads from outpatient mental health clinics providing AUD+CODs treatment. Eligible families will have an adolescent who (1) is aged between 13 and 18 years; (2) meets the Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition, diagnostic criteria for AUD; (3) is enrolled in outpatient treatment at the time of recruitment; and (4) has a legal guardian willing to participate in the study. Caregivers and adolescents will complete an eligibility screening, followed by a baseline assessment during or as close as possible to the second week of treatment. During the baseline assessment, caregivers and adolescents will receive formal training in EMA procedures. Next, caregivers and adolescents will complete a 15-week EMA burst design consisting of three 21-day EMA periods with 3-week breaks between periods. Throughout the study, participants will also complete weekly reports regarding the skills learned or practiced during therapy. The three overarching aims to the proposed study are as follows: (1) examine momentary caregiving practices (eg, support, monitoring, substance use communication quality) and their associations with core treatment targets, (2) examine how these associations change throughout treatment, and (3) examine whether a caregiver report of learning or practicing parenting- or family-focused behaviors in treatment sessions is associated with changes in the use of caregiving practices in daily life. Results: The proposed study was informed by a pilot study assessing the feasibility and acceptability of dyadic EMA during adolescent AUD+COD treatment. Some benchmarks were met during this study (eg, ?80% caregiver retention rate), although most benchmarks were not (eg, adolescent [772/1622, 47.6%] and caregiver [1331/1881, 70.76%] random prompt compliance was below the ?80% target). Data collection is anticipated to begin in December of 2024. The proposed study is designed to be completed over 3 years. Conclusions: Examining momentary caregiving practices using EMA has important implications for refining and scaling caregiver-involved interventions for AUD+CODs so that families who would benefit from caregiver-involved treatments can have access to them. International Registered Report Identifier (IRRID): PRR1-10.2196/63399 UR - https://www.researchprotocols.org/2024/1/e63399 UR - http://dx.doi.org/10.2196/63399 UR - http://www.ncbi.nlm.nih.gov/pubmed/ ID - info:doi/10.2196/63399 ER - TY - JOUR AU - Prignitz, Maren AU - Guldner, Stella AU - Lehmler, Johann Stephan AU - Aggensteiner, Pascal-M AU - Nees, Frauke AU - PY - 2024/12/10 TI - An Ecological Momentary Assessment Approach of Environmental Triggers in the Role of Daily Affect, Rumination, and Movement Patterns in Early Alcohol Use Among Healthy Adolescents: Exploratory Study JO - JMIR Mhealth Uhealth SP - e53401 VL - 12 KW - alcohol use KW - adolescence KW - affect KW - rumination KW - ecological momentary assessment KW - geospatial measures N2 - Background: Adolescence is a period characterized by an increased susceptibility to developing risky alcohol consumption habits. This susceptibility can be influenced by social and situational factors encountered in daily life, which, in conjunction with emotions and thoughts, contribute to behavioral patterns related to alcohol use even in the early stages of alcohol experimentation, when initial experiences with alcohol are formed, and regular consumption is still evolving. Objective: This study aimed to examine the association between detailed behavioral and movement patterns, along with emotional and cognitive factors, and the early onset of alcohol use in the everyday lives of adolescents. Methods: A total of 65 healthy adolescents (33 male, twenty-nine 14-year-olds, and thirty-six 16-year-olds) underwent mobile-based ecological momentary assessments on alcohol (once a day at 9 AM, assessing alcohol use the day before), positive and negative affect, craving, rumination, and social context (6 prompts/day at 9 AM, 11 AM, 2 PM, 4 PM, 6 PM and 8 PM), type of day (weekdays or weekends, with weekend including Fridays, Saturdays, and Sundays), and using geospatial measures (specifically roaming entropy and number and type of trigger points for alcohol use met) over 14 days. After adjusting for a compliance rate of at least 50%, 52 participants (26 male and twenty-four 14-year-olds) were included in the analyses. Results: Generalized linear multilevel models revealed that higher positive affect (b=0.685, P=.007), higher rumination (b=0.586, P=.02), and a larger movement radius (roaming entropy) (b=8.126, P=.02) were positively associated with alcohol use on the same day. However, social context (b=?0.076, P=.90), negative affect (b=?0.077, P=.80), or potential trigger points (all P>.05) did not show significant associations. Alcohol use varied depending on the type of day, with more alcohol use on weekends (b=1.082, P<.001) and age (t50=?2.910, P=.005), with 16-year-olds (mean 1.61, SD 1.66) reporting more days of alcohol consumption than 14-year-olds (mean 0.548, SD 0.72). Conclusions: Our findings support previously identified factors as significant contributors to very early and low levels of alcohol consumption through fine-grained analysis of daily behaviors. These factors include positive affect, rumination, weekend days, and age. In addition, we emphasize that exploratory environmental movement behavior (roaming entropy) is also significantly associated with adolescent alcohol use, highlighting its importance as an additional factor. UR - https://mhealth.jmir.org/2024/1/e53401 UR - http://dx.doi.org/10.2196/53401 UR - http://www.ncbi.nlm.nih.gov/pubmed/ ID - info:doi/10.2196/53401 ER - TY - JOUR AU - Portillo-Van Diest, Ana AU - Mortier, Philippe AU - Ballester, Laura AU - Amigo, Franco AU - Carrasco, Paula AU - Falcó, Raquel AU - Gili, Margalida AU - Kiekens, Glenn AU - H Machancoses, Francisco AU - Piqueras, A. Jose AU - Rebagliato, Marisa AU - Roca, Miquel AU - Rodríguez-Jiménez, Tíscar AU - Alonso, Jordi AU - Vilagut, Gemma PY - 2024/12/10 TI - Ecological Momentary Assessment of Mental Health Problems Among University Students: Data Quality Evaluation Study JO - J Med Internet Res SP - e55712 VL - 26 KW - experience sampling method KW - ecological momentary assessment KW - mental health KW - university students KW - participation KW - compliance KW - reliability KW - sensitivity analysis KW - mobile phone N2 - Background: The use of ecological momentary assessment (EMA) designs has been on the rise in mental health epidemiology. However, there is a lack of knowledge of the determinants of participation in and compliance with EMA studies, reliability of measures, and underreporting of methodological details and data quality indicators. Objective: This study aims to evaluate the quality of EMA data in a large sample of university students by estimating participation rate and mean compliance, identifying predictors of individual-level participation and compliance, evaluating between- and within-person reliability of measures of negative and positive affect, and identifying potential careless responding. Methods: A total of 1259 university students were invited to participate in a 15-day EMA study on mental health problems. Logistic and Poisson regressions were used to investigate the associations between sociodemographic factors, lifetime adverse experiences, stressful events in the previous 12 months, and mental disorder screens and EMA participation and compliance. Multilevel reliability and intraclass correlation coefficients were obtained for positive and negative affect measures. Careless responders were identified based on low compliance or individual reliability coefficients. Results: Of those invited, 62.1% (782/1259) participated in the EMA study, with a mean compliance of 76.9% (SD 27.7%). Participation was higher among female individuals (odds ratio [OR] 1.41, 95% CI 1.06-1.87) and lower among those aged ?30 years (OR 0.20, 95% CI 0.08-0.43 vs those aged 18-21 years) and those who had experienced the death of a friend or family member in the previous 12 months (OR 0.73, 95% CI 0.57-0.94) or had a suicide attempt in the previous 12 months (OR 0.26, 95% CI 0.10-0.64). Compliance was particularly low among those exposed to sexual abuse before the age of 18 years (exponential of ?=0.87) or to sexual assault or rape in the previous year (exponential of ?=0.80) and among those with 12-month positive alcohol use disorder screens (exponential of ?=0.89). Between-person reliability of negative and positive affect was strong (RkRn>0.97), whereas within-person reliability was fair to moderate (Rcn>0.43). Of all answered assessments, 0.86% (291/33,626) were flagged as careless responses because the response time per item was <1 second or the participants gave the same response to all items. Of the participants, 17.5% (137/782) could be considered careless responders due to low compliance (<25/56, 45%) or very low to null individual reliability (raw Cronbach ?<0.11) for either negative or positive affect. Conclusions: Data quality assessments should be carried out in EMA studies in a standardized manner to provide robust conclusions to advance the field. Future EMA research should implement strategies to mitigate nonresponse bias as well as conduct sensitivity analyses to assess possible exclusion of careless responders. UR - https://www.jmir.org/2024/1/e55712 UR - http://dx.doi.org/10.2196/55712 UR - http://www.ncbi.nlm.nih.gov/pubmed/39657180 ID - info:doi/10.2196/55712 ER - TY - JOUR AU - Winstone, Lizzy AU - Heron, Jon AU - John, Ann AU - Kirtley, J. Olivia AU - Moran, Paul AU - Muehlenkamp, Jennifer AU - O'Connor, C. Rory AU - Mars, Becky PY - 2024/12/9 TI - Ecological Momentary Assessment of Self-Harm Thoughts and Behaviors: Systematic Review of Constructs From the Integrated Motivational-Volitional Model JO - JMIR Ment Health SP - e63132 VL - 11 KW - integrated motivational-volitional model KW - IMV model KW - ecological momentary assessment KW - suicidal and nonsuicidal self-harm thoughts and behaviors N2 - Background: The integrated motivational-volitional model (IMV) is one of the leading theoretical models of suicidal thoughts and behavior. There has been a recent proliferation in the assessment of suicidal and nonsuicidal self-harm thoughts and behaviors (SHTBs) in daily life. Objective: This systematic review synthesized evidence from ecological momentary assessment (EMA) studies in the SHTB literature to address the following questions: (1) Which constructs in the IMV model have been assessed using EMA, and how have they been assessed? (2) Do different constructs from the IMV model fluctuate in daily life? (3) What is the relationship between the different IMV constructs and SHTBs in daily life? Methods: Consistent with the PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) guidelines, we conducted systematic searches of 5 databases?Web of Science, Embase, MEDLINE, PsycINFO, and Europe PMC Preprints?from inception to March 26, 2024. Results: Our searches resulted in the inclusion and narrative synthesis of 53 studies across 58 papers. A total of 15 IMV constructs were measured using EMA across the included papers. The most frequently measured constructs were thwarted belongingness (24/58, 41% of the papers), future thinking (20/58, 34% of the papers), and perceived burdensomeness (16/58, 28% of the papers). The least frequently measured constructs were humiliation, social problem-solving, mental imagery, and perceived capability for suicide. None of the included papers measured memory biases, goals, norms, or resilience using EMA. Comparison of intraclass correlation coefficients (45/58, 78% of the papers) revealed moderate but inconsistent within-person variance across all the examined constructs. We found evidence (39/58, 67% of the papers) of concurrent associations between almost all constructs and SHTBs in daily life, with some evidence that entrapment, shame, rumination, thwarted belongingness, hopelessness, social support, and impulsivity are additionally associated with SHTBs in lagged (ie, longitudinal) relationships. Conclusions: Comparisons were hindered by variation in methodology, including the populations studied, EMA sampling scheme, operationalization of IMV constructs and SHTBs, and statistical approach used. Our findings suggest that EMA studies are a useful methodology for examining risk factors for SHTBs; however, more research is needed for some IMV constructs. Quality assessment suggested several areas for improvement in the reporting of EMA studies in this field. Trial Registration: PROSPERO CRD42022349514; https://www.crd.york.ac.uk/prospero/display_record.php?RecordID=349514 UR - https://mental.jmir.org/2024/1/e63132 UR - http://dx.doi.org/10.2196/63132 UR - http://www.ncbi.nlm.nih.gov/pubmed/ ID - info:doi/10.2196/63132 ER - TY - JOUR AU - Lee, Ting-Yi AU - Chen, Ching-Hsuan AU - Chen, I-Ming AU - Chen, Hsi-Chung AU - Liu, Chih-Min AU - Wu, Shu-I AU - Hsiao, Kate Chuhsing AU - Kuo, Po-Hsiu PY - 2024/12/6 TI - Dynamic Bidirectional Associations Between Global Positioning System Mobility and Ecological Momentary Assessment of Mood Symptoms in Mood Disorders: Prospective Cohort Study JO - J Med Internet Res SP - e55635 VL - 26 KW - ecological momentary assessment KW - digital phenotyping KW - GPS mobility KW - bipolar disorder KW - major depressive disorder KW - GPS KW - global positioning system KW - mood disorders KW - assessment KW - depression KW - anxiety KW - digital phenotype KW - smartphone app KW - technology KW - behavioral changes KW - patient KW - monitoring N2 - Background: Although significant research has explored the digital phenotype in mood disorders, the time-lagged and bidirectional relationship between mood and global positioning system (GPS) mobility remains relatively unexplored. Leveraging the widespread use of smartphones, we examined correlations between mood and behavioral changes, which could inform future scalable interventions and personalized mental health monitoring. Objective: This study aims to investigate the bidirectional time lag relationships between passive GPS data and active ecological momentary assessment (EMA) data collected via smartphone app technology. Methods: Between March 2020 and May 2022, we recruited 45 participants (mean age 42.3 years, SD 12.1 years) who were followed up for 6 months: 35 individuals diagnosed with mood disorders referred by psychiatrists and 10 healthy control participants. This resulted in a total of 5248 person-days of data. Over 6 months, we collected 2 types of smartphone data: passive data on movement patterns with nearly 100,000 GPS data points per individual and active data through EMA capturing daily mood levels, including fatigue, irritability, depressed, and manic mood. Our study is limited to Android users due to operating system constraints. Results: Our findings revealed a significant negative correlation between normalized entropy (r=?0.353; P=.04) and weekly depressed mood as well as between location variance (r=?0.364; P=.03) and depressed mood. In participants with mood disorders, we observed bidirectional time-lagged associations. Specifically, changes in homestay were positively associated with fatigue (?=0.256; P=.03), depressed mood (?=0.235; P=.01), and irritability (?=0.149; P=.03). A decrease in location variance was significantly associated with higher depressed mood the following day (?=?0.015; P=.009). Conversely, an increase in depressed mood was significantly associated with reduced location variance the next day (?=?0.869; P<.001). These findings suggest a dynamic interplay between mood symptoms and mobility patterns. Conclusions: This study demonstrates the potential of utilizing active EMA data to assess mood levels and passive GPS data to analyze mobility behaviors, with implications for managing disease progression in patients. Monitoring location variance and homestay can provide valuable insights into this process. The daily use of smartphones has proven to be a convenient method for monitoring patients? conditions. Interventions should prioritize promoting physical movement while discouraging prolonged periods of staying at home. UR - https://www.jmir.org/2024/1/e55635 UR - http://dx.doi.org/10.2196/55635 UR - http://www.ncbi.nlm.nih.gov/pubmed/ ID - info:doi/10.2196/55635 ER - TY - JOUR AU - Linden-Carmichael, Ashley AU - Stull, W. Samuel AU - Wang, Danny AU - Bhandari, Sandesh AU - Lanza, T. Stephanie PY - 2024/12/5 TI - Impact of Providing a Personalized Data Dashboard on Ecological Momentary Assessment Compliance Among College Students Who Use Substances: Pilot Microrandomized Trial JO - JMIR Form Res SP - e60193 VL - 8 KW - ecological momentary assessment KW - data dashboard KW - study compliance KW - substance use KW - substance use behavior KW - college student KW - alcohol KW - cannabis KW - cannabis use KW - personalized data dashboard KW - EMA protocol KW - EMA KW - health behaviors KW - survey KW - compliance KW - self-reported N2 - Background: The landscape of substance use behavior among young adults has observed rapid changes over time. Intensive longitudinal designs are ideal for examining and intervening in substance use behavior in real time but rely on high participant compliance in the study protocol, representing a significant challenge for researchers. Objective: This study aimed to evaluate the effect of including a personalized data dashboard (DD) in a text-based survey prompt on study compliance outcomes among college students participating in a 21-day ecological momentary assessment (EMA) study. Methods: Participants (N=91; 61/91, 67% female and 84/91, 92% White) were college students who engaged in recent alcohol and cannabis use. Participants were randomized to either complete a 21-day EMA protocol with 4 prompts/d (EMA Group) or complete the same EMA protocol with 1 personalized message and a DD indicating multiple metrics of progress in the study, delivered at 1 randomly selected prompt/d (EMA+DD Group) via a microrandomized design. Study compliance, completion time, self-reported protocol experiences, and qualitative responses were assessed for both groups. Results: Levels of compliance were similar across groups. Participants in the EMA+DD Group had overall faster completion times, with significant week-level differences in weeks 2 and 3 of the study (P=.047 and P=.03, respectively). Although nonsignificant, small-to-medium effect sizes were observed when comparing the groups in terms of compensation level (P=.08; Cohen w=0.19) and perceived burden (P=.09; Cohen d=-0.36). Qualitative findings revealed that EMA+DD participants perceived that seeing their progress facilitated engagement. Within the EMA+DD Group, providing a DD at the moment level did not significantly impact participants? likelihood of completing the EMA or completion time at that particular prompt (all P>.05), with the exception of the first prompt of the day (P=.01 and P<.001). Conclusions: Providing a DD may be useful to increase engagement, particularly for researchers aiming to assess health behaviors shortly after a survey prompt is deployed to participants? mobile devices. International Registered Report Identifier (IRRID): RR2-10.2196/57664 UR - https://formative.jmir.org/2024/1/e60193 UR - http://dx.doi.org/10.2196/60193 UR - http://www.ncbi.nlm.nih.gov/pubmed/ ID - info:doi/10.2196/60193 ER - TY - JOUR AU - Edler, Johanna-Sophie AU - Winter, Michael AU - Steinmetz, Holger AU - Cohrdes, Caroline AU - Baumeister, Harald AU - Pryss, Rüdiger PY - 2024/12/3 TI - Predicting Depressive Symptoms Using GPS-Based Regional Data in Germany With the CORONA HEALTH App During the COVID-19 Pandemic: Cross-Sectional Study JO - Interact J Med Res SP - e53248 VL - 13 KW - depression KW - COVID-19 KW - mobile phone KW - geographic information systems KW - GPS-based data KW - mobile applications KW - mental health N2 - Background: Numerous studies have been conducted to predict depressive symptoms using passive smartphone data, mostly integrating the GPS signal as a measure of mobility. Environmental factors have been identified as correlated with depressive symptoms in specialized studies both before and during the pandemic. Objective: This study combined a data-based approach using passive smartphone data to predict self-reported depressive symptoms with a wide range of GPS-based environmental factors as predictors. Methods: The CORONA HEALTH app was developed for the purpose of data collection, and this app enabled the collection of both survey and passive data via smartphone. After obtaining informed consent, we gathered GPS signals at the time of study participation and evaluated depressive symptoms in 249 Android users with the Patient Health Questionnaire-9. The only GPS-based data collected were the participants? location at the time of the questionnaire, which was used to assign participants to the nearest district for linking regional sociodemographic data. Data collection took place from July 2020 to February 2021, coinciding with the COVID-19 pandemic. Using GPS data, each dataset was linked to a wide variety of data on regional sociodemographic, geographic, and economic characteristics describing the respondent?s environment, which were derived from a publicly accessible database from official German statistical offices. Moreover, pandemic-specific predictors such as the current pandemic phase or the number of new regional infections were matched via GPS. For the prediction of individual depressive symptoms, we compared 3 models (ie, ridge, lasso, and elastic net regression) and evaluated the models using 10-fold cross-validation. Results: The final elastic net regression model showed the highest explained variance (R2=0.06) and reduced the dataset from 121 to 9 variables, the 3 main predictors being current COVID-19 infections in the respective district, the number of places in nursing homes, and the proportion of fathers receiving parental benefits. The number of places in nursing homes refers to the availability of care facilities for the elderly, which may indicate regional population characteristics that influence mental health. The proportion of fathers receiving parental benefits reflects family structure and work-life balance, which could impact stress and mental well-being during the pandemic. Conclusions: Passive data describing the environment contributed to the prediction of individual depressive symptoms and revealed regional risk and protective factors that may be of interest without their inclusion in routine assessments being costly. UR - https://www.i-jmr.org/2024/1/e53248 UR - http://dx.doi.org/10.2196/53248 UR - http://www.ncbi.nlm.nih.gov/pubmed/39625745 ID - info:doi/10.2196/53248 ER - TY - JOUR AU - Morrow, L. Emily AU - Nelson, A. Lyndsay AU - Duff, C. Melissa AU - Mayberry, S. Lindsay PY - 2024/11/26 TI - An Ecological Momentary Assessment and Intervention Tool for Memory in Chronic Traumatic Brain Injury: Development and Usability of Memory Ecological Momentary Intervention JO - JMIR Rehabil Assist Technol SP - e59630 VL - 11 KW - chronic traumatic brain injury KW - rehabilitation KW - memory KW - ecological momentary intervention KW - text messaging KW - mobile health KW - mobile application KW - digital health KW - digital intervention N2 - Background: Memory and learning deficits are among the most impactful and longest-lasting symptoms experienced by people with chronic traumatic brain injury (TBI). Despite the persistence of post-TBI memory deficits and their implications for community reintegration, memory rehabilitation is restricted to short-term care within structured therapy sessions. Technology shows promise to extend memory rehabilitation into daily life and to increase the number and contextual diversity of learning opportunities. Ecological momentary assessment and intervention frameworks leverage mobile phone technology to assess and support individuals? behaviors across contexts and have shown benefits in other chronic conditions. However, few studies have used regular outreach via text messaging for adults with chronic TBI, and none have done so to assess and support memory. Objective: This study aimed to develop and test the usability of memory ecological momentary intervention (MEMI), a text message?based assessment and intervention tool for memory in daily life. MEMI is designed to introduce new information, cue retrieval of the information, and assess learning across time and contexts. We tested MEMI via an iterative, user-centered design process to ready it for a future trial. Methods: We developed MEMI by leveraging automated text messages for prompts using a REDCap (Research Electronic Data Capture)/Twilio interface linking to the Gorilla web-based behavioral experimental platform. We recruited 14 adults with chronic, moderate-severe TBI from the Vanderbilt Brain Injury Patient Registry to participate in 3 rounds of usability testing: one round of ThinkAloud sessions using the platform and providing real-time feedback to an experimenter (n=4) and 2 rounds of real-world usability testing in which participants used MEMI in their daily lives for a week and provided feedback (n=5/round). We analyzed engagement and quantitative and qualitative user feedback to assess MEMI?s usability and acceptability. Results: Participants were highly engaged with MEMI, completing an average of 11.8 out of 12 (98%) possible sessions. They rated MEMI as highly usable, with scores on the System Usability Scale across all rounds equivalent to an A+ on a standardized scale. In semistructured interviews, they stated that MEMI was simple and easy to use, that daily retrieval sessions were not burdensome, and that they perceived MEMI as helpful for memory. We identified a few small issues (eg, instruction wording) and made improvements between usability testing rounds. Conclusions: Testing MEMI with adults with chronic TBI revealed that this technology is highly usable and favorably rated for this population. We incorporated feedback regarding users? preferences and plan to test the efficacy of this tool in a future clinical trial. UR - https://rehab.jmir.org/2024/1/e59630 UR - http://dx.doi.org/10.2196/59630 ID - info:doi/10.2196/59630 ER - TY - JOUR AU - Paolillo, W. Emily AU - Bomyea, Jessica AU - Depp, A. Colin AU - Henneghan, M. Ashley AU - Raj, Anunay AU - Moore, C. Raeanne PY - 2024/11/25 TI - Characterizing Performance on a Suite of English-Language NeuroUX Mobile Cognitive Tests in a US Adult Sample: Ecological Momentary Cognitive Testing Study JO - J Med Internet Res SP - e51978 VL - 26 KW - digital health KW - cognition KW - cognitive aging KW - neuropsychology KW - mobile health KW - psychometrics KW - mobile phone KW - Ecological Momentary Assessment KW - EMA KW - NeuroUX N2 - Background: Mobile cognitive testing is growing in popularity, with numerous advantages over traditional cognitive testing; however, the field lacks studies that deeply examine mobile cognitive test data from general adult samples. Objective: This study characterized performance for a suite of 8 mobile cognitive tests from the NeuroUX platform in a sample of US adults across the adult lifespan. Methods: Overall, 393 participants completed 8 NeuroUX cognitive tests and a brief ecological momentary assessment survey once per day on their smartphones for 10 consecutive days; each test was administered 5 times over the testing period. The tests tapped the domains of executive function, processing speed, reaction time, recognition memory, and working memory. Participants also completed a poststudy usability feedback survey. We examined alternate form test-retest reliability; practice effects; and associations between scores (averages and intraindividual variability) and demographics as well as test-taking context (ie, smartphone type, being at home vs not at home, and being alone vs not alone). Results: Our final sample consisted of 393 English-speaking US residents (aged 20-79 y; female: n=198, 50.4%). Of the 367 participants who provided responses about their race and ethnicity, 258 (70.3%) were White. Of the 393 participants, 181 (46.1%) were iOS users, and 212 (53.9%) were Android users. Of 12 test scores derived from the 8 tests, 9 (75%) showed good to excellent test-retest reliability (intraclass correlation coefficients >0.76). Practice effects (ie, improvements in performance) were observed for 4 (33%) of the 12 scores. Older age was associated with worse performance on most of the test scores (9/12, 75%) and greater within-person variability for nearly all reaction time scores (3/4, 75%). Relationships with smartphone type showed better performance among iOS users and those with newer Android software versions compared to those with older software. Being at home (vs not at home) was associated with better performance on tests of processing speed. Being alone (vs not alone) was associated with better performance on tests of recognition and working memory. Poststudy feedback indicated that participants found NeuroUX easy to learn and use, an enjoyable experience, and an app that would be helpful in understanding their thinking skills. Only 4.2% (16/379) endorsed privacy concerns, and 77.3% (293/379) reported that they would be willing to share their results with their health care provider. Older age?but not other demographics?was associated with finding the tests more challenging. Conclusions: In a sample of adults across a wide age range, this study characterized features that are particularly important for the interpretation of remote, repeated mobile cognitive testing performance, including test-retest reliability, practice effects, smartphone type, and test-taking context. These data enhance the understanding and application of mobile cognitive testing, paving the way for improved clinical decision-making, personalized interventions, and advancements in cognitive research. UR - https://www.jmir.org/2024/1/e51978 UR - http://dx.doi.org/10.2196/51978 UR - http://www.ncbi.nlm.nih.gov/pubmed/ ID - info:doi/10.2196/51978 ER - TY - JOUR AU - Sheehan, M. Diana AU - Gwanzura, Tendai AU - Ibarra, Cynthia AU - Ramirez-Ortiz, Daisy AU - Swendeman, Dallas AU - Duncan, T. Dustin AU - Muñoz-Laboy, Miguel AU - Devieux, G. Jessy AU - Trepka, Jo Mary PY - 2024/11/21 TI - Psychometric Properties of Measuring Antiretroviral Therapy Adherence Among Young Latino Sexual Minority Men With HIV: Ecological Momentary Assessment and Electronic Pill Dispenser Study JO - Online J Public Health Inform SP - e51424 VL - 16 KW - human immunodeficiency virus KW - HIV KW - MSM KW - sexual minority KW - antiretroviral therapy KW - Latino KW - Hispanic KW - adherence KW - psychometric KW - ecological momentary assessment KW - electronic pill dispenser KW - validity KW - acceptability KW - compliance KW - medication dispenser KW - reminder KW - alert KW - digital health KW - young adult N2 - Background: Increasing HIV rates among young Latino sexual minority men (YLSMM) warrant innovative and rigorous studies to assess prevention and treatment strategies. Ecological momentary assessments (EMAs) and electronic pill dispensers (EPDs) have been used to measure antiretroviral therapy (ART) adherence repeatedly in real time and in participants? natural environments, but their psychometric properties among YLSMM are unknown. Objective: The study?s objective was to assess the concurrent validity, acceptability, compliance, and behavioral reactivity of EMAs and EPDs among YLSMM with HIV. Methods: A convenience sample of 56 YLSMM with HIV with suboptimal ART adherence, aged 18?34 years, was recruited into a 28-consecutive-day EMA study. Concurrent validity was analyzed by comparing median ART adherence rates and calculating Spearman correlations between ART adherence measured by EMA, EPD, and baseline retrospective validated 3-item and single-item measures. Acceptability was assessed in exit interviews asking participants to rate EMA and EPD burden. Compliance was assessed by computing the percent lost to follow-up, the percent of EMAs missed, and the percentage of days the EPD was not opened that had corresponding EMA data self-reporting adherence to ARTs. Behavioral reactivity was assessed by computing the median change in ART adherence during the study period, using generalized mixed models to assess whether the cumulative number of EMAs completed and days of EPD use predicted ART adherence over time, and by asking participants to rate perceived reactivity using a Likert scale. Results: EMA ART adherence was significantly correlated with baseline validated 3-item (r=0.41, P=.003) and single-item (r=0.52, P<.001) measures, but correlations were only significant for participants that reported EMA was not burdensome. Correlations for EPD ART adherence were weaker but significant (r=0.36, P=.009; r=0.34, P=.01, respectively). Acceptability was high for EMAs (48/54, 89%) and EPDs (52/54, 96%) per self-report. Loss to follow-up was 4% (2/56), with the remaining participants completing 88.6% (1339/1512) of study-prompted EMAs. The percentage of missed EMA surveys increased from 5.8% (22/378) in week 1 of the study to 16.7% (63/378) in week 4. Of 260 days when EPDs were not opened, 68.8% (179) had a corresponding EMA survey self-reporting ART adherence. Reactivity inferred from the median change in ART adherence over time was 8.8% for EMAs and ?0.8% for EPDs. Each completed EMA was associated with 1.03 odds (95% CI 1?1.07) of EMA ART adherence over time, and each day of EPD use with 0.97 odds (95% CI 0.96?0.99) of EPD ART adherence over time. Self-reported perceived behavioral reactivity was 39% for EMAs and 35% for EPDs. Conclusions: This study provides evidence of concurrent validity with retrospective validated measures for EMA- and EPD-measured ART adherence among YLSMM, when participant burden is carefully considered, without significant behavioral reactivity. While acceptability and compliance of EMAs and EPDs were high overall, noncompliance increased over time, suggesting respondent fatigue. UR - https://ojphi.jmir.org/2024/1/e51424 UR - http://dx.doi.org/10.2196/51424 ID - info:doi/10.2196/51424 ER - TY - JOUR AU - van Aubel, Evelyne AU - Vaessen, Thomas AU - Uyttebroek, Lotte AU - Steinhart, Henrietta AU - Beijer-Klippel, Annelie AU - Batink, Tim AU - van Winkel, Ruud AU - de Haan, Lieuwe AU - van der Gaag, Mark AU - van Amelsvoort, Thérèse AU - Marcelis, Machteld AU - Schirmbeck, Frederike AU - Reininghaus, Ulrich AU - Myin-Germeys, Inez PY - 2024/11/21 TI - Engagement and Acceptability of Acceptance and Commitment Therapy in Daily Life in Early Psychosis: Secondary Findings From a Multicenter Randomized Controlled Trial JO - JMIR Form Res SP - e57109 VL - 8 KW - acceptance and commitment therapy KW - ACT KW - first episode of psychosis KW - FEP KW - ultrahigh risk for psychosis KW - UHR KW - ecological momentary intervention KW - EMI KW - mobile health KW - mHealth KW - blended care KW - mobile phone N2 - Background: Acceptance and commitment therapy (ACT) is promising in the treatment of early psychosis. Augmenting face-to-face ACT with mobile health ecological momentary interventions may increase its treatment effects and empower clients to take treatment into their own hands. Objective: This study aimed to investigate and predict treatment engagement with and acceptability of acceptance and commitment therapy in daily life (ACT-DL), a novel ecological momentary intervention for people with an ultrahigh risk state and a first episode of psychosis. Methods: In the multicenter randomized controlled trial, 148 individuals with ultrahigh risk or first-episode psychosis aged 15-65 years were randomized to treatment as usual only (control) or to ACT-DL combined with treatment as usual (experimental), consisting of 8 face-to-face sessions augmented with an ACT-based smartphone app, delivering ACT skills and techniques in daily life. For individuals in the intervention arm, we collected data on treatment engagement with and acceptability of ACT-DL during and after the intervention. Predictors of treatment engagement and acceptability included baseline demographic, clinical, and functional outcomes. Results: Participants who received ACT-DL in addition to treatment as usual (n=71) completed a mean of 6 (SD 3) sessions, with 59% (n=42) of participants completing all sessions. App engagement data (n=58) shows that, on a weekly basis, participants used the app 13 times and were compliant with 6 of 24 (25%) notifications. Distribution plots of debriefing scores (n=46) show that 85%-96% of participants reported usefulness on all acceptability items to at least some extent (scores ?2; 1=no usefulness) and that 91% (n=42) of participants reported perceived burden by number and length of notifications (scores ?2; 1=no burden). Multiple linear regression models were fitted to predict treatment engagement and acceptability. Ethnic minority backgrounds predicted lower notification response compliance (B=?4.37; P=.01), yet higher app usefulness (B=1.25; P=.049). Negative (B=?0.26; P=.01) and affective (B=0.14; P=.04) symptom severity predicted lower and higher ACT training usefulness, respectively. Being female (B=?1.03; P=.005) predicted lower usefulness of the ACT metaphor images on the app. Conclusions: Our results corroborate good treatment engagement with and acceptability of ACT-DL in early psychosis. We provide recommendations for future intervention optimization. Trial Registration: OMON NL46439.068.13; https://onderzoekmetmensen.nl/en/trial/24803 UR - https://formative.jmir.org/2024/1/e57109 UR - http://dx.doi.org/10.2196/57109 UR - http://www.ncbi.nlm.nih.gov/pubmed/39570655 ID - info:doi/10.2196/57109 ER - TY - JOUR AU - Stone, Chris AU - Essery, Rosie AU - Matthews, Joe AU - Naughton, Felix AU - Munafo, Marcus AU - Attwood, Angela AU - Skinner, Andy PY - 2024/11/21 TI - Presenting and Evaluating a Smartwatch-Based Intervention for Smoking Relapse (StopWatch): Feasibility and Acceptability Study JO - JMIR Form Res SP - e56999 VL - 8 KW - smoking KW - smoking cessation KW - passive detection KW - just-in-time intervention KW - JITAI KW - relapse prevention KW - relapse KW - smartwatch KW - wearable technology KW - wearable KW - mobile health KW - mHealth KW - mobile phone N2 - Background: Despite the benefits of smoking cessation, maintaining abstinence during a quit attempt is difficult, and most attempts result in relapse. Innovative, evidence-based methods of preventing relapse are needed. We present a smartwatch-based relapse prevention system that uses passive detection of smoking to trigger just-in-time smoking cessation support. Objective: This study aims to evaluate the feasibility of hosting just-in-time smoking cessation support on a smartwatch and the acceptability of the ?StopWatch? intervention on this platform. Methods: The person-based approach for intervention development was used to design the StopWatch smoking relapse prevention intervention. Intervention delivery was triggered by an algorithm identifying hand movements characteristic of smoking from the smartwatch?s motion sensors, and the system-generated intervention messages (co-designed by smokers) were delivered on the smartwatch screen. A total of 18 smokers tested the intervention over a 2-week period, and at the end of this period, they provided qualitative feedback on the acceptability of both the intervention and the smartwatch platform. Results: Participants reported that the smartwatch intervention increased their awareness of smoking and motivated them to quit. System-generated intervention messages were generally felt to be relevant and timely. There were some challenges with battery life that had implications for intervention adherence, and the bulkiness of the device and the notification style reduced some participants? acceptability of the smartwatch platform. Conclusions: Our findings indicate our smoking relapse prevention intervention and the use of a smartwatch as a platform to host a just-in-time behavior change intervention are both feasible and acceptable to most (12/18, 66%) participants as a relapse prevention intervention, but we identify some concerns around the physical limitations of the smartwatch device. In particular, the bulkiness of the device and the battery capacity present risks to adherence to the intervention and the potential for missed detections. We recommend that a longer-term efficacy trial be carried out as the next step. UR - https://formative.jmir.org/2024/1/e56999 UR - http://dx.doi.org/10.2196/56999 UR - http://www.ncbi.nlm.nih.gov/pubmed/39570656 ID - info:doi/10.2196/56999 ER - TY - JOUR AU - Slade, Christopher AU - Benzo, M. Roberto AU - Washington, Peter PY - 2024/11/18 TI - Design Guidelines for Improving Mobile Sensing Data Collection: Prospective Mixed Methods Study JO - J Med Internet Res SP - e55694 VL - 26 KW - mobile health sensing KW - mHealth KW - active data collection KW - passive data collection KW - ecological momentary assessment KW - mobile data KW - mobile phone KW - machine learning KW - real-world setting KW - mixed method KW - college KW - student KW - user data KW - data consistency N2 - Background: Machine learning models often use passively recorded sensor data streams as inputs to train machine learning models that predict outcomes captured through ecological momentary assessments (EMA). Despite the growth of mobile data collection, challenges in obtaining proper authorization to send notifications, receive background events, and perform background tasks persist. Objective: We investigated challenges faced by mobile sensing apps in real-world settings in order to develop design guidelines. For active data, we compared 2 prompting strategies: setup prompting, where the app requests authorization during its initial run, and contextual prompting, where authorization is requested when an event or notification occurs. Additionally, we evaluated 2 passive data collection paradigms: collection during scheduled background tasks and persistent reminders that trigger passive data collection. We investigated the following research questions (RQs): (RQ1) how do setup prompting and contextual prompting affect scheduled notification delivery and the response rate of notification-initiated EMA? (RQ2) Which authorization paradigm, setup or contextual prompting, is more successful in leading users to grant authorization to receive background events? and (RQ3) Which polling-based method, persistent reminders or scheduled background tasks, completes more background sessions? Methods: We developed mobile sensing apps for iOS and Android devices and tested them through a 30-day user study asking college students (n=145) about their stress levels. Participants responded to a daily EMA question to test active data collection. The sensing apps collected background location events, polled for passive data with persistent reminders, and scheduled background tasks to test passive data collection. Results: For RQ1, setup and contextual prompting yielded no significant difference (ANOVA F1,144=0.0227; P=.88) in EMA compliance, with an average of 23.4 (SD 7.36) out of 30 assessments completed. However, qualitative analysis revealed that contextual prompting on iOS devices resulted in inconsistent notification deliveries. For RQ2, contextual prompting for background events was 55.5% (?21=4.4; P=.04) more effective in gaining authorization. For RQ3, users demonstrated resistance to installing the persistent reminder, but when installed, the persistent reminder performed 226.5% more background sessions than traditional background tasks. Conclusions: We developed design guidelines for improving mobile sensing on consumer mobile devices based on our qualitative and quantitative results. Our qualitative results demonstrated that contextual prompts on iOS devices resulted in inconsistent notification deliveries, unlike setup prompting on Android devices. We therefore recommend using setup prompting for EMA when possible. We found that contextual prompting is more efficient for authorizing background events. We therefore recommend using contextual prompting for passive sensing. Finally, we conclude that developing a persistent reminder and requiring participants to install it provides an additional way to poll for sensor and user data and could improve data collection to support adaptive interventions powered by machine learning. UR - https://www.jmir.org/2024/1/e55694 UR - http://dx.doi.org/10.2196/55694 UR - http://www.ncbi.nlm.nih.gov/pubmed/ ID - info:doi/10.2196/55694 ER - TY - JOUR AU - Lanza, T. Stephanie AU - Linden-Carmichael, N. Ashley AU - Wang, Danny AU - Bhandari, Sandesh AU - Stull, W. Samuel PY - 2024/11/11 TI - A Personalized Data Dashboard to Improve Compliance with Ecological Momentary Assessments in College Students: Protocol for a Microrandomized Trial JO - JMIR Res Protoc SP - e57664 VL - 13 KW - ecological momentary assessments KW - data dashboard KW - study compliance KW - microrandomized trial KW - intensive longitudinal data KW - EMA KW - adolescents KW - substance use KW - wearables N2 - Background: Ecological momentary assessments (EMA) are ideal for capturing the dynamic nature of young adult substance use behavior in daily life and identifying contextual risk factors that signal higher-risk episodes. These methods could provide a signal to trigger real-time intervention delivery. Study compliance and engagement are common barriers to participation but may be improved by personalizing messages. This study compares compliance outcomes between one group of young adults receiving standard (generic) prompts at each assessment and another group that received additional personalization and an updated data dashboard (DD) showing study progress to date at 1 randomly selected prompt per day. Objective: The primary objectives are to (1) develop a real-time DD for giving participants personalized updates on their progress in the study and (2) examine its preliminary overall effects on study compliance and experiences. Secondary objectives are to identify person-, day-, and moment-level characteristics associated with study compliance and person-level characteristics associated with perceived usefulness of the DD. Methods: This is a protocol for Project ENGAGE, a 2-arm randomized controlled trial. Arm 1 (EMA group) is engaged in a standard EMA protocol, and arm 2 (EMA+DD group) is engaged in the same study but with additional personalization and feedback. Inclusion criteria are (1) previous participation in a recent college student survey about health behavior and mental health who indicated willingness to participate in future research studies and (2) indicated past-month alcohol use; lifetime marijuana, hashish, or Delta-8-tetrahydrocannabinol (THC) use; or some combination of these on that survey. All participants in this study completed a baseline survey; EMA at 11 AM, 2 PM, 5 PM, and 8 PM each day for 21 days; and an exit survey. Participants in arm 2 engaged in a microrandomized trial, receiving a personalized DD at 1 randomly selected prompt per day. Primary outcomes include whether a survey was completed, time to complete a survey, and subjective experiences in the study. Primary analyses will compare groups on overall study compliance and, for arm 2, use marginal models to assess the momentary effect of receiving 1 updated DD per day. Results: Approval was granted by the university?s institutional review board on February 8, 2023. Recruitment via direct email occurred on March 30 and April 6, 2023; data collection was completed by April 29, 2023. A total of 91 individuals participated in the study. Results have been accepted for publication in JMIR Formative Research. Conclusions: Results from the evaluation of this study will indicate whether providing (at randomly selected prompts) real-time, personalized feedback on a participant?s progress in an EMA study improves study compliance. Overall, this study will inform whether a simple, automated DD presenting study compliance and incentives earned to date may improve young adults? compliance and engagement in intensive longitudinal studies. International Registered Report Identifier (IRRID): DERR1-10.2196/57664 UR - https://www.researchprotocols.org/2024/1/e57664 UR - http://dx.doi.org/10.2196/57664 UR - http://www.ncbi.nlm.nih.gov/pubmed/ ID - info:doi/10.2196/57664 ER - TY - JOUR AU - Geeraerts, Joran AU - Pivodic, Lara AU - Rosquin, Lise AU - Naert, Eline AU - Crombez, Geert AU - De Ridder, Mark AU - Van den Block, Lieve PY - 2024/11/5 TI - Uncovering the Daily Experiences of People Living With Advanced Cancer Using an Experience Sampling Method Questionnaire: Development, Content Validation, and Optimization Study JO - JMIR Cancer SP - e57510 VL - 10 KW - cancer KW - quality of life KW - ecological momentary assessment KW - experience sampling method KW - telemedicine KW - mHealth KW - eHealth KW - patient outcome assessment KW - validated instruments N2 - Background: The experience sampling method (ESM), a self-report method that typically uses multiple assessments per day, can provide detailed knowledge of the daily experiences of people with cancer, potentially informing oncological care. The use of the ESM among people with advanced cancer is limited, and no validated ESM questionnaires have been developed specifically for oncology. Objective: This study aims to develop, content validate, and optimize the digital Experience Sampling Method for People Living With Advanced Cancer (ESM-AC) questionnaire, covering multidimensional domains and contextual factors. Methods: A 3-round mixed methods study was designed in accordance with the Consensus-Based Standards for the Selection of Health Measurement Instruments (COSMIN) and the European Organization for Research and Treatment of Cancer guidelines. The study included semistructured interviews with 43 people with stage IV breast cancer or stage III to IV lung cancer and 8 health care professionals. Round 1 assessed the appropriateness, relative importance, relevance, and comprehensiveness of an initial set of ESM items that were developed based on the existing questionnaires. Round 2 tested the comprehensibility of ESM items. Round 3 tested the usability of the digital ESM-AC questionnaire using the m-Path app. Analyses included descriptive statistics and qualitative content analysis. Results: Following the first round, we developed an initial core set of 68 items (to be used with all patients) and a supplementary set (optional; patients select items), both covering physical, psychological, social, spiritual-existential, and global well-being domains and concurrent contexts in which experiences occur. We categorized items to be assessed multiple times per day as momentary items (eg, ?At this moment, I feel tired?), once a day in the morning as morning items (eg, ?Last night, I slept well?), or once a day in the evening as evening items (eg, ?Today, I felt hopeful?). We used participants? evaluations to optimize the questionnaire items, the digital app, and its onboarding manual. This resulted in the ESM-AC questionnaire, which comprised a digital core questionnaire containing 31 momentary items, 2 morning items, and 7 evening items and a supplementary set containing 39 items. Participants largely rated the digital questionnaire as ?easy to use,? with an average score of 4.5 (SD 0.5) on a scale from 1 (?completely disagree?) to 5 (?completely agree?). Conclusions: We developed the ESM-AC questionnaire, a content-validated digital questionnaire for people with advanced breast or lung cancer. It showed good usability when administered on smartphone devices. Future research should evaluate the potential of this ESM tool to uncover daily experiences of people with advanced breast or lung cancer, explore its clinical utility, and extend its validation to other populations with advanced diseases. UR - https://cancer.jmir.org/2024/1/e57510 UR - http://dx.doi.org/10.2196/57510 UR - http://www.ncbi.nlm.nih.gov/pubmed/ ID - info:doi/10.2196/57510 ER - TY - JOUR AU - Coppersmith, DL Daniel AU - Bentley, H. Kate AU - Kleiman, M. Evan AU - Jaroszewski, C. Adam AU - Daniel, Merryn AU - Nock, K. Matthew PY - 2024/10/31 TI - Automated Real-Time Tool for Promoting Crisis Resource Use for Suicide Risk (ResourceBot): Development and Usability Study JO - JMIR Ment Health SP - e58409 VL - 11 KW - suicidal thoughts KW - suicidal behaviors KW - ecological momentary assessment KW - crisis resources KW - real-time tool KW - self-report KW - psychoeducation KW - app N2 - Background: Real-time monitoring captures information about suicidal thoughts and behaviors (STBs) as they occur and offers great promise to learn about STBs. However, this approach also introduces questions about how to monitor and respond to real-time information about STBs. Given the increasing use of real-time monitoring, there is a need for novel, effective, and scalable tools for responding to suicide risk in real time. Objective: The goal of this study was to develop and test an automated tool (ResourceBot) that promotes the use of crisis services (eg, 988) in real time through a rule-based (ie, if-then) brief barrier reduction intervention. Methods: ResourceBot was tested in a 2-week real-time monitoring study of 74 adults with recent suicidal thoughts. Results: ResourceBot was deployed 221 times to 36 participants. There was high engagement with ResourceBot (ie, 87% of the time ResourceBot was deployed, a participant opened the tool and submitted a response to it), but zero participants reported using crisis services after engaging with ResourceBot. The most reported reasons for not using crisis services were beliefs that the resources would not help, wanting to handle things on one?s own, and the resources requiring too much time or effort. At the end of the study, participants rated ResourceBot with good usability (mean of 75.6 out of 100) and satisfaction (mean of 20.8 out of 32). Conclusions: This study highlights both the possibilities and challenges of developing effective real-time interventions for suicide risk and areas for refinement in future work. UR - https://mental.jmir.org/2024/1/e58409 UR - http://dx.doi.org/10.2196/58409 UR - http://www.ncbi.nlm.nih.gov/pubmed/ ID - info:doi/10.2196/58409 ER - TY - JOUR AU - Cho, Minseo AU - Park, Doeun AU - Choo, Myounglee AU - Kim, Jinwoo AU - Han, Hyun Doug PY - 2024/10/24 TI - Development and Initial Evaluation of a Digital Phenotype Collection System for Adolescents: Proof-of-Concept Study JO - JMIR Form Res SP - e59623 VL - 8 KW - adolescents KW - adolescent mental health KW - smartphone apps KW - self-monitoring KW - qualitative research KW - phenotypes KW - proof of concept KW - digital phenotyping KW - phenotype data KW - ecological momentary assessment N2 - Background: The growing concern on adolescent mental health calls for proactive early detection and intervention strategies. There is a recognition of the link between digital phenotypes and mental health, drawing attention to their potential use. However, the process of collecting digital phenotype data presents challenges despite its promising prospects. Objective: This study aims to develop and validate system concepts for collecting adolescent digital phenotypes that effectively manage inherent challenges in the process. Methods: In a formative investigation (N=34), we observed adolescent self-recording behaviors and conducted interviews to develop design goals. These goals were then translated into system concepts, which included planners resembling interfaces, simplified data input with tags, visual reports on behaviors and moods, and supportive ecological momentary assessment (EMA) prompts. A proof-of-concept study was conducted over 2 weeks (n=16), using tools that simulated the concepts to record daily activities and complete EMA surveys. The effectiveness of the system was evaluated through semistructured interviews, supplemented by an analysis of the frequency of records and responses. Results: The interview findings revealed overall satisfaction with the system concepts, emphasizing strong support for self-recording. Participants consistently maintained daily records throughout the study period, with no missing data. They particularly valued the recording procedures that aligned well with their self-recording goal of time management, facilitated by the interface design and simplified recording procedures. Visualizations during recording and subsequent report viewing further enhanced engagement by identifying missing data and encouraging deeper self-reflection. The average EMA compliance reached 72%, attributed to a design that faithfully reflected adolescents? lives, with surveys scheduled at convenient times and supportive messages tailored to their daily routines. The high compliance rates observed and positive feedback from participants underscore the potential of our approach in addressing the challenges of collecting digital phenotypes among adolescents. Conclusions: Integrating observations of adolescents? recording behavior into the design process proved to be beneficial for developing an effective and highly compliant digital phenotype collection system. UR - https://formative.jmir.org/2024/1/e59623 UR - http://dx.doi.org/10.2196/59623 UR - http://www.ncbi.nlm.nih.gov/pubmed/39446465 ID - info:doi/10.2196/59623 ER - TY - JOUR AU - Yi, Li AU - Hart, E. Jaime AU - Straczkiewicz, Marcin AU - Karas, Marta AU - Wilt, E. Grete AU - Hu, R. Cindy AU - Librett, Rachel AU - Laden, Francine AU - Chavarro, E. Jorge AU - Onnela, Jukka-Pekka AU - James, Peter PY - 2024/10/11 TI - Measuring Environmental and Behavioral Drivers of Chronic Diseases Using Smartphone-Based Digital Phenotyping: Intensive Longitudinal Observational mHealth Substudy Embedded in 2 Prospective Cohorts of Adults JO - JMIR Public Health Surveill SP - e55170 VL - 10 KW - big data KW - daily mobility KW - digital phenotyping KW - ecological momentary assessment KW - epidemiological monitoring KW - health behavior KW - smartphone apps and sensors KW - mobile phone N2 - Background: Previous studies investigating environmental and behavioral drivers of chronic disease have often had limited temporal and spatial data coverage. Smartphone-based digital phenotyping mitigates the limitations of these studies by using intensive data collection schemes that take advantage of the widespread use of smartphones while allowing for less burdensome data collection and longer follow-up periods. In addition, smartphone apps can be programmed to conduct daily or intraday surveys on health behaviors and psychological well-being. Objective: The aim of this study was to investigate the feasibility and scalability of embedding smartphone-based digital phenotyping in large epidemiological cohorts by examining participant adherence to a smartphone-based data collection protocol in 2 ongoing nationwide prospective cohort studies. Methods: Participants (N=2394) of the Beiwe Substudy of the Nurses? Health Study 3 and Growing Up Today Study were followed over 1 year. During this time, they completed questionnaires every 10 days delivered via the Beiwe smartphone app covering topics such as emotions, stress and enjoyment, physical activity, access to green spaces, pets, diet (vegetables, meats, beverages, nuts and dairy, and fruits), sleep, and sitting. These questionnaires aimed to measure participants? key health behaviors to combine them with objectively assessed high-resolution GPS and accelerometer data provided by participants during the same period. Results: Between July 2021 and June 2023, we received 11.1 TB of GPS and accelerometer data from 2394 participants and 23,682 survey responses. The average follow-up time for each participant was 214 (SD 148) days. During this period, participants provided an average of 14.8 (SD 5.9) valid hours of GPS data and 13.2 (SD 4.8) valid hours of accelerometer data. Using a 10-hour cutoff, we found that 51.46% (1232/2394) and 53.23% (1274/2394) of participants had >50% of valid data collection days for GPS and accelerometer data, respectively. In addition, each participant submitted an average of 10 (SD 11) surveys during the same period, with a mean response rate of 36% across all surveys (SD 17%; median 41%). After initial processing of GPS and accelerometer data, we also found that participants spent an average of 14.6 (SD 7.5) hours per day at home and 1.6 (SD 1.6) hours per day on trips. We also recorded an average of 1046 (SD 1029) steps per day. Conclusions: In this study, smartphone-based digital phenotyping was used to collect intensive longitudinal data on lifestyle and behavioral factors in 2 well-established prospective cohorts. Our assessment of adherence to smartphone-based data collection protocols over 1 year suggests that adherence in our study was either higher or similar to most previous studies with shorter follow-up periods and smaller sample sizes. Our efforts resulted in a large dataset on health behaviors that can be linked to spatial datasets to examine environmental and behavioral drivers of chronic disease. UR - https://publichealth.jmir.org/2024/1/e55170 UR - http://dx.doi.org/10.2196/55170 UR - http://www.ncbi.nlm.nih.gov/pubmed/39392682 ID - info:doi/10.2196/55170 ER - TY - JOUR AU - Polivka, Barbara AU - Krueger, Kathryn AU - Bimbi, Olivia AU - Huntington-Moskos, Luz AU - Nyenhuis, Sharmilee AU - Cramer, Emily AU - Eldeirawi, Kamal PY - 2024/10/10 TI - Integrating Real-Time Air Quality Monitoring, Ecological Momentary Assessment, and Spirometry to Evaluate Asthma Symptoms: Usability Study JO - JMIR Form Res SP - e60147 VL - 8 KW - indoor air quality KW - asthma KW - real-time assessment KW - EMA KW - ecological momentary assessment KW - mobile phone KW - monitoring KW - air quality KW - real time KW - spirometry KW - acceptability KW - usability KW - residential toxins KW - volatile organic compounds KW - VOC KW - adult KW - female KW - women KW - college student N2 - Background: Individuals are exposed to a variety of indoor residential toxins including volatile organic compounds and particulates. In adults with asthma, such exposures are associated with asthma symptoms, asthma exacerbations, and decreased lung function. However, data on these exposures and asthma-related outcomes are generally collected at different times and not in real time. The integration of multiple platforms to collect real-time data on environmental exposure, asthma symptoms, and lung function has rarely been explored. Objective: This paper describes how adults with asthma perceive the acceptability and usability of three integrated devices: (1) residential indoor air quality monitor, (2) ecological momentary assessment (EMA) surveys delivered via a smartphone app, and (3) home spirometry, over 14 days. Methods: Participants (N=40) with uncontrolled asthma were mailed the Awair Omni indoor air quality monitor, ZEPHYRx home spirometer, and detailed instructions required for the in-home monitoring. The air quality monitor, spirometer, and EMA app were set up and tested during a videoconference or phone orientation with a research team member. Midway through the 14-day data collection period, participants completed an interview about the acceptability of the study devices or apps, instructional materials provided, and the setup process. At the end of the 14-day data collection period, participants completed a modified System Usability Scale. A random sample of 20 participants also completed a phone interview regarding the acceptability of the study and the impact of the study on their asthma. Results: Participants ranged in age from 26 to 77 (mean 45, SD 13.5) years and were primarily female (n=36, 90%), White (n=26, 67%), college graduates (n=25, 66%), and residing in a single-family home (n=30, 75%). Most indicated that the air quality monitor (n=23, 58%), the EMA (n=20, 50%), and the spirometer (n=17, 43%) were easy to set up and use. Challenges with the EMA included repetitive surveys, surveys arriving during the night, and technical issues. While the home spirometer was identified as a plausible means to evaluate lung function in real time, the interpretation of the readings was unclear, and several participants reported side effects from home spirometer use. Overall, the acceptability of the study and the System Usability Scale scores were high. Conclusions: The study devices were highly acceptable and usable. Participant feedback was instrumental in identifying technical challenges that should be addressed in future studies. UR - https://formative.jmir.org/2024/1/e60147 UR - http://dx.doi.org/10.2196/60147 UR - http://www.ncbi.nlm.nih.gov/pubmed/ ID - info:doi/10.2196/60147 ER - TY - JOUR AU - Rizvi, L. Shireen AU - Ruork, K. Allison AU - Yin, Qingqing AU - Yeager, April AU - Taylor, E. Madison AU - Kleiman, M. Evan PY - 2024/10/9 TI - Using Biosensor Devices and Ecological Momentary Assessment to Measure Emotion Regulation Processes: Pilot Observational Study With Dialectical Behavior Therapy JO - JMIR Ment Health SP - e60035 VL - 11 KW - wearable device KW - ecological momentary assessment KW - emotion regulation KW - psychotherapy mechanisms KW - dialectical behavior therapy KW - wearable KW - wristwatch KW - novel technology KW - psychological KW - treatment KW - pilot study KW - adult KW - personality disorder KW - mental health KW - mobile phone KW - EMA KW - observational study N2 - Background: Novel technologies, such as ecological momentary assessment (EMA) and wearable biosensor wristwatches, are increasingly being used to assess outcomes and mechanisms of change in psychological treatments. However, there is still a dearth of information on the feasibility and acceptability of these technologies and whether they can be reliably used to measure variables of interest. Objective: Our objectives were to assess the feasibility and acceptability of incorporating these technologies into dialectical behavior therapy and conduct a pilot evaluation of whether these technologies can be used to assess emotion regulation processes and associated problems over the course of treatment. Methods: A total of 20 adults with borderline personality disorder were enrolled in a 6-month course of dialectical behavior therapy. For 1 week out of every treatment month, participants were asked to complete EMA 6 times a day and to wear a biosensor watch. Each EMA assessment included measures of several negative affect and suicidal thinking, among other items. We used multilevel correlations to assess the contemporaneous association between electrodermal activity and 11 negative emotional states reported via EMA. A multilevel regression was conducted in which changes in composite ratings of suicidal thinking were regressed onto changes in negative affect. Results: On average, participants completed 54.39% (SD 33.1%) of all EMA (range 4.7%?92.4%). They also wore the device for an average of 9.52 (SD 6.47) hours per day and for 92.6% of all days. Importantly, no associations were found between emotional state and electrodermal activity, whether examining a composite of all high-arousal negative emotions or individual emotional states (within-person r ranged from ?0.026 to ?0.109). Smaller changes in negative affect composite scores were associated with greater suicidal thinking ratings at the subsequent timepoint, beyond the effect of suicidal thinking at the initial timepoint. Conclusions: Results indicated moderate overall compliance with EMA and wearing the watch; however, there was no concurrence between EMA and wristwatch data on emotions. This pilot study raises questions about the reliability and validity of these technologies incorporated into treatment studies to evaluate emotion regulation mechanisms. UR - https://mental.jmir.org/2024/1/e60035 UR - http://dx.doi.org/10.2196/60035 ID - info:doi/10.2196/60035 ER - TY - JOUR AU - Bronas, G. Ulf AU - Marquez, X. David AU - Fritschi, Cynthia AU - Petrarca, Katherine AU - Kitsiou, Spyros AU - Ajilore, Olu AU - Tintle, Nathan PY - 2024/9/5 TI - Ecological Momentary Intervention to Replace Sedentary Time With Physical Activity to Improve Executive Function in Midlife and Older Latino Adults: Pilot Randomized Controlled Trial JO - J Med Internet Res SP - e55079 VL - 26 KW - sedentary time KW - physical activity KW - cognition KW - older adults KW - Latinos KW - mobile phone N2 - Background: Exercise interventions often improve moderate to vigorous physical activity, but simultaneously increase sedentary time due to a compensatory resting response. A higher level of sedentary time is associated with a lower level of executive function, while increased moderate to vigorous physical activity is associated with improved global cognition and working memory among Latino adults. Latino adults are the fastest-growing minority group in the United States and are at high risk for cognitive decline, spend more time sedentary compared to non-Hispanic populations, and engage in low levels of physical activity. Interventions that are culturally appropriate for Latino adults to replace sedentary time with physical activity are critically needed. Objective: This study aims to develop and test the feasibility and acceptability of an ecological momentary intervention (EMI; delivered in real time) that is individually designed to replace sedentary time with physical activity in Latino adults. Methods: This pilot study randomized 39 (n=26, 67% female; mean age 61, SD 5.8 years) community-dwelling, Spanish-speaking Latino adults (1:1 allocation) to either a 6-week EMI program designed to replace sitting time with physical activity (20/39, 51%) or physical activity guidelines education (19/39, 49%). The program was conducted on the web and in Spanish. The intervention was individualized based on individual interview responses. The intervention included the use of a Fitbit activity monitor, weekly didactic phone meetings, interactive tools (SMS text messages), and coach-delivered feedback. Feasibility and acceptability were assessed via study satisfaction (Likert scales), motivation (ecological momentary assessment), retention, and compliance. Sedentary time and physical activity were assessed via 7-day actigraphy. Cognitive performance was assessed via the trail making test part A and B (part B=executive function) and via the National Institutes of Health Toolbox remote cognitive assessment. Statistical analysis included a linear model on change score from baseline, adjusting for age, sex, and education, emphasizing effect size. Results: Participant satisfaction with EMI was high (9.4/10), with a high degree of motivation to replace sitting time with physical activity (9.8/10). The intervention compliance rate was 79% with low difficulty using the Fitbit (1.7/10). Weekly step count increased in the intervention group by 5543 steps (group difference: d=0.54; P=.05) and sedentary time decreased by a mean 348 (SD 485) minutes (group difference: d=0.47; P=.24) compared to controls, with moderately strong effect sizes. The trail making test part B improved in the intervention group (mean ?35.26, SD 60.35 seconds), compared to the control group (mean 7.19, SD 46 seconds; group difference: d=0.74; P=.01). No group differences were observed in other cognitive measures. Conclusions: An individualized EMI designed for midlife and older Latino adults has the potential to replace sitting time with physical activity and improve executive functioning. The intervention was feasible and well received with a high degree of satisfaction. Trial Registration: ClinicalTrials.gov NCT04507464; https://tinyurl.com/44c4thk5 UR - https://www.jmir.org/2024/1/e55079 UR - http://dx.doi.org/10.2196/55079 UR - http://www.ncbi.nlm.nih.gov/pubmed/39235836 ID - info:doi/10.2196/55079 ER - TY - JOUR AU - Zhang, Jin Min AU - Luk, Tsun Tzu AU - Ho, Yin Sai AU - Wang, Ping Man AU - Lam, Hing Tai AU - Cheung, Derek Yee Tak PY - 2024/9/3 TI - Ecological Momentary Assessment of Alcohol Marketing Exposure, Alcohol Use, and Purchases Among University Students: Prospective Cohort Study JO - JMIR Mhealth Uhealth SP - e60052 VL - 12 KW - alcohol marketing KW - drinking KW - ecological momentary assessment KW - health behaviors KW - young adults KW - mobile phone N2 - 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. UR - https://mhealth.jmir.org/2024/1/e60052 UR - http://dx.doi.org/10.2196/60052 UR - http://www.ncbi.nlm.nih.gov/pubmed/39226102 ID - info:doi/10.2196/60052 ER - TY - JOUR AU - Businelle, S. Michael AU - Hébert, T. Emily AU - Shi, Dingjing AU - Benson, Lizbeth AU - Kezbers, M. Krista AU - Tonkin, Sarah AU - Piper, E. Megan AU - Qian, Tianchen PY - 2024/8/12 TI - Investigating Best Practices for Ecological Momentary Assessment: Nationwide Factorial Experiment JO - J Med Internet Res SP - e50275 VL - 26 KW - ecological momentary assessment KW - mobile health KW - smartphone KW - compliance KW - ambulatory assessment KW - adherence KW - experience sampling KW - mobile phone KW - mHealth KW - real-time data KW - behavior KW - dynamic behavioral processes KW - self-report KW - factorial design N2 - 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 UR - https://www.jmir.org/2024/1/e50275 UR - http://dx.doi.org/10.2196/50275 UR - http://www.ncbi.nlm.nih.gov/pubmed/ ID - info:doi/10.2196/50275 ER - TY - JOUR AU - Wang, D. Shirlene AU - Hatzinger, Lori AU - Morales, Jeremy AU - Hewus, Micaela AU - Intille, Stephen AU - Dunton, F. Genevieve PY - 2024/8/2 TI - Burden and Inattentive Responding in a 12-Month Intensive Longitudinal Study: Interview Study Among Young Adults JO - JMIR Form Res SP - e52165 VL - 8 KW - data quality KW - burden KW - exit interview KW - careless responding KW - ecological momentary assessment KW - intensive longitudinal data collection KW - mobile phone N2 - Background: Intensive longitudinal data (ILD) collection methods have gained popularity in social and behavioral research as a tool to better understand behavior and experiences over time with reduced recall bias. Engaging participants in these studies over multiple months and ensuring high data quality are crucial but challenging due to the potential burden of repeated measurements. It is suspected that participants may engage in inattentive responding (IR) behavior to combat burden, but the processes underlying this behavior are unclear as previous studies have focused on the barriers to compliance rather than the barriers to providing high-quality data. Objective: This study aims to broaden researchers? knowledge about IR during ILD studies using qualitative analysis and uncover the underlying IR processes to aid future hypothesis generation. Methods: We explored the process of IR by conducting semistructured qualitative exit interviews with 31 young adult participants (aged 18-29 years) who completed a 12-month ILD health behavior study with daily evening smartphone-based ecological momentary assessment (EMA) surveys and 4-day waves of hourly EMA surveys. The interviews assessed participants? motivations, the impact of time-varying contexts, changes in motivation and response patterns over time, and perceptions of attention check questions (ACQs) to understand participants? response patterns and potential factors leading to IR. Results: Thematic analysis revealed 5 overarching themes on factors that influence participant engagement: (1) friends and family also had to tolerate the frequent surveys, (2) participants tried to respond to surveys quickly, (3) the repetitive nature of surveys led to neutral responses, (4) ACQs within the surveys helped to combat overly consistent response patterns, and (5) different motivations for answering the surveys may have led to different levels of data quality. Conclusions: This study aimed to examine participants? perceptions of the quality of data provided in an ILD study to contribute to the field?s understanding of engagement. These findings provide insights into the complex process of IR and participant engagement in ILD studies with EMA. The study identified 5 factors influencing IR that could guide future research to improve EMA survey design. The identified themes offer practical implications for researchers and study designers, including the importance of considering social context, the consideration of dynamic motivations, and the potential benefit of including ACQs as a technique to reduce IR and leveraging the intrinsic motivators of participants. By incorporating these insights, researchers might maximize the scientific value of their multimonth ILD studies through better data collection protocols. International Registered Report Identifier (IRRID): RR2-10.2196/36666 UR - https://formative.jmir.org/2024/1/e52165 UR - http://dx.doi.org/10.2196/52165 UR - http://www.ncbi.nlm.nih.gov/pubmed/39093606 ID - info:doi/10.2196/52165 ER - TY - JOUR AU - Gallinat, Christina AU - Moessner, Markus AU - Wilhelm, Maximilian AU - Keuthen, Nancy AU - Bauer, Stephanie PY - 2024/7/18 TI - Patterns of Skin Picking in Skin Picking Disorder: Ecological Momentary Assessment Study JO - Interact J Med Res SP - e53831 VL - 13 KW - skin picking disorder KW - ecological momentary assessment KW - EMA KW - body-focused repetitive behavior KW - obsessive-compulsive spectrum KW - skin KW - dermatology KW - mental health KW - assessment KW - mobile phone N2 - Background: Skin picking disorder (SPD) is an understudied mental illness that is classified as a body-focused repetitive behavior disorder. Literature suggests that pathological skin picking is strongly integrated into the daily lives of affected individuals and may involve a high degree of variability in terms of episode characteristics, frequency, and intensity. However, existing data on the phenomenology of SPD are limited and typically involve retrospective assessments, which may fail to accurately capture the behavior?s variability. Objective: This study aimed to investigate skin picking in the daily lives of individuals with SPD by using ecological momentary assessment (EMA). The first aim focused on the description of skin picking patterns (eg, characteristics, intensity, and distribution of episodes and urges), and the second aim explored differences in characteristics and patterns between automatic and focused skin picking. Methods: Participants were recruited online and underwent a web-based screening, a diagnostic telephone interview, and a comprehensive online self-report questionnaire before participating in an EMA protocol. The latter included 10 consecutive days with 7 pseudorandom, time-contingent assessments per day between 8 AM and 10 PM. The EMA questionnaire assessed the current skin picking urge, the occurrence of the behavior, and a detailed assessment of the episodes? characteristics (eg, length, intensity, and consciousness) if applicable. Results: The final sample consisted of 57 participants, who completed at least 70% of the scheduled assessments (n=54, 94.7% female: mean age 29.3, SD 6.77 years). They completed 3758 EMAs and reported 1467 skin picking episodes. Skin picking occurred frequently (mean 2.57, SD 1.12 episodes per day and person) in relatively short episodes (10-30 min; 10 min: nepisodes=642, 43.8%; 20 min: nepisodes=312, 21.3%; 30 min: nepisodes=217, 14.8%), and it was distributed quite evenly throughout the day and across different days of the week. Focused and automatic episodes were relatively balanced across all reported episodes (focused: nepisodes=806, 54.9%) and over the course of the day. The analyses showed statistically significant differences between self-reported triggers for the different styles. Visual or tactile cues and the desire to pick the skin were more important for the focused style (visual or tactile cues: mean focused style [Mf]=4.01, SD 0.69 vs mean automatic style [Ma]=3.47, SD 0.99; P<.001; SMD=0.64; desire to pick: Mf=2.61, SD 1.06 vs Ma=1.94, SD 1.03; P<.001; SMD=0.82), while boredom and concentration problems were more prominent in automatic skin picking (boredom: Mf=1.69, SD 0.89 vs Ma=1.84, SD 0.89; P=.03; SMD=?0.31; concentration problems: Mf=2.06, SD 0.87 vs Ma=2.31, SD 1.06; P=.006; SMD=?0.41). Conclusions: These results contribute to an enhanced understanding of the phenomenology of SPD using a more rigorous assessment methodology. Our findings underscore that picking can impact affected persons multiple times throughout their daily lives. Trial Registration: German Clinical Trials Register DRKS00025168; https://tinyurl.com/mr35pdwh UR - https://www.i-jmr.org/2024/1/e53831 UR - http://dx.doi.org/10.2196/53831 UR - http://www.ncbi.nlm.nih.gov/pubmed/ ID - info:doi/10.2196/53831 ER - TY - JOUR AU - Hernandez, Raymond AU - Hoogendoorn, Claire AU - Gonzalez, S. Jeffrey AU - Pyatak, A. Elizabeth AU - Crespo-Ramos, Gladys AU - Schneider, Stefan PY - 2024/7/18 TI - Reliability and Validity of Ecological Momentary Assessment Response Time?Based Measures of Emotional Clarity: Secondary Data Analysis JO - JMIR Ment Health SP - e58352 VL - 11 KW - digital mental health KW - drift-diffusion model KW - ecological momentary assessment KW - emotional clarity KW - emotional health KW - emotion regulation KW - response time KW - positive affect KW - negative affect KW - type 1 diabetes KW - mobile phone N2 - Background: Emotional clarity has often been assessed with self-report measures, but efforts have also been made to measure it passively, which has advantages such as avoiding potential inaccuracy in responses stemming from social desirability bias or poor insight into emotional clarity. Response times (RTs) to emotion items administered in ecological momentary assessments (EMAs) may be an indirect indicator of emotional clarity. Another proposed indicator is the drift rate parameter, which assumes that, aside from how fast a person responds to emotion items, the measurement of emotional clarity also requires the consideration of how careful participants were in providing responses. Objective: This paper aims to examine the reliability and validity of RTs and drift rate parameters from EMA emotion items as indicators of individual differences in emotional clarity. Methods: Secondary data analysis was conducted on data from 196 adults with type 1 diabetes who completed a 2-week EMA study involving the completion of 5 to 6 surveys daily. If lower RTs and higher drift rates (from EMA emotion items) were indicators of emotional clarity, we hypothesized that greater levels (ie, higher clarity) should be associated with greater life satisfaction; lower levels of neuroticism, depression, anxiety, and diabetes distress; and fewer difficulties with emotion regulation. Because prior literature suggested emotional clarity could be valence specific, EMA items for negative affect (NA) and positive affect were examined separately. Results: Reliability of the proposed indicators of emotional clarity was acceptable with a small number of EMA prompts (ie, 4 to 7 prompts in total or 1 to 2 days of EMA surveys). Consistent with expectations, the average drift rate of NA items across multiple EMAs had expected associations with other measures, such as correlations of r=?0.27 (P<.001) with depression symptoms, r=?0.27 (P=.001) with anxiety symptoms, r=?0.15 (P=.03) with emotion regulation difficulties, and r=0.63 (P<.001) with RTs to NA items. People with a higher NA drift rate responded faster to NA emotion items, had greater subjective well-being (eg, fewer depression symptoms), and had fewer difficulties with overall emotion regulation, which are all aligned with the expectation for an emotional clarity measure. Contrary to expectations, the validities of average RTs to NA items, the drift rate of positive affect items, and RTs to positive affect items were not strongly supported by our results. Conclusions: Study findings provided initial support for the validity of NA drift rate as an indicator of emotional clarity but not for that of other RT-based clarity measures. Evidence was preliminary because the sample size was not sufficient to detect small but potentially meaningful correlations, as the sample size of the diabetes EMA study was chosen for other more primary research questions. Further research on passive emotional clarity measures is needed. UR - https://mental.jmir.org/2024/1/e58352 UR - http://dx.doi.org/10.2196/58352 UR - http://www.ncbi.nlm.nih.gov/pubmed/39024004 ID - info:doi/10.2196/58352 ER - TY - JOUR AU - Ng, Yi Mei AU - Frederick, A. Jennifer AU - Fisher, J. Aaron AU - Allen, B. Nicholas AU - Pettit, W. Jeremy AU - McMakin, L. Dana PY - 2024/7/16 TI - Identifying Person-Specific Drivers of Depression in Adolescents: Protocol for a Smartphone-Based Ecological Momentary Assessment and Passive Sensing Study JO - JMIR Res Protoc SP - e43931 VL - 13 KW - adolescents KW - depression KW - idiographic assessment KW - network modeling KW - treatment personalization KW - ecological momentary assessment KW - mobile sensing KW - digital phenotyping KW - actigraphy KW - smartphones N2 - Background: Adolescence is marked by an increasing risk of depression and is an optimal window for prevention and early intervention. Personalizing interventions may be one way to maximize therapeutic benefit, especially given the marked heterogeneity in depressive presentations. However, empirical evidence that can guide personalized intervention for youth is lacking. Identifying person-specific symptom drivers during adolescence could improve outcomes by accounting for both developmental and individual differences. Objective: This study leverages adolescents? everyday smartphone use to investigate person-specific drivers of depression and validate smartphone-based mobile sensing data against established ambulatory methods. We describe the methods of this study and provide an update on its status. After data collection is completed, we will address three specific aims: (1) identify idiographic drivers of dynamic variability in depressive symptoms, (2) test the validity of mobile sensing against ecological momentary assessment (EMA) and actigraphy for identifying these drivers, and (3) explore adolescent baseline characteristics as predictors of these drivers. Methods: A total of 50 adolescents with elevated symptoms of depression will participate in 28 days of (1) smartphone-based EMA assessing depressive symptoms, processes, affect, and sleep; (2) mobile sensing of mobility, physical activity, sleep, natural language use in typed interpersonal communication, screen-on time, and call frequency and duration using the Effortless Assessment of Risk States smartphone app; and (3) wrist actigraphy of physical activity and sleep. Adolescents and caregivers will complete developmental and clinical measures at baseline, as well as user feedback interviews at follow-up. Idiographic, within-subject networks of EMA symptoms will be modeled to identify each adolescent?s person-specific drivers of depression. Correlations among EMA, mobile sensor, and actigraph measures of sleep, physical, and social activity will be used to assess the validity of mobile sensing for identifying person-specific drivers. Data-driven analyses of mobile sensor variables predicting core depressive symptoms (self-reported mood and anhedonia) will also be used to assess the validity of mobile sensing for identifying drivers. Finally, between-subject baseline characteristics will be explored as predictors of person-specific drivers. Results: As of October 2023, 84 families were screened as eligible, of whom 70% (n=59) provided informed consent and 46% (n=39) met all inclusion criteria after completing baseline assessment. Of the 39 included families, 85% (n=33) completed the 28-day smartphone and actigraph data collection period and follow-up study visit. Conclusions: This study leverages depressed adolescents? everyday smartphone use to identify person-specific drivers of adolescent depression and to assess the validity of mobile sensing for identifying these drivers. The findings are expected to offer novel insights into the structure and dynamics of depressive symptomatology during a sensitive period of development and to inform future development of a scalable, low-burden smartphone-based tool that can guide personalized treatment decisions for depressed adolescents. International Registered Report Identifier (IRRID): DERR1-10.2196/43931 UR - https://www.researchprotocols.org/2024/1/e43931 UR - http://dx.doi.org/10.2196/43931 UR - http://www.ncbi.nlm.nih.gov/pubmed/39012691 ID - info:doi/10.2196/43931 ER - TY - JOUR AU - Carey, L. Rachel AU - Le, Ha AU - Coffman, L. Donna AU - Nahum-Shani, Inbal AU - Thirumalai, Mohanraj AU - Hagen, Cole AU - Baehr, A. Laura AU - Schmidt-Read, Mary AU - Lamboy, R. Marlyn S. AU - Kolakowsky-Hayner, A. Stephanie AU - Marino, J. Ralph AU - Intille, S. Stephen AU - Hiremath, V. Shivayogi PY - 2024/6/28 TI - mHealth-Based Just-in-Time Adaptive Intervention to Improve the Physical Activity Levels of Individuals With Spinal Cord Injury: Protocol for a Randomized Controlled Trial JO - JMIR Res Protoc SP - e57699 VL - 13 KW - spinal cord injury KW - physical activity KW - just-in-time adaptive intervention KW - mobile health KW - randomized controlled trial KW - microrandomized trial KW - wearable sensors KW - ecological momentary assessment KW - community KW - mobile phone N2 - Background: The lack of regular physical activity (PA) in individuals with spinal cord injury (SCI) in the United States is an ongoing health crisis. Regular PA and exercise-based interventions have been linked with improved outcomes and healthier lifestyles among those with SCI. Providing people with an accurate estimate of their everyday PA level can promote PA. Furthermore, PA tracking can be combined with mobile health technology such as smartphones and smartwatches to provide a just-in-time adaptive intervention (JITAI) for individuals with SCI as they go about everyday life. A JITAI can prompt an individual to set a PA goal or provide feedback about their PA levels. Objective: The primary aim of this study is to investigate whether minutes of moderate-intensity PA among individuals with SCI can be increased by integrating a JITAI with a web-based PA intervention (WI) program. The WI program is a 14-week web-based PA program widely recommended for individuals with disabilities. A secondary aim is to investigate the benefit of a JITAI on proximal PA, defined as minutes of moderate-intensity PA within 120 minutes of a PA feedback prompt. Methods: Individuals with SCI (N=196) will be randomized to a WI arm or a WI+JITAI arm. Within the WI+JITAI arm, a microrandomized trial will be used to randomize participants several times a day to different tailored feedback and PA recommendations. Participants will take part in the 24-week study from their home environment in the community. The study has three phases: (1) baseline, (2) WI program with or without JITAI, and (3) PA sustainability. Participants will provide survey-based information at the initial meeting and at the end of weeks 2, 8, 16, and 24. Participants will be asked to wear a smartwatch every day for ?12 hours for the duration of the study. Results: Recruitment and enrollment began in May 2023. Data analysis is expected to be completed within 6 months of finishing participant data collection. Conclusions: The JITAI has the potential to achieve long-term PA performance by delivering tailored, just-in-time feedback based on the person?s actual PA behavior rather than a generic PA recommendation. New insights from this study may guide intervention designers to develop engaging PA interventions for individuals with disability. Trial Registration: ClinicalTrials.gov NCT05317832; https://clinicaltrials.gov/study/NCT05317832 International Registered Report Identifier (IRRID): DERR1-10.2196/57699 UR - https://www.researchprotocols.org/2024/1/e57699 UR - http://dx.doi.org/10.2196/57699 UR - http://www.ncbi.nlm.nih.gov/pubmed/38941145 ID - info:doi/10.2196/57699 ER - TY - JOUR AU - Kunchay, Sahiti AU - Linden-Carmichael, N. Ashley AU - Abdullah, Saeed PY - 2024/6/20 TI - Using a Smartwatch App to Understand Young Adult Substance Use: Mixed Methods Feasibility Study JO - JMIR Hum Factors SP - e50795 VL - 11 KW - smartwatches KW - substance use KW - ecological momentary assessment KW - mobile health KW - mHealth KW - human-centered design KW - feasibility studies KW - mobile phone N2 - Background: Young adults in the United States exhibit some of the highest rates of substance use compared to other age groups. Heavy and frequent substance use can be associated with a host of acute and chronic health and mental health concerns. Recent advances in ubiquitous technologies have prompted interest and innovation in using technology-based data collection instruments to understand substance use and associated harms. Existing methods for collecting granular, real-world data primarily rely on the use of smartphones to study and understand substance use in young adults. Wearable devices, such as smartwatches, show significant potential as platforms for data collection in this domain but remain underused. Objective: This study aims to describe the design and user evaluation of a smartwatch-based data collection app, which uses ecological momentary assessments to examine young adult substance use in daily life. Methods: This study used a 2-phase iterative design and acceptability evaluation process with young adults (aged 18-25 y) reporting recent alcohol or cannabis use. In phase 1, participants (8/15, 53%) used the data collection app for 14 days on their Apple Watches to report their substance use patterns, social contexts of substance use, and psychosocial risk factors (eg, affect). After this 14-day deployment, the participants completed a user experience survey and a semistructured interview to record their perspectives and experiences of using the app. Formative feedback from this phase informed feature modification and refinement of the app. In phase 2, an additional cohort (7/15, 47%) used the modified app for 14 days and provided feedback through surveys and interviews conducted after the app use period. Results: Analyses of overall app use patterns indicated high, consistent use of the app, with participants using the app for an average of 11.73 (SD 2.60) days out of 14 days of data collection. Participants reported 67 instances of substance use throughout the study, and our analysis indicates that participants were able to respond to ecological momentary assessment prompts in diverse temporal and situational contexts. Our findings from the user experience survey indicate that participants found the app usable and functional. Comparisons of app use metrics and user evaluation scores indicate that the iterative app design had a measurable and positive impact on users? experience. Qualitative data from the participant interviews highlighted the value of recording substance use patterns, low disruption to daily life, minimal overall burden, preference of platforms (smartphones vs smartwatches), and perspectives relating to privacy and app use in social contexts. Conclusions: This study demonstrated the acceptability of using a smartwatch-based app to collect intensive, longitudinal substance use data among young adults. The findings document the utility of smartwatches as a novel platform to understand sensitive and often-stigmatized behaviors such as substance use with minimal burden. UR - https://humanfactors.jmir.org/2024/1/e50795 UR - http://dx.doi.org/10.2196/50795 UR - http://www.ncbi.nlm.nih.gov/pubmed/ ID - info:doi/10.2196/50795 ER - TY - JOUR AU - Geeraerts, Joran AU - de Nooijer, Kim AU - Pivodic, Lara AU - De Ridder, Mark AU - Van den Block, Lieve PY - 2024/6/12 TI - Intensive Longitudinal Methods Among Adults With Breast or Lung Cancer: Scoping Review JO - J Med Internet Res SP - e50224 VL - 26 KW - diary KW - ecological momentary assessment KW - neoplasms KW - quality of life KW - self-report KW - telemedicine KW - scoping review KW - longitudinal methods KW - breast cancer KW - lung cancer KW - patients with cancer KW - cancer KW - intensive monitoring KW - advanced disease stages KW - mobile phone N2 - Background: Intensive longitudinal methods offer a powerful tool for capturing daily experiences of individuals. However, its feasibility, effectiveness, and optimal methodological approaches for studying or monitoring experiences of oncology patients remain uncertain. Objective: This scoping review aims to describe to what extent intensive longitudinal methods with daily electronic assessments have been used among patients with breast or lung cancer and with which methodologies, associated outcomes, and influencing factors. Methods: We searched the electronic databases (PubMed, Embase, and PsycINFO) up to January 2024 and included studies reporting on the use of these methods among adults with breast or lung cancer. Data were extracted on population characteristics, intensive monitoring methodologies used, study findings, and factors influencing the implementation of these methods in research and clinical practice. Results: We identified 1311 articles and included 52 articles reporting on 41 studies. Study aims and intensive monitoring methodologies varied widely, but most studies focused on measuring physical and psychological symptom constructs, such as pain, anxiety, or depression. Compliance and attrition rates seemed acceptable for most studies, although complete methodological reporting was often lacking. Few studies specifically examined these methods among patients with advanced cancer. Factors influencing implementation were linked to both patient (eg, confidence with intensive monitoring system) and methodology (eg, option to use personal devices). Conclusions: Intensive longitudinal methods with daily electronic assessments hold promise to provide unique insights into the daily lives of patients with cancer. Intensive longitudinal methods may be feasible among people with breast or lung cancer. Our findings encourage further research to determine optimal conditions for intensive monitoring, specifically in more advanced disease stages. UR - https://www.jmir.org/2024/1/e50224 UR - http://dx.doi.org/10.2196/50224 UR - http://www.ncbi.nlm.nih.gov/pubmed/38865186 ID - info:doi/10.2196/50224 ER - TY - JOUR AU - Khalifa, Aleya AU - Beres, K. Laura AU - Anok, Aggrey AU - Mbabali, Ismail AU - Katabalwa, Charles AU - Mulamba, Jeremiah AU - Thomas, G. Alvin AU - Bugos, Eva AU - Nakigozi, Gertrude AU - Chang, W. Larry AU - Grabowski, Kate M. PY - 2024/6/10 TI - Leveraging Ecological Momentary Assessment Data to Characterize Individual Mobility: Exploratory Pilot Study in Rural Uganda JO - JMIR Form Res SP - e54207 VL - 8 KW - ecological momentary assessment KW - spatial analysis KW - geographic mobility KW - global positioning system KW - health behaviors KW - Uganda KW - mobility KW - pilot study KW - smartphone KW - alcohol KW - cigarette KW - smoking KW - promoting KW - promotion KW - alcohol use KW - cigarette smoking KW - mobile phone N2 - Background: The geographical environments within which individuals conduct their daily activities may influence health behaviors, yet little is known about individual-level geographic mobility and specific, linked behaviors in rural low- and middle-income settings. Objective: Nested in a 3-month ecological momentary assessment intervention pilot trial, this study aims to leverage mobile health app user GPS data to examine activity space through individual spatial mobility and locations of reported health behaviors in relation to their homes. Methods: Pilot trial participants were recruited from the Rakai Community Cohort Study?an ongoing population-based cohort study in rural south-central Uganda. Participants used a smartphone app that logged their GPS coordinates every 1-2 hours for approximately 90 days. They also reported specific health behaviors (alcohol use, cigarette smoking, and having condomless sex with a non?long-term partner) via the app that were both location and time stamped. In this substudy, we characterized participant mobility using 3 measures: average distance (kilometers) traveled per week, number of unique locations visited (deduplicated points within 25 m of one another), and the percentage of GPS points recorded away from home. The latter measure was calculated using home buffer regions of 100 m, 400 m, and 800 m. We also evaluated the number of unique locations visited for each specific health behavior, and whether those locations were within or outside the home buffer regions. Sociodemographic information, mobility measures, and locations of health behaviors were summarized across the sample using descriptive statistics. Results: Of the 46 participants with complete GPS data, 24 (52%) participants were men, 30 (65%) participants were younger than 35 years, and 33 (72%) participants were in the top 2 socioeconomic status quartiles. On median, participants traveled 303 (IQR 152-585) km per week. Over the study period, participants on median recorded 1292 (IQR 963-2137) GPS points?76% (IQR 58%-86%) of which were outside their 400-m home buffer regions. Of the participants reporting drinking alcohol, cigarette smoking, and engaging in condomless sex, respectively, 19 (83%), 8 (89%), and 12 (86%) reported that behavior at least once outside their 400-m home neighborhood and across a median of 3.0 (IQR 1.5-5.5), 3.0 (IQR 1.0-3.0), and 3.5 (IQR 1.0-7.0) unique locations, respectively. Conclusions: Among residents in rural Uganda, an ecological momentary assessment app successfully captured high mobility and health-related behaviors across multiple locations. Our findings suggest that future mobile health interventions in similar settings can benefit from integrating spatial data collection using the GPS technology in mobile phones. Leveraging such individual-level GPS data can inform place-based strategies within these interventions for promoting healthy behavior change. UR - https://formative.jmir.org/2024/1/e54207 UR - http://dx.doi.org/10.2196/54207 UR - http://www.ncbi.nlm.nih.gov/pubmed/38857493 ID - info:doi/10.2196/54207 ER - TY - JOUR AU - Altweck, Laura AU - Schmidt, Silke AU - Tomczyk, Samuel PY - 2024/5/31 TI - Daily Time-Use Patterns and Quality of Life in Parents: Protocol for a Pilot Quasi-Experimental, Nonrandomized Controlled Trial Using Ecological Momentary Assessment JO - JMIR Res Protoc SP - e54728 VL - 13 KW - time-use KW - well-being KW - parents KW - ecological momentary assessment KW - feasibility KW - health-related quality of life KW - ambulatory assessment KW - work-family conflict KW - gender roles KW - mixed-methods KW - sex differences KW - stress N2 - Background: The gender gap in time use and its impact on health and well-being are still prevalent. Women work longer hours than men when considering both paid and unpaid (eg, childcare and chores) work, and this gender disparity is particularly visible among parents. Less is known about factors that could potentially mediate or moderate this relationship (eg, work-family conflict and gender role beliefs). Ecological momentary assessment (EMA) allows for the documentation of changes in momentary internal states, such as time use, stress, or mood. It has shown particular validity to measure shorter-term activities (eg, unpaid work) and is thus useful to address gender differences. Objective: The feasibility of the daily EMA surveys in a parent sample will be examined. The associations between time use, well-being, and stress will be examined, along with potential moderating and mediating factors such as gender, gender role beliefs, and work-family conflict. Finally, the act of monitoring one?s own time use, well-being, and stress will be examined in relation to, for example, the quality of life. Methods: We conducted a quasi-experimental, nonrandomized controlled trial with 3 data collection methods, namely, online questionnaires, EMA surveys, and qualitative interviews. The intervention group (n=64) will participate in the online questionnaires and EMA surveys, and a subsample of the intervention group (n=6-17) will also be invited to participate in qualitative interviews. Over a period of 1 week, participants in the intervention group will answer daily EMA surveys (4 times per day). In contrast, the control group (n=17) will only participate in the online questionnaires at baseline and after 1 week. The following constructs were surveyed: sociodemographic background (eg, age, gender, and household composition; baseline questionnaire); mediators and moderators (eg, gender role beliefs and work-family conflict; baseline and follow-up questionnaires); well-being, quality of life, and trait mindfulness (baseline and follow-up questionnaires); momentary activity and well-being, as well as state mindfulness (EMA); and feasibility (baseline and follow-up questionnaires as well as interviews). We anticipate that participants will regard the daily EMA as feasible. Particular daily time-use patterns (eg, high paid and unpaid workload) are expected to be related to lower well-being, higher stress, and health-related quality of life. These associations are expected to be moderated and mediated by factors such as gender, gender role beliefs, work-family conflict, and social support. Participants in the intervention group are expected to show higher values of mindfulness, well-being, health-related quality of life, and lower stress. Results: Patient recruitment started in November 2023 and ended in mid April 2024. Data analysis commenced in mid April 2024. Conclusions: This study aims to provide valuable insights into the feasibility of using EMAs and the potential benefits of activity tracking in various aspects of daily life. Trial Registration: Open Science Framework 8qj3d; https://osf.io/8qj3d International Registered Report Identifier (IRRID): PRR1-10.2196/54728 UR - https://www.researchprotocols.org/2024/1/e54728 UR - http://dx.doi.org/10.2196/54728 UR - http://www.ncbi.nlm.nih.gov/pubmed/38820576 ID - info:doi/10.2196/54728 ER - TY - JOUR AU - Zainal, Hani Nur AU - Newman, G. Michelle PY - 2024/5/24 TI - Examining the Effects of a Brief, Fully Self-Guided Mindfulness Ecological Momentary Intervention on Empathy and Theory-of-Mind for Generalized Anxiety Disorder: Randomized Controlled Trial JO - JMIR Ment Health SP - e54412 VL - 11 KW - empathy KW - theory-of-mind KW - mindfulness KW - ecological momentary intervention KW - generalized anxiety disorder KW - randomized controlled trial KW - mobile phone N2 - Background: The utility of brief mindfulness ecological momentary interventions (EMIs) to improve empathy and theory-of-mind has been underinvestigated, particularly in generalized anxiety disorder (GAD). Objective: In this randomized controlled trial, we aimed to examine the efficacy of a 14-day, fully self-guided, mindfulness EMI on the empathy and theory-of-mind domains for GAD. Methods: Adults (aged ?18 y) diagnosed with GAD were randomized to a mindfulness EMI (68/110, 61.8%) or self-monitoring app (42/110, 38.2%) arm. They completed the Interpersonal Reactivity Index self-report empathy measure and theory-of-mind test (Bell-Lysaker Emotion Recognition Task) at prerandomization, postintervention, and 1-month follow-up (1MFU) time points. Hierarchical linear modeling was conducted with the intent-to-treat principle to determine prerandomization to postintervention (pre-post intervention) and prerandomization to 1MFU (pre-1MFU) changes, comparing the mindfulness EMI to self-monitoring. Results: Observed effects were generally stronger from pre-1MFU than from pre-post intervention time points. From pre-post intervention time points, the mindfulness EMI was more efficacious than the self-monitoring app on fantasy (the ability to imagine being in others? shoes; between-intervention effect size: Cohen d=0.26, P=.007; within-intervention effect size: Cohen d=0.22, P=.02 for the mindfulness EMI and Cohen d=?0.16, P=.10 for the self-monitoring app). From pre-1MFU time points, the mindfulness EMI, but not the self-monitoring app, improved theory-of-mind (a window into others? thoughts and intentions through abstract, propositional knowledge about their mental states, encompassing the ability to decipher social cues) and the fantasy, personal distress (stress when witnessing others? negative experiences), and perspective-taking (understanding others? perspective) empathy domains. The effect sizes were small to moderate (Cohen d=0.15-0.36; P<.001 to P=.01) for significant between-intervention effects from pre-1MFU time points. Furthermore, the within-intervention effect sizes for these significant outcomes were stronger for the mindfulness EMI (Cohen d=0.30-0.43; P<.001 to P=.03) than the self-monitoring app (Cohen d=?0.12 to 0.21; P=.001 to P>.99) from pre-1MFU time points. No between-intervention and within-intervention effects on empathic concern (feeling affection, compassion, and care when observing others in distress, primarily attending to their emotional well-being) were observed from pre-post intervention and pre-1MFU time points. Conclusions: The brief mindfulness EMI improved specific domains of empathy (eg, fantasy, personal distress, and perspective-taking) and theory-of-mind with small to moderate effect sizes in persons with GAD. Higher-intensity, self-guided or coach-facilitated, multicomponent mindfulness EMIs targeting the optimization of social relationships are likely necessary to improve the empathic concern domain in this population. Trial Registration: ClinicalTrials.gov NCT04846777; https://clinicaltrials.gov/study/NCT04846777 UR - https://mental.jmir.org/2024/1/e54412 UR - http://dx.doi.org/10.2196/54412 UR - http://www.ncbi.nlm.nih.gov/pubmed/38787613 ID - info:doi/10.2196/54412 ER - TY - JOUR AU - Müller-Bardorff, Miriam AU - Schulz, Ava AU - Paersch, Christina AU - Recher, Dominique AU - Schlup, Barbara AU - Seifritz, Erich AU - Kolassa, Tatjana Iris AU - Kowatsch, Tobias AU - Fisher, Aaron AU - Galatzer-Levy, Isaac AU - Kleim, Birgit PY - 2024/5/14 TI - Optimizing Outcomes in Psychotherapy for Anxiety Disorders Using Smartphone-Based and Passive Sensing Features: Protocol for a Randomized Controlled Trial JO - JMIR Res Protoc SP - e42547 VL - 13 KW - cognitive behavioral therapy KW - CBT KW - transdiagnostic KW - anxiety KW - digital KW - ecological momentary assessment KW - EMA KW - passive sensing N2 - Background: Psychotherapies, such as cognitive behavioral therapy (CBT), currently have the strongest evidence of durable symptom changes for most psychological disorders, such as anxiety disorders. Nevertheless, only about half of individuals treated with CBT benefit from it. Predictive algorithms, including digital assessments and passive sensing features, could better identify patients who would benefit from CBT, and thus, improve treatment choices. Objective: This study aims to establish predictive features that forecast responses to transdiagnostic CBT in anxiety disorders and to investigate key mechanisms underlying treatment responses. Methods: This study is a 2-armed randomized controlled clinical trial. We include patients with anxiety disorders who are randomized to either a transdiagnostic CBT group or a waitlist (referred to as WAIT). We index key features to predict responses prior to starting treatment using subjective self-report questionnaires, experimental tasks, biological samples, ecological momentary assessments, activity tracking, and smartphone-based passive sensing to derive a multimodal feature set for predictive modeling. Additional assessments take place weekly at mid- and posttreatment and at 6- and 12-month follow-ups to index anxiety and depression symptom severity. We aim to include 150 patients, randomized to CBT versus WAIT at a 3:1 ratio. The data set will be subject to full feature and important features selected by minimal redundancy and maximal relevance feature selection and then fed into machine leaning models, including eXtreme gradient boosting, pattern recognition network, and k-nearest neighbors to forecast treatment response. The performance of the developed models will be evaluated. In addition to predictive modeling, we will test specific mechanistic hypotheses (eg, association between self-efficacy, daily symptoms obtained using ecological momentary assessments, and treatment response) to elucidate mechanisms underlying treatment response. Results: The trial is now completed. It was approved by the Cantonal Ethics Committee, Zurich. The results will be disseminated through publications in scientific peer-reviewed journals and conference presentations. Conclusions: The aim of this trial is to improve current CBT treatment by precise forecasting of treatment response and by understanding and potentially augmenting underpinning mechanisms and personalizing treatment. Trial Registration: ClinicalTrials.gov NCT03945617; https://clinicaltrials.gov/ct2/show/results/NCT03945617 International Registered Report Identifier (IRRID): DERR1-10.2196/42547 UR - https://www.researchprotocols.org/2024/1/e42547 UR - http://dx.doi.org/10.2196/42547 UR - http://www.ncbi.nlm.nih.gov/pubmed/38743473 ID - info:doi/10.2196/42547 ER - TY - JOUR AU - Kinoshita, Shotaro AU - Hanashiro, Sayaka AU - Tsutsumi, Shiori AU - Shiga, Kiko AU - Kitazawa, Momoko AU - Wada, Yasuyo AU - Inaishi, Jun AU - Kashiwagi, Kazuhiro AU - Fukami, Toshikazu AU - Mashimo, Yasumasa AU - Minato, Kazumichi AU - Kishimoto, Taishiro PY - 2024/5/2 TI - Assessment of Stress and Well-Being of Japanese Employees Using Wearable Devices for Sleep Monitoring Combined With Ecological Momentary Assessment: Pilot Observational Study JO - JMIR Form Res SP - e49396 VL - 8 KW - wearable device KW - sleep feedback KW - well-being KW - stress KW - ecological momentary assessment KW - feasibility study N2 - Background: Poor sleep quality can elevate stress levels and diminish overall well-being. Japanese individuals often experience sleep deprivation, and workers have high levels of stress. Nevertheless, research examining the connection between objective sleep assessments and stress levels, as well as overall well-being, among Japanese workers is lacking. Objective: This study aims to investigate the correlation between physiological data, including sleep duration and heart rate variability (HRV), objectively measured through wearable devices, and 3 states (sleepiness, mood, and energy) assessed through ecological momentary assessment (EMA) and use of rating scales for stress and well-being. Methods: A total of 40 office workers (female, 20/40, 50%; mean age 40.4 years, SD 11.8 years) participated in the study. Participants were asked to wear a wearable wristband device for 8 consecutive weeks. EMA regarding sleepiness, mood, and energy levels was conducted via email messages sent by participants 4 times daily, with each session spaced 3 hours apart. This assessment occurred on 8 designated days within the 8-week timeframe. Participants? stress levels and perception of well-being were assessed using respective self-rating questionnaires. Subsequently, participants were categorized into quartiles based on their stress and well-being scores, and the sleep patterns and HRV indices recorded by the Fitbit Inspire 2 were compared among these groups. The Mann-Whitney U test was used to assess differences between the quartiles, with adjustments made for multiple comparisons using the Bonferroni correction. Furthermore, EMA results and the sleep and HRV indices were subjected to multilevel analysis for a comprehensive evaluation. Results: The EMA achieved a total response rate of 87.3%, while the Fitbit Inspire 2 wear rate reached 88.0%. When participants were grouped based on quartiles of well-being and stress-related scores, significant differences emerged. Specifically, individuals in the lowest stress quartile or highest subjective satisfaction quartile retired to bed earlier (P<.001 and P=.01, respectively), whereas those in the highest stress quartile exhibited greater variation in the midpoint of sleep (P<.001). A multilevel analysis unveiled notable relationships: intraindividual variability analysis indicated that higher energy levels were associated with lower deviation of heart rate during sleep on the preceding day (?=?.12, P<.001), and decreased sleepiness was observed on days following longer sleep durations (?=?.10, P<.001). Furthermore, interindividual variability analysis revealed that individuals with earlier midpoints of sleep tended to exhibit higher energy levels (?=?.26, P=.04). Conclusions: Increased sleep variabilities, characterized by unstable bedtime or midpoint of sleep, were correlated with elevated stress levels and diminished well-being. Conversely, improved sleep indices (eg, lower heart rate during sleep and earlier average bedtime) were associated with heightened daytime energy levels. Further research with a larger sample size using these methodologies, particularly focusing on specific phenomena such as social jet lag, has the potential to yield valuable insights. Trial Registration: UMIN-CTR UMIN000046858; https://center6.umin.ac.jp/cgi-open-bin/ctr/ctr_view.cgi?recptno=R000053392 UR - https://formative.jmir.org/2024/1/e49396 UR - http://dx.doi.org/10.2196/49396 UR - http://www.ncbi.nlm.nih.gov/pubmed/38696237 ID - info:doi/10.2196/49396 ER - TY - JOUR AU - Weiß, Martin AU - Gründahl, Marthe AU - Jachnik, Annalena AU - Lampe, Caya Emilia AU - Malik, Ishitaa AU - Rittner, Lydia Heike AU - Sommer, Claudia AU - Hein, Grit PY - 2024/4/30 TI - The Effect of Everyday-Life Social Contact on Pain JO - J Med Internet Res SP - e53830 VL - 26 KW - social contact KW - pain KW - ecological momentary assessment UR - https://www.jmir.org/2024/1/e53830 UR - http://dx.doi.org/10.2196/53830 UR - http://www.ncbi.nlm.nih.gov/pubmed/38687594 ID - info:doi/10.2196/53830 ER - TY - JOUR AU - Tate, D. Allan AU - Fertig, R. Angela AU - de Brito, N. Junia AU - Ellis, M. Émilie AU - Carr, Patrick Christopher AU - Trofholz, Amanda AU - Berge, M. Jerica PY - 2024/4/24 TI - Momentary Factors and Study Characteristics Associated With Participant Burden and Protocol Adherence: Ecological Momentary Assessment JO - JMIR Form Res SP - e49512 VL - 8 KW - adherence KW - burden KW - data quality KW - ecological momentary assessment KW - mental health KW - mHealth KW - mobile health KW - participant adherence KW - public health KW - stress KW - study design KW - survey burden KW - survey N2 - Background: Ecological momentary assessment (EMA) has become a popular mobile health study design to understand the lived experiences of dynamic environments. The numerous study design choices available to EMA researchers, however, may quickly increase participant burden and could affect overall adherence, which could limit the usability of the collected data. Objective: This study quantifies what study design, participant attributes, and momentary factors may affect self-reported burden and adherence. Methods: The EMA from the Phase 1 Family Matters Study (n=150 adult Black, Hmong, Latino or Latina, Native American, Somali, and White caregivers; n=1392 observation days) was examined to understand how participant self-reported survey burden was related to both design and momentary antecedents of adherence. The daily burden was measured by the question ?Overall, how difficult was it for you to fill out the surveys today?? on a 5-item Likert scale (0=not at all and 4=extremely). Daily protocol adherence was defined as completing at least 2 signal-contingent surveys, 1 event-contingent survey, and 1 end-of-day survey each. Stress and mood were measured earlier in the day, sociodemographic and psychosocial characteristics were reported using a comprehensive cross-sectional survey, and EMA timestamps for weekends and weekdays were used to parameterize time-series models to evaluate prospective correlates of end-of-day study burden. Results: The burden was low at 1.2 (SD 1.14) indicating ?a little? burden on average. Participants with elevated previous 30-day chronic stress levels (mean burden difference: 0.8; P=.04), 1 in 5 more immigrant households (P=.02), and the language primarily spoken in the home (P=.04; 3 in 20 more non-English?speaking households) were found to be population attributes of elevated moderate-high burden. Current and 1-day lagged nonadherence were correlated with elevated 0.39 and 0.36 burdens, respectively (P=.001), and the association decayed by the second day (?=0.08; P=.47). Unit increases in momentary antecedents, including daily depressed mood (P=.002) and across-day change in stress (P=.008), were positively associated with 0.15 and 0.07 higher end-of-day burdens after controlling for current-day adherence. Conclusions: The 8-day EMA implementation appeared to capture momentary sources of stress and depressed mood without substantial burden to a racially or ethnically diverse and immigrant or refugee sample of parents. Attention to sociodemographic attributes (eg, EMA in the primary language of the caregiver) was important for minimizing participant burden and improving data quality. Momentary stress and depressed mood were strong determinants of participant-experienced EMA burden and may affect adherence to mobile health study protocols. There were no strong indicators of EMA design attributes that created a persistent burden for caregivers. EMA stands to be an important observational design to address dynamic public health challenges related to human-environment interactions when the design is carefully tailored to the study population and to study research objectives. UR - https://formative.jmir.org/2024/1/e49512 UR - http://dx.doi.org/10.2196/49512 UR - http://www.ncbi.nlm.nih.gov/pubmed/38656787 ID - info:doi/10.2196/49512 ER - TY - JOUR AU - Zainal, Hani Nur AU - Tan, Han Hui AU - Hong, Shiun Ryan Yee AU - Newman, Gayle Michelle PY - 2024/4/19 TI - Testing the Efficacy of a Brief, Self-Guided Mindfulness Ecological Momentary Intervention on Emotion Regulation and Self-Compassion in Social Anxiety Disorder: Randomized Controlled Trial JO - JMIR Ment Health SP - e53712 VL - 11 KW - social anxiety disorder KW - mindfulness KW - ecological momentary intervention KW - randomized controlled trial KW - emotion regulation KW - self-compassion KW - mechanisms of change KW - mobile phone KW - momentary interventions KW - self-monitoring app KW - regulations KW - participant N2 - Background: Theories propose that brief, mobile, self-guided mindfulness ecological momentary interventions (MEMIs) could enhance emotion regulation (ER) and self-compassion. Such changes are posited to be mechanisms of change. However, rigorous tests of these theories have not been conducted. Objective: In this assessor-blinded, parallel-group randomized controlled trial, we aimed to test these theories in social anxiety disorder (SAD). Methods: Participants with SAD (defined as having a prerandomization cut-off score ?20 on the Social Phobia Inventory self-report) were randomized to a 14-day fully self-guided MEMI (96/191, 50.3%) or self-monitoring app (95/191, 49.7%) arm. They completed web-based self-reports of 6 clinical outcome measures at prerandomization, 15-day postintervention (administered the day after the intervention ended), and 1-month follow-up time points. ER and self-compassion were assessed at preintervention and 7-day midintervention time points. Multilevel modeling determined the efficacy of MEMI on ER and self-compassion domains from pretrial to midintervention time points. Bootstrapped parallel multilevel mediation analysis examined the mediating role of pretrial to midintervention ER and self-compassion domains on the efficacy of MEMI on 6 clinical outcomes. Results: Participants demonstrated strong compliance, with 78% (149/191) engaging in at least 80% of the MEMI and self-monitoring prompts. MEMI was more efficacious than the self-monitoring app in decreasing ER goal?directed behavior difficulties (between-group Cohen d=?0.24) and lack of emotional clarity (Cohen d=0.16) and increasing self-compassion social connectedness (Cohen d=0.19), nonidentification with emotions (Cohen d=0.16), and self-kindness (Cohen d=0.19) from pretrial to midintervention time points. The within-group effect sizes from pretrial to midintervention were larger in the MEMI arm than in the self-monitoring app arm (ER goal?directed behavior difficulties: Cohen d=?0.73 vs ?0.29, lack of emotional clarity: Cohen d=?0.39 vs ?0.21, self-compassion domains of social connectedness: Cohen d=0.45 vs 0.19, nonidentification with emotions: Cohen d=0.63 vs 0.48, and self-kindness: Cohen d=0.36 vs 0.10). Self-monitoring, but not MEMI, alleviated ER emotional awareness issues (between-group Cohen d=0.11 and within-group: Cohen d=?0.29 vs ?0.13) and reduced self-compassion acknowledging shared human struggles (between-group Cohen d=0.26 and within-group: Cohen d=?0.23 vs 0.13). No ER and self-compassion domains were mediators of the effect of MEMI on SAD symptoms (P=.07-<.99), generalized anxiety symptoms (P=.16-.98), depression severity (P=.20-.94), repetitive negative thinking (P=.12-.96), and trait mindfulness (P=.18-.99) from pretrial to postintervention time points. Similar nonsignificant mediation effects emerged for all of these clinical outcomes from pretrial to 1-month follow-up time points (P=.11-.98). Conclusions: Brief, fully self-guided, mobile MEMIs efficaciously increased specific self-compassion domains and decreased ER difficulties associated with goal pursuit and clarity of emotions from pretrial to midintervention time points. Higher-intensity MEMIs may be required to pinpoint the specific change mechanisms in ER and self-compassion domains of SAD. Trial Registration: Open Science Framework (OSF) Registries; osf.io/m3kxz https://osf.io/m3kxz UR - https://mental.jmir.org/2024/1/e53712 UR - http://dx.doi.org/10.2196/53712 UR - http://www.ncbi.nlm.nih.gov/pubmed/38640015 ID - info:doi/10.2196/53712 ER - TY - JOUR AU - Lauckner, Carolyn AU - Takenaka, Puesta Bryce AU - Sesenu, Fidelis AU - Brown, S. Jaime AU - Kirklewski, J. Sally AU - Nicholson, Erin AU - Haney, Kimberly AU - Adatorwovor, Reuben AU - Boyd, T. Donte AU - Fallin-Bennett, Keisa AU - Restar, Javellana Arjee AU - Kershaw, Trace PY - 2024/4/5 TI - Combined Motivational Interviewing and Ecological Momentary Intervention to Reduce Hazardous Alcohol Use Among Sexual Minority Cisgender Men and Transgender Individuals: Protocol for a Randomized Controlled Trial JO - JMIR Res Protoc SP - e55166 VL - 13 KW - alcohol use KW - sexual minority KW - transgender KW - young adults KW - mobile health KW - mHealth KW - HIV risk behaviors KW - sexual risk behaviors KW - motivational interviewing KW - ecological momentary interventions KW - mobile phone N2 - Background: Sexual minority cisgender men and transgender (SMMT) individuals, particularly emerging adults (aged 18-34 years), often report hazardous drinking. Given that alcohol use increases the likelihood of HIV risk behaviors, and HIV disproportionately affects SMMT individuals, there is a need to test interventions that reduce hazardous alcohol use and subsequent HIV risk behaviors among this population. Ecological momentary interventions (EMIs), which use mobile phones to deliver risk reduction messages based on current location and behaviors, can help to address triggers that lead to drinking in real time. Objective: This study will test an EMI that uses motivational interviewing (MI), smartphone surveys, mobile breathalyzers, and location tracking to provide real-time messaging that addresses triggers for drinking when SMMT individuals visit locations associated with hazardous alcohol use. In addition, the intervention will deliver harm reduction messaging if individuals report engaging in alcohol use. Methods: We will conduct a 3-arm randomized controlled trial (N=405 HIV-negative SMMT individuals; n=135, 33% per arm) comparing the following conditions: (1) Tracking and Reducing Alcohol Consumption (a smartphone-delivered 4-session MI intervention), (2) Tracking and Reducing Alcohol Consumption and Environmental Risk (an EMI combining MI with real-time messaging based on geographic locations that are triggers to drinking), and (3) a smartphone-based alcohol monitoring?only control group. Breathalyzer results and daily self-reports will be used to assess the primary and secondary outcomes of drinking days, drinks per drinking day, binge drinking episodes, and HIV risk behaviors. Additional assessments at baseline, 3 months, 6 months, and 9 months will evaluate exploratory long-term outcomes. Results: The study is part of a 5-year research project funded in August 2022 by the National Institute on Alcohol Abuse and Alcoholism. The first 1.5 years of the study will be dedicated to planning and development activities, including formative research, app design and testing, and message design and testing. The subsequent 3.5 years will see the study complete participant recruitment, data collection, analyses, report writing, and dissemination. We expect to complete all study data collection in or before January 2027. Conclusions: This study will provide novel evidence about the relative efficacy of using a smartphone-delivered MI intervention and real-time messaging to address triggers for hazardous alcohol use and sexual risk behaviors. The EMI approach, which incorporates location-based preventive messaging and behavior surveys, may help to better understand the complexity of daily stressors among SMMT individuals and their impact on hazardous alcohol use and HIV risk behaviors. The tailoring of this intervention toward SMMT individuals helps to address their underrepresentation in existing alcohol use research and will be promising for informing where structural alcohol use prevention and treatment interventions are needed to support SMMT individuals. Trial Registration: ClinicalTrials.gov NCT05576350; https://www.clinicaltrials.gov/study/NCT05576350 International Registered Report Identifier (IRRID): PRR1-10.2196/55166 UR - https://www.researchprotocols.org/2024/1/e55166 UR - http://dx.doi.org/10.2196/55166 UR - http://www.ncbi.nlm.nih.gov/pubmed/38578673 ID - info:doi/10.2196/55166 ER - TY - JOUR AU - Barnett, P. Nancy AU - Sokolovsky, W. Alexander AU - Meisel, K. Matthew AU - Forkus, R. Shannon AU - Jackson, M. Kristina PY - 2024/4/5 TI - A Bluetooth-Based Smartphone App for Detecting Peer Proximity: Protocol for Evaluating Functionality and Validity JO - JMIR Res Protoc SP - e50241 VL - 13 KW - Bluetooth technology KW - passive sensing KW - proximity detection KW - ecological momentary assessment KW - social influence KW - alcohol use KW - mobile phone N2 - Background: While ecological momentary assessment (EMA) is commonly used to study social contexts and social influence in the real world, EMA almost exclusively relies on participant self-report of present circumstances, including the proximity to influential peers. There is the potential for developing a proximity sensing approach that uses small Bluetooth beacons and smartphone-based detection and data collection to collect information about interactions between individuals passively in real time. Objective: This paper aims to describe the methods for evaluating the functionality and validity of a Bluetooth-based beacon and a smartphone app to identify when ?2 individuals are physically proximal. Methods: We will recruit 20 participants aged 18 to 29 years with Android smartphones to complete a 3-week study during which beacon detection and self-report data will be collected using a smartphone app (MEI Research). Using an interviewer-administered social network interview, participants will identify up to 3 peers of the same age who are influential on health behavior (alcohol use in this study). These peers will be asked to carry a Bluetooth beacon (Kontakt asset tag) for the duration of the study; each beacon has a unique ID that, when detected, will be recorded by the app on the participant?s phone. Participants will be prompted to respond to EMA surveys (signal-contingent reports) when a peer beacon encounter meets our criteria and randomly 3 times daily (random reports) and every morning (morning reports) to collect information about the presence of peers. In all reports, the individualized list of peers will be presented to participants, followed by questions about peer and participant behavior, including alcohol use. Data from multiple app data sets, including beacon encounter specifications, notification, and app logs, participant EMA self-reports and postparticipation interviews, and peer surveys, will be used to evaluate project goals. We will examine the functionality of the technology, including the stability of the app (eg, app crashes and issues opening the app), beacon-to-app detection (ie, does the app detect proximal beacons?), and beacon encounter notification when encounter criteria are met. The validity of the technology will be defined as the concordance between passive detection of peers via beacon-to-app communication and the participant?s EMA report of peer presence. Disagreement between the beacon and self-report data (ie, false negatives and false positives) will be investigated in multiple ways (ie, to determine if the reason was technology-related or participant compliance-related) using encounter data and information collected from participants and peers. Results: Participant recruitment began in February 2023, and enrollment was completed in December 2023. Results will be reported in 2025. Conclusions: This Bluetooth-based technology has important applications and clinical implications for various health behaviors, including the potential for just-in-time adaptive interventions that target high-risk behavior in real time. International Registered Report Identifier (IRRID): DERR1-10.2196/50241 UR - https://www.researchprotocols.org/2024/1/e50241 UR - http://dx.doi.org/10.2196/50241 UR - http://www.ncbi.nlm.nih.gov/pubmed/38578672 ID - info:doi/10.2196/50241 ER - TY - JOUR AU - O'Driscoll, Ciarán AU - Singh, Aneesha AU - Chichua, Iya AU - Clodic, Joachim AU - Desai, Anjali AU - Nikolova, Dara AU - Yap, Jie Alex AU - Zhou, Irene AU - Pilling, Stephen PY - 2024/3/20 TI - An Ecological Mobile Momentary Intervention to Support Dynamic Goal Pursuit: Feasibility and Acceptability Study JO - JMIR Form Res SP - e49857 VL - 8 KW - goal pursuit KW - ecological momentary intervention KW - ecological momentary assessment KW - mood KW - dynamics KW - network analysis KW - MCII KW - COM-B KW - support KW - pilot study KW - training KW - feasibility KW - acceptability KW - self-monitoring KW - implementation KW - psychological KW - effectiveness N2 - Background: Individuals can experience difficulties pursuing their goals amid multiple competing priorities in their environment. Effective goal dynamics require flexible and generalizable pursuit skills. Supporting successful goal pursuit requires a perpetually adapting intervention responsive to internal states. Objective: The purpose of this study was to (1) develop a flexible intervention that can adapt to an individual?s changing short to medium-term goals and be applied to their daily life and (2) examine the feasibility and acceptability of the just-in-time adaptive intervention for goal pursuit. Methods: This study involved 3 iterations to test and systematically enhance all aspects of the intervention. During the pilot phase, 73 participants engaged in an ecological momentary assessment (EMA) over 1 month. After week 1, they attended an intervention training session and received just-in-time intervention prompts during the following 3 weeks. The training employed the Capability, Opportunity, Motivation, and Behavior (COM-B) framework for goal setting, along with mental contrasting with implementation intentions (MCII). Subsequent prompts, triggered by variability in goal pursuit, guided the participants to engage in MCII in relation to their current goal. We evaluated feasibility and acceptability, efficacy, and individual change processes by combining intensive (single-case experimental design) and extensive methods. Results: The results suggest that the digital intervention was feasible and acceptable to participants. Compliance with the intervention was high (n=63, 86%). The participants endorsed high acceptability ratings relating to both the study procedures and the intervention. All participants (N=73, 100%) demonstrated significant improvements in goal pursuit with an average difference of 0.495 units in the outcome (P<.001). The results of the dynamic network modeling suggest that self-monitoring behavior (EMA) and implementing the MCII strategy may aid in goal reprioritization, where goal pursuit itself is a driver of further goal pursuit. Conclusions: This pilot study demonstrated the feasibility and acceptability of a just-in-time adaptive intervention among a nonclinical adult sample. This intervention used self-monitoring of behavior, the COM-B framework, and MCII strategies to improve dynamic goal pursuit. It was delivered via an Ecological Momentary Intervention (EMI) procedure. Future research should consider the utility of this approach as an additional intervention element within psychological interventions to improve goal pursuit. Sustaining goal pursuit throughout interventions is central to their effectiveness and warrants further evaluation. UR - https://formative.jmir.org/2024/1/e49857 UR - http://dx.doi.org/10.2196/49857 UR - http://www.ncbi.nlm.nih.gov/pubmed/38506904 ID - info:doi/10.2196/49857 ER - TY - JOUR AU - Edwards, Katie AU - Croker, Helen AU - Farrow, Claire AU - Haycraft, Emma AU - Herle, Moritz AU - Llewellyn, Clare AU - Pickard, Abigail AU - Blissett, Jacqueline PY - 2024/3/19 TI - Examining Parent Mood, Feeding Context, and Feeding Goals as Predictors of Feeding Practices Used by Parents of Preschool Children With Avid Eating Behavior: Protocol for an Ecological Momentary Assessment Study JO - JMIR Res Protoc SP - e55193 VL - 13 KW - ecological momentary assessment KW - avid eating KW - children?s eating behavior KW - parental feeding practices KW - feeding behaviour KW - parent KW - children KW - eating behaviour KW - obesity KW - environmental factors KW - observational study KW - feeding KW - United Kingdom N2 - Background: An avid eating behavior profile is characterized by a greater interest in food and a tendency to overeat in response to negative emotions. Parents use specific strategies to manage feeding interactions with children with avid eating behavior. While momentary and contextual factors, such as parental mood, have been found to influence parental feeding practices, there is a lack of research examining parents? daily experiences of feeding children with avid eating behavior. Examining this is important because parental feeding practices are key levers in tailored interventions to support children?s healthy eating behavior. Objective: We aim to describe the ecological momentary assessment methods and procedures used in the APPETItE (Appetite in Preschoolers: Producing Evidence for Tailoring Interventions Effectively) project, which aims to examine how variation in parental mood, feeding goals, and the context of eating occasions affect the parental feeding practices used to manage feeding interactions with children with an avid eating behavior profile. Methods: Participants are primary caregivers from the APPETItE cohort who have a preschool-age child (aged 3-5 years) with an avid eating behavior profile. Caregivers complete a 10-day ecological momentary assessment period using signal- and event-contingent surveys to examine (1) mood and stress, (2) parental feeding goals, and (3) contextual factors as predictors of parental feeding practices. Results: Recruitment and data collection began in October 2023 and is expected to be completed by spring 2024. The data have a 3-level structure: repeated measurements (level 1) nested within days (level 2) nested within an individual (level 3). Thus, lag-dependent models will be conducted to test the main hypotheses. Conclusions: The findings from this study will provide an understanding of caregivers? daily experiences of feeding preschool children with avid eating behavior, who are at greater risk for the development of obesity. Understanding the predictors of feeding practices at the moment they occur, and across various contexts, will inform the development of tailored resources to support caregivers in managing children?s avid eating behavior. International Registered Report Identifier (IRRID): DERR1-10.2196/55193 UR - https://www.researchprotocols.org/2024/1/e55193 UR - http://dx.doi.org/10.2196/55193 UR - http://www.ncbi.nlm.nih.gov/pubmed/38502178 ID - info:doi/10.2196/55193 ER - TY - JOUR AU - Luken, Amanda AU - Rabinowitz, A. Jill AU - Wells, L. Jonathan AU - Sosnowski, W. David AU - Strickland, C. Justin AU - Thrul, Johannes AU - Kirk, D. Gregory AU - Maher, S. Brion PY - 2024/2/27 TI - Designing and Validating a Novel Method for Assessing Delay Discounting Associated With Health Behaviors: Ecological Momentary Assessment Study JO - JMIR Form Res SP - e48954 VL - 8 KW - delay discounting KW - measurement KW - Monetary Choice Questionnaire KW - ecological momentary assessment KW - substance use KW - substance abuse KW - questionnaire KW - validity KW - validation KW - monetary KW - reward KW - rewards KW - survey KW - mobile phone N2 - Background: Delay discounting quantifies an individual?s preference for smaller, short-term rewards over larger, long-term rewards and represents a transdiagnostic factor associated with numerous adverse health outcomes. Rather than a fixed trait, delay discounting may vary over time and place, influenced by individual and contextual factors. Continuous, real-time measurement could inform adaptive interventions for various health conditions. Objective: The goals of this paper are 2-fold. First, we present and validate a novel, short, ecological momentary assessment (EMA)?based delay discounting scale we developed. Second, we assess this tool?s ability to reproduce known associations between delay discounting and health behaviors (ie, substance use and craving) using a convenience-based sample. Methods: Participants (N=97) were adults (age range 18-71 years), recruited on social media. In phase 1, data were collected on participant sociodemographic characteristics, and delay discounting was evaluated via the traditional Monetary Choice Questionnaire (MCQ) and our novel method (ie, 7-item time-selection and 7-item monetary-selection scales). During phase 2 (approximately 6 months later), participants completed the MCQ, our novel delay discounting measures, and health outcomes questions. The correlations between our method and the traditional MCQ within and across phases were examined. For scale reduction, a random number of items were iteratively selected, and the correlation between the full and random scales was assessed. We then examined the association between our time- and monetary-selection scales assessed during phase 2 and the percentage of assessments that participants endorsed using or craving alcohol, tobacco, or cannabis. Results: In total, 6 of the 7 individual time-selection items were highly correlated with the full scale (r>0.89). Both time-selection (r=0.71; P<.001) and monetary-selection (r=0.66; P<.001) delay discounting rates had high test-retest reliability across phases 1 and 2. Phase 1 MCQ delay discounting function highly correlated with phase 1 (r=0.76; P<.001) and phase 2 (r=0.45; P<.001) time-selection delay discounting scales. One or more randomly chosen time-selection items were highly correlated with the full scale (r>0.94). Greater delay discounting measured via the time-selection measure (adjusted mean difference=5.89, 95% CI 1.99-9.79), but not the monetary-selection scale (adjusted mean difference=?0.62, 95% CI ?3.57 to 2.32), was associated with more past-hour tobacco use endorsement in follow-up surveys. Conclusions: This study evaluated a novel EMA-based scale?s ability to validly and reliably assess delay discounting. By measuring delay discounting with fewer items and in situ via EMA in natural environments, researchers may be better able to identify individuals at risk for poor health outcomes. UR - https://formative.jmir.org/2024/1/e48954 UR - http://dx.doi.org/10.2196/48954 UR - http://www.ncbi.nlm.nih.gov/pubmed/38412027 ID - info:doi/10.2196/48954 ER - TY - JOUR AU - Nizio, Pamella AU - Clausen, Bryce AU - Businelle, S. Michael AU - Ponton, Natalia AU - Jones, A. Ava AU - Redmond, Y. Brooke AU - Buckner, D. Julia AU - Obasi, M. Ezemenari AU - Zvolensky, J. Michael AU - Garey, Lorra PY - 2024/2/19 TI - Mobile Intervention to Address Cannabis Use Disorder Among Black Adults: Protocol for a Randomized Controlled Trial JO - JMIR Res Protoc SP - e52776 VL - 13 KW - cannabis use KW - false safety behaviors KW - mobile health, just-in-time adaptive interventions KW - Black or African American KW - mobile phone KW - African American KW - Black KW - cannabis KW - adults KW - adult KW - Hispanic KW - Latin KW - adaptive intervention KW - cannabis reduction KW - cessation KW - ecological momentary assessments N2 - Background: African American or Black (hereafter referred to as Black) adults who use cannabis use it more frequently and are more likely to meet criteria for cannabis use disorder (CUD) than both White and Hispanic or Latin individuals. Black adults may be more apt to use cannabis to cope with distress, which constitutes a false safety behavior (FSB; a behavior designed to reduce psychological distress in the short term). Although FSB engagement can perpetuate the cycle of high rates of CUD among Black individuals, limited work has applied an FSB elimination treatment approach to Black adults with CUD, and no previous work has evaluated FSB reduction or elimination in the context of a culturally tailored and highly accessible treatment developed for Black individuals. Objective: This study aims to develop and pilot-test a culturally tailored adaptive intervention that integrates FSB reduction or elimination skills for cannabis reduction or cessation among Black adults with probable CUD (Culturally Tailored-Mobile Integrated Cannabis and Anxiety Reduction Treatment [CT-MICART]). Methods: Black adults with probable CUD (N=50) will complete a web-based screener, enrollment call, baseline assessment, 3 daily ecological momentary assessments (EMAs) for 6 weeks, and a follow-up self-report assessment and qualitative interview at 6 weeks after randomization. Participants will be randomized into 1 out of the 2 conditions after baseline assessment: (1) CT-MICART+EMAs for 6 weeks or (2) EMAs only for 6 weeks. Results: The enrollment started in June 2023 and ended in November 2023. Data analysis will be completed in March 2024. Conclusions: No culturally tailored, evidence-based treatment currently caters to the specific needs of Black individuals with CUD. This study will lay the foundation for a new approach to CUD treatment among Black adults that is easily accessible and has the potential to overcome barriers to treatment and reduce practitioner burden in order to support Black individuals who use cannabis with probable CUD. Trial Registration: ClinicalTrials.gov NCT05566730; https://clinicaltrials.gov/study/NCT05566730 International Registered Report Identifier (IRRID): DERR1-10.2196/52776 UR - https://www.researchprotocols.org/2024/1/e52776 UR - http://dx.doi.org/10.2196/52776 UR - http://www.ncbi.nlm.nih.gov/pubmed/38373037 ID - info:doi/10.2196/52776 ER - TY - JOUR AU - King, D. Zachary AU - Yu, Han AU - Vaessen, Thomas AU - Myin-Germeys, Inez AU - Sano, Akane PY - 2024/2/7 TI - Investigating Receptivity and Affect Using Machine Learning: Ecological Momentary Assessment and Wearable Sensing Study JO - JMIR Mhealth Uhealth SP - e46347 VL - 12 KW - mobile health KW - mHealth KW - affect inference KW - study design KW - ecological momentary assessment KW - EMA KW - just-in-time adaptive interventions KW - JITAIs KW - receptivity KW - mobile phone N2 - Background: As mobile health (mHealth) studies become increasingly productive owing to the advancements in wearable and mobile sensor technology, our ability to monitor and model human behavior will be constrained by participant receptivity. Many health constructs are dependent on subjective responses, and without such responses, researchers are left with little to no ground truth to accompany our ever-growing biobehavioral data. This issue can significantly impact the quality of a study, particularly for populations known to exhibit lower compliance rates. To address this challenge, researchers have proposed innovative approaches that use machine learning (ML) and sensor data to modify the timing and delivery of surveys. However, an overarching concern is the potential introduction of biases or unintended influences on participants? responses when implementing new survey delivery methods. Objective: This study aims to demonstrate the potential impact of an ML-based ecological momentary assessment (EMA) delivery system (using receptivity as the predictor variable) on the participants? reported emotional state. We examine the factors that affect participants? receptivity to EMAs in a 10-day wearable and EMA?based emotional state?sensing mHealth study. We study the physiological relationships indicative of receptivity and affect while also analyzing the interaction between the 2 constructs. Methods: We collected data from 45 healthy participants wearing 2 devices measuring electrodermal activity, accelerometer, electrocardiography, and skin temperature while answering 10 EMAs daily, containing questions about perceived mood. Owing to the nature of our constructs, we can only obtain ground truth measures for both affect and receptivity during responses. Therefore, we used unsupervised and supervised ML methods to infer affect when a participant did not respond. Our unsupervised method used k-means clustering to determine the relationship between physiology and receptivity and then inferred the emotional state during nonresponses. For the supervised learning method, we primarily used random forest and neural networks to predict the affect of unlabeled data points as well as receptivity. Results: Our findings showed that using a receptivity model to trigger EMAs decreased the reported negative affect by >3 points or 0.29 SDs in our self-reported affect measure, scored between 13 and 91. The findings also showed a bimodal distribution of our predicted affect during nonresponses. This indicates that this system initiates EMAs more commonly during states of higher positive emotions. Conclusions: Our results showed a clear relationship between affect and receptivity. This relationship can affect the efficacy of an mHealth study, particularly those that use an ML algorithm to trigger EMAs. Therefore, we propose that future work should focus on a smart trigger that promotes EMA receptivity without influencing affect during sampled time points. UR - https://mhealth.jmir.org/2024/1/e46347 UR - http://dx.doi.org/10.2196/46347 UR - http://www.ncbi.nlm.nih.gov/pubmed/38324358 ID - info:doi/10.2196/46347 ER - TY - JOUR AU - Adams, B. Leslie AU - Watts, Thomasina AU - DeVinney, Aubrey AU - Haroz, E. Emily AU - Thrul, Johannes AU - Stephens, Brooks Jasmin AU - Campbell, N. Mia AU - Antoine, Denis AU - Lê Cook, Benjamin AU - Joe, Sean AU - Thorpe Jr, J. Roland PY - 2024/1/22 TI - Acceptability and Feasibility of a Smartphone-Based Real-Time Assessment of Suicide Among Black Men: Mixed Methods Pilot Study JO - JMIR Form Res SP - e48992 VL - 8 KW - Black men KW - suicide KW - ecological momentary assessment KW - feasibility KW - acceptability KW - mixed methods KW - smartphone KW - real-time assessment KW - suicide prevention KW - user experience KW - behavior KW - implementation KW - intervention KW - mobile phone N2 - Background: Suicide rates in the United States have increased recently among Black men. To address this public health crisis, smartphone-based ecological momentary assessment (EMA) platforms are a promising way to collect dynamic, real-time data that can help improve suicide prevention efforts. Despite the promise of this methodology, little is known about its suitability in detecting experiences related to suicidal thoughts and behavior (STB) among Black men. Objective: This study aims to clarify the acceptability and feasibility of using smartphone-based EMA through a pilot study that assesses the user experience among Black men. Methods: We recruited Black men aged 18 years and older using the MyChart patient portal messaging (the patient-facing side of the Epic electronic medical record system) or outpatient provider referrals. Eligible participants self-identified as Black men with a previous history of STB and ownership of an Android or iOS smartphone. Eligible participants completed a 7-day smartphone-based EMA study. They received a prompt 4 times per day to complete a brief survey detailing their STB, as well as proximal risk factors, such as depression, social isolation, and feeling like a burden to others. At the conclusion of each day, participants also received a daily diary survey detailing their sleep quality and their daily experiences of everyday discrimination. Participants completed a semistructured exit interview of 60-90 minutes at the study?s conclusion. Results: In total, 10 participants completed 166 EMA surveys and 39 daily diary entries. A total of 4 of the 10 participants completed 75% (21/28) or more of the EMA surveys, while 9 (90%) out of 10 completed 25% (7/28) or more. The average completion rate of all surveys was 58% (20.3/35), with a minimum of 17% (6/35) and maximum of 100% (35/35). A total of 4 (40%) out of 10 participants completed daily diary entries for the full pilot study. No safety-related incidents were reported. On average, participants took 2.08 minutes to complete EMA prompts and 2.72 minutes for daily diary surveys. Our qualitative results generally affirm the acceptability and feasibility of the study procedures, but the participants noted difficulties with the technology and the redundancy of the survey questions. Emerging themes also addressed issues such as reduced EMA survey compliance and diminished mood related to deficit-framed questions related to suicide. Conclusions: Findings from this study will be used to clarify the suitability of EMA for Black men. Overall, our EMA pilot study demonstrated mixed feasibility and acceptability when delivered through smartphone-based apps to Black men. Specific recommendations are provided for managing safety within these study designs and for refinements in future intervention and implementation science research. International Registered Report Identifier (IRRID): RR2-10.2196/31241 UR - https://formative.jmir.org/2024/1/e48992 UR - http://dx.doi.org/10.2196/48992 UR - http://www.ncbi.nlm.nih.gov/pubmed/38252475 ID - info:doi/10.2196/48992 ER - TY - JOUR AU - Wadle, Lisa-Marie AU - Ebner-Priemer, W. Ulrich AU - Foo, C. Jerome AU - Yamamoto, Yoshiharu AU - Streit, Fabian AU - Witt, H. Stephanie AU - Frank, Josef AU - Zillich, Lea AU - Limberger, F. Matthias AU - Ablimit, Ayimnisagul AU - Schultz, Tanja AU - Gilles, Maria AU - Rietschel, Marcella AU - Sirignano, Lea PY - 2024/1/18 TI - Speech Features as Predictors of Momentary Depression Severity in Patients With Depressive Disorder Undergoing Sleep Deprivation Therapy: Ambulatory Assessment Pilot Study JO - JMIR Ment Health SP - e49222 VL - 11 KW - ambulatory assessment KW - experience sampling KW - ecological momentary assessment KW - speech features KW - speech pattern KW - depression KW - sleep deprivation therapy KW - mobile phone N2 - Background: The use of mobile devices to continuously monitor objectively extracted parameters of depressive symptomatology is seen as an important step in the understanding and prevention of upcoming depressive episodes. Speech features such as pitch variability, speech pauses, and speech rate are promising indicators, but empirical evidence is limited, given the variability of study designs. Objective: Previous research studies have found different speech patterns when comparing single speech recordings between patients and healthy controls, but only a few studies have used repeated assessments to compare depressive and nondepressive episodes within the same patient. To our knowledge, no study has used a series of measurements within patients with depression (eg, intensive longitudinal data) to model the dynamic ebb and flow of subjectively reported depression and concomitant speech samples. However, such data are indispensable for detecting and ultimately preventing upcoming episodes. Methods: In this study, we captured voice samples and momentary affect ratings over the course of 3 weeks in a sample of patients (N=30) with an acute depressive episode receiving stationary care. Patients underwent sleep deprivation therapy, a chronotherapeutic intervention that can rapidly improve depression symptomatology. We hypothesized that within-person variability in depressive and affective momentary states would be reflected in the following 3 speech features: pitch variability, speech pauses, and speech rate. We parametrized them using the extended Geneva Minimalistic Acoustic Parameter Set (eGeMAPS) from open-source Speech and Music Interpretation by Large-Space Extraction (openSMILE; audEERING GmbH) and extracted them from a transcript. We analyzed the speech features along with self-reported momentary affect ratings, using multilevel linear regression analysis. We analyzed an average of 32 (SD 19.83) assessments per patient. Results: Analyses revealed that pitch variability, speech pauses, and speech rate were associated with depression severity, positive affect, valence, and energetic arousal; furthermore, speech pauses and speech rate were associated with negative affect, and speech pauses were additionally associated with calmness. Specifically, pitch variability was negatively associated with improved momentary states (ie, lower pitch variability was linked to lower depression severity as well as higher positive affect, valence, and energetic arousal). Speech pauses were negatively associated with improved momentary states, whereas speech rate was positively associated with improved momentary states. Conclusions: Pitch variability, speech pauses, and speech rate are promising features for the development of clinical prediction technologies to improve patient care as well as timely diagnosis and monitoring of treatment response. Our research is a step forward on the path to developing an automated depression monitoring system, facilitating individually tailored treatments and increased patient empowerment. UR - https://mental.jmir.org/2024/1/e49222 UR - http://dx.doi.org/10.2196/49222 UR - http://www.ncbi.nlm.nih.gov/pubmed/38236637 ID - info:doi/10.2196/49222 ER - TY - JOUR AU - Stevens, R. Elizabeth AU - Li, Rina AU - Xiang, Grace AU - Wisniewski, Rachel AU - Rojas, Sidney AU - O'Connor, Katherine AU - Wilker, Olivia AU - Vojjala, Mahathi AU - El-Shahawy, Omar AU - Sherman, E. Scott PY - 2024/1/16 TI - Trial Participants? Perceptions of the Impact of Ecological Momentary Assessment on Smoking Behaviors: Qualitative Analysis JO - JMIR Mhealth Uhealth SP - e52122 VL - 12 KW - smoking behavior KW - ecological momentary assessment KW - bias KW - behavioral impact KW - smoking KW - smoker KW - qualitative analysis KW - pilot study KW - tool KW - data collection KW - tobacco KW - text message KW - accountability KW - mHealth KW - mobile health KW - message KW - trigger KW - cigarette N2 - Background: Ecological momentary assessment (EMA) is an increasingly used tool for data collection in behavioral research, including smoking cessation studies. As previous addiction research suggests, EMA has the potential to elicit cue reactivity by triggering craving and increasing behavioral awareness. However, there has been limited evaluation of its potential influence on behavior. Objective: By examining the perspectives of research participants enrolled in a tobacco treatment intervention trial, this qualitative analysis aims to understand the potential impact that EMA use may have had on smoking behaviors that may not have otherwise been captured through other study measures. Methods: We performed a qualitative analysis of in-depth interviews with participants enrolled in a pilot randomized controlled trial of a tobacco treatment intervention that used SMS text messaging to collect EMA data on smoking behaviors. In the pilot randomized controlled trial, combustible cigarette and e-cigarette use and smoking-related cravings were measured as part of an EMA protocol, in which SMS text messaging served as a smoking diary. SMS text messaging was intended for data collection only and not designed to serve as part of the intervention. After a baseline assessment, participants were asked to record daily nicotine use for 12 weeks by responding to text message prompts that they received 4 times per day. Participants were prompted to share their experiences with the EMA text messaging component of the trial but were not directly asked about the influence of EMA on their behaviors. Transcripts were coded according to the principles of the framework for applied research. The codes were then examined, summarized, and grouped into themes based on the principles of grounded theory. Results: Interviews were analyzed for 26 participants. The themes developed from the analysis suggested the potential for EMA, in the form of an SMS text messaging smoking diary, to influence participants? smoking behaviors. The perceived impacts of EMA text messaging on smoking behaviors were polarized; some participants emphasized the positive impacts of text messages on their efforts to reduce smoking, while others stressed the ways that text messaging negatively impacted their smoking reduction efforts. These contrasting experiences were captured by themes reflecting the positive impacts on smoking behaviors, including increased awareness of smoking behaviors and a sense of accountability, and the negative impacts on emotions and smoking behaviors, including provoking a sense of guilt and triggering smoking behaviors. Conclusions: The collection of EMA smoking behavior data via SMS text messaging may influence the behaviors and perceptions of participants in tobacco treatment interventions. More research is needed to determine the magnitude of impact and mechanisms, to account for the potential effects of EMA. A broader discussion of the unintended effects introduced by EMA use is warranted among the research community. UR - https://mhealth.jmir.org/2024/1/e52122 UR - http://dx.doi.org/10.2196/52122 ID - info:doi/10.2196/52122 ER - TY - JOUR AU - Gunsilius, Zimmerman Chloe AU - Heffner, Joseph AU - Bruinsma, Sienna AU - Corinha, Madison AU - Cortinez, Maria AU - Dalton, Hadley AU - Duong, Ellen AU - Lu, Joshua AU - Omar, Aisulu AU - Owen, Whittington Lucy Long AU - Roarr, Nazario Bradford AU - Tang, Kevin AU - Petzschner, H. Frederike PY - 2024/1/12 TI - SOMAScience: A Novel Platform for Multidimensional, Longitudinal Pain Assessment JO - JMIR Mhealth Uhealth SP - e47177 VL - 12 KW - acute pain KW - acute-chronic pain transition KW - chronic pain KW - clinical outcome measurement KW - digital health KW - ecological momentary assessment KW - EMA KW - ESM KW - experience sampling methodology KW - mHealth KW - mobile health KW - pain management KW - pain self-management KW - patient reported outcomes KW - smartphone app UR - https://mhealth.jmir.org/2024/1/e47177 UR - http://dx.doi.org/10.2196/47177 UR - http://www.ncbi.nlm.nih.gov/pubmed/38214952 ID - info:doi/10.2196/47177 ER - TY - JOUR AU - Jia, Si Si AU - Allman-Farinelli, Margaret AU - Roy, Rajshri AU - Phongsavan, Philayrath AU - Hyun, Karice AU - Gibson, Anne Alice AU - Partridge, Ruth Stephanie PY - 2023/11/29 TI - Using Mobile Ecological Momentary Assessment to Understand Consumption and Context Around Online Food Delivery Use: Pilot Feasibility and Acceptability Study JO - JMIR Mhealth Uhealth SP - e49135 VL - 11 KW - ecological momentary assessment KW - mobile applications KW - mobile apps KW - feasibility studies KW - online food delivery KW - smartphone KW - young adult KW - adolescent KW - food environment KW - consumer behavior KW - mobile phone N2 - Background: Mobile ecological momentary assessment (EMA) is a powerful tool for collecting real-time and contextual data from individuals. As our reliance on online technologies to increase convenience accelerates, the way we access food is changing. Online food delivery (OFD) services may further encourage unhealthy food consumption habits, given the high availability of energy-dense, nutrient-poor foods. We used EMA to understand the real-time effects of OFD on individuals? food choices and consumption behaviors. Objective: The primary aims of this pilot study were to assess the feasibility and acceptability of using EMA in young users of OFD and compare 2 different EMA sampling methods. The secondary aims were to gather data on OFD events and their context and examine any correlations between demographics, lifestyle chronic disease risk factors, and OFD use. Methods: This study used EMA methods via a mobile app (mEMASense, ilumivu Inc). Existing users of OFD services aged 16 to 35 years in Australia who had access to a smartphone were recruited. Participants were randomly assigned to 1 of 2 groups: signal-contingent or event-contingent. The signal-contingent group was monitored over 3 days between 7 AM and 10 PM. They received 5 prompts each day to complete EMA surveys via the smartphone app. In contrast, the event-contingent group was monitored over 7 days and was asked to self-report any instance of OFD. Results: A total of 102 participants were analyzed, with 53 participants in the signal-contingent group and 49 participants in the event-contingent group. Compliance rates, indicating the feasibility of signal-contingent and event-contingent protocols, were similar at 72.5% (574/792) and 73.2% (251/343), respectively. Feedback from the participants suggested that the EMA app was not easy to use, which affected their acceptability of the study. Participants in the event-contingent group were 3.53 (95% CI 1.52-8.17) times more likely to have had an OFD event captured during the study. Pizza (23/124, 18.5%) and fried chicken (18/124, 14.5%) comprised a bulk of the 124 OFD orders captured. Most orders were placed at home (98/124, 79%) for 1 person (68/124, 54.8%). Age (incidence rate ratio 0.95, 95% CI 0.91-0.99; P=.03) and dependents (incidence rate ratio 2.01, 95% CI 1.16-3.49; P=.01) were significantly associated with the number of OFD events in a week after adjusting for gender, socioeconomic status, diet quality score, and perceived stress levels. Conclusions: This pilot study showed that EMA using an event-contingent sampling approach may be a better method to capture OFD events and context than signal-contingent sampling. The compliance rates showed that both sampling methods were feasible and acceptable. Although the findings from this study have gathered some insight on the consumption and context of OFD in young people, further studies are required to develop targeted interventions. UR - https://mhealth.jmir.org/2023/1/e49135 UR - http://dx.doi.org/10.2196/49135 UR - http://www.ncbi.nlm.nih.gov/pubmed/38019563 ID - info:doi/10.2196/49135 ER - TY - JOUR AU - Maes, Iris AU - Mertens, Lieze AU - Poppe, Louise AU - Vetrovsky, Tomas AU - Crombez, Geert AU - De Backere, Femke AU - Brondeel, Ruben AU - Van Dyck, Delfien PY - 2023/11/23 TI - Within-Person Associations of Accelerometer-Assessed Physical Activity With Time-Varying Determinants in Older Adults: Time-Based Ecological Momentary Assessment Study JO - JMIR Aging SP - e44425 VL - 6 KW - ecological momentary assessment KW - EMA KW - associations KW - emotions KW - physical concerns KW - intention KW - self-efficacy KW - older adult KW - mobile phone N2 - Background: Despite the availability of physical activity (PA) interventions, many older adults are still not active enough. This might be partially explained by the often-limited effects of PA interventions. In general, health behavior change interventions often do not focus on contextual and time-varying determinants, which may limit their effectiveness. However, before the dynamic tailoring of interventions can be developed, one should know which time-dependent determinants are associated with PA and how strong these associations are. Objective: The aim of this study was to examine within-person associations between multiple determinants of the capability, opportunity, motivation, and behavior framework assessed using Ecological Momentary Assessment (EMA) and accelerometer-assessed light PA, moderate to vigorous PA, and total PA performed at 15, 30, 60, and 120 minutes after the EMA trigger. Methods: Observational data were collected from 64 healthy older adults (36/64, 56% men; mean age 72.1, SD 5.6 y). Participants were asked to answer a time-based EMA questionnaire 6 times per day that assessed emotions (ie, relaxation, satisfaction, irritation, and feeling down), the physical complaint fatigue, intention, intention, and self-efficacy. An Axivity AX3 was wrist worn to capture the participants? PA. Multilevel regression analyses in R were performed to examine these within-person associations. Results: Irritation, feeling down, intention, and self-efficacy were positively associated with subsequent light PA or moderate to vigorous PA at 15, 30, 60, or 120 minutes after the trigger, whereas relaxation, satisfaction, and fatigue were negatively associated. Conclusions: Multiple associations were observed in this study. This knowledge in combination with the time dependency of the determinants is valuable information for future interventions so that suggestions to be active can be provided when the older adult is most receptive. UR - https://aging.jmir.org/2023/1/e44425 UR - http://dx.doi.org/10.2196/44425 UR - http://www.ncbi.nlm.nih.gov/pubmed/37995131 ID - info:doi/10.2196/44425 ER - TY - JOUR AU - Weermeijer, Merlijn Jeroen Dennis AU - Wampers, Martien AU - de Thurah, Lena AU - Bonnier, Rafaël AU - Piot, Maarten AU - Kuppens, Peter AU - Myin-Germeys, Inez AU - Kiekens, Glenn PY - 2023/11/21 TI - Usability of the Experience Sampling Method in Specialized Mental Health Care: Pilot Evaluation Study JO - JMIR Form Res SP - e48821 VL - 7 KW - experience sampling KW - ecological momentary assessment KW - implementation KW - digital mental health KW - mobile phone N2 - Background: Mental health problems occur in interactions in daily life. Yet, it is challenging to bring contextual information into the therapy room. The experience sampling method (ESM) may facilitate this by assessing clients? thoughts, feelings, symptoms, and behaviors as they are experienced in everyday life. However, the ESM is still primarily used in research settings, with little uptake in clinical practice. One aspect that may facilitate clinical implementation concerns the use of ESM protocols, which involves providing practitioners with ready-to-use ESM questionnaires, sampling schemes, visualizations, and training. Objective: This pilot study?s objective was to evaluate the usability of an ESM protocol for using the ESM in a specialized mental health care setting. Methods: We created the ESM protocol using the m-Path software platform and tested its usability in clinical practice. The ESM protocol consists of a dashboard for practitioners (ie, including the setup of the template and data visualizations) and an app for clients (ie, for completing the ESM questionnaires). A total of 8 practitioners and 17 clients used the ESM in practice between December 1, 2020, and July 31, 2021. Usability was assessed using questionnaires, ESM compliance rates, and semistructured interviews. Results: The usability was overall rated reasonable to good by practitioners (mean scores of usability items ranging from 5.33, SD 0.91, to 6.06, SD 0.73, on a scale ranging from 1 to 7). However, practitioners expressed difficulty in personalizing the template and reported insufficient guidelines on how to use the ESM in clinical practice. On average, clients completed 55% (SD 25%) of the ESM questionnaires. They rated the usability as reasonable to good, but their scores were slightly lower and more variable than those of the practitioners (mean scores of usability items ranging from 4.18, SD 1.70, to 5.94, SD 1.50 on a scale ranging from 1 to 7). Clients also voiced several concerns over the piloted ESM template, with some indicating no interest in the continued use of the ESM. Conclusions: The findings suggest that using an ESM protocol may facilitate the implementation of the ESM as a mobile health assessment tool in psychiatry. However, additional adaptions should be made before further implementation. Adaptions include providing training on personalizing questionnaires, adding additional sampling scheme formats as well as an open-text field, and creating a dynamic data visualization interface. Future studies should also identify factors determining the suitability of the ESM for specific treatment goals among different client populations. UR - https://formative.jmir.org/2023/1/e48821 UR - http://dx.doi.org/10.2196/48821 UR - http://www.ncbi.nlm.nih.gov/pubmed/37988137 ID - info:doi/10.2196/48821 ER - TY - JOUR AU - El Dahr, Yola AU - Perquier, Florence AU - Moloney, Madison AU - Woo, Guyyunge AU - Dobrin-De Grace, Roksana AU - Carvalho, Daniela AU - Addario, Nicole AU - Cameron, E. Emily AU - Roos, E. Leslie AU - Szatmari, Peter AU - Aitken, Madison PY - 2023/11/9 TI - Feasibility of Using Research Electronic Data Capture (REDCap) to Collect Daily Experiences of Parent-Child Dyads: Ecological Momentary Assessment Study JO - JMIR Form Res SP - e42916 VL - 7 KW - ambulatory assessment KW - children KW - ecological momentary assessment KW - longitudinal KW - parents KW - survey N2 - Background: Intensive longitudinal data collection, including ecological momentary assessment (EMA), has the potential to reduce recall biases, collect more ecologically valid data, and increase our understanding of dynamic associations between variables. EMA is typically administered using an application that is downloaded on participants? devices, which presents cost and privacy concerns that may limit its use. Research Electronic Data Capture (REDCap), a web-based survey application freely available to nonprofit organizations, may allow researchers to overcome these barriers; however, at present, little guidance is available to researchers regarding the setup of EMA in REDCap, especially for those who are new to using REDCap or lack advanced programming expertise. Objective: We provide an example of a simplified EMA setup in REDCap. This study aims to demonstrate the feasibility of this approach. We provide information on survey completion and user behavior in a sample of parents and children recruited across Canada. Methods: We recruited 66 parents and their children (aged 9-13 years old) from an existing longitudinal cohort study to participate in a study on risk and protective factors for children?s mental health. Parents received survey prompts (morning and evening) by email or SMS text message for 14 days, twice daily. Each survey prompt contained 2 sections, one for parents and one for children to complete. Results: The completion rates were good (mean 82%, SD 8%) and significantly higher on weekdays than weekends and in dyads with girls than dyads with boys. Children were available to respond to their own survey questions most of the time (in 1134/1498, 75.7% of surveys submitted). The number of assessments submitted was significantly higher, and response times were significantly faster among participants who selected SMS text message survey notifications compared to email survey notifications. The average response time was 47.0 minutes after the initial survey notification, and the use of reminder messages increased survey completion. Conclusions: Our results support the feasibility of using REDCap for EMA studies with parents and children. REDCap also has features that can accommodate EMA studies by recruiting participants across multiple time zones and providing different survey delivery methods. Offering the option of SMS text message survey notifications and reminders may be an important way to increase completion rates and the timeliness of responses. REDCap is a potentially useful tool for researchers wishing to implement EMA in settings in which cost or privacy are current barriers. Researchers should weigh these benefits with the potential limitations of REDCap and this design, including staff time to set up, monitor, and clean the data outputs of the project. UR - https://formative.jmir.org/2023/1/e42916 UR - http://dx.doi.org/10.2196/42916 UR - http://www.ncbi.nlm.nih.gov/pubmed/37943593 ID - info:doi/10.2196/42916 ER - TY - JOUR AU - Edney, Sarah AU - Goh, Marie Claire AU - Chua, Hui Xin AU - Low, Alicia AU - Chia, Janelle AU - S Koek, Daphne AU - Cheong, Karen AU - van Dam, Rob AU - Tan, Seng Chuen AU - Müller-Riemenschneider, Falk PY - 2023/10/19 TI - Evaluating the Effects of Rewards and Schedule Length on Response Rates to Ecological Momentary Assessment Surveys: Randomized Controlled Trials JO - J Med Internet Res SP - e45764 VL - 25 KW - experience sampling KW - ambulatory assessment KW - compliance KW - mobile phone N2 - 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 UR - https://www.jmir.org/2023/1/e45764 UR - http://dx.doi.org/10.2196/45764 UR - http://www.ncbi.nlm.nih.gov/pubmed/37856188 ID - info:doi/10.2196/45764 ER - TY - JOUR AU - Tutunji, Rayyan AU - Kogias, Nikos AU - Kapteijns, Bob AU - Krentz, Martin AU - Krause, Florian AU - Vassena, Eliana AU - Hermans, J. Erno PY - 2023/10/19 TI - Detecting Prolonged Stress in Real Life Using Wearable Biosensors and Ecological Momentary Assessments: Naturalistic Experimental Study JO - J Med Internet Res SP - e39995 VL - 25 KW - biosensor KW - devices KW - ecological momentary assessments KW - experience sampling KW - machine learning KW - mental disorder KW - mental health KW - monitoring KW - physiological KW - prevention KW - psychological KW - smartwatches KW - stress KW - wearables N2 - Background: Increasing efforts toward the prevention of stress-related mental disorders have created a need for unobtrusive real-life monitoring of stress-related symptoms. Wearable devices have emerged as a possible solution to aid in this process, but their use in real-life stress detection has not been systematically investigated. Objective: We aimed to determine the utility of ecological momentary assessments (EMA) and physiological arousal measured through wearable devices in detecting ecologically relevant stress states. Methods: Using EMA combined with wearable biosensors for ecological physiological assessments (EPA), we investigated the impact of an ecological stressor (ie, a high-stakes examination week) on physiological arousal and affect compared to a control week without examinations in first-year medical and biomedical science students (51/83, 61.4% female). We first used generalized linear mixed-effects models with maximal fitting approaches to investigate the impact of examination periods on subjective stress exposure, mood, and physiological arousal. We then used machine learning models to investigate whether we could use EMA, wearable biosensors, or the combination of both to classify momentary data (ie, beeps) as belonging to examination or control weeks. We tested both individualized models using a leave-one-beep-out approach and group-based models using a leave-one-subject-out approach. Results: During stressful high-stakes examination (versus control) weeks, participants reported increased negative affect and decreased positive affect. Intriguingly, physiological arousal decreased on average during the examination week. Time-resolved analyses revealed peaks in physiological arousal associated with both momentary self-reported stress exposure and self-reported positive affect. Mediation models revealed that the decreased physiological arousal in the examination week was mediated by lower positive affect during the same period. We then used machine learning to show that while individualized EMA outperformed EPA in its ability to classify beeps as originating from examinations or from control weeks (1603/4793, 33.45% and 1648/4565, 36.11% error rates, respectively), a combination of EMA and EPA yields optimal classification (1363/4565, 29.87% error rate). Finally, when comparing individualized models to group-based models, we found that the individualized models significantly outperformed the group-based models across all 3 inputs (EMA, EPA, and the combination). Conclusions: This study underscores the potential of wearable biosensors for stress-related mental health monitoring. However, it emphasizes the necessity of psychological context in interpreting physiological arousal captured by these devices, as arousal can be related to both positive and negative contexts. Moreover, our findings support a personalized approach in which momentary stress is optimally detected when referenced against an individual?s own data. UR - https://www.jmir.org/2023/1/e39995 UR - http://dx.doi.org/10.2196/39995 UR - http://www.ncbi.nlm.nih.gov/pubmed/37856180 ID - info:doi/10.2196/39995 ER - TY - JOUR AU - Jordan, J. Evan AU - Shih, C. Patrick AU - Nelson, J. Erik AU - Carter, J. Stephen AU - Schootman, Mario AU - Prather, A. Aric AU - Yao, Xing AU - Peters, D. Chasie AU - Perry, E. Canaan S. PY - 2023/10/5 TI - Ecological Momentary Assessment of Midlife Adults? Daily Stress: Protocol for the Stress Reports in Variable Environments (STRIVE) App Study JO - JMIR Res Protoc SP - e51845 VL - 12 KW - activity trackers KW - built environment KW - ecological momentary assessment KW - heart rate monitoring KW - life stress KW - physical activity KW - spatial analysis KW - wearable technology N2 - Background: Daily stressors are associated with cognitive decline and increased risk of heart disease, depression, and other debilitating chronic illnesses in midlife adults. Daily stressors tend to occur at home or at work and are more frequent in urban versus rural settings. Conversely, spending time in natural environments such as parks or forests, or even viewing nature-themed images in a lab setting, is associated with lower levels of perceived stress and is hypothesized to be a strong stress ?buffer,? reducing perceived stress even after leaving the natural setting. However, many studies of daily stress have not captured environmental contexts and relied on end-of-day recall instead of in-the-moment data capture. With new technology, these limitations can be addressed to enhance knowledge of the daily stress experience. Objective: We propose to use our novel custom-built Stress Reports in Variable Environments (STRIVE) ecological momentary assessment mobile phone app to measure the experience of daily stress of midlife adults in free-living conditions. Using our app to capture data in real time will allow us to determine (1) where and when daily stress occurs for midlife adults, (2) whether midlife adults? daily stressors are linked to certain elements of the built and natural environment, and (3) how ecological momentary assessment measurement of daily stress is similar to and different from a modified version of the popular Daily Inventory of Stressful Events measurement tool that captures end-of-day stress reports (used in the Midlife in the United States [MIDUS] survey). Methods: We will enroll a total of 150 midlife adults living in greater Indianapolis, Indiana, in this study on a rolling basis for 3-week periods. As those in underrepresented minority groups and low-income areas have previously been found to experience greater levels of stress, we will use stratified sampling to ensure that half of our study sample is composed of underrepresented minorities (eg, Black, American Indian, Hispanic, or Native Pacific Islanders) and approximately one-third of our sample falls within low-, middle-, and high-income brackets. Results: This project is funded by the National Institute on Aging from December 2022 to November 2024. Participant enrollment began in August 2023 and is expected to finish in July 2024. Data will be spatiotemporally analyzed to determine where and when stress occurs for midlife adults. Pictures of stressful environments will be qualitatively analyzed to determine the common elements of stressful environments. Data collected by the STRIVE app will be compared with retrospective Daily Inventory of Stressful Events data. Conclusions: Completing this study will expand our understanding of midlife adults? experience of stress in free-living conditions and pave the way for data-driven individual and community-based intervention designs to promote health and well-being in midlife adults. International Registered Report Identifier (IRRID): DERR1-10.2196/51845 UR - https://www.researchprotocols.org/2023/1/e51845 UR - http://dx.doi.org/10.2196/51845 UR - http://www.ncbi.nlm.nih.gov/pubmed/37796561 ID - info:doi/10.2196/51845 ER - TY - JOUR AU - Ader, Leonie AU - Schick, Anita AU - Löffler, Martin AU - Löffler, Annette AU - Beiner, Eva AU - Eich, Wolfgang AU - Vock, Stephanie AU - Sirazitdinov, Andrei AU - Malone, Christopher AU - Hesser, Jürgen AU - Hopp, Michael AU - Ruckes, Christian AU - Flor, Herta AU - Tesarz, Jonas AU - Reininghaus, Ulrich PY - 2023/9/20 TI - Refocusing of Attention on Positive Events Using Monitoring-Based Feedback and Microinterventions for Patients With Chronic Musculoskeletal Pain in the PerPAIN Randomized Controlled Trial: Protocol for a Microrandomized Trial JO - JMIR Res Protoc SP - e43376 VL - 12 KW - experience sampling method KW - ESM KW - ecological momentary intervention KW - EMI KW - microrandomized trial KW - mobile health KW - mHealth KW - positive intervention KW - complex intervention KW - mobile phone N2 - Background: Chronic musculoskeletal pain (CMSP) affects between 13% and 47% of the population, with a global growth rate of 20.3% within the last 15 years, suggesting that there is a high need for effective treatments. Pain diaries have long been a common tool in nonpharmacological pain treatment for monitoring and providing feedback on patients? symptoms in daily life. More recently, positive refocusing techniques have come to be used, promoting pain-free episodes and positive outcomes rather than focusing on managing the pain. Objective: This study aims to evaluate the feasibility (ie, acceptability, intervention adherence, and fidelity) and initial signals of efficacy of the PerPAIN app, an ecological momentary intervention for patients with CMSP. The app comprises digitalized monitoring using the experience sampling method (ESM) and feedback. In addition, the patients receive 3 microinterventions targeted at refocusing of attention on positive events. Methods: In a microrandomized trial, we will recruit 35 patients with CMSP who will be offered the app for 12 weeks. Participants will be prompted to fill out 4 ESM monitoring questionnaires a day assessing information on their current context and the proximal outcome variables: absence of pain, positive mood, and subjective activity. Participants will be randomized daily and weekly to receive no feedback, verbal feedback, or visual feedback on proximal outcomes assessed by the ESM. In addition, the app will encourage participants to complete 3 microinterventions based on positive psychology and cognitive behavioral therapy techniques. These microinterventions are prompts to report joyful moments and everyday successes or to plan pleasant activities. After familiarizing themselves with each microintervention individually, participants will be randomized daily to receive 1 of the 3 exercises or none. We will assess whether the 2 feedback types and the 3 microinterventions increase proximal outcomes at the following time point. The microrandomized trial is part of the PerPAIN randomized controlled trial (German Clinical Trials Register DRKS00022792) investigating a personalized treatment approach to enhance treatment outcomes in CMSP. Results: Approval was granted by the Ethics Committee II of the University of Heidelberg on August 4, 2020. Recruitment for the microrandomized trial began in May 2021 and is ongoing at the time of submission. By October 10, 2022, a total of 24 participants had been enrolled in the microrandomized trial. Conclusions: This trial will provide evidence on the feasibility of the PerPAIN app and the initial signals of efficacy of the different intervention components. In the next step, the intervention would need to be further refined and investigated in a definitive trial. This ecological momentary intervention presents a potential method for offering low-level accessible treatment to a wide range of people, which could have substantial implications for public health by reducing disease burden of chronic pain in the population. International Registered Report Identifier (IRRID): DERR1-10.2196/43376 UR - https://www.researchprotocols.org/2023/1/e43376 UR - http://dx.doi.org/10.2196/43376 UR - http://www.ncbi.nlm.nih.gov/pubmed/37728983 ID - info:doi/10.2196/43376 ER - TY - JOUR AU - Cearns, Micah AU - Clark, R. Scott PY - 2023/9/19 TI - The Effects of Dose, Practice Habits, and Objects of Focus on Digital Meditation Effectiveness and Adherence: Longitudinal Study of 280,000 Digital Meditation Sessions Across 103 Countries JO - J Med Internet Res SP - e43358 VL - 25 KW - mindfulness KW - meditation KW - digital meditation KW - mindfulness dose-response KW - meditation dose-response KW - dose-response KW - meditation adherence KW - mindfulness adherence KW - longitudinal meditation research KW - outcome KW - ecological memory assessment KW - mental well-being KW - healthy lifestyle KW - digital health intervention N2 - Background: The efficacy of digital meditation is well established. However, the extent to which the benefits remain after 12 weeks in real-world settings remains unknown. Additionally, findings related to dosage and practice habits have been mixed, and the studies were conducted on small and homogeneous samples and used a limited range of analytical procedures and meditation techniques. Findings related to the predictors of adherence are also lacking and may help inform future meditators and meditation programs on how to best structure healthy sustainable practices. Objective: This study aimed to measure outcome change across a large and globally diverse population of meditators and meditations in their naturalistic practice environments, assess the dose-response relationships between practice habits and outcome change, and identify predictors of adherence. Methods: We used ecological momentary assessment to assess participants? well-being over a 14-month period. We engineered outcomes related to the variability of change over time (equanimity) and recovery following a drop in mood (resilience) and established the convergent and divergent validity of these outcomes using a validated scale. Using linear mixed-effects and generalized additive mixed-effects models, we modeled outcome changes and patterns of dose-response across outcomes. We then used logistic regression to study the practice habits of participants in their first 30 sessions to derive odds ratios of long-term adherence. Results: Significant improvements were observed in all outcomes (P<.001). Generalized additive mixed models revealed rapid improvements over the first 50-100 sessions, with further improvements observed until the end of the study period. Outcome change corresponded to 1 extra day of improved mood for every 5 days meditated and half-a-day-faster mood recovery compared with baseline. Overall, consistency of practice was associated with the largest outcome change (4-7 d/wk). No significant differences were observed across session lengths in linear models (mood: P=.19; equanimity: P=.10; resilience: P=.29); however, generalized additive models revealed significant differences over time (P<.001). Longer sessions (21-30 min) were associated with the largest magnitude of change in mood from the 20th session onward and fewer sessions to recovery (increased resilience); midlength sessions (11-20 min) were associated with the largest decreases in recovery; and mood stability was similar across session lengths (equanimity). Completing a greater variety of practice types was associated with significantly greater improvements across all outcomes. Adhering to a long-term practice was best predicted by practice consistency (4-7 d/wk), a morning routine, and maintaining an equal balance between interoceptive and exteroceptive meditations. Conclusions: Long-term real-world digital meditation practice is effective and associated with improvements in mood, equanimity, and resilience. Practice consistency and variety rather than length best predict improvement. Long-term sustainable practices are best predicted by consistency, a morning routine, and a practice balanced across objects of focus that are internal and external to the body. UR - https://www.jmir.org/2023/1/e43358 UR - http://dx.doi.org/10.2196/43358 UR - http://www.ncbi.nlm.nih.gov/pubmed/37725801 ID - info:doi/10.2196/43358 ER - TY - JOUR AU - Harrison, Conrad AU - Trickett, Ryan AU - Wormald, Justin AU - Dobbs, Thomas AU - Lis, Przemys?aw AU - Popov, Vesselin AU - Beard, J. David AU - Rodrigues, Jeremy PY - 2023/9/14 TI - Remote Symptom Monitoring With Ecological Momentary Computerized Adaptive Testing: Pilot Cohort Study of a Platform for Frequent, Low-Burden, and Personalized Patient-Reported Outcome Measures JO - J Med Internet Res SP - e47179 VL - 25 KW - patient-reported outcome measures KW - ecological momentary assessment KW - computerized adaptive testing KW - EMCAT KW - symptom monitoring KW - monitoring KW - assessment KW - smartphone app KW - trauma KW - arthritis KW - usability KW - mobile phone N2 - Background: Remote patient-reported outcome measure (PROM) data capture can provide useful insights into research and clinical practice and deeper insights can be gained by administering assessments more frequently, for example, in ecological momentary assessment. However, frequent data collection can be limited by the burden of multiple, lengthy questionnaires. This burden can be reduced with computerized adaptive testing (CAT) algorithms that select only the most relevant items from a PROM for an individual respondent. In this paper, we propose ?ecological momentary computerized adaptive testing? (EMCAT): the use of CAT algorithms to reduce PROM response burden and facilitate high-frequency data capture via a smartphone app. We develop and pilot a smartphone app for performing EMCAT using a popular hand surgery PROM. Objective: The aim of this study is to determine the feasibility of EMCAT as a system for remote PROM administration. Methods: We built the EMCAT web app using Concerto, an open-source CAT platform maintained by the Psychometrics Centre, University of Cambridge, and hosted it on an Amazon Web Service cloud server. The platform is compatible with any questionnaire that has been parameterized with item response theory or Rasch measurement theory. For this study, the PROM we chose was the patient evaluation measure, which is commonly used in hand surgery. CAT algorithms were built using item response theory models derived from UK Hand Registry data. In the pilot study, we enrolled 40 patients with hand trauma or thumb-base arthritis, across 2 sites, between July 13, 2022, and September 14, 2022. We monitored their symptoms with the patient evaluation measure, via EMCAT, over a 12-week period. Patients were assessed thrice weekly, once daily, or thrice daily. We additionally administered full-length PROM assessments at 0, 6, and 12 weeks, and the User Engagement Scale at 12 weeks. Results: The use of EMCAT significantly reduced the length of the PROM (median 2 vs 11 items) and the time taken to complete it (median 8.8 seconds vs 1 minute 14 seconds). Very similar scores were obtained when EMCAT was administered concurrently with the full-length PROM, with a mean error of <0.01 on a logit (z score) scale. The median response rate in the daily assessment group was 93%. The median perceived usability score of the User Engagement Scale was 4.0 (maximum possible score 5.0). Conclusions: EMCAT reduces the burden of PROM assessments, enabling acceptable high-frequency, remote PROM data capture. This has potential applications in both research and clinical practice. In research, EMCAT could be used to study temporal variations in symptom severity, for example, recovery trajectories after surgery. In clinical practice, EMCAT could be used to monitor patients remotely, prompting early intervention if a patient?s symptom trajectory causes clinical concern. Trial Registration: ISRCTN 19841416; https://www.isrctn.com/ISRCTN19841416 UR - https://www.jmir.org/2023/1/e47179 UR - http://dx.doi.org/10.2196/47179 UR - http://www.ncbi.nlm.nih.gov/pubmed/37707947 ID - info:doi/10.2196/47179 ER - TY - JOUR AU - Wyant, Kendra AU - Moshontz, Hannah AU - Ward, B. Stephanie AU - Fronk, E. Gaylen AU - Curtin, J. John PY - 2023/8/28 TI - Acceptability of Personal Sensing Among People With Alcohol Use Disorder: Observational Study JO - JMIR Mhealth Uhealth SP - e41833 VL - 11 KW - personal sensing KW - digital therapeutics KW - mobile health KW - smartphone KW - alcohol use disorder KW - self-report KW - alcohol use KW - symptom monitoring KW - mental health KW - acceptability KW - alcohol intake KW - mobile phone N2 - Background: Personal sensing may improve digital therapeutics for mental health care by facilitating early screening, symptom monitoring, risk prediction, and personalized adaptive interventions. However, further development and the use of personal sensing requires a better understanding of its acceptability to people targeted for these applications. Objective: We aimed to assess the acceptability of active and passive personal sensing methods in a sample of people with moderate to severe alcohol use disorder using both behavioral and self-report measures. This sample was recruited as part of a larger grant-funded project to develop a machine learning algorithm to predict lapses. Methods: Participants (N=154; n=77, 50% female; mean age 41, SD 11.9 years; n=134, 87% White and n=150, 97% non-Hispanic) in early recovery (1-8 weeks of abstinence) were recruited to participate in a 3-month longitudinal study. Participants were modestly compensated for engaging with active (eg, ecological momentary assessment [EMA], audio check-in, and sleep quality) and passive (eg, geolocation, cellular communication logs, and SMS text message content) sensing methods that were selected to tap into constructs from the Relapse Prevention model by Marlatt. We assessed 3 behavioral indicators of acceptability: participants? choices about their participation in the study at various stages in the procedure, their choice to opt in to provide data for each sensing method, and their adherence to a subset of the active methods (EMA and audio check-in). We also assessed 3 self-report measures of acceptability (interference, dislike, and willingness to use for 1 year) for each method. Results: Of the 192 eligible individuals screened, 191 consented to personal sensing. Most of these individuals (169/191, 88.5%) also returned 1 week later to formally enroll, and 154 participated through the first month follow-up visit. All participants in our analysis sample opted in to provide data for EMA, sleep quality, geolocation, and cellular communication logs. Out of 154 participants, 1 (0.6%) did not provide SMS text message content and 3 (1.9%) did not provide any audio check-ins. The average adherence rate for the 4 times daily EMA was .80. The adherence rate for the daily audio check-in was .54. Aggregate participant ratings indicated that all personal sensing methods were significantly more acceptable (all P<.001) compared with neutral across subjective measures of interference, dislike, and willingness to use for 1 year. Participants did not significantly differ in their dislike of active methods compared with passive methods (P=.23). However, participants reported a higher willingness to use passive (vs active) methods for 1 year (P=.04). Conclusions: These results suggest that active and passive sensing methods are acceptable for people with alcohol use disorder over a longer period than has previously been assessed. Important individual differences were observed across people and methods, indicating opportunities for future improvement. UR - https://mhealth.jmir.org/2023/1/e41833 UR - http://dx.doi.org/10.2196/41833 UR - http://www.ncbi.nlm.nih.gov/pubmed/37639300 ID - info:doi/10.2196/41833 ER - TY - JOUR AU - Meinlschmidt, Gunther AU - Grossert, Astrid AU - Meffert, Cornelia AU - Roemmel, Noa AU - Hess, Viviane AU - Rochlitz, Christoph AU - Pless, Miklos AU - Hunziker, Sabina AU - Wössmer, Brigitta AU - Geuter, Ulfried AU - Schaefert, Rainer PY - 2023/8/28 TI - Smartphone-Based Psychotherapeutic Interventions in Blended Care of Cancer Survivors: Nested Randomized Clinical Trial JO - JMIR Cancer SP - e38515 VL - 9 KW - digital therapeutics KW - ecological momentary assessment (EMA) KW - ecological momentary intervention (EMI) KW - internet- and mobile-based intervention KW - microintervention KW - neoplasm KW - smartphone-based intervention KW - postcancer treatment KW - body psychotherapy KW - mobile phone N2 - Background: Cancer is related to not only physical but also mental suffering. Notably, body image disturbances are highly relevant to cancer-related changes often persisting beyond recovery from cancer. Scalable and low-barrier interventions that can be blended with face-to-face psychotherapy for cancer survivors are highly warranted. Objective: The aim of the study is to investigate whether smartphone-based bodily interventions are more effective to improve the mood of patients with cancer than smartphone-based fairy tale interventions (control intervention). Methods: We recruited patients with cancer in 2 Swiss hospitals and conducted daily, fully automated smartphone-based interventions 6 times a week for 5 consecutive weeks, blended with weekly face-to-face group body psychotherapy. We applied 2 types of smartphone-based interventions using a within-subject design, randomly assigning patients daily to either bodily interventions or fairy tales. Each intervention type was presented 3 times a week. For this secondary analysis, 3-level mixed models were estimated with mood assessed by the 3 Multidimensional Mood Questionnaire subscales for good-bad mood, wakefulness, and calmness as key indicators. In addition, the effects on experience of presence, vitality, and burden assessed with visual analog scales were investigated. Results: Based on the data from s=732 interventions performed by 36 participants, good-bad mood improved (?=.27; 95% CI 0.062-0.483), and participants became calmer (?=.98; 95% CI 0.740-1.211) following smartphone-based interventions. Wakefulness did not significantly change from pre- to postsmartphone?based intervention (?=.17; 95% CI ?0.081 to 0.412). This was true for both intervention types. There was no interaction effect of intervention type with change in good-bad mood (?=?.01; 95% CI ?0.439 to 0.417), calmness (?=.22; 95% CI ?0.228 to 0.728), or wakefulness (?=.14; 95% CI ?0.354 to 0.644). Experience of presence (?=.34; 95% CI 0.271-0.417) and vitality (?=.35; 95% CI 0.268-0.426) increased from pre- to postsmartphone?based intervention, while experience of burden decreased (?=?0.40; 95% CI ?0.481 to 0.311). Again, these effects were present for both intervention types. There were no significant interaction effects of intervention type with pre- to postintervention changes in experience of presence (?=.14; 95% CI ?0.104 to 0.384), experience of vitality (?=.06; 95% CI ?0.152 to 0.265), and experience of burden (?=?.16; 95% CI ?0.358 to 0.017). Conclusions: Our results suggest that both smartphone-based audio-guided bodily interventions and fairy tales have the potential to improve the mood of cancer survivors. Trial Registration: ClinicalTrials.gov NCT03707548; https://clinicaltrials.gov/study/NCT03707548 International Registered Report Identifier (IRRID): RR2-10.1186/s40359-019-0357-1 UR - https://cancer.jmir.org/2023/1/e38515 UR - http://dx.doi.org/10.2196/38515 UR - http://www.ncbi.nlm.nih.gov/pubmed/37639296 ID - info:doi/10.2196/38515 ER - TY - JOUR AU - Kreibig, D. Sylvia AU - ten Brink, Maia AU - Mehta, Ashish AU - Talmon, Anat AU - Zhang, Jin-Xiao AU - Brown, S. Alan AU - Lucas-Griffin, S. Sawyer AU - Axelrod, K. Ariel AU - Manber, Rachel AU - Lavigne, J. Gilles AU - Gross, J. James PY - 2023/8/24 TI - The Role of Emotion Regulation, Affect, and Sleep in Individuals With Sleep Bruxism and Those Without: Protocol for a Remote Longitudinal Observational Study JO - JMIR Res Protoc SP - e41719 VL - 12 KW - sleep bruxism KW - emotion regulation KW - ecological momentary assessment KW - rhythmic masticatory muscle activity KW - heart rate variability KW - wrist actigraphy N2 - Background: Sleep bruxism (SB) is an oral behavior characterized by high levels of repetitive jaw muscle activity during sleep, leading to teeth grinding and clenching, and may develop into a disorder. Despite its prevalence and negative outcomes on oral health and quality of life, there is currently no cure for SB. The etiology of SB remains poorly understood, but recent research suggests a potential role of negative emotions and maladaptive emotion regulation (ER). Objective: This study?s primary aim investigates whether ER is impaired in individuals with SB, while controlling for affective and sleep disturbances. The secondary aim tests for the presence of cross-sectional and longitudinal mediation pathways in the bidirectional relationships among SB, ER, affect, and sleep. Methods: The study used a nonrandomized repeated-measures observational design and was conducted remotely. Participants aged 18-49 years underwent a 14-day ambulatory assessment. Data collection was carried out using electronic platforms. We assessed trait and state SB and ER alongside affect and sleep variables. We measured SB using self-reported trait questionnaires, ecological momentary assessment (EMA) for real-time reports of SB behavior, and portable electromyography for multinight assessment of rhythmic masticatory muscle activity. We assessed ER through self-reported trait questionnaires, EMA for real-time reports of ER strategies, and heart rate variability derived from an electrocardiography wireless physiological sensor as an objective physiological measure. Participants? trait affect and real-time emotional experiences were obtained using self-reported trait questionnaires and EMA. Sleep patterns and quality were evaluated using self-reported trait questionnaires and sleep diaries, as well as actigraphy as a physiological measure. For the primary objective, analyses will test for maladaptive ER in terms of strategy use frequency and effectiveness as a function of SB using targeted contrasts in the general linear model. Control analyses will be conducted to examine the persistence of the SB-ER relationship after adjusting for affective and sleep measures, as well as demographic variables. For the secondary objective, cross-sectional and longitudinal mediation analyses will test various competing models of directional effects among self-reported and physiological measures of SB, ER, affect, and sleep. Results: This research received funding in April 2017. Data collection took place from August 2020 to March 2022. In all, 237 participants were eligible and completed the study. Data analysis has not yet started. Conclusions: We hope that the effort to thoroughly measure SB and ER using gold standard methods and cutting-edge technology will advance the knowledge of SB. The findings of this study may contribute to a better understanding of the relationship among SB, ER, affect, and sleep disturbances. By identifying the role of ER in SB, the results may pave the way for the development of targeted interventions for SB management to alleviate the pain and distress of those affected. International Registered Report Identifier (IRRID): DERR1-10.2196/41719 UR - https://www.researchprotocols.org/2023/1/e41719 UR - http://dx.doi.org/10.2196/41719 UR - http://www.ncbi.nlm.nih.gov/pubmed/37616042 ID - info:doi/10.2196/41719 ER - TY - JOUR AU - Ruf, Alea AU - Neubauer, B. Andreas AU - Koch, D. Elena AU - Ebner-Priemer, Ulrich AU - Reif, Andreas AU - Matura, Silke PY - 2023/8/17 TI - Microtemporal Dynamics of Dietary Intake, Physical Activity, and Impulsivity in Adult Attention-Deficit/Hyperactivity Disorder: Ecological Momentary Assessment Study Within Nutritional Psychiatry JO - JMIR Ment Health SP - e46550 VL - 10 KW - impulsivity KW - nutrition KW - macronutrient intake KW - physical activity KW - ecological momentary assessment KW - EMA KW - attention-deficit/hyperactivity disorder KW - ADHD KW - diet KW - neurodevelopmental KW - hyperactivity KW - macronutrient KW - psychiatry KW - symptoms KW - mobile KW - mobile phone N2 - Background: Increasing attention is being paid to lifestyle factors, such as nutrition and physical activity (PA), as potential complementary treatment options in attention-deficit/hyperactivity disorder (ADHD). Previous research indicates that sugar and saturated fat intake may be linked to increased impulsivity, a core symptom of ADHD, whereas protein intake and PA may be related to reduced impulsivity. However, most studies rely on cross-sectional data that lack microtemporal resolution and ecological validity, wherefore questions of microtemporal dynamics (eg, is the consumption of foods high in sugar associated with increased impulsivity within minutes or hours?) remain largely unanswered. Ecological momentary assessment (EMA) has the potential to bridge this gap. Objective: This study is the first to apply EMA to assess microtemporal associations among macronutrient intake, PA, and state impulsivity in the daily life of adults with and without ADHD. Methods: Over a 3-day period, participants reported state impulsivity 8 times per day (signal-contingent), recorded food and drink intake (event-contingent), and wore an accelerometer. Multilevel 2-part models were used to study the association among macronutrient intake, PA, and the probability to be impulsive as well as the intensity of impulsivity (ADHD: n=36; control: n=137). Results: No association between macronutrient intake and state impulsivity was found. PA was not related to the intensity of impulsivity but to a higher probability to be impulsive (ADHD: ?=?.09, 95% CI ?0.14 to ?0.04; control: ?=?.03, 95% CI ?0.05 to ?0.01). No evidence was found that the combined intake of saturated fat and sugar amplified the increase in state impulsivity and that PA alleviated the positive association between sugar or fat intake and state impulsivity. Conclusions: Important methodological considerations are discussed that can contribute to the optimization of future EMA protocols. EMA research in the emerging field of nutritional psychiatry is still in its infancy; however, EMA is a highly promising and innovative approach as it offers insights into the microtemporal dynamics of psychiatric symptomology, dietary intake, and PA in daily life. UR - https://mental.jmir.org/2023/1/e46550 UR - http://dx.doi.org/10.2196/46550 UR - http://www.ncbi.nlm.nih.gov/pubmed/37590053 ID - info:doi/10.2196/46550 ER - TY - JOUR AU - Murray, Aja AU - Ushakova, Anastasia AU - Zhu, Xinxin AU - Yang, Yi AU - Xiao, Zhuoni AU - Brown, Ruth AU - Speyer, Lydia AU - Ribeaud, Denis AU - Eisner, Manuel PY - 2023/8/2 TI - Predicting Participation Willingness in Ecological Momentary Assessment of General Population Health and Behavior: Machine Learning Study JO - J Med Internet Res SP - e41412 VL - 25 KW - ecological momentary assessment KW - experience sampling KW - machine learning KW - recruitment KW - sampling N2 - Background: Ecological momentary assessment (EMA) is widely used in health research to capture individuals? experiences in the flow of daily life. The majority of EMA studies, however, rely on nonprobability sampling approaches, leaving open the possibility of nonrandom participation concerning the individual characteristics of interest in EMA research. Knowledge of the factors that predict participation in EMA research is required to evaluate this possibility and can also inform optimal recruitment strategies. Objective: This study aimed to examine the extent to which being willing to participate in EMA research is related to respondent characteristics and to identify the most critical predictors of participation. Methods: We leveraged the availability of comprehensive data on a general young adult population pool of potential EMA participants and used and compared logistic regression, classification and regression trees, and random forest approaches to evaluate respondents? characteristic predictors of willingness to participate in the Decades-to-Minutes EMA study. Results: In unadjusted logistic regression models, gender, migration background, anxiety, attention deficit hyperactivity disorder symptoms, stress, and prosociality were significant predictors of participation willingness; in logistic regression models, mutually adjusting for all predictors, migration background, tobacco use, and social exclusion were significant predictors. Tree-based approaches also identified migration status, tobacco use, and prosociality as prominent predictors. However, overall, willingness to participate in the Decades-to-Minutes EMA study was only weakly predictable from respondent characteristics. Cross-validation areas under the curve for the best models were only in the range of 0.56 to 0.57. Conclusions: Results suggest that migration background is the single most promising target for improving EMA participation and sample representativeness; however, more research is needed to improve prediction of participation in EMA studies in health. UR - https://www.jmir.org/2023/1/e41412 UR - http://dx.doi.org/10.2196/41412 UR - http://www.ncbi.nlm.nih.gov/pubmed/37531181 ID - info:doi/10.2196/41412 ER - TY - JOUR AU - Maher, P. Jaclyn AU - Hevel, J. Derek AU - Bittel, M. Kelsey AU - Hudgins, L. Brynn AU - Labban, D. Jeffery AU - Kennedy-Malone, Laurie PY - 2023/7/28 TI - Studying Movement-Related Behavioral Maintenance and Adoption in Real Time: Protocol for an Intensive Ecological Momentary Assessment Study Among Older Adults JO - JMIR Res Protoc SP - e47320 VL - 12 KW - physical activity KW - sedentary behavior KW - aging KW - multiburst design KW - ambulatory assessment KW - experience sampling method KW - accelerometers KW - stage of change KW - dual process KW - motivation KW - mobile phone N2 - Background: Older adults struggle to maintain newly initiated levels of physical activity (PA) or sedentary behavior (SB) and often regress to baseline levels over time. This is partly because health behavior theories that inform interventions rarely address how the changing contexts of daily life influence the processes regulating PA and SB or how those processes differ across the behavior change continuum. Few studies have focused on motivational processes that regulate the dynamic nature of PA and SB adoption and maintenance on microtimescales (ie, across minutes, hours, or days). Objective: The overarching goal of Project Studying Maintenance and Adoption in Real Time (SMART) is to determine the motivational processes that regulate behavioral adoption versus maintenance over microtimescales, using a dual process framework combined with ecological momentary assessment and sensor-based monitoring of behavior. This paper describes the recruitment, enrollment, data collection, and analytics protocols for Project SMART. Methods: In Project SMART, older adults engaging in at least 30 minutes of moderate-to-vigorous intensity PA per week complete 3 data collection periods over 1 year, with each data collection period lasting 14 days. Across each data collection period, participants wear an ActiGraph GT3X accelerometer (ActiGraph, LLC) on their nondominant waist and an ActivPAL micro4 accelerometer (PAL Technologies, Ltd) on their anterior thigh to measure PA and SB, respectively. Ecological momentary assessment questionnaires are randomly delivered via smartphone 10 times per day on 4 selected days in each data collection period and assess reflective processes (eg, evaluating one?s efficacy and exerting self-control) and reactive processes (eg, contextual cues) within the dual process framework. At the beginning and end of each data collection period, participants complete a computer-based questionnaire to learn more about their typical motivation for PA and SB, physical and mental health, and life events over the course of the study. Results: Recruitment and enrollment began in January 2021; enrollment in the first data collection period was completed by February 2022; and all participants completed their second and third data collection by July 2022 and December 2022, respectively. Data were collected from 202 older adults during the first data collection period, with approximate retention rates of 90.1% (n=182) during the second data collection period and 88.1% (n=178) during the third data collection period. Multilevel models and mixed-effects location scale modeling will be used to evaluate the study aims. Conclusions: Project SMART seeks to predict and model the adoption and maintenance of optimal levels of PA and SB among older adults. In turn, this will inform the future delivery of personalized intervention content under conditions where the content will be most effective to promote sustained behavior change among older adults. International Registered Report Identifier (IRRID): DERR1-10.2196/47320 UR - https://www.researchprotocols.org/2023/1/e47320 UR - http://dx.doi.org/10.2196/47320 UR - http://www.ncbi.nlm.nih.gov/pubmed/37505805 ID - info:doi/10.2196/47320 ER - TY - JOUR AU - Sommerhoff, Amanda AU - Ehring, Thomas AU - Takano, Keisuke PY - 2023/7/19 TI - Effects of Induced Mindfulness at Night on Repetitive Negative Thinking: Ecological Momentary Assessment Study JO - JMIR Ment Health SP - e44365 VL - 10 KW - mindfulness KW - repetitive negative thinking KW - stress KW - daily life KW - ecological momentary assessment KW - mobile phone N2 - Background: Repetitive negative thinking (RNT) is a cognitive risk factor for various disorders. Although brief mindfulness-based interventions (MBIs; lasting 20-30 minutes or shorter) are effective tools to reduce RNT, the effect of a minimal (5-minute) MBI remains largely unknown. Objective: We investigated the acute changes in RNT induced by a 10-day minimal MBI (body scan before sleeping) using an ecological momentary assessment (EMA) administered during the MBI training phase. In addition, we examined longer-term effects on the postintervention and 2-month follow-up assessments for questionnaire-based RNT and psychological distress. Methods: A total of 68 participants (community sample, aged 18-55 years; n=58, 85% women) were randomly allocated to either the intervention group (n=35, 51%) or the no-training control group (n=33, 49%). Both groups completed a 10-day EMA phase of RNT, during which only the intervention group performed a daily 5-minute body scan before sleeping. Results: The intervention group showed a significantly larger reduction in questionnaire-based RNT than the control group at the follow-up assessment (for growth-curve modeling analysis [GMA], dGMA=?0.91; P<.001), but this effect was not observed during the EMA phase or at the postintervention assessment. Furthermore, the intervention group showed significantly larger decreases in stress both at the postintervention (dGMA=?0.78; P<.001) and follow-up (dGMA=?0.60; P<.001) assessments than the control group. We found no intervention effects on depressive and anxiety symptoms. Conclusions: A 5-minute body scan before sleeping reduces RNT and stress when continued for at least 10 days; however, the results suggest that this effect only appears with some time lag because no acute changes during and immediately after the intervention emerged for RNT. UR - https://mental.jmir.org/2023/1/e44365 UR - http://dx.doi.org/10.2196/44365 UR - http://www.ncbi.nlm.nih.gov/pubmed/37467038 ID - info:doi/10.2196/44365 ER - TY - JOUR AU - Zarbo, Cristina AU - Zamparini, Manuel AU - Nielssen, Olav AU - Casiraghi, Letizia AU - Rocchetti, Matteo AU - Starace, Fabrizio AU - de Girolamo, Giovanni AU - PY - 2023/7/18 TI - Comparing Adherence to the Experience Sampling Method Among Patients With Schizophrenia Spectrum Disorder and Unaffected Individuals: Observational Study From the Multicentric DiAPAson Project JO - J Med Internet Res SP - e42093 VL - 25 KW - ecological momentary assessment KW - multicenter study KW - mobile application KW - mobile app KW - compliance KW - psychosis N2 - Background: The Experience Sampling Method (ESM) is a valid method of remotely recording activities and mood, but the predictors of adherence to ESM in patients with Schizophrenia Spectrum Disorder (SSD) are not known. Studies on adherence are significant as they highlight the strengths and weaknesses of ESM-based study designs and allow the development of recommendations and practical guidelines for implementing future studies or treatment plans. Objective: The aim of this study was to compare the adherence to ESM in patients with SSD and unaffected control individuals, investigate their patterns, and report the predictors of adherence. Methods: In total, 131 patients with SSD (74 in residential facilities and 57 outpatients) and 115 unaffected control individuals were recruited at 10 different centers in Italy as part of the DiAPAson project. Demographic information, symptom severity, disability level, and level of function were recorded for the clinical sample. Participants were evaluated for daily time use and mood through a smartphone-based ESM 8 times a day for 7 consecutive days. Adherence was measured by the response rate to ESM notifications. Results were analyzed using the chi-square test, ANOVA, Kruskal-Wallis test, and Friedman test, and a logistic regression model. Results: The overall adherence rate in this study was 50% for residents, 59% for outpatients, and 78% for unaffected control individuals. Indeed, patients with SSD had a lower rate of adherence to ESM than the unaffected control group (P?.001), independent of time slot, day of monitoring, or day of the week. No differences in adherence rates between weekdays and weekends were found among the 3 groups. The adherence rate was the lowest in the late evening time slot (8 PM to 12 AM) and days 6-7 of the study for both patients with SSD and unaffected control individuals. The adherence rate among patients with SSD was not predicted by sociodemographic characteristics, cognitive function, or other clinical features. A higher adherence rate (ie, ?70%) among patients with SSD was predicted by higher collaboration skills (odds ratio [OR] 2.952; P=.046) and self-esteem (OR 3.394; P=.03), and lower positive symptom severity (OR 0.835; P=.04). Conclusions: Adherence to ESM prompts for both patients with SSD and unaffected control individuals decreased during late evening and after 6 days of monitoring. Higher self-esteem and collaboration skills predicted higher adherence to ESM among patients with SSD, while higher positive symptom scores predicted lower adherence rates. This study provides important information to guide protocols for future studies using ESM. Future clinical or research studies should set ESM monitoring to waking hours, limit the number of days of monitoring, select patients with more collaborative skills and avoid those with marked positive symptoms, provide intensive training sessions, and improve participants? self-confidence with technologies. International Registered Report Identifier (IRRID): RR2-10.1186/s12888-020-02588-y UR - https://www.jmir.org/2023/1/e42093 UR - http://dx.doi.org/10.2196/42093 UR - http://www.ncbi.nlm.nih.gov/pubmed/37463030 ID - info:doi/10.2196/42093 ER - TY - JOUR AU - Wackerhagen, Carolin AU - Veer, M. Ilya AU - van Leeuwen, C. Judith M. AU - Reppmann, Zala AU - Riepenhausen, Antje AU - Bögemann, A. Sophie AU - Mor, Netali AU - Puhlmann, C. Lara M. AU - U?ci?ko, Aleksandra AU - Zerban, Matthias AU - Mituniewicz, Julian AU - Lerner, Avigail AU - Yuen, L. Kenneth S. AU - Köber, Göran AU - Marciniak, A. Marta AU - Pooseh, Shakoor AU - Weermeijer, Jeroen AU - Arias-Vásquez, Alejandro AU - Binder, Harald AU - de Raedt, Walter AU - Kleim, Birgit AU - Myin-Germeys, Inez AU - Roelofs, Karin AU - Timmer, Jens AU - Tüscher, Oliver AU - Hendler, Talma AU - Kobyli?ska, Dorota AU - Hermans, J. Erno AU - Kalisch, Raffael AU - Walter, Henrik PY - 2023/7/4 TI - Dynamic Modelling of Mental Resilience in Young Adults: Protocol for a Longitudinal Observational Study (DynaM-OBS) JO - JMIR Res Protoc SP - e39817 VL - 12 KW - resilience KW - stress KW - stressor reactivity KW - resilience factors KW - mental health KW - stress disorders KW - longitudinal KW - prospective KW - neuroimaging KW - ecological momentary assessment KW - mobile phone N2 - Background: Stress-related mental disorders are highly prevalent and pose a substantial burden on individuals and society. Improving strategies for the prevention and treatment of mental disorders requires a better understanding of their risk and resilience factors. This multicenter study aims to contribute to this endeavor by investigating psychological resilience in healthy but susceptible young adults over 9 months. Resilience is conceptualized in this study as the maintenance of mental health or quick recovery from mental health perturbations upon exposure to stressors, assessed longitudinally via frequent monitoring of stressors and mental health. Objective: This study aims to investigate the factors predicting mental resilience and adaptive processes and mechanisms contributing to mental resilience and to provide a methodological and evidence-based framework for later intervention studies. Methods: In a multicenter setting, across 5 research sites, a sample with a total target size of 250 young male and female adults was assessed longitudinally over 9 months. Participants were included if they reported at least 3 past stressful life events and an elevated level of (internalizing) mental health problems but were not presently affected by any mental disorder other than mild depression. At baseline, sociodemographic, psychological, neuropsychological, structural, and functional brain imaging; salivary cortisol and ?-amylase levels; and cardiovascular data were acquired. In a 6-month longitudinal phase 1, stressor exposure, mental health problems, and perceived positive appraisal were monitored biweekly in a web-based environment, while ecological momentary assessments and ecological physiological assessments took place once per month for 1 week, using mobile phones and wristbands. In a subsequent 3-month longitudinal phase 2, web-based monitoring was reduced to once a month, and psychological resilience and risk factors were assessed again at the end of the 9-month period. In addition, samples for genetic, epigenetic, and microbiome analyses were collected at baseline and at months 3 and 6. As an approximation of resilience, an individual stressor reactivity score will be calculated. Using regularized regression methods, network modeling, ordinary differential equations, landmarking methods, and neural net?based methods for imputation and dimension reduction, we will identify the predictors and mechanisms of stressor reactivity and thus be able to identify resilience factors and mechanisms that facilitate adaptation to stressors. Results: Participant inclusion began in October 2020, and data acquisition was completed in June 2022. A total of 249 participants were assessed at baseline, 209 finished longitudinal phase 1, and 153 finished longitudinal phase 2. Conclusions: The Dynamic Modelling of Resilience?Observational Study provides a methodological framework and data set to identify predictors and mechanisms of mental resilience, which are intended to serve as an empirical foundation for future intervention studies. International Registered Report Identifier (IRRID): DERR1-10.2196/39817 UR - https://www.researchprotocols.org/2023/1/e39817 UR - http://dx.doi.org/10.2196/39817 UR - http://www.ncbi.nlm.nih.gov/pubmed/37402143 ID - info:doi/10.2196/39817 ER - TY - JOUR AU - Hartson, R. Kimberly AU - Huntington-Moskos, Luz AU - Sears, G. Clara AU - Genova, Gina AU - Mathis, Cara AU - Ford, Wessly AU - Rhodes, E. Ryan PY - 2023/6/29 TI - Use of Electronic Ecological Momentary Assessment Methodologies in Physical Activity, Sedentary Behavior, and Sleep Research in Young Adults: Systematic Review JO - J Med Internet Res SP - e46783 VL - 25 KW - ecological momentary assessment KW - young adults KW - 24-hour movement behaviors KW - physical activity KW - sedentary behavior KW - sleep KW - mobile phone N2 - 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 UR - https://www.jmir.org/2023/1/e46783 UR - http://dx.doi.org/10.2196/46783 UR - http://www.ncbi.nlm.nih.gov/pubmed/37384367 ID - info:doi/10.2196/46783 ER - TY - JOUR AU - Latorre, Eligado Angelica Anne AU - Nakamura, Keiko AU - Seino, Kaoruko AU - Hasegawa, Takanori PY - 2023/6/27 TI - Vector Autoregression for Forecasting the Number of COVID-19 Cases and Analyzing Behavioral Indicators in the Philippines: Ecologic Time-Trend Study JO - JMIR Form Res SP - e46357 VL - 7 KW - COVID-19 KW - forecasting KW - interest by the general public KW - mobility KW - surveillance KW - vector autoregression N2 - Background: Traditional surveillance systems rely on routine collection of data. The inherent delay in retrieval and analysis of data leads to reactionary rather than preventive measures. Forecasting and analysis of behavior-related data can supplement the information from traditional surveillance systems. Objective: We assessed the use of behavioral indicators, such as the general public?s interest in the risk of contracting SARS-CoV-2 and changes in their mobility, in building a vector autoregression model for forecasting and analysis of the relationships of these indicators with the number of COVID-19 cases in the National Capital Region. Methods: An etiologic, time-trend, ecologic study design was used to forecast the daily number of cases in 3 periods during the resurgence of COVID-19. We determined the lag length by combining knowledge on the epidemiology of SARS-CoV-2 and information criteria measures. We fitted 2 models to the training data set and computed their out-of-sample forecasts. Model 1 contains changes in mobility and number of cases with a dummy variable for the day of the week, while model 2 also includes the general public?s interest. The forecast accuracy of the models was compared using mean absolute percentage error. Granger causality test was performed to determine whether changes in mobility and public?s interest improved the prediction of cases. We tested the assumptions of the model through the Augmented Dickey-Fuller test, Lagrange multiplier test, and assessment of the moduli of eigenvalues. Results: A vector autoregression (8) model was fitted to the training data as the information criteria measures suggest the appropriateness of 8. Both models generated forecasts with similar trends to the actual number of cases during the forecast period of August 11-18 and September 15-22. However, the difference in the performance of the 2 models became substantial from January 28 to February 4, as the accuracy of model 2 remained within reasonable limits (mean absolute percentage error [MAPE]=21.4%) while model 1 became inaccurate (MAPE=74.2%). The results of the Granger causality test suggest that the relationship of public interest with number of cases changed over time. During the forecast period of August 11-18, only change in mobility (P=.002) improved the forecasting of cases, while public interest was also found to Granger-cause the number of cases during September 15-22 (P=.001) and January 28 to February 4 (P=.003). Conclusions: To the best of our knowledge, this is the first study that forecasted the number of COVID-19 cases and explored the relationship of behavioral indicators with the number of COVID-19 cases in the Philippines. The resemblance of the forecasts from model 2 with the actual data suggests its potential in providing information about future contingencies. Granger causality also implies the importance of examining changes in mobility and public interest for surveillance purposes. UR - https://formative.jmir.org/2023/1/e46357 UR - http://dx.doi.org/10.2196/46357 UR - http://www.ncbi.nlm.nih.gov/pubmed/37368473 ID - info:doi/10.2196/46357 ER - TY - JOUR AU - Lauvsnes, Forsmo Anders Dahlen AU - Hansen, Ivar Tor AU - Ankill, Øiungen Sebastian AU - Bae, Won Sang AU - Gråwe, W. Rolf AU - Braund, A. Taylor AU - Larsen, Mark AU - Langaas, Mette PY - 2023/6/23 TI - Mobile Assessments of Mood, Cognition, Smartphone-Based Sensor Activity, and Variability in Craving and Substance Use in Patients With Substance Use Disorders in Norway: Prospective Observational Feasibility Study JO - JMIR Form Res SP - e45254 VL - 7 KW - executive functioning KW - substance use disorder KW - ecological momentary assessment KW - clinical inference KW - substance use KW - pilot study KW - mood KW - mental health KW - neurocognitive functioning KW - smartphone use KW - mobile sensor KW - sensor KW - decision support KW - mobile phone N2 - Background: Patients with substance use disorders (SUDs) are at increased risk for symptom deterioration following treatment, with up to 60% resuming substance use within the first year posttreatment. Substance use craving together with cognitive and mental health variables play important roles in the understanding of the trajectories from abstinence to substance use. Objective: This prospective observational feasibility study aims to improve our understanding of specific profiles of variables explaining SUD symptom deterioration, in particular, how individual variability in mental health, cognitive functioning, and smartphone use is associated with craving and substance use in a young adult clinical population. Methods: In this pilot study, 26 patients with SUDs were included at about 2 weeks prior to discharge from inpatient SUD treatment from 3 different treatment facilities in Norway. Patients underwent baseline neuropsychological and mental health assessments; they were equipped with smartwatches and they downloaded an app for mobile sensor data collection in their smartphones. Every 2 days for up to 8 weeks, the patients were administered mobile ecological momentary assessments (EMAs) to evaluate substance use, craving, mental health, cognition, and a mobile Go/NoGo performance task. Repeated EMAs as well as the smartphone?s battery use data were averaged across all days per individual and used as candidate input variables together with the baseline measures in models of craving intensity and the occurrence of any substance use episodes. Results: A total of 455 momentary assessments were completed out of a potential maximum of 728 assessments. Using EMA and baseline data as candidate input variables and craving and substance use as responses, model selection identified mean craving intensity as the most important predictor of having one or more substance use episodes and with variabilities in self-reported impulsivity, mental health, and battery use as significant explanatory variables of craving intensity. Conclusions: This prospective observational feasibility study adds novelty by collecting high-intensity data for a considerable period of time, including mental health data, mobile cognitive assessments, and mobile sensor data. Our study also contributes to our knowledge about a clinical population with the most severe SUD presentations in a vulnerable period during and after discharge from inpatient treatment. We confirmed the importance of variability in cognitive function and mood in explaining variability in craving and that smartphone usage may possibly add to this understanding. Further, we found that craving intensity is an important explanatory variable in understanding substance use episodes. UR - https://formative.jmir.org/2023/1/e45254 UR - http://dx.doi.org/10.2196/45254 UR - http://www.ncbi.nlm.nih.gov/pubmed/37351934 ID - info:doi/10.2196/45254 ER - TY - JOUR AU - Tonkin, Sarah AU - Gass, Julie AU - Wray, Jennifer AU - Maguin, Eugene AU - Mahoney, Martin AU - Colder, Craig AU - Tiffany, Stephen AU - Hawk Jr, W. Larry PY - 2023/6/22 TI - Evaluating Declines in Compliance With Ecological Momentary Assessment in Longitudinal Health Behavior Research: Analyses From a Clinical Trial JO - J Med Internet Res SP - e43826 VL - 25 KW - ecological momentary assessment KW - compliance KW - health behavior KW - methodology KW - longitudinal KW - smoking KW - smoker KW - cessation KW - quit KW - adherence KW - dropout KW - RCT KW - cigar KW - retention N2 - 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 UR - https://www.jmir.org/2023/1/e43826 UR - http://dx.doi.org/10.2196/43826 UR - http://www.ncbi.nlm.nih.gov/pubmed/37347538 ID - info:doi/10.2196/43826 ER - TY - JOUR AU - Luken, Amanda AU - Desjardins, R. Michael AU - Moran, B. Meghan AU - Mendelson, Tamar AU - Zipunnikov, Vadim AU - Kirchner, R. Thomas AU - Naughton, Felix AU - Latkin, Carl AU - Thrul, Johannes PY - 2023/6/16 TI - Using Smartphone Survey and GPS Data to Inform Smoking Cessation Intervention Delivery: Case Study JO - JMIR Mhealth Uhealth SP - e43990 VL - 11 KW - adult KW - application KW - case study KW - cessation KW - delivery KW - GIS KW - GPS KW - health interventions KW - mHealth KW - mobile phone KW - smartphone application KW - smartphone KW - smoker KW - smoking cessation KW - smoking N2 - Background: Interest in quitting smoking is common among young adults who smoke, but it can prove challenging. Although evidence-based smoking cessation interventions exist and are effective, a lack of access to these interventions specifically designed for young adults remains a major barrier for this population to successfully quit smoking. Therefore, researchers have begun to develop modern, smartphone-based interventions to deliver smoking cessation messages at the appropriate place and time for an individual. A promising approach is the delivery of interventions using geofences?spatial buffers around high-risk locations for smoking that trigger intervention messages when an individual?s phone enters the perimeter. Despite growth in personalized and ubiquitous smoking cessation interventions, few studies have incorporated spatial methods to optimize intervention delivery using place and time information. Objective: This study demonstrates an exploratory method of generating person-specific geofences around high-risk areas for smoking by presenting 4 case studies using a combination of self-reported smartphone-based surveys and passively tracked location data. The study also examines which geofence construction method could inform a subsequent study design that will automate the process of deploying coping messages when young adults enter geofence boundaries. Methods: Data came from an ecological momentary assessment study with young adult smokers conducted from 2016 to 2017 in the San Francisco Bay area. Participants reported smoking and nonsmoking events through a smartphone app for 30 days, and GPS data was recorded by the app. We sampled 4 cases along ecological momentary assessment compliance quartiles and constructed person-specific geofences around locations with self-reported smoking events for each 3-hour time interval using zones with normalized mean kernel density estimates exceeding 0.7. We assessed the percentage of smoking events captured within geofences constructed for 3 types of zones (census blocks, 500 ft2 fishnet grids, and 1000 ft2 fishnet grids). Descriptive comparisons were made across the 4 cases to better understand the strengths and limitations of each geofence construction method. Results: The number of reported past 30-day smoking events ranged from 12 to 177 for the 4 cases. Each 3-hour geofence for 3 of the 4 cases captured over 50% of smoking events. The 1000 ft2 fishnet grid captured the highest percentage of smoking events compared to census blocks across the 4 cases. Across 3-hour periods except for 3:00 AM-5:59 AM for 1 case, geofences contained an average of 36.4%-100% of smoking events. Findings showed that fishnet grid geofences may capture more smoking events compared to census blocks. Conclusions: Our findings suggest that this geofence construction method can identify high-risk smoking situations by time and place and has potential for generating individually tailored geofences for smoking cessation intervention delivery. In a subsequent smartphone-based smoking cessation intervention study, we plan to use fishnet grid geofences to inform the delivery of intervention messages. UR - https://mhealth.jmir.org/2023/1/e43990 UR - http://dx.doi.org/10.2196/43990 UR - http://www.ncbi.nlm.nih.gov/pubmed/37327031 ID - info:doi/10.2196/43990 ER - TY - JOUR AU - Schreiber, Mike AU - Dohle, Simone PY - 2023/6/15 TI - A Smartphone-Based Implicit Theories Intervention for Health Behavior Change: Randomized Trial JO - JMIR Mhealth Uhealth SP - e36578 VL - 11 KW - daily diary KW - ecological momentary assessment KW - health behavior KW - implicit theories KW - lay theories KW - mindsets KW - multiple health behavior change KW - randomized trial KW - smartphone-based intervention N2 - Background: Implicit theories of health describe individuals? beliefs about the malleability of health. Individuals with an incremental theory of health believe that health, in general, is malleable, whereas individuals with an entity theory of health endorse the idea that health is largely fixed and predetermined. Previous research has shown that an incremental theory of health is associated with beneficial health outcomes and behaviors. A mobile health implicit theories intervention could be an effective way to increase health-promoting behaviors in the general population. Objective: The aim of this study was to estimate the effect of a smartphone-based intervention designed to promote an incremental theory of health on the frequency of health-promoting behaviors in everyday life. The study used ecological momentary assessment to measure health behavior change. Methods: This 2-arm, single-blind, delayed intervention design included 149 German participants (mean age 30.58, SD 9.71 years; n=79 female). Participants were asked to report their engagement in 10 health-promoting behaviors throughout the day for 3 weeks. Participants were randomly assigned to either an early intervention group (n=72) or a delayed intervention group (n=77). The intervention materials, designed to promote an incremental theory of health, were provided to participants after 1 week (early intervention group) or 2 weeks (delayed intervention group) of baseline behavior measurement. Data for this study were collected between September 2019 and October 2019. Results: A paired-samples 2-tailed t test revealed that participants reported a stronger incremental theory after responding to the intervention materials (mean 5.58, SE 0.07) compared with incremental theory measured in an entry questionnaire (mean 5.29, SE 0.08; t148=4.07, SE 0.07; P<.001; 95% CI 0.15-0.43; d=0.33). Multilevel analyses showed that participants reported engaging in health-promoting behaviors more often after being presented with the intervention materials compared with baseline across conditions (b=0.14; t146.65=2.06, SE 0.07; P=.04; 95% CI 0.01-0.28). However, when the analysis was conducted separately for the early and delayed intervention groups, the intervention effect was only significant for the delayed intervention group (b=0.27; t1492.37=3.50, SE 0.08; P<.001; 95% CI 0.12-0.42). There was no significant increase in health-promoting behaviors for the early intervention group (b=0.02; t69.23=0.14, SE 0.11;P=.89; 95% CI ?0.2 to 0.23). Conclusions: This study suggests that a smartphone-based intervention designed to promote an incremental theory of health is a cost- and time-effective approach to increase the frequency of engaging in health-promoting behaviors. However, research is needed to understand the reasons for the difference in intervention effects between the early and delayed intervention groups. The results of this study can guide the development of future digital health interventions that focus on implicit theories to promote health behavior change. Trial Registration: DRKS ? German Clinical Trials Register DRKS00017379; https://drks.de/search/de/trial/DRKS00017379 UR - https://mhealth.jmir.org/2023/1/e36578 UR - http://dx.doi.org/10.2196/36578 UR - http://www.ncbi.nlm.nih.gov/pubmed/37318864 ID - info:doi/10.2196/36578 ER - TY - JOUR AU - Kiekens, Glenn AU - Claes, Laurence AU - Schoefs, Steffie AU - Kemme, F. Nian D. AU - Luyckx, Koen AU - Kleiman, M. Evan AU - Nock, K. Matthew AU - Myin-Germeys, Inez PY - 2023/6/15 TI - The Detection of Acute Risk of Self-injury Project: Protocol for an Ecological Momentary Assessment Study Among Individuals Seeking Treatment JO - JMIR Res Protoc SP - e46244 VL - 12 KW - nonsuicidal self-injury KW - suicidal thoughts and behaviors KW - real-time KW - experience sampling KW - ecological momentary assessment KW - digital interventions KW - mobile phone N2 - Background: Nonsuicidal self-injury (NSSI) is a major mental health concern. Despite increased research efforts on establishing the prevalence and correlates of the presence and severity of NSSI, we still lack basic knowledge of the course, predictors, and relationship of NSSI with other self-damaging behaviors in daily life. Such information will be helpful for better informing mental health professionals and allocating treatment resources. The DAILY (Detection of Acute rIsk of seLf-injurY) project will address these gaps among individuals seeking treatment. Objective: This protocol paper presents the DAILY project?s aims, design, and materials used. The primary objectives are to advance understanding of (1) the short-term course and contexts of elevated risk for NSSI thoughts, urges, and behavior; (2) the transition from NSSI thoughts and urges to NSSI behavior; and (3) the association of NSSI with disordered eating, substance use, and suicidal thoughts and behaviors. A secondary aim is to evaluate the perspectives of individuals seeking treatment and mental health professionals regarding the feasibility, scope, and utility of digital self-monitoring and interventions that target NSSI in daily life. Methods: The DAILY project is funded by the Research Foundation Flanders (Belgium). Data collection involves 3 phases: a baseline assessment (phase 1), 28 days of ecological momentary assessment (EMA) followed by a clinical session and feedback survey (phase 2), and 2 follow-up surveys and an optional interview (phase 3). The EMA protocol consists of regular EMA surveys (6 times per day), additional burst EMA surveys spaced at a higher frequency when experiencing intense NSSI urges (3 surveys within 30 minutes), and event registrations of NSSI behavior. The primary outcomes are NSSI thoughts, NSSI urges, self-efficacy to resist NSSI, and NSSI behavior, with disordered eating (restrictive eating, binge eating, and purging), substance use (binge drinking and smoking cannabis), and suicidal thoughts and behaviors surveyed as secondary outcomes. The assessed predictors include emotions, cognitions, contextual information, and social appraisals. Results: We will recruit approximately 120 individuals seeking treatment aged 15 to 39 years from mental health services across the Flanders region of Belgium. Recruitment began in June 2021 and data collection is anticipated to conclude in August 2023. Conclusions: The findings of the DAILY project will provide a detailed characterization of the short-term course and patterns of risk for NSSI and advance understanding of how, why, and when NSSI and other self-damaging behaviors unfold among individuals seeking treatment. This will inform clinical practice and provide the scientific building blocks for novel intervention approaches outside of the therapy room that support people who self-injure in real time. International Registered Report Identifier (IRRID): DERR1-10.2196/46244 UR - https://www.researchprotocols.org/2023/1/e46244 UR - http://dx.doi.org/10.2196/46244 UR - http://www.ncbi.nlm.nih.gov/pubmed/37318839 ID - info:doi/10.2196/46244 ER - TY - JOUR AU - Campbell, I. Cynthia AU - Chen, Ching-Hua AU - Adams, R. Sara AU - Asyyed, Asma AU - Athale, R. Ninad AU - Does, B. Monique AU - Hassanpour, Saeed AU - Hichborn, Emily AU - Jackson-Morris, Melanie AU - Jacobson, C. Nicholas AU - Jones, K. Heather AU - Kotz, David AU - Lambert-Harris, A. Chantal AU - Li, Zhiguo AU - McLeman, Bethany AU - Mishra, Varun AU - Stanger, Catherine AU - Subramaniam, Geetha AU - Wu, Weiyi AU - Zegers, Christopher AU - Marsch, A. Lisa PY - 2023/6/13 TI - Patient Engagement in a Multimodal Digital Phenotyping Study of Opioid Use Disorder JO - J Med Internet Res SP - e45556 VL - 25 KW - opioid use disorder KW - digital phenotyping KW - medication for opioid use disorder KW - MOUD KW - ecological momentary assessment KW - EMA KW - passive sensing KW - social media KW - opioid KW - OUD KW - data collection KW - smartphone KW - digital health N2 - Background: Multiple digital data sources can capture moment-to-moment information to advance a robust understanding of opioid use disorder (OUD) behavior, ultimately creating a digital phenotype for each patient. This information can lead to individualized interventions to improve treatment for OUD. Objective: The aim is to examine patient engagement with multiple digital phenotyping methods among patients receiving buprenorphine medication for OUD. Methods: The study enrolled 65 patients receiving buprenorphine for OUD between June 2020 and January 2021 from 4 addiction medicine programs in an integrated health care delivery system in Northern California. Ecological momentary assessment (EMA), sensor data, and social media data were collected by smartphone, smartwatch, and social media platforms over a 12-week period. Primary engagement outcomes were meeting measures of minimum phone carry (?8 hours per day) and watch wear (?18 hours per day) criteria, EMA response rates, social media consent rate, and data sparsity. Descriptive analyses, bivariate, and trend tests were performed. Results: The participants? average age was 37 years, 47% of them were female, and 71% of them were White. On average, participants met phone carrying criteria on 94% of study days, met watch wearing criteria on 74% of days, and wore the watch to sleep on 77% of days. The mean EMA response rate was 70%, declining from 83% to 56% from week 1 to week 12. Among participants with social media accounts, 88% of them consented to providing data; of them, 55% of Facebook, 54% of Instagram, and 57% of Twitter participants provided data. The amount of social media data available varied widely across participants. No differences by age, sex, race, or ethnicity were observed for any outcomes. Conclusions: To our knowledge, this is the first study to capture these 3 digital data sources in this clinical population. Our findings demonstrate that patients receiving buprenorphine treatment for OUD had generally high engagement with multiple digital phenotyping data sources, but this was more limited for the social media data. International Registered Report Identifier (IRRID): RR2-10.3389/fpsyt.2022.871916 UR - https://www.jmir.org/2023/1/e45556 UR - http://dx.doi.org/10.2196/45556 UR - http://www.ncbi.nlm.nih.gov/pubmed/37310787 ID - info:doi/10.2196/45556 ER - TY - JOUR AU - Singh, Shifali AU - Strong, Roger AU - Xu, Irene AU - Fonseca, M. Luciana AU - Hawks, Zoe AU - Grinspoon, Elizabeth AU - Jung, Lanee AU - Li, Frances AU - Weinstock, S. Ruth AU - Sliwinski, J. Martin AU - Chaytor, S. Naomi AU - Germine, T. Laura PY - 2023/6/2 TI - Ecological Momentary Assessment of Cognition in Clinical and Community Samples: Reliability and Validity Study JO - J Med Internet Res SP - e45028 VL - 25 KW - ecological momentary assessment KW - cognition KW - digital neuropsychology KW - remote assessment KW - digital technology KW - type 1 diabetes, teleneuropsychology KW - reliability KW - validity KW - cognitive functioning KW - psychological KW - physiological KW - glucose KW - community N2 - Background: The current methods of evaluating cognitive functioning typically rely on a single time point to assess and characterize an individual?s performance. However, cognitive functioning fluctuates within individuals over time in relation to environmental, psychological, and physiological contexts. This limits the generalizability and diagnostic utility of single time point assessments, particularly among individuals who may exhibit large variations in cognition depending on physiological or psychological context (eg, those with type 1 diabetes [T1D], who may have fluctuating glucose concentrations throughout the day). Objective: We aimed to report the reliability and validity of cognitive ecological momentary assessment (EMA) as a method for understanding between-person differences and capturing within-person variation in cognition over time in a community sample and sample of adults with T1D. Methods: Cognitive performance was measured 3 times a day for 15 days in the sample of adults with T1D (n=198, recruited through endocrinology clinics) and for 10 days in the community sample (n=128, recruited from TestMyBrain, a web-based citizen science platform) using ultrabrief cognitive tests developed for cognitive EMA. Our cognitive EMA platform allowed for remote, automated assessment in participants? natural environments, enabling the measurement of within-person cognitive variation without the burden of repeated laboratory or clinic visits. This allowed us to evaluate reliability and validity in samples that differed in their expected degree of cognitive variability as well as the method of recruitment. Results: The results demonstrate excellent between-person reliability (ranging from 0.95 to 0.99) and construct validity of cognitive EMA in both the sample of adults with T1D and community sample. Within-person reliability in both samples (ranging from 0.20 to 0.80) was comparable with that observed in previous studies in healthy older adults. As expected, the full-length baseline and EMA versions of TestMyBrain tests correlated highly with one another and loaded together on the expected cognitive domains when using exploratory factor analysis. Interruptions had higher negative impacts on accuracy-based outcomes (?=?.34 to ?.26; all P values <.001) than on reaction time?based outcomes (?=?.07 to ?.02; P<.001 to P=.40). Conclusions: We demonstrated that ultrabrief mobile assessments are both reliable and valid across 2 very different clinic versus community samples, despite the conditions in which cognitive EMAs are administered, which are often associated with more noise and variability. The psychometric characteristics described here should be leveraged appropriately depending on the goals of the cognitive assessment (eg, diagnostic vs everyday functioning) and the population being studied. UR - https://www.jmir.org/2023/1/e45028 UR - http://dx.doi.org/10.2196/45028 UR - http://www.ncbi.nlm.nih.gov/pubmed/37266996 ID - info:doi/10.2196/45028 ER - TY - JOUR AU - Hernandez, Raymond AU - Hoogendoorn, Claire AU - Gonzalez, S. Jeffrey AU - Jin, Haomiao AU - Pyatak, A. Elizabeth AU - Spruijt-Metz, Donna AU - Junghaenel, U. Doerte AU - Lee, Pey-Jiuan AU - Schneider, Stefan PY - 2023/5/30 TI - Reliability and Validity of Noncognitive Ecological Momentary Assessment Survey Response Times as an Indicator of Cognitive Processing Speed in People?s Natural Environment: Intensive Longitudinal Study JO - JMIR Mhealth Uhealth SP - e45203 VL - 11 KW - cognitive performance KW - processing speed KW - ecological momentary assessment KW - ambulatory assessment KW - type 1 diabetes KW - survey response times KW - paradata KW - chronic illness KW - smartphone KW - mobile health KW - mHealth KW - mobile phone N2 - Background: Various populations with chronic conditions are at risk for decreased cognitive performance, making assessment of their cognition important. Formal mobile cognitive assessments measure cognitive performance with greater ecological validity than traditional laboratory-based testing but add to participant task demands. Given that responding to a survey is considered a cognitively demanding task itself, information that is passively collected as a by-product of ecological momentary assessment (EMA) may be a means through which people?s cognitive performance in their natural environment can be estimated when formal ambulatory cognitive assessment is not feasible. We specifically examined whether the item response times (RTs) to EMA questions (eg, mood) can serve as approximations of cognitive processing speed. Objective: This study aims to investigate whether the RTs from noncognitive EMA surveys can serve as approximate indicators of between-person (BP) differences and momentary within-person (WP) variability in cognitive processing speed. Methods: Data from a 2-week EMA study investigating the relationships among glucose, emotion, and functioning in adults with type 1 diabetes were analyzed. Validated mobile cognitive tests assessing processing speed (Symbol Search task) and sustained attention (Go-No Go task) were administered together with noncognitive EMA surveys 5 to 6 times per day via smartphones. Multilevel modeling was used to examine the reliability of EMA RTs, their convergent validity with the Symbol Search task, and their divergent validity with the Go-No Go task. Other tests of the validity of EMA RTs included the examination of their associations with age, depression, fatigue, and the time of day. Results: Overall, in BP analyses, evidence was found supporting the reliability and convergent validity of EMA question RTs from even a single repeatedly administered EMA item as a measure of average processing speed. BP correlations between the Symbol Search task and EMA RTs ranged from 0.43 to 0.58 (P<.001). EMA RTs had significant BP associations with age (P<.001), as expected, but not with depression (P=.20) or average fatigue (P=.18). In WP analyses, the RTs to 16 slider items and all 22 EMA items (including the 16 slider items) had acceptable (>0.70) WP reliability. After correcting for unreliability in multilevel models, EMA RTs from most combinations of items showed moderate WP correlations with the Symbol Search task (ranged from 0.29 to 0.58; P<.001) and demonstrated theoretically expected relationships with momentary fatigue and the time of day. The associations between EMA RTs and the Symbol Search task were greater than those between EMA RTs and the Go-No Go task at both the BP and WP levels, providing evidence of divergent validity. Conclusions: Assessing the RTs to EMA items (eg, mood) may be a method of approximating people?s average levels of and momentary fluctuations in processing speed without adding tasks beyond the survey questions. UR - https://mhealth.jmir.org/2023/1/e45203 UR - http://dx.doi.org/10.2196/45203 UR - http://www.ncbi.nlm.nih.gov/pubmed/37252787 ID - info:doi/10.2196/45203 ER - TY - JOUR AU - Lind, N. Monika AU - Kahn, E. Lauren AU - Crowley, Ryann AU - Reed, Wyatt AU - Wicks, Geordie AU - Allen, B. Nicholas PY - 2023/4/26 TI - Reintroducing the Effortless Assessment Research System (EARS) JO - JMIR Ment Health SP - e38920 VL - 10 KW - mobile sensing KW - passive sensing KW - personal sensing KW - digital phenotyping KW - ecological momentary assessment KW - digital mental health UR - https://mental.jmir.org/2023/1/e38920 UR - http://dx.doi.org/10.2196/38920 UR - http://www.ncbi.nlm.nih.gov/pubmed/37099361 ID - info:doi/10.2196/38920 ER - TY - JOUR AU - Takano, Ayumi AU - Ono, Koki AU - Nozawa, Kyosuke AU - Sato, Makito AU - Onuki, Masaki AU - Sese, Jun AU - Yumoto, Yosuke AU - Matsushita, Sachio AU - Matsumoto, Toshihiko PY - 2023/4/11 TI - 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 JO - JMIR Res Protoc SP - e44275 VL - 12 KW - alcohol and drug use KW - alcoholism KW - digital health KW - drug use KW - ecological momentary assessment KW - ecological momentary intervention KW - electronic health record KW - Fitbit KW - machine learning KW - mHealth KW - mobile app KW - self-monitoring KW - wearables devices N2 - 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 UR - https://www.researchprotocols.org/2023/1/e44275 UR - http://dx.doi.org/10.2196/44275 UR - http://www.ncbi.nlm.nih.gov/pubmed/37040162 ID - info:doi/10.2196/44275 ER - TY - JOUR AU - Bittel, M. Kelsey AU - O'Briant, Y. Kate AU - Ragaglia, M. Rena AU - Buseth, Lake AU - Murtha, Courtney AU - Yu, Jessica AU - Stanely, M. Jennifer AU - Hudgins, L. Brynn AU - Hevel, J. Derek AU - Maher, P. Jaclyn PY - 2023/4/7 TI - Associations Between Social Cognitive Determinants and Movement-Related Behaviors in Studies Using Ecological Momentary Assessment Methods: Systematic Review JO - JMIR Mhealth Uhealth SP - e44104 VL - 11 KW - motivation KW - psychosocial KW - physical activity KW - sedentary behavior KW - ambulatory assessment KW - mobile phone N2 - Background: The social cognitive framework is a long-standing framework within physical activity promotion literature to explain and predict movement-related behaviors. However, applications of the social cognitive framework to explain and predict movement-related behaviors have typically examined the relationships between determinants and behavior across macrotimescales (eg, weeks and months). There is more recent evidence suggesting that movement-related behaviors and their social cognitive determinants (eg, self-efficacy and intentions) change across microtimescales (eg, hours and days). Therefore, efforts have been devoted to examining the relationship between social cognitive determinants and movement-related behaviors across microtimescales. Ecological momentary assessment (EMA) is a growing methodology that can capture movement-related behaviors and social cognitive determinants as they change across microtimescales. Objective: The objective of this systematic review was to summarize evidence from EMA studies examining associations between social cognitive determinants and movement-related behaviors (ie, physical activity and sedentary behavior). Methods: Studies were included if they quantitatively tested such an association at the momentary or day level and excluded if they were an active intervention. Using keyword searches, articles were identified across the PubMed, SPORTDiscus, and PsycINFO databases. Articles were first assessed through abstract and title screening followed by full-text review. Each article was screened independently by 2 reviewers. For eligible articles, data regarding study design, associations between social cognitive determinants and movement-related behaviors, and study quality (ie, Methodological Quality Questionnaire and Checklist for Reporting Ecological Momentary Assessment Studies) were extracted. At least 4 articles were required to draw a conclusion regarding the overall associations between a social cognitive determinant and movement-related behavior. For the social cognitive determinants in which a conclusion regarding an overall association could be drawn, 60% of the articles needed to document a similar association (ie, positive, negative, or null) to conclude that the association existed in a particular direction. Results: A total of 24 articles including 1891 participants were eligible for the review. At the day level, intentions and self-efficacy were positively associated with physical activity. No other associations could be determined because of conflicting findings or the small number of studies investigating associations. Conclusions: Future research would benefit from validating EMA assessments of social cognitive determinants and systematically investigating associations across different operationalizations of key constructs. Despite the only recent emergence of EMA to understand social cognitive determinants of movement-related behaviors, the findings indicate that daily intentions and self-efficacy play an important role in regulating physical activity in everyday life. Trial Registration: PROSPERO CRD42022328500; https://www.crd.york.ac.uk/prospero/display_record.php?RecordID=328500 UR - https://mhealth.jmir.org/2023/1/e44104 UR - http://dx.doi.org/10.2196/44104 UR - http://www.ncbi.nlm.nih.gov/pubmed/37027185 ID - info:doi/10.2196/44104 ER - TY - JOUR AU - Lehman, Natacha AU - Trouillet, Raphaël AU - Genevieve, David PY - 2023/4/3 TI - Evaluation of the Effectiveness of Therapy for Anxiety in Williams Beuren Syndrome Using a Smartphone App: Protocol for a Single-Case Experiment JO - JMIR Res Protoc SP - e44393 VL - 12 KW - single case experimental design KW - cognitive behavioral therapy KW - intellectual disability KW - rare disease KW - Williams syndrome KW - smartphone application KW - ecological momentary assessment N2 - Background: Williams syndrome (WS-OMIM 194050, orphaned number: Orpha 904) is a rare condition mostly associated with intellectual disability. People with Williams syndrome are 8 times more likely to have anxiety disorders than the general population. Therapeutic solutions to treat the anxiety remain limited, particularly nonpharmacological therapy. However, cognitive behavioral therapy (CBT) has been found efficacious in managing anxiety disorders and can be used for people with intellectual disability. Objective: This paper describes a protocol to assess the efficiency of a CBT program based on digital support for people with Williams syndrome and anxiety based on a research methodology designed for rare diseases. Methods: We will recruit 5 individuals with Williams syndrome and anxiety. They will participate in 9 CBT sessions. Participants will perform daily self-assessments of anxiety using a digital app, which will allow for ecological and repeated evaluation of their anxiety. This digital app will provide support for each therapy session. Anxiety and quality of life will be externally assessed before and after the program and at a 3-month follow-up. This is a single-case intervention research design with multiple baselines implying repeated measures of judgment criteria. The present protocol ensures high internal validity and will help identify encouraging contributions for later clinical trials. Results: Participant recruitment and data collection began in September 2019, and we project that the study findings will be available for dissemination by spring 2023. Conclusions: This study will allow the assessment of the efficiency of a CBT program based on digital support to treat anxiety in people with Williams syndrome. Finally, the program could be used as an example of nonpharmacological therapy for rare diseases. Trial Registration: ClinicalTrials.gov ID: NCT03827525; https://clinicaltrials.gov/ct2/show/NCT03827525 International Registered Report Identifier (IRRID): DERR1-10.2196/44393 UR - https://www.researchprotocols.org/2023/1/e44393 UR - http://dx.doi.org/10.2196/44393 UR - http://www.ncbi.nlm.nih.gov/pubmed/37010888 ID - info:doi/10.2196/44393 ER - TY - JOUR AU - Aalbers, George AU - Hendrickson, T. Andrew AU - Vanden Abeele, MP Mariek AU - Keijsers, Loes PY - 2023/3/23 TI - Smartphone-Tracked Digital Markers of Momentary Subjective Stress in College Students: Idiographic Machine Learning Analysis JO - JMIR Mhealth Uhealth SP - e37469 VL - 11 KW - mobile health KW - mobile phone KW - digital phenotype KW - digital biomarker KW - machine learning KW - personalized models N2 - Background: Stress is an important predictor of mental health problems such as burnout and depression. Acute stress is considered adaptive, whereas chronic stress is viewed as detrimental to well-being. To aid in the early detection of chronic stress, machine learning models are increasingly trained to learn the quantitative relation from digital footprints to self-reported stress. Prior studies have investigated general principles in population-wide studies, but the extent to which the findings apply to individuals is understudied. Objective: We aimed to explore to what extent machine learning models can leverage features of smartphone app use log data to recognize momentary subjective stress in individuals, which of these features are most important for predicting stress and represent potential digital markers of stress, the nature of the relations between these digital markers and stress, and the degree to which these relations differ across people. Methods: Student participants (N=224) self-reported momentary subjective stress 5 times per day up to 60 days in total (44,381 observations); in parallel, dedicated smartphone software continuously logged their smartphone app use. We extracted features from the log data (eg, time spent on app categories such as messenger apps and proxies for sleep duration and onset) and trained machine learning models to predict momentary subjective stress from these features using 2 approaches: modeling general relations at the group level (nomothetic approach) and modeling relations for each person separately (idiographic approach). To identify potential digital markers of momentary subjective stress, we applied explainable artificial intelligence methodology (ie, Shapley additive explanations). We evaluated model accuracy on a person-to-person basis in out-of-sample observations. Results: We identified prolonged use of messenger and social network site apps and proxies for sleep duration and onset as the most important features across modeling approaches (nomothetic vs idiographic). The relations of these digital markers with momentary subjective stress differed from person to person, as did model accuracy. Sleep proxies, messenger, and social network use were heterogeneously related to stress (ie, negative in some and positive or zero in others). Model predictions correlated positively and statistically significantly with self-reported stress in most individuals (median person-specific correlation=0.15-0.19 for nomothetic models and median person-specific correlation=0.00-0.09 for idiographic models). Conclusions: Our findings indicate that smartphone log data can be used for identifying digital markers of stress and also show that the relation between specific digital markers and stress differs from person to person. These findings warrant follow-up studies in other populations (eg, professionals and clinical populations) and pave the way for similar research using physiological measures of stress. UR - https://mhealth.jmir.org/2023/1/e37469 UR - http://dx.doi.org/10.2196/37469 UR - http://www.ncbi.nlm.nih.gov/pubmed/36951924 ID - info:doi/10.2196/37469 ER - TY - JOUR AU - Davanzo, Antonella AU - d´Huart, Delfine AU - Seker, Süheyla AU - Moessner, Markus AU - Zimmermann, Ronan AU - Schmeck, Klaus AU - Behn, Alex PY - 2023/3/15 TI - Study Features and Response Compliance in Ecological Momentary Assessment Research in Borderline Personality Disorder: Systematic Review and Meta-analysis JO - J Med Internet Res SP - e44853 VL - 25 KW - borderline personality disorder KW - ecological momentary assessment KW - compliance KW - study design features KW - e?mental health KW - mobile phone N2 - Background: Borderline personality disorder (BPD) is characterized by frequent and intense moment-to-moment changes in affect, behavior, identity, and interpersonal relationships, which typically result in significant and negative deterioration of the person?s overall functioning and well-being. Measuring and characterizing the rapidly changing patterns of instability in BPD dysfunction as they occur in a person?s daily life can be challenging. Ecological momentary assessment (EMA) is a method that can capture highly dynamic processes in psychopathology research and, thus, is well suited to study intense variability patterns across areas of dysfunction in BPD. EMA studies are characterized by frequent repeated assessments that are delivered to participants in real-life, real-time settings using handheld devices capable of registering responses to short self-report questions in daily life. Compliance in EMA research is defined as the proportion of prompts answered by the participant, considering all planned prompts sent. Low compliance with prompt schedules can compromise the relative advantages of using this method. Despite the growing EMA literature on BPD in recent years, findings regarding study design features that affect compliance with EMA protocols have not been compiled, aggregated, and estimated. Objective: This systematic meta-analytic review aimed to investigate the relationship between study design features and participant compliance in EMA research of BPD. Methods: A systematic review was conducted on November 12, 2021, following the PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) and MOOSE (Meta-analyses of Observational Studies in Epidemiology) guidelines to search for articles featuring EMA studies of BPD that reported compliance rates and included sufficient data to extract relevant design features. For studies with complete data, random-effect models were used to estimate the overall compliance rate and explore its association with design features. Results: In total, 28 peer-reviewed EMA studies comprising 2052 participants were included in the study. Design features (sampling strategy, average prompting frequency, number of items, response window, sampling device, financial incentive, and dropout rate) showed a large variability across studies, and many studies did not report design features. The meta-analytic synthesis was restricted to 64% (18/28) of articles and revealed a pooled compliance rate of 79% across studies. We did not find any significant relationship between design features and compliance rates. Conclusions: Our results show wide variability in the design and reporting of EMA studies assessing BPD. Compliance rates appear to be stable across varying setups, and it is likely that standard design features are not directly responsible for improving or diminishing compliance. We discuss possible nonspecific factors of study design that may have an impact on compliance. Given the promise of EMA research in BPD, we also discuss the importance of unifying standards for EMA reporting so that data stemming from this rich literature can be aggregated and interpreted jointly. UR - https://www.jmir.org/2023/1/e44853 UR - http://dx.doi.org/10.2196/44853 UR - http://www.ncbi.nlm.nih.gov/pubmed/36920466 ID - info:doi/10.2196/44853 ER - TY - JOUR AU - Niemeijer, Koen AU - Mestdagh, Merijn AU - Verdonck, Stijn AU - Meers, Kristof AU - Kuppens, Peter PY - 2023/3/7 TI - Combining Experience Sampling and Mobile Sensing for Digital Phenotyping With m-Path Sense: Performance Study JO - JMIR Form Res SP - e43296 VL - 7 KW - digital phenotyping KW - mobile health KW - mHealth KW - mobile sensing KW - passive sensing KW - ambulatory assessment KW - experience sampling KW - ecological momentary assessment KW - smartphones KW - mobile phone N2 - Background: The experience sampling methodology (ESM) has long been considered as the gold standard for gathering data in everyday life. In contrast, current smartphone technology enables us to acquire data that are much richer, more continuous, and unobtrusive than is possible via ESM. Although data obtained from smartphones, known as mobile sensing, can provide useful information, its stand-alone usefulness is limited when not combined with other sources of information such as data from ESM studies. Currently, there are few mobile apps available that allow researchers to combine the simultaneous collection of ESM and mobile sensing data. Furthermore, such apps focus mostly on passive data collection with only limited functionality for ESM data collection. Objective: In this paper, we presented and evaluated the performance of m-Path Sense, a novel, full-fledged, and secure ESM platform with background mobile sensing capabilities. Methods: To create an app with both ESM and mobile sensing capabilities, we combined m-Path, a versatile and user-friendly platform for ESM, with the Copenhagen Research Platform Mobile Sensing framework, a reactive cross-platform framework for digital phenotyping. We also developed an R package, named mpathsenser, which extracts raw data to an SQLite database and allows the user to link and inspect data from both sources. We conducted a 3-week pilot study in which we delivered ESM questionnaires while collecting mobile sensing data to evaluate the app?s sampling reliability and perceived user experience. As m-Path is already widely used, the ease of use of the ESM system was not investigated. Results: Data from m-Path Sense were submitted by 104 participants, totaling 69.51 GB (430.43 GB after decompression) or approximately 37.50 files or 31.10 MB per participant per day. After binning accelerometer and gyroscope data to 1 value per second using summary statistics, the entire SQLite database contained 84,299,462 observations and was 18.30 GB in size. The reliability of sampling frequency in the pilot study was satisfactory for most sensors, based on the absolute number of collected observations. However, the relative coverage rate?the ratio between the actual and expected number of measurements?was below its target value. This could mostly be ascribed to gaps in the data caused by the operating system pushing away apps running in the background, which is a well-known issue in mobile sensing. Finally, some participants reported mild battery drain, which was not considered problematic for the assessed participants? perceived user experience. Conclusions: To better study behavior in everyday life, we developed m-Path Sense, a fusion of both m-Path for ESM and Copenhagen Research Platform Mobile Sensing. Although reliable passive data collection with mobile phones remains challenging, it is a promising approach toward digital phenotyping when combined with ESM. UR - https://formative.jmir.org/2023/1/e43296 UR - http://dx.doi.org/10.2196/43296 UR - http://www.ncbi.nlm.nih.gov/pubmed/36881444 ID - info:doi/10.2196/43296 ER - TY - JOUR AU - Arend, Ann-Kathrin AU - Kaiser, Tim AU - Pannicke, Björn AU - Reichenberger, Julia AU - Naab, Silke AU - Voderholzer, Ulrich AU - Blechert, Jens PY - 2023/2/23 TI - Toward Individualized Prediction of Binge-Eating Episodes Based on Ecological Momentary Assessment Data: Item Development and Pilot Study in Patients With Bulimia Nervosa and Binge-Eating Disorder JO - JMIR Med Inform SP - e41513 VL - 11 KW - idiographic KW - individualized KW - N of 1 KW - Ecological Momentary Assessment (EMA) KW - Just-In-Time Adaptive Intervention (JITAI) KW - binge eating KW - literature research KW - focus group KW - prediction algorithm KW - machine learning KW - Best Items Scales that are Cross-validated, Unit-weighted, Informative and Transparent KW - BISCUIT N2 - Background: Prevention of binge eating through just-in-time mobile interventions requires the prediction of respective high-risk times, for example, through preceding affective states or associated contexts. However, these factors and states are highly idiographic; thus, prediction models based on averages across individuals often fail. Objective: We developed an idiographic, within-individual binge-eating prediction approach based on ecological momentary assessment (EMA) data. Methods: We first derived a novel EMA-item set that covers a broad set of potential idiographic binge-eating antecedents from literature and an eating disorder focus group (n=11). The final EMA-item set (6 prompts per day for 14 days) was assessed in female patients with bulimia nervosa or binge-eating disorder. We used a correlation-based machine learning approach (Best Items Scale that is Cross-validated, Unit-weighted, Informative, and Transparent) to select parsimonious, idiographic item subsets and predict binge-eating occurrence from EMA data (32 items assessing antecedent contextual and affective states and 12 time-derived predictors). Results: On average 67.3 (SD 13.4; range 43-84) EMA observations were analyzed within participants (n=13). The derived item subsets predicted binge-eating episodes with high accuracy on average (mean area under the curve 0.80, SD 0.15; mean 95% CI 0.63-0.95; mean specificity 0.87, SD 0.08; mean sensitivity 0.79, SD 0.19; mean maximum reliability of rD 0.40, SD 0.13; and mean rCV 0.13, SD 0.31). Across patients, highly heterogeneous predictor sets of varying sizes (mean 7.31, SD 1.49; range 5-9 predictors) were chosen for the respective best prediction models. Conclusions: Predicting binge-eating episodes from psychological and contextual states seems feasible and accurate, but the predictor sets are highly idiographic. This has practical implications for mobile health and just-in-time adaptive interventions. Furthermore, current theories around binge eating need to account for this high between-person variability and broaden the scope of potential antecedent factors. Ultimately, a radical shift from purely nomothetic models to idiographic prediction models and theories is required. UR - https://medinform.jmir.org/2023/1/e41513 UR - http://dx.doi.org/10.2196/41513 UR - http://www.ncbi.nlm.nih.gov/pubmed/36821359 ID - info:doi/10.2196/41513 ER - TY - JOUR AU - Miller, Mia AU - Wright, Cassandra AU - Kuntsche, Emmanuel AU - Kuntsche, Sandra PY - 2023/2/2 TI - The Effects of a Web-Based Intervention to Reduce Alcohol Consumption Among Middle-Aged Women: Protocol for a Randomized Controlled Trial JO - JMIR Res Protoc SP - e34842 VL - 12 KW - alcohol consumption KW - web-based KW - online intervention KW - middle-aged women KW - Australia KW - intervention KW - alcohol research KW - alcohol KW - ecological momentary assessment KW - EMA N2 - Background: In the last decade, alcohol consumption among middle-aged women (40-65 years old) in Australia increased, despite declines in overall population consumption. Web-based, brief interventions are promising for reducing alcohol consumption, with efficacy shown in a wide range of populations. However, no published interventions have been designed specifically for and tested with middle-aged women. Objective: This study aims to design and implement a web-based intervention intended to reduce alcohol consumption among middle-aged women. Methods: The study is a 3-arm randomized controlled trial with a web-based intervention plus ecological momentary assessment (EMA) group compared to an EMA-only and a pre-post only control group. The study is aimed at middle-aged women, defined as women aged between 40 and 65 years, who consume alcohol at least weekly or who have consumed 4 or more drinks on 1 occasion in the last month. The intervention aims to reduce alcohol consumption through 4 modules that provide information on the health impacts of alcohol, mindfulness, social influences, and alcohol marketing. Intervention participants will also fill out biweekly EMA assessments. The comparators are EMA-only and pre-post control only. The primary outcome is alcohol consumption at 8 weeks compared between groups. Secondary outcomes are awareness of alcohol-related harms, readiness to change alcohol consumption, health status, mental health, and social support. Results: Ethics approval for this project was received on September 11, 2019. The trial was registered on August 14, 2020. Recruitment has commenced, and the expected results will be available in 2022. Conclusions: This web-based intervention aims to reduce alcohol consumption among middle-aged women, a currently understudied cohort in alcohol research. Trial Registration: Australia New Zealand Clinical Trials Registry (ANZCTR) ACTRN12620000814976; https://www.anzctr.org.au/Trial/Registration/TrialReview.aspx?ACTRN=12620000814976 International Registered Report Identifier (IRRID): DERR1-10.2196/34842 UR - https://www.researchprotocols.org/2023/1/e34842 UR - http://dx.doi.org/10.2196/34842 UR - http://www.ncbi.nlm.nih.gov/pubmed/36729575 ID - info:doi/10.2196/34842 ER - TY - JOUR AU - Hakun, G. Jonathan AU - Roque, A. Nelson AU - Gerver, R. Courtney AU - Cerino, S. Eric PY - 2023/1/27 TI - Ultra-brief Assessment of Working Memory Capacity: Ambulatory Assessment Study Using Smartphones JO - JMIR Form Res SP - e40188 VL - 7 KW - ecological momentary assessment KW - EMA KW - mobile cognitive assessment KW - working memory capacity KW - measurement burst design KW - mobile phone N2 - Background: The development of mobile technology with substantial computing power (ie, smartphones) has enabled the adaptation of performance-based cognitive assessments to remote administration and novel intensive longitudinal study designs (eg, measurement burst designs). Although an ?ambulatory? cognitive assessment paradigm may provide new research opportunities, the adaptation of conventional measures to a mobile format conducive to intensive repeated measurement involves balancing measurement precision, administration time, and procedural consistency. Objective: Across 3 studies, we adapted ?complex span? tests of working memory capacity (WMC) for ultra-brief, smartphone-based administration and examined their reliability, sufficiency, and associations with full-length, laboratory-based computerized administrations. Methods: In a laboratory-based setting, study 1 examined associations between ultra-brief smartphone adaptations of the operation span, symmetry span, and rotation span tasks and full-length computerized versions. In study 2, we conducted a 4-day ecological momentary assessment (EMA) study (4 assessments per day), where we examined the reliability of ultra-brief, ambulatory administrations of each task. In study 3, we conducted a 7-day EMA study (5 assessments per day) involving the ultra-brief rotation span task, where we examined reliability in the absence of extensive onboarding and training. Results: Measurement models in study 1 suggest that comparable estimates of latent WMC can be recovered from ultra-brief complex span task performance on smartphones. Significant correlations between the ultra-brief tasks and respective full-length versions were observed in study 1 and 2, ranging from r=0.4 to r=0.57. Results of study 2 and study 3 suggest that reliable between-person estimates of operation span, symmetry span, rotation span, and latent WMC can be obtained in 2-3 ultra-brief administrations (equivalent to <1 day of testing in an EMA study design). The results of study 3 replicated our findings, showing that reliable between-person estimates of rotation span may be obtained in as few as 2 ultra-brief administrations in the absence of extensive onboarding and training. In addition, the modification of task parameterization for study 3 improved the estimates of reliability of within-person change. Conclusions: Ultra-brief administration of complex span tasks on smartphones in a measurement burst design can generate highly reliable cross-sectional estimates of WMC. Considerations for future mobile cognitive assessment designs and parameterizations are discussed. UR - https://formative.jmir.org/2023/1/e40188 UR - http://dx.doi.org/10.2196/40188 UR - http://www.ncbi.nlm.nih.gov/pubmed/36705953 ID - info:doi/10.2196/40188 ER - TY - JOUR AU - Oh, Jung Yoo AU - Hoffmann, J. Thomas AU - Fukuoka, Yoshimi PY - 2023/1/27 TI - A Novel Approach to Assess Weekly Self-efficacy for Meeting Personalized Physical Activity Goals Via a Cellphone: 12-Week Longitudinal Study JO - JMIR Form Res SP - e38877 VL - 7 KW - self-efficacy KW - physical activity KW - exercise KW - cellphone KW - mobile phone KW - application KW - app KW - Ecological Momentary Assessment N2 - Background: Despite the health benefits of engaging in regular physical activity (PA), the majority of American adults do not meet the PA guidelines for aerobic and muscle-strengthening activities. Self-efficacy, the belief that one can execute specific actions, has been suggested to be a strong determinant of PA behaviors. With the increasing availability of digital technologies, collecting longitudinal real-time self-efficacy and PA data has become feasible. However, evidence in longitudinal real-time assessment of self-efficacy in relation to objectively measured PA is scarce. Objective: This study aimed to examine a novel approach to measure individuals' real-time weekly self-efficacy in response to their personalized PA goals and performance over the 12-week intervention period in community-dwelling women who were not meeting PA guidelines. Methods: In this secondary data analysis, 140 women who received a 12-week PA intervention were asked to report their real-time weekly self-efficacy via a study mobile app. PA (daily step counts) was measured by an accelerometer every day for 12 weeks. Participants rated their self-efficacy on meeting PA goals (ranging from ?not confident? to ?very confident?) at the end of each week via a mobile app. We used a logistic mixed model to examine the association between weekly self-efficacy and weekly step goal success, controlling for age, BMI, self-reported White race, having a college education or higher, being married, and being employed. Results: The mean age was 52.7 (SD 11.5, range 25-68) years. Descriptive analyses showed the dynamics of real-time weekly self-efficacy on meeting PA goals and weekly step goal success. The majority (74.4%) of participants reported being confident in the first week, whereas less than half of them (46.4%) reported confidence in the final week of the intervention. Participants who met weekly step goals were 4.41 times more likely to be confident about achieving the following week's step goals than those who did not meet weekly step goals (adjusted odds ratio 4.41; 95% CI 2.59-7.50; P<.001). Additional analysis revealed that participants who were confident about meeting the following week?s step goals were 2.07 times more likely to meet their weekly step goals in the following week (adjusted odds ratio 2.07; 95% CI 1.16-3.70; P=.01). The significant bidirectional association between real-time self-efficacy and weekly step goal success was confirmed in a series of sensitivity analyses. Conclusions: This study demonstrates the potential utility of a novel approach to examine self-efficacy in real time for analysis of self-efficacy in conjunction with objectively measured PA. Discovering the dynamic patterns and changes in weekly self-efficacy on meeting PA goals may aid in designing a personalized PA intervention. Evaluation of this novel approach in an RCT is warranted. UR - https://formative.jmir.org/2023/1/e38877 UR - http://dx.doi.org/10.2196/38877 UR - http://www.ncbi.nlm.nih.gov/pubmed/36705945 ID - info:doi/10.2196/38877 ER - TY - JOUR AU - Hietbrink, G. Eclaire A. AU - Middelweerd, Anouk AU - van Empelen, Pepijn AU - Preuhs, Katharina AU - Konijnendijk, J. Annemieke A. AU - Oude Nijeweme-d?Hollosy, Wendy AU - Schrijver, K. Laura AU - Laverman, D. Gozewijn AU - Vollenbroek-Hutten, R. Miriam M. PY - 2023/1/12 TI - A Digital Lifestyle Coach (E-Supporter 1.0) to Support People With Type 2 Diabetes: Participatory Development Study JO - JMIR Hum Factors SP - e40017 VL - 10 KW - eHealth KW - mHealth KW - diet KW - nutrition KW - physical activity KW - lifestyle change KW - coaching KW - dynamic tailoring KW - behavior change KW - blended care KW - type 2 diabetes KW - design KW - treatment KW - chronic disease KW - behavioral KW - theory KW - intervention KW - acceptability KW - usability KW - cost N2 - Background: A healthy lifestyle, including regular physical activity and a healthy diet, is becoming increasingly important in the treatment of chronic diseases. eHealth interventions that incorporate behavior change techniques (BCTs) and dynamic tailoring strategies could effectively support a healthy lifestyle. E-Supporter 1.0 is an eCoach designed to support physical activity and a healthy diet in people with type 2 diabetes (T2D). Objective: This paper aimed to describe the systematic development of E-Supporter 1.0. Methods: Our systematic design process consisted of 3 phases. The definition phase included the selection of the target group and formulation of intervention objectives, and the identification of behavioral determinants based on which BCTs were selected to apply in the intervention. In the development phase, intervention content was developed by specifying tailoring variables, intervention options, and decision rules. In the last phase, E-Supporter 1.0 integrated in the Diameter app was evaluated using a usability test in 9 people with T2D to assess intervention usage and acceptability. Results: The main intervention objectives were to stimulate light to moderate-vigorous physical activities or adherence to the Dutch dietary guidelines in people with T2D. The selection of behavioral determinants was informed by the health action process approach and theories explaining behavior maintenance. BCTs were included to address relevant behavioral determinants (eg, action control, self-efficacy, and coping planning). Development of the intervention resulted in 3 types of intervention options, consisting of motivational messages, behavioral feedback, and tailor-made supportive exercises. On the basis of IF-THEN rules, intervention options could be tailored to, among others, type of behavioral goal and (barriers to) goal achievement. Data on these variables could be collected using app data, activity tracker data, and daily ecological momentary assessments. Usability testing revealed that user experiences were predominantly positive, despite some problems in the fixed delivery of content. Conclusions: The systematic development approach resulted in a theory-based and dynamically tailored eCoach. Future work should focus on expanding intervention content to other chronic diseases and lifestyle behaviors, enhancing the degree of tailoring and evaluating intervention effects on acceptability, use, and cost-effectiveness. UR - https://humanfactors.jmir.org/2023/1/e40017 UR - http://dx.doi.org/10.2196/40017 UR - http://www.ncbi.nlm.nih.gov/pubmed/36633898 ID - info:doi/10.2196/40017 ER - TY - JOUR AU - Anderson, A. Molly AU - Budney, J. Alan AU - Jacobson, C. Nicholas AU - Nahum-Shani, Inbal AU - Stanger, Catherine PY - 2022/12/15 TI - End User Participation in the Development of an Ecological Momentary Intervention to Improve Coping With Cannabis Cravings: Formative Study JO - JMIR Form Res SP - e40139 VL - 6 IS - 12 KW - cannabis KW - formative KW - distraction KW - mindfulness KW - coping KW - youth KW - public health KW - mental health KW - health intervention KW - ecological momentary intervention N2 - Background: Cannabis misuse in young adults is a major public health concern. An important predictor of continued use is cannabis craving. Due to the time-varying nature of cravings, brief momentary interventions delivered while cravings are elevated may improve the use of strategies to cope with cravings and reduce cannabis use. Objective: The goal of this manuscript is to describe a formative study to develop coping strategy messages for use in a subsequent intervention. Methods: Young adults (aged 19-25 years; n=20) who reported using cannabis >10 of the past 30 days recruited via social media participated in this formative study. Participants rated an initial set of 15 mindfulness and 15 distraction coping strategies on a scale from 1 to 4 (very low degree to very high degree) for clarity, usefulness, and tone. They also provided comments about the content. Results: Participants found the initial distraction messages slightly clearer than mindfulness (mean 3.5, SD 0.4 and mean 3.4, SD 0.4, respectively), both were comparable in tone (mean 3.2, SD 0.5 and mean 3.2, SD 0.4, respectively), and mindfulness messages were more useful than distraction (mean 3.0, SD 0.5 and mean 2.8, SD 0.6, respectively). Of the 30 messages, 29 received a rating of very low or low (<2) on any domain by >3 participants or received a comment suggesting a change. We revised all these messages based on this feedback, and the participants rated the revised messages approximately 2 weeks later. Participants earned US $10 for completing the first and US $20 for the second survey. The ratings improved on usefulness (especially the distraction items) with very little change in clarity and tone. The top 10 messages of each coping type (mindfulness and distraction) were identified by overall average rating (collapsed across all 3 dimensions: all rated >3.0). The final items were comparable in clarity (distraction mean 3.6, SD 0.4; mindfulness mean 3.6, SD 0.4), tone (distraction mean 3.4, SD 0.4; mindfulness mean 3.4, SD 0.4), and usefulness (distraction mean 3.1, SD 0.5; mindfulness mean 3.2, SD 0.5). Conclusions: The inclusion of end users in the formative process of developing these messages was valuable and resulted in improvements to the content of the messages. The majority of the messages were changed in some way including the removal of potentially triggering language. These messages were subsequently used in an ecological momentary intervention. UR - https://formative.jmir.org/2022/12/e40139 UR - http://dx.doi.org/10.2196/40139 UR - http://www.ncbi.nlm.nih.gov/pubmed/36520509 ID - info:doi/10.2196/40139 ER - TY - JOUR AU - Kanning, Martina AU - Bollenbach, Lukas AU - Schmitz, Julian AU - Niermann, Christina AU - Fina, Stefan PY - 2022/11/25 TI - Analyzing Person-Place Interactions During Walking Episodes: Innovative Ambulatory Assessment Approach of Walking-Triggered e-Diaries JO - JMIR Form Res SP - e39322 VL - 6 IS - 11 KW - ecological momentary assessment KW - active transport KW - socio-ecological model KW - subjective well-being KW - mental health KW - urban health KW - GEMA KW - geographically explicit ecological momentary assessment KW - behaviour change KW - walking KW - experience KW - environment KW - monitoring KW - activity KW - tracking KW - e-diary KW - assessment N2 - Background: Walking behavior is positively associated with physiological and mental health as much evidence has already shown. Walking is also becoming a critical issue for health promotion in urban environments as it is the most often used form of active mobility and helps to replace carbon dioxide emissions from motorized forms of transport. It therefore contributes to mitigate the negative effects of climate change and heat islands within cities. However, to promote walking among urban dwellers and to utilize its health-enhancing potential, we need to know more about the way in which physical and social environments shape individual experiences during walking episodes. Such person-place interactions could not adequately be analyzed in former studies owing to methodological constraints. Objective: This study introduces walking-triggered e-diaries as an innovative ambulatory assessment approach for time-varying associations, and investigates its accuracy with 2 different validation strategies. Methods: The walking trigger consists of a combination of movement acceleration via an accelerometer and mobile positioning of the cellphone via GPS and transmission towers to track walking activities. The trigger starts an e-diary whenever a movement acceleration exceeds a predetermined threshold and participants' locations are identified as nonstationary outside a predefined place of residence. Every 420 (±300) seconds, repeated e-diaries were prompted as long as the trigger conditions were met. Data were assessed on 10 consecutive days. First, to investigate accuracy, we reconstructed walking routes and calculated a percentage score for all triggered prompts in relation to all walking routes where a prompt could have been triggered. Then, to provide data about its specificity, we used momentary self-reports and objectively assessed movement behavior to describe activity levels before the trigger prompted an e-diary. Results: Data of 67 participants could be analyzed and the walking trigger led to 3283 e-diary prompts, from which 2258 (68.8%) were answered. Regarding accuracy, the walking trigger prompted an e-diary on 732 of 842 (86.9%) reconstructed walking routes. Further, in 838 of 1206 (69.5%) triggered e-diaries, participants self-reported that they were currently walking outdoors. Steps and acceleration movement was higher during these self-reported walking episodes than when participants denied walking outdoors (steps: 106 vs 32; acceleration>0.2 g in 58.4% vs 19% of these situations). Conclusions: Accuracy analysis revealed that walking-triggered e-diaries are suitable to collect different data of individuals' current experiences in situations in which a person walks outdoors. Combined with environmental data, such an approach increases knowledge about person-place interactions and provides the possibility to gain knowledge about user preferences for health-enhancing urban environments. From a methodological viewpoint, however, specificity analysis showed how changes in trigger conditions (eg, increasing the threshold for movement acceleration) lead to changes in accuracy. UR - https://formative.jmir.org/2022/11/e39322 UR - http://dx.doi.org/10.2196/39322 UR - http://www.ncbi.nlm.nih.gov/pubmed/36427231 ID - info:doi/10.2196/39322 ER - TY - JOUR AU - Zhang, Lili AU - Monacelli, Greta AU - Vashisht, Himanshu AU - Schlee, Winfried AU - Langguth, Berthold AU - Ward, Tomas PY - 2022/11/11 TI - The Effects of Tinnitus in Probabilistic Learning Tasks: Protocol for an Ecological Momentary Assessment Study JO - JMIR Res Protoc SP - e36583 VL - 11 IS - 11 KW - chronic tinnitus KW - computational modeling KW - decision-making KW - ecological momentary assessment KW - mobile phone N2 - Background: Chronic tinnitus is an increasing worldwide health concern, causing a significant burden to the health care system each year. The COVID-19 pandemic has seen a further increase in reported cases. For people with tinnitus, symptoms are exacerbated because of social isolation and the elevated levels of anxiety and depression caused by quarantines and lockdowns. Although it has been reported that patients with tinnitus can experience changes in cognitive capabilities, changes in adaptive learning via decision-making tasks for people with tinnitus have not yet been investigated. Objective: In this study, we aim to assess state- and trait-related impairments in adaptive learning ability on probabilistic learning tasks among people with tinnitus. Given that performance in such tasks can be quantified through computational modeling methods using a small set of neural-informed model parameters, such approaches are promising in terms of the assessment of tinnitus severity. We will first examine baseline differences in the characterization of decision-making under uncertainty between healthy individuals and people with tinnitus in terms of differences in the parameters of computational models in a cross-sectional experiment. We will also investigate whether these computational markers, which capture characteristics of decision-making, can be used to understand the cognitive impact of tinnitus symptom fluctuations through a longitudinal experimental design. Methods: We have developed a mobile app, AthenaCX, to deliver e-consent and baseline tinnitus and psychological assessments as well as regular ecological momentary assessments (EMAs) of perceived tinnitus loudness and a web-based aversive version of a probabilistic decision-making task, which can be triggered based on the participants? responses to the EMA surveys. Computational models will be developed to fit participants? choice data in the task, and cognitive parameters will be estimated to characterize participants? current ability to adapt learning to the change of the simulated environment at each session when the task is triggered. Linear regression analysis will be conducted to evaluate the impacts of baseline tinnitus severity on adapting decision-making performance. Repeated measures linear regression analysis will be used to examine model-derived parameters of decision-making in measuring real-time perceived tinnitus loudness fluctuations. Results: Ethics approval was received in December 2020 from Dublin City University (DCUREC/2021/070). The implementation of the experiments, including both the surveys and the web-based decision-making task, has been prepared. Recruitment flyers have been shared with audiologists, and a video instruction has been created to illustrate to the participants how to participate in the experiment. We expect to finish data collection over 12 months and complete data analysis 6 months after this. The results are expected to be published in December 2023. Conclusions: We believe that EMA with context-aware triggering can facilitate a deeper understanding of the effects of tinnitus symptom severity upon decision-making processes as measured outside of the laboratory. International Registered Report Identifier (IRRID): PRR1-10.2196/36583 UR - https://www.researchprotocols.org/2022/11/e36583 UR - http://dx.doi.org/10.2196/36583 UR - http://www.ncbi.nlm.nih.gov/pubmed/36367761 ID - info:doi/10.2196/36583 ER - TY - JOUR AU - Rathjens, Larisa AU - Fingerhut, Ingo AU - Martin, David AU - Hamideh Kerdar, Sara AU - Gwiasda, Moritz AU - Schwarz, Silke AU - Jenetzky, Ekkehart PY - 2022/11/2 TI - Data Completeness and Concordance in the FeverApp Registry: Comparative Study JO - JMIR Pediatr Parent SP - e35510 VL - 5 IS - 4 KW - registry KW - data quality KW - completeness KW - concordance KW - ecological momentary assessment N2 - Background: The FeverApp registry uses ecological momentary assessment (EMA) to collect parental data on pediatric fever for scientific research. The mobile app FeverApp educates parents on safe fever management and serves as a fever diary. Objective: The focus of this study was to evaluate the completeness and concordance of the EMA-based FeverApp registry with regard to its data quality from a multilevel perspective. Methods: Structured descriptions of fever episodes by health care professionals from an office were used as reference. The number of children, their sociodemographic data, and agreement of fever episodes, with maximum temperature, intake of antipyretics and antibiotics, and physician visits, were compared with the entries in the corresponding physician?s reference records. The data quality indicators for completeness, meaning the extent to which the necessary data for the registry has actually been submitted, and concordance, which is the correspondence of the value of a data element with a reference source, were chosen to analyze whether EMA may be a suitable method for this kind of registry. Results: In both data sources, 1012 children were available for comparison over 16 months. The completeness of gender (1012/1012, 100%) and date of birth (1004/1012, 99.2%) information was high, and the mismatches were 0.69% (7/1012) and 1.19% (12/1012), respectively, between the sources. Of these 1012 children, 668 (66%) registered fever episodes in FeverApp. They relate to 534 families with 953 fever episodes in the reference records and 1452 episodes in the FeverApp registry. Of the 534 families, 183 (34.3%) refrained from visiting the office during fever episodes but nevertheless documented them in FeverApp. Largest part (766/1452, 52.75%) episodes were recorded exclusively in the FeverApp registry by 371 (371/534, 69.5%) families. The remaining 686 (47.2%) episodes of 391 (58.5%) children from 351 (65.7%) families were comparable with the reference data source in terms of physician visits, medication, and temperature. The completeness ranged, depending on the kind of variable, from 11.5% to 65% in the registry and from 7.6% to 42.6% in the office. The 953 fever episodes reported by the reference office consisted of 681 (71.5%) acute and 272 (28.5%) past episodes. In FeverApp, most past (262/272, 96.3%) but less acute (424/681, 62.3%) episodes have been entered. The concordance rates were varied: 90.2% for antibiotic use, 66.6% for antipyretic use, 61.7% for physician visits, and 16% for the highest temperature during the fever episode. Conclusions: Both sources delivered only partial data, and the rates of completeness and concordance depended on the kind of variable. However, the FeverApp registry showed higher documentation and precision rates than professional records for all considered variables. Therefore, EMA may play a unique supplement for research in ambulatory care. FeverApp could support pediatric offices, especially during the pandemic. UR - https://pediatrics.jmir.org/2022/4/e35510 UR - http://dx.doi.org/10.2196/35510 UR - http://www.ncbi.nlm.nih.gov/pubmed/36322119 ID - info:doi/10.2196/35510 ER - TY - JOUR AU - Heron, E. Kristin AU - Braitman, L. Abby AU - Dawson, A. Charlotte AU - Sandoval, M. Cassidy AU - Butler, V. Lauren AU - Moulder, Alicia AU - Lewis, J. Robin PY - 2022/10/21 TI - Rationale and Design of an Ecological Momentary Assessment Study Examining Predictors of Binge Eating Among Sexual Minority and Heterosexual Young Women: Protocol for the Health and Experiences in Real Life (HER Life) Study JO - JMIR Res Protoc SP - e41199 VL - 11 IS - 10 KW - sexual minority women KW - ecological momentary assessment KW - binge eating KW - sexual minority stress KW - negative affective states KW - mobile phone N2 - Background: Previous research has identified health disparities between sexual minority and heterosexual women, including increased rates of obesity and binge eating in sexual minority women. Established predictors of binge eating behavior include negative emotions and sociocultural processes; however, these studies are generally conducted in samples of young women where sexual identity is not known or reported. There is a dearth of research evaluating how sexual minority?specific factors (eg, minority stress and connectedness to the lesbian, gay, bisexual, transgender, and queer community) may affect binge eating in sexual minority women. In addition, no studies have examined these processes in racially diverse samples or considered how intersecting minority identities (eg, Black and sexual minority) may affect eating behaviors. Objective: The Health and Experiences in Real Life (HER Life) Project aims to clarify real-world predictors of binge eating in young heterosexual and sexual minority women using ecological momentary assessment. The role of affective, social, and health behavior factors in binge eating will be examined for all women (aim 1), and sexual minority?specific predictors will also be considered for sexual minority women participants (aim 2). Person-level moderators of race, body- and eating-related factors, and sexual minority?specific factors will also be examined to better understand how real-world binge eating predictors may differ for various demographic groups (aim 3). Methods: Researchers aim to recruit 150 sexual minority and 150 heterosexual women from across the United States, including at least 50 Black women for each group, using web-based recruitment methods. The eligibility criteria include identifying as a woman, being aged between 18 and 30 years, and having had at least two binge eating episodes in the last 2 weeks. Participants must endorse being only or mostly attracted to men (considered heterosexual) or only or mostly attracted to women or having a current or most recent female partner (considered sexual minority). Eligible participants complete an initial web-based baseline survey and then 14 days of ecological momentary assessment involving the completion of a morning and before-bed survey and 5 prompted surveys per day as well as a user-initiated survey after binge eating episodes. The data will be analyzed using a series of multilevel models. Results: Data collection started in February 2021. We have currently enrolled 129 sexual minority women and 146 heterosexual women. Data collection is expected to conclude in fall 2022. Conclusions: The Health and Experiences in Real Life Project aims to elucidate potential differences between sexual minority and heterosexual women in within-person factors predicting binge eating and inform eating disorder interventions for sexual minority women. The challenges in recruiting sexual minority women, including the determination of eligibility criteria and considerations for remote data collection, are discussed. International Registered Report Identifier (IRRID): DERR1-10.2196/41199 UR - https://www.researchprotocols.org/2022/10/e41199 UR - http://dx.doi.org/10.2196/41199 UR - http://www.ncbi.nlm.nih.gov/pubmed/36269642 ID - info:doi/10.2196/41199 ER - TY - JOUR AU - Takeuchi, Hiroki AU - Suwa, Kaori AU - Kishi, Akifumi AU - Nakamura, Toru AU - Yoshiuchi, Kazuhiro AU - Yamamoto, Yoshiharu PY - 2022/10/6 TI - The Effects of Objective Push-Type Sleep Feedback on Habitual Sleep Behavior and Momentary Symptoms in Daily Life: mHealth Intervention Trial Using a Health Care Internet of Things System JO - JMIR Mhealth Uhealth SP - e39150 VL - 10 IS - 10 KW - wearable activity monitor KW - smartphone app KW - sleep feedback KW - ecological momentary assessment KW - stabilized sleep timing KW - mood and physical symptoms N2 - Background: Sleep is beneficial for physical and mental health. Several mobile and wearable sleep-tracking devices have been developed, and personalized sleep feedback is the most common functionality among these devices. To date, no study has implemented an objective push-type feedback message and investigated the characteristics of habitual sleep behavior and diurnal symptoms when receiving sleep feedback. Objective: We conducted a mobile health intervention trial to examine whether sending objective push-type sleep feedback changes the self-reported mood, physical symptoms, and sleep behavior of Japanese office workers. Methods: In total, 31 office workers (mean age 42.3, SD 7.9 years; male-to-female ratio 21:10) participated in a 2-arm intervention trial from November 30 to December 19, 2020. The participants were instructed to indicate their momentary mood and physical symptoms (depressive mood, anxiety, stress, sleepiness, fatigue, and neck and shoulder stiffness) 5 times a day using a smartphone app. In addition, daily work performance was rated once a day after work. They were randomly assigned to either a feedback or control group, wherein they did or did not receive messages about their sleep status on the app every morning, respectively. All participants wore activity monitors on their nondominant wrists, through which objective sleep data were registered on the web on a server. On the basis of the estimated sleep data on the server, personalized sleep feedback messages were generated and sent to the participants in the feedback group using the app. These processes were fully automated. Results: Using hierarchical statistical models, we examined the differences in the statistical properties of sleep variables (sleep duration and midpoint of sleep) and daily work performance over the trial period. Group differences in the diurnal slopes for mood and physical symptoms were examined using a linear mixed effect model. We found a significant group difference among within-individual residuals at the midpoint of sleep (expected a posteriori for the difference: ?15, 95% credible interval ?26 to ?4 min), suggesting more stable sleep timing in the feedback group. However, there were no significant group differences in daily work performance. We also found significant group differences in the diurnal slopes for sleepiness (P<.001), fatigue (P=.002), and neck and shoulder stiffness (P<.001), which was largely due to better scores in the feedback group at wake-up time relative to those in the control group. Conclusions: This is the first mobile health study to demonstrate that objective push-type sleep feedback improves sleep timing of and physical symptoms in healthy office workers. Future research should incorporate specific behavioral instructions intended to improve sleep habits and examine the effectiveness of these instructions. UR - https://mhealth.jmir.org/2022/10/e39150 UR - http://dx.doi.org/10.2196/39150 UR - http://www.ncbi.nlm.nih.gov/pubmed/36201383 ID - info:doi/10.2196/39150 ER - TY - JOUR AU - Parker, Hannah AU - Burkart, Sarah AU - Reesor-Oyer, Layton AU - Smith, T. Michal AU - Dugger, Roddrick AU - von Klinggraeff, Lauren AU - Weaver, Glenn R. AU - Beets, W. Michael AU - Armstrong, Bridget PY - 2022/9/29 TI - Feasibility of Measuring Screen Time, Activity, and Context Among Families With Preschoolers: Intensive Longitudinal Pilot Study JO - JMIR Form Res SP - e40572 VL - 6 IS - 9 KW - ecological momentary assessment KW - accelerometry KW - objective digital media use KW - screen time KW - sleep KW - activity KW - preschool KW - dyads KW - mobile phone N2 - Background: Digital media has made screen time more available across multiple contexts, but our understanding of the ways children and families use digital media has lagged behind the rapid adoption of this technology. Objective: This study evaluated the feasibility of an intensive longitudinal data collection protocol to objectively measure digital media use, physical activity, sleep, sedentary behavior, and socioemotional context among caregiver-child dyads. This paper also describes preliminary convergent validity of ecological momentary assessment (EMA) measures and preliminary agreement between caregiver self-reported phone use and phone use collected from passive mobile sensing. Methods: Caregivers and their preschool-aged child (3-5 years) were recruited to complete a 30-day assessment protocol. Within 30-days, caregivers completed 7 days of EMA to measure child behavior problems and caregiver stress. Caregivers and children wore an Axivity AX3 (Newcastle Upon Tyne) accelerometer to assess physical activity, sedentary behavior, and sleep. Phone use was assessed via passive mobile sensing; we used Chronicle for Android users and screenshots of iOS screen time metrics for iOS users. Participants were invited to complete a second 14-day protocol approximately 3-12 months after their first assessment. We used Pearson correlations to examine preliminary convergent validity between validated questionnaire measures of caregiver psychological functioning, child behavior, and EMA items. Root mean square errors were computed to examine the preliminary agreement between caregiver self-reported phone use and objective phone use. Results: Of 110 consenting participants, 105 completed all protocols (105/110, 95.5% retention rate). Compliance was defined a priori as completing ?70%-75% of each protocol task. There were high compliance rates for passive mobile sensing for both Android (38/40, 95%) and iOS (64/65, 98%). EMA compliance was high (105/105, 100%), but fewer caregivers and children were compliant with accelerometry (62/99, 63% and 40/100, 40%, respectively). Average daily phone use was 383.4 (SD 157.0) minutes for Android users and 354.7 (SD 137.6) minutes for iOS users. There was poor agreement between objective and caregiver self-reported phone use; root mean square errors were 157.1 and 81.4 for Android and iOS users, respectively. Among families who completed the first assessment, 91 re-enrolled to complete the protocol a second time, approximately 7 months later (91/105, 86.7% retention rate). Conclusions: It is feasible to collect intensive longitudinal data on objective digital media use simultaneously with accelerometry and EMA from an economically and racially diverse sample of families with preschool-aged children. The high compliance and retention of the study sample are encouraging signs that these methods of intensive longitudinal data collection can be completed in a longitudinal cohort study. The lack of agreement between self-reported and objectively measured mobile phone use highlights the need for additional research using objective methods to measure digital media use. International Registered Report Identifier (IRRID): RR2-36240 UR - https://formative.jmir.org/2022/9/e40572 UR - http://dx.doi.org/10.2196/40572 UR - http://www.ncbi.nlm.nih.gov/pubmed/36173677 ID - info:doi/10.2196/40572 ER - TY - JOUR AU - Reesor-Oyer, Layton AU - Parker, Hannah AU - Burkart, Sarah AU - Smith, T. Michal AU - Dugger, Roddrick AU - von Klinggraeff, Lauren AU - Weaver, Glenn R. AU - Beets, W. Michael AU - Armstrong, Bridget PY - 2022/9/28 TI - Measuring Microtemporal Processes Underlying Preschoolers? Screen Use and Behavioral Health: Protocol for the Tots and Tech Study JO - JMIR Res Protoc SP - e36240 VL - 11 IS - 9 KW - ecological momentary assessment KW - accelerometery KW - objective screen time monitoring KW - mobile phone N2 - Background: Excessive screen time is associated with poor health and behavioral outcomes in children. However, research on screen time use has been hindered by methodological limitations, including retrospective reports of usual screen time and lack of momentary etiologic processes occurring within each day. Objective: This study is designed to assess the feasibility and utility of a comprehensive multibehavior protocol to measure the digital media use and screen time context among a racially and economically diverse sample of preschoolers and their families. This paper describes the recruitment, data collection, and analytical protocols for the Tots and Tech study. Methods: The Tots and Tech study is a longitudinal, observational study of 100 dyads: caregivers and their preschool-age children (aged 3-5 years). Both caregivers and children will wear an Axivity AX3 accelerometer (Axivity Ltd) for 30 days to assess their physical activity, sedentary behavior, and sleep. Caregivers will complete ecological momentary assessments (EMAs) for 1 week to measure child behavioral problems, caregiver stress, and child screen time. Results: The Tots and Tech study was funded in March 2020. This study maintains rolling recruitment, with each dyad on their own assessment schedule, depending on the time of enrollment. Enrollment was scheduled to take place between September 2020 and May 2022. We aim to enroll 100 caregiver-child dyads. The Tots and Tech outcome paper is expected to be published in 2022. Conclusions: The Tots and Tech study attempts to overcome previous methodological limitations by using objective measures of screen time, physical activity, sedentary behavior, and sleep behaviors with contextual factors measured by EMA. The results will be used to evaluate the feasibility and utility of a comprehensive multibehavior protocol using objective measures of mobile screen time and accelerometry in conjunction with EMA among caregiver-child dyads. Future observational and intervention studies will be able to use this study protocol to better measure screen time and its context. International Registered Report Identifier (IRRID): DERR1-10.2196/36240 UR - https://www.researchprotocols.org/2022/9/e36240 UR - http://dx.doi.org/10.2196/36240 UR - http://www.ncbi.nlm.nih.gov/pubmed/36169993 ID - info:doi/10.2196/36240 ER - TY - JOUR AU - Lopez, Virginia Nanette AU - Lai, HC Mark AU - Yang, Chih-Hsiang AU - Dunton, Fridlund Genevieve AU - Belcher, Ryan Britni PY - 2022/8/10 TI - Associations of Maternal and Paternal Parenting Practices With Children?s Fruit and Vegetable Intake and Physical Activity: Preliminary Findings From an Ecological Momentary Study JO - JMIR Form Res SP - e38326 VL - 6 IS - 8 KW - parenting KW - ecological momentary assessment KW - fruit and vegetable consumption KW - physical activity KW - pediatrics KW - obesity N2 - Background: Childhood obesity prevention interventions routinely focus on changing maternal parenting practices. Failure to assess how fathers? weight-related (ie, diet and physical activity) parenting practices contribute to children?s energy balance behaviors limits the understanding of their paternal role within the family. Examining the independent and interacting effects of fathers? and mothers? weight-related parenting practices on children?s diet and physical activity addresses this important research gap. Objective: This study used ecological momentary assessment (EMA) to investigate the within-subject and between-subject independent and interactive effects of maternal and paternal encouragement to eat and preparation of fruits and vegetables (F/V) and encouragement of and taking their child to be physically active on their child?s self-reported F/V intake and physical activity engagement. Methods: Participants included mother-father-child triads (n=22 triads, n=205-213 prompts/occasions) in the Mothers and Their Children?s Health Study and the University of Southern California Fathers Study. Simultaneously, mothers and fathers (agesmean 44.2 years, SD 5.6, and 45.2 years, SD 8.1, respectively), and their children (agemean 12.0 years, SD 0.7) completed up to 8 randomly prompted EMA surveys per day on separate smartphones for 7 days. At each prompt, mothers and fathers each reported whether they did the following in the past 2 hours: (1) encouraged their child to eat F/V, (2) prepared F/V for their child, (3) encouraged their child to be physically active, or (4) took their child to be physically active. Children self-reported whether they consumed F/V or were physically active in the past 2 hours. Results: Results from Bayesian multilevel logistic models (all in log-odd units) indicated that at the within-subject level, greater maternal encouragement (?=2.28, 95% CI 0.08 to 5.68) of eating F/V was associated with greater child report of eating F/V, but paternal encouragement (?=1.50, 95% CI ?0.83 to 4.52) showed no effects above and beyond maternal encouragement. Additionally, greater than usual paternal encouragement (?=2.28, 95% CI 0.08 to 5.54) and maternal encouragement (?=2.94, 95% CI 0.36 to 6.69) of physical activity had significant independent effects and were associated with greater child report of physical activity. No other within-subject or between-subject associations nor interactive effects were significant. Conclusions: Findings from this study suggest that fathers play a role in supporting their children?s physical activity but not their intake of F/V. Future EMA studies should recruit larger samples to evaluate the independent and interacting roles of mothers? and fathers? weight-related parenting practices on child?s obesogenic behaviors. UR - https://formative.jmir.org/2022/8/e38326 UR - http://dx.doi.org/10.2196/38326 UR - http://www.ncbi.nlm.nih.gov/pubmed/35947425 ID - info:doi/10.2196/38326 ER - TY - JOUR AU - Bos, M. Fionneke AU - von Klipstein, Lino AU - Emerencia, C. Ando AU - Veermans, Erwin AU - Verhage, Tom AU - Snippe, Evelien AU - Doornbos, Bennard AU - Hadders-Prins, Grietje AU - Wichers, Marieke AU - Riese, Harriëtte PY - 2022/8/9 TI - A Web-Based Application for Personalized Ecological Momentary Assessment in Psychiatric Care: User-Centered Development of the PETRA Application JO - JMIR Ment Health SP - e36430 VL - 9 IS - 8 KW - eHealth KW - clinical implementation KW - ecological momentary assessment KW - experience sampling method KW - smartphone KW - mobile health KW - mHealth KW - personalized diaries KW - personalized psychiatry KW - client-tailored KW - cocreation KW - shared decision-making KW - mobile phone N2 - Background: Smartphone self-monitoring of mood, symptoms, and contextual factors through ecological momentary assessment (EMA) provides insights into the daily lives of people undergoing psychiatric treatment. Therefore, EMA has the potential to improve their care. To integrate EMA into treatment, a clinical tool that helps clients and clinicians create personalized EMA diaries and interpret the gathered data is needed. Objective: This study aimed to develop a web-based application for personalized EMA in specialized psychiatric care in close collaboration with all stakeholders (ie, clients, clinicians, researchers, and software developers). Methods: The participants were 52 clients with mood, anxiety, and psychotic disorders and 45 clinicians (psychiatrists, psychologists, and psychiatric nurses). We engaged them in interviews, focus groups, and usability sessions to determine the requirements for an EMA web application and repeatedly obtained feedback on iteratively improved high-fidelity EMA web application prototypes. We used human-centered design principles to determine important requirements for the web application and designed high-fidelity prototypes that were continuously re-evaluated and adapted. Results: The iterative development process resulted in Personalized Treatment by Real-time Assessment (PETRA), which is a scientifically grounded web application for the integration of personalized EMA in Dutch clinical care. PETRA includes a decision aid to support clients and clinicians with constructing personalized EMA diaries, an EMA diary item repository, an SMS text message?based diary delivery system, and a feedback module for visualizing the gathered EMA data. PETRA is integrated into electronic health record systems to ensure ease of use and sustainable integration in clinical care and adheres to privacy regulations. Conclusions: PETRA was built to fulfill the needs of clients and clinicians for a user-friendly and personalized EMA tool embedded in routine psychiatric care. PETRA is unique in this codevelopment process, its extensive but user-friendly personalization options, its integration into electronic health record systems, its transdiagnostic focus, and its strong scientific foundation in the design of EMA diaries and feedback. The clinical effectiveness of integrating personalized diaries via PETRA into care requires further research. As such, PETRA paves the way for a systematic investigation of the utility of personalized EMA for routine mental health care. UR - https://mental.jmir.org/2022/8/e36430 UR - http://dx.doi.org/10.2196/36430 UR - http://www.ncbi.nlm.nih.gov/pubmed/35943762 ID - info:doi/10.2196/36430 ER - TY - JOUR AU - Ng, Ada AU - Wei, Boyang AU - Jain, Jayalakshmi AU - Ward, A. Erin AU - Tandon, Darius S. AU - Moskowitz, T. Judith AU - Krogh-Jespersen, Sheila AU - Wakschlag, S. Lauren AU - Alshurafa, Nabil PY - 2022/8/2 TI - Predicting the Next-Day Perceived and Physiological Stress of Pregnant Women by Using Machine Learning and Explainability: Algorithm Development and Validation JO - JMIR Mhealth Uhealth SP - e33850 VL - 10 IS - 8 KW - explainability KW - just-in-time interventions KW - machine learning KW - prenatal stress KW - stress prediction KW - wearable KW - mobile phone N2 - Background: Cognitive behavioral therapy?based interventions are effective in reducing prenatal stress, which can have severe adverse health effects on mothers and newborns if unaddressed. Predicting next-day physiological or perceived stress can help to inform and enable pre-emptive interventions for a likely physiologically and perceptibly stressful day. Machine learning models are useful tools that can be developed to predict next-day physiological and perceived stress by using data collected from the previous day. Such models can improve our understanding of the specific factors that predict physiological and perceived stress and allow researchers to develop systems that collect selected features for assessment in clinical trials to minimize the burden of data collection. Objective: The aim of this study was to build and evaluate a machine-learned model that predicts next-day physiological and perceived stress by using sensor-based, ecological momentary assessment (EMA)?based, and intervention-based features and to explain the prediction results. Methods: We enrolled pregnant women into a prospective proof-of-concept study and collected electrocardiography, EMA, and cognitive behavioral therapy intervention data over 12 weeks. We used the data to train and evaluate 6 machine learning models to predict next-day physiological and perceived stress. After selecting the best performing model, Shapley Additive Explanations were used to identify the feature importance and explainability of each feature. Results: A total of 16 pregnant women enrolled in the study. Overall, 4157.18 hours of data were collected, and participants answered 2838 EMAs. After applying feature selection, 8 and 10 features were found to positively predict next-day physiological and perceived stress, respectively. A random forest classifier performed the best in predicting next-day physiological stress (F1 score of 0.84) and next-day perceived stress (F1 score of 0.74) by using all features. Although any subset of sensor-based, EMA-based, or intervention-based features could reliably predict next-day physiological stress, EMA-based features were necessary to predict next-day perceived stress. The analysis of explainability metrics showed that the prolonged duration of physiological stress was highly predictive of next-day physiological stress and that physiological stress and perceived stress were temporally divergent. Conclusions: In this study, we were able to build interpretable machine learning models to predict next-day physiological and perceived stress, and we identified unique features that were highly predictive of next-day stress that can help to reduce the burden of data collection. UR - https://mhealth.jmir.org/2022/8/e33850 UR - http://dx.doi.org/10.2196/33850 UR - http://www.ncbi.nlm.nih.gov/pubmed/35917157 ID - info:doi/10.2196/33850 ER - TY - JOUR AU - Nyenhuis, Sharmilee AU - Cramer, Emily AU - Grande, Matthew AU - Huntington-Moskos, Luz AU - Krueger, Kathryn AU - Bimbi, Olivia AU - Polivka, Barbara AU - Eldeirawi, Kamal PY - 2022/8/2 TI - Utilizing Real-time Technology to Assess the Impact of Home Environmental Exposures on Asthma Symptoms: Protocol for an Observational Pilot Study JO - JMIR Res Protoc SP - e39887 VL - 11 IS - 8 KW - asthma KW - home environment KW - ecologic momentary assessment KW - air quality KW - spirometry N2 - Background: It is estimated that over 60% of adults with asthma have uncontrolled symptoms, representing a substantial health and economic impact. The effects of the home environment and exposure to volatile organic compounds (VOCs) and fine particulate matter (PM2.5) on adults with asthma remain unknown. In addition, methods currently used to assess the home environment do not capture real-time data on potentially modifiable environmental exposures or their effect on asthma symptoms. Objective: The aims of this study are to (1) determine the feasibility and usability of ecological momentary assessment (EMA) to assess self-report residential environmental exposures and asthma symptoms, home monitoring of objective environmental exposures (total VOCs and PM2.5), and lung function in terms of forced expiratory volume in 1 second (FEV1%); (2) assess the frequency and level of residential environmental exposures (eg, disinfectants/cleaners, secondhand smoke) via self-reported data and home monitoring objective measures; (3) assess the level of asthma control as indicated by self-reported asthma symptoms and lung function; and (4) explore associations of self-reported and objective measures of residential environmental exposures with self-reported and objective measures of asthma control. Methods: We will recruit 50 adults with asthma who have completed our online Global COVID-19 Asthma Study, indicated willingness to be contacted for future studies, reported high use of disinfectant/cleaning products, and have asthma that is not well controlled. Participants will receive an indoor air quality monitor and a home spirometer to measure VOCs, PM2.5, and FEV1%, respectively. EMA data will be collected using a personal smartphone and EMA software platform. Participants will be sent scheduled and random EMA notifications to assess asthma symptoms, environmental exposures, lung function, and mitigation strategies. After the 14-day data collection period, participants will respond to survey items related to acceptability, appropriateness, and feasibility. Results: This study was funded in March 2021. We pilot tested our procedures and began recruitment in April 2022. The anticipated completion of the study is 2023. Conclusions: Findings from this feasibility study will support a powered study to address the impact of home environmental exposures on asthma symptoms and develop tailored, home-based asthma interventions that are responsive to the changing home environment and home routines. Trial Registration: ClinicalTrials.gov NCT05224076; https://clinicaltrials.gov/ct2/show/NCT05224076 International Registered Report Identifier (IRRID): DERR1-10.2196/39887 UR - https://www.researchprotocols.org/2022/8/e39887 UR - http://dx.doi.org/10.2196/39887 UR - http://www.ncbi.nlm.nih.gov/pubmed/35916686 ID - info:doi/10.2196/39887 ER - TY - JOUR AU - Moore, C. Raeanne AU - Parrish, M. Emma AU - Van Patten, Ryan AU - Paolillo, Emily AU - Filip, F. Tess AU - Bomyea, Jessica AU - Lomas, Derek AU - Twamley, W. Elizabeth AU - Eyler, T. Lisa AU - Depp, A. Colin PY - 2022/7/29 TI - Initial Psychometric Properties of 7 NeuroUX Remote Ecological Momentary Cognitive Tests Among People With Bipolar Disorder: Validation Study JO - J Med Internet Res SP - e36665 VL - 24 IS - 7 KW - neuropsychology KW - mobile health KW - ambulatory assessment KW - ecological momentary assessment KW - practice effects KW - validity KW - testing KW - serious mental illness KW - mobile phone N2 - Background: As smartphone technology has become nearly ubiquitous, there is a growing body of literature suggesting that ecological momentary cognitive testing (EMCT) offers advantages over traditional pen-and-paper psychological assessment. We introduce a newly developed platform for the self-administration of cognitive tests in ecologically valid ways. Objective: The aim of this study is to develop a Health Insurance Portability and Accountability Act?compliant EMCT smartphone-based platform for the frequent and repeated testing of cognitive abilities in everyday life. This study examines the psychometric properties of 7 mobile cognitive tests covering domains of processing speed, visual working memory, recognition memory, and response inhibition within our platform among persons with and without bipolar disorder (BD). Ultimately, if shown to have adequate psychometric properties, EMCTs may be useful in research on BD and other neurological and psychiatric illnesses. Methods: A total of 45 persons with BD and 21 demographically comparable healthy volunteer participants (aged 18-65 years) completed smartphone-based EMCTs 3 times daily for 14 days. Each EMCT session lasted approximately 1.5 minutes. Only 2 to 3 tests were administered in any given session, no test was administered more than once per day, and alternate test versions were administered in each session. Results: The mean adherence to the EMCT protocol was 69.7% (SD 20.5%), resulting in 3965 valid and complete tests across the full sample. Participants were significantly more likely to miss tests on later versus earlier study days. Adherence did not differ by diagnostic status, suggesting that BD does not interfere with EMCT participation. In most tests, age and education were related to EMCT performance in expected directions. The average performances on most EMCTs were moderately to strongly correlated with the National Institutes of Health Toolbox Cognition Battery. Practice effects were observed in 5 tests, with significant differences in practice effects by BD status in 3 tests. Conclusions: Although additional reliability and validity data are needed, this study provides initial psychometric support for EMCTs in the assessment of cognitive performance in real-world contexts in BD. UR - https://www.jmir.org/2022/7/e36665 UR - http://dx.doi.org/10.2196/36665 UR - http://www.ncbi.nlm.nih.gov/pubmed/35904876 ID - info:doi/10.2196/36665 ER - TY - JOUR AU - Wang, Shirlene AU - Intille, Stephen AU - Ponnada, Aditya AU - Do, Bridgette AU - Rothman, Alexander AU - Dunton, Genevieve PY - 2022/7/14 TI - Investigating Microtemporal Processes Underlying Health Behavior Adoption and Maintenance: Protocol for an Intensive Longitudinal Observational Study JO - JMIR Res Protoc SP - e36666 VL - 11 IS - 7 KW - emerging adulthood KW - behavior change KW - longitudinal data collection KW - ecological momentary assessment KW - sensing KW - theory KW - young adult KW - weight gain KW - EMA KW - chronic disease KW - physical activity N2 - Background: Young adulthood (ages 18-29 years) is marked by substantial weight gain, leading to increased lifetime risks of chronic diseases. Engaging in sufficient levels of physical activity and sleep, and limiting sedentary time are important contributors to the prevention of weight gain. Dual-process models of decision-making and behavior that delineate reflective (ie, deliberative, slow) and reactive (ie, automatic, fast) processes shed light on different mechanisms underlying the adoption versus maintenance of these energy-balance behaviors. However, reflective and reactive processes may unfold at different time scales and vary across people. Objective: This paper describes the study design, recruitment, and data collection procedures for the Temporal Influences on Movement and Exercise (TIME) study, a 12-month intensive longitudinal data collection study to examine real-time microtemporal influences underlying the adoption and maintenance of physical activity, sedentary behavior, and sleep. Methods: Intermittent ecological momentary assessment (eg, intentions, self-control) and continuous, sensor-based passive monitoring (eg, location, phone/app use, activity levels) occur using smartwatches and smartphones. Data analyses will combine idiographic (person-specific, data-driven) and nomothetic (generalizable, theory-driven) approaches to build models that may predict within-subject variation in the likelihood of behavior ?episodes? (eg, ?10 minutes of physical activity, ?120 minutes of sedentary time, ?7 hours sleep) and ?lapses? (ie, not attaining recommended levels for ?7 days) as a function of reflective and reactive factors. Results: The study recruited young adults across the United States (N=246). Rolling recruitment began in March 2020 and ended August 2021. Data collection will continue until August 2022. Conclusions: Results from the TIME study will be used to build more predictive health behavior theories, and inform personalized behavior interventions to reduce obesity and improve public health. International Registered Report Identifier (IRRID): DERR1-10.2196/36666 UR - https://www.researchprotocols.org/2022/7/e36666 UR - http://dx.doi.org/10.2196/36666 UR - http://www.ncbi.nlm.nih.gov/pubmed/35834296 ID - info:doi/10.2196/36666 ER - TY - JOUR AU - Sharma, Pravesh AU - Peck, Robert AU - Sinicrope, R. Anthony AU - Pavey, Thomas AU - Muehlenkamp, J. Jennifer PY - 2022/7/12 TI - Proximal Risk for Suicide: Protocol for an Ecological Momentary Assessment Study JO - JMIR Res Protoc SP - e37583 VL - 11 IS - 7 KW - suicide KW - suicide risk KW - suicide ideation KW - suicide prevention KW - diary KW - ecological momentary assessment KW - Integrative-Volitional-Motivational Theory N2 - Background: Suicide is a prevalent public health concern in the United States across all age groups. Research has emphasized the need to identify risk markers that prevent suicide along shorter timeframes, such as days to weeks. Furthermore, little has been done to explore the relative significance of factors that can predict short-term suicide risk or to evaluate how daily variability in these factors impacts suicidal ideation or behavior. This proposed project aims to identify risk factors that best predict near-time changes in suicidal ideation and examine potential interactions between these factors to predict transitions into suicidal thinking or behaviors. Objective: The aim of this proposed study is threefold: (1) To identify which psychological risk factors are most strongly associated with proximal changes in suicide risk across days and weeks. (2) To evaluate theoretical assumptions of the Integrative-Motivational-Volitional Theory of Suicide. (3) To determine how disruptions in physiological arousal interact with theoretical mechanisms of risk to predict concurrent and short-term prospective increase in suicidal thoughts and behaviors. Methods: A daily diary or ecological momentary assessment design will be utilized with 200 participants. Participants will complete 2 in-person visits separated by 3 weeks during which they will complete 3 brief daily assessments within their natural environments using the ilumivu research app on a smart device. Research will occur at the Mayo Clinic Health System (MCHS) Eau Claire site. Participants will be recruited through chart review and standard care delivery assessment. Results: This manuscript outlines the protocol that will guide the conduct of the forthcoming study. Conclusions: The proposed project aims to lead efforts using technological advances to capture microchanges in suicidal thinking/behavior over shorter timeframes and thereby guide future clinical assessment and management of suicidal patients. Results of this study will generate robust evidence to evaluate which risk factors predict proximal changes in suicidal ideation and behaviors. They will also provide the ability to examine potential interactions with multiple theoretically derived risk factors to predict proximal transitions into worsening suicidal thinking or behaviors. Such information will provide new targets for intervention that could ultimately reduce suicide-related morbidity and mortality. International Registered Report Identifier (IRRID): PRR1-10.2196/37583 UR - https://www.researchprotocols.org/2022/7/e37583 UR - http://dx.doi.org/10.2196/37583 UR - http://www.ncbi.nlm.nih.gov/pubmed/35819832 ID - info:doi/10.2196/37583 ER - TY - JOUR AU - Victor, E. Sarah AU - Christensen, Kirsten AU - Johnson, L. Sheri AU - Van Allen, Jason AU - Brick, A. Leslie PY - 2022/6/30 TI - Dynamic Regulatory Processes in the Transition From Suicidal Ideation to Action in Adults Leaving Inpatient Psychiatric Care: Protocol for an Intensive Longitudinal Study JO - JMIR Res Protoc SP - e38582 VL - 11 IS - 6 KW - ecological momentary assessment KW - suicidal ideation KW - suicidal behavior KW - actigraphy KW - sleep KW - cognitive control KW - longitudinal KW - affect KW - impulsivity N2 - Background: US suicide rates have risen steadily in the past decade, and suicide risk is especially high in the months after discharge from inpatient psychiatric treatment. However, suicide research has lagged in examining dynamic within-person processes that contribute to risk over time among individuals known to be at high risk of suicide. Almost no research has examined how affective, cognitive, and physiological processes change over minutes, hours, or days to confer risk of suicidal behavior in daily life. Objective: This protocol describes a longitudinal study designed to examine real-world changes in risk of suicide across multiple assessment domains. Specifically, the study involves following adults known to be at high risk of suicide after discharge from inpatient psychiatric care using self-report, interview, actigraphy, and behavioral methods to identify proximal contributors to suicidal thoughts and behaviors. First, we hypothesize that negative affective experiences, which are featured in most major suicide theories, will comprise a latent factor indicative of psychache (emotional pain), which will predict increases in suicidal thinking over time. Second, we hypothesize that poor inhibitory control in the context of negative affective stimuli, as well as emotion-related impulsivity, will predict the transition from suicidal thinking to suicidal behavior over time. Third, we hypothesize that short sleep duration will precede within-person increases in suicidal ideation as well as increased odds of suicidal behavior among those reporting suicidal thoughts. Methods: The desired sample size is 130 adults with past-week suicidal thoughts or behaviors who are receiving inpatient psychiatric treatment. Participants will complete a battery of measures while on the inpatient unit to assess negative affective experiences, emotion-related impulsivity, inhibitory control, typical sleep patterns, and relevant covariates. After discharge from inpatient care, participants will complete 4 weeks of signal-contingent ecological momentary assessment surveys, as well as mobile behavioral measures of inhibitory control, while wearing an actigraphy device that will gather objective data on sleep. Participants will complete interviews regarding suicidal thoughts and behaviors at 4 and 8 weeks after discharge. Results: The study was funded by the National Institutes of Health in November 2020. Recruitment began in April 2021. Data analysis will begin after completion of data collection. Conclusions: This study will elucidate how affective, cognitive, and physiological risk factors contribute (or do not contribute) to within-person fluctuations in suicide risk in daily life, with important implications for extant theories of suicide. Of import, the examined risk factors are all modifiable; thus, the results will inform identification of key targets for just-in-time, flexible, personalized, digital interventions that can be used to decrease emotional distress and prevent suicide among those at highest risk. International Registered Report Identifier (IRRID): DERR1-10.2196/38582 UR - https://www.researchprotocols.org/2022/6/e38582 UR - http://dx.doi.org/10.2196/38582 UR - http://www.ncbi.nlm.nih.gov/pubmed/35771618 ID - info:doi/10.2196/38582 ER - TY - JOUR AU - Taylor, E. Madison AU - Lozy, Olivia AU - Conti, Kaileigh AU - Wacha-Montes, Annmarie AU - Bentley, H. Kate AU - Kleiman, M. Evan PY - 2022/6/29 TI - The Effectiveness of a Brief Telehealth and Smartphone Intervention for College Students Receiving Traditional Therapy: Longitudinal Study Using Ecological Momentary Assessment Data JO - JMIR Ment Health SP - e33750 VL - 9 IS - 6 KW - college students KW - digital mental health KW - brief interventions N2 - Background: Brief interventions such as mental health apps and single-session interventions are increasingly popular, efficacious, and accessible delivery formats that may be beneficial for college students whose mental health needs may not be adequately met by college counseling centers. However, no studies so far have examined the effectiveness of these modes of treatment for college students who are already receiving traditional therapy, despite it being common among this population. Objective: The aim of this study was to compare the differences in self-reported momentary negative affect between college students in therapy and not in therapy who received a brief single-session intervention delivered by counseling center staff and a supplemental mobile app. Methods: Data for this study were drawn from E-Manage, a brief mobile health intervention geared toward college students. Participants in the study were 173 college students who indicated whether they had received therapy. We conducted a multilevel model to determine whether there were differences between those in therapy versus not in therapy in negative affect reported throughout the study. Following this, we conducted multilevel models with therapy status as the predictor and negative affect as the outcome. Results: Results of the multilevel model testing showed that the cross-level interaction between the time point (ie, pre- vs postexercise) and therapy status was significant (P=.008), with the reduction in negative affect from pre- to postexercise greater for those in therapy (b=?0.65, 95% CI ?0.91 to ?0.40; P<.001) than it was for those not in therapy (b=?0.31, 95% CI ?0.43 to ?0.19; P<.001). Therapy status was unassociated with both the pre-exercise (b=?1.69, 95% CI ?3.51 to 0.13; P=.07) and postexercise (b=?1.37, 95% CI ?3.17 to 0.43; P=.14) ratings of negative affect. Conclusions: These findings suggest that app-based and single-session interventions are also appropriate to use among college students who are receiving traditional therapy. A randomized controlled trial comparing students receiving therapy to students receiving therapy and E-Manage will be necessary to determine to what extent E-Manage contributed to the reductions in negative affect that therapy-attending college students experienced. UR - https://mental.jmir.org/2022/6/e33750 UR - http://dx.doi.org/10.2196/33750 UR - http://www.ncbi.nlm.nih.gov/pubmed/35767338 ID - info:doi/10.2196/33750 ER - TY - JOUR AU - Zink, Jennifer AU - Yang, Chih-Hsiang AU - Alves, M. Jasmin AU - McAlister, L. Kelsey AU - Huh, Jimi AU - Pentz, Ann Mary AU - Page, A. Kathleen AU - Dunton, F. Genevieve AU - Belcher, R. Britni PY - 2022/6/10 TI - Time-Varying Associations Between Device-Based and Ecological Momentary Assessment?Reported Sedentary Behaviors and the Concurrent Affective States Among Adolescents: Proof-of-Concept Study JO - JMIR Form Res SP - e37743 VL - 6 IS - 6 KW - accelerometry KW - intensive longitudinal data KW - mood KW - youth KW - mobile phone N2 - Background: Previous studies on affective state?sedentary behavior (SB) associations have not accounted for their potentially time-varying nature and have used inconsistent SB measurement modalities. We investigated whether the strength of the associations between affective states and SB varied as a function of the time of day and by SB measurement modality (device-measured SB vs ecological momentary assessment?reported screen-based SB) in youth. Objective: This study aimed to establish a proof of concept that SB?affective state associations may not be static during the day. In addition, we aimed to inform the methodology of future work, which may need to model associations as functions of the time of day and carefully consider how SB is operationalized or measured. Methods: A total of 15 adolescents (age: mean 13.07, SD 1.03 years; 10/15, 67% female; 6/15, 40% Hispanic; 10/15, 67% healthy weight) wore thigh-mounted activPAL accelerometers and simultaneously reported their screen-based SBs and concurrent positive and negative affective states via ecological momentary assessment for 7 to 14 days (N=636 occasions). Time-varying effect models (varying slopes) examined how each measure of SB was associated with concurrent affective states from 7 AM to 8 PM. Results: Time-varying effect model plots revealed that these associations varied in strength throughout the day. Specifically, device-based SB was related to greater concurrent negative affect only after approximately 5 PM and was unrelated to concurrent positive affect. Screen-based SB was related to greater concurrent negative affect only from 7 AM to approximately 9 AM. This was also related to greater concurrent positive affect from 7 AM to approximately 9:30 AM and from approximately 3 PM to approximately 7 PM. Conclusions: We provide preliminary evidence to suggest that future confirmatory studies investigating the SB?affective state relationship should consider the time-varying nature of these associations and SB measurement modality. There may be critical time windows when specific types of SBs co-occur with affect, suggesting that interventions may need tailoring to the time of day and type of SB if future studies using similar methodologies can replicate our findings. UR - https://formative.jmir.org/2022/6/e37743 UR - http://dx.doi.org/10.2196/37743 UR - http://www.ncbi.nlm.nih.gov/pubmed/35687383 ID - info:doi/10.2196/37743 ER - TY - JOUR AU - Businelle, S. Michael AU - Garey, Lorra AU - Gallagher, W. Matthew AU - Hébert, T. Emily AU - Vujanovic, Anka AU - Alexander, Adam AU - Kezbers, Krista AU - Matoska, Cameron AU - Robison, Jillian AU - Montgomery, Audrey AU - Zvolensky, J. Michael PY - 2022/5/30 TI - An Integrated mHealth App for Smoking Cessation in Black Smokers With Anxiety: Protocol for a Randomized Controlled Trial JO - JMIR Res Protoc SP - e38905 VL - 11 IS - 5 KW - smoking cessation KW - treatment KW - Black KW - African American KW - anxiety sensitivity KW - mHealth KW - just-in-time adaptive intervention KW - mobile phone N2 - Background: Black smokers have greater difficulty in quitting and higher rates of smoking-related diseases and disabilities than the general population. The smoking disparities experienced by this group are, in part, a consequence of multiple chronic life stressors (eg, racial discrimination) that engender increased exposure to interoceptive stress symptoms (eg, anxiety), which can ultimately lead to smoking as a means of immediate emotion regulation. Objective: This study aimed to culturally adapt and initially test a novel mobile intervention (ie, Mobile Anxiety Sensitivity Program for Smoking [MASP]) that targets anxiety sensitivity (AS; a proxy for difficulty and responsivity to interoceptive stress) among Black smokers. The MASP intervention is culturally informed to address interoceptive stress management difficulties among Black smokers and is thus hypothesized to facilitate smoking cessation. Methods: In phase 1, a total of 25 Black smokers with elevated AS will be administered MASP for 6 weeks. Following the completion of phase 1, we will further refine the MASP based on qualitative and quantitative data from participants to produce the final MASP iteration. In phase 2, a total of 200 Black smokers with elevated AS will be enrolled and randomly assigned to receive nicotine replacement therapy and either the smartphone-based National Cancer Institute QuitGuide app for standard mobile smoking cessation treatment or the MASP intervention. All participants in phases 1 and 2 will be enrolled remotely and will complete a web-based study screener; smartphone-based baseline assessment; daily smartphone-based ecological momentary assessments for 6 weeks; phone-based end-of-treatment qualitative interviews; and smartphone-based follow-up assessments at postbaseline weeks 1, 2 (quit date), 3, 4, 5, 6, 28, and 54 (weeks 28 and 54 follow-ups will be completed by phase 2 participants only). The MASP intervention is intended to offset barriers to treatment and encourage treatment engagement via smartphones. Results: This project was funded in September 2020. Phase 1 data collection began in January 2022. Phase 2 data collection is scheduled to begin in July 2022. Conclusions: If successful, data from this study will support culturally informed treatment approaches for Black smokers and, pending findings of efficacy, provide an evidence-based mobile intervention for smoking cessation that is ready for dissemination and implementation. Trial Registration: ClinicalTrials.gov NCT04838236; https://clinicaltrials.gov/ct2/show/NCT04838236 International Registered Report Identifier (IRRID): DERR1-10.2196/38905 UR - https://www.researchprotocols.org/2022/5/e38905 UR - http://dx.doi.org/10.2196/38905 UR - http://www.ncbi.nlm.nih.gov/pubmed/35635746 ID - info:doi/10.2196/38905 ER - TY - JOUR AU - Kellerman, K. John AU - Hamilton, L. Jessica AU - Selby, A. Edward AU - Kleiman, M. Evan PY - 2022/5/25 TI - The Mental Health Impact of Daily News Exposure During the COVID-19 Pandemic: Ecological Momentary Assessment Study JO - JMIR Ment Health SP - e36966 VL - 9 IS - 5 KW - news consumption KW - worry KW - hopelessness KW - ecological momentary assessment KW - news media KW - COVID-19 KW - pandemic KW - mental health KW - depression KW - stress KW - psychological distress KW - mediation model KW - digital health N2 - Background: Consumption of distressing news media, which substantially increased during the COVID-19 pandemic, has demonstrable negative effects on mental health. Objective: This study examines the proximal impact of daily exposure to news about COVID-19 on mental health in the first year of the pandemic. Methods: A sample of 546 college students completed daily ecological momentary assessments (EMAs) for 8 weeks, measuring exposure to news about COVID-19, worry and optimism specifically related to COVID-19, hopelessness, and general worry. Results: Participants completed >80,000 surveys. Multilevel mediation models indicated that greater daily exposure to news about COVID-19 is associated with higher same-day and next-day worry about the pandemic. Elevations in worry specifically about COVID-19 were in turn associated with greater next-day hopelessness and general worry. Optimism about COVID-19 mediated the relationship between daily exposure to COVID-19 news and next-day general worry but was not related to hopelessness. Conclusions: This study demonstrates the mental health impact of daily exposure to COVID-19 news and highlights how worry about the pandemic contributes over time to hopelessness and general worry. UR - https://mental.jmir.org/2022/5/e36966 UR - http://dx.doi.org/10.2196/36966 UR - http://www.ncbi.nlm.nih.gov/pubmed/35377320 ID - info:doi/10.2196/36966 ER - TY - JOUR AU - Dewa, H. Lindsay AU - Pappa, Sofia AU - Greene, Talya AU - Cooke, James AU - Mitchell, Lizzie AU - Hadley, Molly AU - Di Simplicio, Martina AU - Woodcock, Thomas AU - Aylin, Paul PY - 2022/5/17 TI - The Association Between Sleep Disturbance and Suicidality in Psychiatric Inpatients Transitioning to the Community: Protocol for an Ecological Momentary Assessment Study JO - JMIR Res Protoc SP - e33817 VL - 11 IS - 5 KW - sleep KW - suicide KW - psychiatric inpatient KW - ecological momentary assessment KW - EMA KW - experience sampling KW - coproduction KW - sleep disturbance KW - discharge N2 - Background: Patients are at high risk of suicidal behavior and death by suicide immediately following discharge from inpatient psychiatric hospitals. Furthermore, there is a high prevalence of sleep problems in inpatient settings, which is associated with worse outcomes following hospitalization. However, it is unknown whether poor sleep is associated with suicidality following initial hospital discharge. Objective: Our study objective is to describe a protocol for an ecological momentary assessment (EMA) study that aims to examine the relationship between sleep and suicidality in discharged patients. Methods: Our study will use an EMA design based on a wearable device to examine the sleep-suicide relationship during the transition from acute inpatient care to the community. Prospectively discharged inpatients 18 to 35 years old with mental disorders (N=50) will be assessed for eligibility and recruited across 2 sites. Data on suicidal ideation, behavior, and imagery; nonsuicidal self-harm and imagery; defeat, entrapment, and hopelessness; affect; and sleep will be collected on the Pro-Diary V wrist-worn electronic watch for up to 14 days. Objective sleep and daytime activity will be measured using the inbuilt MotionWare software. Questionnaires will be administered face-to-face at baseline and follow up, and data will also be collected on the acceptability and feasibility of using the Pro-Diary V watch to monitor the transition following discharge. The study has been, and will continue to be, coproduced with young people with experience of being in an inpatient setting and suicidality. Results: South Birmingham Research Ethics Committee (21/WM/0128) approved the study on June 28, 2021. We expect to see a relationship between poor sleep and postdischarge suicidality. Results will be available in 2022. Conclusions: This protocol describes the first coproduced EMA study to examine the relationship between sleep and suicidality and to apply the integrated motivational volitional model in young patients transitioning from a psychiatric hospital to the community. We expect our findings will inform coproduction in suicidology research and clarify the role of digital monitoring of suicidality and sleep before and after initial hospital discharge. International Registered Report Identifier (IRRID): PRR1-10.2196/33817 UR - https://www.researchprotocols.org/2022/5/e33817 UR - http://dx.doi.org/10.2196/33817 UR - http://www.ncbi.nlm.nih.gov/pubmed/35579920 ID - info:doi/10.2196/33817 ER - TY - JOUR AU - Nereim, Cameron AU - Bickham, David AU - Rich, Michael PY - 2022/5/12 TI - Exploring Use Patterns and Racial and Ethnic Differences in Real Time Affective States During Social Media Use Among a Clinical Sample of Adolescents With Depression: Prospective Cohort Study JO - JMIR Form Res SP - e30900 VL - 6 IS - 5 KW - depression KW - race/ethnicity KW - ecological momentary assessment KW - internet KW - mental health KW - mood KW - social media KW - mobile phone N2 - Background: Increasing youth mental health problems over time correlate with increasing rates of social media use (SMU); however, a proposed contributory relationship remains unproven. To better understand how SMU impacts mental health requires a more nuanced understanding of the relationship between different patterns of SMU and specific individual factors. Studies suggest that more active forms of SMU may offer mental health benefits when compared with more passive forms. Furthermore, the literature suggests important differences in patterns of SMU and affective states among those identifying as racial and ethnic minorities. Objective: Using ecological momentary assessment (EMA), this study aims to investigate potential differences in affective states during active and passive forms of SMU and whether such differences vary by race and ethnicity. Methods: We recruited patients seeking care at a large urban adolescent medicine clinic who exhibited at least mild depressive symptoms based on Patient Health Questionnaire-9 (PHQ-9) scores. Participants completed an enrollment survey and a 7-day EMA protocol, receiving 5 EMA questionnaires per day, which assessed real time SMU behaviors and affective states using the Positive and Negative Affect Schedule?Expanded form subscales. To correct for nonindependent data with EMA responses clustered within individuals, data were analyzed using mixed-effects modeling, allowing for a random intercept at the individual level to examine associations between EMA-reported SMU and affective states while adjusting results for age, gender, race and ethnicity, PHQ-9 score, and EMA response rate. Results: A racially and ethnically diverse group of 55 adolescents aged 14 to 19 years provided a total of 976 EMA responses, averaging 17.76 (SD 8.76) responses per participant, with a response rate of 51.15%. Participants reported higher mean levels of negative affect during active SMU (F1,215=3.86; SE 0.05; t1,215=1.96; P=.05) and lower mean levels of positive affect during passive SMU (F1,369=3.90; SE 0.09; t1,369=?1.98; P=.049). However, within different racial and ethnic groups, higher levels of negative affect during moments of active SMU were seen only among Black non-Hispanic participants: F1,81=6.31; SE 0.05; t81=2.51; P=.01). Similarly, lower levels of positive affect during passive SMU were seen only among White non-Hispanic participants (F1,295=10.52; SE 0.13; t295=?3.24; P=.001). Conclusions: Although in aggregate, adolescents with depressive symptoms experienced more negative affect during active SMU and less positive affect during passive SMU, these mean outcomes were driven solely by greater negative affect during active SMU by Black non-Hispanic participants and lower positive affect during passive SMU by White non-Hispanic participants. Differences in intentionality, content, context, and expectations of SMU among youths across racial and ethnic groups may result in different affective outcomes. Exploration of the interactions among cultural differences in SMU strategies and characteristics will be critical to furthering our understanding of the impact of SMU on youth mental health. UR - https://formative.jmir.org/2022/5/e30900 UR - http://dx.doi.org/10.2196/30900 UR - http://www.ncbi.nlm.nih.gov/pubmed/35550316 ID - info:doi/10.2196/30900 ER - TY - JOUR AU - Scherer, A. Emily AU - Kim, Jung Sunny AU - Metcalf, A. Stephen AU - Sweeney, Ann Mary AU - Wu, Jialing AU - Xie, Haiyi AU - Mazza, L. Gina AU - Valente, J. Matthew AU - MacKinnon, P. David AU - Marsch, A. Lisa PY - 2022/5/10 TI - Momentary Self-regulation: Scale Development and Preliminary Validation JO - JMIR Ment Health SP - e35273 VL - 9 IS - 5 KW - self-regulation KW - momentary self-regulation KW - ecological momentary assessment KW - psychometric KW - health behavior change KW - health risk behaviors KW - mobile phone N2 - Background: Self-regulation refers to a person?s ability to manage their cognitive, emotional, and behavioral processes to achieve long-term goals. Most prior research has examined self-regulation at the individual level; however, individual-level assessments do not allow the examination of dynamic patterns of intraindividual variability in self-regulation and thus cannot aid in understanding potential malleable processes of self-regulation that may occur in response to the daily environment. Objective: This study aims to develop a brief, psychometrically sound momentary self-regulation scale that can be practically administered through participants? mobile devices at a momentary level. Methods: This study was conducted in 2 phases. In the first phase, in a sample of 522 adults collected as part of a larger self-regulation project, we examined 23 previously validated assessments of self-regulation containing 594 items in total to evaluate the underlying structure of self-regulation via exploratory and confirmatory factor analyses. We then selected 20 trait-level items to be carried forward to the second phase. In the second phase, we converted each item into a momentary question and piloted the momentary items in a sample of 53 adults over 14 days. Using the results from the momentary pilot study, we explored the psychometric properties of the items and assessed their underlying structure. We then proposed a set of subscale and total score calculations. Results: In the first phase, the selected individual-level items appeared to measure 4 factors of self-regulation. The factors identified were perseverance, sensation seeking, emotion regulation, and mindfulness. In the second phase of the ecological momentary assessment pilot, the selected items demonstrated strong construct validity as well as predictive validity for health risk behaviors. Conclusions: Our findings provide preliminary evidence for a 12-item momentary self-regulation scale comprising 4 subscales designed to capture self-regulatory dynamics at the momentary level. UR - https://mental.jmir.org/2022/5/e35273 UR - http://dx.doi.org/10.2196/35273 UR - http://www.ncbi.nlm.nih.gov/pubmed/35536605 ID - info:doi/10.2196/35273 ER - TY - JOUR AU - Hart, Alexander AU - Reis, Dorota AU - Prestele, Elisabeth AU - Jacobson, C. Nicholas PY - 2022/4/28 TI - Using Smartphone Sensor Paradata and Personalized Machine Learning Models to Infer Participants? Well-being: Ecological Momentary Assessment JO - J Med Internet Res SP - e34015 VL - 24 IS - 4 KW - digital biomarkers KW - machine learning KW - ecological momentary assessment KW - smartphone sensors KW - internal states KW - paradata KW - accelerometer KW - gyroscope KW - mood KW - mobile phone N2 - Background: Sensors embedded in smartphones allow for the passive momentary quantification of people?s states in the context of their daily lives in real time. Such data could be useful for alleviating the burden of ecological momentary assessments and increasing utility in clinical assessments. Despite existing research on using passive sensor data to assess participants? moment-to-moment states and activity levels, only limited research has investigated temporally linking sensor assessment and self-reported assessment to further integrate the 2 methodologies. Objective: We investigated whether sparse movement-related sensor data can be used to train machine learning models that are able to infer states of individuals? work-related rumination, fatigue, mood, arousal, life engagement, and sleep quality. Sensor data were only collected while the participants filled out the questionnaires on their smartphones. Methods: We trained personalized machine learning models on data from employees (N=158) who participated in a 3-week ecological momentary assessment study. Results: The results suggested that passive smartphone sensor data paired with personalized machine learning models can be used to infer individuals? self-reported states at later measurement occasions. The mean R2 was approximately 0.31 (SD 0.29), and more than half of the participants (119/158, 75.3%) had an R2 of ?0.18. Accuracy was only slightly attenuated compared with earlier studies and ranged from 38.41% to 51.38%. Conclusions: Personalized machine learning models and temporally linked passive sensing data have the capability to infer a sizable proportion of variance in individuals? daily self-reported states. Further research is needed to investigate factors that affect the accuracy and reliability of the inference. UR - https://www.jmir.org/2022/4/e34015 UR - http://dx.doi.org/10.2196/34015 UR - http://www.ncbi.nlm.nih.gov/pubmed/35482397 ID - info:doi/10.2196/34015 ER - TY - JOUR AU - Dauber, Sarah AU - Beacham, Alexa AU - Hammond, Cori AU - West, Allison AU - Thrul, Johannes PY - 2022/4/4 TI - Adaptive Text Messaging for Postpartum Risky Drinking: Conceptual Model and Protocol for an Ecological Momentary Assessment Study JO - JMIR Res Protoc SP - e36849 VL - 11 IS - 4 KW - postpartum KW - alcohol use KW - risky drinking KW - mobile health KW - ecologic momentary assessment KW - mobile phone N2 - Background: Risky drinking is prevalent among women of childbearing age. Although many women reduce their drinking during pregnancy, more than half return to prepregnancy levels during the early postpartum period. Risky drinking in new mothers may be associated with negative child and maternal health outcomes; however, new mothers are unlikely to seek treatment for risky drinking because of stigma and fear of child protective service involvement. SMS text messaging is a promising approach for reaching non?treatment-seeking new mothers at risk because of risky drinking. SMS text messaging interventions (TMIs) are empirically supported for alcohol use, but a tailored intervention for new mothers does not exist. This study aims to fill this gap by developing a just-in-time adaptive TMI for postpartum risky drinking. Objective: The objectives of this paper are to present a preliminary conceptual model of postpartum risky drinking and describe the protocol for conducting an ecological momentary assessment (EMA) study with new mothers to inform the refinement of the conceptual model and development of the TMI. Methods: This paper presents a preliminary conceptual model of postpartum risky drinking based on the motivational model of alcohol use, social cognitive theory, and temporal self-regulation theory. The model proposes three primary intervention targets: motivation, self-efficacy, and self-regulation. Theoretical and empirical literature in support of the conceptual model is described. The paper also describes procedures for a study that will collect EMA data from 30 participants recruited via social media and the perinatal Central Intake system of New Jersey. Following the baseline assessment, EMA surveys will be sent 5 times per day for 14 days. The assessment instruments and data analysis procedures are described. Results: Recruitment is scheduled to begin in January 2022 and is anticipated to conclude in March 2022. Study results are estimated to be published in July 2022. Conclusions: The study findings will enhance our understanding of daily and momentary fluctuations in risk and protective factors for risky drinking during the early postpartum period. The findings will be used to refine the conceptual model and inform the development of the TMI. The next steps for this work include the development of intervention components via an iterative participatory design process and testing of the resulting intervention in a pilot microrandomized trial. International Registered Report Identifier (IRRID): PRR1-10.2196/36849 UR - https://www.researchprotocols.org/2022/4/e36849 UR - http://dx.doi.org/10.2196/36849 UR - http://www.ncbi.nlm.nih.gov/pubmed/35373778 ID - info:doi/10.2196/36849 ER - TY - JOUR AU - Boemo, Teresa AU - Socastro, Angela AU - Blanco, Ivan AU - Martin-Garcia, Oscar AU - Pacheco-Romero, Mar Ana AU - Rodríguez-Carvajal, Raquel AU - Sanchez-Lopez, Alvaro PY - 2022/3/28 TI - A Novel Experience Sampling Method Tool Integrating Momentary Assessments of Cognitive Biases: Two Compliance, Usability, and Measurement Reactivity Studies JO - JMIR Form Res SP - e32537 VL - 6 IS - 3 KW - experience sampling method KW - compliance KW - usability KW - measurement reactivity KW - emotion KW - cognitive biases N2 - Background: Experience sampling methods (ESMs) are increasingly being used to study ecological emotion dynamics in daily functioning through repeated assessments taken over several days. However, most of these ESM approaches are only based on self-report assessments, and therefore, studies on the ecological trajectories of their underlying mechanisms are scarce (ie, cognitive biases) and require evaluation through experimental tasks. We developed a novel ESM tool that integrates self-report measures of emotion and emotion regulation with a previously validated app-based cognitive task that allows for the assessment of underlying mechanisms during daily functioning. Objective: The objective of the study is to test this new tool and study its usability and the possible factors related to compliance with it in terms of latency and missing responses. Among the compliance predictors, we considered psychological and time-related variables, as well as usability, measurement reactivity, and participants? satisfaction with the tool. Methods: We conducted 2 extensive ESM studies?study 1 (N=84; a total of 3 assessments per day for 5 days) and study 2 (N=135; a total of 3 assessments per day for 10 days). Results: In both studies, participants found the tool highly usable (average usability score >81). By using mixed regression models, we found both common and specific results for the compliance predictors. In both study 1 and study 2, latency was significantly predicted by the day (P<.001 and P=.003, respectively). Participants showed slower responses to the notification as the days of the study progressed. In study 2 but not in study 1, latency was further predicted by individual differences in overload with the use of the app, and missing responses were accounted for by individual differences in stress reactivity to notifications (P=.04). Thus, by using a more extensive design, participants who experienced higher overload during the study were characterized by slower responses to notifications (P=.01), whereas those who experienced higher stress reactivity to the notification system were characterized by higher missing responses. Conclusions: The new tool had high levels of usability. Furthermore, the study of compliance is of enormous importance when implementing novel ESM methods, including app-based cognitive tasks. The main predictors of latency and missing responses found across studies, specifically when using extensive ESM protocols (study 2), are methodology-related variables. Future research that integrates cognitive tasks in ESM designs should take these results into consideration by performing accurate estimations of participants? response rates to facilitate the optimal quality of novel eHealth approaches, as in this study. UR - https://formative.jmir.org/2022/3/e32537 UR - http://dx.doi.org/10.2196/32537 UR - http://www.ncbi.nlm.nih.gov/pubmed/35343900 ID - info:doi/10.2196/32537 ER - TY - JOUR AU - Semborski, Sara AU - Henwood, Benjamin AU - Redline, Brian AU - Dzubur, Eldin AU - Mason, Tyler AU - Intille, Stephen PY - 2022/3/25 TI - Feasibility and Acceptability of Ecological Momentary Assessment With Young Adults Who Are Currently or Were Formerly Homeless: Mixed Methods Study JO - JMIR Form Res SP - e33387 VL - 6 IS - 3 KW - ecological momentary assessment KW - homelessness KW - young adults KW - reactivity KW - compliance KW - mobile phone N2 - Background: Ecological momentary assessment (EMA) has been used with young people experiencing homelessness to gather information on contexts associated with homelessness and risk behavior in real time and has proven feasible in this population. However, the extent to which EMA may affect the attitudes or behaviors of young adults who are currently or were formerly homeless and are residing in supportive housing has not been well investigated. Objective: This study aims to describe the feedback regarding EMA study participation from young adults who are currently or were formerly homeless and examine the reactivity to EMA participation and compliance. Methods: This mixed methods study used cross-sectional data collected before and after EMA, intensive longitudinal data from a 7-day EMA prompting period, and focus groups of young adults who are currently or were formerly homeless in Los Angeles, California, between 2017 and 2019. Results: Qualitative data confirmed the quantitative findings. Differences in the experience of EMA between young adults who are currently or were formerly homeless were found to be related to stress or anxiety, interference with daily life, difficulty charging, behavior change, and honesty in responses. Anxiety and depression symptomatology decreased from before to after EMA; however, compliance was not significantly associated with this decrease. Conclusions: The results point to special considerations when administering EMA to young adults who are currently or were formerly homeless. EMA appears to be slightly more burdensome for young adults who are currently homeless than for those residing in supportive housing, which are nuances to consider in the study design. The lack of a relationship between study compliance and symptomatology suggests low levels of reactivity. UR - https://formative.jmir.org/2022/3/e33387 UR - http://dx.doi.org/10.2196/33387 UR - http://www.ncbi.nlm.nih.gov/pubmed/35333187 ID - info:doi/10.2196/33387 ER - TY - JOUR AU - Krohn, Holly AU - Guintivano, Jerry AU - Frische, Rachel AU - Steed, Jamie AU - Rackers, Hannah AU - Meltzer-Brody, Samantha PY - 2022/3/23 TI - App-Based Ecological Momentary Assessment to Enhance Clinical Care for Postpartum Depression: Pilot Acceptability Study JO - JMIR Form Res SP - e28081 VL - 6 IS - 3 KW - postpartum care KW - depression KW - mobile health KW - mHealth KW - ecological momentary assessment (EMA) KW - mobile apps KW - personalized care KW - mobile phone N2 - Background: Wearable tracking devices and mobile health technology are increasingly used in an effort to enhance clinical care and the delivery of personalized medical treatment. Postpartum depression is the most frequently diagnosed complication of childbirth; however, significant gaps in screening and treatment remain. Objective: This study aims to investigate the clinical utility, predictive ability, and acceptability of using ecological momentary assessment to collect daily mood, sleep, and activity data through the use of an Apple Watch and mobile app among women with postpartum depression. Methods: This was a pilot study consisting of 3 in-person research visits over the course of a 6-week enrollment period. Questionnaires to assess depression, anxiety, and maternal functioning were periodically collected, along with daily self-reported symptoms and passively collected physiological data via an Apple Watch. Feedback was collected from study participants and the study clinician to determine the utility and acceptability of daily tracking. Logistic regression was used to determine whether mood scores in the 2 weeks before a visit predicted scores at follow-up. Compliance with daily assessments was also measured. Results: Of the 26 women enrolled, 23 (88%) completed the 6-week study period. On average, the participants completed 67% (34.4/51.5 days) of all active daily assessments and 74% (38/51.5 days) of all passive measures. Furthermore, all 23 participants completed the 3 required visits with the research team. Predictive correlations were found between self-reported mood and Edinburgh Postnatal Depression Scale score at follow-up, self-reported anxiety and EDPS, and sleep quality and Edinburgh Postnatal Depression Scale. Conclusions: Using ecological momentary assessment to track daily symptoms of postpartum depression using a wearable device was largely endorsed as acceptable and clinically useful by participants and the study clinician and could be an innovative solution to increase care access during the COVID-19 pandemic. UR - https://formative.jmir.org/2022/3/e28081 UR - http://dx.doi.org/10.2196/28081 UR - http://www.ncbi.nlm.nih.gov/pubmed/35319483 ID - info:doi/10.2196/28081 ER - TY - JOUR AU - Haucke, Matthias AU - Heinz, Andreas AU - Liu, Shuyan AU - Heinzel, Stephan PY - 2022/3/17 TI - The Impact of COVID-19 Lockdown on Daily Activities, Cognitions, and Stress in a Lonely and Distressed Population: Temporal Dynamic Network Analysis JO - J Med Internet Res SP - e32598 VL - 24 IS - 3 KW - COVID-19 KW - mental health KW - outbreak KW - epidemic KW - pandemic KW - psychological response KW - emotional well-being KW - ecological momentary assessment KW - risk KW - protective factors KW - lockdown measures KW - loneliness KW - mood inertia KW - stressors KW - mobile apps KW - mHealth KW - digital health KW - EMA KW - smartphone apps KW - network model KW - cognition KW - stress KW - temporal dynamic network KW - permutation testing KW - network comparison KW - network characteristics KW - multilevel vector autoregressive model KW - mlVAR N2 - Background: The COVID-19 pandemic and its associated lockdown measures impacted mental health worldwide. However, the temporal dynamics of causal factors that modulate mental health during lockdown are not well understood. Objective: We aimed to understand how a COVID-19 lockdown changes the temporal dynamics of loneliness and other factors affecting mental health. This is the first study that compares network characteristics between lockdown stages to prioritize mental health intervention targets. Methods: We combined ecological momentary assessments with wrist-worn motion tracking to investigate the mechanism and changes in network centrality of symptoms and behaviors before and during lockdown. A total of 258 participants who reported at least mild loneliness and distress were assessed 8 times a day for 7 consecutive days over a 213-day period from August 8, 2020, through March 9, 2021, in Germany, covering a ?no-lockdown? and a ?lockdown? stage. COVID-19?related worry, information-seeking, perceived restriction, and loneliness were assessed by digital visual analog scales ranging from 0 to 100. Social activity was assessed on a 7-point Likert scale, while physical activity was recorded from wrist-worn actigraphy devices. Results: We built a multilevel vector autoregressive model to estimate dynamic networks. To compare network characteristics between a no-lockdown stage and a lockdown stage, we performed permutation tests. During lockdown, loneliness had the highest impact within the network, as indicated by its centrality index (ie, an index to identify variables that have a strong influence on the other variables). Moreover, during lockdown, the centrality of loneliness significantly increased. Physical activity contributed to a decrease in loneliness amid the lockdown stage. Conclusions: The COVID-19 lockdown increased the central role of loneliness in triggering stress-related behaviors and cognition. Our study indicates that loneliness should be prioritized in mental health interventions during lockdown. Moreover, physical activity can serve as a buffer for loneliness amid social restrictions. UR - https://www.jmir.org/2022/3/e32598 UR - http://dx.doi.org/10.2196/32598 UR - http://www.ncbi.nlm.nih.gov/pubmed/35191843 ID - info:doi/10.2196/32598 ER - TY - JOUR AU - Elavsky, Steriani AU - Blaho?ová, Jana AU - Lebedíková, Michaela AU - Tkaczyk, Micha? AU - Tancos, Martin AU - Plhák, Jaromír AU - Sotolá?, Ond?ej AU - Smahel, David PY - 2022/3/8 TI - Researching the Links Between Smartphone Behavior and Adolescent Well-being With the FUTURE-WP4 (Modeling the Future: Understanding the Impact of Technology on Adolescent?s Well-being Work Package 4) Project: Protocol for an Ecological Momentary Assessment Study JO - JMIR Res Protoc SP - e35984 VL - 11 IS - 3 KW - well-being KW - adolescents KW - smartphones KW - intensive data KW - ecological momentary assessment N2 - Background: Smartphone ownership has increased among teens within the last decade, with up to 89% of adolescents owning a smartphone and engaging daily with the online world through it. Although the results of recent meta-analyses suggest that engaging digital technology plays only a small role in adolescent well-being, parents, professionals, and policymakers remain concerned about the impact that the instant connectivity of smartphones has on adolescent well-being. Objective: Herein, we introduce the protocol of a research study investigating the associations between adolescent smartphone use and different facets of well-being (social, physical, and psychological), with the aim to apply innovative methods to address the limitations of existing empirical studies. Methods: This 12-month prospective study of adolescents uses a repeated measurement-burst design with the ecological momentary assessment methodology. Adolescents (N=203; age range 13-17 years) complete baseline assessments through online questionnaires, four 14-day intensive data collection bursts, and an online questionnaire at the end of the study. As part of the 4 measurement bursts, adolescent smartphone behavior is assessed objectively by passive data collection of smartphone data logs and through self-reports in short questionnaires administered via a custom-built Android app. Results: The protocol describes the study objectives, research tools (including the development of the Android app and specialized software), and process (including pilot studies, the main study, and targets for machine learning approaches). Two of the 203 enrolled participants provided no data during the first data collection burst of the main study. Preliminary analyses of the data from the first data collection burst indicated an acceptable level of compliance (72.25%) with the daily questionnaires. The design of the study will allow for the assessment of both within- and between-person variabilities in smartphone behavior, as well as short-term variation and long-term change in smartphone behavior and how it impacts the indicators of social, physical, and psychological well-being. Conclusions: The innovative methods applied in this study (objective smartphone logs, ecological momentary assessment, and machine learning) will allow for a more nuanced assessment of the links between smartphone use and well-being, informing strategies to help adolescents navigate the online world more constructively in terms of the development of their physical, social, and psychological well-being. International Registered Report Identifier (IRRID): DERR1-10.2196/35984 UR - https://www.researchprotocols.org/2022/3/e35984 UR - http://dx.doi.org/10.2196/35984 UR - http://www.ncbi.nlm.nih.gov/pubmed/35258467 ID - info:doi/10.2196/35984 ER - TY - JOUR AU - Burke, Louise AU - Naylor, Graham PY - 2022/3/8 TI - Smartphone App?Based Noncontact Ecological Momentary Assessment With Experienced and Naïve Older Participants: Feasibility Study JO - JMIR Form Res SP - e27677 VL - 6 IS - 3 KW - ecological momentary assessment KW - EMA KW - smartphone KW - mobile phone KW - mHealth KW - app KW - noncontact EMA KW - remote EMA KW - hearing KW - hearing loss KW - feasibility N2 - Background: Smartphone app?based ecological momentary assessment (EMA) without face-to-face contact between researcher and participant (app-based noncontact EMA) potentially provides a valuable data collection tool when geographic, time, and situational factors (eg, COVID-19 restrictions) place constraints on in-person research. Nevertheless, little is known about the feasibility of this method, particularly in older and naïve EMA participants. Objective: This study aims to assess the feasibility of app-based noncontact EMA as a function of previous EMA experience, by recruiting and comparing a group of participants who had never participated in EMA before against a group of participants who had been part of an earlier in-person EMA study, and age, by recruiting middle-aged to older adults. Methods: Overall, 151 potential participants were invited via email; 46.4% (70/151) enrolled in the study by completing the baseline questionnaire set and were emailed instructions for the EMA phase. Of these participants, 67% (47/70) downloaded an EMA app and ran the survey sequence for 1 week. In total, 5 daytime surveys and 1 evening survey, each day, assessed participants? listening environment, social activity, and conversational engagement. A semistructured exit telephone interview probed the acceptability of the method. As markers of feasibility, we assessed the enrollment rate, study completion rate, reason for noncompletion, EMA survey response rate, and likelihood of reporting an issue with survey alerts and requested assistance from researchers, family, or friends. Results: Enrollment rates among invitees (63.3% vs 38.2%; P=.004) and completion rates among enrollees (83.9% vs 53.8%; P<.001) were higher in the experienced than in the naïve EMA group. On average, experienced participants responded to 64.1% (SD 30.2%) of the daytime EMA surveys, and naïve participants responded to 54.3% (SD 29.5%) of the daytime EMA surveys (P=.27). Among participants who retrospectively reported issues with survey alerts, only 19% (3/16) requested researcher assistance during data collection. Older participants were more likely to report not being alerted to EMA surveys (P=.008), but age was unrelated to all other markers of feasibility. Post hoc analyses of the effect of the phone operating system on markers of feasibility revealed that response rates were higher among iOS users (mean 74.8%, SD 20.25%) than among Android users (mean 48.5%, SD 31.35%; P=.002). Conclusions: Smartphone app?based noncontact EMA appears to be feasible, although participants with previous EMA experience, younger participants, and iOS users performed better on certain markers of feasibility. Measures to increase feasibility may include extensive testing of the app with different phone types, encouraging participants to seek timely assistance for any issues experienced, and recruiting participants who have some previous EMA experience where possible. The limitations of this study include participants? varying levels of existing relationship with the researcher and the implications of collecting data during the COVID-19 social restrictions. UR - https://formative.jmir.org/2022/3/e27677 UR - http://dx.doi.org/10.2196/27677 UR - http://www.ncbi.nlm.nih.gov/pubmed/35258471 ID - info:doi/10.2196/27677 ER - TY - JOUR AU - Zhang, Peng AU - Fonnesbeck, Christopher AU - Schmidt, C. Douglas AU - White, Jules AU - Kleinberg, Samantha AU - Mulvaney, A. Shelagh PY - 2022/3/3 TI - Using Momentary Assessment and Machine Learning to Identify Barriers to Self-management in Type 1 Diabetes: Observational Study JO - JMIR Mhealth Uhealth SP - e21959 VL - 10 IS - 3 KW - machine learning KW - type 1 diabetes KW - psychosocial KW - self-management KW - adolescents KW - behavioral medicine KW - ecological momentary assessment KW - informatics KW - mobile phone N2 - Background: For adolescents living with type 1 diabetes (T1D), completion of multiple daily self-management tasks, such as monitoring blood glucose and administering insulin, can be challenging because of psychosocial and contextual barriers. These barriers are hard to assess accurately and specifically by using traditional retrospective recall. Ecological momentary assessment (EMA) uses mobile technologies to assess the contexts, subjective experiences, and psychosocial processes that surround self-management decision-making in daily life. However, the rich data generated via EMA have not been frequently examined in T1D or integrated with machine learning analytic approaches. Objective: The goal of this study is to develop a machine learning algorithm to predict the risk of missed self-management in young adults with T1D. To achieve this goal, we train and compare a number of machine learning models through a learned filtering architecture to explore the extent to which EMA data were associated with the completion of two self-management behaviors: mealtime self-monitoring of blood glucose (SMBG) and insulin administration. Methods: We analyzed data from a randomized controlled pilot study using machine learning?based filtering architecture to investigate whether novel information related to contextual, psychosocial, and time-related factors (ie, time of day) relate to self-management. We combined EMA-collected contextual and insulin variables via the MyDay mobile app with Bluetooth blood glucose data to construct machine learning classifiers that predicted the 2 self-management behaviors of interest. Results: With 1231 day-level SMBG frequency counts for 45 participants, demographic variables and time-related variables were able to predict whether daily SMBG was below the clinical threshold of 4 times a day. Using the 1869 data points derived from app-based EMA data of 31 participants, our learned filtering architecture method was able to infer nonadherence events with high accuracy and precision. Although the recall score is low, there is high confidence that the nonadherence events identified by the model are truly nonadherent. Conclusions: Combining EMA data with machine learning methods showed promise in the relationship with risk for nonadherence. The next steps include collecting larger data sets that would more effectively power a classifier that can be deployed to infer individual behavior. Improvements in individual self-management insights, behavioral risk predictions, enhanced clinical decision-making, and just-in-time patient support in diabetes could result from this type of approach. UR - https://mhealth.jmir.org/2022/3/e21959 UR - http://dx.doi.org/10.2196/21959 UR - http://www.ncbi.nlm.nih.gov/pubmed/35238791 ID - info:doi/10.2196/21959 ER - TY - JOUR AU - Bell, Marie Brooke AU - Alam, Ridwan AU - Mondol, Sayeed Abu AU - Ma, Meiyi AU - Emi, Afrin Ifat AU - Preum, Masud Sarah AU - de la Haye, Kayla AU - Stankovic, A. John AU - Lach, John AU - Spruijt-Metz, Donna PY - 2022/2/18 TI - Validity and Feasibility of the Monitoring and Modeling Family Eating Dynamics System to Automatically Detect In-field Family Eating Behavior: Observational Study JO - JMIR Mhealth Uhealth SP - e30211 VL - 10 IS - 2 KW - ecological momentary assessment KW - wearable sensors KW - automatic dietary assessment KW - eating behavior KW - eating context KW - smartwatch KW - mobile phone N2 - Background: The field of dietary assessment has a long history, marked by both controversies and advances. Emerging technologies may be a potential solution to address the limitations of self-report dietary assessment methods. The Monitoring and Modeling Family Eating Dynamics (M2FED) study uses wrist-worn smartwatches to automatically detect real-time eating activity in the field. The ecological momentary assessment (EMA) methodology was also used to confirm whether eating occurred (ie, ground truth) and to measure other contextual information, including positive and negative affect, hunger, satiety, mindful eating, and social context. Objective: This study aims to report on participant compliance (feasibility) to the 2 distinct EMA protocols of the M2FED study (hourly time-triggered and eating event?triggered assessments) and on the performance (validity) of the smartwatch algorithm in automatically detecting eating events in a family-based study. Methods: In all, 20 families (58 participants) participated in the 2-week, observational, M2FED study. All participants wore a smartwatch on their dominant hand and responded to time-triggered and eating event?triggered mobile questionnaires via EMA while at home. Compliance to EMA was calculated overall, for hourly time-triggered mobile questionnaires, and for eating event?triggered mobile questionnaires. The predictors of compliance were determined using a logistic regression model. The number of true and false positive eating events was calculated, as well as the precision of the smartwatch algorithm. The Mann-Whitney U test, Kruskal-Wallis test, and Spearman rank correlation were used to determine whether there were differences in the detection of eating events by participant age, gender, family role, and height. Results: The overall compliance rate across the 20 deployments was 89.26% (3723/4171) for all EMAs, 89.7% (3328/3710) for time-triggered EMAs, and 85.7% (395/461) for eating event?triggered EMAs. Time of day (afternoon odds ratio [OR] 0.60, 95% CI 0.42-0.85; evening OR 0.53, 95% CI 0.38-0.74) and whether other family members had also answered an EMA (OR 2.07, 95% CI 1.66-2.58) were significant predictors of compliance to time-triggered EMAs. Weekend status (OR 2.40, 95% CI 1.25-4.91) and deployment day (OR 0.92, 95% CI 0.86-0.97) were significant predictors of compliance to eating event?triggered EMAs. Participants confirmed that 76.5% (302/395) of the detected events were true eating events (ie, true positives), and the precision was 0.77. The proportion of correctly detected eating events did not significantly differ by participant age, gender, family role, or height (P>.05). Conclusions: This study demonstrates that EMA is a feasible tool to collect ground-truth eating activity and thus evaluate the performance of wearable sensors in the field. The combination of a wrist-worn smartwatch to automatically detect eating and a mobile device to capture ground-truth eating activity offers key advantages for the user and makes mobile health technologies more accessible to nonengineering behavioral researchers. UR - https://mhealth.jmir.org/2022/2/e30211 UR - http://dx.doi.org/10.2196/30211 UR - http://www.ncbi.nlm.nih.gov/pubmed/35179508 ID - info:doi/10.2196/30211 ER - TY - JOUR AU - Zhai, DongHui AU - van Stiphout, Ruud AU - Schiavone, Giuseppina AU - De Raedt, Walter AU - Van Hoof, Chris PY - 2022/2/18 TI - Characterizing and Modeling Smoking Behavior Using Automatic Smoking Event Detection and Mobile Surveys in Naturalistic Environments: Observational Study JO - JMIR Mhealth Uhealth SP - e28159 VL - 10 IS - 2 KW - smoking behavior modeling KW - ambulatory study KW - wearable sensors KW - temporal patterns of smoking KW - Poisson mixed-effects model KW - mobile phone N2 - Background: There are 1.1 billion smokers worldwide, and each year, more than 8 million die prematurely because of cigarette smoking. More than half of current smokers make a serious quit every year. Nonetheless, 90% of unaided quitters relapse within the first 4 weeks of quitting due to the lack of limited access to cost-effective and efficient smoking cessation tools in their daily lives. Objective: This study aims to enable quantified monitoring of ambulatory smoking behavior 24/7 in real life by using continuous and automatic measurement techniques and identifying and characterizing smoking patterns using longitudinal contextual signals. This work also intends to provide guidance and insights into the design and deployment of technology-enabled smoking cessation applications in naturalistic environments. Methods: A 4-week observational study consisting of 46 smokers was conducted in both working and personal life environments. An electric lighter and a smartphone with an experimental app were used to track smoking events and acquire concurrent contextual signals. In addition, the app was used to prompt smoking-contingent ecological momentary assessment (EMA) surveys. The smoking rate was assessed based on the timestamps of smoking and linked statistically to demographics, time, and EMA surveys. A Poisson mixed-effects model to predict smoking rate in 1-hour windows was developed to assess the contribution of each predictor. Results: In total, 8639 cigarettes and 1839 EMA surveys were tracked over 902 participant days. Most smokers were found to have an inaccurate and often biased estimate of their daily smoking rate compared with the measured smoking rate. Specifically, 74% (34/46) of the smokers made more than one (mean 4.7, SD 4.2 cigarettes per day) wrong estimate, and 70% (32/46) of the smokers overestimated it. On the basis of the timestamp of the tracked smoking events, smoking rates were visualized at different hours and were found to gradually increase and peak at 6 PM in the day. In addition, a 1- to 2-hour shift in smoking patterns was observed between weekdays and weekends. When moderate and heavy smokers were compared with light smokers, their ages (P<.05), Fagerström Test of Nicotine Dependence (P=.01), craving level (P<.001), enjoyment of cigarettes (P<.001), difficulty resisting smoking (P<.001), emotional valence (P<.001), and arousal (P<.001) were all found to be significantly different. In the Poisson mixed-effects model, the number of cigarettes smoked in a 1-hour time window was highly dependent on the smoking status of an individual (P<.001) and was explained by hour (P=.02) and age (P=.005). Conclusions: This study reported the high potential and challenges of using an electronic lighter for smoking annotation and smoking-triggered EMAs in an ambulant environment. These results also validate the techniques for smoking behavior monitoring and pave the way for the design and deployment of technology-enabled smoking cessation applications. International Registered Report Identifier (IRRID): RR2-10.1136/bmjopen-2018-028284 UR - https://mhealth.jmir.org/2022/2/e28159 UR - http://dx.doi.org/10.2196/28159 UR - http://www.ncbi.nlm.nih.gov/pubmed/35179512 ID - info:doi/10.2196/28159 ER - TY - JOUR AU - Carlier, Chiara AU - Niemeijer, Koen AU - Mestdagh, Merijn AU - Bauwens, Michael AU - Vanbrabant, Peter AU - Geurts, Luc AU - van Waterschoot, Toon AU - Kuppens, Peter PY - 2022/2/11 TI - In Search of State and Trait Emotion Markers in Mobile-Sensed Language: Field Study JO - JMIR Ment Health SP - e31724 VL - 9 IS - 2 KW - depression KW - emotions KW - mobile sensing KW - language KW - LIWC KW - openSMILE KW - speech KW - writing KW - mobile phone N2 - Background: Emotions and mood are important for overall well-being. Therefore, the search for continuous, effortless emotion prediction methods is an important field of study. Mobile sensing provides a promising tool and can capture one of the most telling signs of emotion: language. Objective: The aim of this study is to examine the separate and combined predictive value of mobile-sensed language data sources for detecting both momentary emotional experience as well as global individual differences in emotional traits and depression. Methods: In a 2-week experience sampling method study, we collected self-reported emotion ratings and voice recordings 10 times a day, continuous keyboard activity, and trait depression severity. We correlated state and trait emotions and depression and language, distinguishing between speech content (spoken words), speech form (voice acoustics), writing content (written words), and writing form (typing dynamics). We also investigated how well these features predicted state and trait emotions using cross-validation to select features and a hold-out set for validation. Results: Overall, the reported emotions and mobile-sensed language demonstrated weak correlations. The most significant correlations were found between speech content and state emotions and between speech form and state emotions, ranging up to 0.25. Speech content provided the best predictions for state emotions. None of the trait emotion?language correlations remained significant after correction. Among the emotions studied, valence and happiness displayed the most significant correlations and the highest predictive performance. Conclusions: Although using mobile-sensed language as an emotion marker shows some promise, correlations and predictive R2 values are low. UR - https://mental.jmir.org/2022/2/e31724 UR - http://dx.doi.org/10.2196/31724 UR - http://www.ncbi.nlm.nih.gov/pubmed/35147507 ID - info:doi/10.2196/31724 ER - TY - JOUR AU - Ponnada, Aditya AU - Wang, Shirlene AU - Chu, Daniel AU - Do, Bridgette AU - Dunton, Genevieve AU - Intille, Stephen PY - 2022/2/9 TI - Intensive Longitudinal Data Collection Using Microinteraction Ecological Momentary Assessment: Pilot and Preliminary Results JO - JMIR Form Res SP - e32772 VL - 6 IS - 2 KW - intensive longitudinal data KW - ecological momentary assessment KW - experience sampling KW - microinteractions KW - smartwatch KW - health behavior research KW - mobile phone N2 - Background: Ecological momentary assessment (EMA) uses mobile technology to enable in situ self-report data collection on behaviors and states. In a typical EMA study, participants are prompted several times a day to answer sets of multiple-choice questions. Although the repeated nature of EMA reduces recall bias, it may induce participation burden. There is a need to explore complementary approaches to collecting in situ self-report data that are less burdensome yet provide comprehensive information on an individual?s behaviors and states. A new approach, microinteraction EMA (?EMA), restricts EMA items to single, cognitively simple questions answered on a smartwatch with single-tap assessments using a quick, glanceable microinteraction. However, the viability of using ?EMA to capture behaviors and states in a large-scale longitudinal study has not yet been demonstrated. Objective: This paper describes the ?EMA protocol currently used in the Temporal Influences on Movement & Exercise (TIME) Study conducted with young adults, the interface of the ?EMA app used to gather self-report responses on a smartwatch, qualitative feedback from participants after a pilot study of the ?EMA app, changes made to the main TIME Study ?EMA protocol and app based on the pilot feedback, and preliminary ?EMA results from a subset of active participants in the TIME Study. Methods: The TIME Study involves data collection on behaviors and states from 246 individuals; measurements include passive sensing from a smartwatch and smartphone and intensive smartphone-based hourly EMA, with 4-day EMA bursts every 2 weeks. Every day, participants also answer a nightly EMA survey. On non?EMA burst days, participants answer ?EMA questions on the smartwatch, assessing momentary states such as physical activity, sedentary behavior, and affect. At the end of the study, participants describe their experience with EMA and ?EMA in a semistructured interview. A pilot study was used to test and refine the ?EMA protocol before the main study. Results: Changes made to the ?EMA study protocol based on pilot feedback included adjusting the single-question selection method and smartwatch vibrotactile prompting. We also added sensor-triggered questions for physical activity and sedentary behavior. As of June 2021, a total of 81 participants had completed at least 6 months of data collection in the main study. For 662,397 ?EMA questions delivered, the compliance rate was 67.6% (SD 24.4%) and the completion rate was 79% (SD 22.2%). Conclusions: The TIME Study provides opportunities to explore a novel approach for collecting temporally dense intensive longitudinal self-report data in a sustainable manner. Data suggest that ?EMA may be valuable for understanding behaviors and states at the individual level, thus possibly supporting future longitudinal interventions that require within-day, temporally dense self-report data as people go about their lives. UR - https://formative.jmir.org/2022/2/e32772 UR - http://dx.doi.org/10.2196/32772 UR - http://www.ncbi.nlm.nih.gov/pubmed/35138253 ID - info:doi/10.2196/32772 ER - TY - JOUR AU - Zlatar, Z. Zvinka AU - Campbell, M. Laura AU - Tang, Bin AU - Gabin, Spenser AU - Heaton, Anne AU - Higgins, Michael AU - Swendsen, Joel AU - Moore, J. David AU - Moore, C. Raeanne PY - 2022/1/31 TI - Daily Level Association of Physical Activity and Performance on Ecological Momentary Cognitive Tests in Free-living Environments: A Mobile Health Observational Study JO - JMIR Mhealth Uhealth SP - e33747 VL - 10 IS - 1 KW - smartphones KW - neuropsychology KW - ecological momentary assessment KW - digital health KW - exercise KW - people living with HIV KW - aging KW - wearables KW - mobile cognition KW - mobile phone N2 - Background: Research suggests that physical activity (PA) has both acute and chronic beneficial effects on cognitive function in laboratory settings and under supervised conditions. Mobile health technologies make it possible to reliably measure PA and cognition in free-living environments, thus increasing generalizability and reach. Research is needed to determine whether the benefits of PA on cognitive function extend from the laboratory to real-world contexts. Objective: This observational study aims to examine the association between daily fluctuations in PA and cognitive performance using mobile health technologies in free-living environments. Methods: A total of 90 adults (mean age 59, SD 6.3 years; 65/90, 72% men) with various comorbidities (eg, cardiovascular risk and HIV) and different levels of baseline cognition (ranging from cognitively normal to impaired) completed ecological momentary cognitive tests (EMCTs) on a smartphone twice daily while wearing an accelerometer to capture PA levels for 14 days. Linear mixed-effects models examined the daily associations of PA with executive function and verbal learning EMCTs. Moderation analyses investigated whether the relationship between daily PA and daily performance on EMCTs changed as a function of baseline cognition, cardiovascular risk, and functional status (independent vs dependent). Results: Days with greater PA were associated with better (faster) performance on an executive function EMCT after covariate adjustment (estimate ?0.013; ?=?.16; P=.04). Moderation analyses (estimate 0.048; ?=.58; P=.001) indicated that days with greater PA were associated with better (faster) executive function performance in individuals who were functionally dependent (effect size ?0.53; P<.001) and not in functionally independent adults (effect size ?0.01; P=.91). Conclusions: EMCTs may be a sensitive tool for capturing daily-level PA-related fluctuations in cognitive performance in real-world contexts and could be a promising candidate for tracking cognitive performance in digital health interventions aimed at increasing PA. Further research is needed to determine individual characteristics that may moderate the association between daily PA and EMCT performance in free-living environments. UR - https://mhealth.jmir.org/2022/1/e33747 UR - http://dx.doi.org/10.2196/33747 UR - http://www.ncbi.nlm.nih.gov/pubmed/35099402 ID - info:doi/10.2196/33747 ER - TY - JOUR AU - Gansner, Meredith AU - Nisenson, Melanie AU - Lin, Vanessa AU - Pong, Sovannarath AU - Torous, John AU - Carson, Nicholas PY - 2022/1/28 TI - Problematic Internet Use Before and During the COVID-19 Pandemic in Youth in Outpatient Mental Health Treatment: App-Based Ecological Momentary Assessment Study JO - JMIR Ment Health SP - e33114 VL - 9 IS - 1 KW - COVID-19 KW - problematic internet use KW - ecological momentary assessment KW - internet KW - app KW - youth KW - young adult KW - teenager KW - outpatient KW - mental health KW - treatment KW - pilot KW - cohort KW - change N2 - Background: Youth with existing psychiatric illness are more apt to use the internet as a coping skill. Because many ?in-person? coping skills were not easily accessible during the COVID-19 pandemic, youth in outpatient mental health treatment may have been particularly vulnerable to the development of problematic internet use (PIU). The identification of a pandemic-associated worsening of PIU in this population is critical in order to guide clinical care; if these youth have become dependent upon the internet to regulate their negative emotions, PIU must be addressed as part of mental health treatment. However, many existing studies of youth digital media use in the pandemic do not include youth in psychiatric treatment or are reliant upon cross-sectional methodology and self-report measures of digital media use. Objective: This is a retrospective cohort study that used data collected from an app-based ecological momentary assessment protocol to examine potential pandemic-associated changes in digital media youth in outpatient mental health treatment. Secondary analyses assessed for differences in digital media use dependent upon personal and familial COVID-19 exposure and familial hospitalization, as well as factors associated with PIU in this population. Methods: The participants were aged 12-23 years and were receiving mental health treatment in an outpatient community hospital setting. All participants completed a 6-week daily ecological momentary assessment protocol on their personal smartphones. Questions were asked about depression (PHQ-8 [8-item Patient Health Questionnaire]), anxiety (GAD-7 [7-item General Anxiety Disorder]), PIU (PIU-SF-6 [Problematic Internet Use Short Form 6]), digital media use based on Apple?s daily screen time reports, and personal and familial COVID-19 exposure. The analyses compared screen time, psychiatric symptoms, and PIU between cohorts, as well as between youth with personal or familial COVID-19 exposures and those without. The analyses also assessed for demographic and psychiatric factors associated with clinically significant PIU-SF-6 scores. Results: A total of 69 participants completed the study. The participants recruited during the pandemic were significantly more likely to meet the criteria for PIU based on their average PIU-SF-6 score (P=.02) and to spend more time using social media each day (P=.049). The overall amount of daily screen time did not differ between cohorts. Secondary analyses revealed a significant increase in average daily screen time among subjects who were exposed to COVID-19 (P=.01). Youth with clinically significant PIU-SF-6 scores were younger and more likely to have higher PHQ-8 (P=.003) and GAD-7 (P=.003) scores. No differences in scale scores or media use were found between subjects based on familial COVID-19 exposure or hospitalization. Conclusions: Our findings support our hypothesis that PIU may have worsened for youth in mental health treatment during the pandemic, particularly the problematic use of social media. Mental health clinicians should incorporate screening for PIU into routine clinical care in order to prevent potential familial conflict and subsequent psychiatric crises that might stem from unrecognized PIU. UR - https://mental.jmir.org/2022/1/e33114 UR - http://dx.doi.org/10.2196/33114 UR - http://www.ncbi.nlm.nih.gov/pubmed/35089157 ID - info:doi/10.2196/33114 ER - TY - JOUR AU - Trang, Kathy AU - Le, X. Lam AU - Brown, A. Carolyn AU - To, Q. Margaret AU - Sullivan, S. Patrick AU - Jovanovic, Tanja AU - Worthman, M. Carol AU - Giang, Minh Le PY - 2022/1/27 TI - Feasibility, Acceptability, and Design of a Mobile Ecological Momentary Assessment for High-Risk Men Who Have Sex With Men in Hanoi, Vietnam: Qualitative Study JO - JMIR Form Res SP - e30360 VL - 6 IS - 1 KW - men who have sex with men KW - HIV KW - mental disorder KW - ecological momentary assessment KW - mobile phone KW - mHealth KW - sexual minorities KW - pilot projects N2 - Background: Men who have sex with men (MSM) are at a disproportionate risk for HIV infection and common mental disorders worldwide. In the context of HIV, common mental disorders are important and are frequent drivers of suboptimal prevention and treatment outcomes. Mobile ecological momentary assessments (EMAs), or the repeated sampling of people?s behaviors and psychological states in their daily lives using mobile phones, can clarify the triggers and HIV-related sequelae of depressive-anxious symptoms and contribute toward the design of ecological momentary interventions (EMIs) that cater to the contextually varying needs of individuals to optimize prevention and treatment outcomes. Objective: This study aims to characterize the feasibility and acceptability of mobile EMA among high-risk MSM in Hanoi, Vietnam. It aims to evaluate the perceived relevance, usability, and concerns of this group with regard to the content and delivery of mobile EMA and the potential of leveraging such platforms in the future to deliver EMIs. Methods: Between January and April 2018, a total of 46 participants were recruited. The participants completed 6 to 8 mobile EMA surveys daily for 7 days. Surveys occurred once upon waking, 4 to 6 times throughout the day, and once before sleeping. All surveys queried participants? perceived safety, social interactions, psychological state, and mental health symptoms. The morning survey further queried on sleep and medication use within the past 24 hours, whereas the night survey queried on sexual activity and substance use and allowed participants to share an audio recording of a stressful experience they had that day. At the end of the week, participants were interviewed about their experiences with using the app. Results: Participants completed an average of 21.7 (SD 12.7) prompts over the 7-day period. Excluding nonresponders, the average compliance rate was 61.8% (SD 26.6%). A thematic analysis of qualitative interviews suggested an overall positive reception of the app and 5 recurring themes, which were centered on the relevance of psychological and behavioral items to daily experiences (eg, mental health symptoms and audio recording), benefits of using the app (eg, increased self-understanding), worries and concerns (eg, privacy), usability (eg, confusion about the interface), and recommendations for future design (eg, integrating more open-ended questions). Conclusions: Mobile EMA is feasible and acceptable among young MSM in Vietnam; however, more research is needed to adapt EMA protocols to this context and enhance compliance. Most participants eagerly provided information about their mental health status and daily activities. As several participants looked toward the app for further mental health and psychosocial support, EMIs have the potential to reduce HIV and mental health comorbidity among MSM. UR - https://formative.jmir.org/2022/1/e30360 UR - http://dx.doi.org/10.2196/30360 UR - http://www.ncbi.nlm.nih.gov/pubmed/35084340 ID - info:doi/10.2196/30360 ER - TY - JOUR AU - Bouldin, D. Erin AU - Delgado, Roxana AU - Peacock, Kimberly AU - Hale, Willie AU - Roghani, Ali AU - Trevino, Y. Amira AU - Viny, Mikayla AU - Wetter, W. David AU - Pugh, Jo Mary PY - 2022/1/5 TI - Military Injuries?Understanding Posttraumatic Epilepsy, Health, and Quality-of-Life Effects of Caregiving: Protocol for a Longitudinal Mixed Methods Observational Study JO - JMIR Res Protoc SP - e30975 VL - 11 IS - 1 KW - epilepsy KW - military personnel KW - veterans KW - caregiver KW - traumatic brain injury KW - quality of life KW - health status KW - longitudinal studies KW - ecologic momentary assessment KW - qualitative research N2 - Background: Veterans with posttraumatic epilepsy (PTE), particularly those with comorbidities associated with epilepsy or traumatic brain injury (TBI), have poorer health status and higher symptom burden than their peers without PTE. One area that has been particularly poorly studied is that of the role of caregivers in the health of veterans with PTE and the impact caring for someone with PTE has on the caregivers themselves. Objective: In this study, we aim to address the following: describe and compare the health and quality of life of veterans and caregivers of veterans with and without PTE; evaluate the change in available supports and unmet needs for services among caregivers of post-9/11 veterans with PTE over a 2-year period and to compare support and unmet needs with those without PTE; and identify veteran and caregiver characteristics associated with the 2-year health trajectories of caregivers and veterans with PTE compared with veterans without PTE. Methods: We conducted a prospective cohort study of the health and quality of life among 4 groups of veterans and their caregivers: veterans with PTE, nontraumatic epilepsy, TBI only, and neither epilepsy nor TBI. We will recruit participants from previous related studies and collect information about both the veterans and their primary informal caregivers on health, quality of life, unmet needs for care, PTE and TBI symptoms and treatment, relationship, and caregiver experience. Data sources will include existing data supplemented with primary data, such as survey data collected at baseline, intermittent brief reporting using ecological momentary assessment, and qualitative interviews. We will make both cross-sectional and longitudinal comparisons, using veteran-caregiver dyads, along with qualitative findings to better understand risk and promotive factors for quality of life and health among veterans and caregivers, as well as the bidirectional impact of caregivers and care recipients on one another. Results: This study was approved by the institutional review boards of the University of Utah and Salt Lake City Veterans Affairs and is under review by the Human Research Protection Office of the United States Army Medical Research and Development Command. The Service Member, Veteran, and Caregiver Community Stakeholders Group has been formed and the study questionnaire will be finalized once the panel reviews it. We anticipate the start of recruitment and primary data collection by January 2022. Conclusions: New national initiatives aim to incorporate the caregiver into the veteran?s treatment plan; however, we know little about the impact of caregiving?both positive and negative?on the caregivers themselves and on the veterans for whom they provide care. We will identify specific needs in this understudied population, which will inform clinicians, patients, families, and policy makers about the specific impact and needs to equip caregivers in caring for veterans at home. International Registered Report Identifier (IRRID): PRR1-10.2196/30975 UR - https://www.researchprotocols.org/2022/1/e30975 UR - http://dx.doi.org/10.2196/30975 UR - http://www.ncbi.nlm.nih.gov/pubmed/34989689 ID - info:doi/10.2196/30975 ER - TY - JOUR AU - Bai, Yang AU - Copeland, E. William AU - Burns, Ryan AU - Nardone, Hilary AU - Devadanam, Vinay AU - Rettew, Jeffrey AU - Hudziak, James PY - 2022/1/4 TI - Ecological Momentary Assessment of Physical Activity and Wellness Behaviors in College Students Throughout a School Year: Longitudinal Naturalistic Study JO - JMIR Public Health Surveill SP - e25375 VL - 8 IS - 1 KW - young adulthood KW - wellness KW - substance use KW - Apple Watch N2 - Background: The Wellness Environment app study is a longitudinal study focused on promoting health in college students. Objective: The two aims of this study were (1) to assess physical activity (PA) variation across the days of the week and throughout the academic year and (2) to explore the correlates that were associated with PA, concurrently and longitudinally. Methods: The participants were asked to report their wellness and risk behaviors on a 14-item daily survey through a smartphone app. Each student was provided an Apple Watch to track their real time PA. Data were collected from 805 college students from Sept 2017 to early May 2018. PA patterns across the days of the week and throughout the academic year were summarized. Concurrent associations of daily steps with wellness or risk behavior were tested in the general linear mixed-effects model. The longitudinal, reciprocal association between daily steps and health or risk behaviors were tested with cross-lagged analysis. Results: Female college students were significantly more active than male ones. The students were significantly more active during the weekday than weekend. Temporal patterns also revealed that the students were less active during Thanksgiving, winter, and spring breaks. Strong concurrent positive correlations were found between higher PA and self-reported happy mood, 8+ hours of sleep, ?1 fruit and vegetable consumption, ?4 bottles of water intake, and ?2 hours of screen time (P<.001). Similar longitudinal associations found that the previous day?s wellness behaviors independently predicted the following day?s higher PA except for mood. Conversely, the higher previous-day PA levels were associated with better mood, more fruit and vegetable consumption, and playing less music, but with higher liquor consumption the next day. Conclusions: This study provides a comprehensive surveillance of longitudinal PA patterns and their independent association with a variety of wellness and risk behaviors in college students. UR - https://publichealth.jmir.org/2022/1/e25375 UR - http://dx.doi.org/10.2196/25375 UR - http://www.ncbi.nlm.nih.gov/pubmed/34982721 ID - info:doi/10.2196/25375 ER - TY - JOUR AU - van Genugten, Rosalie Claire AU - Schuurmans, Josien AU - Hoogendoorn, W. Adriaan AU - Araya, Ricardo AU - Andersson, Gerhard AU - Baños, Rosa AU - Botella, Cristina AU - Cerga Pashoja, Arlinda AU - Cieslak, Roman AU - Ebert, Daniel David AU - García-Palacios, Azucena AU - Hazo, Jean-Baptiste AU - Herrero, Rocío AU - Holtzmann, Jérôme AU - Kemmeren, Lise AU - Kleiboer, Annet AU - Krieger, Tobias AU - Smoktunowicz, Ewelina AU - Titzler, Ingrid AU - Topooco, Naira AU - Urech, Antoine AU - Smit, H. Johannes AU - Riper, Heleen PY - 2021/12/6 TI - Examining the Theoretical Framework of Behavioral Activation for Major Depressive Disorder: Smartphone-Based Ecological Momentary Assessment Study JO - JMIR Ment Health SP - e32007 VL - 8 IS - 12 KW - depression KW - behavioral activation KW - theoretical framework KW - ecological momentary assessment KW - random-intercept cross-lagged panel model KW - behavior KW - framework KW - EMA KW - smartphone KW - mental health KW - treatment KW - engagement KW - mood N2 - Background: Behavioral activation (BA), either as a stand-alone treatment or as part of cognitive behavioral therapy, has been shown to be effective for treating depression. The theoretical underpinnings of BA derive from Lewinsohn et al?s theory of depression. The central premise of BA is that having patients engage in more pleasant activities leads to them experiencing more pleasure and elevates their mood, which, in turn, leads to further (behavioral) activation. However, there is a dearth of empirical evidence about the theoretical framework of BA. Objective: This study aims to examine the assumed (temporal) associations of the 3 constructs in the theoretical framework of BA. Methods: Data were collected as part of the ?European Comparative Effectiveness Research on Internet-based Depression Treatment versus treatment-as-usual? trial among patients who were randomly assigned to receive blended cognitive behavioral therapy (bCBT). As part of bCBT, patients completed weekly assessments of their level of engagement in pleasant activities, the pleasure they experienced as a result of these activities, and their mood over the course of the treatment using a smartphone-based ecological momentary assessment (EMA) application. Longitudinal cross-lagged and cross-sectional associations of 240 patients were examined using random intercept cross-lagged panel models. Results: The analyses did not reveal any statistically significant cross-lagged coefficients (all P>.05). Statistically significant cross-sectional positive associations between activities, pleasure, and mood levels were identified. Moreover, the levels of engagement in activities, pleasure, and mood slightly increased over the duration of the treatment. In addition, mood seemed to carry over, over time, while both levels of engagement in activities and pleasurable experiences did not. Conclusions: The results were partially in accordance with the theoretical framework of BA, insofar as the analyses revealed cross-sectional relationships between levels of engagement in activities, pleasurable experiences deriving from these activities, and enhanced mood. However, given that no statistically significant temporal relationships were revealed, no conclusions could be drawn about potential causality. A shorter measurement interval (eg, daily rather than weekly EMA reports) might be more attuned to detecting potential underlying temporal pathways. Future research should use an EMA methodology to further investigate temporal associations, based on theory and how treatments are presented to patients. Trial Registration: ClinicalTrials.gov, NCT02542891, https://clinicaltrials.gov/ct2/show/NCT02542891; German Clinical Trials Register, DRKS00006866, https://tinyurl.com/ybja3xz7; Netherlands Trials Register, NTR4962, https://www.trialregister.nl/trial/4838; ClinicalTrials.Gov, NCT02389660, https://clinicaltrials.gov/ct2/show/NCT02389660; ClinicalTrials.gov, NCT02361684, https://clinicaltrials.gov/ct2/show/NCT02361684; ClinicalTrials.gov, NCT02449447, https://clinicaltrials.gov/ct2/show/NCT02449447; ClinicalTrials.gov, NCT02410616, https://clinicaltrials.gov/ct2/show/NCT02410616; ISRCTN registry, ISRCTN12388725, https://www.isrctn.com/ISRCTN12388725 UR - https://mental.jmir.org/2021/12/e32007 UR - http://dx.doi.org/10.2196/32007 UR - http://www.ncbi.nlm.nih.gov/pubmed/34874888 ID - info:doi/10.2196/32007 ER - TY - JOUR AU - Schick, Anita AU - Paetzold, Isabell AU - Rauschenberg, Christian AU - Hirjak, Dusan AU - Banaschewski, Tobias AU - Meyer-Lindenberg, Andreas AU - Boehnke, R. Jan AU - Boecking, Benjamin AU - Reininghaus, Ulrich PY - 2021/12/3 TI - Effects of a Novel, Transdiagnostic, Hybrid Ecological Momentary Intervention for Improving Resilience in Youth (EMIcompass): Protocol for an Exploratory Randomized Controlled Trial JO - JMIR Res Protoc SP - e27462 VL - 10 IS - 12 KW - experience sampling methodology (ESM) KW - ecological momentary assessment (EMA) KW - mobile intervention KW - at-risk individuals KW - smartphone training KW - blended care KW - mental health KW - stress reactivity KW - mobile phone N2 - Background: Most mental disorders first emerge in youth and, in their early stages, surface as subthreshold expressions of symptoms comprising a transdiagnostic phenotype of psychosis, mania, depression, and anxiety. Elevated stress reactivity is one of the most widely studied mechanisms underlying psychotic and affective mental health problems. Thus, targeting stress reactivity in youth is a promising indicated and translational preventive strategy for adverse mental health outcomes that could develop later in life and for improving resilience. Compassion-focused interventions offer a wide range of innovative therapeutic techniques that are particularly amenable to being implemented as ecological momentary interventions (EMIs), a specific type of mobile health intervention, to enable youth to access interventions in a given moment and context in daily life. This approach may bridge the current gap in youth mental health care. Objective: This study aims to investigate the clinical feasibility, candidate underlying mechanisms, and initial signals of the efficacy of a novel, transdiagnostic, hybrid EMI for improving resilience to stress in youth?EMIcompass. Methods: In an exploratory randomized controlled trial, youth aged between 14 and 25 years with current distress, a broad Clinical High At-Risk Mental State, or the first episode of a severe mental disorder will be randomly allocated to the EMIcompass intervention (ie, EMI plus face-to-face training sessions) in addition to treatment as usual or a control condition of treatment as usual only. Primary (stress reactivity) and secondary candidate mechanisms (resilience, interpersonal sensitivity, threat anticipation, negative affective appraisals, and momentary physiological markers of stress reactivity), as well as primary (psychological distress) and secondary outcomes (primary psychiatric symptoms and general psychopathology), will be assessed at baseline, postintervention, and at the 4-week follow-up. Results: The first enrollment was in August 2019, and as of May 2021, enrollment and randomization was completed (N=92). We expect data collection to be completed by August 2021. Conclusions: This study is the first to establish feasibility, evidence on underlying mechanisms, and preliminary signals of the efficacy of a compassion-focused EMI in youth. If successful, a confirmatory randomized controlled trial will be warranted. Overall, our approach has the potential to significantly advance preventive interventions in youth mental health provision. Trial Registration: German Clinical Trials Register DRKS00017265; https://www.drks.de/drks_web/navigate.do?navigationId=trial.HTML&TRIAL_ID=DRKS00017265 International Registered Report Identifier (IRRID): DERR1-10.2196/27462 UR - https://www.researchprotocols.org/2021/12/e27462 UR - http://dx.doi.org/10.2196/27462 UR - http://www.ncbi.nlm.nih.gov/pubmed/34870613 ID - info:doi/10.2196/27462 ER - TY - JOUR AU - Harrington, Katharine AU - Zenk, N. Shannon AU - Van Horn, Linda AU - Giurini, Lauren AU - Mahakala, Nithya AU - Kershaw, N. Kiarri PY - 2021/12/2 TI - The Use of Food Images and Crowdsourcing to Capture Real-time Eating Behaviors: Acceptability and Usability Study JO - JMIR Form Res SP - e27512 VL - 5 IS - 12 KW - ecological momentary assessment KW - eating behaviors KW - crowdsourcing KW - food consumption images KW - food image processing KW - mobile phone N2 - Background: As poor diet quality is a significant risk factor for multiple noncommunicable diseases prevalent in the United States, it is important that methods be developed to accurately capture eating behavior data. There is growing interest in the use of ecological momentary assessments to collect data on health behaviors and their predictors on a micro timescale (at different points within or across days); however, documenting eating behaviors remains a challenge. Objective: This pilot study (N=48) aims to examine the feasibility?usability and acceptability?of using smartphone-captured and crowdsource-labeled images to document eating behaviors in real time. Methods: Participants completed the Block Fat/Sugar/Fruit/Vegetable Screener to provide a measure of their typical eating behavior, then took pictures of their meals and snacks and answered brief survey questions for 7 consecutive days using a commercially available smartphone app. Participant acceptability was determined through a questionnaire regarding their experiences administered at the end of the study. The images of meals and snacks were uploaded to Amazon Mechanical Turk (MTurk), a crowdsourcing distributed human intelligence platform, where 2 Workers assigned a count of food categories to the images (fruits, vegetables, salty snacks, and sweet snacks). The agreement among MTurk Workers was assessed, and weekly food counts were calculated and compared with the Screener responses. Results: Participants reported little difficulty in uploading photographs and remembered to take photographs most of the time. Crowdsource-labeled images (n=1014) showed moderate agreement between the MTurk Worker responses for vegetables (688/1014, 67.85%) and high agreement for all other food categories (871/1014, 85.89% for fruits; 847/1014, 83.53% for salty snacks, and 833/1014, 81.15% for sweet snacks). There were no significant differences in weekly food consumption between the food images and the Block Screener, suggesting that this approach may measure typical eating behaviors as accurately as traditional methods, with lesser burden on participants. Conclusions: Our approach offers a potentially time-efficient and cost-effective strategy for capturing eating events in real time. UR - https://formative.jmir.org/2021/12/e27512 UR - http://dx.doi.org/10.2196/27512 UR - http://www.ncbi.nlm.nih.gov/pubmed/34860666 ID - info:doi/10.2196/27512 ER - TY - JOUR AU - Trofholz, Amanda AU - Tate, Allan AU - Janowiec, Mark AU - Fertig, Angela AU - Loth, Katie AU - de Brito, N. Junia AU - Berge, Jerica PY - 2021/12/1 TI - Ecological Momentary Assessment of Weight-Related Behaviors in the Home Environment of Children From Low-Income and Racially and Ethnically Diverse Households: Development and Usability Study JO - JMIR Res Protoc SP - e30525 VL - 10 IS - 12 KW - methods KW - ecological momentary assessment KW - weight-related behaviors KW - racially and ethnically diverse KW - children KW - mobile phone N2 - Background: Ecological momentary assessment (EMA) is an innovative tool for capturing in-the-moment health behaviors as people go about their daily lives. EMA is an ideal tool to measure weight-related behaviors, such as parental feeding practices, stress, and dietary intake, as these occur on a daily basis and vary across time and context. A recent systematic review recommended standardized reporting of EMA design for studies that address weight-related behaviors. Objective: To answer the call for reporting study designs using EMA, this paper describes in detail the EMA design of the Family Matters study and how it was adapted over time to improve functionality and meet the needs of a racially, ethnically, and socioeconomically diverse sample. Methods: Family Matters is an incremental, 2-phased, mixed methods study, conducted with a racially and ethnically diverse, immigrant and refugee sample from largely low-income households, designed to examine risk and protective factors for child weight and weight-related behaviors in the home environment. The Family Matters study intentionally recruited White, Black, Hmong, Latino, Native American, and Somali parents with young children. Parents in phase 1 of the study completed 8 days of EMA on their smartphones, which included signal-contingent surveys (eg, asking about the parent?s stress at the time of the survey), event-contingent surveys (eg, descriptions of the meal the child ate), and end-of-day surveys (eg, overall assessment of the child?s day). Results: A detailed description of EMA strategies, protocols, and methods used in phase 1 of the Family Matters study is provided. Compliance with EMA surveys and participants? time spent completing EMA surveys are presented and stratified by race and ethnicity. In addition, lessons learned while conducting phase 1 EMA are shared to document how EMA methods were improved and expanded upon for phase 2 of the Family Matters study. Conclusions: The results from this study provided an important next step in identifying best practices for EMA use in assessing weight-related behaviors in the home environment. International Registered Report Identifier (IRRID): DERR1-10.2196/30525 UR - https://www.researchprotocols.org/2021/12/e30525 UR - http://dx.doi.org/10.2196/30525 UR - http://www.ncbi.nlm.nih.gov/pubmed/34855612 ID - info:doi/10.2196/30525 ER - TY - JOUR AU - Schulz, Johannes Peter AU - Andersson, M. Elin AU - Bizzotto, Nicole AU - Norberg, Margareta PY - 2021/11/29 TI - Using Ecological Momentary Assessment to Study the Development of COVID-19 Worries in Sweden: Longitudinal Study JO - J Med Internet Res SP - e26743 VL - 23 IS - 11 KW - COVID-19 KW - coronavirus KW - longitudinal studies KW - EMA KW - worry KW - fear KW - pandemics N2 - Background: The foray of COVID-19 around the globe has certainly instigated worries in many people, and lockdown measures may well have triggered more specific worries. Sweden, more than other countries, relied on voluntary measures to fight the pandemic. This provides a particularly interesting context to assess people?s reactions to the threat of the pandemic. Objective: The general aim of this study was to better understand the worried reactions to the virus and the associated lockdown measures. As there have been very few longitudinal studies in this area published to date, development of feelings of worry over time was analyzed over a longer range than in previous research. Affective variables, worry in particular, were included because most of the research in this field has focused on cognitive variables. To employ new methodology, ecological momentary assessment was used for data collection and a multilevel modeling approach was adopted for data analysis. Methods: Results were based on an unbalanced panel sample of 260 Swedish participants filling in 3226 interview questionnaires by smartphone over a 7-week period in 2020 during the rapid rise of cases in the early phase of the pandemic. Causal factors considered in this study included the perceived severity of an infection, susceptibility of a person to the threat posed by the virus, perceived efficacy of safeguarding measures, and assessment of government action against the spread of COVID-19. The effect of these factors on worries was traced in two analytical steps: the effects at the beginning of the study and the effect on the trend during the study. Results: The level of general worry related to COVID-19 was modest (mean 6.67, SD 2.54 on an 11-point Likert scale); the increase during the study period was small, but the interindividual variation of both the worry level and its increase over time was large. Findings confirmed that the hypothesized causal factors (severity of infection, susceptibility to the threat of the virus, efficacy of safeguarding, and assessment of government preventive action) did indeed affect the level of worry. Conclusions: The results confirmed earlier research in a very special case and demonstrated the usefulness of a different study design, which takes a longitudinal perspective, and a new type of data analysis borrowed from multilevel study design. UR - https://www.jmir.org/2021/11/e26743 UR - http://dx.doi.org/10.2196/26743 UR - http://www.ncbi.nlm.nih.gov/pubmed/34847065 ID - info:doi/10.2196/26743 ER - TY - JOUR AU - Paetzold, Isabell AU - Hermans, M. Karlijn S. F. AU - Schick, Anita AU - Nelson, Barnaby AU - Velthorst, Eva AU - Schirmbeck, Frederike AU - AU - van Os, Jim AU - Morgan, Craig AU - van der Gaag, Mark AU - de Haan, Lieuwe AU - Valmaggia, Lucia AU - McGuire, Philip AU - Kempton, Matthew AU - Myin-Germeys, Inez AU - Reininghaus, Ulrich PY - 2021/11/19 TI - Momentary Manifestations of Negative Symptoms as Predictors of Clinical Outcomes in People at High Risk for Psychosis: Experience Sampling Study JO - JMIR Ment Health SP - e30309 VL - 8 IS - 11 KW - ecological momentary assessment KW - psychotic disorder KW - psychopathology N2 - Background: Negative symptoms occur in individuals at ultrahigh risk (UHR) for psychosis. Although there is evidence that observer ratings of negative symptoms are associated with level of functioning, the predictive value of subjective experience in daily life for individuals at UHR has not been studied yet. Objective: This study therefore aims to investigate the predictive value of momentary manifestations of negative symptoms for clinical outcomes in individuals at UHR. Methods: Experience sampling methodology was used to measure momentary manifestations of negative symptoms (blunted affective experience, lack of social drive, anhedonia, and social anhedonia) in the daily lives of 79 individuals at UHR. Clinical outcomes (level of functioning, illness severity, UHR status, and transition status) were assessed at baseline and at 1- and 2-year follow-ups. Results: Lack of social drive, operationalized as greater experienced pleasantness of being alone, was associated with poorer functioning at the 2-year follow-up (b=?4.62, P=.01). Higher levels of anhedonia were associated with poorer functioning at the 1-year follow-up (b=5.61, P=.02). Higher levels of social anhedonia were associated with poorer functioning (eg, disability subscale: b=6.36, P=.006) and greater illness severity (b=?0.38, P=.045) at the 1-year follow-up. In exploratory analyses, there was evidence that individuals with greater variability of positive affect (used as a measure of blunted affective experience) experienced a shorter time to remission from UHR status at follow-up (hazard ratio=4.93, P=.005). Conclusions: Targeting negative symptoms in individuals at UHR may help to predict clinical outcomes and may be a promising target for interventions in the early stages of psychosis. UR - https://mental.jmir.org/2021/11/e30309 UR - http://dx.doi.org/10.2196/30309 UR - http://www.ncbi.nlm.nih.gov/pubmed/34807831 ID - info:doi/10.2196/30309 ER - TY - JOUR AU - Dao, Phuong Kim AU - De Cocker, Katrien AU - Tong, Ly Huong AU - Kocaballi, Baki A. AU - Chow, Clara AU - Laranjo, Liliana PY - 2021/11/19 TI - Smartphone-Delivered Ecological Momentary Interventions Based on Ecological Momentary Assessments to Promote Health Behaviors: Systematic Review and Adapted Checklist for Reporting Ecological Momentary Assessment and Intervention Studies JO - JMIR Mhealth Uhealth SP - e22890 VL - 9 IS - 11 KW - ecological momentary assessment KW - ecological momentary intervention KW - behavior change KW - health behavior KW - mHealth KW - mobile health KW - smartphone apps KW - mobile phone N2 - Background: Healthy 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. Objective: This 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. Methods: We 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. Results: We 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. Conclusions: The 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 Registration: PROSPERO CRD42019138739; https://www.crd.york.ac.uk/prospero/display_record.php?RecordID=138739 UR - https://mhealth.jmir.org/2021/11/e22890 UR - http://dx.doi.org/10.2196/22890 UR - http://www.ncbi.nlm.nih.gov/pubmed/34806995 ID - info:doi/10.2196/22890 ER - TY - JOUR AU - Kiekens, Glenn AU - Robinson, Kealagh AU - Tatnell, Ruth AU - Kirtley, J. Olivia PY - 2021/11/19 TI - Opening the Black Box of Daily Life in Nonsuicidal Self-injury Research: With Great Opportunity Comes Great Responsibility JO - JMIR Ment Health SP - e30915 VL - 8 IS - 11 KW - real-time monitoring KW - nonsuicidal self-injury KW - NSSI KW - experience sampling KW - ecological momentary assessment KW - digital psychiatry UR - https://mental.jmir.org/2021/11/e30915 UR - http://dx.doi.org/10.2196/30915 UR - http://www.ncbi.nlm.nih.gov/pubmed/34807835 ID - info:doi/10.2196/30915 ER - TY - JOUR AU - Jimah, Tamara AU - Borg, Holly AU - Kehoe, Priscilla AU - Pimentel, Pamela AU - Turner, Arlene AU - Labbaf, Sina AU - Asgari Mehrabadi, Milad AU - Rahmani, M. Amir AU - Dutt, Nikil AU - Guo, Yuqing PY - 2021/11/17 TI - A Technology-Based Pregnancy Health and Wellness Intervention (Two Happy Hearts): Case Study JO - JMIR Form Res SP - e30991 VL - 5 IS - 11 KW - ecological momentary assessment KW - heart rate KW - mHealth KW - physical activity KW - pregnancy KW - sleep KW - wearable electronic device N2 - Background: The physical and emotional well-being of women is critical for healthy pregnancy and birth outcomes. The Two Happy Hearts intervention is a personalized mind-body program coached by community health workers that includes monitoring and reflecting on personal health, as well as practicing stress management strategies such as mindful breathing and movement. Objective: The aims of this study are to (1) test the daily use of a wearable device to objectively measure physical and emotional well-being along with subjective assessments during pregnancy, and (2) explore the user?s engagement with the Two Happy Hearts intervention prototype, as well as understand their experiences with various intervention components. Methods: A case study with a mixed design was used. We recruited a 29-year-old woman at 33 weeks of gestation with a singleton pregnancy. She had no medical complications or physical restrictions, and she was enrolled in the Medi-Cal public health insurance plan. The participant engaged in the Two Happy Hearts intervention prototype from her third trimester until delivery. The Oura smart ring was used to continuously monitor objective physical and emotional states, such as resting heart rate, resting heart rate variability, sleep, and physical activity. In addition, the participant self-reported her physical and emotional health using the Two Happy Hearts mobile app?based 24-hour recall surveys (sleep quality and level of physical activity) and ecological momentary assessment (positive and negative emotions), as well as the Perceived Stress Scale, Center for Epidemiologic Studies Depression Scale, and State-Trait Anxiety Inventory. Engagement with the Two Happy Hearts intervention was recorded via both the smart ring and phone app, and user experiences were collected via Research Electronic Data Capture satisfaction surveys. Objective data from the Oura ring and subjective data on physical and emotional health were described. Regression plots and Pearson correlations between the objective and subjective data were presented, and content analysis was performed for the qualitative data. Results: Decreased resting heart rate was significantly correlated with increased heart rate variability (r=?0.92, P<.001). We found significant associations between self-reported responses and Oura ring measures: (1) positive emotions and heart rate variability (r=0.54, P<.001), (2) sleep quality and sleep score (r=0.52, P<.001), and (3) physical activity and step count (r=0.77, P<.001). In addition, deep sleep appeared to increase as light and rapid eye movement sleep decreased. The psychological measures of stress, depression, and anxiety appeared to decrease from baseline to post intervention. Furthermore, the participant had a high completion rate of the components of the Two Happy Hearts intervention prototype and shared several positive experiences, such as an increased self-efficacy and a normal delivery. Conclusions: The Two Happy Hearts intervention prototype shows promise for potential use by underserved pregnant women. UR - https://formative.jmir.org/2021/11/e30991 UR - http://dx.doi.org/10.2196/30991 UR - http://www.ncbi.nlm.nih.gov/pubmed/34787576 ID - info:doi/10.2196/30991 ER - TY - JOUR AU - Martinez, J. Gonzalo AU - Mattingly, M. Stephen AU - Robles-Granda, Pablo AU - Saha, Koustuv AU - Sirigiri, Anusha AU - Young, Jessica AU - Chawla, Nitesh AU - De Choudhury, Munmun AU - D'Mello, Sidney AU - Mark, Gloria AU - Striegel, Aaron PY - 2021/11/12 TI - Predicting Participant Compliance With Fitness Tracker Wearing and Ecological Momentary Assessment Protocols in Information Workers: Observational Study JO - JMIR Mhealth Uhealth SP - e22218 VL - 9 IS - 11 KW - adherence KW - compliance KW - wearables KW - smartphones KW - research design KW - ecological momentary assessment KW - mobile sensing KW - mobile phone N2 - Background: Studies that use ecological momentary assessments (EMAs) or wearable sensors to track numerous attributes, such as physical activity, sleep, and heart rate, can benefit from reductions in missing data. Maximizing compliance is one method of reducing missing data to increase the return on the heavy investment of time and money into large-scale studies. Objective: This paper aims to identify the extent to which compliance can be prospectively predicted from individual attributes and initial compliance. Methods: We instrumented 757 information workers with fitness trackers for 1 year and conducted EMAs in the first 56 days of study participation as part of an observational study. Their compliance with the EMA and fitness tracker wearing protocols was analyzed. Overall, 31 individual characteristics (eg, demographics and personalities) and behavioral variables (eg, early compliance and study portal use) were considered, and 14 variables were selected to create beta regression models for predicting compliance with EMAs 56 days out and wearable compliance 1 year out. We surveyed study participation and correlated the results with compliance. Results: Our modeling indicates that 16% and 25% of the variance in EMA compliance and wearable compliance, respectively, could be explained through a survey of demographics and personality in a held-out sample. The likelihood of higher EMA and wearable compliance was associated with being older (EMA: odds ratio [OR] 1.02, 95% CI 1.00-1.03; wearable: OR 1.02, 95% CI 1.01-1.04), speaking English as a first language (EMA: OR 1.38, 95% CI 1.05-1.80; wearable: OR 1.39, 95% CI 1.05-1.85), having had a wearable before joining the study (EMA: OR 1.25, 95% CI 1.04-1.51; wearable: OR 1.50, 95% CI 1.23-1.83), and exhibiting conscientiousness (EMA: OR 1.25, 95% CI 1.04-1.51; wearable: OR 1.34, 95% CI 1.14-1.58). Compliance was negatively associated with exhibiting extraversion (EMA: OR 0.74, 95% CI 0.64-0.85; wearable: OR 0.67, 95% CI 0.57-0.78) and having a supervisory role (EMA: OR 0.65, 95% CI 0.54-0.79; wearable: OR 0.66, 95% CI 0.54-0.81). Furthermore, higher wearable compliance was negatively associated with agreeableness (OR 0.68, 95% CI 0.56-0.83) and neuroticism (OR 0.85, 95% CI 0.73-0.98). Compliance in the second week of the study could help explain more variance; 62% and 66% of the variance in EMA compliance and wearable compliance, respectively, was explained. Finally, compliance correlated with participants? self-reflection on the ease of participation, usefulness of our compliance portal, timely resolution of issues, and compensation adequacy, suggesting that these are avenues for improving compliance. Conclusions: We recommend conducting an initial 2-week pilot to measure trait-like compliance and identify participants at risk of long-term noncompliance, performing oversampling based on participants? individual characteristics to avoid introducing bias in the sample when excluding data based on noncompliance, using an issue tracking portal, and providing special care in troubleshooting to help participants maintain compliance. UR - https://mhealth.jmir.org/2021/11/e22218 UR - http://dx.doi.org/10.2196/22218 UR - http://www.ncbi.nlm.nih.gov/pubmed/34766911 ID - info:doi/10.2196/22218 ER - TY - JOUR AU - Klein, Arno AU - Clucas, Jon AU - Krishnakumar, Anirudh AU - Ghosh, S. Satrajit AU - Van Auken, Wilhelm AU - Thonet, Benjamin AU - Sabram, Ihor AU - Acuna, Nino AU - Keshavan, Anisha AU - Rossiter, Henry AU - Xiao, Yao AU - Semenuta, Sergey AU - Badioli, Alessandra AU - Konishcheva, Kseniia AU - Abraham, Ann Sanu AU - Alexander, M. Lindsay AU - Merikangas, R. Kathleen AU - Swendsen, Joel AU - Lindner, B. Ariel AU - Milham, P. Michael PY - 2021/11/11 TI - Remote Digital Psychiatry for Mobile Mental Health Assessment and Therapy: MindLogger Platform Development Study JO - J Med Internet Res SP - e22369 VL - 23 IS - 11 KW - mental health KW - mHealth KW - mobile health KW - digital health KW - eHealth KW - digital psychiatry KW - digital phenotyping KW - teletherapy KW - mobile device KW - mobile phone KW - smartphone KW - ecological momentary assessment KW - ecological momentary intervention KW - EMA KW - EMI KW - ESM KW - experience sampling KW - experience sampling methods N2 - Background: Universal access to assessment and treatment of mental health and learning disorders remains a significant and unmet need. There are many people without access to care because of economic, geographic, and cultural barriers, as well as the limited availability of clinical experts who could help advance our understanding and treatment of mental health. Objective: This study aims to create an open, configurable software platform to build clinical measures, mobile assessments, tasks, and interventions without programming expertise. Specifically, our primary requirements include an administrator interface for creating and scheduling recurring and customized questionnaires where end users receive and respond to scheduled notifications via an iOS or Android app on a mobile device. Such a platform would help relieve overwhelmed health systems and empower remote and disadvantaged subgroups in need of accurate and effective information, assessment, and care. This platform has the potential to advance scientific research by supporting the collection of data with instruments tailored to specific scientific questions from large, distributed, and diverse populations. Methods: We searched for products that satisfy these requirements. We designed and developed a new software platform called MindLogger, which exceeds the requirements. To demonstrate the platform?s configurability, we built multiple applets (collections of activities) within the MindLogger mobile app and deployed several of them, including a comprehensive set of assessments underway in a large-scale, longitudinal mental health study. Results: Of the hundreds of products we researched, we found 10 that met our primary requirements with 4 that support end-to-end encryption, 2 that enable restricted access to individual users? data, 1 that provides open-source software, and none that satisfy all three. We compared features related to information presentation and data capture capabilities; privacy and security; and access to the product, code, and data. We successfully built MindLogger mobile and web applications, as well as web browser?based tools for building and editing new applets and for administering them to end users. MindLogger has end-to-end encryption, enables restricted access, is open source, and supports a variety of data collection features. One applet is currently collecting data from children and adolescents in our mental health study, and other applets are in different stages of testing and deployment for use in clinical and research settings. Conclusions: We demonstrated the flexibility and applicability of the MindLogger platform through its deployment in a large-scale, longitudinal, mobile mental health study and by building a variety of other mental health?related applets. With this release, we encourage a broad range of users to apply the MindLogger platform to create and test applets to advance health care and scientific research. We hope that increasing the availability of applets designed to assess and administer interventions will facilitate access to health care in the general population. UR - https://www.jmir.org/2021/11/e22369 UR - http://dx.doi.org/10.2196/22369 UR - http://www.ncbi.nlm.nih.gov/pubmed/34762054 ID - info:doi/10.2196/22369 ER - TY - JOUR AU - Elavsky, Steriani AU - Klocek, Adam AU - Knapova, Lenka AU - Smahelova, Martina AU - Smahel, David AU - Cimler, Richard AU - Kuhnova, Jitka PY - 2021/11/10 TI - Feasibility of Real-time Behavior Monitoring Via Mobile Technology in Czech Adults Aged 50 Years and Above: 12-Week Study With Ecological Momentary Assessment JO - JMIR Aging SP - e15220 VL - 4 IS - 4 KW - mHealth KW - mobile phone KW - older adults KW - health behavior KW - physical activity KW - Fitbit N2 - Background: Czech older adults have lower rates of physical activity than the average population and lag behind in the use of digital technologies, compared with their peers from other European countries. Objective: This study aims to assess the feasibility of intensive behavior monitoring through technology in Czech adults aged ?50 years. Methods: Participants (N=30; mean age 61.2 years, SD 6.8 years, range 50-74 years; 16/30, 53% male; 7/30, 23% retired) were monitored for 12 weeks while wearing a Fitbit Charge 2 monitor and completed three 8-day bursts of intensive data collection through surveys presented on a custom-made mobile app. Web-based surveys were also completed before and at the end of the 12-week period (along with poststudy focus groups) to evaluate participants? perceptions of their experience in the study. Results: All 30 participants completed the study. Across the three 8-day bursts, participants completed 1454 out of 1744 (83% compliance rate) surveys administered 3 times per day on a pseudorandom schedule, 451 out of 559 (81% compliance rate) end-of-day surveys, and 736 episodes of self-reported planned physical activity (with 29/736, 3.9% of the reports initiated but returned without data). The overall rating of using the mobile app and Fitbit was above average (74.5 out of 100 on the System Usability Scale). The majority reported that the Fitbit (27/30, 90%) and mobile app (25/30, 83%) were easy to use and rated their experience positively (25/30, 83%). Focus groups revealed that some surveys were missed owing to notifications not being noticed or that participants needed a longer time window for survey completion. Some found wearing the monitor in hot weather or at night uncomfortable, but overall, participants were highly motivated to complete the surveys and be compliant with the study procedures. Conclusions: The use of a mobile survey app coupled with a wearable device appears feasible for use among Czech older adults. Participants in this study tolerated the intensive assessment schedule well, but lower compliance may be expected in studies of more diverse groups of older adults. Some difficulties were noted with the pairing and synchronization of devices on some types of smartphones, posing challenges for large-scale studies. UR - https://aging.jmir.org/2021/4/e15220 UR - http://dx.doi.org/10.2196/15220 UR - http://www.ncbi.nlm.nih.gov/pubmed/34757317 ID - info:doi/10.2196/15220 ER - TY - JOUR AU - Engelhard, M. Matthew AU - D'Arcy, Joshua AU - Oliver, A. Jason AU - Kozink, Rachel AU - McClernon, Joseph F. PY - 2021/11/1 TI - Prediction of Smoking Risk From Repeated Sampling of Environmental Images: Model Validation JO - J Med Internet Res SP - e27875 VL - 23 IS - 11 KW - smoking KW - smoking cessation KW - machine learning KW - computer vision KW - digital health KW - eHealth KW - behavior KW - CNN KW - neural network KW - artificial intelligence KW - AI KW - images KW - environment KW - ecological momentary assessment KW - mobile health KW - mHealth KW - mobile phone N2 - Background: Viewing their habitual smoking environments increases smokers? craving and smoking behaviors in laboratory settings. A deep learning approach can differentiate between habitual smoking versus nonsmoking environments, suggesting that it may be possible to predict environment-associated smoking risk from continuously acquired images of smokers? daily environments. Objective: In this study, we aim to predict environment-associated risk from continuously acquired images of smokers? daily environments. We also aim to understand how model performance varies by location type, as reported by participants. Methods: Smokers from Durham, North Carolina and surrounding areas completed ecological momentary assessments both immediately after smoking and at randomly selected times throughout the day for 2 weeks. At each assessment, participants took a picture of their current environment and completed a questionnaire on smoking, craving, and the environmental setting. A convolutional neural network?based model was trained to predict smoking, craving, whether smoking was permitted in the current environment and whether the participant was outside based on images of participants? daily environments, the time since their last cigarette, and baseline data on daily smoking habits. Prediction performance, quantified using the area under the receiver operating characteristic curve (AUC) and average precision (AP), was assessed for out-of-sample prediction as well as personalized models trained on images from days 1 to 10. The models were optimized for mobile devices and implemented as a smartphone app. Results: A total of 48 participants completed the study, and 8008 images were acquired. The personalized models were highly effective in predicting smoking risk (AUC=0.827; AP=0.882), craving (AUC=0.837; AP=0.798), whether smoking was permitted in the current environment (AUC=0.932; AP=0.981), and whether the participant was outside (AUC=0.977; AP=0.956). The out-of-sample models were also effective in predicting smoking risk (AUC=0.723; AP=0.785), whether smoking was permitted in the current environment (AUC=0.815; AP=0.937), and whether the participant was outside (AUC=0.949; AP=0.922); however, they were not effective in predicting craving (AUC=0.522; AP=0.427). Omitting image features reduced AUC by over 0.1 when predicting all outcomes except craving. Prediction of smoking was more effective for participants whose self-reported location type was more variable (Spearman ?=0.48; P=.001). Conclusions: Images of daily environments can be used to effectively predict smoking risk. Model personalization, achieved by incorporating information about daily smoking habits and training on participant-specific images, further improves prediction performance. Environment-associated smoking risk can be assessed in real time on a mobile device and can be incorporated into device-based smoking cessation interventions. UR - https://www.jmir.org/2021/11/e27875 UR - http://dx.doi.org/10.2196/27875 UR - http://www.ncbi.nlm.nih.gov/pubmed/34723819 ID - info:doi/10.2196/27875 ER - TY - JOUR AU - Psihogios, M. Alexandra AU - Rabbi, Mashfiqui AU - Ahmed, Annisa AU - McKelvey, R. Elise AU - Li, Yimei AU - Laurenceau, Jean-Philippe AU - Hunger, P. Stephen AU - Fleisher, Linda AU - Pai, LH Ahna AU - Schwartz, A. Lisa AU - Murphy, A. Susan AU - Barakat, P. Lamia PY - 2021/10/22 TI - Understanding Adolescent and Young Adult 6-Mercaptopurine Adherence and mHealth Engagement During Cancer Treatment: Protocol for Ecological Momentary Assessment JO - JMIR Res Protoc SP - e32789 VL - 10 IS - 10 KW - mHealth KW - ecological momentary assessment KW - adolescents KW - young adults KW - oncology KW - cancer KW - self-management KW - mobile phone N2 - Background: Adolescents and young adults (AYAs) with cancer demonstrate suboptimal oral chemotherapy adherence, increasing their risk of cancer relapse. It is unclear how everyday time-varying contextual factors (eg, mood) affect their adherence, stalling the development of personalized mobile health (mHealth) interventions. Poor engagement is also a challenge across mHealth trials; an effective adherence intervention must be engaging to promote uptake. Objective: This protocol aims to determine the temporal associations between daily contextual factors and 6-mercaptopurine (6-MP) adherence and explore the proximal impact of various engagement strategies on ecological momentary assessment survey completion. Methods: At the Children?s Hospital of Philadelphia, AYAs with acute lymphoblastic leukemia or lymphoma who are prescribed prolonged maintenance chemotherapy that includes daily oral 6-MP are eligible, along with their matched caregivers. Participants will use an ecological momentary assessment app called ADAPTS (Adherence Assessments and Personalized Timely Support)?a version of an open-source app that was modified for AYAs with cancer through a user-centered process?and complete surveys in bursts over 6 months. Theory-informed engagement strategies will be microrandomized to estimate the causal effects on proximal survey completion. Results: With funding from the National Cancer Institute and institutional review board approval, of the proposed 30 AYA-caregiver dyads, 60% (18/30) have been enrolled; of the 18 enrolled, 15 (83%) have completed the study so far. Conclusions: This protocol represents an important first step toward prescreening tailoring variables and engagement components for a just-in-time adaptive intervention designed to promote both 6-MP adherence and mHealth engagement. International Registered Report Identifier (IRRID): DERR1-10.2196/32789 UR - https://www.researchprotocols.org/2021/10/e32789 UR - http://dx.doi.org/10.2196/32789 UR - http://www.ncbi.nlm.nih.gov/pubmed/34677129 ID - info:doi/10.2196/32789 ER - TY - JOUR AU - Pyatak, Ann Elizabeth AU - Hernandez, Raymond AU - Pham, T. Loree AU - Mehdiyeva, Khatira AU - Schneider, Stefan AU - Peters, Anne AU - Ruelas, Valerie AU - Crandall, Jill AU - Lee, Pey-Jiuan AU - Jin, Haomiao AU - Hoogendoorn, J. Claire AU - Crespo-Ramos, Gladys AU - Mendez-Rodriguez, Heidy AU - Harmel, Mark AU - Walker, Martha AU - Serafin-Dokhan, Sara AU - Gonzalez, S. Jeffrey AU - Spruijt-Metz, Donna PY - 2021/10/22 TI - Function and Emotion in Everyday Life With Type 1 Diabetes (FEEL-T1D): Protocol for a Fully Remote Intensive Longitudinal Study JO - JMIR Res Protoc SP - e30901 VL - 10 IS - 10 KW - ecological momentary assessments KW - type 1 diabetes KW - patient-centered outcomes research KW - actigraphy KW - ambulatory monitoring KW - continuous glucose monitoring KW - EMA KW - diabetes KW - patient-centered outcome KW - outcome KW - monitoring KW - function KW - emotion KW - longitudinal KW - well-being N2 - Background: Although short-term blood glucose levels and variability are thought to underlie diminished function and emotional well-being in people with type 1 diabetes (T1D), these relationships are poorly understood. The Function and Emotion in Everyday Life with T1D (FEEL-T1D) study focuses on investigating these short-term dynamic relationships among blood glucose levels, functional ability, and emotional well-being in adults with T1D. Objective: The aim of this study is to present the FEEL-T1D study design, methods, and study progress to date, including adaptations necessitated by the COVID-19 pandemic to implement the study fully remotely. Methods: The FEEL-T1D study will recruit 200 adults with T1D in the age range of 18-75 years. Data collection includes a comprehensive survey battery, along with 14 days of intensive longitudinal data using blinded continuous glucose monitoring, ecological momentary assessments, ambulatory cognitive tasks, and accelerometers. All study procedures are conducted remotely by mailing the study equipment and by using videoconferencing for study visits. Results: The study received institutional review board approval in January 2019 and was funded in April 2019. Data collection began in June 2020 and is projected to end in December 2021. As of June 2021, after 12 months of recruitment, 124 participants have enrolled in the FEEL-T1D study. Approximately 87.6% (7082/8087) of ecological momentary assessment surveys have been completed with minimal missing data, and 82.0% (82/100) of the participants provided concurrent continuous glucose monitoring data, ecological momentary assessment data, and accelerometer data for at least 10 of the 14 days of data collection. Conclusions: Thus far, our reconfiguration of the FEEL-T1D protocol to be implemented remotely during the COVID-19 pandemic has been a success. The FEEL-T1D study will elucidate the dynamic relationships among blood glucose levels, emotional well-being, cognitive function, and participation in daily activities. In doing so, it will pave the way for innovative just-in-time interventions and produce actionable insights to facilitate tailoring of diabetes treatments to optimize the function and well-being of individuals with T1D. International Registered Report Identifier (IRRID): DERR1-10.2196/30901 UR - https://www.researchprotocols.org/2021/10/e30901 UR - http://dx.doi.org/10.2196/30901 UR - http://www.ncbi.nlm.nih.gov/pubmed/34463626 ID - info:doi/10.2196/30901 ER - TY - JOUR AU - Adams, Leslie AU - Igbinedion, Godwin AU - DeVinney, Aubrey AU - Azasu, Enoch AU - Nestadt, Paul AU - Thrul, Johannes AU - Joe, Sean PY - 2021/10/20 TI - Assessing the Real-time Influence of Racism-Related Stress and Suicidality Among Black Men: Protocol for an Ecological Momentary Assessment Study JO - JMIR Res Protoc SP - e31241 VL - 10 IS - 10 KW - Black men KW - suicide KW - racism KW - ecological momentary assessment N2 - Background: Suicide is the third leading cause of death among Black adults aged 18-35 years. Although men represent a majority of suicide deaths among Black adults, less is known regarding the extent to which unique cultural stressors, such as racism-related stress (eg, racial discrimination), are salient in exacerbating suicide risk among Black men. Moreover, few studies examine the daily influence of racism-related stressors on suicide outcomes using real-time smartphone-based approaches. Smartphone-based mobile health approaches using ecological momentary assessments (EMA) provide an opportunity to assess and characterize racism-related stressors as a culturally sensitive suicide risk factor among Black young adult men. Objective: The goal of this study is to describe a protocol development process that aims to capture real-time racism-related stressors and suicide outcomes using a smartphone-based EMA platform (MetricWire). Methods: Guided by the Interpersonal Theory of Suicide (ITS), we developed a brief EMA protocol using a multiphased approach. First, we conducted a literature review to identify brief measures previously used in EMA studies, with special emphasis on studies including Black participants. The identified measures were then shortened to items with the highest construct validity (eg, factor loadings) and revised to reflect momentary or daily frequency. Feasibility and acceptability of the study protocol will be assessed using self-report survey and qualitative responses. To protect participants from harm, a three-tier safety protocol was developed to identify participants with moderate, elevated, and acute risk based on EMA survey response to trigger outreach by the study coordinator. Results: The final EMA protocol, which will be completed over a 7-day period, is comprised of 15 questions administered 4 times per day and a daily questionnaire of 22 items related to sleep-related impairment and disruption, as well as racism-related stress. Study recruitment is currently underway. We anticipate the study will be completed in February 2023. Dissemination will be conducted through peer-reviewed publications and conference presentations. Conclusions: This protocol will address gaps in our understanding of Black men?s suicide outcomes in the social contexts that they regularly navigate and will clarify the temporal role of racism-related stressors that influence suicidal outcomes. International Registered Report Identifier (IRRID): PRR1-10.2196/31241 UR - https://www.researchprotocols.org/2021/10/e31241 UR - http://dx.doi.org/10.2196/31241 UR - http://www.ncbi.nlm.nih.gov/pubmed/34668869 ID - info:doi/10.2196/31241 ER - TY - JOUR AU - Brogly, Chris AU - Shoemaker, Kevin J. AU - Lizotte, J. Daniel AU - Kueper, K. Jacqueline AU - Bauer, Michael PY - 2021/10/19 TI - A Mobile App to Identify Lifestyle Indicators Related to Undergraduate Mental Health (Smart Healthy Campus): Observational App-Based Ecological Momentary Assessment JO - JMIR Form Res SP - e29160 VL - 5 IS - 10 KW - smartphones KW - undergraduates KW - mental health KW - lifestyle KW - postsecondary institutions KW - mHealth KW - mobile application KW - ecological momentary assessment KW - mobile phone N2 - Background: Undergraduate 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. Objective: The 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). Methods: This 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. Results: First, 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. Conclusions: Given 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. UR - https://formative.jmir.org/2021/10/e29160 UR - http://dx.doi.org/10.2196/29160 UR - http://www.ncbi.nlm.nih.gov/pubmed/34665145 ID - info:doi/10.2196/29160 ER - TY - JOUR AU - Suffoletto, Brian AU - Goldstein, Tina AU - Gotkiewicz, Dawn AU - Gotkiewicz, Emily AU - George, Brandie AU - Brent, David PY - 2021/10/14 TI - Acceptability, Engagement, and Effects of a Mobile Digital Intervention to Support Mental Health for Young Adults Transitioning to College: Pilot Randomized Controlled Trial JO - JMIR Form Res SP - e32271 VL - 5 IS - 10 KW - college KW - mental health KW - self-management KW - digital intervention KW - mHealth N2 - Background: The transition from high school to college can exacerbate mental health problems in young adults yet barriers prevent seamless mental health care. Existing digital support tools show promise but are not yet designed to optimize engagement or implementation. Objective: The goal of the research was to test acceptability and effects of an automated digital Mobile Support Tool for Mental Health (MoST-MH) for young adults transitioning to college. Methods: Youths aged 18 years and older with a current mental health diagnosis preparing to transition to college (n=52; 85% female [45/52], 91% White [48/52]) were recruited from a primary care (n=31) and a mental health clinic (n=21). Participants were randomized 2:1 to either receive MoST-MH (n=34) or enhanced Usual Care (eUC; n=18). MoST-MH included periodic text message and web-based check-ins of emotional health, stressors, negative impacts, and self-efficacy that informed tailored self-care support messages. Both eUC and MoST-MH participants received links to a library of psychoeducational videos and were asked to complete web-based versions of the Mental Health Self-Efficacy Scale (MHSES), College Counseling Center Assessment of Psychological Symptoms (CCAPS), and Client Service Receipt Inventory for Mental Health (C-SRI) monthly for 3 months and the Post-Study System Usability Scale (PSSUQ) at 3-months. Results: MoST-MH participants were sent a median of 5 (range 3 to 10) text message check-in prompts over the 3-month study period and 100% were completed; participants were sent a median of 2 (range 1 to 8) web-based check-in prompts among which 78% (43/55) were completed. PSSUQ scores indicate high usability (mean score 2.0). Results from the completer analysis demonstrated reductions in mental health symptoms over time and significant between-group effects of MoST-MH compared to eUC on depressive symptom severity (d=0.36, 95% CI 0.08 to 0.64). No significant differences in mental health self-efficacy or mental health health care use were observed. Conclusions: In this pilot trial, we found preliminary evidence that MoST-MH was engaged with at high rates and found to be highly usable and reduced depression symptoms relative to eUC among youth with mental health disorders transitioning to college. Findings were measured during the COVID-19 pandemic, and the study was not powered to detect differences in outcomes between groups; therefore, further testing is needed. Trial Registration: ClinicalTrials.gov NCT04560075; https://clinicaltrials.gov/ct2/show/NCT04560075 UR - https://formative.jmir.org/2021/10/e32271 UR - http://dx.doi.org/10.2196/32271 UR - http://www.ncbi.nlm.nih.gov/pubmed/34647893 ID - info:doi/10.2196/32271 ER - TY - JOUR AU - de Vries, Herman AU - Kamphuis, Wim AU - Oldenhuis, Hilbrand AU - van der Schans, Cees AU - Sanderman, Robbert PY - 2021/10/4 TI - Moderation of the Stressor-Strain Process in Interns by Heart Rate Variability Measured With a Wearable and Smartphone App: Within-Subject Design Using Continuous Monitoring JO - JMIR Cardio SP - e28731 VL - 5 IS - 2 KW - stress KW - strain KW - burnout KW - resilience KW - heart rate variability KW - sleep KW - wearables KW - digital health KW - sensors KW - ecological momentary assessment KW - mobile phone N2 - Background: The emergence of smartphones and wearable sensor technologies enables easy and unobtrusive monitoring of physiological and psychological data related to an individual?s resilience. Heart rate variability (HRV) is a promising biomarker for resilience based on between-subject population studies, but observational studies that apply a within-subject design and use wearable sensors in order to observe HRV in a naturalistic real-life context are needed. Objective: This study aims to explore whether resting HRV and total sleep time (TST) are indicative and predictive of the within-day accumulation of the negative consequences of stress and mental exhaustion. The tested hypotheses are that demands are positively associated with stress and resting HRV buffers against this association, stress is positively associated with mental exhaustion and resting HRV buffers against this association, stress negatively impacts subsequent-night TST, and previous-evening mental exhaustion negatively impacts resting HRV, while previous-night TST buffers against this association. Methods: In total, 26 interns used consumer-available wearables (Fitbit Charge 2 and Polar H7), a consumer-available smartphone app (Elite HRV), and an ecological momentary assessment smartphone app to collect resilience-related data on resting HRV, TST, and perceived demands, stress, and mental exhaustion on a daily basis for 15 weeks. Results: Multiple linear regression analysis of within-subject standardized data collected on 2379 unique person-days showed that having a high resting HRV buffered against the positive association between demands and stress (hypothesis 1) and between stress and mental exhaustion (hypothesis 2). Stress did not affect TST (hypothesis 3). Finally, mental exhaustion negatively predicted resting HRV in the subsequent morning but TST did not buffer against this (hypothesis 4). Conclusions: To our knowledge, this study provides first evidence that having a low within-subject resting HRV may be both indicative and predictive of the short-term accumulation of the negative effects of stress and mental exhaustion, potentially forming a negative feedback loop. If these findings can be replicated and expanded upon in future studies, they may contribute to the development of automated resilience interventions that monitor daily resting HRV and aim to provide users with an early warning signal when a negative feedback loop forms, to prevent the negative impact of stress on long-term health outcomes. UR - https://cardio.jmir.org/2021/2/e28731 UR - http://dx.doi.org/10.2196/28731 UR - http://www.ncbi.nlm.nih.gov/pubmed/34319877 ID - info:doi/10.2196/28731 ER - TY - JOUR AU - Markowski, L. Kelly AU - Smith, A. Jeffrey AU - Gauthier, Robin G. AU - Harcey, R. Sela PY - 2021/9/24 TI - Patterns of Missing Data With Ecological Momentary Assessment Among People Who Use Drugs: Feasibility Study Using Pilot Study Data JO - JMIR Form Res SP - e31421 VL - 5 IS - 9 KW - EMA KW - ecological momentary assessment KW - PWUD KW - people who use drugs KW - noncompliance KW - missing data KW - mobile phone N2 - Background: Ecological momentary assessment (EMA) is a set of research methods that capture events, feelings, and behaviors as they unfold in their real-world setting. Capturing data in the moment reduces important sources of measurement error but also generates challenges for noncompliance (ie, missing data). To date, EMA research has only examined the overall rates of noncompliance. Objective: In this study, we identify four types of noncompliance among people who use drugs and aim to examine the factors associated with the most common types. Methods: Data were obtained from a recent pilot study of 28 Nebraskan people who use drugs who answered EMA questions for 2 weeks. We examined questions that were not answered because they were skipped, they expired, the phone was switched off, or the phone died after receiving them. Results: We found that the phone being switched off and questions expiring comprised 93.34% (1739/1863 missing question-instances) of our missing data. Generalized structural equation model results show that participant-level factors, including age (relative risk ratio [RRR]=0.93; P=.005), gender (RRR=0.08; P=.006), homelessness (RRR=3.80; P=.04), personal device ownership (RRR=0.14; P=.008), and network size (RRR=0.57; P=.001), are important for predicting off missingness, whereas only question-level factors, including time of day (ie, morning compared with afternoon, RRR=0.55; P<.001) and day of week (ie, Tuesday-Saturday compared with Sunday, RRR=0.70, P=.02; RRR=0.64, P=.005; RRR=0.58, P=.001; RRR=0.55, P<.001; and RRR=0.66, P=.008, respectively) are important for predicting expired missingness. The week of study is important for both (ie, week 2 compared with week 1, RRR=1.21, P=.03, for off missingness and RRR=1.98, P<.001, for expired missingness). Conclusions: We suggest a three-pronged strategy to preempt missing EMA data with high-risk populations: first, provide additional resources for participants likely to experience phone charging problems (eg, people experiencing homelessness); second, ask questions when participants are not likely to experience competing demands (eg, morning); and third, incentivize continued compliance as the study progresses. Attending to these issues can help researchers ensure maximal data quality. UR - https://formative.jmir.org/2021/9/e31421 UR - http://dx.doi.org/10.2196/31421 UR - http://www.ncbi.nlm.nih.gov/pubmed/34464327 ID - info:doi/10.2196/31421 ER - TY - JOUR AU - Omowale, S. Serwaa AU - Casas, Andrea AU - Lai, Yu-Hsuan AU - Sanders, A. Sarah AU - Hill, V. Ashley AU - Wallace, L. Meredith AU - Rathbun, L. Stephen AU - Gary-Webb, L. Tiffany AU - Burke, E. Lora AU - Davis, M. Esa AU - Mendez, D. Dara PY - 2021/9/21 TI - Trends in Stress Throughout Pregnancy and Postpartum Period During the COVID-19 Pandemic: Longitudinal Study Using Ecological Momentary Assessment and Data From the Postpartum Mothers Mobile Study JO - JMIR Ment Health SP - e30422 VL - 8 IS - 9 KW - COVID-19 KW - ecological momentary assessment KW - health status disparities KW - pandemics KW - postpartum KW - pregnancy KW - psychological stress N2 - Background: Stress is associated with adverse birth and postpartum health outcomes. Few studies have longitudinally explored racial differences in maternal stress in a birthing population in the United States during the ongoing COVID-19 pandemic. Objective: This study aimed to do the following: (1) assess changes in reported stress before, during, and after initial emergency declarations (eg, stay-at-home orders) were in place due to the COVID-19 pandemic, and (2) assess Black-White differences in reported stress in a pregnant and postpartum population from Southwestern Pennsylvania. Methods: We leveraged data from the ongoing Postpartum Mothers Mobile Study (PMOMS), which surveys participants in real time throughout the pregnancy and postpartum periods via ecological momentary assessment (EMA) and smartphone technology. We analyzed data from a subset of PMOMS participants (n=85) who were either Black or White, and who submitted EMA responses regarding stress between November 1, 2019, and August 31, 2020, the time frame of this study. We divided data into four phases based on significant events during the COVID-19 pandemic: ?pre? phase (baseline), ?early? phase (first case of COVID-19 reported in United States), ?during? phase (stay-at-home orders), and ?post? phase (stay-at-home orders eased). We assessed mean stress levels at each phase using linear mixed-effects models and post hoc contrasts based on the models. Results: Overall mean stress (0=not at all to 4=a lot) during the pre phase was 0.8 for Black and White participants (range for Black participants: 0-3.9; range for White participants: 0-2.8). There was an increase of 0.3 points (t5649=5.2, P<.001) in the during phase as compared with the pre phase, and an increase of 0.2 points (t5649=3.1, P=.002) in the post phase compared with the pre phase (n=85). No difference was found between Black and White participants in the change in mean stress from the pre phase to the during phase (overall change predicted for the regression coefficient=?0.02, P=.87). There was a significant difference between Black and White participants in the change in mean stress from the during phase to the post phase (overall change predicted for the regression coefficient=0.4, P<.001). Conclusions: There was an overall increase in mean stress levels in this subset of pregnant and postpartum participants during the same time as the emergency declarations/stay-at-home orders in the United States. Compared to baseline, mean stress levels remained elevated when stay-at-home orders eased. We found no significant difference in the mean stress levels by race. Given that stress is associated with adverse birth outcomes and postpartum health, stress induced by the ongoing COVID-19 pandemic may have adverse implications for birthing populations in the United States. International Registered Report Identifier (IRRID): RR2-10.2196/13569 UR - https://mental.jmir.org/2021/9/e30422 UR - http://dx.doi.org/10.2196/30422 UR - http://www.ncbi.nlm.nih.gov/pubmed/34328420 ID - info:doi/10.2196/30422 ER - TY - JOUR AU - Ryu, Jihan AU - Sükei, Emese AU - Norbury, Agnes AU - H Liu, Shelley AU - Campaña-Montes, José Juan AU - Baca-Garcia, Enrique AU - Artés, Antonio AU - Perez-Rodriguez, Mercedes M. PY - 2021/9/15 TI - Shift in Social Media App Usage During COVID-19 Lockdown and Clinical Anxiety Symptoms: Machine Learning?Based Ecological Momentary Assessment Study JO - JMIR Ment Health SP - e30833 VL - 8 IS - 9 KW - anxiety disorder KW - COVID-19 KW - social media KW - public health KW - digital phenotype KW - ecological momentary assessment KW - smartphone KW - machine learning KW - hidden Markov model N2 - Background: Anxiety symptoms during public health crises are associated with adverse psychiatric outcomes and impaired health decision-making. The interaction between real-time social media use patterns and clinical anxiety during infectious disease outbreaks is underexplored. Objective: We aimed to evaluate the usage pattern of 2 types of social media apps (communication and social networking) among patients in outpatient psychiatric treatment during the COVID-19 surge and lockdown in Madrid, Spain and their short-term anxiety symptoms (7-item General Anxiety Disorder scale) at clinical follow-up. Methods: The individual-level shifts in median social media usage behavior from February 1 through May 3, 2020 were summarized using repeated measures analysis of variance that accounted for the fixed effects of the lockdown (prelockdown versus postlockdown), group (clinical anxiety group versus nonclinical anxiety group), the interaction of lockdown and group, and random effects of users. A machine learning?based approach that combined a hidden Markov model and logistic regression was applied to predict clinical anxiety (n=44) and nonclinical anxiety (n=51), based on longitudinal time-series data that comprised communication and social networking app usage (in seconds) as well as anxiety-associated clinical survey variables, including the presence of an essential worker in the household, worries about life instability, changes in social interaction frequency during the lockdown, cohabitation status, and health status. Results: Individual-level analysis of daily social media usage showed that the increase in communication app usage from prelockdown to lockdown period was significantly smaller in the clinical anxiety group than that in the nonclinical anxiety group (F1,72=3.84, P=.05). The machine learning model achieved a mean accuracy of 62.30% (SD 16%) and area under the receiver operating curve 0.70 (SD 0.19) in 10-fold cross-validation in identifying the clinical anxiety group. Conclusions: Patients who reported severe anxiety symptoms were less active in communication apps after the mandated lockdown and more engaged in social networking apps in the overall period, which suggested that there was a different pattern of digital social behavior for adapting to the crisis. Predictive modeling using digital biomarkers?passive-sensing of shifts in category-based social media app usage during the lockdown?can identify individuals at risk for psychiatric sequelae. UR - https://mental.jmir.org/2021/9/e30833 UR - http://dx.doi.org/10.2196/30833 UR - http://www.ncbi.nlm.nih.gov/pubmed/34524091 ID - info:doi/10.2196/30833 ER - TY - JOUR AU - Yerushalmi, Mor AU - Sixsmith, Andrew AU - Pollock Star, Ariel AU - King, B. David AU - O'Rourke, Norm PY - 2021/9/2 TI - Ecological Momentary Assessment of Bipolar Disorder Symptoms and Partner Affect: Longitudinal Pilot Study JO - JMIR Form Res SP - e30472 VL - 5 IS - 9 KW - bipolar disorder KW - couples KW - dyadic analyses KW - ecological momentary assessment KW - EMA KW - partner KW - relationships KW - mHealth KW - mobile apps KW - mental health KW - depression KW - BPD KW - mood N2 - Background: The World Health Organization ranks bipolar disorder (BD) as the 7th leading cause of disability. Although the effects on those with BD are well described, less is reported on the impact of BD on cohabiting partners or any interactions between the two; this requires in vivo data collection measured each day over several months. Objective: We set out to demonstrate the utility of ecological momentary assessment with BD couples measured using yoked smartphone apps. When randomly prompted over time, we assumed distinct patterns of association would emerge between BD symptoms (both depression and hypo/mania) and partner mood (positive and negative affect). Methods: For this pilot study, we recruited an international sample of young and older adults with BD and their cohabiting partners where available. Both participants and partners downloaded separate apps onto their respective smartphones. Within self-specified ?windows of general availability,? participants with BD were randomly prompted to briefly report symptoms of depression and hypo/mania (ie, BDSx), positive and negative mood (ie, POMS-15; partners), and any important events of the day (both). The partner app was yoked to the participant app so that the former was prompted roughly 30 minutes after the participant with BD or the next morning if outside the partner?s specified availability. Results: Four couples provided 312 matched BD symptom and partner mood responses over an average of 123 days (range 65-221 days). Both were GPS- and time-stamped (mean 3:11 hrs between questionnaires, SD 4:51 hrs). Total depression had a small but significant association with positive (r=?.14; P=.02) and negative partner affect (r=.15; P=.01]. Yet total hypo/mania appeared to have no association with positive partner affect (r=?.01; P=.87); instead, negative partner affect was significantly correlated with total hypo/mania (r=.26; P=.01). However, when we look specifically at BD factors, we see that negative partner affect is associated only with affrontive symptoms of hypo/mania (r=.38; P=.01); elation or loss of insight appears unrelated to either positive (r=.10; P=.09) or negative partner affect (r=.02; P=.71). Yet affrontive symptoms of hypo/mania were significantly correlated with negative affect, but only when couples were together (r=.41; P=.01), not when apart (r=.22; P=.12). That is, these angry interpersonal symptoms of hypo/mania appear to be experienced most negatively by spouses when couples are together. Conclusions: These initial findings demonstrate the utility of in vivo ambulatory data collection in longitudinal mental health research. Preliminary analyses suggest different BD symptoms are associated with negative and positive partner mood. These negative effects appear greater for hypo/mania than depressive symptoms, but proximity to the person with BD is important. UR - https://formative.jmir.org/2021/9/e30472 UR - http://dx.doi.org/10.2196/30472 UR - http://www.ncbi.nlm.nih.gov/pubmed/34473069 ID - info:doi/10.2196/30472 ER - TY - JOUR AU - Yu, Jessica AU - Chiu, Carter AU - Wang, Yajuan AU - Dzubur, Eldin AU - Lu, Wei AU - Hoffman, Julia PY - 2021/8/27 TI - A Machine Learning Approach to Passively Informed Prediction of Mental Health Risk in People with Diabetes: Retrospective Case-Control Analysis JO - J Med Internet Res SP - e27709 VL - 23 IS - 8 KW - diabetes mellitus KW - mental health KW - risk detection KW - passive sensing KW - ecological momentary assessment KW - machine learning N2 - Background: Proactive detection of mental health needs among people with diabetes mellitus could facilitate early intervention, improve overall health and quality of life, and reduce individual and societal health and economic burdens. Passive sensing and ecological momentary assessment are relatively newer methods that may be leveraged for such proactive detection. Objective: The primary aim of this study was to conceptualize, develop, and evaluate a novel machine learning approach for predicting mental health risk in people with diabetes mellitus. Methods: A retrospective study was designed to develop and evaluate a machine learning model, utilizing data collected from 142,432 individuals with diabetes enrolled in the Livongo for Diabetes program. First, participants? mental health statuses were verified using prescription and medical and pharmacy claims data. Next, four categories of passive sensing signals were extracted from the participants? behavior in the program, including demographics and glucometer, coaching, and event data. Data sets were then assembled to create participant-period instances, and descriptive analyses were conducted to understand the correlation between mental health status and passive sensing signals. Passive sensing signals were then entered into the model to train and test its performance. The model was evaluated based on seven measures: sensitivity, specificity, precision, area under the curve, F1 score, accuracy, and confusion matrix. SHapley Additive exPlanations (SHAP) values were computed to determine the importance of individual signals. Results: In the training (and validation) and three subsequent test sets, the model achieved a confidence score greater than 0.5 for sensitivity, specificity, area under the curve, and accuracy. Signals identified as important by SHAP values included demographics such as race and gender, participant?s emotional state during blood glucose checks, time of day of blood glucose checks, blood glucose values, and interaction with the Livongo mobile app and web platform. Conclusions: Results of this study demonstrate the utility of a passively informed mental health risk algorithm and invite further exploration to identify additional signals and determine when and where such algorithms should be deployed. UR - https://www.jmir.org/2021/8/e27709 UR - http://dx.doi.org/10.2196/27709 UR - http://www.ncbi.nlm.nih.gov/pubmed/34448707 ID - info:doi/10.2196/27709 ER - TY - JOUR AU - Haucke, Matthias AU - Liu, Shuyan AU - Heinzel, Stephan PY - 2021/8/26 TI - The Persistence of the Impact of COVID-19?Related Distress, Mood Inertia, and Loneliness on Mental Health During a Postlockdown Period in Germany: An Ecological Momentary Assessment Study JO - JMIR Ment Health SP - e29419 VL - 8 IS - 8 KW - COVID-19 KW - outbreaks KW - epidemics KW - pandemics KW - psychological responses and emotional well-being KW - ecological momentary assessment KW - risk and protective factors KW - low incidence and restrictions N2 - Background: The first wave of the COVID-19 pandemic in early 2020 increased mental health problems globally. However, little is known about mental health problems during a low-incidence period of the pandemic without strict public health measures. Objective: We aim to investigate whether COVID-19?related risk factors for mental health problems persist beyond lockdown measures. We targeted a vulnerable population that is at risk of developing low mental health and assessed their daily dynamics of mood and emotion regulation after a strict lockdown. Methods: During a postlockdown period in Germany (between August 8, 2020, and November 1, 2020), we conducted an ecological momentary assessment with 131 participants who experienced at least mild COVID-19?related distress and loneliness. To estimate negative mood inertia, we built a lag-1 three-level autoregressive model. Results: We found that information exposure and active daily COVID-19 cases did not have an impact on negative mood amid a postlockdown period. However, there was a day-to-day carryover effect of negative mood. In addition, worrying about COVID-19, feeling restricted by COVID-19, and feeling lonely increased negative mood. Conclusions: The mental health of a vulnerable population is still challenged by COVID-19?related stressors after the lifting of a strict lockdown. This study highlights the need to protect mental health during postpandemic periods. UR - https://mental.jmir.org/2021/8/e29419 UR - http://dx.doi.org/10.2196/29419 UR - http://www.ncbi.nlm.nih.gov/pubmed/34347622 ID - info:doi/10.2196/29419 ER - TY - JOUR AU - Ledermann, Katharina AU - Abou Khaled, Omar AU - Caon, Maurizio AU - Berger, Thomas AU - Chabwine, N. Joelle AU - Wicht, Joachim AU - Martin-Soelch, Chantal PY - 2021/8/26 TI - An Ecological Monitoring and Management App (EMMA) for Older Adults With Chronic Pain: Protocol for a Design and Feasibility Study JO - JMIR Res Protoc SP - e26930 VL - 10 IS - 8 KW - chronic pain KW - older adults KW - mHealth KW - online intervention KW - self-management N2 - Background: Chronic pain is a complex problem for many older adults that affects both physical functioning and psychological well-being. Mobile health (mHealth) technologies have shown promise in supporting older persons in managing chronic conditions. Cognitive behavior therapy is recommended for older people with chronic pain. However, web-based treatment programs for chronic pain are not aimed at the needs of older people and offer standard therapies without providing tailored treatment for this population. Objective: To address this problem, we aim to develop a psychological web-based intervention for ecological monitoring of daily life experiences with chronic pain called EMMA to support self-management of chronic pain in older adults. Methods: The key clinical and engagement features of the intervention were established through the integration of evidence-based material from cognitive behavioral therapy for the treatment of chronic pain in older adults. The development process uses a co-design approach and actively involves end-users in the design process by incorporating feedback from focus groups with older adults in order to inform a user-centered intervention design. For the co-design process, we will include 10 older adults with chronic pain, who will discuss the requirements for the app in workshops in order to ensure suitability of the app for older adults with chronic pain. In order to test the feasibility and acceptability of the intervention, we will include a sample of 30 older adults with chronic pain who will test all features of the intervention for a period of 8 consecutive weeks. After the trial period, validated instruments will be used to assess usability and acceptability, as well as influence on pain levels and associated physical and psychological symptoms. Participants will be invited to take part in a semistructured telephone interviews after the trial period to explore their experiences using the app. Results: Digitalization of the pain diary and psychotherapeutic content has started. Recruitment of participants for the co-design workshops will start as soon as we have a functioning prototype of the electronic pain diary and EMMA intervention, which is expected to be in September 2021. The feasibility study will start as soon as the co-design process is finished and required changes have been implemented into the pain diary and the EMMA intervention. We expect to start the feasibility study early in 2022. Conclusions: Required changes to assure usability and acceptability will be directly implemented in the app. EMMA brings together a strong body of evidence using cognitive behavioral and self-management theory with contemporary mHealth principles, allowing for a cost-effective intervention that can be used to target chronic pain anywhere and anytime by older adults. Given the ubiquity of mHealth interventions for chronic conditions, the results of this study may serve to inform the development of tailored self-management interventions. International Registered Report Identifier (IRRID): PRR1-10.2196/26930 UR - https://www.researchprotocols.org/2021/8/e26930 UR - http://dx.doi.org/10.2196/26930 UR - http://www.ncbi.nlm.nih.gov/pubmed/34435969 ID - info:doi/10.2196/26930 ER - TY - JOUR AU - Aný?, Ji?í AU - Bak?tein, Eduard AU - Dally, Andrea AU - Koleni?, Marián AU - Hlinka, Jaroslav AU - Hartmannová, Tereza AU - Urbanová, Kate?ina AU - Correll, U. Christoph AU - Novák, Daniel AU - ?paniel, Filip PY - 2021/8/9 TI - Validity of the Aktibipo Self-rating Questionnaire for the Digital Self-assessment of Mood and Relapse Detection in Patients With Bipolar Disorder: Instrument Validation Study JO - JMIR Ment Health SP - e26348 VL - 8 IS - 8 KW - bipolar disorder KW - symptom monitoring KW - ecological mood assessment KW - relapse detection KW - mobile application KW - mobile phone N2 - Background: Self-reported mood is a valuable clinical data source regarding disease state and course in patients with mood disorders. However, validated, quick, and scalable digital self-report measures that can also detect relapse are still not available for clinical care. Objective: In this study, we aim to validate the newly developed ASERT (Aktibipo Self-rating) questionnaire?a 10-item, mobile app?based, self-report mood questionnaire consisting of 4 depression, 4 mania, and 2 nonspecific symptom items, each with 5 possible answers. The validation data set is a subset of the ongoing observational longitudinal AKTIBIPO400 study for the long-term monitoring of mood and activity (via actigraphy) in patients with bipolar disorder (BD). Patients with confirmed BD are included and monitored with weekly ASERT questionnaires and monthly clinical scales (Montgomery-Åsberg Depression Rating Scale [MADRS] and Young Mania Rating Scale [YMRS]). Methods: The content validity of the ASERT questionnaire was assessed using principal component analysis, and the Cronbach ? was used to assess the internal consistency of each factor. The convergent validity of the depressive or manic items of the ASERT questionnaire with the MADRS and YMRS, respectively, was assessed using a linear mixed-effects model and linear correlation analyses. In addition, we investigated the capability of the ASERT questionnaire to distinguish relapse (YMRS?15 and MADRS?15) from a nonrelapse (interepisode) state (YMRS<15 and MADRS<15) using a logistic mixed-effects model. Results: A total of 99 patients with BD were included in this study (follow-up: mean 754 days, SD 266) and completed an average of 78.1% (SD 18.3%) of the requested ASERT assessments (completion time for the 10 ASERT questions: median 24.0 seconds) across all patients in this study. The ASERT depression items were highly associated with MADRS total scores (P<.001; bootstrap). Similarly, ASERT mania items were highly associated with YMRS total scores (P<.001; bootstrap). Furthermore, the logistic mixed-effects regression model for scale-based relapse detection showed high detection accuracy in a repeated holdout validation for both depression (accuracy=85%; sensitivity=69.9%; specificity=88.4%; area under the receiver operating characteristic curve=0.880) and mania (accuracy=87.5%; sensitivity=64.9%; specificity=89.9%; area under the receiver operating characteristic curve=0.844). Conclusions: The ASERT questionnaire is a quick and acceptable mood monitoring tool that is administered via a smartphone app. The questionnaire has a good capability to detect the worsening of clinical symptoms in a long-term monitoring scenario. UR - https://mental.jmir.org/2021/8/e26348 UR - http://dx.doi.org/10.2196/26348 UR - http://www.ncbi.nlm.nih.gov/pubmed/34383689 ID - info:doi/10.2196/26348 ER - TY - JOUR AU - Rauschenberg, Christian AU - Boecking, Benjamin AU - Paetzold, Isabell AU - Schruers, Koen AU - Schick, Anita AU - van Amelsvoort, Thérèse AU - Reininghaus, Ulrich PY - 2021/8/5 TI - A Compassion-Focused Ecological Momentary Intervention for Enhancing Resilience in Help-Seeking Youth: Uncontrolled Pilot Study JO - JMIR Ment Health SP - e25650 VL - 8 IS - 8 KW - mental health KW - adolescent psychopathology KW - digital interventions KW - mobile health KW - self-compassion KW - ecological momentary assessment KW - mobile phone N2 - Background: Digital interventions offer new avenues for low-threshold prevention and treatment in young people. Ecological momentary interventions (EMIs) represent a powerful approach that allows for adaptive, real-time, and real-world delivery of intervention components in daily life by real-time processing of ecological momentary assessment (EMA) data. Compassion-focused interventions (CFIs) may be particularly amenable to translation into an EMI to strengthen emotional resilience and modify putative risk mechanisms, such as stress sensitivity, in the daily lives of young help-seeking individuals. Objective: This study aims to investigate the feasibility, safety, and initial therapeutic effects of a novel, accessible, transdiagnostic, ecological momentary CFI for improving emotional resilience to stress (EMIcompass). Methods: In this uncontrolled pilot study, help-seeking youth with psychotic, depressive, or anxiety symptoms were offered the EMIcompass intervention in addition to treatment as usual. The EMIcompass intervention consisted of a 3-week EMI (including enhancing, consolidating, and EMA-informed interactive tasks) administered through a mobile health app and three face-to-face sessions with a trained psychologist intended to provide guidance and training on the CFI exercises presented in the app (ie, training session, follow-up booster session, and review session). Results: In total, 10 individuals (mean age 20.3 years, SD 3.8; range 14-25) were included in the study. Most (8/10, 80%) participants were satisfied and reported a low burden of app usage. No adverse events were observed. In approximately one-third of all EMAs, individuals scored high on stress, negative affect, or threat anticipation during the intervention period, resulting in real-time, interactive delivery of the CFI intervention components in addition to weekly enhancing and daily consolidating tasks. Although the findings should be interpreted with caution because of the small sample size, reduced stress sensitivity, momentary negative affect, and psychotic experiences, along with increased positive affect, were found at postintervention and the 4-week follow-up. Furthermore, reductions in psychotic, anxiety, and depressive symptoms were found (r=0.30-0.65). Conclusions: Our findings provide evidence on the feasibility and safety of the EMIcompass intervention for help-seeking youth and lend initial support to beneficial effects on stress sensitivity and mental health outcomes. An exploratory randomized controlled trial is warranted to establish the feasibility and preliminary evidence of its efficacy. UR - https://mental.jmir.org/2021/8/e25650 UR - http://dx.doi.org/10.2196/25650 UR - http://www.ncbi.nlm.nih.gov/pubmed/34383687 ID - info:doi/10.2196/25650 ER - TY - JOUR AU - Niculescu, Iulia AU - Quirt, Hannah AU - Arora, Twinkle AU - Borsook, Terry AU - Green, Robin AU - Ford, Brett AU - Iaboni, Andrea PY - 2021/8/4 TI - Ecological Momentary Assessment of Depression in People With Advanced Dementia: Longitudinal Pilot Study JO - JMIR Aging SP - e29021 VL - 4 IS - 3 KW - dementia KW - depression KW - ecological momentary assessment KW - tool performance N2 - Background: Barriers to assessing depression in advanced dementia include the presence of informant and patient recall biases. Ecological momentary assessment provides an improved approach for mood assessment by collecting observations in intervals throughout the day, decreasing recall bias, and increasing ecological validity. Objective: This study aims to evaluate the feasibility, reliability, and validity of the modified 4-item Cornell Scale for Depression in Dementia for Momentary Assessment (mCSDD4-MA) tool to assess depression in patients with advanced dementia. Methods: A intensive longitudinal pilot study design was used. A total of 12 participants with advanced dementia were enrolled from an inpatient psychogeriatric unit. Participants were assessed using clinical depression assessments at admission and discharge. Research staff recorded observations four times a day for 6 weeks on phones with access to the mCSDD4-MA tool. Descriptive data related to feasibility were reported (ie, completion rates). Statistical models were used to examine the interrater reliability and construct and predictive validity of the data. Results: Overall, 1923 observations were completed, representing 55.06% (1923/3496) of all rating opportunities with 2 raters and 66.01% (1923/2913) with at least one rater. Moderate interrater reliability was demonstrated for all items, except for lack of interest. Moderate correlations were observed between observers and patient-reported outcomes, where observers reported fewer symptoms relative to participants? self-reports. Several items were associated with and able to predict depression. Conclusions: The mCSDD4-MA tool was feasible to use, and most items in the tool showed moderate reliability and validity for assessing depression in dementia. Repeated and real-time depression assessment in advanced dementia holds promise for the identification of clinical depression and depressive symptoms. UR - https://aging.jmir.org/2021/3/e29021 UR - http://dx.doi.org/10.2196/29021 UR - http://www.ncbi.nlm.nih.gov/pubmed/34346884 ID - info:doi/10.2196/29021 ER - TY - JOUR AU - Clark, Viktor AU - Kim, Jung Sunny PY - 2021/8/3 TI - Ecological Momentary Assessment and mHealth Interventions Among Men Who Have Sex With Men: Scoping Review JO - J Med Internet Res SP - e27751 VL - 23 IS - 8 KW - mHealth KW - men who have sex with men KW - mobile health KW - interventions KW - mental health KW - sexual health KW - ecological momentary assessment KW - behavior N2 - Background: Ecological momentary assessment (EMA) is a research design that allows for the measurement of nearly instantaneous experiences within the participant?s natural environment. Using EMA can help improve recall bias, ecological validity, and patient engagement while enhancing personalization and the ubiquity of interventions. People that can benefit from the use of EMA are men who have sex with men (MSM). Previous EMA studies have been successful in capturing patterns of depression, anxiety, substance use, and risky sexual behavior. These findings are directly relevant to MSM, who have high rates of each of these psychological and behavioral outcomes. Although there is a driving force behind the growing literature surrounding EMAs among MSM, no synthesizing reviews yet exist. Objective: The aims of this study were to (1) synthesize the literature across fields on how EMA methods have been used among MSM, (2) better understand the feasibility and acceptability of EMA interventions among MSM, and (3) inform designs for future research studies on best evidence-based practices for EMA interventions. Methods: Based on 4 library databases, we conducted a scoping review of EMAs used within interventions among MSM. The eligibility criteria included peer-reviewed studies conducted in the United States and the use of EMA methodology in an intervention for MSM. Modeling after the Centers for Disease Control and Prevention?s Compendium of Evidence-Based Interventions as the framework, we applied a typology that used 8 distinct review criteria, for example, sample size, design of the intervention, random assignment, design of the follow-up investigation, rate of retention, and rate of engagement. Results: Our results (k=15, N=952) indicated a range of sample sizes; the smallest sample size was 12, while the largest sample size was 120. Of the 15 studies, 7 (47%) focused on outcomes related to substance use or outcomes related to psychological experiences. Of the 15 studies, 5 (33%) implemented an EMA intervention across 30 days. Of the 15 studies, 2 studies (13%) used random assignment, and 2 studies (13%) had quasi-experimental designs. Of the 15 studies, 10 studies (67%) reported acceptable retention rates greater than 70%. The outcomes that had event-contingent prompts (ie, prompts after engaging in substance use) were not as effective in engaging participants, with overall engagement rates as low as 37%. Conclusions: Our systematic scoping review indicates strong evidence that the EMA methodology is both feasible and acceptable at high rates among MSM, especially, when examining psychological and behavioral outcomes such as negative or positive affect, risky sexual behavior, or substance use. Further research on optimal designs of EMA interventions for MSM is warranted. UR - https://www.jmir.org/2021/8/e27751 UR - http://dx.doi.org/10.2196/27751 UR - http://www.ncbi.nlm.nih.gov/pubmed/34342585 ID - info:doi/10.2196/27751 ER - TY - JOUR AU - Lopez-Morinigo, Javier-David AU - Barrigón, Luisa María AU - Porras-Segovia, Alejandro AU - Ruiz-Ruano, González Verónica AU - Escribano Martínez, Sánchez Adela AU - Escobedo-Aedo, Jhoana Paula AU - Sánchez Alonso, Sergio AU - Mata Iturralde, Laura AU - Muñoz Lorenzo, Laura AU - Artés-Rodríguez, Antonio AU - David, S. Anthony AU - Baca-García, Enrique PY - 2021/7/26 TI - Use of Ecological Momentary Assessment Through a Passive Smartphone-Based App (eB2) by Patients With Schizophrenia: Acceptability Study JO - J Med Internet Res SP - e26548 VL - 23 IS - 7 KW - ecological momentary assessment KW - acceptability KW - schizophrenia spectrum disorders KW - eB2 KW - digital tools KW - mental health KW - schizophrenia KW - real-time data KW - patients KW - digital health KW - internet KW - mobile apps N2 - Background: Ecological momentary assessment (EMA) tools appear to be useful interventions for collecting real-time data on patients? behavior and functioning. However, concerns have been voiced regarding the acceptability of EMA among patients with schizophrenia and the factors influencing EMA acceptability. Objective: The aim of this study was to investigate the acceptability of a passive smartphone-based EMA app, evidence-based behavior (eB2), among patients with schizophrenia spectrum disorders and the putative variables underlying their acceptance. Methods: The participants in this study were from an ongoing randomized controlled trial (RCT) of metacognitive training, consisting of outpatients with schizophrenia spectrum disorders (F20-29 of 10th revision of the International Statistical Classification of Diseases and Related Health Problems), aged 18-64 years, none of whom received any financial compensation. Those who consented to installation of the eB2 app (users) were compared with those who did not (nonusers) in sociodemographic, clinical, premorbid adjustment, neurocognitive, psychopathological, insight, and metacognitive variables. A multivariable binary logistic regression tested the influence of the above (independent) variables on ?being user versus nonuser? (acceptability), which was the main outcome measure. Results: Out of the 77 RCT participants, 24 (31%) consented to installing eB2, which remained installed till the end of the study (median follow-up 14.50 weeks) in 14 participants (70%). Users were younger and had a higher education level, better premorbid adjustment, better executive function (according to the Trail Making Test), and higher cognitive insight levels (measured with the Beck Cognitive Insight Scale) than nonusers (univariate analyses) although only age (OR 0.93, 95% CI 0.86-0.99; P=.048) and early adolescence premorbid adjustment (OR 0.75, 95% CI 0.61-0.93; P=.01) survived the multivariable regression model, thus predicting eB2 acceptability. Conclusions: Acceptability of a passive smartphone-based EMA app among participants with schizophrenia spectrum disorders in this RCT where no participant received financial compensation was, as expected, relatively low, and linked with being young and good premorbid adjustment. Further research should examine how to increase EMA acceptability in patients with schizophrenia spectrum disorders, in particular, older participants and those with poor premorbid adjustment. Trial Registration: ClinicalTrials.gov NCT04104347; https://clinicaltrials.gov/ct2/show/NCT04104347 UR - https://www.jmir.org/2021/7/e26548 UR - http://dx.doi.org/10.2196/26548 UR - http://www.ncbi.nlm.nih.gov/pubmed/34309576 ID - info:doi/10.2196/26548 ER - TY - JOUR AU - Woolf, B. Thomas AU - Goheer, Attia AU - Holzhauer, Katherine AU - Martinez, Jonathan AU - Coughlin, W. Janelle AU - Martin, Lindsay AU - Zhao, Di AU - Song, Shanshan AU - Ahmad, Yanif AU - Sokolinskyi, Kostiantyn AU - Remayeva, Tetyana AU - Clark, M. Jeanne AU - Bennett, Wendy AU - Lehmann, Harold PY - 2021/7/23 TI - Development of a Mobile App for Ecological Momentary Assessment of Circadian Data: Design Considerations and Usability Testing JO - JMIR Form Res SP - e26297 VL - 5 IS - 7 KW - mhealth KW - circadian KW - sleep KW - ecological momentary assessment KW - timing of eating KW - mobile applications KW - habits KW - body weight KW - surveys and questionnaires N2 - Background: Collecting data on daily habits across a population of individuals is challenging. Mobile-based circadian ecological momentary assessment (cEMA) is a powerful frame for observing the impact of daily living on long-term health. Objective: In this paper, we (1) describe the design, testing, and rationale for specifications of a mobile-based cEMA app to collect timing of eating and sleeping data and (2) compare cEMA and survey data collected as part of a 6-month observational cohort study. The ultimate goal of this paper is to summarize our experience and lessons learned with the Daily24 mobile app and to highlight the pros and cons of this data collection modality. Methods: Design specifications for the Daily24 app were drafted by the study team based on the research questions and target audience for the cohort study. The associated backend was optimized to provide real-time data to the study team for participant monitoring and engagement. An external 8-member advisory board was consulted throughout the development process, and additional test users recruited as part of a qualitative study provided feedback through in-depth interviews. Results: After ?4 days of at-home use, 37 qualitative study participants provided feedback on the app. The app generally received positive feedback from test users for being fast and easy to use. Test users identified several bugs and areas where modifications were necessary to in-app text and instructions and also provided feedback on the engagement strategy. Data collected through the mobile app captured more variability in eating windows than data collected through a one-time survey, though at a significant cost. Conclusions: Researchers should consider the potential uses of a mobile app beyond the initial data collection when deciding whether the time and monetary expenditure are advisable for their situation and goals. UR - https://formative.jmir.org/2021/7/e26297 UR - http://dx.doi.org/10.2196/26297 UR - http://www.ncbi.nlm.nih.gov/pubmed/34296999 ID - info:doi/10.2196/26297 ER - TY - JOUR AU - Tamura, Kosuke AU - Curlin, Kaveri AU - Neally, J. Sam AU - Vijayakumar, P. Nithya AU - Mitchell, M. Valerie AU - Collins, S. Billy AU - Gutierrez-Huerta, Cristhian AU - Troendle, F. James AU - Baumer, Yvonne AU - Osei Baah, Foster AU - Turner, S. Briana AU - Gray, Veronica AU - Tirado, A. Brian AU - Ortiz-Chaparro, Erika AU - Berrigan, David AU - Mehta, N. Nehal AU - Vaccarino, Viola AU - Zenk, N. Shannon AU - Powell-Wiley, M. Tiffany PY - 2021/7/22 TI - Geospatial Analysis of Neighborhood Environmental Stress in Relation to Biological Markers of Cardiovascular Health and Health Behaviors in Women: Protocol for a Pilot Study JO - JMIR Res Protoc SP - e29191 VL - 10 IS - 7 KW - wearables KW - global positioning system KW - ecological momentary assessment KW - accelerometer KW - biomarkers of stress KW - mobile phone N2 - Background: Innovative analyses of cardiovascular (CV) risk markers and health behaviors linked to neighborhood stressors are essential to further elucidate the mechanisms by which adverse neighborhood social conditions lead to poor CV outcomes. We propose to objectively measure physical activity (PA), sedentary behavior, and neighborhood stress using accelerometers, GPS, and real-time perceived ecological momentary assessment via smartphone apps and to link these to biological measures in a sample of White and African American women in Washington, DC, neighborhoods. Objective: The primary aim of this study is to test the hypothesis that living in adverse neighborhood social conditions is associated with higher stress-related neural activity among 60 healthy women living in high or low socioeconomic status neighborhoods in Washington, DC. Sub-aim 1 of this study is to test the hypothesis that the association is moderated by objectively measured PA using an accelerometer. A secondary objective is to test the hypothesis that residing in adverse neighborhood social environment conditions is related to differences in vascular function. Sub-aim 2 of this study is to test the hypothesis that the association is moderated by objectively measured PA. The third aim of this study is to test the hypothesis that adverse neighborhood social environment conditions are related to differences in immune system activation. Methods: The proposed study will be cross-sectional, with a sample of at least 60 women (30 healthy White women and 30 healthy Black women) from Wards 3 and 5 in Washington, DC. A sample of the women (n=30) will be recruited from high-income areas in Ward 3 from census tracts within a 15% of Ward 3?s range for median household income. The other participants (n=30) will be recruited from low-income areas in Wards 5 from census tracts within a 15% of Ward 5?s range for median household income. Finally, participants from Wards 3 and 5 will be matched based on age, race, and BMI. Participants will wear a GPS unit and accelerometer and report their stress and mood in real time using a smartphone. We will then examine the associations between GPS-derived neighborhood variables, stress-related neural activity measures, and adverse biological markers. Results: The National Institutes of Health Institutional Review Board has approved this study. Recruitment will begin in the summer of 2021. Conclusions: Findings from this research could inform the development of multilevel behavioral interventions and policies to better manage environmental factors that promote immune system activation or psychosocial stress while concurrently working to increase PA, thereby influencing CV health. International Registered Report Identifier (IRRID): PRR1-10.2196/29191 UR - https://www.researchprotocols.org/2021/7/e29191 UR - http://dx.doi.org/10.2196/29191 UR - http://www.ncbi.nlm.nih.gov/pubmed/34292168 ID - info:doi/10.2196/29191 ER - TY - JOUR AU - Beres, K. Laura AU - Mbabali, Ismail AU - Anok, Aggrey AU - Katabalwa, Charles AU - Mulamba, Jeremiah AU - Thomas, G. Alvin AU - Bugos, Eva AU - Nakigozi, Gertrude AU - Grabowski, K. Mary AU - Chang, W. Larry PY - 2021/7/20 TI - Mobile Ecological Momentary Assessment and Intervention and Health Behavior Change Among Adults in Rakai, Uganda: Pilot Randomized Controlled Trial JO - JMIR Form Res SP - e22693 VL - 5 IS - 7 KW - ecological momentary assessment KW - ecological momentary intervention KW - mHealth KW - digital health KW - smartphone KW - mobile phone KW - randomized trial KW - Uganda KW - Africa N2 - Background: An extraordinary increase in mobile phone ownership has revolutionized the opportunities to use mobile health approaches in lower- and middle-income countries (LMICs). Ecological momentary assessment and intervention (EMAI) uses mobile technology to gather data and deliver timely, personalized behavior change interventions in an individual?s natural setting. To our knowledge, there have been no previous trials of EMAI in sub-Saharan Africa. Objective: To advance the evidence base for mobile health (mHealth) interventions in LMICs, we conduct a pilot randomized trial to assess the feasibility of EMAI and establish estimates of the potential effect of EMAI on a range of health-related behaviors in Rakai, Uganda. Methods: This prospective, parallel-group, randomized pilot trial compared health behaviors between adult participants submitting ecological momentary assessment (EMA) data and receiving behaviorally responsive interventional health messaging (EMAI) with those submitting EMA data alone. Using a fully automated mobile phone app, participants submitted daily reports on 5 different health behaviors (fruit consumption, vegetable consumption, alcohol intake, cigarette smoking, and condomless sex with a non?long-term partner) during a 30-day period before randomization (P1). Participants were then block randomized to the control arm, continuing EMA reporting through exit, or the intervention arm, EMA reporting and behavioral health messaging receipt. Participants exited after 90 days of follow-up, divided into study periods 2 (P2: randomization + 29 days) and 3 (P3: 30 days postrandomization to exit). We used descriptive statistics to assess the feasibility of EMAI through the completeness of data and differences in reported behaviors between periods and study arms. Results: The study included 48 participants (24 per arm; 23/48, 48% women; median age 31 years). EMA data collection was feasible, with 85.5% (3777/4418) of the combined days reporting behavioral data. There was a decrease in the mean proportion of days when alcohol was consumed in both arms over time (control: P1, 9.6% of days to P2, 4.3% of days; intervention: P1, 7.2% of days to P3, 2.4% of days). Decreases in sex with a non?long-term partner without a condom were also reported in both arms (P1 to P3 control: 1.9% of days to 1% of days; intervention: 6.6% of days to 1.3% of days). An increase in vegetable consumption was found in the intervention (vegetable: 65.6% of days to 76.6% of days) but not in the control arm. Between arms, there was a significant difference in the change in reported vegetable consumption between P1 and P3 (control: 8% decrease in the mean proportion of days vegetables consumed; intervention: 11.1% increase; P=.01). Conclusions: Preliminary estimates suggest that EMAI may be a promising strategy for promoting behavior change across a range of behaviors. Larger trials examining the effectiveness of EMAI in LMICs are warranted. Trial Registration: ClinicalTrials.gov NCT04375423; https://www.clinicaltrials.gov/ct2/show/NCT04375423 UR - https://formative.jmir.org/2021/7/e22693 UR - http://dx.doi.org/10.2196/22693 UR - http://www.ncbi.nlm.nih.gov/pubmed/34283027 ID - info:doi/10.2196/22693 ER - TY - JOUR AU - Miguel, Andre AU - Smith, Crystal AU - Perea, Nicole AU - Johnson, Kim AU - McDonell, Michael AU - McPherson, Sterling PY - 2021/7/19 TI - Development of Automated Reinforcement Management System (ARMS): Protocol for a Phase I Feasibility and Usability Study JO - JMIR Form Res SP - e25796 VL - 5 IS - 7 KW - alcohol use disorder KW - contingency management KW - ecological momentary assessment KW - treatment N2 - Background: Alcohol use is directly related to over 3 million deaths worldwide every year. Contingency management is a cost-effective treatment for substance use disorders; however, few studies have examined its efficacy for alcohol use disorder. Recent technological advances have enabled the combined use of mobile apps and low-cost electronic breathalyzer devices to remotely monitor alcohol use. Leveraging this type of technology, our study group has recently developed an integrated contingency management system that would enable community treatment programs to remotely deliver contingency management to anyone who owns a smartphone. Objective: In this paper, we present a full description of our integrated contingency management system, Automated Reinforcement Management System (ARMS), and describe a protocol that will evaluate its feasibility and usability. Methods: Initially, 6 clinicians will participate in a 1-hour focus group where the study staff will navigate through ARMS as it would be used by clinicians and patients. Clinicians will provide feedback on the intervention in general, which will be used to modify ARMS to make it more user friendly, time saving, and relevant to treatment. A second focus group will summarize the changes made following the initial clinician feedback and will provide additional input regarding the potential utilization of ARMS. Thereafter, the clinicians? acceptability of ARMS will be evaluated using the System Usability Scale. Following the clinicians? assessments of ARMS and final modifications, the system will be evaluated in terms of feasibility and patient usability by using an A-B-A within-subject experimental design wherein 20 treatment-seeking individuals with alcohol use disorder will be recruited. The two A phases (control conditions) will each last 2 weeks, and the B phase (contingency management condition) will last 4 weeks. During all phases, participants will be asked to use the ARMS app to submit three breathalyzer samples per day (at 10 AM, 2 PM, and 8 PM). Participants will be prompted by the ARMS app at these predetermined times to record and submit their breathalyzer samples. During the A phases, participants will earn vouchers for every breathalyzer sample submitted, independent of their sample results. During the B phase, vouchers will be provided contingent upon the submission of alcohol-negative breathalyzer samples (breath alcohol content = 0.00). At the end of the A-B-A experiment trial, patients? usability of the ARMS app will be evaluated using the System Usability Scale. Feasibility will be measured based on whether the ARMS app helped significantly increase alcohol abstinence. Results: Recruitment for this study began in January 2021 and is expected to be completed by December 2021. Conclusions: This study will provide the baseline capability for the implementation of a remotely monitored contingency management platform. If successful, ARMS has the potential to provide effective treatment for alcohol use disorders to individuals living in remote rural areas. UR - https://formative.jmir.org/2021/7/e25796 UR - http://dx.doi.org/10.2196/25796 UR - http://www.ncbi.nlm.nih.gov/pubmed/34279238 ID - info:doi/10.2196/25796 ER - TY - JOUR AU - Rouzaud Laborde, Charlotte AU - Cenko, Erta AU - Mardini, T. Mamoun AU - Nerella, Subhash AU - Kheirkhahan, Matin AU - Ranka, Sanjay AU - Fillingim, B. Roger AU - Corbett, B. Duane AU - Weber, Eric AU - Rashidi, Parisa AU - Manini, Todd PY - 2021/7/14 TI - Satisfaction, Usability, and Compliance With the Use of Smartwatches for Ecological Momentary Assessment of Knee Osteoarthritis Symptoms in Older Adults: Usability Study JO - JMIR Aging SP - e24553 VL - 4 IS - 3 KW - ehealth KW - mobile health KW - ecological momentary assessment KW - real-time online assessment and mobility monitor KW - ROAMM KW - older adults KW - compliance KW - personal satisfaction KW - usability KW - smartwatch KW - knee osteoarthritis KW - pain KW - fatigue KW - wearable electronic device KW - mobile application N2 - Background: Smartwatches enable physicians to monitor symptoms in patients with knee osteoarthritis, their behavior, and their environment. Older adults experience fluctuations in their pain and related symptoms (mood, fatigue, and sleep quality) that smartwatches are ideally suited to capture remotely in a convenient manner. Objective: The aim of this study was to evaluate satisfaction, usability, and compliance using the real-time, online assessment and mobility monitoring (ROAMM) mobile app designed for smartwatches for individuals with knee osteoarthritis. Methods: Participants (N=28; mean age 73.2, SD 5.5 years; 70% female) with reported knee osteoarthritis were asked to wear a smartwatch with the ROAMM app installed. They were prompted to report their prior night?s sleep quality in the morning, followed by ecological momentary assessments (EMAs) of their pain, fatigue, mood, and activity in the morning, afternoon, and evening. Satisfaction, comfort, and usability were evaluated using a standardized questionnaire. Compliance with regard to answering EMAs was calculated after excluding time when the watch was not being worn for technical reasons (eg, while charging). Results: A majority of participants reported that the text displayed was large enough to read (22/26, 85%), and all participants found it easy to enter ratings using the smartwatch. Approximately half of the participants found the smartwatch to be comfortable (14/26, 54%) and would consider wearing it as their personal watch (11/24, 46%). Most participants were satisfied with its battery charging system (20/26, 77%). A majority of participants (19/26, 73%) expressed their willingness to use the ROAMM app for a 1-year research study. The overall EMA compliance rate was 83% (2505/3036 responses). The compliance rate was lower among those not regularly wearing a wristwatch (10/26, 88% vs 16/26, 71%) and among those who found the text too small to read (4/26, 86% vs 22/26, 60%). Conclusions: Older adults with knee osteoarthritis positively rated the ROAMM smartwatch app and were generally satisfied with the device. The high compliance rates coupled with the willingness to participate in a long-term study suggest that the ROAMM app is a viable approach to remotely collecting health symptoms and behaviors for both research and clinical endeavors. UR - https://aging.jmir.org/2021/3/e24553 UR - http://dx.doi.org/10.2196/24553 UR - http://www.ncbi.nlm.nih.gov/pubmed/34259638 ID - info:doi/10.2196/24553 ER - TY - JOUR AU - Fulford, Daniel AU - Gard, E. David AU - Mueser, T. Kim AU - Mote, Jasmine AU - Gill, Kathryn AU - Leung, Lawrence AU - Mow, Jessica PY - 2021/6/15 TI - Preliminary Outcomes of an Ecological Momentary Intervention for Social Functioning in Schizophrenia: Pre-Post Study of the Motivation and Skills Support App JO - JMIR Ment Health SP - e27475 VL - 8 IS - 6 KW - schizophrenia KW - psychosis KW - social functioning KW - social skills KW - motivation KW - mHealth KW - smartphone KW - mobile phone N2 - Background: People with schizophrenia and other serious mental illnesses often lack access to evidence-based interventions, particularly interventions that target meaningful recovery outcomes such as social functioning and quality of life. Mobile technologies, including smartphone apps, have the potential to provide scalable support that places elements of evidence-based interventions at the palm of patients? hands. Objective: We aim to develop a smartphone app?called Motivation and Skills Support?to provide targeted social goal support (eg, making new friends and improving existing relationships) for people with schizophrenia enrolled in a stand-alone open trial. Methods: In this paper, we presented preliminary outcomes of 31 participants who used the Motivation and Skills Support app for 8 weeks, including social functioning pre- to postintervention, and momentary reports of treatment targets (eg, social motivation and appraisals) during the intervention. Results: The findings suggest that the intervention improved self-reported social functioning from baseline to treatment termination, particularly in female participants. Gains were not maintained at the 3-month follow-up. Furthermore, increased social functioning was predicted by momentary reports of social appraisals, including perceived social competence and the extent to which social interactions were worth the effort. Conclusions: The implications of these findings and future directions for addressing social functioning in schizophrenia using mobile technology have been discussed. Trial Registration: ClinicalTrials.gov NCT03404219; https://clinicaltrials.gov/ct2/show/NCT03404219 UR - https://mental.jmir.org/2021/6/e27475 UR - http://dx.doi.org/10.2196/27475 UR - http://www.ncbi.nlm.nih.gov/pubmed/34128812 ID - info:doi/10.2196/27475 ER - TY - JOUR AU - Mascheroni, Alessandro AU - Choe, Kyoung Eun AU - Luo, Yuhan AU - Marazza, Michele AU - Ferlito, Clara AU - Caverzasio, Serena AU - Mezzanotte, Francesco AU - Kaelin-Lang, Alain AU - Faraci, Francesca AU - Puiatti, Alessandro AU - Ratti, Luca Pietro PY - 2021/6/8 TI - The SleepFit Tablet Application for Home-Based Clinical Data Collection in Parkinson Disease: User-Centric Development and Usability Study JO - JMIR Mhealth Uhealth SP - e16304 VL - 9 IS - 6 KW - Parkinson disease KW - ecological momentary assessment KW - finger-tapping test KW - subjective scales KW - sleep diaries KW - tablet application KW - home-based system N2 - Background: Parkinson disease (PD) is a common, multifaceted neurodegenerative disorder profoundly impacting patients' autonomy and quality of life. Assessment in real-life conditions of subjective symptoms and objective metrics of mobility and nonmotor symptoms such as sleep disturbance is strongly advocated. This information would critically guide the adaptation of antiparkinsonian medications and nonpharmacological interventions. Moreover, since the spread of the COVID-19 pandemic, health care practices are being reshaped toward a more home-based care. New technologies could play a pivotal role in this new approach to clinical care. Nevertheless, devices and information technology tools might be unhandy for PD patients, thus dramatically limiting their widespread employment. Objective: The goals of the research were development and usability evaluation of an application, SleepFit, for ecological momentary assessment of objective and subjective clinical metrics at PD patients? homes, and as a remote tool for researchers to monitor patients and integrate and manage data. Methods: An iterative and user-centric strategy was employed for the development of SleepFit. The core structure of SleepFit consists of (1) an electronic finger-tapping test; (2) motor, sleepiness, and emotional subjective scales; and (3) a sleep diary. Applicable design, ergonomic, and navigation principles have been applied while tailoring the application to the specific patient population. Three progressively enhanced versions of the application (alpha, v1.0, v2.0) were tested by a total of 56 patients with PD who were asked to perform multiple home assessments 4 times per day for 2 weeks. Patient compliance was calculated as the proportion of completed tasks out of the total number of expected tasks. Satisfaction on the latest version (v2.0) was evaluated as potential willingness to use SleepFit again after the end of the study. Results: From alpha to v1.0, SleepFit was improved in graphics, ergonomics, and navigation, with automated flows guiding the patients in performing tasks throughout the 24 hours, and real-time data collection and consultation were made possible thanks to a remote web portal. In v2.0, the kiosk-mode feature restricts the use of the tablet to the SleepFit application only, thus preventing users from accidentally exiting the application. A total of 52 (4 dropouts) patients were included in the analyses. Overall compliance (all versions) was 88.89% (5707/6420). SleepFit was progressively enhanced and compliance increased from 87.86% (2070/2356) to 89.92% (2899/3224; P=.04). Among the patients who used v2.0, 96% (25/26) declared they would use SleepFit again. Conclusions: SleepFit can be considered a state-of-the-art home-based system that increases compliance in PD patients, ensures high-quality data collection, and works as a handy tool for remote monitoring and data management in clinical research. Thanks to its user-friendliness and modular structure, it could be employed in other clinical studies with minimum adaptation efforts. Trial Registration: ClinicalTrials.gov NCT02723396; https://clinicaltrials.gov/ct2/show/NCT02723396 UR - https://mhealth.jmir.org/2021/6/e16304 UR - http://dx.doi.org/10.2196/16304 UR - http://www.ncbi.nlm.nih.gov/pubmed/34100767 ID - info:doi/10.2196/16304 ER - TY - JOUR AU - Nam, Soohyun AU - Jeon, Sangchoon AU - Ash, Garrett AU - Whittemore, Robin AU - Vlahov, David PY - 2021/6/7 TI - Racial Discrimination, Sedentary Time, and Physical Activity in African Americans: Quantitative Study Combining Ecological Momentary Assessment and Accelerometers JO - JMIR Form Res SP - e25687 VL - 5 IS - 6 KW - racial discrimination KW - physical activity KW - ecological momentary assessment KW - African American KW - pilot study KW - mobile phone N2 - Background: A growing number of studies indicate that exposure to social stress, such as perceived racial discrimination, may contribute to poor health, health behaviors, and health disparities. Increased physical activity (PA) may buffer the impact of social stress resulting from racial discrimination. However, to date, data on the relationship between racial discrimination and PA have been mixed. Part of the reason is that the effect of perceived racial discrimination on PA has primarily been examined in cross-sectional studies that captured retrospective measures of perceived racial discrimination associated with individuals? current PA outcomes. The association between real-time perceived racial discrimination and PA among African Americans remains unclear. Objective: The purpose of this study is to examine the relationship among demographic, anthropometric and clinical, and psychological factors with lifetime racial discrimination and examine the within- and between-person associations between daily real-time racial discrimination and PA outcomes (total energy expenditure, sedentary time, and moderate-to-vigorous PA patterns) measured by ecological momentary assessment (EMA) and accelerometers in healthy African Americans. Methods: This pilot study used an intensive, observational, case-crossover design of African Americans (n=12) recruited from the community. After participants completed baseline surveys, they were asked to wear an accelerometer for 7 days to measure their PA levels. EMA was sent to participants 5 times per day for 7 days to assess daily real-time racial discrimination. Multilevel models were used to examine the within- and between-person associations of daily racial discrimination on PA. Results: More EMA-reported daily racial discrimination was associated with younger age (r=0.75; P=.02). Daily EMA-reported microaggression was associated with depressive symptoms (r=0.66; P=.05), past race-related events (r=0.82; P=.004), and lifetime discrimination (r=0.78; P=.01). In the within-person analyses, the day-level association of racial discrimination and sedentary time was significant (?=.30, SE 0.14; P=.03), indicating that on occasions when participants reported more racial discrimination than usual, more sedentary time was observed. Between-person associations of racial discrimination (?=?.30, SE 0.28; P=.29) or microaggression (?=?.34, SE 0.36; P=.34) with total energy expenditure were suggestive but inconclusive. Conclusions: Concurrent use of EMA and accelerometers is a feasible method to examine the relationship between racial discrimination and PA in real time. Examining daily processes at the within-person level has the potential to elucidate the mechanisms of which racial discrimination may have on health and health behaviors and to guide the development of personalized interventions for increasing PA in racial ethnic minorities. Future studies with a precision health approach, incorporating within- and between-person associations, are warranted to further elucidate the effects of racial discrimination and PA. International Registered Report Identifier (IRRID): RR2-10.1002/nur.22068 UR - https://formative.jmir.org/2021/6/e25687 UR - http://dx.doi.org/10.2196/25687 UR - http://www.ncbi.nlm.nih.gov/pubmed/34096870 ID - info:doi/10.2196/25687 ER - TY - JOUR AU - Mack, L. Dante AU - DaSilva, W. Alex AU - Rogers, Courtney AU - Hedlund, Elin AU - Murphy, I. Eilis AU - Vojdanovski, Vlado AU - Plomp, Jane AU - Wang, Weichen AU - Nepal, K. Subigya AU - Holtzheimer, E. Paul AU - Wagner, D. Dylan AU - Jacobson, C. Nicholas AU - Meyer, L. Meghan AU - Campbell, T. Andrew AU - Huckins, F. Jeremy PY - 2021/6/4 TI - Mental Health and Behavior of College Students During the COVID-19 Pandemic: Longitudinal Mobile Smartphone and Ecological Momentary Assessment Study, Part II JO - J Med Internet Res SP - e28892 VL - 23 IS - 6 KW - anxiety KW - college KW - COVID-19 KW - COVID fatigue KW - depression KW - George Floyd KW - mobile sensing KW - phone usage KW - sleep KW - digital phenotyping N2 - Background: Since late 2019, the lives of people across the globe have been disrupted by COVID-19. Millions of people have become infected with the disease, while billions of people have been continually asked or required by local and national governments to change their behavioral patterns. Previous research on the COVID-19 pandemic suggests that it is associated with large-scale behavioral and mental health changes; however, few studies have been able to track these changes with frequent, near real-time sampling or compare these changes to previous years of data for the same individuals. Objective: By combining mobile phone sensing and self-reported mental health data in a cohort of college-aged students enrolled in a longitudinal study, we seek to understand the behavioral and mental health impacts associated with the COVID-19 pandemic, measured by interest across the United States in the search terms coronavirus and COVID fatigue. Methods: Behaviors such as the number of locations visited, distance traveled, duration of phone use, number of phone unlocks, sleep duration, and sedentary time were measured using the StudentLife mobile smartphone sensing app. Depression and anxiety were assessed using weekly self-reported ecological momentary assessments, including the Patient Health Questionnaire-4. The participants were 217 undergraduate students. Differences in behaviors and self-reported mental health collected during the Spring 2020 term, as compared to previous terms in the same cohort, were modeled using mixed linear models. Results: Linear mixed models demonstrated differences in phone use, sleep, sedentary time and number of locations visited associated with the COVID-19 pandemic. In further models, these behaviors were strongly associated with increased interest in COVID fatigue. When mental health metrics (eg, depression and anxiety) were added to the previous measures (week of term, number of locations visited, phone use, sedentary time), both anxiety and depression (P<.001) were significantly associated with interest in COVID fatigue. Notably, these behavioral and mental health changes are consistent with those observed around the initial implementation of COVID-19 lockdowns in the spring of 2020. Conclusions: In the initial lockdown phase of the COVID-19 pandemic, people spent more time on their phones, were more sedentary, visited fewer locations, and exhibited increased symptoms of anxiety and depression. As the pandemic persisted through the spring, people continued to exhibit very similar changes in both mental health and behaviors. Although these large-scale shifts in mental health and behaviors are unsurprising, understanding them is critical in disrupting the negative consequences to mental health during the ongoing pandemic. UR - https://www.jmir.org/2021/6/e28892 UR - http://dx.doi.org/10.2196/28892 UR - http://www.ncbi.nlm.nih.gov/pubmed/33900935 ID - info:doi/10.2196/28892 ER - TY - JOUR AU - Ray, Katherine Mary AU - McMichael, Alana AU - Rivera-Santana, Maria AU - Noel, Jacob AU - Hershey, Tamara PY - 2021/6/3 TI - Technological Ecological Momentary Assessment Tools to Study Type 1 Diabetes in Youth: Viewpoint of Methodologies JO - JMIR Diabetes SP - e27027 VL - 6 IS - 2 KW - ecological momentary assessment KW - continuous glucose monitoring KW - actigraphy KW - accelerometer KW - ambulatory blood pressure monitoring KW - personal digital assistant KW - mobile phone KW - smartphone KW - mHealth UR - https://diabetes.jmir.org/2021/2/e27027 UR - http://dx.doi.org/10.2196/27027 UR - http://www.ncbi.nlm.nih.gov/pubmed/34081017 ID - info:doi/10.2196/27027 ER - TY - JOUR AU - Daniëls, M. Naomi E. AU - Hochstenbach, J. Laura M. AU - van Zelst, Catherine AU - van Bokhoven, A. Marloes AU - Delespaul, G. Philippe A. E. AU - Beurskens, M. Anna J. H. PY - 2021/6/1 TI - Factors That Influence the Use of Electronic Diaries in Health Care: Scoping Review JO - JMIR Mhealth Uhealth SP - e19536 VL - 9 IS - 6 KW - compliance KW - delivery of health care KW - diary KW - ecological momentary assessment KW - intention KW - motivation KW - scoping review N2 - Background: A large number of people suffer from psychosocial or physical problems. Adequate strategies to alleviate needs are scarce or lacking. Symptom variation can offer insights into personal profiles of coping and resilience (detailed functional analyses). Hence, diaries are used to report mood and behavior occurring in daily life. To reduce inaccuracies, biases, and noncompliance with paper diaries, a shift to electronic diaries has occurred. Although these diaries are increasingly used in health care, information is lacking about what determines their use. Objective: The aim of this study was to map the existing empirical knowledge and gaps concerning factors that influence the use of electronic diaries, defined as repeated recording of psychosocial or physical data lasting at least one week using a smartphone or a computer, in health care. Methods: A scoping review of the literature published between January 2000 and December 2018 was conducted using queries in PubMed and PsycInfo databases. English or Dutch publications based on empirical data about factors that influence the use of electronic diaries for psychosocial or physical purposes in health care were included. Both databases were screened, and findings were summarized using a directed content analysis organized by the Consolidated Framework for Implementation Research (CFIR). Results: Out of 3170 articles, 22 studies were selected for qualitative synthesis. Eleven themes were determined in the CFIR categories of intervention, user characteristics, and process. No information was found for the CFIR categories inner (eg, organizational resources, innovation climate) and outer (eg, external policies and incentives, pressure from competitors) settings. Reminders, attractive designs, tailored and clear data visualizations (intervention), smartphone experience, and intrinsic motivation to change behavior (user characteristics) could influence the use of electronic diaries. During the implementation process, attention should be paid to both theoretical and practical training. Conclusions: Design aspects, user characteristics, and training and instructions determine the use of electronic diaries in health care. It is remarkable that there were no empirical data about factors related to embedding electronic diaries in daily clinical practice. More research is needed to better understand influencing factors for optimal electronic diary use. UR - https://mhealth.jmir.org/2021/6/e19536 UR - http://dx.doi.org/10.2196/19536 UR - http://www.ncbi.nlm.nih.gov/pubmed/34061036 ID - info:doi/10.2196/19536 ER - TY - JOUR AU - Wen, Fred Cheng K. AU - Junghaenel, U. Doerte AU - Newman, B. David AU - Schneider, Stefan AU - Mendez, Marilyn AU - Goldstein, E. Sarah AU - Velasco, Sarah AU - Smyth, M. Joshua AU - Stone, A. Arthur PY - 2021/5/26 TI - The Effect of Training on Participant Adherence With a Reporting Time Frame for Momentary Subjective Experiences in Ecological Momentary Assessment: Cognitive Interview Study JO - JMIR Form Res SP - e28007 VL - 5 IS - 5 KW - ecological momentary assessment KW - EMA KW - cognitive interview KW - participant training KW - reporting period N2 - Background: Ecological momentary assessment (EMA) has the potential to minimize recall bias by having people report on their experiences in the moment (momentary model) or over short periods (coverage model). This potential hinges on the assumption that participants provide their ratings based on the reporting time frame instructions prescribed in the EMA items. However, it is unclear what time frames participants actually use when answering the EMA questions and whether participant training improves participants? adherence to the reporting instructions. Objective: This study aims to investigate the reporting time frames participants used when answering EMA questions and whether participant training improves participants? adherence to the EMA reporting timeframe instructions. Methods: Telephone-based cognitive interviews were used to investigate the research questions. In a 2×2 factorial design, participants (n=100) were assigned to receive either basic or enhanced EMA training and randomized to rate their experiences using a momentary (at the moment you were called) or a coverage (since the last phone call) model. Participants received five calls over the course of a day to provide ratings; after each rating, participants were immediately interviewed about the time frame they used to answer the EMA questions. A total of 2 raters independently coded the momentary interview responses into time frame categories (Cohen ?=0.64, 95% CI 0.55-0.73). Results: The results from the momentary conditions showed that most of the calls referred to the period during the call (57/199, 28.6%) or just before the call (98/199, 49.2%) to provide ratings; the remainder were from longer reporting periods. Multinomial logistic regression results indicated a significant training effect (?21=16.6; P<.001) in which the enhanced training condition yielded more reports within the intended reporting time frames for momentary EMA reports. Cognitive interview data from the coverage model did not lend themselves to reliable coding and were not analyzed. Conclusions: The results of this study provide the first evidence about adherence to EMA instructions to reporting periods and that enhanced participant training improves adherence to the time frame specified in momentary EMA studies. UR - https://formative.jmir.org/2021/5/e28007 UR - http://dx.doi.org/10.2196/28007 UR - http://www.ncbi.nlm.nih.gov/pubmed/34037524 ID - info:doi/10.2196/28007 ER - TY - JOUR AU - Santa Maria, Diane AU - Lightfoot, Marguerita AU - Nyamathi, Adey AU - Businelle, Michael AU - Paul, Mary AU - Quadri, Yasmeen AU - Padhye, Nikhil AU - Jones, Jennifer AU - Calvo Armijo, Margarita PY - 2021/5/21 TI - A Nurse Case Management HIV Prevention Intervention (Come As You Are) for Youth Experiencing Homelessness: Protocol for a Randomized Wait-list Controlled Trial JO - JMIR Res Protoc SP - e26716 VL - 10 IS - 5 KW - HIV prevention KW - nurse case management KW - motivational interviewing KW - homelessness KW - youth KW - just-in-time-adaptive intervention KW - ecological momentary assessment N2 - Background: Youth experiencing homelessness are more likely than housed youth to experience premature death, suicide, drug overdose, pregnancy, substance use, and mental illness. Yet while youth experiencing homelessness are 6 to 12 times more likely to become infected with HIV than housed youth, with HIV prevalence as high as 16%, many do not access the prevention services they need. Despite adversities, youth experiencing homelessness are interested in health promotion programs, can be recruited and retained in interventions and research studies, and demonstrate improved outcomes when programs are tailored and relevant to them. Objective: The study aims to compare the efficacy of a nurse case management HIV prevention and care intervention, titled Come As You Are, with that of usual care among youth experiencing homelessness aged 16 to 25 years. Methods: The study is designed as a 2-armed randomized wait-list controlled trial. Participants (n=450) will be recruited and followed up for 9 months after the intervention for a total study period of 12 months. Come As You Are combines nurse case management with a smartphone-based daily ecological momentary assessment to develop participant-driven HIV prevention behavioral goals that can be monitored in real-time. Youth in the city of Houston, Texas will be recruited from drop-in centers, shelters, street outreach programs, youth-serving organizations, and clinics. Results: Institutional review board approval (Committee for the Protection of Human Subjects, University of Texas Health Science Center at Houston) was obtained in November 2018. The first participant was enrolled in November 2019. Data collection is ongoing. To date, 123 participants have consented to participate in the study, 89 have been enrolled, and 15 have completed their final follow-up. Conclusions: There is a paucity of HIV prevention research regarding youth experiencing homelessness. Novel and scalable interventions that address the full continuum of behavioral and biomedical HIV prevention are needed. This study will determine whether a personalized and mobile HIV prevention approach can reduce HIV risk among a hard-to-reach, transient population of youth at high risk. International Registered Report Identifier (IRRID): DERR1-10.2196/26716 UR - https://www.researchprotocols.org/2021/5/e26716 UR - http://dx.doi.org/10.2196/26716 UR - http://www.ncbi.nlm.nih.gov/pubmed/34018967 ID - info:doi/10.2196/26716 ER - TY - JOUR AU - Acorda, Darlene AU - Businelle, Michael AU - Santa Maria, Diane PY - 2021/4/6 TI - Perceived Impacts, Acceptability, and Recommendations for Ecological Momentary Assessment Among Youth Experiencing Homelessness: Qualitative Study JO - JMIR Form Res SP - e21638 VL - 5 IS - 4 KW - youth experiencing homelessness KW - ecological momentary assessment KW - mobile apps KW - behavior change N2 - 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 the acceptability 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. Semistructured exit interviews were performed using an interview guide that focused on the YEH experience with the EMA app, and included perceived barriers and recommendations for future studies. Data analyses used an inductive approach with thematic analysis to identify major themes and subthemes. Results: A total of 18 YEH aged 19-24 years participated in individual and group exit interviews. The EMA was highly acceptable to YEH and they found the app and EMA surveys 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 prompts. Technology-related barriers included the ?freezing? of the app, battery charge, and connectivity issues. Recommendations for future studies included the need to provide real-time mental health support for symptomatic youth, to create individually customized questions, and to test 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 in studies. Further studies are warranted to understand the impact of EMA on YEH behaviors. Incorporating the YEH perspective into the design and implementation of EMA studies may help minimize barriers, increase acceptability, and improve participation rates in this hard-to-reach, disconnected population. UR - https://formative.jmir.org/2021/4/e21638 UR - http://dx.doi.org/10.2196/21638 UR - http://www.ncbi.nlm.nih.gov/pubmed/33821805 ID - info:doi/10.2196/21638 ER - TY - JOUR AU - Hawker, O. Chloe AU - Merkouris, S. Stephanie AU - Youssef, J. George AU - Dowling, A. Nicki PY - 2021/3/26 TI - A Smartphone-Delivered Ecological Momentary Intervention for Problem Gambling (GamblingLess: Curb Your Urge): Single-Arm Acceptability and Feasibility Trial JO - J Med Internet Res SP - e25786 VL - 23 IS - 3 KW - gambling KW - craving KW - urge KW - self-efficacy KW - relapse KW - smartphone KW - self-help KW - treatment KW - ecological momentary assessment KW - ecological momentary intervention KW - mobile phone N2 - Background: Low uptake rates of traditional gambling treatments highlight the need for innovative treatment modalities. Smartphone apps can provide unprecedented access to real-time ecological momentary interventions (EMIs) delivered in people?s everyday lives. Objective: This study aims to examine the acceptability, feasibility, and preliminary effectiveness of GamblingLess: Curb Your Urge, the first smartphone app?delivered EMI that aims to prevent gambling episodes by reducing craving intensity in people seeking help for gambling problems. Methods: This study was a single-arm, 5-week acceptability and feasibility trial (1-week baseline and 4-week intervention periods) involving ecological momentary assessments (EMAs) delivered 3 times daily. The EMAs measured gambling episodes, cravings, and self-efficacy. Web-based evaluations at baseline, postintervention, and 1-month follow-up measured gambling outcomes (severity, cravings, frequency, expenditure, and self-efficacy) and the intervention?s perceived helpfulness, relevance, burden, satisfaction, and impact in relation to gambling cravings. Results: A total of 36 participants, of whom 22/36 (61%) were male and 34/36 (94%) were problem gamblers, completed the baseline measures, with 61% (22/36) completing the postintervention evaluation and 58% (21/36) completing the follow-up evaluation. The intervention was considered acceptable, as participants perceived all intervention content to be above average in helpfulness and the EMA to be highly relevant but somewhat burdensome. Participants reported that they were satisfied with the intervention and that the intervention improved their knowledge, attitudes, awareness, behavior change, intention to change, and help-seeking behavior for gambling cravings. Regarding the intervention?s feasibility, compliance rates for the EMA (51%) and EMI (15%) were low; however, the intervention was used 166 times, including 59 uses within 60 minutes of EMA completion and 107 on-demand uses. Regarding the intervention?s preliminary effectiveness, descriptive EMA data showed that, compared with the baseline period, 71% and 72% reductions in the average number of gambling episodes and craving occurrences were reported in the intervention period, respectively. In addition, clustered paired-sample two-tailed t tests revealed a significant 5.4% reduction in real-time craving intensity (P=.01) immediately after intervention use, which increased to 10.5% (P=.01), where use was recommended based on craving occurrence. At the group level, significant medium-to-large reductions were observed in mean gambling symptom severity (P=.01 and .003), cravings (P=.03 and .02), frequency (P=.01 and .004), and expenditure (P=.04 and .003) at postintervention and follow-up; moreover, increased mean gambling self-efficacy and craving self-efficacy (P=.01 and .01) were observed at postintervention and increased gambling self-efficacy (P=.04) was observed at follow-up. At the individual level, over a quarter of participants (6/22, 27% to 10/21, 48%) could be categorized as recovered or improved regarding their gambling symptom severity and cravings. Conclusions: The results support the acceptability, feasibility, and preliminary effectiveness of this app-delivered EMI for preventing gambling episodes through craving management in people with gambling problems, which has implications for extending the reach of evidence-based treatment to moments of vulnerability in people?s everyday lives. UR - https://www.jmir.org/2021/3/e25786 UR - http://dx.doi.org/10.2196/25786 UR - http://www.ncbi.nlm.nih.gov/pubmed/33769294 ID - info:doi/10.2196/25786 ER - TY - JOUR AU - Ponnada, Aditya AU - Thapa-Chhetry, Binod AU - Manjourides, Justin AU - Intille, Stephen PY - 2021/3/10 TI - Measuring Criterion Validity of Microinteraction Ecological Momentary Assessment (Micro-EMA): Exploratory Pilot Study With Physical Activity Measurement JO - JMIR Mhealth Uhealth SP - e23391 VL - 9 IS - 3 KW - ecological momentary assessment (EMA) KW - experience sampling KW - physical activity KW - smartwatch KW - microinteractions KW - criterion validity KW - activity monitor KW - ?EMA N2 - Background: Ecological momentary assessment (EMA) is an in situ method of gathering self-report on behaviors using mobile devices. In typical phone-based EMAs, participants are prompted repeatedly with multiple-choice questions, often causing participation burden. Alternatively, microinteraction EMA (micro-EMA or ?EMA) is a type of EMA where all the self-report prompts are single-question surveys that can be answered using a 1-tap glanceable microinteraction conveniently on a smartwatch. Prior work suggests that ?EMA may permit a substantially higher prompting rate than EMA, yielding higher response rates and lower participation burden. This is achieved by ensuring ?EMA prompt questions are quick and cognitively simple to answer. However, the validity of participant responses from ?EMA self-report has not yet been formally assessed. Objective: In this pilot study, we explored the criterion validity of ?EMA self-report on a smartwatch, using physical activity (PA) assessment as an example behavior of interest. Methods: A total of 17 participants answered 72 ?EMA prompts each day for 1 week using a custom-built ?EMA smartwatch app. At each prompt, they self-reported whether they were doing sedentary, light/standing, moderate/walking, or vigorous activities by tapping on the smartwatch screen. Responses were compared with a research-grade activity monitor worn on the dominant ankle simultaneously (and continuously) measuring PA. Results: Participants had an 87.01% (5226/6006) ?EMA completion rate and a 74.00% (5226/7062) compliance rate taking an average of only 5.4 (SD 1.5) seconds to answer a prompt. When comparing ?EMA responses with the activity monitor, we observed significantly higher (P<.001) momentary PA levels on the activity monitor when participants self-reported engaging in moderate+vigorous activities compared with sedentary or light/standing activities. The same comparison did not yield any significant differences in momentary PA levels as recorded by the activity monitor when the ?EMA responses were randomly generated (ie, simulating careless taps on the smartwatch). Conclusions: For PA measurement, high-frequency ?EMA self-report could be used to capture information that appears consistent with that of a research-grade continuous sensor for sedentary, light, and moderate+vigorous activity, suggesting criterion validity. The preliminary results show that participants were not carelessly answering ?EMA prompts by randomly tapping on the smartwatch but were reporting their true behavior at that moment. However, more research is needed to examine the criterion validity of ?EMA when measuring vigorous activities. UR - https://mhealth.jmir.org/2021/3/e23391 UR - http://dx.doi.org/10.2196/23391 UR - http://www.ncbi.nlm.nih.gov/pubmed/33688843 ID - info:doi/10.2196/23391 ER - TY - JOUR AU - Williams, T. Marie AU - Lewthwaite, Hayley AU - Fraysse, François AU - Gajewska, Alexandra AU - Ignatavicius, Jordan AU - Ferrar, Katia PY - 2021/3/3 TI - Compliance With Mobile Ecological Momentary Assessment of Self-Reported Health-Related Behaviors and Psychological Constructs in Adults: Systematic Review and Meta-analysis JO - J Med Internet Res SP - e17023 VL - 23 IS - 3 KW - mobile momentary ecological assessment KW - adult KW - compliance KW - systematic review KW - meta-analysis KW - mobile phone N2 - Background: Mobile ecological momentary assessment (mEMA) permits real-time capture of self-reported participant behaviors and perceptual experiences. Reporting of mEMA protocols and compliance has been identified as problematic within systematic reviews of children, youth, and specific clinical populations of adults. Objective: This study aimed to describe the use of mEMA for self-reported behaviors and psychological constructs, mEMA protocol and compliance reporting, and associations between key components of mEMA protocols and compliance in studies of nonclinical and clinical samples of adults. Methods: In total, 9 electronic databases were searched (2006-2016) for observational studies reporting compliance to mEMA for health-related data from adults (>18 years) in nonclinical and clinical settings. Screening and data extraction were undertaken by independent reviewers, with discrepancies resolved by consensus. Narrative synthesis described participants, mEMA target, protocol, and compliance. Random effects meta-analysis explored factors associated with cohort compliance (monitoring duration, daily prompt frequency or schedule, device type, training, incentives, and burden score). Random effects analysis of variance (P?.05) assessed differences between nonclinical and clinical data sets. Results: Of the 168 eligible studies, 97/105 (57.7%) reported compliance in unique data sets (nonclinical=64/105 [61%], clinical=41/105 [39%]). The most common self-reported mEMA target was affect (primary target: 31/105, 29.5% data sets; secondary target: 50/105, 47.6% data sets). The median duration of the mEMA protocol was 7 days (nonclinical=7, clinical=12). Most protocols used a single time-based (random or interval) prompt type (69/105, 65.7%); median prompt frequency was 5 per day. The median number of items per prompt was similar for nonclinical (8) and clinical data sets (10). More than half of the data sets reported mEMA training (84/105, 80%) and provision of participant incentives (66/105, 62.9%). Less than half of the data sets reported number of prompts delivered (22/105, 21%), answered (43/105, 41%), criterion for valid mEMA data (37/105, 35.2%), or response latency (38/105, 36.2%). Meta-analysis (nonclinical=41, clinical=27) estimated an overall compliance of 81.9% (95% CI 79.1-84.4), with no significant difference between nonclinical and clinical data sets or estimates before or after data exclusions. Compliance was associated with prompts per day and items per prompt for nonclinical data sets. Although widespread heterogeneity existed across analysis (I2>90%), no compelling relationship was identified between key features of mEMA protocols representing burden and mEMA compliance. Conclusions: In this 10-year sample of studies using the mEMA of self-reported health-related behaviors and psychological constructs in adult nonclinical and clinical populations, mEMA was applied across contexts and health conditions and to collect a range of health-related data. There was inconsistent reporting of compliance and key features within protocols, which limited the ability to confidently identify components of mEMA schedules likely to have a specific impact on compliance. UR - https://www.jmir.org/2021/3/e17023 UR - http://dx.doi.org/10.2196/17023 UR - http://www.ncbi.nlm.nih.gov/pubmed/33656451 ID - info:doi/10.2196/17023 ER - TY - JOUR AU - Maatoug, Redwan AU - Peiffer-Smadja, Nathan AU - Delval, Guillaume AU - Brochu, Térence AU - Pitrat, Benjamin AU - Millet, Bruno PY - 2021/2/24 TI - Ecological Momentary Assessment Using Smartphones in Patients With Depression: Feasibility Study JO - JMIR Form Res SP - e14179 VL - 5 IS - 2 KW - ecological momentary assessment KW - depression KW - smartphone KW - feasibility study KW - user experience N2 - Background: Ecological momentary assessment (EMA) is a promising tool in the management of psychiatric disorders and particularly depression. It allows for a real-time evaluation of symptoms and an earlier detection of relapse or treatment efficacy. The generalization of the smartphone in the modern world offers a new, large-scale support for EMA. Objective: The main objective of this study was twofold: (1) to assess patients? compliance with an EMA smartphone app defined by the number of EMAs completed, and (2) to estimate the external validity of the EMA using a correlation between self-esteem/guilt/mood variables and Hamilton Depression Rating Scale (HDRS) score. Methods: Eleven patients at the Pitié-Salpêtrière Hospital, Paris, France, were monitored for 28 days by means of a smartphone app. Every patient enrolled in the study had two types of assessment: (1) three outpatient consultations with a psychiatrist at three different time points (days 1, 15, and 28), and (2) real-time data collection using an EMA smartphone app with a single, fixed notification per day at 3 pm for 28 days. The results of the real-time data collected were reviewed during the three outpatient consultations by a psychiatrist using a dashboard that aggregated all of the patients? data into a user-friendly format. Results: Of the 11 patients in the study, 6 patients attended the 3 outpatient consultations with the psychiatrist and completed the HDRS at each consultation. We found a positive correlation between the HDRS score and the variables of self-esteem, guilt, and mood (Spearman correlation coefficient 0.57). Seven patients completed the daily EMAs for 28 days or longer, with an average response rate to the EMAs of 62.5% (175/280). Furthermore, we observed a positive correlation between the number of responses to EMAs and the duration of follow-up (Spearman correlation coefficient 0.63). Conclusions: This preliminary study with a prolonged follow-up demonstrates significant patient compliance with the smartphone app. In addition, the self-assessments performed by patients seemed faithful to the standardized measurements performed by the psychiatrist. The results also suggest that for some patients it is more convenient to use the smartphone app than to attend outpatient consultations. UR - https://formative.jmir.org/2021/2/e14179 UR - http://dx.doi.org/10.2196/14179 UR - http://www.ncbi.nlm.nih.gov/pubmed/33625367 ID - info:doi/10.2196/14179 ER - TY - JOUR AU - Mardini, T. Mamoun AU - Nerella, Subhash AU - Kheirkhahan, Matin AU - Ranka, Sanjay AU - Fillingim, B. Roger AU - Hu, Yujie AU - Corbett, B. Duane AU - Cenko, Erta AU - Weber, Eric AU - Rashidi, Parisa AU - Manini, M. Todd PY - 2021/1/13 TI - The Temporal Relationship Between Ecological Pain and Life-Space Mobility in Older Adults With Knee Osteoarthritis: A Smartwatch-Based Demonstration Study JO - JMIR Mhealth Uhealth SP - e19609 VL - 9 IS - 1 KW - ecological momentary assessment KW - smartwatch app KW - life-space mobility KW - pain KW - knee osteoarthritis KW - global positioning system N2 - Background: Older adults who experience pain are more likely to reduce their community and life-space mobility (ie, the usual range of places in an environment in which a person engages). However, there is significant day-to-day variability in pain experiences that offer unique insights into the consequences on life-space mobility, which are not well understood. This variability is complex and cannot be captured with traditional recall-based pain surveys. As a solution, ecological momentary assessments record repeated pain experiences throughout the day in the natural environment. Objective: The aim of this study was to examine the temporal association between ecological momentary assessments of pain and GPS metrics in older adults with symptomatic knee osteoarthritis by using a smartwatch platform called Real-time Online Assessment and Mobility Monitor. Methods: Participants (n=19, mean 73.1 years, SD 4.8; female: 13/19, 68%; male: 6/19, 32%) wore a smartwatch for a mean period of 13.16 days (SD 2.94). Participants were prompted in their natural environment about their pain intensity (range 0-10) at random time windows in the morning, afternoon, and evening. GPS coordinates were collected at 15-minute intervals and aggregated each day into excursion, ellipsoid, clustering, and trip frequency features. Pain intensity ratings were averaged across time windows for each day. A random effects model was used to investigate the within and between-person effects. Results: The daily mean pain intensities reported by participants ranged between 0 and 8 with 40% reporting intensities ?2. The within-person associations between pain intensity and GPS features were more likely to be statistically significant than those observed between persons. Within-person pain intensity was significantly associated with excursion size, and others (excursion span, total distance, and ellipse major axis) showed a statistical trend (excursion span: P=.08; total distance: P=.07; ellipse major axis: P=.07). Each point increase in the mean pain intensity was associated with a 3.06 km decrease in excursion size, 2.89 km decrease in excursion span, 5.71 km decrease total distance travelled per day, 31.4 km2 decrease in ellipse area, 0.47 km decrease ellipse minor axis, and 3.64 km decrease in ellipse major axis. While not statistically significant, the point estimates for number of clusters (P=.73), frequency of trips (P=.81), and homestay (P=.15) were positively associated with pain intensity, and entropy (P=.99) was negatively associated with pain intensity. Conclusions: In this demonstration study, higher intensity knee pain in older adults was associated with lower life-space mobility. Results demonstrate that a custom-designed smartwatch platform is effective at simultaneously collecting rich information about ecological pain and life-space mobility. Such smart tools are expected to be important for remote health interventions that harness the variability in pain symptoms while understanding their impact on life-space mobility. UR - http://mhealth.jmir.org/2021/1/e19609/ UR - http://dx.doi.org/10.2196/19609 UR - http://www.ncbi.nlm.nih.gov/pubmed/33439135 ID - info:doi/10.2196/19609 ER - TY - JOUR AU - Bin Morshed, Mehrab AU - Kulkarni, Shreeram Samruddhi AU - Li, Richard AU - Saha, Koustuv AU - Roper, Galante Leah AU - Nachman, Lama AU - Lu, Hong AU - Mirabella, Lucia AU - Srivastava, Sanjeev AU - De Choudhury, Munmun AU - de Barbaro, Kaya AU - Ploetz, Thomas AU - Abowd, D. Gregory PY - 2020/12/18 TI - A Real-Time Eating Detection System for Capturing Eating Moments and Triggering Ecological Momentary Assessments to Obtain Further Context: System Development and Validation Study JO - JMIR Mhealth Uhealth SP - e20625 VL - 8 IS - 12 KW - eating detection KW - eating behavior KW - eating context KW - well-being KW - smartwatch KW - ecological momentary assessment N2 - Background: Eating behavior has a high impact on the well-being of an individual. Such behavior involves not only when an individual is eating, but also various contextual factors such as with whom and where an individual is eating and what kind of food the individual is eating. Despite the relevance of such factors, most automated eating detection systems are not designed to capture contextual factors. Objective: The aims of this study were to (1) design and build a smartwatch-based eating detection system that can detect meal episodes based on dominant hand movements, (2) design ecological momentary assessment (EMA) questions to capture meal contexts upon detection of a meal by the eating detection system, and (3) validate the meal detection system that triggers EMA questions upon passive detection of meal episodes. Methods: The meal detection system was deployed among 28 college students at a US institution over a period of 3 weeks. The participants reported various contextual data through EMAs triggered when the eating detection system correctly detected a meal episode. The EMA questions were designed after conducting a survey study with 162 students from the same campus. Responses from EMAs were used to define exclusion criteria. Results: Among the total consumed meals, 89.8% (264/294) of breakfast, 99.0% (406/410) of lunch, and 98.0% (589/601) of dinner episodes were detected by our novel meal detection system. The eating detection system showed a high accuracy by capturing 96.48% (1259/1305) of the meals consumed by the participants. The meal detection classifier showed a precision of 80%, recall of 96%, and F1 of 87.3%. We found that over 99% (1248/1259) of the detected meals were consumed with distractions. Such eating behavior is considered ?unhealthy? and can lead to overeating and uncontrolled weight gain. A high proportion of meals was consumed alone (680/1259, 54.01%). Our participants self-reported 62.98% (793/1259) of their meals as healthy. Together, these results have implications for designing technologies to encourage healthy eating behavior. Conclusions: The presented eating detection system is the first of its kind to leverage EMAs to capture the eating context, which has strong implications for well-being research. We reflected on the contextual data gathered by our system and discussed how these insights can be used to design individual-specific interventions. UR - http://mhealth.jmir.org/2020/12/e20625/ UR - http://dx.doi.org/10.2196/20625 UR - http://www.ncbi.nlm.nih.gov/pubmed/33337336 ID - info:doi/10.2196/20625 ER - TY - JOUR AU - Kleiman, M. Evan AU - Yeager, L. April AU - Grove, L. Jeremy AU - Kellerman, K. John AU - Kim, S. Joanne PY - 2020/12/15 TI - Real-time Mental Health Impact of the COVID-19 Pandemic on College Students: Ecological Momentary Assessment Study JO - JMIR Ment Health SP - e24815 VL - 7 IS - 12 KW - ecological momentary assessment KW - college students KW - COVID-19, anxiety KW - real-time KW - mental health KW - impact KW - student N2 - Background: College students? mental health may be disproportionally affected by the COVID-19 pandemic because of the abrupt shift off campus and subsequent loss of a social network and potential long-term impact on job prospects. Objective: We sought to assess the nature of COVID-19?s mental health impact among a sample of undergraduates who were experiencing the pandemic as it occurred in real time. Methods: In total, 140 college students completed smartphone-based ecological momentary assessments of anxiety and optimism related to COVID-19 and other generic mental health variables 6 times daily. Results: Participants completed >23,750 surveys. Overall, >75% of these surveys indicated at least some level of anxiety about COVID-19. On average, the proportion of responses each day at the highest levels of anxiety about COVID-19 was 7 times greater than the proportion of responses at the highest levels of non?COVID-19?specific anxiety. Structural change analyses indicated a significant downward trend in COVID-19 anxiety after the first week of June, but even at the lowest point, >15% of the participants in the sample still reported high levels of COVID-19 anxiety each day. Participants felt more anxious about COVID-19 on days when the number of new cases and deaths due to COVID-19 were higher. When participants felt anxious about COVID-19, they also felt sad, anxious (in general), and had a greater desire to drink and use drugs. Participants felt more optimistic about COVID-19 when they received more support from others and from their university. Conclusions: This study demonstrated the widespread mental health impact that COVID-19 has had on college students. UR - http://mental.jmir.org/2020/12/e24815/ UR - http://dx.doi.org/10.2196/24815 UR - http://www.ncbi.nlm.nih.gov/pubmed/33207308 ID - info:doi/10.2196/24815 ER - TY - JOUR AU - Willoughby, Fitts Jessica AU - Myrick, Gall Jessica AU - Gibbons, Stephanie AU - Kogan, Clark PY - 2020/12/10 TI - Associations Between Emotions, Social Media Use, and Sun Exposure Among Young Women: Ecological Momentary Assessment Study JO - JMIR Dermatol SP - e18371 VL - 3 IS - 1 KW - social media KW - skin cancer KW - emotions KW - cancer prevention KW - health communication KW - ecological momentary assessment N2 - Background: Research has pointed to a connection between social media use, emotions, and tanning behaviors. However, less is known about the role specific emotions may play in influencing social media use and how emotions and social media use may each be associated with outdoor tanning. Objective: This paper aims to examine the connection between emotions, social media use, and outdoor tanning behaviors among young women, a group particularly important for skin cancer prevention efforts. Methods: We used ecological momentary assessment to collect data from 197 women aged 18 to 25 years 3 times a day for 7 days in July 2018. We collected data from women in 2 states. Results: We found that boredom was associated with increased time spent on social media and that increased time spent on social media was associated with increased time spent outdoors without sun protection. Conclusions: Our results highlight that social media may be a particularly important channel for skin cancer prevention efforts targeting young women, as more social media use was associated with increased time spent outdoors with skin exposed. Researchers should consider the role of emotions in motivating social media use and subsequent tanning behaviors. Additionally, as boredom was associated with social media use, intervention developers would benefit from developing digital and social media interventions that entertain as well as educate. UR - http://derma.jmir.org/2020/1/e18371/ UR - http://dx.doi.org/10.2196/18371 UR - http://www.ncbi.nlm.nih.gov/pubmed/ ID - info:doi/10.2196/18371 ER - TY - JOUR AU - Richter, Frederike Maike AU - Storck, Michael AU - Blitz, Rogério AU - Goltermann, Janik AU - Seipp, Juliana AU - Dannlowski, Udo AU - Baune, T. Bernhard AU - Dugas, Martin AU - Opel, Nils PY - 2020/12/1 TI - Repeated Digitized Assessment of Risk and Symptom Profiles During Inpatient Treatment of Affective Disorder: Observational Study JO - JMIR Ment Health SP - e24066 VL - 7 IS - 12 KW - affective disorders KW - digital data collection KW - psychiatry KW - P4 medicine N2 - Background: Predictive models have revealed promising results for the individual prognosis of treatment response and relapse risk as well as for differential diagnosis in affective disorders. Yet, in order to translate personalized predictive modeling from research contexts to psychiatric clinical routine, standardized collection of information of sufficient detail and temporal resolution in day-to-day clinical care is needed. Digital collection of self-report measures by patients is a time- and cost-efficient approach to gain such data throughout treatment. Objective: The objective of this study was to investigate whether patients with severe affective disorders were willing and able to participate in such efforts, whether the feasibility of such systems might vary depending on individual patient characteristics, and if digitally acquired assessments were of sufficient diagnostic validity. Methods: We implemented a system for longitudinal digital collection of risk and symptom profiles based on repeated self-reports via tablet computers throughout inpatient treatment of affective disorders at the Department of Psychiatry at the University of Münster. Tablet-handling competency and the speed of data entry were assessed. Depression severity was additionally assessed by a clinical interviewer at baseline and before discharge. Results: Of 364 affective disorder patients who were approached, 242 (66.5%) participated in the study; 88.8% of participants (215/242) were diagnosed with major depressive disorder, and 27 (11.2%) had bipolar disorder. During the duration of inpatient treatment, 79% of expected assessments were completed, with an average of 4 completed assessments per participant; 4 participants (4/242, 1.6%) dropped out of the study prematurely. During data entry, 89.3% of participants (216/242) did not require additional support. Needing support with tablet handling and slower data entry pace were predicted by older age, whereas depression severity at baseline did not influence these measures. Patient self-reporting of depression severity showed high agreement with standardized external assessments by a clinical interviewer. Conclusions: Our results indicate that digital collection of self-report measures is a feasible, accessible, and valid method for longitudinal data collection in psychiatric routine, which will eventually facilitate the identification of individual risk and resilience factors for affective disorders and pave the way toward personalized psychiatric care. UR - https://mental.jmir.org/2020/12/e24066 UR - http://dx.doi.org/10.2196/24066 UR - http://www.ncbi.nlm.nih.gov/pubmed/33258791 ID - info:doi/10.2196/24066 ER - TY - JOUR AU - Staiger, Karin Petra AU - O'Donnell, Renee AU - Liknaitzky, Paul AU - Bush, Rachel AU - Milward, Joanna PY - 2020/11/24 TI - Mobile Apps to Reduce Tobacco, Alcohol, and Illicit Drug Use: Systematic Review of the First Decade JO - J Med Internet Res SP - e17156 VL - 22 IS - 11 KW - smartphone app KW - mobile phone KW - mobile app KW - problematic substance use KW - addiction KW - systematic review KW - mHealth KW - ecological momentary intervention KW - alcohol KW - tobacco KW - smoking KW - illicit drugs N2 - Background: Mobile apps for problematic substance use have the potential to bypass common barriers to treatment seeking. Ten years following the release of the first app targeting problematic tobacco, alcohol, and illicit drug use, their effectiveness, use, and acceptability remains unclear. Objective: This study aims to conduct a systematic literature review of trials evaluating mobile app interventions for problematic tobacco, alcohol, and illicit drug use. Methods: The review was conducted according to recommended guidelines. Relevant databases were searched, and articles were included if the mobile app study was a controlled intervention trial and reported alcohol, tobacco, or illicit drug consumption as outcomes. Results: A total of 20 studies met eligibility criteria across a range of substances: alcohol (n=11), tobacco (n=6), alcohol and tobacco (n=1), illicit drugs (n=1), and illicit drugs and alcohol (n=1). Samples included the general community, university students, and clinical patients. The analyzed intervention sample sizes ranged from 22 to 14,228, and content was considerably diverse, from simple stand-alone apps delivering self-monitoring or psychoeducation to multicomponent apps with interactive features and audio content, or used as adjuncts alongside face-to-face treatment. Intervention duration ranged from 1 to 35 weeks, with notifications ranging from none to multiple times per day. A total of 6 of the 20 app interventions reported significant reductions in substance use at post or follow-up compared with a comparison condition, with small to moderate effect sizes. Furthermore, two other app interventions reported significant reductions during the intervention but not at post treatment, and a third reported a significant interaction of two app intervention components. Conclusions: Although most app interventions were associated with reductions in problematic substance use, less than one-third were significantly better than the comparison conditions at post treatment. A total of 5 out of the 6 apps that reported intervention effects targeted alcohol (of those, one targeted alcohol and illicit drugs and another alcohol and tobacco) and 1 targeted tobacco. Moreover, 3 out of 6 apps included feedback (eg, personalized) and 2 had high risk of bias, 1 some risk, and 3 low risk. All 6 apps included interventions of 6 weeks or longer. Common study limitations were small sample sizes; risk of bias; lack of relevant details; and, in some cases, poorly balanced comparison conditions. Appropriately powered trials are required to understand which app interventions are most effective, length of engagement required, and subgroups most likely to benefit. In sum, evidence to date for the effectiveness of apps targeting problematic substance use is not compelling, although the heterogeneous comparison conditions and trial designs across studies limit the ability to compare efficacy between apps. We discuss potential approaches that can help ascertain whether the promise of mobile app interventions for problematic substance use can be fulfilled. UR - http://www.jmir.org/2020/11/e17156/ UR - http://dx.doi.org/10.2196/17156 UR - http://www.ncbi.nlm.nih.gov/pubmed/33231555 ID - info:doi/10.2196/17156 ER - TY - JOUR AU - Nicol, E. Ginger AU - Ricchio, R. Amanda AU - Metts, L. Christopher AU - Yingling, D. Michael AU - Ramsey, T. Alex AU - Schweiger, A. Julia AU - Miller, Philip J. AU - Lenze, J. Eric PY - 2020/11/13 TI - A Smartphone-Based Technique to Detect Dynamic User Preferences for Tailoring Behavioral Interventions: Observational Utility Study of Ecological Daily Needs Assessment JO - JMIR Mhealth Uhealth SP - e18609 VL - 8 IS - 11 KW - mobile health KW - telemedicine KW - needs assessment KW - healthy lifestyle KW - ecological momentary assessment KW - mobile applications KW - behavior intervention KW - behavior therapy N2 - Background: Mobile health apps are promising vehicles for delivering scalable health behavior change interventions to populations that are otherwise difficult to reach and engage, such as young adults with psychiatric conditions. To improve uptake and sustain consumer engagement, mobile health interventions need to be responsive to individuals? needs and preferences, which may change over time. We previously created an ecological daily needs assessment to capture microprocesses influencing user needs and preferences for mobile health treatment adaptation. Objective: The objective of our study was to test the utility of a needs assessment anchored within a mobile app to capture individualized, contextually relevant user needs and preferences within the framework of a weight management mobile health app. Methods: Participants with an iOS device could download the study app via the study website or links from social media. In this fully remote study, we screened, obtained informed consent from, and enrolled participants through the mobile app. The mobile health framework included daily health goal setting and self-monitoring, with up to 6 daily prompts to determine in-the-moment needs and preferences for mobile health?assisted health behavior change. Results: A total of 24 participants downloaded the app and provided e-consent (22 female; 2 male), with 23 participants responding to at least one prompt over 2 weeks. The mean length of engagement was 5.6 (SD 4.7) days, with a mean of 2.8 (1.1) responses per day. We observed individually dynamic needs and preferences, illustrating daily variability within and between individuals. Qualitative feedback indicated preferences for self-adapting features, simplified self-monitoring, and the ability to personalize app-generated message timing and content. Conclusions: The technique provided an individually dynamic and contextually relevant alternative and complement to traditional needs assessment for assessing individually dynamic user needs and preferences during treatment development or adaptation. The results of this utility study suggest the importance of personalization and learning algorithms for sustaining app engagement in young adults with psychiatric conditions. Further study in broader user populations is needed. UR - http://mhealth.jmir.org/2020/11/e18609/ UR - http://dx.doi.org/10.2196/18609 UR - http://www.ncbi.nlm.nih.gov/pubmed/33055063 ID - info:doi/10.2196/18609 ER - TY - JOUR AU - Marciniak, Anna Marta AU - Shanahan, Lilly AU - Rohde, Judith AU - Schulz, Ava AU - Wackerhagen, Carolin AU - Kobyli?ska, Dorota AU - Tuescher, Oliver AU - Binder, Harald AU - Walter, Henrik AU - Kalisch, Raffael AU - Kleim, Birgit PY - 2020/11/12 TI - Standalone Smartphone Cognitive Behavioral Therapy?Based Ecological Momentary Interventions to Increase Mental Health: Narrative Review JO - JMIR Mhealth Uhealth SP - e19836 VL - 8 IS - 11 KW - mHealth KW - mobile app KW - ecological momentary intervention KW - EMI KW - cognitive behavioral therapy KW - CBT KW - COVID-19 KW - mobile phone KW - smartphone N2 - Background: A growing number of psychological interventions are delivered via smartphones with the aim of increasing the efficacy and effectiveness of these treatments and providing scalable access to interventions for improving mental health. Most of the scientifically tested apps are based on cognitive behavioral therapy (CBT) principles, which are considered the gold standard for the treatment of most mental health problems. Objective: This review investigates standalone smartphone-based ecological momentary interventions (EMIs) built on principles derived from CBT that aim to improve mental health. Methods: We searched the MEDLINE, PsycINFO, EMBASE, and PubMed databases for peer-reviewed studies published between January 1, 2007, and January 15, 2020. We included studies focusing on standalone app-based approaches to improve mental health and their feasibility, efficacy, or effectiveness. Both within- and between-group designs and studies with both healthy and clinical samples were included. Blended interventions, for example, app-based treatments in combination with psychotherapy, were not included. Selected studies were evaluated in terms of their design, that is, choice of the control condition, sample characteristics, EMI content, EMI delivery characteristics, feasibility, efficacy, and effectiveness. The latter was defined in terms of improvement in the primary outcomes used in the studies. Results: A total of 26 studies were selected. The results show that EMIs based on CBT principles can be successfully delivered, significantly increase well-being among users, and reduce mental health symptoms. Standalone EMIs were rated as helpful (mean 70.8%, SD 15.3; n=4 studies) and satisfying for users (mean 72.6%, SD 17.2; n=7 studies). Conclusions: Study quality was heterogeneous, and feasibility was often not reported in the reviewed studies, thus limiting the conclusions that can be drawn from the existing data. Together, the studies show that EMIs may help increase mental health and thus support individuals in their daily lives. Such EMIs provide readily available, scalable, and evidence-based mental health support. These characteristics appear crucial in the context of a global crisis such as the COVID-19 pandemic but may also help reduce personal and economic costs of mental health impairment beyond this situation or in the context of potential future pandemics. UR - https://mhealth.jmir.org/2020/11/e19836 UR - http://dx.doi.org/10.2196/19836 UR - http://www.ncbi.nlm.nih.gov/pubmed/33180027 ID - info:doi/10.2196/19836 ER - TY - JOUR AU - Galve Villa, Maria AU - S Palsson, Thorvaldur AU - Cid Royo, Albert AU - R Bjarkam, Carsten AU - Boudreau, A. Shellie PY - 2020/10/26 TI - Digital Pain Mapping and Tracking in Patients With Chronic Pain: Longitudinal Study JO - J Med Internet Res SP - e21475 VL - 22 IS - 10 KW - eHealth KW - medical illustrations KW - pain perception KW - mHealth KW - pain measurement KW - disease progression KW - patient-reported outcome measures KW - musculoskeletal pain KW - mobile phone KW - surveys and questionnaires KW - pain management N2 - Background: Digital pain mapping allows for remote and ecological momentary assessment in patients over multiple time points spanning days to months. Frequent ecological assessments may reveal tendencies and fluctuations more clearly and provide insights into the trajectory of a patient?s pain. Objective: The primary aim of this study is to remotely map and track the intensity and distribution of pain and discomfort (eg, burning, aching, and tingling) in patients with nonmalignant spinal referred pain over 12 weeks using a web-based app for digital pain mapping. The secondary aim is to explore the barriers of use by determining the differences in clinical and user characteristics between patients with good (regular users) and poor (nonregular users) reporting compliance. Methods: Patients (N=91; n=53 women) with spinal referred pain were recruited using web-based and traditional in-house strategies. Patients were asked to submit weekly digital pain reports for 12 weeks. Each pain report consisted of digital pain drawings on a pseudo?three-dimensional body chart and pain intensity ratings. The pain drawings captured the distribution of pain and discomfort (pain quality descriptors) expressed as the total extent and location. Differences in weekly pain reports were explored using the total extent (pixels), current and usual pain intensity ratings, frequency of quality descriptor selection, and Jaccard similarity index. Validated e-questionnaires were completed at baseline to determine the patients? characteristics (adapted Danish National Spine Register), disability (Oswestry Disability Index and Neck Disability Index), and pain catastrophizing (Pain Catastrophizing Scale) profiles. Barriers of use were assessed at 6 weeks using a health care?related usability and acceptance e-questionnaire and a self-developed technology-specific e-questionnaire to assess the accessibility and ease of access of the pain mapping app. Associations between total extent, pain intensity, disability, and catastrophizing were explored to further understand pain. Differences between regular and nonregular users were assessed to understand the pain mapping app reporting compliance. Results: Fluctuations were identified in pain reports for total extent and pain intensity ratings (P<.001). However, quality descriptor selection (P=.99) and pain drawing (P=.49), compared using the Jaccard index, were similar over time. Interestingly, current pain intensity was greater than usual pain intensity (P<.001), suggesting that the timing of pain reporting coincided with a more intense pain experience than usual. Usability and acceptance were similar between regular and nonregular users. Regular users were younger (P<.001) and reported a larger total extent of pain than nonregular users (P<.001). Conclusions: This is the first study to examine digital reports of pain intensity and distribution in patients with nonmalignant spinal referred pain remotely for a sustained period and barriers of use and compliance using a digital pain mapping app. Differences in age, pain distribution, and current pain intensity may influence reporting behavior and compliance. UR - http://www.jmir.org/2020/10/e21475/ UR - http://dx.doi.org/10.2196/21475 UR - http://www.ncbi.nlm.nih.gov/pubmed/33104012 ID - info:doi/10.2196/21475 ER - TY - JOUR AU - Bartels, Laureen Sara AU - van Knippenberg, M. Rosalia J. AU - Malinowsky, Camilla AU - Verhey, J. Frans R. AU - de Vugt, E. Marjolein PY - 2020/10/16 TI - Smartphone-Based Experience Sampling in People With Mild Cognitive Impairment: Feasibility and Usability Study JO - JMIR Aging SP - e19852 VL - 3 IS - 2 KW - experience sampling method KW - mild cognitive impairment KW - cognition KW - feasibility KW - smartphones N2 - Background: Daily functioning of people with cognitive disorders such as mild cognitive impairment (MCI) is usually depicted by retrospective questionnaires, which can be memory-biased and neglect fluctuations over time or contexts. Objective: This study examines the feasibility and usability of applying the experience sampling method (ESM) in people with MCI to provide a detailed and dynamic picture of behavioral, emotional, and cognitive patterns in everyday life. Methods: For 6 consecutive days, 21 people with MCI used an ESM app on their smartphones. At 8 semi-random timepoints per day, participants filled in momentary questionnaires on mood, activities, social context, and subjective cognitive complaints. Feasibility was determined through self-reports and observable human-technology interactions. Usability was demonstrated on an individual and group level. Results: Of the 21 participants, 3 dropped out due to forgetting to carry their smartphones or forgetting the study instructions. In the remaining 18 individuals, the compliance rate was high, at 78.7%. Participants reported that momentary questions reflected their daily experiences well. Of the 18 participants, 13 (72%) experienced the increase in awareness of their own memory functions as pleasant or neutral. Conclusions: Support was found for the general feasibility of smartphone-based experience sampling in people with MCI. However, many older adults with MCI are currently not in possession of smartphones, and study adherence seems challenging for a minority of individuals. Momentary data can increase the insights into daily patterns and may guide the person-tailored development of self-management strategies in clinical settings. UR - http://aging.jmir.org/2020/2/e19852/ UR - http://dx.doi.org/10.2196/19852 UR - http://www.ncbi.nlm.nih.gov/pubmed/33064084 ID - info:doi/10.2196/19852 ER - TY - JOUR AU - Turner, Marie Caitlin AU - Trujillo, Dillon AU - Le, Victory AU - Wilson, C. Erin AU - Arayasirikul, Sean PY - 2020/10/15 TI - Event-Level Association Between Daily Alcohol Use and Same-Day Nonadherence to Antiretroviral Therapy Among Young Men Who Have Sex With Men and Trans Women Living With HIV: Intensive Longitudinal Study JO - JMIR Mhealth Uhealth SP - e22733 VL - 8 IS - 10 KW - ecological momentary assessment KW - event-level KW - alcohol KW - antiretroviral therapy KW - men who have sex with men KW - trans women KW - adherence N2 - Background: Young trans women (TW) and men who have sex with men (MSM) are disproportionately impacted by HIV. Optimizing adherence to antiretroviral therapy (ART) is one mechanism by which public health experts aim to achieve favorable HIV health outcomes while reducing disease transmission. However, alcohol use is prevalent among young TW and MSM and threatens optimal adherence. In addition, the daily variations in alcohol use and ART adherence and their association with each other are poorly understood, warranting more appropriate methodological approaches, such as analysis of ecological momentary assessment (EMA) data. Objective: The aim of this analysis is to characterize the association between daily alcohol use and same-day ART nonadherence captured by an EMA study of young MSM and TW living with HIV in San Francisco. Methods: Young MSM and TW enrolled in the Health eNav digital HIV care navigation intervention were included in the analytic sample (N=113). Data on alcohol and ART use were collected by daily EMA surveys administered via text messaging and were analyzed over 30 days of follow-up. A multivariable mixed-effects logistic regression model adjusting for baseline sociodemographic characteristics was specified to investigate whether daily alcohol use was associated with same-day ART nonuse. Results: Daily alcohol use was associated with higher same-day ART nonuse. On average, participants drank alcohol on 15.20 (SD 8.93) days and used ART on 15.19 (SD 10.16) days out of 30 days. Daily alcohol use was associated with 1.89 (95% CI 1.14-3.15) times the adjusted odds of same-day ART nonuse for each participant. Conclusions: Results are consistent with other analyses of daily alcohol and ART use and underscore the importance of individually targeted interventions that are sensitive to each participant?s dynamic risk environment. International Registered Report Identifier (IRRID): RR2-10.2196/16406 UR - http://mhealth.jmir.org/2020/10/e22733/ UR - http://dx.doi.org/10.2196/22733 UR - http://www.ncbi.nlm.nih.gov/pubmed/33055070 ID - info:doi/10.2196/22733 ER - TY - JOUR AU - Arigo, Danielle AU - Brown, M. Megan AU - Pasko, Kristen AU - Ainsworth, Cole Matthew AU - Travers, Laura AU - Gupta, Adarsh AU - Downs, Symons Danielle AU - Smyth, M. Joshua PY - 2020/10/15 TI - Rationale and Design of the Women?s Health And Daily Experiences Project: Protocol for an Ecological Momentary Assessment Study to Identify Real-Time Predictors of Midlife Women?s Physical Activity JO - JMIR Res Protoc SP - e19044 VL - 9 IS - 10 KW - women's health KW - midlife KW - cardiovascular risk KW - physical activity KW - ecological momentary assessment KW - mobile phone N2 - Background: Midlife women are at an elevated risk for cardiovascular disease (CVD) and associated mortality. Those who have additional risk conditions such as obesity or hypertension report specific barriers to engaging in cardioprotective behaviors such as physical activity (PA). Considerable effort has been devoted to understanding PA determinants and designing interventions for midlife women, although with suboptimal success, as increasing PA could meaningfully attenuate CVD risk. An updated approach to understanding PA among midlife women could improve upon existing resources by focusing on novel psychosocial influences on PA in this population (ie, body satisfaction, social interactions, social comparisons, mood state) and within-person relations between these influences and PA in the natural environment. Objective: The overarching goal of Project WHADE (Women?s Health And Daily Experiences) is to use an ecological momentary assessment (EMA) approach to capture ecologically valid relations between midlife women?s psychosocial experiences and PA as they engage in their normal daily activities. The primary aim of the study is to identify within-person psychosocial predictors of variability in PA (ie, experiences associated with higher vs lower PA for a given individual). Methods: Midlife women (aged 40-60 years) with one or more additional risk markers for CVD (eg, hypertension) will be recruited from primary care clinics and the general community (target n=100). Eligible women will complete an initial survey and a face-to-face baseline session before engaging in a 10-day EMA protocol. Psychosocial experiences will be assessed using a brief self-report via a smartphone 5 times per day, and PA will be assessed throughout waking hours using a research-grade monitor. Participants will return for a brief exit interview at the end of 10 days. Multilevel models that address the nested structure of EMA data will be used to evaluate the study aims. Results: Recruitment and enrollment are ongoing, and a total of 75 women have completed the protocol to date. Data collection is expected to be completed in Fall 2020. Conclusions: Project WHADE is designed to identify naturally occurring psychosocial experiences that predict short-term variability in midlife women?s PA. As such, the results of this study should advance the current understanding of PA among midlife women by providing further insight into within-person psychosocial influences on PA in this group. In the future, this information could help inform the design of interventions for this population. International Registered Report Identifier (IRRID): DERR1-10.2196/19044 UR - http://www.researchprotocols.org/2020/10/e19044/ UR - http://dx.doi.org/10.2196/19044 UR - http://www.ncbi.nlm.nih.gov/pubmed/33055065 ID - info:doi/10.2196/19044 ER - TY - JOUR AU - Ziesemer, Katrin AU - König, Maria Laura AU - Boushey, Jo Carol AU - Villinger, Karoline AU - Wahl, Ronja Deborah AU - Butscher, Simon AU - Müller, Jens AU - Reiterer, Harald AU - Schupp, Thomas Harald AU - Renner, Britta PY - 2020/10/14 TI - Occurrence of and Reasons for ?Missing Events? in Mobile Dietary Assessments: Results From Three Event-Based Ecological Momentary Assessment Studies JO - JMIR Mhealth Uhealth SP - e15430 VL - 8 IS - 10 KW - dietary assessment KW - diet records KW - mobile phone KW - mobile applications KW - technology KW - adherence KW - compliance KW - missing events KW - Ecological Momentary Assessment KW - mHealth N2 - Background: Establishing a methodology for assessing nutritional behavior comprehensively and accurately poses a great challenge. Mobile technologies such as mobile image-based food recording apps enable eating events to be assessed in the moment in real time, thereby reducing memory biases inherent in retrospective food records. However, users might find it challenging to take images of the food they consume at every eating event over an extended period, which might lead to incomplete records of eating events (missing events). Objective: Analyzing data from 3 studies that used mobile image-based food recording apps and varied in their technical enrichment, this study aims to assess how often eating events (meals and snacks) were missed over a period of 8 days in a naturalistic setting by comparing the number of recorded events with the number of normative expected events, over time, and with recollections of missing events. Methods: Participants in 3 event-based Ecological Momentary Assessment (EMA) studies using mobile image-based dietary assessments were asked to record all eating events (study 1, N=38, 1070 eating events; study 2, N=35, 934 eating events; study 3, N=110, 3469 eating events). Study 1 used a basic app; study 2 included 1 fixed reminder and the possibility to add meals after the actual eating events occurred instead of in the moment (addendum); and study 3 included 2 fixed reminders, an addendum feature, and the option to record skipped meals. The number of recalled missed events and their reasons were assessed by semistructured interviews after the EMA period (studies 1 and 2) and daily questionnaires (study 3). Results: Overall, 183 participants reported 5473 eating events. Although the momentary adherence rate as indexed by a comparison with normative expected events was generally high across all 3 studies, a differential pattern of results emerged with a higher rate of logged meals in the more technically intensive study 3. Multilevel models for the logging trajectories of reported meals in all 3 studies showed a significant, albeit small, decline over time (b=?.11 to ?.14, Ps<.001, pseudo-R²=0.04-0.06), mainly because of a drop in reported snacks between days 1 and 2. Intraclass coefficients indicated that 38% or less of the observed variance was because of individual differences. The most common reasons for missing events were competing activities and technical issues, whereas situational barriers were less important. Conclusions: Three different indicators (normative, time stability, and recalled missing events) consistently indicated missing events. However, given the intensive nature of diet EMA protocols, the effect sizes were rather small and the logging trajectories over time were remarkably stable. Moreover, the individual?s actual state and context seemed to exert a greater influence on adherence rates than stable individual differences, which emphasizes the need for a more nuanced understanding of the factors that affect momentary adherence. UR - https://mhealth.jmir.org/2020/10/e15430 UR - http://dx.doi.org/10.2196/15430 UR - http://www.ncbi.nlm.nih.gov/pubmed/33052123 ID - info:doi/10.2196/15430 ER - TY - JOUR AU - Morgiève, Margot AU - Genty, Catherine AU - Azé, Jérôme AU - Dubois, Jonathan AU - Leboyer, Marion AU - Vaiva, Guillaume AU - Berrouiguet, Sofian AU - Courtet, Philippe PY - 2020/10/9 TI - A Digital Companion, the Emma App, for Ecological Momentary Assessment and Prevention of Suicide: Quantitative Case Series Study JO - JMIR Mhealth Uhealth SP - e15741 VL - 8 IS - 10 KW - suicide KW - ecological momentary assessment KW - prediction KW - prevention KW - mobile health KW - mHealth KW - case reports KW - ecological momentary intervention N2 - Background: Many suicide risk factors have been identified, but traditional clinical methods do not allow for the accurate prediction of suicide behaviors. To face this challenge, emma, an app for ecological momentary assessment (EMA), ecological momentary intervention (EMI), and prediction of suicide risk in high-risk patients, was developed. Objective: The aim of this case report study was to describe how subjects at high risk of suicide use the emma app in real-world conditions. Methods: The Ecological Mental Momentary Assessment (EMMA) study is an ongoing, longitudinal, interventional, multicenter trial in which patients at high risk for suicide are recruited to test emma, an app designed to be used as a self-help tool for suicidal crisis management. Participants undergo clinical assessment at months 0, 1, 3, and 6 after inclusion, mainly to assess and characterize the presence of mental disorders and suicidal thoughts and behaviors. Patient recruitment is still ongoing. Some data from the first 14 participants who already completed the 6-month follow-up were selected for this case report study, which evaluated the following: (1) data collected by emma (ie, responses to EMAs), (2) metadata on emma use, (3) clinical data, and (4) qualitative assessment of the participants' experiences. Results: EMA completion rates were extremely heterogeneous with a sharp decrease over time. The completion rates of the weekly EMAs (25%-87%) were higher than those of the daily EMAs (0%-53%). Most patients (10/14, 71%) answered the EMA questionnaires spontaneously. Similarly, the use of the Safety Plan Modules was very heterogeneous (2-75 times). Specifically, 11 patients out of 14 (79%) used the Call Module (1-29 times), which was designed by our team to help them get in touch with health care professionals and/or relatives during a crisis. The diversity of patient profiles and use of the EMA and EMI modules proposed by emma were highlighted by three case reports. Conclusions: These preliminary results indicate that patients have different clinical and digital profiles and needs that require a highly scalable, interactive, and customizable app. They also suggest that it is possible and acceptable to collect longitudinal, fine-grained, contextualized data (ie, EMA) and to offer personalized intervention (ie, EMI) in real time to people at high risk of suicide. To become a complementary tool for suicide prevention, emma should be integrated into existing emergency procedures. Trial Registration: ClinicalTrials.gov NCT03410381; https://clinicaltrials.gov/ct2/show/NCT03410381 UR - https://mhealth.jmir.org/2020/10/e15741 UR - http://dx.doi.org/10.2196/15741 UR - http://www.ncbi.nlm.nih.gov/pubmed/33034567 ID - info:doi/10.2196/15741 ER - TY - JOUR AU - Papp, M. Lauren AU - Barringer, Alexandra AU - Blumenstock, M. Shari AU - Gu, Pamela AU - Blaydes, Madison AU - Lam, Jaime AU - Kouros, D. Chrystyna PY - 2020/10/1 TI - Development and Acceptability of a Method to Investigate Prescription Drug Misuse in Daily Life: Ecological Momentary Assessment Study JO - JMIR Mhealth Uhealth SP - e21676 VL - 8 IS - 10 KW - compliance KW - ecological momentary assessment KW - prescription drug misuse KW - young adult N2 - Background: Prescription drug misuse and abuse is an established public health challenge, and young adults are particularly affected. There is a striking lack of real-time, naturalistic data collection assessing intentions to misuse and other precipitating factors at the time of actual misuse, leaving the conditions under which individuals are most likely to misuse prescription medications unknown. Ecological momentary assessment (EMA) apps and protocols designed to capture this information would accelerate and expand the knowledge base and could directly contribute to prevention and treatment efforts. Objective: The objectives of this study are to describe the development and administration of a mobile app and the EMA protocol designed to collect real-time factors associated with college students? prescription drug misuse intentions and behaviors in daily life; present completion rates, compliance, acceptability, and reactivity associated with the EMA protocol for participants who endorsed recent prescription drug misuse at screening (ie, risk group; n=300) and those who did not (ie, nonrisk group; n=55); and establish initial construct validity by linking the reports of misuse behaviors in daily life collected via the EMA app to prescription drug misuse reported on a standard survey. Methods: An EMA data collection app and protocol were designed specifically to capture hypothesized contextual factors along with prescription drug misuse intentions and behaviors in daily life. Using this protocol, young adult college students (N=352) completed signal- and event-contingent reports over a 28-day period. When the intention to misuse a prescription drug was endorsed, a brief follow-up prompt was sent 15 min later to collect participants? indications of whether or not misuse had occurred. Results: Risk-group participants were significantly more likely than nonrisk counterparts to endorse any prescription drug misuse intentions in daily life (P<.001), to complete one or more follow-up reports (P<.001), and to endorse any prescription drug misuse behavior in daily life on the follow-ups (P<.001). Overall, participants demonstrated consistent engagement with the EMA procedures and returned an average of 74.5 (SD 23.82; range 10-122) reports. Participants in the risk and nonrisk groups did not differ in the number of reports they completed (P=.12), the number of their reporting days (P=.32), or their average completion rates (P=.14). The results indicated some evidence of reactivity to the momentary reporting procedure. Participants reported uniformly positive experiences and remained highly engaged throughout the reporting protocol and broader study. Conclusions: The novel EMA app and protocol provide an effective way to assess real-time factors associated with prescription drug misuse intentions and behaviors in daily life. The resulting investigations offer the potential to provide highly translatable information for research and prevention efforts. UR - https://mhealth.jmir.org/2020/10/e21676 UR - http://dx.doi.org/10.2196/21676 UR - http://www.ncbi.nlm.nih.gov/pubmed/32877351 ID - info:doi/10.2196/21676 ER - TY - JOUR AU - Sultana, Madeena AU - Al-Jefri, Majed AU - Lee, Joon PY - 2020/9/29 TI - Using Machine Learning and Smartphone and Smartwatch Data to Detect Emotional States and Transitions: Exploratory Study JO - JMIR Mhealth Uhealth SP - e17818 VL - 8 IS - 9 KW - mHealth KW - mental health KW - emotion detection KW - emotional transition detection KW - spatiotemporal context KW - supervised machine learning KW - artificial intelligence KW - mobile phone KW - digital biomarkers KW - digital phenotyping N2 - Background: Emotional state in everyday life is an essential indicator of health and well-being. However, daily assessment of emotional states largely depends on active self-reports, which are often inconvenient and prone to incomplete information. Automated detection of emotional states and transitions on a daily basis could be an effective solution to this problem. However, the relationship between emotional transitions and everyday context remains to be unexplored. Objective: This study aims to explore the relationship between contextual information and emotional transitions and states to evaluate the feasibility of detecting emotional transitions and states from daily contextual information using machine learning (ML) techniques. Methods: This study was conducted on the data of 18 individuals from a publicly available data set called ExtraSensory. Contextual and sensor data were collected using smartphone and smartwatch sensors in a free-living condition, where the number of days for each person varied from 3 to 9. Sensors included an accelerometer, a gyroscope, a compass, location services, a microphone, a phone state indicator, light, temperature, and a barometer. The users self-reported approximately 49 discrete emotions at different intervals via a smartphone app throughout the data collection period. We mapped the 49 reported discrete emotions to the 3 dimensions of the pleasure, arousal, and dominance model and considered 6 emotional states: discordant, pleased, dissuaded, aroused, submissive, and dominant. We built general and personalized models for detecting emotional transitions and states every 5 min. The transition detection problem is a binary classification problem that detects whether a person?s emotional state has changed over time, whereas state detection is a multiclass classification problem. In both cases, a wide range of supervised ML algorithms were leveraged, in addition to data preprocessing, feature selection, and data imbalance handling techniques. Finally, an assessment was conducted to shed light on the association between everyday context and emotional states. Results: This study obtained promising results for emotional state and transition detection. The best area under the receiver operating characteristic (AUROC) curve for emotional state detection reached 60.55% in the general models and an average of 96.33% across personalized models. Despite the highly imbalanced data, the best AUROC curve for emotional transition detection reached 90.5% in the general models and an average of 88.73% across personalized models. In general, feature analyses show that spatiotemporal context, phone state, and motion-related information are the most informative factors for emotional state and transition detection. Our assessment showed that lifestyle has an impact on the predictability of emotion. Conclusions: Our results demonstrate a strong association of daily context with emotional states and transitions as well as the feasibility of detecting emotional states and transitions using data from smartphone and smartwatch sensors. UR - http://mhealth.jmir.org/2020/9/e17818/ UR - http://dx.doi.org/10.2196/17818 UR - http://www.ncbi.nlm.nih.gov/pubmed/32990638 ID - info:doi/10.2196/17818 ER - TY - JOUR AU - Schneider, Stefan AU - Junghaenel, U. Doerte AU - Gutsche, Tania AU - Mak, Wa Hio AU - Stone, A. Arthur PY - 2020/9/24 TI - Comparability of Emotion Dynamics Derived From Ecological Momentary Assessments, Daily Diaries, and the Day Reconstruction Method: Observational Study JO - J Med Internet Res SP - e19201 VL - 22 IS - 9 KW - ecological momentary assessment KW - daily diaries KW - day reconstruction method KW - emotion dynamics KW - emotion variability KW - mobile phone N2 - Background: Interest in the measurement of the temporal dynamics of people?s emotional lives has risen substantially in psychological and medical research. Emotions fluctuate and change over time, and measuring the ebb and flow of people?s affective experiences promises enhanced insights into people?s health and functioning. Researchers have used a variety of intensive longitudinal assessment (ILA) methods to create measures of emotion dynamics, including ecological momentary assessments (EMAs), end-of-day (EOD) diaries, and the day reconstruction method (DRM). To date, it is unclear whether they can be used interchangeably or whether ostensibly similar emotion dynamics captured by the methods differ in meaningful ways. Objective: This study aims to examine the extent to which different ILA methods yield comparable measures of intraindividual emotion dynamics. Methods: Data from 90 participants aged 50 years or older were collected in a probability-based internet panel, the Understanding America Study, and analyzed. Participants provided positive and negative affect ratings using 3 ILA methods: (1) smartphone-based EMA, administered 6 times per day over 1 week, (2) web-based EOD diaries, administered daily over the same week, and (3) web-based DRM, administered once during that week. We calculated 11 measures of emotion dynamics (addressing mean levels, variability, instability, and inertia separately for positive and negative affect, as well as emotion network density, mixed emotions, and emotional dialecticism) from each ILA method. The analyses examined mean differences and correlations of scores addressing the same emotion dynamic across the ILA methods. We also compared the patterns of intercorrelations among the emotion dynamics and their relationships with health outcomes (general health, pain, and fatigue) across ILA methods. Results: Emotion dynamics derived from EMAs and EOD diaries demonstrated moderate-to-high correspondence for measures of mean emotion levels (??0.95), variability (??0.68), instability (??0.51), mixed emotions (?=0.92), and emotional dialecticism (?=0.57), and low correspondence for measures of inertia (??0.17) and emotion network density (?=0.36). DRM-derived measures showed correlations with EMAs and EOD diaries that were high for mean emotion levels and mixed emotions (??0.74), moderate for variability (?=0.38-.054), and low to moderate for other measures (?=0.03-0.41). Intercorrelations among the emotion dynamics showed high convergence across EMAs and EOD diaries, and moderate convergence between the DRM and EMAs as well as EOD diaries. Emotion dynamics from all 3 ILA methods produced very similar patterns of relationships with health outcomes. Conclusions: EMAs and EOD diaries provide corresponding information about individual differences in various emotion dynamics, whereas the DRM provides corresponding information about emotion levels and (to a lesser extent) variability, but not about more complex emotion dynamics. Our results caution researchers against viewing these ILA methods as universally interchangeable. UR - http://www.jmir.org/2020/9/e19201/ UR - http://dx.doi.org/10.2196/19201 UR - http://www.ncbi.nlm.nih.gov/pubmed/32969835 ID - info:doi/10.2196/19201 ER - TY - JOUR AU - Campbell, M. Laura AU - Paolillo, W. Emily AU - Heaton, Anne AU - Tang, Bin AU - Depp, A. Colin AU - Granholm, Eric AU - Heaton, K. Robert AU - Swendsen, Joel AU - Moore, J. David AU - Moore, C. Raeanne PY - 2020/9/24 TI - Daily Activities Related to Mobile Cognitive Performance in Middle-Aged and Older Adults: An Ecological Momentary Cognitive Assessment Study JO - JMIR Mhealth Uhealth SP - e19579 VL - 8 IS - 9 KW - ecological momentary assessment KW - daily functioning KW - telemedicine KW - digital health KW - neuropsychological test KW - cognition KW - HIV KW - aging KW - mobile phone N2 - Background: Daily activities have been associated with neurocognitive performance. However, much of this research has used in-person neuropsychological testing that requires participants to travel to a laboratory or clinic, which may not always be feasible and does not allow for the examination of real-time relationships between cognition and behavior. Thus, there is a need to understand the real-time relationship between activities in the real world and neurocognitive functioning to improve tracking of symptoms or disease states and aid in the early identification of neurocognitive deficits among at-risk individuals. Objective: We used a smartphone-based ecological momentary cognitive assessment (EMCA) platform to examine real-time relationships between daily activities and neurocognitive performance (executive functioning and verbal learning) in the everyday environment of middle-aged and older adults with and without HIV. Methods: A total of 103 adults aged 50-74 years (67 persons with HIV; mean age 59 years, SD 6.4) were recruited from the University of California, San Diego HIV Neurobehavioral Research Program and the San Diego community. Participants completed our EMCA protocol for 14 days. Participants reported their current daily activities 4 times per day; following 2 of the 4 daily ecological momentary assessment (EMA) surveys, participants were administered the mobile Color-Word Interference Test (mCWIT) and mobile Verbal Learning Test (mVLT), each once per day. Activities were categorized into cognitively stimulating activities, passive leisure activities, and instrumental activities of daily living (IADLs). We used multilevel modeling to examine the same-survey and lagged within-person and between-person effects of each activity type on mobile cognitive performance. Results: On average, participants completed 91% of the EMA surveys, 85% of the mCWIT trials, and 80% of the mVLT trials, and they reported engaging in cognitively stimulating activities on 17% of surveys, passive leisure activities on 33% of surveys, and IADLs on 20% of surveys. Adherence and activity percentages did not differ by HIV status. Within-persons, engagement in cognitively stimulating activities was associated with better mCWIT performance (?=?1.12; P=.007), whereas engagement in passive leisure activities was associated with worse mCWIT performance (?=.94; P=.005). There were no lagged associations. At the aggregate between-person level, a greater percentage of time spent in cognitively stimulating activities was associated with better mean mVLT performance (?=.07; P=.02), whereas a greater percentage of time spent in passive leisure activities was associated with worse mean mVLT performance (?=?.07; P=.01). IADLs were not associated with mCWIT or mVLT performance. Conclusions: Smartphones present unique opportunities for assessing neurocognitive performance and behavior in middle-aged and older adults? own environment. Measurement of cognition and daily functioning outside of clinical settings may generate novel insights on the dynamic association of daily behaviors and neurocognitive performance and may add new dimensions to understanding the complexity of human behavior. UR - http://mhealth.jmir.org/2020/9/e19579/ UR - http://dx.doi.org/10.2196/19579 UR - http://www.ncbi.nlm.nih.gov/pubmed/32969829 ID - info:doi/10.2196/19579 ER - TY - JOUR AU - Ryan, Ann Kelly AU - Babu, Pallavi AU - Easter, Rebecca AU - Saunders, Erika AU - Lee, Jinseok Andy AU - Klasnja, Predrag AU - Verchinina, Lilia AU - Micol, Valerie AU - Doil, Brent AU - McInnis, G. Melvin AU - Kilbourne, M. Amy PY - 2020/9/22 TI - A Smartphone App to Monitor Mood Symptoms in Bipolar Disorder: Development and Usability Study JO - JMIR Ment Health SP - e19476 VL - 7 IS - 9 KW - bipolar disorder KW - momentary assessment KW - mood KW - mobile phone KW - mobile app N2 - Background: There is considerable scientific interest in finding new and innovative ways to capture rapid fluctuations in functioning within individuals with bipolar disorder (BD), a severe, recurrent mental disorder associated with frequent shifts in symptoms and functioning. The use of smartphones can provide valid and real-world tools for use in measurement-based care and could be used to inform more personalized treatment options for this group, which can improve standard of care. Objective: We examined the feasibility and usability of a smartphone to capture daily fluctuations in mood within BD and to relate daily self-rated mood to smartphone use behaviors indicative of psychomotor activity or symptoms of the illness. Methods: Participants were 26 individuals with BD and 12 healthy control individuals who were recruited from the Prechter Longitudinal Study of BD. All were given a smartphone with a custom-built app and prompted twice a day to complete questions of mood for 28 days. The app automatically and unobtrusively collected phone usage data. A poststudy satisfaction survey was also completed. Results: Our sample showed a very high adherence rate to the daily momentary assessments (91% of the 58 prompts completed). Multivariate mixed effect models showed that an increase in rapid thoughts over time was associated with a decrease in outgoing text messages (?=?.02; P=.04), and an increase in impulsivity self-ratings was related to a decrease in total call duration (?=?.29; P=.02). Participants generally reported positive experiences using the smartphone and completing daily prompts. Conclusions: Use of mobile technology shows promise as a way to collect important clinical information that can be used to inform treatment decision making and monitor outcomes in a manner that is not overly burdensome to the patient or providers, highlighting its potential use in measurement-based care. UR - http://mental.jmir.org/2020/9/e19476/ UR - http://dx.doi.org/10.2196/19476 UR - http://www.ncbi.nlm.nih.gov/pubmed/32960185 ID - info:doi/10.2196/19476 ER - TY - JOUR AU - Giurgiu, Marco AU - Niermann, Christina AU - Ebner-Priemer, Ulrich AU - Kanning, Martina PY - 2020/9/15 TI - Accuracy of Sedentary Behavior?Triggered Ecological Momentary Assessment for Collecting Contextual Information: Development and Feasibility Study JO - JMIR Mhealth Uhealth SP - e17852 VL - 8 IS - 9 KW - sedentariness KW - Ecological Momentary Assessment KW - accelerometry KW - mHealth KW - context N2 - Background: Sedentary behavior has received much attention in the scientific community over the past decade. There is growing evidence that sedentary behavior is negatively associated with physical and mental health. However, an in-depth understanding of the social and environmental context of sedentary behavior is missing. Information about sedentary behavior, such as how everyday sedentary behavior occurs throughout the day (eg, number and length of sedentary bouts), where, when, and with whom it takes place, and what people are doing while being sedentary, is useful to inform the development of interventions aimed at reducing sedentary time. However, examining everyday sedentary behavior requires specific methods. Objective: The purpose of this paper is (1) to introduce sedentary behavior?triggered Ecological Momentary Assessment (EMA) as a methodological advancement in the field of sedentary behavior research and (2) to examine the accuracy of sedentary behavior?triggered EMA in 3 different studies in healthy adults. Moreover, we compare the accuracy of sedentary behavior?triggered EMA to simulations of random-trigger designs. Methods: Sedentary behavior?triggered EMA comprises a continuous assessment of sedentary behavior via accelerometers and repeated contextual assessments via electronic diaries (ie, an application on a smartphone). More specifically, the accelerometer analyzes and transfers data regarding body position (a sitting or lying position, or an upright position) via Bluetooth Low Energy (BLE) to a smartphone in real time and triggers the deployment of questionnaires. Each time a participant spends a specified time (eg, 20 minutes) in a sedentary position, the e-diary triggers contextual assessments. To test the accuracy of this method, we calculated a percentage score for all triggered prompts in relation to the total number of bouts that could trigger a prompt. Results: Based on the accelerometer recordings, 29.3% (5062/17278) of all sedentary bouts were classified as moderate-to-long (20-40 minutes) and long bouts (? 41 minutes). On average, the accuracy by participant was 82.77% (3339/4034; SD 21.01%, range 71.00-88.22%) on the study level. Compared to simulations of random prompts (every 120 minutes), the number of triggered prompts was up to 47.9% (n=704) higher through the sedentary behavior?triggered EMA approach. Nearly 40% (799/2001) of all prolonged sedentary bouts (? 20 minutes) occurred during work, and in 57% (1140/2001) of all bouts, the participants were not alone. Conclusions: Sedentary behavior?triggered EMA is an accurate method for collecting contextual information on sedentary behavior in daily life. Given the growing interest in sedentary behavior research, this sophisticated approach offers a real advancement as it can be used to collect social and environmental contextual information or to unravel dynamic associations. Furthermore, it can be modified to develop sedentary behavior?triggered mHealth interventions. UR - http://mhealth.jmir.org/2020/9/e17852/ UR - http://dx.doi.org/10.2196/17852 UR - http://www.ncbi.nlm.nih.gov/pubmed/32930668 ID - info:doi/10.2196/17852 ER - TY - JOUR AU - Berrocal, Allan AU - Concepcion, Waldo AU - De Dominicis, Stefano AU - Wac, Katarzyna PY - 2020/8/7 TI - Complementing Human Behavior Assessment by Leveraging Personal Ubiquitous Devices and Social Links: An Evaluation of the Peer-Ceived Momentary Assessment Method JO - JMIR Mhealth Uhealth SP - e15947 VL - 8 IS - 8 KW - peer-ceived momentary assessment KW - PeerMA KW - ecological momentary assessment KW - EMA KW - human state assessment KW - behavior modeling KW - human-smartphone interaction KW - digital health KW - well-being KW - mobile phone N2 - Background: Ecological momentary assessment (EMA) enables individuals to self-report their subjective momentary physical and emotional states. However, certain conditions, including routine observable behaviors (eg, moods, medication adherence) as well as behaviors that may suggest declines in physical or mental health (eg, memory losses, compulsive disorders) cannot be easily and reliably measured via self-reports. Objective: This study aims to examine a method complementary to EMA, denoted as peer-ceived momentary assessment (PeerMA), which enables the involvement of peers (eg, family members, friends) to report their perception of the individual?s subjective physical and emotional states. In this paper, we aim to report the feasibility results and identified human factors influencing the acceptance and reliability of the PeerMA Methods: We conducted two studies of 4 weeks each, collecting self-reports from 20 participants about their stress, fatigue, anxiety, and well-being, in addition to collecting peer-reported perceptions from 27 of their peers. Results: Preliminary results showed that some of the peers reported daily assessments for stress, fatigue, anxiety, and well-being statistically equal to those reported by the participant. We also showed how pairing assessments of participants and peers in time enables a qualitative and quantitative exploration of unique research questions not possible with EMA-only based assessments. We reported on the usability and implementation aspects based on the participants? experience to guide the use of the PeerMA to complement the information obtained via self-reports for observable behaviors and physical and emotional states among healthy individuals. Conclusions: It is possible to leverage the PeerMA method as a complement to EMA to assess constructs that fall in the realm of observable behaviors and states in healthy individuals. UR - https://mhealth.jmir.org/2020/8/e15947 UR - http://dx.doi.org/10.2196/15947 UR - http://www.ncbi.nlm.nih.gov/pubmed/32763876 ID - info:doi/10.2196/15947 ER - TY - JOUR AU - Elliston, G. Katherine AU - Schüz, Benjamin AU - Albion, Tim AU - Ferguson, G. Stuart PY - 2020/7/22 TI - Comparison of Geographic Information System and Subjective Assessments of Momentary Food Environments as Predictors of Food Intake: An Ecological Momentary Assessment Study JO - JMIR Mhealth Uhealth SP - e15948 VL - 8 IS - 7 KW - ecological momentary assessment KW - mHealth KW - geographic information systems KW - food intake KW - mobile phone N2 - Background: It has been observed that eating is influenced by the presence and availability of food. Being aware of the presence of food in the environment may enable mobile health (mHealth) apps to use geofencing techniques to determine the most appropriate time to proactively deliver interventions. To date, however, studies on eating typically rely on self-reports of environmental contexts, which may not be accurate or feasible for issuing mHealth interventions. Objective: This study aimed to compare the subjective and geographic information system (GIS) assessments of the momentary food environment to explore the feasibility of using GIS data to predict eating behavior and inform geofenced interventions. Methods: In total, 72 participants recorded their food intake in real-time for 14 days using an ecological momentary assessment approach. Participants logged their food intake and responded to approximately 5 randomly timed assessments each day. During each assessment, the participants reported the number and type of food outlets nearby. Their electronic diaries simultaneously recorded their GPS coordinates. The GPS data were later overlaid with a GIS map of food outlets to produce an objective count of the number of food outlets within 50 m of the participant. Results: Correlations between self-reported and GIS counts of food outlets within 50 m were only of a small size (r=0.17; P<.001). Logistic regression analyses revealed that the GIS count significantly predicted eating similar to the self-reported counts (area under the curve for the receiver operating characteristic curve [AUC-ROC] self-report=0.53, SE 0.00 versus AUC-ROC 50 m GIS=0.53, SE 0.00; P=.41). However, there was a significant difference between the GIS-derived and self-reported counts of food outlets and the self-reported type of food outlets (AUC-ROC self-reported outlet type=0.56, SE 0.01; P<.001). Conclusions: The subjective food environment appears to predict eating better than objectively measured food environments via GIS. mHealth apps may need to consider the type of food outlets rather than the raw number of outlets in an individual?s environment. UR - https://mhealth.jmir.org/2020/7/e15948 UR - http://dx.doi.org/10.2196/15948 UR - http://www.ncbi.nlm.nih.gov/pubmed/32706728 ID - info:doi/10.2196/15948 ER - TY - JOUR AU - Yang, Sook Yong AU - Ryu, Wook Gi AU - Delespaul, G. Philippe A. E. AU - Choi, Mona PY - 2020/7/21 TI - Psychometric Properties of the Korean Version of the PsyMate Scale Using a Smartphone App: Ecological Momentary Assessment Study JO - JMIR Mhealth Uhealth SP - e17926 VL - 8 IS - 7 KW - psychometrics KW - reliability KW - validity KW - PsyMate scale KW - ecological momentary assessment N2 - Background: Ecological momentary assessment (EMA) is a method for capturing the changes in the variables in daily life with increased accuracy and decreased recall bias. The PsyMate scale assesses momentary moods in daily life and can be used in various settings. Objective: The aim of this study was to develop a Korean version of the PsyMate (K-PsyMate) scale and evaluate its psychometric properties by using the EMA method in patients with moyamoya disease (MMD) in South Korea. Methods: Patients with MMD aged over 18 years were recruited from July 2018 to January 2019 at the inpatient and outpatient departments of a university hospital in South Korea. The K-PsyMate scale comprising 13 items was developed following a translation/back translation approach of the English version and loaded onto a mobile app. Participants were instructed to enter their moods 4 times a day for 7 consecutive days. Content validity index, factor analysis, and Pearson?s correlation were performed for validity analysis. For reliability, intraclass correlation coefficients between the first and last measurements were estimated by mean rating, absolute agreement, and a 2-way mixed-effects model. Usability was analyzed through a descriptive analysis, 2-tailed t test, and analysis of variance, and the results were confirmed by Mann-Whitney U test and the Kruskal-Wallis test, as the dependent variable was not normally distributed. Results: In total, 1929 assessments from 93 patients were analyzed. The mean age of the participants was 40.59 (SD 10.06) years, and 66 (71%) of the 93 participants were women. Content validity was excellent as content validity index was 0.99, and 2 factors, negative affect and positive affect, were derived by an exploratory factor analysis. The correlations between the subdomains of the K-PsyMate scale and Hospital Anxiety and Depression Scale were significant (P<.001). The agreement between the first and last measurements was poor to moderate according to the obtained intraclass correlation coefficient values. Usability was evaluated by 67 (72%) out of the 93 participants. The participants rated the accuracy of assessing their momentary moods on the app at 4.13 (SD 0.97), easiness in understanding questions, operating, and inputting answers at 4.12 (SD 0.88), and interruption by the survey alarms at 2.48 (SD 1.02) out of 5. Conclusions: The K-PsyMate scale has good validity but poor to moderate agreement, which reflects the characteristics of the EMA data collected in real and natural living environments without control. The findings of our study show that the K-PsyMate scale uploaded in a mobile app can be a valid and reliable tool for evaluating the momentary mood of patients with MMD because using a mobile app is convenient and patients are familiar with their own smartphones, which they use in their daily lives. UR - http://mhealth.jmir.org/2020/7/e17926/ UR - http://dx.doi.org/10.2196/17926 UR - http://www.ncbi.nlm.nih.gov/pubmed/32706707 ID - info:doi/10.2196/17926 ER - TY - JOUR AU - Niks, MW Irene AU - van Drongelen, Alwin AU - de Korte, M. Elsbeth PY - 2020/7/14 TI - Promoting Employees? Recovery During Shift Work: Protocol for a Workplace Intervention Study JO - JMIR Res Protoc SP - e17368 VL - 9 IS - 7 KW - shift work KW - recovery during work KW - fatigue KW - intervention study KW - participatory action research KW - ecological momentary assessment KW - mobile phone N2 - Background: Shift work can be demanding owing to disturbances in the biological and social rhythms. This can cause short-term negative effects in employees, such as increased fatigue and reduced alertness. A potential way to counteract these negative effects is to enhance employees? recovery from work during working hours. Objective: The aim of this study is to develop and implement an intervention that focuses on promoting ?on-job? recovery of shift workers. Methods: This study is performed in 2 department units with shift workers at a multinational company in the steel industry. For each department, an intervention will be developed and implemented through an iterative process of user-centered design and evaluation. This approach consists of various sessions in which employees and a project group (ie, researchers, line managers, human resource managers, and occupational health experts) provide input on the intervention content and implementation. Intervention effects will be evaluated using pretest and posttest web-based surveys. Digital ecological momentary assessment will be performed to gain insight into the link between the intervention and daily within-person processes. The intervention process and participants? perception of the interventions will be assessed through a process evaluation. Intervention results will be analyzed by performing mixed model repeated measures analyses and multilevel analyses. Results: This study is supported by the Netherlands Organization for Applied Scientific Research Work and Health Research Program, which is funded by the Ministry of Economic Affairs and supported by the Dutch Ministry of Social Affairs and Employment, program number 19.204.1-3. This study was approved by the institutional review board on February 7, 2019. From June to August 2019, baseline data were collected, and from November to December 2019, the first follow-up data were collected. The second follow-up data collection and data analysis are planned for the first two quarters of 2020. Dissemination of the results is planned for the last two quarters of 2020. Conclusions: A strength of this study design is the participatory action approach to enhance the stakeholder commitments, intervention adherence, and compliance. Moreover, since the target group will be participating in the development and implementation of the intervention, the proposed impact will be high. In addition, the short-term as well as the long-term effects will be evaluated. Finally, this study uses a unique combination of quantitative and qualitative evaluation methods. A limitation of this study is that it is impossible to randomly assign participants to an intervention or control group. Furthermore, the follow-up period (6 months) might be too short to establish health-related effects. Lastly, the results of this study might be specific to the department, organization, or sector, which limits the generalizability of the findings. However, as workplace intervention research for shift workers is scarce, this study might serve as a starting point for future research on shift work interventions. UR - https://www.researchprotocols.org/2020/7/e17368 UR - http://dx.doi.org/10.2196/17368 UR - http://www.ncbi.nlm.nih.gov/pubmed/32459635 ID - info:doi/10.2196/17368 ER - TY - JOUR AU - Potts, Courtney AU - Bond, Raymond AU - Ryan, Assumpta AU - Mulvenna, Maurice AU - McCauley, Claire AU - Laird, Elizabeth AU - Goode, Deborah PY - 2020/7/6 TI - Ecological Momentary Assessment Within a Digital Health Intervention for Reminiscence in Persons With Dementia and Caregivers: User Engagement Study JO - JMIR Mhealth Uhealth SP - e17120 VL - 8 IS - 7 KW - ecological momentary assessment KW - EMA KW - app KW - behaviour analytics KW - event logging KW - dementia KW - carers KW - reminiscence KW - reminiscing KW - mHealth N2 - Background: User-interaction event logs provide rich and large data sets that can provide valuable insights into how people engage with technology. Approaches such as ecological momentary assessment (EMA) can be used to gather accurate real-time data in an individual?s natural environment by asking questions at any given instant. Objective: The purpose of this study was to evaluate user engagement and responses to EMA questions using InspireD, an app used for reminiscence by persons with dementia and their caregivers. Research findings can be used to inform EMA use within digital health interventions. Methods: A feasibility trial was conducted in which participants (n=56) used the InspireD app over a 12-week period. Participants were a mean age of 73 (SD 13) and were either persons with dementia (n=28) or their caregivers (n=28). Questions, which they could either answer or choose to dismiss, were presented to participants at various instants after reminiscence with personal or generic photos, videos, and music. Presentation and dismissal rates for questions were compared by hour of the day and by trial week to investigate user engagement. Results: Overall engagement was high, with 69.1% of questions answered when presented. Questions that were presented in the evening had the lowest dismissal rate; the dismissal rate for questions presented at 9 PM was significantly lower than the dismissal rate for questions presented at 11 AM (9 PM: 10%; 11 AM: 50%; ?21=21.4, P<.001). Questions asked following reminiscence with personal media, especially those asked after personal photos, were less likely to be answered compared to those asked after other media. In contrast, questions asked after the user had listened to generic media, in particular those asked after generic music, were much more likely to be answered. Conclusions: The main limitation of our study was the lack of generalizability of results to a larger population given the quasi-experimental design and older demographic where half of participants were persons with dementia; however, this study shows that older people are willing to participate and engage in EMA. Based on this study, we propose a series of recommendations for app design to increase user engagement with EMA. These include presenting questions no more than once per day, after 8 PM in the evening, and only if the user is not trying to complete a task within the app. UR - https://mhealth.jmir.org/2020/7/e17120 UR - http://dx.doi.org/10.2196/17120 UR - http://www.ncbi.nlm.nih.gov/pubmed/32420890 ID - info:doi/10.2196/17120 ER - TY - JOUR AU - Langer, L. Shelby AU - Ghosh, Neeta AU - Todd, Michael AU - Randall, K. Ashley AU - Romano, M. Joan AU - Bricker, B. Jonathan AU - Bolger, Niall AU - Burns, W. John AU - Hagan, C. Rachel AU - Porter, S. Laura PY - 2020/7/6 TI - Usability and Acceptability of a Smartphone App to Assess Partner Communication, Closeness, Mood, and Relationship Satisfaction: Mixed Methods Study JO - JMIR Form Res SP - e14161 VL - 4 IS - 7 KW - ecological momentary assessment KW - smartphone KW - mobile phone KW - communication KW - disclosure KW - affect N2 - Background: Interpersonal communication is critical for a healthy romantic relationship. Emotional disclosure, coupled with perceived partner responsiveness, fosters closeness and adjustment (better mood and relationship satisfaction). On the contrary, holding back from disclosure is associated with increased distress and decreased relationship satisfaction. Prior studies assessing these constructs have been cross-sectional and have utilized global retrospective reports of communication. In addition, studies assessing holding back or perceived partner responsiveness have not taken advantage of smartphone ownership for data collection and have instead required website access or use of a study-provided device. Objective: This study aimed to examine the (1) usability and acceptability of a smartphone app designed to assess partner communication, closeness, mood, and relationship satisfaction over 14 days and (2) between-person versus within-person variability of key constructs to inform the utility of their capture via ecological momentary assessment using the participants? own handheld devices. Methods: Adult community volunteers in a married or cohabiting partnered relationship received 2 smartphone prompts per day, one in the afternoon and one in the evening, for 14 days. In each prompt, participants were asked whether they had conversed with their partner either since awakening (afternoon prompt) or since the last assessment (evening prompt). If yes, a series of items assessed enacted communication, perceived partner communication, closeness, mood, and relationship satisfaction (evening only). Participants were interviewed by phone, 1 week after the end of the 14-day phase, to assess perceptions of the app. Content analysis was employed to identify key themes. Results: Participants (N=27; mean age 36, SD 12 years; 24/27, 89% female; 25/27, 93% white and 2/27, 7% Hispanic) responded to 79.2% (555/701) of the total prompts sent and completed 553 (78.9%) of those assessments. Of the responded prompts, 79.3% (440/555) were characterized by a report of having conversed with one?s partner. The app was seen as highly convenient (mean 4.15, SD 0.78, scale: 1-5) and easy to use (mean 4.39, SD 0.70, scale: 1-5). Qualitative analyses indicated that participants found the app generally easy to navigate, but the response window too short (45 min) and the random nature of receiving notifications vexing. With regard to the variability of the app-delivered items, intraclass correlation coefficients were generally <0.40, indicating that the majority of the variability in each measure was at the within-person level. Notable exceptions were enacted disclosure and relationship satisfaction. Conclusions: The findings of this study support the usability and acceptability of the app, with valuable user input to modify timing windows in future work. The findings also underscore the utility of an intensive repeated-measures approach, given the meaningful day-to-day variation (greater within-person vs between-person variability) in communication and mood. UR - https://formative.jmir.org/2020/7/e14161 UR - http://dx.doi.org/10.2196/14161 UR - http://www.ncbi.nlm.nih.gov/pubmed/32628614 ID - info:doi/10.2196/14161 ER - TY - JOUR AU - Nichols, Michelle AU - Miller, Sarah AU - Treiber, Frank AU - Ruggiero, Kenneth AU - Dawley, Erin AU - Teufel II, Ronald PY - 2020/7/3 TI - Patient and Parent Perspectives on Improving Pediatric Asthma Self-Management Through a Mobile Health Intervention: Pilot Study JO - JMIR Form Res SP - e15295 VL - 4 IS - 7 KW - asthma KW - mobile health KW - ecological momentary assessment KW - adolescents KW - medication adherence KW - self-management KW - mobile phone N2 - Background: Asthma is a common chronic pediatric disease that can negatively impact children and families. Self-management strategies are challenging to adopt but critical for achieving positive outcomes. Mobile health technology may facilitate self-management of pediatric asthma, especially as adolescents mature and assume responsibility for their disease. Objective: This study aimed to explore the perceptions of youths with high-risk asthma and their caregivers on the use of a smartphone app, Smartphone Asthma Management System, in the prevention and treatment of asthma symptoms, possible use of the app to improve self-management of asthma outside traditional clinical settings, and the impact of asthma on everyday life to identify potential needs for future intervention development. Methods: Key informant interviews were completed with parent-child dyads post participation in an asthma management feasibility intervention study to explore the perceptions of users on a smartphone app designed to monitor symptoms and medication use and offer synchronous and asynchronous provider encounters. A thematic qualitative analysis was conducted inductively through emergent findings and deductively based on the self-determination theory (SDT), identifying 4 major themes. Results: A total of 19 parent-child dyads completed the postintervention interviews. The major themes identified included autonomy, competence, relatedness, and the impact of asthma on life. The participants also shared their perceptions of the benefits and challenges associated with using the app and in the self-management of asthma. Both children and parents conveyed a preference for using technology to facilitate medication and disease management, and children demonstrated a strong willingness and ability to actively engage in their care. Conclusions: Our study included support for the app and demonstrated the feasibility of enhancing the self-management of asthma by youth in the community. Participant feedback led to intervention refinement and app improvements, and the use of the SDT allowed insight into motivational drivers of behavioral change. The use of mobile apps among high-risk children with asthma and their parents shows promise in improving self-management, medication adherence, and disease awareness and in reducing overall disease morbidity. UR - https://formative.jmir.org/2020/7/e15295 UR - http://dx.doi.org/10.2196/15295 UR - http://www.ncbi.nlm.nih.gov/pubmed/32442127 ID - info:doi/10.2196/15295 ER - TY - JOUR AU - Pryss, Rüdiger AU - Schlee, Winfried AU - Hoppenstedt, Burkhard AU - Reichert, Manfred AU - Spiliopoulou, Myra AU - Langguth, Berthold AU - Breitmayer, Marius AU - Probst, Thomas PY - 2020/6/30 TI - Applying Machine Learning to Daily-Life Data From the TrackYourTinnitus Mobile Health Crowdsensing Platform to Predict the Mobile Operating System Used With High Accuracy: Longitudinal Observational Study JO - J Med Internet Res SP - e15547 VL - 22 IS - 6 KW - mHealth KW - crowdsensing KW - tinnitus KW - machine learning KW - mobile operating system differences KW - ecological momentary assessment KW - mobile phone N2 - Background: Tinnitus is often described as the phantom perception of a sound and is experienced by 5.1% to 42.7% of the population worldwide, at least once during their lifetime. The symptoms often reduce the patient?s quality of life. The TrackYourTinnitus (TYT) mobile health (mHealth) crowdsensing platform was developed for two operating systems (OS)?Android and iOS?to help patients demystify the daily moment-to-moment variations of their tinnitus symptoms. In all platforms developed for more than one OS, it is important to investigate whether the crowdsensed data predicts the OS that was used in order to understand the degree to which the OS is a confounder that is necessary to consider. Objective: In this study, we explored whether the mobile OS?Android and iOS?used during user assessments can be predicted by the dynamic daily-life TYT data. Methods: TYT mainly applies the paradigms ecological momentary assessment (EMA) and mobile crowdsensing to collect dynamic EMA (EMA-D) daily-life data. The dynamic daily-life TYT data that were analyzed included eight questions as part of the EMA-D questionnaire. In this study, 518 TYT users were analyzed, who each completed at least 11 EMA-D questionnaires. Out of these, 221 were iOS users and 297 were Android users. The iOS users completed, in total, 14,708 EMA-D questionnaires; the number of EMA-D questionnaires completed by the Android users was randomly reduced to the same number to properly address the research question of the study. Machine learning methods?a feedforward neural network, a decision tree, a random forest classifier, and a support vector machine?were applied to address the research question. Results: Machine learning was able to predict the mobile OS used with an accuracy up to 78.94% based on the provided EMA-D questionnaires on the assessment level. In this context, the daily measurements regarding how users concentrate on the actual activity were particularly suitable for the prediction of the mobile OS used. Conclusions: In the work at hand, two particular aspects have been revealed. First, machine learning can contribute to EMA-D data in the medical context. Second, based on the EMA-D data of TYT, we found that the accuracy in predicting the mobile OS used has several implications. Particularly, in clinical studies using mobile devices, the OS should be assessed as a covariate, as it might be a confounder. UR - http://www.jmir.org/2020/6/e15547/ UR - http://dx.doi.org/10.2196/15547 UR - http://www.ncbi.nlm.nih.gov/pubmed/32602842 ID - info:doi/10.2196/15547 ER - TY - JOUR AU - Gatsios, Dimitris AU - Antonini, Angelo AU - Gentile, Giovanni AU - Marcante, Andrea AU - Pellicano, Clelia AU - Macchiusi, Lucia AU - Assogna, Francesca AU - Spalletta, Gianfranco AU - Gage, Heather AU - Touray, Morro AU - Timotijevic, Lada AU - Hodgkins, Charo AU - Chondrogiorgi, Maria AU - Rigas, George AU - Fotiadis, I. Dimitrios AU - Konitsiotis, Spyridon PY - 2020/6/29 TI - Feasibility and Utility of mHealth for the Remote Monitoring of Parkinson Disease: Ancillary Study of the PD_manager Randomized Controlled Trial JO - JMIR Mhealth Uhealth SP - e16414 VL - 8 IS - 6 KW - Parkinson's disease KW - determinants of compliance KW - clinically meaningful data KW - ecological validity N2 - Background: Mobile health, predominantly wearable technology and mobile apps, have been considered in Parkinson disease to provide valuable ecological data between face-to-face visits and improve monitoring of motor symptoms remotely. Objective: We explored the feasibility of using a technology-based mHealth platform comprising a smartphone in combination with a smartwatch and a pair of smart insoles, described in this study as the PD_manager system, to collect clinically meaningful data. We also explored outcomes and disease-related factors that are important determinants to establish feasibility. Finally, we further validated a tremor evaluation method with data collected while patients performed their daily activities. Methods: PD_manager trial was an open-label parallel group randomized study.The mHealth platform consists of a wristband, a pair of sensor insoles, a smartphone (with dedicated mobile Android apps) and a knowledge platform serving as the cloud backend. Compliance was assessed with statistical analysis and the factors affecting it using appropriate regression analysis. The correlation of the scores of our previous algorithm for tremor evaluation and the respective Unified Parkinson?s Disease Rating Scale estimations by clinicians were explored. Results: Of the 75 study participants, 65 (87%) completed the protocol. They used the PD_manager system for a median 11.57 (SD 3.15) days. Regression analysis suggests that the main factor associated with high use was caregivers? burden. Motor Aspects of Experiences of Daily Living and patients? self-rated health status also influence the system?s use. Our algorithm provided clinically meaningful data for the detection and evaluation of tremor. Conclusions: We found that PD patients, regardless of their demographics and disease characteristics, used the system for 11 to 14 days. The study further supports that mHealth can be an effective tool for the ecologically valid, passive, unobtrusive monitoring and evaluation of symptoms. Future studies will be required to demonstrate that an mHealth platform can improve disease management and care. Trial Registration: ISRCTN Registry ISRCTN17396879; http://www.isrctn.com/ISRCTN17396879 International Registered Report Identifier (IRRID): RR2-10.1186/s13063-018-2767-4 UR - https://mhealth.jmir.org/2020/6/e16414 UR - http://dx.doi.org/10.2196/16414 UR - http://www.ncbi.nlm.nih.gov/pubmed/32442154 ID - info:doi/10.2196/16414 ER - TY - JOUR AU - Swendeman, Dallas AU - Sumstine, Stephanie AU - Brink, Amber AU - Mindry, Deborah AU - Medich, Melissa AU - Russell, Michael PY - 2020/6/23 TI - Smartphone Self-Monitoring by Young Adolescents and Parents to Assess and Improve Family Functioning: Qualitative Feasibility Study JO - JMIR Form Res SP - e15777 VL - 4 IS - 6 KW - adolescents KW - parenting KW - conflict KW - self-monitoring KW - smartphones KW - mHealth KW - ecological momentary assessment KW - mobile phone N2 - Background: The natural integration of mobile phones into the daily routines of families provides novel opportunities to study and support family functioning and the quality of interactions between family members in real time. Objective: This study aimed to examine user experiences of feasibility, acceptability, and reactivity (ie, changes in awareness and behaviors) of using a smartphone app for self-monitoring of family functioning with 36 participants across 15 family dyads and triads of young adolescents aged 10 to 14 years and their parents. Methods: Participants were recruited from 2 family wellness centers in a middle-to-upper income shopping area and a low-income school site. Participants were instructed and prompted by alarms to complete ecological momentary assessments (EMAs) by using a smartphone app over 2 weeks 4 times daily (upon waking in the morning, afternoon, early evening, and end of day at bedtime). The domains assessed included parental monitoring and positive parenting, parent involvement and discipline, parent-child conflict and resolution, positive interactions and support, positive and negative affect, sleep, stress, family meals, and general child and family functioning. Qualitative interviews assessed user experiences generally and with prompts for positive and negative feedback. Results: The participants were primarily white and Latino of mixed-income- and education levels. Children were aged 10 to 14 years, and parents had a mean age of 45 years (range 37-50). EMA response rates were high (95% to over 100%), likely because of cash incentives for EMA completion, engaging content per user feedback, and motivated sample from recruitment sites focused on social-emotional programs for family wellness. Some participants responded for up to 19 days, consistent with some user experience interview feedback of desires to continue participation for up to 3 or 4 weeks. Over 80% (25/31) of participants reported increased awareness of their families? daily routines and functioning of their families. Most also reported positive behavior changes in the following domains: decision making, parental monitoring, quantity and quality of time together, communication, self-regulation of stress and conflict, discipline, and sleep. Conclusions: The results of this study support the feasibility and acceptability of using smartphone EMA by young adolescents and parents for assessing and self-monitoring family daily routines and interactions. The findings also suggest that smartphone self-monitoring may be a useful tool to support improvement in family functioning through functions of reflection on antecedents and consequences of situations, prompting positive and negative alternatives, seeding goals, and reinforcement by self-tracking for self-correction and self-rewards. Future studies should include larger samples with more diverse and higher-risk populations, longer study durations, the inclusion of passive phone sensors and peripheral biometric devices, and integration with counseling and parenting interventions and programs. UR - http://formative.jmir.org/2020/6/e15777/ UR - http://dx.doi.org/10.2196/15777 UR - http://www.ncbi.nlm.nih.gov/pubmed/32574148 ID - info:doi/10.2196/15777 ER - TY - JOUR AU - Huckins, F. Jeremy AU - daSilva, W. Alex AU - Wang, Weichen AU - Hedlund, Elin AU - Rogers, Courtney AU - Nepal, K. Subigya AU - Wu, Jialing AU - Obuchi, Mikio AU - Murphy, I. Eilis AU - Meyer, L. Meghan AU - Wagner, D. Dylan AU - Holtzheimer, E. Paul AU - Campbell, T. Andrew PY - 2020/6/17 TI - Mental Health and Behavior of College Students During the Early Phases of the COVID-19 Pandemic: Longitudinal Smartphone and Ecological Momentary Assessment Study JO - J Med Internet Res SP - e20185 VL - 22 IS - 6 KW - COVID-19 KW - depression KW - anxiety KW - mobile sensing KW - sedentary KW - phone usage KW - mental health KW - behavior KW - pandemic KW - app N2 - Background: The vast majority of people worldwide have been impacted by coronavirus disease (COVID-19). In addition to the millions of individuals who have been infected with the disease, billions of individuals have been asked or required by local and national governments to change their behavioral patterns. Previous research on epidemics or traumatic events suggests that this can lead to profound behavioral and mental health changes; however, researchers are rarely able to track these changes with frequent, near-real-time sampling or compare their findings to previous years of data for the same individuals. Objective: By combining mobile phone sensing and self-reported mental health data among college students who have been participating in a longitudinal study for the past 2 years, we sought to answer two overarching questions. First, have the behaviors and mental health of the participants changed in response to the COVID-19 pandemic compared to previous time periods? Second, are these behavior and mental health changes associated with the relative news coverage of COVID-19 in the US media? Methods: Behaviors such as the number of locations visited, distance traveled, duration of phone usage, number of phone unlocks, sleep duration, and sedentary time were measured using the StudentLife smartphone sensing app. Depression and anxiety were assessed using weekly self-reported ecological momentary assessments of the Patient Health Questionnaire-4. The participants were 217 undergraduate students, with 178 (82.0%) students providing data during the Winter 2020 term. Differences in behaviors and self-reported mental health collected during the Winter 2020 term compared to previous terms in the same cohort were modeled using mixed linear models. Results: During the first academic term impacted by COVID-19 (Winter 2020), individuals were more sedentary and reported increased anxiety and depression symptoms (P<.001) relative to previous academic terms and subsequent academic breaks. Interactions between the Winter 2020 term and the week of the academic term (linear and quadratic) were significant. In a mixed linear model, phone usage, number of locations visited, and week of the term were strongly associated with increased amount of COVID-19?related news. When mental health metrics (eg, depression and anxiety) were added to the previous measures (week of term, number of locations visited, and phone usage), both anxiety (P<.001) and depression (P=.03) were significantly associated with COVID-19?related news. Conclusions: Compared with prior academic terms, individuals in the Winter 2020 term were more sedentary, anxious, and depressed. A wide variety of behaviors, including increased phone usage, decreased physical activity, and fewer locations visited, were associated with fluctuations in COVID-19 news reporting. While this large-scale shift in mental health and behavior is unsurprising, its characterization is particularly important to help guide the development of methods to reduce the impact of future catastrophic events on the mental health of the population. UR - http://www.jmir.org/2020/6/e20185/ UR - http://dx.doi.org/10.2196/20185 UR - http://www.ncbi.nlm.nih.gov/pubmed/32519963 ID - info:doi/10.2196/20185 ER - TY - JOUR AU - Brick, R. Timothy AU - Mundie, James AU - Weaver, Jonathan AU - Fraleigh, Robert AU - Oravecz, Zita PY - 2020/6/17 TI - Low-Burden Mobile Monitoring, Intervention, and Real-Time Analysis Using the Wear-IT Framework: Example and Usability Study JO - JMIR Form Res SP - e16072 VL - 4 IS - 6 KW - smartphone apps KW - ecological momentary assessment KW - real-time analysis KW - behavior change N2 - Background: Mobile health (mHealth) methods often rely on active input from participants, for example, in the form of self-report questionnaires delivered via web or smartphone, to measure health and behavioral indicators and deliver interventions in everyday life settings. For short-term studies or interventions, these techniques are deployed intensively, causing nontrivial participant burden. For cases where the goal is long-term maintenance, limited infrastructure exists to balance information needs with participant constraints. Yet, the increasing precision of passive sensors such as wearable physiology monitors, smartphone-based location history, and internet-of-things devices, in combination with statistical feature selection and adaptive interventions, have begun to make such things possible. Objective: In this paper, we introduced Wear-IT, a smartphone app and cloud framework intended to begin addressing current limitations by allowing researchers to leverage commodity electronics and real-time decision making to optimize the amount of useful data collected while minimizing participant burden. Methods: The Wear-IT framework uses real-time decision making to find more optimal tradeoffs between the utility of data collected and the burden placed on participants. Wear-IT integrates a variety of consumer-grade sensors and provides adaptive, personalized, and low-burden monitoring and intervention. Proof of concept examples are illustrated using artificial data. The results of qualitative interviews with users are provided. Results: Participants provided positive feedback about the ease of use of studies conducted using the Wear-IT framework. Users expressed positivity about their overall experience with the framework and its utility for balancing burden and excitement about future studies that real-time processing will enable. Conclusions: The Wear-IT framework uses a combination of passive monitoring, real-time processing, and adaptive assessment and intervention to provide a balance between high-quality data collection and low participant burden. The framework presents an opportunity to deploy adaptive assessment and intervention designs that use real-time processing and provides a platform to study and overcome the challenges of long-term mHealth intervention. UR - https://formative.jmir.org/2020/6/e16072 UR - http://dx.doi.org/10.2196/16072 UR - http://www.ncbi.nlm.nih.gov/pubmed/32554373 ID - info:doi/10.2196/16072 ER - TY - JOUR AU - Huckins, F. Jeremy AU - DaSilva, W. Alex AU - Hedlund, L. Elin AU - Murphy, I. Eilis AU - Rogers, Courtney AU - Wang, Weichen AU - Obuchi, Mikio AU - Holtzheimer, E. Paul AU - Wagner, D. Dylan AU - Campbell, T. Andrew PY - 2020/6/10 TI - Causal Factors of Anxiety and Depression in College Students: Longitudinal Ecological Momentary Assessment and Causal Analysis Using Peter and Clark Momentary Conditional Independence JO - JMIR Ment Health SP - e16684 VL - 7 IS - 6 KW - depression KW - anxiety KW - self-esteem KW - stress KW - causality KW - ecological momentary assessments KW - mental health KW - network KW - college N2 - Background: Across college campuses, the prevalence of clinically relevant depression or anxiety is affecting more than 27% of the college population at some point between entry to college and graduation. Stress and self-esteem have both been hypothesized to contribute to depression and anxiety levels. Although contemporaneous relationships between these variables have been well-defined, the causal relationship between these mental health factors is not well understood, as frequent sampling can be invasive, and many of the current causal techniques are not well suited to investigate correlated variables. Objective: This study aims to characterize the causal and contemporaneous networks between these critical mental health factors in a cohort of first-year college students and then determine if observed results replicate in a second, distinct cohort. Methods: Ecological momentary assessments of depression, anxiety, stress, and self-esteem were obtained weekly from two cohorts of first-year college students for 40 weeks (1 academic year). We used the Peter and Clark Momentary Conditional Independence algorithm to identify the contemporaneous (t) and causal (t-1) network structures between these mental health metrics. Results: All reported results are significant at P<.001 unless otherwise stated. Depression was causally influenced by self-esteem (t-1 rp, cohort 1 [C1]=?0.082, cohort 2 [C2]=?0.095) and itself (t-1 rp, C1=0.388, C2=0.382) in both cohorts. Anxiety was causally influenced by stress (t-1 rp, C1=0.095, C2=0.104), self-esteem (t-1 rp, C1=?0.067, C2=?0.064, P=.002), and itself (t-1 rp, of C1=0.293, C2=0.339) in both cohorts. A causal link between anxiety and depression was observed in the first cohort (t-1 rp, C1=0.109) and only observed in the second cohort with a more liberal threshold (t-1 rp, C2=0.044, P=.03). Self-esteem was only causally influenced by itself (t-1 rp, C1=0.389, C2=0.393). Stress was only causally influenced by itself (t-1 rp, C1=0.248, C2=0.273). Anxiety had positive contemporaneous links to depression (t rp, C1=0.462, C2=0.444) and stress (t rp, C1=0.354, C2=0.358). Self-esteem had negative contemporaneous links to each of the other three mental health metrics, with the strongest negative relationship being stress (t rp, C1=?0.334, C2=?0.340), followed by depression (t rp, C1=?0.302, C2=?0.274) and anxiety (t rp, C1=?0.256, C2=?0.208). Depression had positive contemporaneous links to anxiety (previously mentioned) and stress (t rp, C1=0.250, C2=0.231). Conclusions: This paper is an initial attempt to describe the contemporaneous and causal relationships among these four mental health metrics in college students. We replicated previous research identifying concurrent relationships between these variables and extended them by identifying causal links among these metrics. These results provide support for the vulnerability model of depression and anxiety. Understanding how causal factors impact the evolution of these mental states over time may provide key information for targeted treatment or, perhaps more importantly, preventative interventions for individuals at risk for depression and anxiety. UR - https://mental.jmir.org/2020/6/e16684 UR - http://dx.doi.org/10.2196/16684 UR - http://www.ncbi.nlm.nih.gov/pubmed/32519971 ID - info:doi/10.2196/16684 ER - TY - JOUR AU - Kim, Heejung AU - Kim, Sunah AU - Kong, Sook Seong AU - Jeong, Yi-Rang AU - Kim, Hyein AU - Kim, Namhee PY - 2020/6/2 TI - Possible Application of Ecological Momentary Assessment to Older Adults? Daily Depressive Mood: Integrative Literature Review JO - JMIR Ment Health SP - e13247 VL - 7 IS - 6 KW - ecological momentary assessment KW - depression KW - aged KW - review N2 - 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. UR - https://mental.jmir.org/2020/6/e13247 UR - http://dx.doi.org/10.2196/13247 UR - http://www.ncbi.nlm.nih.gov/pubmed/32484442 ID - info:doi/10.2196/13247 ER - TY - JOUR AU - Yang, Sook Yong AU - Ryu, Wook Gi AU - Park, Gi Chang AU - Yeom, Insun AU - Shim, Won Kyu AU - Choi, Mona PY - 2020/5/25 TI - Mood and Stress Evaluation of Adult Patients With Moyamoya Disease in Korea: Ecological Momentary Assessment Method Using a Mobile Phone App JO - JMIR Mhealth Uhealth SP - e17034 VL - 8 IS - 5 KW - affect KW - ecological momentary assessment KW - mood KW - Moyamoya disease KW - psychological stress N2 - Background: Moyamoya disease (MMD) is a known progressive obstructive cerebrovascular disorder. Monitoring and managing mood and stress are critical for patients with MMD, as they affect clinical outcomes. The ecological momentary assessment (EMA) method is a longitudinal study design by which multiple variable assessments can be performed over time to detect momentary fluctuations and changes in psychological dimensions such as mood and stress over time. Objective: This study aimed to identify predicting factors associated with momentary mood and stress at both the within-person and between-person levels and to examine individual fluctuation of mood over time in the short term using an EMA method combined with a mobile phone app. Methods: Participants aged older than 18 years were recruited from a tertiary hospital in Seoul, Korea, between July 2018 and January 2019. The PsyMate scale for negative affect (NA) and positive affect (PA) and the Trier Inventory for Chronic Stress Scale were uploaded on patient mobile phones. Using a mobile app, data were collected four times a day for 7 days. Pearson correlations and mixed modeling were used to predict relationships between repeatedly measured variables at both the between-person and within-person levels. Results: The mean age of the 93 participants was 40.59 (SD 10.06) years, 66 (71%) were female, and 71 (76%) were married. Participants provided 1929 responses out of a possible 2604 responses (1929/2604, 74.08%). The mean momentary NA and PA values were 2.15 (SD 1.12) and 4.70 (SD 1.31) out of 7, respectively. The momentary stress value was 2.03 (SD 0.98) out of 5. Momentary NA, PA, and stress were correlated (P<.001) and varied over time in relation to momentary variables. Common momentary variables associated with momentary mood and stress at both the within-person (level 1) and between-person (level 2) levels were identified. Momentary NA increased when being alone and being at the hospital at both levels, whereas momentary PA increased when eating or drinking, resting, being at a café, restaurant or a public place but decreased when being alone at both levels. Momentary stress increased when being at the office, at a public place, or as the time of the day went by but decreased when resting or during the weekend. Different factors affecting mood and stress at different levels were identified. Fluctuations in individual momentary mood over time at the within-person level were captured. Conclusions: The EMA method using a mobile phone app demonstrated its ability to capture changes in mood and stress in various environmental contexts in patients with MMD. The results could provide baseline information for developing interventions to manage negative mood and stress of patients with MMD based on the identified predictors affecting mood and stress at two different levels. UR - http://mhealth.jmir.org/2020/5/e17034/ UR - http://dx.doi.org/10.2196/17034 UR - http://www.ncbi.nlm.nih.gov/pubmed/32449687 ID - info:doi/10.2196/17034 ER - TY - JOUR AU - Broers, Rosalinde Eva AU - Kop, Johan Willem AU - Denollet, Johan AU - Widdershoven, Jos AU - Wetzels, Mart AU - Ayoola, Idowu AU - Piera-Jimenez, Jordi AU - Habibovic, Mirela PY - 2020/5/22 TI - A Personalized eHealth Intervention for Lifestyle Changes in Patients With Cardiovascular Disease: Randomized Controlled Trial JO - J Med Internet Res SP - e14570 VL - 22 IS - 5 KW - cardiovascular diseases KW - lifestyle KW - habits KW - eHealth KW - mHealth N2 - Background: Behavior change methods involving new ambulatory technologies may improve lifestyle and cardiovascular disease outcomes. Objective: This study aimed to provide proof-of-concept analyses of an intervention aiming to increase (1) behavioral flexibility, (2) lifestyle change, and (3) quality of life. The feasibility and patient acceptance of the intervention were also evaluated. Methods: Patients with cardiovascular disease (N=149; mean age 63.57, SD 8.30 years; 50/149, 33.5% women) were recruited in the Do Cardiac Health Advanced New Generation Ecosystem (Do CHANGE) trial and randomized to the Do CHANGE intervention or care as usual (CAU). The intervention involved a 3-month behavioral program in combination with ecological momentary assessment and intervention technologies. Results: The intervention was perceived to be feasible and useful. A significant increase in lifestyle scores over time was found for both groups (F2,146.6=9.99; P<.001), which was similar for CAU and the intervention group (F1,149.9=0.09; P=.77). Quality of life improved more in the intervention group (mean 1.11, SD 0.11) than CAU (mean ?1.47, SD 0.11) immediately following the intervention (3 months), but this benefit was not sustained at the 6-month follow-up (interaction: P=.02). No significant treatment effects were observed for behavioral flexibility (F1,149.0=0.48; P=.07). Conclusions: The Do CHANGE 1 intervention was perceived as useful and easy to use. However, no long-term treatment effects were found on the outcome measures. More research is warranted to examine which components of behavioral interventions are effective in producing long-term behavior change. Trial Registration: ClinicalTrials.gov NCT02946281; https://www.clinicaltrials.gov/ct2/show/NCT02946281 UR - https://www.jmir.org/2020/5/e14570 UR - http://dx.doi.org/10.2196/14570 UR - http://www.ncbi.nlm.nih.gov/pubmed/32441658 ID - info:doi/10.2196/14570 ER - TY - JOUR AU - Kumar, Anupama AU - Wang, Michael AU - Riehm, Alison AU - Yu, Eileen AU - Smith, Ted AU - Kaplin, Adam PY - 2020/5/20 TI - An Automated Mobile Mood Tracking Technology (Mood 24/7): Validation Study JO - JMIR Ment Health SP - e16237 VL - 7 IS - 5 KW - depression KW - text messaging KW - patient monitoring KW - mobile phone KW - short message service KW - ecological momentary assessment KW - digital health N2 - Background: Electronic tracking has been utilized for a variety of health conditions. Previous studies have shown that there is higher adherence to electronic methods vs paper-and-pencil tracking modalities. Electronic tracking also ensures that there are no back-filled entries, where patients have?to appear compliant?entered their responses retrospectively just before their visits with their health care provider. On the basis of the recognition of an unmet need for a Web-based automated platform to track psychiatric outcomes, Johns Hopkins University partnered with Health Central (a subsidiary of Remedy Health Media LLC) to develop Mood 24/7, an electronic, mobile, automated, SMS-based mood tracker. This is a pilot study to validate the use of Mood 24/7 in anticipation of clinical trials to demonstrate the therapeutic benefit on patients? health outcomes of utilizing digital mood-tracking technology. Objective: Mood 24/7 is an electronic mood-monitoring platform developed to accurately and efficiently track mood over time through automated daily SMS texts or emails. This study was designed to assess the accuracy and validity of Mood 24/7 in an outpatient psychiatric setting. Methods: This pilot study involved a retrospective chart review for depressed outpatients (N=9) to compare their self-reported Mood 24/7 daily mood ratings with their psychiatrist?s independent clinical mood assessment at the time of the patient?s visit. Their mood ratings via Mood 24/7 were collected over 36 weeks. In addition, a mixed model analysis was applied to compare the weekly Montgomery-Åsberg Depression Rating Scale (MADRS) scores with Mood 24/7 scores over an average of 3 months. Results: A 97.2% (315/324) digital mood reporting adherence was found over 36 weeks, and a significant correlation (r=0.86, P<.001) was observed between patients? Mood 24/7 scores and their psychiatrist?s blinded clinical assessment of the patient?s mood when seen in the clinic. In addition, a significant concordance (intraclass correlation of 0.69, 95% CI 0.33-0.91, P<.001) was observed in the mixed model analysis of the clinician-administered MADRS vs Mood 24/7 scores over time. Conclusions: Our chart review and mixed model analyses demonstrate that Mood 24/7 is a valid instrument for convenient, simple, noninvasive, and accurate longitudinal mood assessment in the outpatient clinical setting. UR - https://mental.jmir.org/2020/5/e16237 UR - http://dx.doi.org/10.2196/16237 UR - http://www.ncbi.nlm.nih.gov/pubmed/32432558 ID - info:doi/10.2196/16237 ER - TY - JOUR AU - de Brito, N. Junia AU - Loth, A. Katie AU - Tate, Allan AU - Berge, M. Jerica PY - 2020/5/19 TI - Associations Between Parent Self-Reported and Accelerometer-Measured Physical Activity and Sedentary Time in Children: Ecological Momentary Assessment Study JO - JMIR Mhealth Uhealth SP - e15458 VL - 8 IS - 5 KW - ecological momentary assessment KW - accelerometry KW - mobile devices KW - physical activity KW - sedentary behavior KW - children N2 - Background: Retrospective self-report questionnaires are the most common method for assessing physical activity (PA) and sedentary behavior (SB) in children when the use of objective assessment methods (eg, accelerometry) is cost prohibitive. However, self-report measures have limitations (eg, recall bias). The use of real-time, mobile ecological momentary assessment (EMA) has been proposed to address these shortcomings. The study findings will provide useful information for researchers interested in using EMA surveys for measuring PA and SB in children, particularly when reported by a parent or caregiver. Objective: This study aimed to examine the associations between the parent?s EMA report of their child?s PA and SB and accelerometer-measured sedentary time (ST), light-intensity PA (LPA), and moderate-to-vigorous?intensity PA (MVPA) and to examine if these associations differed by day of week, sex, and season. Methods: A total of 140 parent-child dyads (mean child age 6.4 years, SD 0.8; n=66 girls; n=21 African American; n=24 American Indian; n=25 Hispanic/Latino; n=24 Hmong; n=22 Somali; and n=24 white) participated in this study. During an 8-day period, parents reported child PA and SB via multiple daily signal contingent EMA surveys, and children wore a hip-mounted accelerometer to objectively measure ST, LPA, and MVPA. Accelerometer data was matched to the time period occurring before parent EMA-report of child PA and SB. Generalized estimating equations with interaction-term analyses were performed to determine whether the relationship between parent-EMA report of child PA and SB and accelerometer-measured ST and LPA and MVPA outcomes differed by day of the week, sex and season. Results: The parent?s EMA report of their child?s PA and SB was strongly associated with accelerometer-measured ST, LPA, and MVPA. The parent?s EMA report of their child?s PA was stronger during the weekend than on weekdays for accelerometer-measured ST (P?.001) and LPA (P<.001). For the parent?s EMA report of their child?s SB, strong associations were observed with accelerometer-measured ST (P<.001), LPA (P=.005), and MVPA (P=.008). The findings related to sex-interaction terms indicated that the association between the parent-reported child?s PA via EMA and the accelerometer-measured MVPA was stronger for boys than girls (P=.02). The association between the parent?s EMA report of their child?s PA and SB and accelerometer-measured ST and PA was similar across seasons in this sample (all P values >.31). Conclusions: When the use of accelerometry-based methods is not feasible and in contexts where the parent is able to spend more proximate time observing the child?s PA and SB, the parent?s EMA report might be a superior method for measuring PA and SB in young children relative to self-report, given the EMA?s strong associations with accelerometer-measured PA and ST. UR - http://mhealth.jmir.org/2020/5/e15458/ UR - http://dx.doi.org/10.2196/15458 UR - http://www.ncbi.nlm.nih.gov/pubmed/32348283 ID - info:doi/10.2196/15458 ER - TY - JOUR AU - Davies, Alan AU - Mueller, Julia AU - Hennings, Jean AU - Caress, Ann-Louise AU - Jay, Caroline PY - 2020/5/15 TI - Recommendations for Developing Support Tools With People Suffering From Chronic Obstructive Pulmonary Disease: Co-Design and Pilot Testing of a Mobile Health Prototype JO - JMIR Hum Factors SP - e16289 VL - 7 IS - 2 KW - chronic obstructive pulmonary disease KW - app design KW - mHealth KW - ecological momentary assessment KW - mobile phone N2 - Background: Gaps exist between developers, commissioners, and end users in terms of the perceived desirability of different features and functionalities of mobile apps. Objective: The objective of this study was to co-design a prototype mobile app for people with chronic obstructive pulmonary disease (COPD). We present lessons learned and recommendations from working on a large project with various stakeholders to develop a mobile app for patients with COPD. Methods: We adopted a user-centered, participatory approach to app development. Following a series of focus groups and interviews to capture requirements, we developed a prototype app designed to enable daily symptom recording (experience sampling). The prototype was tested in a usability study applying the think aloud protocol with people with COPD. It was then released via the Android app store, and experience sampling data and event data were captured to gather further usability data. Results: A total of 5 people with COPD participated in the pilot study. Identified themes include familiarity with technology, appropriate levels for feeding back information, and usability issues such as manual dexterity. Moreover, 37 participants used the app over a 4-month period (median age 47 years). The symptoms most correlated to perceived well-being were tiredness (r=0.61; P<.001) and breathlessness (r=0.59; P<.001). Conclusions: Design implications for COPD apps include the need for clearly labeled features (rather than relying on colors or symbols that require experience using smartphones), providing weather information, and using the same terminology as health care professionals (rather than simply lay terms). Target users, researchers, and developers should be involved at every stage of app development, using an iterative approach to build a prototype app, which should then be tested in controlled settings as well as in the wild (ie, when deployed and used in real-world settings) over longer periods. UR - http://humanfactors.jmir.org/2020/2/e16289/ UR - http://dx.doi.org/10.2196/16289 UR - http://www.ncbi.nlm.nih.gov/pubmed/32410730 ID - info:doi/10.2196/16289 ER - TY - JOUR AU - Habets, Jeroen AU - Heijmans, Margot AU - Herff, Christian AU - Simons, Claudia AU - Leentjens, FG Albert AU - Temel, Yasin AU - Kuijf, Mark AU - Kubben, Pieter PY - 2020/5/11 TI - Mobile Health Daily Life Monitoring for Parkinson Disease: Development and Validation of Ecological Momentary Assessments JO - JMIR Mhealth Uhealth SP - e15628 VL - 8 IS - 5 KW - ecological momentary assessment KW - experience sampling method KW - electronic diary KW - Parkinson?s disease monitoring N2 - Background: Parkinson disease monitoring is currently transitioning from periodic clinical assessments to continuous daily life monitoring in free-living conditions. Traditional Parkinson disease monitoring methods lack intraday fluctuation detection. Electronic diaries (eDiaries) hold the potential to collect subjective experiences on the severity and burden of motor and nonmotor symptoms in free-living conditions. Objective: This study aimed to develop a Parkinson disease?specific eDiary based on ecological momentary assessments (EMAs) and to explore its validation. Methods: An observational cohort of 20 patients with Parkinson disease used the smartphone-based EMA eDiary for 14 consecutive days without adjusting free-living routines. The eDiary app presented an identical questionnaire consisting of questions regarding affect, context, motor and nonmotor symptoms, and motor performance 7 times daily at semirandomized moments. In addition, patients were asked to complete a morning and an evening questionnaire. Results: Mean affect correlated moderate-to-strong and moderate with motor performance (R=0.38 to 0.75; P<.001) and motor symptom (R=0.34 to 0.50; P<.001) items, respectively. The motor performance showed a weak-to-moderate negative correlation with motor symptoms (R=?0.31 to ?0.48; P<.001). Mean group answers given for on-medication conditions vs wearing-off-medication conditions differed significantly (P<.05); however, not enough questionnaires were completed for the wearing-off-medication condition to reproduce these findings on individual levels. Conclusions: We presented a Parkinson disease?specific EMA eDiary. Correlations between given answers support the internal validity of the eDiary and underline EMA?s potential in free-living Parkinson disease monitoring. Careful patient selection and EMA design adjustment to this targeted population and their fluctuations are necessary to generate robust proof of EMA validation in future work. Combining clinical Parkinson disease knowledge with practical EMA experience is inevitable to design and perform studies, which will lead to the successful integration of eDiaries in free-living Parkinson disease monitoring. UR - https://mhealth.jmir.org/2020/5/e15628 UR - http://dx.doi.org/10.2196/15628 UR - http://www.ncbi.nlm.nih.gov/pubmed/32339999 ID - info:doi/10.2196/15628 ER - TY - JOUR AU - Hsiang, Elaine AU - Offer, Claudine AU - Prescott, Maximo AU - Rodriguez, Amy AU - Behar, Emily AU - Matheson, Tim AU - Santa Maria, Diane AU - Santos, Glenn-Milo PY - 2020/4/29 TI - Bridging the Digital Divide Among Racial and Ethnic Minority Men Who Have Sex With Men to Reduce Substance Use and HIV Risk: Mixed Methods Feasibility Study JO - JMIR Mhealth Uhealth SP - e15282 VL - 8 IS - 4 KW - ecological momentary assessment KW - men who have sex with men KW - text messaging KW - substance use KW - HIV KW - digital divide KW - focus group N2 - Background: Ecological momentary assessment (EMA) is a promising data collection tool for mobile health interventions targeting episodic health behaviors. For substance-using men who have sex with men (SUMSM), EMA is becoming more widely utilized in efforts to characterize substance use and sexual risk factors for HIV transmission. However, recent literature demonstrates emerging concerns over compliance and lower EMA engagement and data concordance among racial and ethnic minority SUMSM. Objective: This study aimed to provide a qualitative evaluation of the barriers and facilitators of EMA as a data collection tool among racial and ethnic minority SUMSM. Methods: Between October and November 2017, 45 racial and ethnic minority SUMSM were recruited from a list of prior research participants at the San Francisco Department of Public Health to participate in daily EMA surveys on their substance use and sexual health behaviors for 1 week, followed by in-person focus groups (FGs). A total of 4 FGs explored the participants? experiences with the surveys, issues regarding privacy and confidentiality, and suggestions for improvement. Qualitative analysis was performed using content analysis. Descriptive statistics and Fisher exact tests were used to assess the associations between demographics or substance use behaviors and EMA completion. Results: Overall, 93.9% (295/314) of all delivered surveys were initiated, and of those, 98.0% (289/295) were completed. Neither participant demographics, including race (P=.65) or age (P=.43), nor substance use behaviors, including the frequency of alcohol (P=.40) or methamphetamine (P=.91) use or any cocaine (P=.28), crack (P=.99), or polysubstance use (P=.24), were found to be associated with survey completion. Overall, participants were receptive to the text message?based EMA surveys. Facilitators included survey timing, user-friendly survey design, survey-stimulated self-reflection, coding of sensitive phrases, and other privacy benefits of a mobile survey. Barriers included an inability to correct texting errors and participants? perception of judgment or stigmatization related to questions about condomless sex. To improve EMA compliance and uptake, participants suggested adding response confirmations, clarifying survey language, and continuing to diversify the study audience. Conclusions: EMA appears to be feasible and acceptable among this sample of racial and ethnic minority SUMSM. Close attention to EMA study design and the development of nonjudgmental, contextualized questions regarding stigmatized health behaviors may be critical to further improve EMA compliance. UR - http://mhealth.jmir.org/2020/4/e15282/ UR - http://dx.doi.org/10.2196/15282 UR - http://www.ncbi.nlm.nih.gov/pubmed/32347807 ID - info:doi/10.2196/15282 ER - TY - JOUR AU - Lancaster, Claire AU - Koychev, Ivan AU - Blane, Jasmine AU - Chinner, Amy AU - Wolters, Leona AU - Hinds, Chris PY - 2020/4/2 TI - Evaluating the Feasibility of Frequent Cognitive Assessment Using the Mezurio Smartphone App: Observational and Interview Study in Adults With Elevated Dementia Risk JO - JMIR Mhealth Uhealth SP - e16142 VL - 8 IS - 4 KW - technology assessment KW - cognition KW - smartphone KW - mhealth KW - mobile phone KW - Alzheimer disease KW - early diagnosis KW - feasibility study KW - ecological momentary assessment N2 - Background: By enabling frequent, sensitive, and economic remote assessment, smartphones will facilitate the detection of early cognitive decline at scale. Previous studies have sustained participant engagement with remote cognitive assessment over a week; extending this to a period of 1 month clearly provides a greater opportunity for measurement. However, as study durations are increased, the need to understand how participant burden and scientific value might be optimally balanced also increases. Objective: This study explored the little but often approach to assessment employed by the Mezurio app when prompting participants to interact every day for over a month. Specifically, this study aimed to understand whether this extended duration of remote study is feasible, and which factors promote sustained participant engagement over such periods. Methods: A total of 35 adults (aged 40-59 years) with no diagnosis of cognitive impairment were prompted to interact with the Mezurio smartphone app platform for up to 36 days, completing short, daily episodic memory tasks in addition to optional executive function and language tests. A subset (n=20) of participants completed semistructured interviews focused on their experience of using the app. Results: Participants complied with 80% of the daily learning tasks scheduled for subsequent tests of episodic memory, with 88% of participants still actively engaged by the final task. A thematic analysis of the participants? experiences highlighted schedule flexibility, a clear user interface, and performance feedback as important considerations for engagement with remote digital assessment. Conclusions: Despite the extended study duration, participants demonstrated high compliance with the schedule of daily learning tasks and were extremely positive about their experiences. Long durations of remote digital interaction are therefore definitely feasible but only when careful attention is paid to the design of the users? experience. UR - https://mhealth.jmir.org/2020/4/e16142 UR - http://dx.doi.org/10.2196/16142 UR - http://www.ncbi.nlm.nih.gov/pubmed/32238339 ID - info:doi/10.2196/16142 ER - TY - JOUR AU - Busk, Jonas AU - Faurholt-Jepsen, Maria AU - Frost, Mads AU - Bardram, E. Jakob AU - Vedel Kessing, Lars AU - Winther, Ole PY - 2020/4/1 TI - Forecasting Mood in Bipolar Disorder From Smartphone Self-assessments: Hierarchical Bayesian Approach JO - JMIR Mhealth Uhealth SP - e15028 VL - 8 IS - 4 KW - bipolar disorder KW - mood KW - early medical intervention KW - digital phenotyping KW - machine learning KW - forecasting KW - Bayesian analysis N2 - Background: Bipolar disorder is a prevalent mental health condition that is imposing significant burden on society. Accurate forecasting of symptom scores can be used to improve disease monitoring, enable early intervention, and eventually help prevent costly hospitalizations. Although several studies have examined the use of smartphone data to detect mood, only few studies deal with forecasting mood for one or more days. Objective: This study aimed to examine the feasibility of forecasting daily subjective mood scores based on daily self-assessments collected from patients with bipolar disorder via a smartphone-based system in a randomized clinical trial. Methods: We applied hierarchical Bayesian regression models, a multi-task learning method, to account for individual differences and forecast mood for up to seven days based on 15,975 smartphone self-assessments from 84 patients with bipolar disorder participating in a randomized clinical trial. We reported the results of two time-series cross-validation 1-day forecast experiments corresponding to two different real-world scenarios and compared the outcomes with commonly used baseline methods. We then applied the best model to evaluate a 7-day forecast. Results: The best performing model used a history of 4 days of self-assessment to predict future mood scores with historical mood being the most important predictor variable. The proposed hierarchical Bayesian regression model outperformed pooled and separate models in a 1-day forecast time-series cross-validation experiment and achieved the predicted metrics, R2=0.51 and root mean squared error of 0.32, for mood scores on a scale of ?3 to 3. When increasing the forecast horizon, forecast errors also increased and the forecast regressed toward the mean of data distribution. Conclusions: Our proposed method can forecast mood for several days with low error compared with common baseline methods. The applicability of a mood forecast in the clinical treatment of bipolar disorder has also been discussed. UR - https://mhealth.jmir.org/2020/4/e15028 UR - http://dx.doi.org/10.2196/15028 UR - http://www.ncbi.nlm.nih.gov/pubmed/32234702 ID - info:doi/10.2196/15028 ER - TY - JOUR AU - NeCamp, Timothy AU - Sen, Srijan AU - Frank, Elena AU - Walton, A. Maureen AU - Ionides, L. Edward AU - Fang, Yu AU - Tewari, Ambuj AU - Wu, Zhenke PY - 2020/3/31 TI - Assessing Real-Time Moderation for Developing Adaptive Mobile Health Interventions for Medical Interns: Micro-Randomized Trial JO - J Med Internet Res SP - e15033 VL - 22 IS - 3 KW - mobile health KW - digital health KW - smartphone KW - mobile phone KW - wearable devices KW - ecological momentary assessment KW - depression KW - mood KW - physical activity KW - sleep KW - moderator variables N2 - Background: Individuals in stressful work environments often experience mental health issues, such as depression. Reducing depression rates is difficult because of persistently stressful work environments and inadequate time or resources to access traditional mental health care services. Mobile health (mHealth) interventions provide an opportunity to deliver real-time interventions in the real world. In addition, the delivery times of interventions can be based on real-time data collected with a mobile device. To date, data and analyses informing the timing of delivery of mHealth interventions are generally lacking. Objective: This study aimed to investigate when to provide mHealth interventions to individuals in stressful work environments to improve their behavior and mental health. The mHealth interventions targeted 3 categories of behavior: mood, activity, and sleep. The interventions aimed to improve 3 different outcomes: weekly mood (assessed through a daily survey), weekly step count, and weekly sleep time. We explored when these interventions were most effective, based on previous mood, step, and sleep scores. Methods: We conducted a 6-month micro-randomized trial on 1565 medical interns. Medical internship, during the first year of physician residency training, is highly stressful, resulting in depression rates several folds higher than those of the general population. Every week, interns were randomly assigned to receive push notifications related to a particular category (mood, activity, sleep, or no notifications). Every day, we collected interns? daily mood valence, sleep, and step data. We assessed the causal effect moderation by the previous week?s mood, steps, and sleep. Specifically, we examined changes in the effect of notifications containing mood, activity, and sleep messages based on the previous week?s mood, step, and sleep scores. Moderation was assessed with a weighted and centered least-squares estimator. Results: We found that the previous week?s mood negatively moderated the effect of notifications on the current week?s mood with an estimated moderation of ?0.052 (P=.001). That is, notifications had a better impact on mood when the studied interns had a low mood in the previous week. Similarly, we found that the previous week?s step count negatively moderated the effect of activity notifications on the current week?s step count, with an estimated moderation of ?0.039 (P=.01) and that the previous week?s sleep negatively moderated the effect of sleep notifications on the current week?s sleep with an estimated moderation of ?0.075 (P<.001). For all three of these moderators, we estimated that the treatment effect was positive (beneficial) when the moderator was low, and negative (harmful) when the moderator was high. Conclusions: These findings suggest that an individual?s current state meaningfully influences their receptivity to mHealth interventions for mental health. Timing interventions to match an individual?s state may be critical to maximizing the efficacy of interventions. Trial Registration: ClinicalTrials.gov NCT03972293; http://clinicaltrials.gov/ct2/show/NCT03972293 UR - http://www.jmir.org/2020/3/e15033/ UR - http://dx.doi.org/10.2196/15033 UR - http://www.ncbi.nlm.nih.gov/pubmed/32229469 ID - info:doi/10.2196/15033 ER - TY - JOUR AU - Wright, Cassandra AU - Dietze, M. Paul AU - Kuntsche, Emmanuel AU - Livingston, Michael AU - Agius, A. Paul AU - Room, Robin AU - Raggatt, Michelle AU - Hellard, Margaret AU - Lim, C. Megan S. PY - 2020/3/31 TI - Effectiveness of an Ecological Momentary Intervention for Reducing Risky Alcohol Consumption Among Young Adults: Protocol for a Three-Arm Randomized Controlled Trial JO - JMIR Res Protoc SP - e14190 VL - 9 IS - 3 KW - alcohol KW - brief intervention KW - young adult KW - alcohol drinking KW - prevention and control KW - mobile phone N2 - Background: Recent research has investigated the utility of mobile phone?delivered interventions for reducing risky single-occasion drinking, also known as binge drinking. In the past five years, focus has been placed on ecological momentary interventions (EMIs), which aim to deliver intervention content in correspondence to real-time assessments of behavior, also known as ecological momentary assessments (EMAs). Objective: This study aims to assess the effect of a fully automated, tailored, mobile phone?delivered EMI termed Mobile Intervention for Drinking in Young people (MIDY) on young people's risky single-occasion drinking behavior. Methods: We will use a three-armed randomized controlled trial design to determine the impact of MIDY on peak consumption of alcohol among young people. A list of mobile telephone numbers for random digit dialing will be generated, and researchers will telephone potential participants to screen for eligibility. Participants will be randomized into one of three intervention groups. For 6 weeks, EMI, EMA, and attention control groups will complete hourly EMA surveys on their mobile phones on Friday and Saturday nights. EMI participants will receive personalized feedback in the form of text messages corresponding to their EMA survey responses, which focus on alcohol consumption, spending, and mood. EMA participants will not receive feedback. A third group will also complete EMA and receive feedback text messages at the same time intervals, but these will be focused on sedentary behavior and technology use. All groups will also complete a short survey on Saturday and Sunday mornings, with the primary outcome measure taken on Sunday mornings. A more detailed survey will be sent on the final Sunday of the 6-week period, and then again 1 year after recruitment. Results: The primary outcome measure will be an observed change (ie, reduction) in the mean peak number of drinks consumed in a single night over the 6-week intervention period between the EMI and attention control groups as measured in the weekly EMA. We expect to see a greater reduction in mean peak drinking in the EMI group compared to that in the attention control group. As a secondary aim, we will assess whether mean peak drinking is reduced in the EMA group compared to the attention control group. We will use a random-effects mixed-modeling approach using maximum-likelihood estimation to provide estimates of differences in peak drinking across time periods between those receiving the intervention (EMI) and attention control participants. An intention-to-treat approach will be taken for the analysis. Individuals and study groups will be modeled as random and fixed factors, respectively. Conclusions: This study extends our previous work investigating the efficacy of a mobile EMI (MIDY) for reducing risky drinking among young adults in Australia, and will add to the expanding literature on the use of mobile interventions for reducing risky alcohol consumption. Trial Registration: Australian New Zealand Clinical Trials Registration (ANZCTR): ACTRN12617001509358p; http://www.anzctr.org.au/ACTRN12617001509358p.aspx International Registered Report Identifier (IRRID): DERR1-10.2196/14190 UR - http://www.researchprotocols.org/2020/3/e14190/ UR - http://dx.doi.org/10.2196/14190 UR - http://www.ncbi.nlm.nih.gov/pubmed/32229471 ID - info:doi/10.2196/14190 ER - TY - JOUR AU - Hébert, T. Emily AU - Ra, K. Chaelin AU - Alexander, C. Adam AU - Helt, Angela AU - Moisiuc, Rachel AU - Kendzor, E. Darla AU - Vidrine, J. Damon AU - Funk-Lawler, K. Rachel AU - Businelle, S. Michael PY - 2020/3/9 TI - A Mobile Just-in-Time Adaptive Intervention for Smoking Cessation: Pilot Randomized Controlled Trial JO - J Med Internet Res SP - e16907 VL - 22 IS - 3 KW - smartphones KW - mobile phones KW - smoking cessation KW - just-in-time adaptive intervention KW - mHealth N2 - Background: Smartphone apps for smoking cessation could offer easily accessible, highly tailored, intensive interventions at a fraction of the cost of traditional counseling. Although there are hundreds of publicly available smoking cessation apps, few have been empirically evaluated using a randomized controlled trial (RCT) design. The Smart-Treatment (Smart-T2) app is a just-in-time adaptive intervention that uses ecological momentary assessments (EMAs) to assess the risk for imminent smoking lapse and tailors treatment messages based on the risk of lapse and reported symptoms. Objective: This 3-armed pilot RCT aimed to determine the feasibility and preliminary efficacy of an automated smartphone-based smoking cessation intervention (Smart-T2) relative to standard in-person smoking cessation clinic care and the National Cancer Institute?s free smoking cessation app, QuitGuide. Methods: Adult smokers who attended a clinic-based tobacco cessation program were randomized into groups and followed for 13 weeks (1 week prequitting through 12 weeks postquitting). All study participants received nicotine patches and gum and were asked to complete EMAs five times a day on study-provided smartphones for 5 weeks. Participants in the Smart-T2 group received tailored treatment messages after the completion of each EMA. Both Smart-T2 and QuitGuide apps offer on-demand smoking cessation treatment. Results: Of 81 participants, 41 (50%) were women and 55 (68%) were white. On average, participants were aged 49.6 years and smoked 22.4 cigarettes per day at baseline. A total of 17% (14/81) of participants were biochemically confirmed 7-day point prevalence abstinent at 12 weeks postquitting (Smart-T2: 6/27, 22%, QuitGuide: 4/27, 15%, and usual care: 4/27, 15%), with no significant differences across groups (P>.05). Participants in the Smart-T2 group rated the app positively, with most participants agreeing that they can rely on the app to help them quit smoking, and endorsed the belief that the app would help them stay quit, and these responses were not significantly different from the ratings given by participants in the usual care group. Conclusions: Dynamic smartphone apps that tailor intervention content in real time may increase user engagement and exposure to treatment-related materials. The results of this pilot RCT suggest that smartphone-based smoking cessation treatments may be capable of providing similar outcomes to traditional, in-person counseling. Trial Registration: ClinicalTrials.gov NCT02930200; https://clinicaltrials.gov/show/NCT02930200 UR - https://www.jmir.org/2020/3/e16907 UR - http://dx.doi.org/10.2196/16907 UR - http://www.ncbi.nlm.nih.gov/pubmed/32149716 ID - info:doi/10.2196/16907 ER - TY - JOUR AU - Kim, Gyu Myeong AU - Kim, Jungu AU - Kim, Cheol Su AU - Jeong, Jaegwon PY - 2020/2/24 TI - Twitter Analysis of the Nonmedical Use and Side Effects of Methylphenidate: Machine Learning Study JO - J Med Internet Res SP - e16466 VL - 22 IS - 2 KW - methylphenidate KW - social media KW - Twitter KW - prescription drug misuse KW - drug-related side effects and adverse reactions KW - machine learning KW - support vector machine N2 - Background: Methylphenidate, a stimulant used to treat attention deficit hyperactivity disorder, has the potential to be used nonmedically, such as for studying and recreation. In an era when many people actively use social networking services, experience with the nonmedical use or side effects of methylphenidate might be shared on Twitter. Objective: The purpose of this study was to analyze tweets about the nonmedical use and side effects of methylphenidate using a machine learning approach. Methods: A total of 34,293 tweets mentioning methylphenidate from August 2018 to July 2019 were collected using searches for ?methylphenidate? and its brand names. Tweets in a randomly selected training dataset (6860/34,293, 20.00%) were annotated as positive or negative for two dependent variables: nonmedical use and side effects. Features such as personal noun, nonmedical use terms, medical use terms, side effect terms, sentiment scores, and the presence of a URL were generated for supervised learning. Using the labeled training dataset and features, support vector machine (SVM) classifiers were built and the performance was evaluated using F1 scores. The classifiers were applied to the test dataset to determine the number of tweets about nonmedical use and side effects. Results: Of the 6860 tweets in the training dataset, 5.19% (356/6860) and 5.52% (379/6860) were about nonmedical use and side effects, respectively. Performance of SVM classifiers for nonmedical use and side effects, expressed as F1 scores, were 0.547 (precision: 0.926, recall: 0.388, and accuracy: 0.967) and 0.733 (precision: 0.920, recall: 0.609, and accuracy: 0.976), respectively. In the test dataset, the SVM classifiers identified 361 tweets (1.32%) about nonmedical use and 519 tweets (1.89%) about side effects. The proportion of tweets about nonmedical use was highest in May 2019 (46/2624, 1.75%) and December 2018 (36/2041, 1.76%). Conclusions: The SVM classifiers that were built in this study were highly precise and accurate and will help to automatically identify the nonmedical use and side effects of methylphenidate using Twitter. UR - http://www.jmir.org/2020/2/e16466/ UR - http://dx.doi.org/10.2196/16466 UR - http://www.ncbi.nlm.nih.gov/pubmed/32130160 ID - info:doi/10.2196/16466 ER - TY - JOUR AU - Stone, A. Arthur AU - Wen, Fred Cheng K. AU - Schneider, Stefan AU - Junghaenel, U. Doerte PY - 2020/2/21 TI - Evaluating the Effect of Daily Diary Instructional Phrases on Respondents? Recall Time Frames: Survey Experiment JO - J Med Internet Res SP - e16105 VL - 22 IS - 2 KW - end-of-day dairy KW - daily diary study KW - recall time frame N2 - Background: Daily diaries are extensively used for examining participants? daily experience in behavioral and medical science. However, little attention is paid to whether participants recall their experiences within the time frames prescribed by the task. Objective: This study aimed to describe survey respondents? self-reported recall time frames and to evaluate the impact of different daily diary items on respondents? reported affective states. Methods: In this study, 577 participants completed a mood survey with one of the following 4 time frame instructions: (1) today, (2) since waking up today, (3) during the last 24 hours, or (4) in the last day. They were also asked to indicate the periods they considered when answering these items and to recall the instructional phrases associated with the items. Results: Almost all participants in the today (141/146, 96.6%) and since waking up today (136/145, 93.8%) conditions reported using periods consistent with our expectations, whereas a lower proportion was observed in the during the last 24 hours (100/145, 69.0%) condition. A diverse range of responses was observed in the in the last day condition. Furthermore, the instructions influenced the levels of some self-reported affects, although exploratory analyses were not able to identify the mechanism underlying this finding. Conclusions: Overall, these results indicate that today and since waking up today are the most effective instructional phrases for inquiring about daily experience and that investigators should use caution when using the other 2 instructional phrases. UR - http://www.jmir.org/2020/2/e16105/ UR - http://dx.doi.org/10.2196/16105 UR - http://www.ncbi.nlm.nih.gov/pubmed/32130129 ID - info:doi/10.2196/16105 ER - TY - JOUR AU - Poelman, P. Maartje AU - van Lenthe, J. Frank AU - Scheider, Simon AU - Kamphuis, BM Carlijn PY - 2020/1/28 TI - A Smartphone App Combining Global Positioning System Data and Ecological Momentary Assessment to Track Individual Food Environment Exposure, Food Purchases, and Food Consumption: Protocol for the Observational FoodTrack Study JO - JMIR Res Protoc SP - e15283 VL - 9 IS - 1 KW - ecological momentary assessment KW - eating behavior KW - environmental exposure KW - mobile apps KW - smartphone KW - geographic information systems KW - food preferences KW - diet records N2 - Background: Our understanding of how food choices are affected by exposure to the food environment is limited, and there are important gaps in the literature. Recently developed smartphone-based technologies, including global positioning systems and ecological momentary assessment, enable these gaps to be filled. Objective: We present the FoodTrack study design and methods, as well as participants? compliance with the study protocol and their experiences with the app. We propose future analyses of the data to examine individual food environmental exposure taking into account the accessible food environment and individual time constraints; to assess people?s food choices in relation to food environmental exposure; and to examine the moderating role of individual and contextual determinants of food purchases and consumption. Methods: We conducted a 7-day observational study among adults (25-45 years of age) living in urban areas in the Netherlands. Participants completed a baseline questionnaire, used an app (incorporating global positioning system tracking and ecological momentary assessment) for 7 days, and then completed a closing survey. The app automatically collected global positioning system tracking data, and participants uploaded information on all food purchases over the 7-day period into the app. Participants also answered questions on contextual or individual purchase-related determinants directly after each purchase. During the final 3 days of the study, the participants also uploaded data on fruit, vegetable, and snack consumption and answered similar ecological momentary assessment questions after each intake. Results: In total, 140 participants completed the study. More than half of the participants said they liked the app (81/140, 57.9%) and found it easy to use (75/140, 53.6%). Of the 140 participants, 126 (90.0%) said that they had collected data on all or almost all purchases and intakes during the 7-day period. Most found the additional ecological momentary assessment questions ?easy to answer? (113/140, 80.7%) with ?no effort? (99/140, 70.7%). Of 106 participants who explored their trips in the app, 20 (18.8%) had trouble with their smartphone?s global positioning system tracking function. Therefore, we will not be able to include all participants in some of the proposed analyses, as we lack these data. We are analyzing data from the first study aim and we expect to publish the results in the spring of 2020. Conclusions: Participants perceived the FoodTrack app as a user-friendly tool. The app is particularly useful for observational studies that aim to gain insight into daily food environment exposure and food choices. Further analyses of the FoodTrack study data will provide novel insights into individual food environmental exposure, evidence on the individual food environment-diet interaction, and insights into the underlying individual and contextual mechanisms of food purchases and consumption. International Registered Report Identifier (IRRID): DERR1-10.2196/15283 UR - http://www.researchprotocols.org/2020/1/e15283/ UR - http://dx.doi.org/10.2196/15283 UR - http://www.ncbi.nlm.nih.gov/pubmed/32012100 ID - info:doi/10.2196/15283 ER - TY - JOUR AU - Goodday, M. Sarah AU - Atkinson, Lauren AU - Goodwin, Guy AU - Saunders, Kate AU - South, Matthew AU - Mackay, Clare AU - Denis, Mike AU - Hinds, Chris AU - Attenburrow, Mary-Jane AU - Davies, Jim AU - Welch, James AU - Stevens, William AU - Mansfield, Karen AU - Suvilehto, Juulia AU - Geddes, John PY - 2020/1/15 TI - The True Colours Remote Symptom Monitoring System: A Decade of Evolution JO - J Med Internet Res SP - e15188 VL - 22 IS - 1 KW - symptom assessment KW - signs and symptoms KW - digital health KW - ecological momentary assessment KW - mood disorders UR - https://www.jmir.org/2020/1/e15188 UR - http://dx.doi.org/10.2196/15188 UR - http://www.ncbi.nlm.nih.gov/pubmed/31939746 ID - info:doi/10.2196/15188 ER - TY - JOUR AU - Wahl, Ronja Deborah AU - Villinger, Karoline AU - Blumenschein, Michael AU - König, Maria Laura AU - Ziesemer, Katrin AU - Sproesser, Gudrun AU - Schupp, Thomas Harald AU - Renner, Britta PY - 2020/1/7 TI - Why We Eat What We Eat: Assessing Dispositional and In-the-Moment Eating Motives by Using Ecological Momentary Assessment JO - JMIR Mhealth Uhealth SP - e13191 VL - 8 IS - 1 KW - mHealth KW - eating KW - motivation KW - mobile app KW - EMA KW - in-the-moment KW - disposition KW - trait KW - state N2 - Background: Why do we eat? Our motives for eating are diverse, ranging from hunger and liking to social norms and affect regulation. Although eating motives can vary from eating event to eating event, which implies substantial moment-to-moment differences, current ways of measuring eating motives rely on single timepoint questionnaires that assess eating motives as situation-stable dispositions (traits). However, mobile technologies including smartphones allow eating events and motives to be captured in real time and real life, thus capturing experienced eating motives in-the-moment (states). Objective: This study aimed to examine differences between why people think they eat (trait motives) and why they eat in the moment of consumption (state motives) by comparing a dispositional (trait) and an in-the-moment (state) assessment of eating motives. Methods: A total of 15 basic eating motives included in The Eating Motivation Survey (ie, liking, habit, need and hunger, health, convenience, pleasure, traditional eating, natural concerns, sociability, price, visual appeal, weight control, affect regulation, social norms, and social image) were assessed in 35 participants using 2 methodological approaches: (1) a single timepoint dispositional assessment and (2) a smartphone-based ecological momentary assessment (EMA) across 8 days (N=888 meals) capturing eating motives in the moment of eating. Similarities between dispositional and in-the-moment eating motive profiles were assessed according to 4 different indices of profile similarity, that is, overall fit, shape, scatter, and elevation. Moreover, a visualized person × motive data matrix was created to visualize and analyze between- and within-person differences in trait and state eating motives. Results: Similarity analyses yielded a good overall fit between the trait and state eating motive profiles across participants, indicated by a double-entry intraclass correlation of 0.52 (P<.001). However, although trait and state motives revealed a comparable rank order (r=0.65; P<.001), trait motives overestimated 12 of 15 state motives (P<.001; d=1.97). Specifically, the participants assumed that 6 motives (need and hunger, price, habit, sociability, traditional eating, and natural concerns) are more essential for eating than they actually were in the moment (d>0.8). Furthermore, the visualized person × motive data matrix revealed substantial interindividual differences in intraindividual motive profiles. Conclusions: For a comprehensive understanding of why we eat what we eat, dispositional assessments need to be extended by in-the-moment assessments of eating motives. Smartphone-based EMAs reveal considerable intra- and interindividual differences in eating motives, which are not captured by single timepoint dispositional assessments. Targeting these differences between why people think they eat what they eat and why they actually eat in the moment may hold great promise for tailored mobile health interventions facilitating behavior changes. UR - https://mhealth.jmir.org/2020/1/e13191 UR - http://dx.doi.org/10.2196/13191 UR - http://www.ncbi.nlm.nih.gov/pubmed/31909719 ID - info:doi/10.2196/13191 ER - TY - JOUR AU - Ferreri, Florian AU - Bourla, Alexis AU - Peretti, Charles-Siegfried AU - Segawa, Tomoyuki AU - Jaafari, Nemat AU - Mouchabac, Stéphane PY - 2019/12/10 TI - How New Technologies Can Improve Prediction, Assessment, and Intervention in Obsessive-Compulsive Disorder (e-OCD): Review JO - JMIR Ment Health SP - e11643 VL - 6 IS - 12 KW - obsessive-compulsive disorder KW - ecological momentary assessment KW - biofeedback KW - digital biomarkers KW - digital phenotyping KW - mobile health KW - virtual reality KW - machine learning N2 - Background: New technologies are set to profoundly change the way we understand and manage psychiatric disorders, including obsessive-compulsive disorder (OCD). Developments in imaging and biomarkers, along with medical informatics, may well allow for better assessments and interventions in the future. Recent advances in the concept of digital phenotype, which involves using computerized measurement tools to capture the characteristics of a given psychiatric disorder, is one paradigmatic example. Objective: The impact of new technologies on health professionals? practice in OCD care remains to be determined. Recent developments could disrupt not just their clinical practices, but also their beliefs, ethics, and representations, even going so far as to question their professional culture. This study aimed to conduct an extensive review of new technologies in OCD. Methods: We conducted the review by looking for titles in the PubMed database up to December 2017 that contained the following terms: [Obsessive] AND [Smartphone] OR [phone] OR [Internet] OR [Device] OR [Wearable] OR [Mobile] OR [Machine learning] OR [Artificial] OR [Biofeedback] OR [Neurofeedback] OR [Momentary] OR [Computerized] OR [Heart rate variability] OR [actigraphy] OR [actimetry] OR [digital] OR [virtual reality] OR [Tele] OR [video]. Results: We analyzed 364 articles, of which 62 were included. Our review was divided into 3 parts: prediction, assessment (including diagnosis, screening, and monitoring), and intervention. Conclusions: The review showed that the place of connected objects, machine learning, and remote monitoring has yet to be defined in OCD. Smartphone assessment apps and the Web Screening Questionnaire demonstrated good sensitivity and adequate specificity for detecting OCD symptoms when compared with a full-length structured clinical interview. The ecological momentary assessment procedure may also represent a worthy addition to the current suite of assessment tools. In the field of intervention, CBT supported by smartphone, internet, or computer may not be more effective than that delivered by a qualified practitioner, but it is easy to use, well accepted by patients, reproducible, and cost-effective. Finally, new technologies are enabling the development of new therapies, including biofeedback and virtual reality, which focus on the learning of coping skills. For them to be used, these tools must be properly explained and tailored to individual physician and patient profiles. UR - https://mental.jmir.org/2019/12/e11643 UR - http://dx.doi.org/10.2196/11643 UR - http://www.ncbi.nlm.nih.gov/pubmed/31821153 ID - info:doi/10.2196/11643 ER - TY - JOUR AU - Morton, Emma AU - Hole, Rachelle AU - Murray, Greg AU - Buzwell, Simone AU - Michalak, Erin PY - 2019/12/4 TI - Experiences of a Web-Based Quality of Life Self-Monitoring Tool for Individuals With Bipolar Disorder: A Qualitative Exploration JO - JMIR Ment Health SP - e16121 VL - 6 IS - 12 KW - bipolar disorder KW - self-monitoring KW - self-management KW - qualitative KW - recovery KW - quality of life KW - eHealth N2 - Background: Self-monitoring of symptoms is a cornerstone of psychological interventions in bipolar disorder (BD), but individuals with lived experience also value tracking holistic outcomes, such as quality of life (QoL). Importantly, self-monitoring is not always experienced positively by people with BD and may have lower than expected rates of engagement. Therefore, before progressing into QoL tracking tools, it is important to explore user perspectives to identify possible risks and benefits, optimal methods to support engagement, and possible avenues to integrate QoL self-monitoring practices into clinical work. Objective: This study aimed to conduct a qualitative exploration of how individuals with BD engaged with a Web-based version of a BD-specific QoL self-monitoring instrument, the QoL tool. Methods: A total of 43 individuals with BD engaged with a self-management intervention with an optional Web-based QoL self-assessment tool as part of an overarching mixed method study. Individuals were later interviewed about personal experiences of engagement with the intervention, including experiences of gauging their own QoL. A thematic analysis was used to identify salient aspects of the experience of QoL self-monitoring in BD. Results: In total, 4 categories describing people?s experiences of QoL self-monitoring were identified: (1) breadth of QoL monitoring, (2) highlighting the positive, (3) connecting self-monitoring to action, and (4) self-directed patterns of use. Conclusions: The findings of this research generate novel insights into ways in which individuals with BD experience the Web-based QoL self-assessment tool. The value of tracking the breadth of domains was an overarching aspect, facilitating the identification of both areas of strength and life domains in need of intervention. Importantly, monitoring QoL appeared to have an inherently therapeutic quality, through validating flourishing areas and reinforcing self-management efforts. This contrasts the evidence suggesting that symptom tracking may be distressing because of its focus on negative experiences and positions QoL as a valuable adjunctive target of observation in BD. Flexibility and personalization of use of the QoL tool were key to engagement, informing considerations for health care providers wishing to support self-monitoring and future research into Web- or mobile phone?based apps. UR - https://mental.jmir.org/2019/12/e16121 UR - http://dx.doi.org/10.2196/16121 UR - http://www.ncbi.nlm.nih.gov/pubmed/31799936 ID - info:doi/10.2196/16121 ER - TY - JOUR AU - Johnson, Amanda AU - Yang, Fan AU - Gollarahalli, Siddharth AU - Banerjee, Tanvi AU - Abrams, Daniel AU - Jonassaint, Jude AU - Jonassaint, Charles AU - Shah, Nirmish PY - 2019/12/2 TI - Use of Mobile Health Apps and Wearable Technology to Assess Changes and Predict Pain During Treatment of Acute Pain in Sickle Cell Disease: Feasibility Study JO - JMIR Mhealth Uhealth SP - e13671 VL - 7 IS - 12 KW - pain KW - sickle cell disease KW - SCD KW - machine learning N2 - Background: Sickle cell disease (SCD) is an inherited red blood cell disorder affecting millions worldwide, and it results in many potential medical complications throughout the life course. The hallmark of SCD is pain. Many patients experience daily chronic pain as well as intermittent, unpredictable acute vaso-occlusive painful episodes called pain crises. These pain crises often require acute medical care through the day hospital or emergency department. Following presentation, a number of these patients are subsequently admitted with continued efforts of treatment focused on palliative pain control and hydration for management. Mitigating pain crises is challenging for both the patients and their providers, given the perceived unpredictability and subjective nature of pain. Objective: The objective of this study was to show the feasibility of using objective, physiologic measurements obtained from a wearable device during an acute pain crisis to predict patient-reported pain scores (in an app and to nursing staff) using machine learning techniques. Methods: For this feasibility study, we enrolled 27 adult patients presenting to the day hospital with acute pain. At the beginning of pain treatment, each participant was given a wearable device (Microsoft Band 2) that collected physiologic measurements. Pain scores from our mobile app, Technology Resources to Understand Pain Assessment in Patients with Pain, and those obtained by nursing staff were both used with wearable signals to complete time stamp matching and feature extraction and selection. Following this, we constructed regression and classification machine learning algorithms to build between-subject pain prediction models. Results: Patients were monitored for an average of 3.79 (SD 2.23) hours, with an average of 5826 (SD 2667) objective data values per patient. As expected, we found that pain scores and heart rate decreased for most patients during the course of their stay. Using the wearable sensor data and pain scores, we were able to create a regression model to predict subjective pain scores with a root mean square error of 1.430 and correlation between observations and predictions of 0.706. Furthermore, we verified the hypothesis that the regression model outperformed the classification model by comparing the performances of the support vector machines (SVM) and the SVM for regression. Conclusions: The Microsoft Band 2 allowed easy collection of objective, physiologic markers during an acute pain crisis in adults with SCD. Features can be extracted from these data signals and matched with pain scores. Machine learning models can then use these features to feasibly predict patient pain scores. UR - https://mhealth.jmir.org/2019/12/e13671 UR - http://dx.doi.org/10.2196/13671 UR - http://www.ncbi.nlm.nih.gov/pubmed/31789599 ID - info:doi/10.2196/13671 ER - TY - JOUR AU - Fridberg, J. Daniel AU - Faria, James AU - Cao, Dingcai AU - King, C. Andrea PY - 2019/11/20 TI - Real-Time Mobile Monitoring of Drinking Episodes in Young Adult Heavy Drinkers: Development and Comparative Survey Study JO - JMIR Mhealth Uhealth SP - e13765 VL - 7 IS - 11 KW - ecological momentary assessment KW - young adults KW - binge drinking N2 - Background: Binge drinking, defined as consuming five or more standard alcoholic drinks for men (four for women) within a 2-hour period, is common among young adults and is associated with significant alcohol-related morbidity and mortality. To date, most research on this problem in young adults has relied upon retrospective questionnaires or costly laboratory-based procedures. Smartphone-based ecological momentary assessment (EMA) may address these limitations by allowing researchers to measure alcohol use and related consequences in real time and in drinkers? natural environments. To date, however, relatively less research has systematically examined the utility of this approach in a sample of young adults targeting real-world heavy drinking episodes specifically. Objective: This study aimed to evaluate the feasibility, acceptability, and safety of a smartphone-based EMA method targeting binge drinking and related outcomes in heavy drinking young adults during real-world drinking occasions. Methods: Young adult binge drinkers in the smartphone group (N=83; mean 25.4 (SD 2.6) years; 58% (48/83) male; bingeing on 23.2% (6.5/28) days in the past month) completed baseline measures of alcohol use and drinking-related consequences, followed by up to two smartphone-based EMA sessions of typical drinking behavior and related outcomes in their natural environments. They also completed next-day and two-week follow-up surveys further assessing alcohol use and related consequences during the EMA sessions and two weeks after study participation, respectively. A separate demographic- and drinking-matched safety comparison group (N=25) completed the baseline and two-week follow-up surveys but did not complete EMA of real-world drinking behavior. Results: Most participants (71%, 59/83) in the smartphone group engaged in binge drinking during at least one 3-hour EMA session, consuming 7.3 (SD 3.0) standard alcoholic drinks. They completed 87.2% (507/581) system-initiated EMA prompts during the real-world drinking episode, supporting the feasibility of this approach. The procedure was acceptable, as evidenced by high participant ratings for overall satisfaction with the EMA software and study procedures and low ratings for intrusiveness of the mobile surveys. Regarding safety, participants endorsed few drinking-related consequences during or after the real-world drinking episode, with no adverse or serious adverse events reported. There were no differences between the groups in terms of changes in drinking behavior or consequences from baseline to two-week follow-up. Conclusions: This study provided preliminary support for the feasibility, acceptability, and safety of a smartphone-based EMA of real-time alcohol use and related outcomes in young adult heavy drinkers. The results suggest that young adults can use smartphones to safely monitor drinking even during very heavy drinking episodes. Smartphone-based EMA has strong potential to inform future research on the epidemiology of and intervention for alcohol use disorder by providing researchers with an efficient and inexpensive way to capture large amounts of data on real-world drinking behavior and consequences. UR - https://mhealth.jmir.org/2019/11/e13765 UR - http://dx.doi.org/10.2196/13765 UR - http://www.ncbi.nlm.nih.gov/pubmed/31746774 ID - info:doi/10.2196/13765 ER - TY - JOUR AU - Cormack, Francesca AU - McCue, Maggie AU - Taptiklis, Nick AU - Skirrow, Caroline AU - Glazer, Emilie AU - Panagopoulos, Elli AU - van Schaik, A. Tempest AU - Fehnert, Ben AU - King, James AU - Barnett, H. Jennifer PY - 2019/11/18 TI - Wearable Technology for High-Frequency Cognitive and Mood Assessment in Major Depressive Disorder: Longitudinal Observational Study JO - JMIR Ment Health SP - e12814 VL - 6 IS - 11 KW - depression KW - cognition KW - mood KW - mobile health KW - mHealth KW - mobile apps KW - ecological momentary assessment KW - digital phenotyping KW - digital biomarkers N2 - Background: Cognitive symptoms are common in major depressive disorder and may help to identify patients who need treatment or who are not experiencing adequate treatment response. Digital tools providing real-time data assessing cognitive function could help support patient treatment and remediation of cognitive and mood symptoms. Objective: The aim of this study was to examine feasibility and validity of a wearable high-frequency cognitive and mood assessment app over 6 weeks, corresponding to when antidepressant pharmacotherapy begins to show efficacy. Methods: A total of 30 patients (aged 19-63 years; 19 women) with mild-to-moderate depression participated in the study. The new Cognition Kit app was delivered via the Apple Watch, providing a high-resolution touch screen display for task presentation and logging responses. Cognition was assessed by the n-back task up to 3 times daily and depressed mood by 3 short questions once daily. Adherence was defined as participants completing at least 1 assessment daily. Selected tests sensitive to depression from the Cambridge Neuropsychological Test Automated Battery and validated questionnaires of depression symptom severity were administered on 3 occasions (weeks 1, 3, and 6). Exploratory analyses examined the relationship between mood and cognitive measures acquired in low- and high-frequency assessment. Results: Adherence was excellent for mood and cognitive assessments (95% and 96%, respectively), did not deteriorate over time, and was not influenced by depression symptom severity or cognitive function at study onset. Analyses examining the relationship between high-frequency cognitive and mood assessment and validated measures showed good correspondence. Daily mood assessments correlated moderately with validated depression questionnaires (r=0.45-0.69 for total daily mood score), and daily cognitive assessments correlated moderately with validated cognitive tests sensitive to depression (r=0.37-0.50 for mean n-back). Conclusions: This study supports the feasibility and validity of high-frequency assessment of cognition and mood using wearable devices over an extended period in patients with major depressive disorder. UR - https://mental.jmir.org/2019/11/e12814 UR - http://dx.doi.org/10.2196/12814 UR - http://www.ncbi.nlm.nih.gov/pubmed/31738172 ID - info:doi/10.2196/12814 ER - TY - JOUR AU - Meule, Adrian AU - Richard, Anna AU - Dinic, Radomir AU - Blechert, Jens PY - 2019/11/1 TI - Effects of a Smartphone-Based Approach-Avoidance Intervention on Chocolate Craving and Consumption: Randomized Controlled Trial JO - JMIR Mhealth Uhealth SP - e12298 VL - 7 IS - 11 KW - food KW - chocolate KW - craving KW - smartphone KW - mobile phone KW - mhealth KW - digital health KW - eating behavior N2 - Background: Repeatedly pushing high-calorie food stimuli away based on joystick movements has been found to reduce approach biases toward these stimuli. Some studies also found that such avoidance training reduced consumption of high-calorie foods. Objective: This study aimed to test effects of a smartphone-based approach-avoidance intervention on chocolate craving and consumption, to make such interventions suitable for daily use. Methods: Within a 10-day period, regular chocolate eaters (n=105, 86% female) performed five sessions during which they continuously avoided (ie, swiped upward) chocolate stimuli (experimental group, n=35), performed five sessions during which they approached and avoided chocolate stimuli equally often (placebo control group, n=35), or did not perform any training sessions (inactive control group, n=35). Training effects were measured during laboratory sessions before and after the intervention period and further continuously through daily ecological momentary assessment. Results: Self-reported chocolate craving and consumption as well as body fat mass significantly decreased from pre- to postmeasurement across all groups. Ecological momentary assessment reports evidenced no differences in chocolate craving and consumption between intervention days and rest days as a function of the group. Conclusions: A smartphone-based approach-avoidance training did not affect eating-related and anthropometric measures over and above measurement-based changes in this study. Future controlled studies need to examine whether other techniques of modifying food approach tendencies show an add-on benefit over conventional, monitoring-based intervention effects. Trial Registration: AsPredicted 8203; https://aspredicted.org/pt9df.pdf. UR - https://mhealth.jmir.org/2019/11/e12298 UR - http://dx.doi.org/10.2196/12298 UR - http://www.ncbi.nlm.nih.gov/pubmed/31682584 ID - info:doi/10.2196/12298 ER - TY - JOUR AU - Pryss, Rüdiger AU - John, Dennis AU - Schlee, Winfried AU - Schlotz, Wolff AU - Schobel, Johannes AU - Kraft, Robin AU - Spiliopoulou, Myra AU - Langguth, Berthold AU - Reichert, Manfred AU - O'Rourke, Teresa AU - Peters, Henning AU - Pieh, Christoph AU - Lahmann, Claas AU - Probst, Thomas PY - 2019/10/30 TI - Exploring the Time Trend of Stress Levels While Using the Crowdsensing Mobile Health Platform, TrackYourStress, and the Influence of Perceived Stress Reactivity: Ecological Momentary Assessment Pilot Study JO - JMIR Mhealth Uhealth SP - e13978 VL - 7 IS - 10 KW - mHealth KW - psychological stress KW - crowdsensing KW - ecological momentary assessment KW - pilot study N2 - Background: The mobile phone app, TrackYourStress (TYS), is a new crowdsensing mobile health platform for ecological momentary assessments of perceived stress levels. Objective: In this pilot study, we aimed to investigate the time trend of stress levels while using TYS for the entire population being studied and whether the individuals? perceived stress reactivity moderates stress level changes while using TYS. Methods: Using TYS, stress levels were measured repeatedly with the 4-item version of the Perceived Stress Scale (PSS-4), and perceived stress reactivity was measured once with the Perceived Stress Reactivity Scale (PSRS). A total of 78 nonclinical participants, who provided 1 PSRS assessment and at least 4 repeated PSS-4 measurements, were included in this pilot study. Linear multilevel models were used to analyze the time trend of stress levels and interactions with perceived stress reactivity. Results: Across the whole sample, stress levels did not change while using TYS (P=.83). Except for one subscale of the PSRS, interindividual differences in perceived stress reactivity did not influence the trajectories of stress levels. However, participants with higher scores on the PSRS subscale reactivity to failure showed a stronger increase of stress levels while using TYS than participants with lower scores (P=.04). Conclusions: TYS tracks the stress levels in daily life, and most of the results showed that stress levels do not change while using TYS. Controlled trials are necessary to evaluate whether it is specifically TYS or any other influence that worsens the stress levels of participants with higher reactivity to failure. UR - http://mhealth.jmir.org/2019/10/e13978/ UR - http://dx.doi.org/10.2196/13978 UR - http://www.ncbi.nlm.nih.gov/pubmed/31670692 ID - info:doi/10.2196/13978 ER - TY - JOUR AU - Kim, Heejung AU - Lee, SungHee AU - Lee, SangEun AU - Hong, Soyun AU - Kang, HeeJae AU - Kim, Namhee PY - 2019/10/16 TI - Depression Prediction by Using Ecological Momentary Assessment, Actiwatch Data, and Machine Learning: Observational Study on Older Adults Living Alone JO - JMIR Mhealth Uhealth SP - e14149 VL - 7 IS - 10 KW - elderly KW - one-person household KW - depression KW - ecological momentary assessment KW - actigraphy KW - machine learning N2 - Background: Although geriatric depression is prevalent, diagnosis using self-reporting instruments has limitations when measuring the depressed mood of older adults in a community setting. Ecological momentary assessment (EMA) by using wearable devices could be used to collect data to classify older adults into depression groups. Objective: The objective of this study was to develop a machine learning algorithm to predict the classification of depression groups among older adults living alone. We focused on utilizing diverse data collected through a survey, an Actiwatch, and an EMA report related to depression. Methods: The prediction model using machine learning was developed in 4 steps: (1) data collection, (2) data processing and representation, (3) data modeling (feature engineering and selection), and (4) training and validation to test the prediction model. Older adults (N=47), living alone in community settings, completed an EMA to report depressed moods 4 times a day for 2 weeks between May 2017 and January 2018. Participants wore an Actiwatch that measured their activity and ambient light exposure every 30 seconds for 2 weeks. At baseline and the end of the 2-week observation, depressive symptoms were assessed using the Korean versions of the Short Geriatric Depression Scale (SGDS-K) and the Hamilton Depression Rating Scale (K-HDRS). Conventional classification based on binary logistic regression was built and compared with 4 machine learning models (the logit, decision tree, boosted trees, and random forest models). Results: On the basis of the SGDS-K and K-HDRS, 38% (18/47) of the participants were classified into the probable depression group. They reported significantly lower scores of normal mood and physical activity and higher levels of white and red, green, and blue (RGB) light exposures at different degrees of various 4-hour time frames (all P<.05). Sleep efficiency was chosen for modeling through feature selection. Comparing diverse combinations of the selected variables, daily mean EMA score, daily mean activity level, white and RGB light at 4:00 pm to 8:00 pm exposure, and daily sleep efficiency were selected for modeling. Conventional classification based on binary logistic regression had a good model fit (accuracy: 0.705; precision: 0.770; specificity: 0.859; and area under receiver operating characteristic curve or AUC: 0.754). Among the 4 machine learning models, the logit model had the best fit compared with the others (accuracy: 0.910; precision: 0.929; specificity: 0.940; and AUC: 0.960). Conclusions: This study provides preliminary evidence for developing a machine learning program to predict the classification of depression groups in older adults living alone. Clinicians should consider using this method to identify underdiagnosed subgroups and monitor daily progression regarding treatment or therapeutic intervention in the community setting. Furthermore, more efforts are needed for researchers and clinicians to diversify data collection methods by using a survey, EMA, and a sensor. UR - http://mhealth.jmir.org/2019/10/e14149/ UR - http://dx.doi.org/10.2196/14149 UR - http://www.ncbi.nlm.nih.gov/pubmed/31621642 ID - info:doi/10.2196/14149 ER - TY - JOUR AU - Þórarinsdóttir, Helga AU - Faurholt-Jepsen, Maria AU - Ullum, Henrik AU - Frost, Mads AU - Bardram, E. Jakob AU - Kessing, Vedel Lars PY - 2019/08/19 TI - The Validity of Daily Self-Assessed Perceived Stress Measured Using Smartphones in Healthy Individuals: Cohort Study JO - JMIR Mhealth Uhealth SP - e13418 VL - 7 IS - 8 KW - emotional stress KW - smartphone KW - ecological momentary assessment KW - mobile phone KW - self-report KW - healthy individuals N2 - Background: Smartphones may offer a new and easy tool to assess stress, but the validity has never been investigated. Objective: This study aimed to investigate (1) the validity of smartphone-based self-assessed stress compared with Cohen Perceived Stress Scale (PSS) and (2) whether smartphone-based self-assessed stress correlates with neuroticism (Eysenck Personality Questionnaire-Neuroticism, EPQ-N), psychosocial functioning (Functioning Assessment Short Test, FAST), and prior stressful life events (Kendler Questionnaire for Stressful Life Events, SLE). Methods: A cohort of 40 healthy blood donors with no history of personal or first-generation family history of psychiatric illness and who used an Android smartphone were instructed to self-assess their stress level daily (on a scale from 0 to 2; beta values reflect this scale) for 4 months. At baseline, participants were assessed with the FAST rater-blinded and filled out the EPQ, the PSS, and the SLE. The PSS assessment was repeated after 4 months. Results: In linear mixed-effect regression and linear regression models, there were statistically significant positive correlations between self-assessed stress and the PSS (beta=.0167; 95% CI 0.0070-0.0026; P=.001), the EPQ-N (beta=.0174; 95% CI 0.0023-0.0325; P=.02), and the FAST (beta=.0329; 95% CI 0.0036-0.0622; P=.03). No correlation was found between smartphone-based self-assessed stress and the SLE. Conclusions: Daily smartphone-based self-assessed stress seems to be a valid measure of perceived stress. Our study contains a modest sample of 40 healthy participants and adds knowledge to a new but growing field of research. Smartphone-based self-assessed stress is a promising tool for measuring stress in real time in future studies of stress and stress-related behavior. UR - http://mhealth.jmir.org/2019/8/e13418/ UR - http://dx.doi.org/10.2196/13418 UR - http://www.ncbi.nlm.nih.gov/pubmed/31429413 ID - info:doi/10.2196/13418 ER - TY - JOUR AU - Mendez, D. Dara AU - Sanders, A. Sarah AU - Karimi, A. Hassan AU - Gharani, Pedram AU - Rathbun, L. Stephen AU - Gary-Webb, L. Tiffany AU - Wallace, L. Meredith AU - Gianakas, J. John AU - Burke, E. Lora AU - Davis, M. Esa PY - 2019/06/26 TI - Understanding Pregnancy and Postpartum Health Using Ecological Momentary Assessment and Mobile Technology: Protocol for the Postpartum Mothers Mobile Study JO - JMIR Res Protoc SP - e13569 VL - 8 IS - 6 KW - ecological momentary assessment (EMA) KW - wireless technology KW - remote sensing technology KW - maternal health KW - pregnancy KW - postpartum KW - body weight KW - health status disparities KW - health equity N2 - Background: There are significant racial disparities in pregnancy and postpartum health outcomes, including postpartum weight retention and cardiometabolic risk. These racial disparities are a result of a complex interplay between contextual, environmental, behavioral, and psychosocial factors. Objective: This protocol provides a description of the development and infrastructure for the Postpartum Mothers Mobile Study (PMOMS), designed to better capture women?s daily experiences and exposures from late pregnancy through 1 year postpartum. The primary aims of PMOMS are to understand the contextual, psychosocial, and behavioral factors contributing to racial disparities in postpartum weight and cardiometabolic health, with a focus on the daily experiences of stress and racism, as well as contextual forms of stress (eg, neighborhood stress and structural racism). Methods: PMOMS is a longitudinal observation study that is ancillary to an existing randomized control trial, GDM2 (Comparison of Two Screening Strategies for Gestational Diabetes). PMOMS uses an efficient and cost-effective approach for recruitment by leveraging the infrastructure of GDM2, facilitating enrollment of participants while consolidating staff support from both studies. The primary data collection method is ecological momentary assessment (EMA) and through smart technology (ie, smartphones and scales). The development of the study includes: (1) the pilot phase and development of the smartphone app; (2) feedback and further development of the app including selection of key measures; and (3) implementation, recruitment, and retention. Results: PMOMS aims to recruit 350 participants during pregnancy, to be followed through the first year after delivery. Recruitment and data collection started in December 2017 and are expected to continue through September 2020. Initial results are expected in December 2020. As of early May 2019, PMOMS recruited a total of 305 participants. Key strengths and features of PMOMS have included data collection via smartphone technology to reduce the burden of multiple on-site visits, low attrition rate because of participation in an ongoing trial in which women are already motivated and enrolled, high EMA survey completion and the use of EMA as a unique data collection method to understand daily experiences, and shorter than expected timeframe for enrollment because of the infrastructure of the GDM2 trial. Conclusions: This protocol outlines the development of the PMOMS, one of the first published studies to use an ongoing EMA and mobile technology protocol during pregnancy and throughout 1 year postpartum to understand the health of childbearing populations and enduring racial disparities in postpartum weight and cardiometabolic health. Our findings will contribute to the improvement of data collection methods, particularly the role of EMA in capturing multiple exposures and knowledge in real time. Furthermore, the results of the study will inform future studies investigating weight and cardiometabolic health during pregnancy and the postpartum period, including how social determinants produce population disparities in these outcomes. International Registered Report Identifier (IRRID): DERR1-10.2196/13569 UR - http://www.researchprotocols.org/2019/6/e13569/ UR - http://dx.doi.org/10.2196/13569 UR - http://www.ncbi.nlm.nih.gov/pubmed/31244478 ID - info:doi/10.2196/13569 ER - TY - JOUR AU - Romanzini, Possamai Catiana Leila AU - Romanzini, Marcelo AU - Batista, Biagi Mariana AU - Barbosa, Lopes Cynthia Correa AU - Shigaki, Blasquez Gabriela AU - Dunton, Genevieve AU - Mason, Tyler AU - Ronque, Vaz Enio Ricardo PY - 2019/05/15 TI - Methodology Used in Ecological Momentary Assessment Studies About Sedentary Behavior in Children, Adolescents, and Adults: Systematic Review Using the Checklist for Reporting Ecological Momentary Assessment Studies JO - J Med Internet Res SP - e11967 VL - 21 IS - 5 KW - physical activity KW - accelerometry KW - health behavior N2 - Background: The use of ecological momentary assessment (EMA) to measure sedentary behavior (SB) in children, adolescents, and adults can increase the understanding of the role of the context of SB in health outcomes. Objective: The aim of this study was to systematically review literature to describe EMA methodology used in studies on SB in youth and adults, verify how many studies adhere to the Methods aspect of the Checklist for Reporting EMA Studies (CREMAS), and detail measures used to assess SB and this associated context. Methods: A systematic literature review was conducted in the PubMed, Scopus, Web of Science, PsycINFO, Cumulative Index to Nursing and Allied Health Literature (CINAHL), and SPORTDiscus databases, covering the entire period of existence of the databases until January 2018. Results: This review presented information about the characteristics and methodology used in 21 articles that utilized EMA to measure SB in youth and adults. There were more studies conducted among youth compared with adults, and studies of youth included more waves and more participants (n=696) than studies with adults (n=97). Most studies (85.7%) adhered to the Methods aspect of the CREMAS. The main criteria used to measure SB in EMA were self-report (81%) with only 19% measuring SB using objective methods (eg, accelerometer). The main equipment to collect objective SB was the ActiGraph, and the cutoff point to define SB was <100 counts/min. Studies most commonly used a 15-min window to compare EMA and accelerometer data. Conclusions: The majority of studies in this review met minimum CREMAS criteria for studies conducted with EMA. Most studies measured SB with EMA self-report (n=17; 81.0%), and a few studies also used objective methods (n=4; 19%). The standardization of the 15-min window criteria to compare EMA and accelerometer data would lead to a comparison between these and new studies. New studies using EMA with mobile phones should be conducted as they can be considered an attractive method for capturing information about the specific context of SB activities of young people and adults in real time or very close to it. UR - https://www.jmir.org/2019/5/e11967/ UR - http://dx.doi.org/10.2196/11967 UR - http://www.ncbi.nlm.nih.gov/pubmed/31094349 ID - info:doi/10.2196/11967 ER - TY - JOUR AU - Smelror, Elle Runar AU - Bless, Johann Josef AU - Hugdahl, Kenneth AU - Agartz, Ingrid PY - 2019/05/14 TI - Feasibility and Acceptability of Using a Mobile Phone App for Characterizing Auditory Verbal Hallucinations in Adolescents With Early-Onset Psychosis: Exploratory Study JO - JMIR Form Res SP - e13882 VL - 3 IS - 2 KW - experience sampling method KW - ecological momentary assessment KW - schizophrenia KW - mHealth KW - health care technology N2 - Background: Auditory verbal hallucinations (AVH) are the most frequent symptom in early-onset psychosis (EOP) and a risk factor for increased suicide attempts in adolescents. Increased knowledge of AVH characteristics can lead to better prediction of risk and precision of diagnosis and help identify individuals with AVH who need care. As 98% of Norwegian adolescents aged 12 to 16 years own a mobile phone, the use of mobile phone apps in symptom assessment and patient communication is a promising new tool. However, when introducing new technology to patients, their subjective experiences are crucial in identifying risks, further development, and potential integration into clinical care. Objective: The objective was to explore the feasibility and acceptability of a newly developed mobile phone app in adolescents with EOP by examining compliance with the app and user experiences. Indication of validity was explored by examining associations between AVH dimensions, which were correlated and analyzed. Methods: Three adolescents with EOP and active AVH were enrolled. Real-time AVH were logged on an iPod touch using the experience sampling method (ESM), for seven or more consecutive days. The app included five dimensions of AVH characteristics and was programmed with five daily notifications. Feasibility and acceptability were examined using the mean response rate of data sampling and by interviewing the participants. Validity was assessed by examining associations between the AVH dimensions using nonparametric correlation analysis and by visual inspection of temporal fluctuations of the AVH dimensions. Results: One participant was excluded from the statistical analyses but completed the interview and was included in the examination of acceptability. The sampling period of the two participants was mean 12 (SD 6) days with overall completed sampling rate of 74% (SD 30%), indicating adequate to high compliance with the procedure. The user experiences from the interviews clustered into four categories: (1) increased awareness, (2) personal privacy, (3) design and procedure, and (4) usefulness and clinical care. One participant experienced more commenting voices during the sampling period, and all three participants had concerns regarding personal privacy when using electronic devices in symptom assessment. The AVH dimensions of content, control, and influence showed moderate to strong significant correlations with all dimensions (P<.001). Days of data sampling showed weak to moderate correlations with localization (P<.001) and influence (P=.03). Visual inspection indicated that the app was able to capture fluctuations within and across days for all AVH dimensions. Conclusions: This study demonstrates the value of including patients? experiences in the development and pilot-testing of new technology. Based on the small sample size, the use of mobile phones with ESM seems feasible for patients with EOP, but the acceptability of using apps should be considered. Further investigation with larger samples is warranted before definitive conclusions are made. UR - http://formative.jmir.org/2019/2/e13882/ UR - http://dx.doi.org/10.2196/13882 UR - http://www.ncbi.nlm.nih.gov/pubmed/31094321 ID - info:doi/10.2196/13882 ER - TY - JOUR AU - Turner, M. Caitlin AU - Arayasirikul, Sean AU - Trujillo, Dillon AU - Lê, Victory AU - Wilson, C. Erin PY - 2019/05/08 TI - Social Inequity and Structural Barriers to Completion of Ecological Momentary Assessments for Young Men Who Have Sex With Men and Trans Women Living With HIV in San Francisco JO - JMIR Mhealth Uhealth SP - e13241 VL - 7 IS - 5 KW - ecological momentary assessment KW - EMA KW - MSM KW - trans women KW - people living with HIV KW - feasibility KW - acceptability N2 - Background: Ecological momentary assessments (EMAs) administered via text messaging facilitate real-time data collection. With widespread cell phone access, EMAs are becoming more available to even the most disenfranchised communities, such as those living with HIV. However, structural barriers disproportionately burden young men who have sex with men (MSM) and trans women (TW) living with HIV and threaten participation in HIV research. Objective: We aim to identify structural barriers to completing EMA text surveys nested within a digital HIV care intervention for young MSM and TW living with HIV in San Francisco. Methods: A total of 10,800 EMA text messages were delivered daily over 90 days to 120 participants enrolled in the Health eNav intervention (2017-2018) at the San Francisco Department of Public Health. EMA surveys inquired about participants? daily affect, sexual behaviors, substance use, and treatment adherence. Survey completion was calculated after 30, 60, and 90 days of follow-up. We described characteristics of nonstarters (those who provided less than four complete responses to the first seven EMA surveys) and analyzed structural correlates of days to first weeklong or more EMA survey noncompletion using multivariable Cox proportional hazards regression. Qualitative interviews were used to evaluate the acceptability of EMA surveys. Results: Participants completed 4384 of 10,800 (40.59%) EMA surveys. Completion of 70% or more of EMA surveys was attained by 56 of 120 participants (46.7%) at 30 days of follow-up, 40/120 (33.3%) at 60 days of follow-up, and 30/120 (25.0%) by the end of the 90-day study period. Twenty-eight participants (23.3%) were identified as nonstarters, and were more likely to be recently incarcerated (prevalence ratio [PR] 2.3, 95% CI 1.3-4.4), forego basic needs for HIV medications (PR 2.4, 95% CI 1.3-4.5), and be diagnosed with HIV in the last year (PR 2.2, 95% CI 1.1-4.1). Adjusting for nonstarters, young MSM and TW living in temporary/transitional housing (adjusted hazard ratio [aHR] 1.8, 95% CI 1.1-3.0), foregoing HIV medications to afford basic needs (aHR 1.7, 95% CI 1.1-2.7), and having less than a college education (aHR 3.5, 95% CI 1.4-9.0) had greater hazard of weeklong or more EMA survey noncompletion. Overall, there was high acceptability of the EMA surveys. Conclusions: Although access to and use of technology is increasingly ubiquitous, this analysis demonstrates persisting gaps in EMA completion by socioeconomic factors such as incarceration, education level, housing, and competing needs for young MSM and TW living with HIV in San Francisco. Moreover, those recently diagnosed with HIV were more likely to experience an immediate drop-off in completing EMA surveys. EMAs are feasible for individuals not experiencing social inequity and structural barriers. HIV prevention technologies addressing these barriers and leveraging similar methodology may prove effective for young MSM and TW living with HIV. UR - https://mhealth.jmir.org/2019/5/e13241/ UR - http://dx.doi.org/10.2196/13241 UR - http://www.ncbi.nlm.nih.gov/pubmed/31066714 ID - info:doi/10.2196/13241 ER - TY - JOUR AU - Mofsen, M. Aaron AU - Rodebaugh, L. Thomas AU - Nicol, E. Ginger AU - Depp, A. Colin AU - Miller, Philip J. AU - Lenze, J. Eric PY - 2019/4/21 TI - When All Else Fails, Listen to the Patient: A Viewpoint on the Use of Ecological Momentary Assessment in Clinical Trials JO - JMIR Ment Health SP - e11845 VL - 6 IS - 5 KW - ecological momentary assessment KW - mental health KW - controlled clinical trial KW - psychiatry KW - health technology UR - https://mental.jmir.org/2019/5/e11845/ UR - http://dx.doi.org/10.2196/11845 UR - http://www.ncbi.nlm.nih.gov/pubmed/31066701 ID - info:doi/10.2196/11845 ER - TY - JOUR AU - Rozet, Alan AU - Kronish, M. Ian AU - Schwartz, E. Joseph AU - Davidson, W. Karina PY - 2019/04/26 TI - Using Machine Learning to Derive Just-In-Time and Personalized Predictors of Stress: Observational Study Bridging the Gap Between Nomothetic and Ideographic Approaches JO - J Med Internet Res SP - e12910 VL - 21 IS - 4 KW - ecological momentary assessment KW - machine learning KW - stress-behavior pathway KW - personal informatics KW - self-quantification KW - exercise KW - weather KW - just-in-time interventions N2 - Background: Investigations into person-specific predictors of stress have typically taken either a population-level nomothetic approach or an individualized ideographic approach. Nomothetic approaches can quickly identify predictors but can be hindered by the heterogeneity of these predictors across individuals and time. Ideographic approaches may result in more predictive models at the individual level but require a longer period of data collection to identify robust predictors. Objective: Our objectives were to compare predictors of stress identified through nomothetic and ideographic models and to assess whether sequentially combining nomothetic and ideographic models could yield more accurate and actionable predictions of stress than relying on either model. At the same time, we sought to maintain the interpretability necessary to retrieve individual predictors of stress despite using nomothetic models. Methods: Data collected in a 1-year observational study of 79 participants performing low levels of exercise were used. Physical activity was continuously and objectively monitored by actigraphy. Perceived stress was recorded by participants via daily ecological momentary assessments on a mobile app. Environmental variables including daylight time, temperature, and precipitation were retrieved from the public archives. Using these environmental, actigraphy, and mobile assessment data, we built machine learning models to predict individual stress ratings using linear, decision tree, and neural network techniques employing nomothetic and ideographic approaches. The accuracy of the approaches for predicting individual stress ratings was compared based on classification errors. Results: Across the group of patients, an individual?s recent history of stress ratings was most heavily weighted in predicting a future stress rating in the nomothetic recurrent neural network model, whereas environmental factors such as temperature and daylight, as well as duration and frequency of bouts of exercise, were more heavily weighted in the ideographic models. The nomothetic recurrent neural network model was the highest performing nomothetic model and yielded 72% accuracy for an 80%/20% train/test split. Using the same 80/20 split, the ideographic models yielded 75% accuracy. However, restricting ideographic models to participants with more than 50 valid days in the training set, with the same 80/20 split, yielded 85% accuracy. Conclusions: We conclude that for some applications, nomothetic models may be useful for yielding higher initial performance while still surfacing personalized predictors of stress, before switching to ideographic models upon sufficient data collection. UR - http://www.jmir.org/2019/4/e12910/ UR - http://dx.doi.org/10.2196/12910 UR - http://www.ncbi.nlm.nih.gov/pubmed/31025942 ID - info:doi/10.2196/12910 ER - TY - JOUR AU - Lemey, Christophe AU - Larsen, Erik Mark AU - Devylder, Jordan AU - Courtet, Philippe AU - Billot, Romain AU - Lenca, Philippe AU - Walter, Michel AU - Baca-García, Enrique AU - Berrouiguet, Sofian PY - 2019/04/25 TI - Clinicians? Concerns About Mobile Ecological Momentary Assessment Tools Designed for Emerging Psychiatric Problems: Prospective Acceptability Assessment of the MEmind App JO - J Med Internet Res SP - e10111 VL - 21 IS - 4 KW - acceptability KW - feasibility studies KW - mobile applications KW - ecological momentary assessment KW - decision support systems, clinical KW - internet KW - outpatients KW - young adult KW - prodromal symptoms KW - mental health N2 - Background: Many 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. Objective: The 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. Methods: We 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. Results: Of 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. Conclusions: We 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. UR - https://www.jmir.org/2019/4/e10111/ UR - http://dx.doi.org/10.2196/10111 UR - http://www.ncbi.nlm.nih.gov/pubmed/31021327 ID - info:doi/10.2196/10111 ER - TY - JOUR AU - Srinivas, Preethi AU - Bodke, Kunal AU - Ofner, Susan AU - Keith, R. NiCole AU - Tu, Wanzhu AU - Clark, O. Daniel PY - 2019/04/03 TI - Context-Sensitive Ecological Momentary Assessment: Application of User-Centered Design for Improving User Satisfaction and Engagement During Self-Report JO - JMIR Mhealth Uhealth SP - e10894 VL - 7 IS - 4 KW - mhealth KW - health status KW - obesity KW - ecological momentary assessment N2 - Background: Ecological momentary assessment (EMA) can be a useful tool for collecting real-time behavioral data in studies of health and health behavior. However, EMA administered through mobile technology can be burdensome, and it tends to suffer from suboptimal user engagement, particularly in low health-literacy populations. Objective: This study aimed to report a case study involving the design and evaluation of a mobile EMA tool that supports context-sensitive EMA-reporting of location and social situations accompanying eating and sedentary behavior. Methods: An iterative, user-centered design process with obese, middle-aged women seeking care in a safety-net health system was used to identify the preferred format of self-report measures and the look, feel, and interaction of the mobile EMA tool. A single-arm feasibility field trial with 21 participants receiving 12 prompts each day for momentary self-reports over a 4-week period (336 total prompts per participant) was used to determine user satisfaction with interface quality and user engagement, operationalized as response rate. A second trial among 38 different participants randomized to receive or not to receive a feature designed to improve engagement was conducted. Results: The feasibility trial results showed high interface satisfaction and engagement, with an average response rate of 50% over 4 weeks. Qualitative feedback pointed to the need for auditory alerts. We settled on 3 alerts at 10-min intervals to accompany each EMA-reporting prompt. The second trial testing this feature showed a statistically significant increase in the response rate between participants randomized to receive repeat auditory alerts versus those who were not (60% vs 40%). Conclusions: This paper reviews the design research and a set of design constraints that may be considered in the creation of mobile EMA interfaces personalized to users? preferences. Novel aspects of the study include the involvement of low health-literacy adults in design research, the capture of data on time, place, and social context of eating and sedentary behavior, and reporting prompts tailored to an individual?s location and schedule. Trial Registration: ClinicalTrials.gov NCT03083964; https://clinicaltrials.gov/ct2/show/NCT03083964 UR - http://mhealth.jmir.org/2019/4/e10894/ UR - http://dx.doi.org/10.2196/10894 UR - http://www.ncbi.nlm.nih.gov/pubmed/30942698 ID - info:doi/10.2196/10894 ER - TY - JOUR AU - Hartmann, Ralf AU - Sander, Christian AU - Lorenz, Noah AU - Böttger, Daniel AU - Hegerl, Ulrich PY - 2019/04/03 TI - Utilization of Patient-Generated Data Collected Through Mobile Devices: Insights From a Survey on Attitudes Toward Mobile Self-Monitoring and Self-Management Apps for Depression JO - JMIR Ment Health SP - e11671 VL - 6 IS - 4 KW - mHealth KW - depression KW - adherence KW - mobile applications, self-management N2 - Background: Depression is a severe psychiatric disease with high prevalence and an elevated risk for recurrence and chronicity. A substantial proportion of individuals with a diagnosis of unipolar depressive disorder do not receive treatment as advised by national guidelines. Consequently, self-monitoring and self-management become increasingly important. New mobile technologies create unique opportunities to obtain and utilize patient-generated data. As common adherence rates to mobile technologies are scarce, a profound knowledge of user behavior and attitudes and preferences is important throughout any developmental process of mobile technologies and apps. Objective: The aim of this survey was to provide descriptive data upon usage and anticipated usage of self-monitoring and self-management of depression and preferences of potential users in terms of documented parameters and data-sharing options. Methods: A Web-based survey comprising 55 questions was conducted to obtain data on the usage of mobile devices, app usage, and participant?s attitudes and preferences toward mobile health apps for the self-monitoring and self-management of depression. Results: A total of 825 participants provided information. Moreover, two-thirds of the sample self-reported to be affected by depressive symptoms, but only 12.1% (81/668) of those affected by depression have ever used any mobile self-monitoring or self-management app. Analysis showed that people want personally relevant information and feedback but also focus on handling sensitive data. Conclusions: New mobile technologies and smartphone apps, especially in combination with mobile sensor systems, offer unique opportunities to overcome challenges in the treatment of depression by utilizing the potential of patient-generated data. Focus on patient-relevant information, security and safe handling of sensitive personal data, as well as options to share data with self-selected third parties should be considered mandatory throughout any development process. UR - https://mental.jmir.org/2019/4/e11671/ UR - http://dx.doi.org/10.2196/11671 UR - http://www.ncbi.nlm.nih.gov/pubmed/30942693 ID - info:doi/10.2196/11671 ER - TY - JOUR AU - Yang, Sook Yong AU - Ryu, Wook Gi AU - Choi, Mona PY - 2019/04/01 TI - Methodological Strategies for Ecological Momentary Assessment to Evaluate Mood and Stress in Adult Patients Using Mobile Phones: Systematic Review JO - JMIR Mhealth Uhealth SP - e11215 VL - 7 IS - 4 KW - review KW - experience sampling method KW - ecological momentary assessment KW - mobile apps KW - mood KW - stress N2 - 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. UR - https://mhealth.jmir.org/2019/4/e11215/ UR - http://dx.doi.org/10.2196/11215 UR - http://www.ncbi.nlm.nih.gov/pubmed/30932866 ID - info:doi/10.2196/11215 ER - TY - JOUR AU - Triantafillou, Sofia AU - Saeb, Sohrab AU - Lattie, G. Emily AU - Mohr, C. David AU - Kording, Paul Konrad PY - 2019/03/27 TI - Relationship Between Sleep Quality and Mood: Ecological Momentary Assessment Study JO - JMIR Ment Health SP - e12613 VL - 6 IS - 3 KW - sleep KW - affect KW - ecological momentary assessment KW - smartphone KW - depression KW - causality N2 - Background: Sleep disturbances play an important role in everyday affect and vice versa. However, the causal day-to-day interaction between sleep and mood has not been thoroughly explored, partly because of the lack of daily assessment data. Mobile phones enable us to collect ecological momentary assessment data on a daily basis in a noninvasive manner. Objective: This study aimed to investigate the relationship between self-reported daily mood and sleep quality. Methods: A total of 208 adult participants were recruited to report mood and sleep patterns daily via their mobile phones for 6 consecutive weeks. Participants were recruited in 4 roughly equal groups: depressed and anxious, depressed only, anxious only, and controls. The effect of daily mood on sleep quality and vice versa were assessed using mixed effects models and propensity score matching. Results: All methods showed a significant effect of sleep quality on mood and vice versa. However, within individuals, the effect of sleep quality on next-day mood was much larger than the effect of previous-day mood on sleep quality. We did not find these effects to be confounded by the participants? past mood and sleep quality or other variables such as stress, physical activity, and weather conditions. Conclusions: We found that daily sleep quality and mood are related, with the effect of sleep quality on mood being significantly larger than the reverse. Correcting for participant fixed effects dramatically affected results. Causal analysis suggests that environmental factors included in the study and sleep and mood history do not mediate the relationship. UR - http://mental.jmir.org/2019/3/e12613/ UR - http://dx.doi.org/10.2196/12613 UR - http://www.ncbi.nlm.nih.gov/pubmed/30916663 ID - info:doi/10.2196/12613 ER - TY - JOUR AU - Bangerter, Abigail AU - Manyakov, V. Nikolay AU - Lewin, David AU - Boice, Matthew AU - Skalkin, Andrew AU - Jagannatha, Shyla AU - Chatterjee, Meenakshi AU - Dawson, Geraldine AU - Goodwin, S. Matthew AU - Hendren, Robert AU - Leventhal, Bennett AU - Shic, Frederick AU - Ness, Seth AU - Pandina, Gahan PY - 2019/03/26 TI - Caregiver Daily Reporting of Symptoms in Autism Spectrum Disorder: Observational Study Using Web and Mobile Apps JO - JMIR Ment Health SP - e11365 VL - 6 IS - 3 KW - autism spectrum disorder KW - ecological momentary assessment KW - symptom assessment KW - mobile app KW - mHealth KW - affect KW - patient reported outcome measures N2 - Background: Currently, no medications are approved to treat core symptoms of autism spectrum disorder (ASD). One barrier to ASD medication development is the lack of validated outcome measures able to detect symptom change. Current ASD interventions are often evaluated using retrospective caregiver reports that describe general clinical presentation but often require recall of specific behaviors weeks after they occur, potentially reducing accuracy of the ratings. My JAKE, a mobile and Web-based mobile health (mHealth) app that is part of the Janssen Autism Knowledge Engine?a dynamically updated clinical research system?was designed to help caregivers of individuals with ASD to continuously log symptoms, record treatments, and track progress, to mitigate difficulties associated with retrospective reporting. Objective: My JAKE was deployed in an exploratory, noninterventional clinical trial to evaluate its utility and acceptability to monitor clinical outcomes in ASD. Hypotheses regarding relationships among daily tracking of symptoms, behavior, and retrospective caregiver reports were tested. Methods: Caregivers of individuals with ASD aged 6 years to adults (N=144) used the My JAKE app to make daily reports on their child?s sleep quality, affect, and other self-selected specific behaviors across the 8- to 10-week observational study. The results were compared with commonly used paper-and-pencil scales acquired over a concurrent period at regular 4-week intervals. Results: Caregiver reporting of behaviors in real time was successfully captured by My JAKE. On average, caregivers made reports 2-3 days per week across the study period. Caregivers were positive about their use of the system, with over 50% indicating that they would like to use My JAKE to track behavior outside of a clinical trial. More positive average daily reporting of overall type of day was correlated with 4 weekly reports of lower caregiver burden made at 4-week intervals (r=?0.27, P=.006, n=88) and with ASD symptoms (r=?0.42, P<.001, n=112). Conclusions: My JAKE reporting aligned with retrospective Web-based or paper-and-pencil scales. Use of mHealth apps, such as My JAKE, has the potential to increase the validity and accuracy of caregiver-reported outcomes and could be a useful way of identifying early changes in response to intervention. Such systems may also assist caregivers in tracking symptoms and behavior outside of a clinical trial, help with personalized goal setting, and monitoring of progress, which could collectively improve understanding of and quality of life for individuals with ASD and their families. Trial Registration: ClinicalTrials.gov NCT02668991; https://clinicaltrials.gov/ct2/show/NCT02668991  UR - http://mental.jmir.org/2019/3/e11365/ UR - http://dx.doi.org/10.2196/11365 UR - http://www.ncbi.nlm.nih.gov/pubmed/30912762 ID - info:doi/10.2196/11365 ER - TY - JOUR AU - Manini, Matthew Todd AU - Mendoza, Tonatiuh AU - Battula, Manoj AU - Davoudi, Anis AU - Kheirkhahan, Matin AU - Young, Ellen Mary AU - Weber, Eric AU - Fillingim, Benton Roger AU - Rashidi, Parisa PY - 2019/03/26 TI - Perception of Older Adults Toward Smartwatch Technology for Assessing Pain and Related Patient-Reported Outcomes: Pilot Study JO - JMIR Mhealth Uhealth SP - e10044 VL - 7 IS - 3 KW - smartwatch KW - focus group KW - ecological momentary assessment (EMA) KW - patient-reported outcomes (PRO) N2 - Background: Chronic pain, including arthritis, affects about 100 million adults in the United States. Complexity and diversity of the pain experience across time and people and its fluctuations across and within days show the need for valid pain reports that do not rely on patient?s long-term recall capability. Smartwatches can be used as digital ecological momentary assessment (EMA) tools for real-time collection of pain scores. Smartwatches are generally less expensive than smartphones, are highly portable, and have a simpler user interface, providing an excellent medium for continuous data collection and enabling a higher compliance rate. Objective: The aim of this study was to explore the attitudes and perceptions of older adults towards design and technological aspects of a smartwatch framework for measuring patient report outcomes (PRO) as an EMA tool. Methods: A focus group session was conducted to explore the perception of participants towards smartwatch technology and its utility for PRO assessment. Participants included older adults (age 65+), with unilateral or bilateral symptomatic knee osteoarthritis. A preliminary user interface with server communication capability was developed and deployed on 10 Samsung Gear S3 smartwatches and provided to the users during the focus group. Pain was designated as the main PRO, while fatigue, mood, and sleep quality were included as auxiliary PROs. Pre-planned topics included participants? attitude towards the smartwatch technology, usability of the custom-designed app interface, and suitability of the smartwatch technology for PRO assessment. Discussions were transcribed, and content analysis with theme characterization was performed to identify and code the major themes. Results: We recruited 19 participants (age 65+) who consented to take part in the focus group study. The overall attitude of the participants toward the smartwatch technology was positive. They showed interest in the direct phone-call capability, availability of extra apps such as the weather apps and sensors for tracking health and wellness such as accelerometer and heart rate sensor. Nearly three-quarters of participants showed willingness to participate in a one-year study to wear the watch daily. Concerns were raised regarding usability, including accessibility (larger icons), notification customization, and intuitive interface design (unambiguous icons and assessment scales). Participants expressed interest in using smartwatch technology for PRO assessment and the availability of methods for sharing data with health care providers. Conclusions: All participants had overall positive views of the smartwatch technology for measuring PROs to facilitate patient-provider communications and to provide more targeted treatments and interventions in the future. Usability concerns were the major issues that will require special consideration in future smartwatch PRO user interface designs, especially accessibility issues, notification design, and use of intuitive assessment scales. UR - http://mhealth.jmir.org/2019/3/e10044/ UR - http://dx.doi.org/10.2196/10044 UR - http://www.ncbi.nlm.nih.gov/pubmed/30912756 ID - info:doi/10.2196/10044 ER - TY - JOUR AU - DaSilva, W. Alex AU - Huckins, F. Jeremy AU - Wang, Rui AU - Wang, Weichen AU - Wagner, D. Dylan AU - Campbell, T. Andrew PY - 2019/03/19 TI - Correlates of Stress in the College Environment Uncovered by the Application of Penalized Generalized Estimating Equations to Mobile Sensing Data JO - JMIR Mhealth Uhealth SP - e12084 VL - 7 IS - 3 KW - psychology KW - stress KW - mobile sensing KW - college campuses N2 - Background: Stress levels among college students have been on the rise for the last few decades. Currently, rates of reported stress among college students are at an all-time high. Traditionally, the dominant way to assess stress levels has been through pen-and-paper surveys. Objective: The aim of this study is to use passive sensing data collected via mobile phones to obtain a rich and potentially less-biased source of data that can be used to help better understand stressors in the college experience. Methods: We used a mobile sensing app, StudentLife, in tandem with a pictorial mobile phone?based measure of stress, the Mobile Photographic Stress Meter, to investigate the situations and contexts that are more likely to precipitate stress. Results: Using recently developed methods for handling high-dimensional longitudinal data, penalized generalized estimating equations, we identified a set of mobile sensing features (absolute values of beta >0.001 and robust z>1.96) across the domains of social activity, movement, location, and ambient noise that were predictive of student stress levels. Conclusions: By combining recent statistical methods and mobile phone sensing, we have been able to study stressors in the college experience in a way that is more objective, detailed, and less intrusive than past research. Future work can leverage information gained from passive sensing and use that to develop real-time, targeted interventions for students experiencing a stressful time. UR - http://mhealth.jmir.org/2019/3/e12084/ UR - http://dx.doi.org/10.2196/12084 UR - http://www.ncbi.nlm.nih.gov/pubmed/30888327 ID - info:doi/10.2196/12084 ER - TY - JOUR AU - Nandy, R. Rajesh AU - Nandy, Karabi AU - Hébert, T. Emily AU - Businelle, S. Michael AU - Walters, T. Scott PY - 2019/02/07 TI - Identifying Behaviors Predicting Early Morning Emotions by Observing Permanent Supportive Housing Residents: An Ecological Momentary Assessment JO - JMIR Ment Health SP - e10186 VL - 6 IS - 2 KW - permanent supportive housing KW - circumplex model of affect KW - ecological momentary assessment KW - emotion KW - valence KW - arousal KW - hierarchical mixed effects model KW - mobile phone N2 - Background: Behavior and emotions are closely intertwined. The relationship between behavior and emotions might be particularly important in populations of underserved people, such as people with physical or mental health issues. We used ecological momentary assessment (EMA) to examine the relationship between emotional state and other characteristics among people with a history of chronic homelessness who were participating in a health coaching program. Objective: The goal of this study was to identify relationships between daily emotional states (valence and arousal) shortly after waking and behavioral variables such as physical activity, diet, social interaction, medication compliance, and tobacco usage the prior day, controlling for demographic characteristics. Methods: Participants in m.chat, a technology-assisted health coaching program, were recruited from housing agencies in Fort Worth, Texas, United States. All participants had a history of chronic homelessness and reported at least one mental health condition. We asked a subset of participants to complete daily EMAs of emotions and other behaviors. From the circumplex model of affect, the EMA included 9 questions related to the current emotional state of the participant (happy, frustrated, sad, worried, restless, excited, calm, bored, and sluggish). The responses were used to calculate two composite scores for valence and arousal. Results: Nonwhites reported higher scores for both valence and arousal, but not at a statistically significant level after correcting for multiple testing. Among momentary predictors, greater time spent in one-on-one interactions, greater time spent in physical activities, a greater number of servings of fruits and vegetables, greater time spent interacting in a one-on-one setting as well as adherence to prescribed medication the previous day were generally associated with higher scores for both valence and arousal, and statistical significance was achieved in most cases. Number of cigarettes smoked the previous day was generally associated with lower scores on both valence and arousal, although statistical significance was achieved for valence only when correcting for multiple testing. Conclusions: This study provides an important glimpse into factors that predict morning emotions among people with mental health issues and a history of chronic homelessness. Behaviors considered to be positive (eg, physical activity and consumption of fruits and vegetables) generally enhanced positive affect and restrained negative affect the following morning. The opposite was true for behaviors such as smoking, which are considered to be negative. UR - http://mental.jmir.org/2019/2/e10186/ UR - http://dx.doi.org/10.2196/10186 UR - http://www.ncbi.nlm.nih.gov/pubmed/30730296 ID - info:doi/10.2196/10186 ER - TY - JOUR AU - Ono, Masakatsu AU - Schneider, Stefan AU - Junghaenel, U. Doerte AU - Stone, A. Arthur PY - 2019/02/05 TI - What Affects the Completion of Ecological Momentary Assessments in Chronic Pain Research? An Individual Patient Data Meta-Analysis JO - J Med Internet Res SP - e11398 VL - 21 IS - 2 KW - chronic pain KW - completion rate KW - compliance rate KW - ecological momentary assessment KW - experience sampling KW - IPD meta-analysis N2 - Background: Ecological momentary assessment (EMA) involves repeated sampling of people?s current experiences in real time in their natural environments, which offers a granular perspective on patients? experience of pain and other symptoms. However, EMA can be burdensome to patients, and its benefits depend upon patients? engagement in the assessments. Objective: The goal of this study was to investigate factors affecting EMA-completion rates among patients with chronic pain. Methods: This individual patient data meta-analysis was based on 12 EMA datasets that examined patients with chronic noncancer-related pain (n=701). The EMA-completion rates were calculated on a daily basis for each patient. Multilevel models were used to test the following predictors of completion rates at different levels: within-patient factors (days into the study and daily pain level), between-patient factors (age, sex, pain diagnosis, and average pain level per person), and between-study EMA design factors (study duration, sampling density, and survey length). Results: Across datasets, an EMA-completion rate of 85% was observed. The strongest results were found for the between-patient factor age: Younger respondents reported lower completion rates than older respondents (P=.002). One within-patient factor, study day, was associated with completion rates (P<.001): over the course of the studies, the completion rates declined. The two abovementioned factors interacted with each other (P=.02) in that younger participants showed a more rapid decline in EMA completion over time. In addition, none of the other hypothesized factors including gender, chronic pain diagnoses, pain intensity levels, or measures of study burden showed any significant effects. Conclusion: Many factors thought to influence the EMA-completion rates in chronic pain studies were not confirmed. However, future EMA research in chronic pain should note that study length and young age can impact the quality of the momentary data and devise strategies to maximize completion rates across different age groups and study days. UR - https://www.jmir.org/2019/2/e11398/ UR - http://dx.doi.org/10.2196/11398 UR - http://www.ncbi.nlm.nih.gov/pubmed/30720437 ID - info:doi/10.2196/11398 ER - TY - JOUR AU - Parsey, M. Carolyn AU - Schmitter-Edgecombe, Maureen PY - 2019/01/18 TI - Using Actigraphy to Predict the Ecological Momentary Assessment of Mood, Fatigue, and Cognition in Older Adulthood: Mixed-Methods Study JO - JMIR Aging SP - e11331 VL - 2 IS - 1 KW - actigraphy KW - aging KW - ecological momentary assessment KW - mood KW - sleep N2 - Background: Sleep quality has been associated with cognitive and mood outcomes in otherwise healthy older adults. However, most studies have evaluated sleep quality as aggregate and mean measures, rather than addressing the impact of previous night?s sleep on next-day functioning. Objective: This study aims to evaluate the ability of previous night?s sleep parameters on self-reported mood, cognition, and fatigue to understand short-term impacts of sleep quality on next-day functioning. Methods: In total, 73 cognitively healthy older adults (19 males, 54 females) completed 7 days of phone-based self-report questions, along with 24-hour actigraph data collection. We evaluated a model of previous night?s sleep parameters as predictors of mood, fatigue, and perceived thinking abilities the following day. Results: Previous night?s sleep predicted fatigue in the morning and midday, as well as sleepiness or drowsiness in the morning; however, sleep measures did not predict subjective report of mood or perceived thinking abilities the following day. Conclusions: This study suggests that objectively measured sleep quality from the previous night may not have a direct or substantial relationship with subjective reporting of cognition or mood the following day, despite frequent patient reports. Continued efforts to examine the relationship among cognition, sleep, and everyday functioning are encouraged. UR - http://aging.jmir.org/2019/1/e11331/ UR - http://dx.doi.org/10.2196/11331 UR - http://www.ncbi.nlm.nih.gov/pubmed/31518282 ID - info:doi/10.2196/11331 ER - TY - JOUR AU - Henwood, F. Benjamin AU - Redline, Brian AU - Dzubur, Eldin AU - Madden, R. Danielle AU - Rhoades, Harmony AU - Dunton, F. Genevieve AU - Rice, Eric AU - Semborski, Sara AU - Tang, Qu AU - Intille, S. Stephen PY - 2019/01/10 TI - Investigating Health Risk Environments in Housing Programs for Young Adults: Protocol for a Geographically Explicit Ecological Momentary Assessment Study JO - JMIR Res Protoc SP - e12112 VL - 8 IS - 1 KW - homelessness KW - ecological momentary assessment KW - experience sampling KW - social environment KW - qualitative research KW - geography N2 - Background: Young adults who experience homelessness are exposed to environments that contribute to risk behavior. However, few studies have examined how access to housing may affect the health risk behaviors of young adults experiencing homelessness. Objective: This paper describes the Log My Life study that uses an innovative, mixed-methods approach based on geographically explicit ecological momentary assessment (EMA) through cell phone technology to understand the risk environment of young adults who have either enrolled in housing programs or are currently homeless. Methods: For the quantitative arm, study participants age 18-27 respond to momentary surveys via a smartphone app that collects geospatial information repeatedly during a 1-week period. Both EMAs (up to 8 per day) and daily diaries are prompted to explore within-day and daily variations in emotional affect, context, and health risk behavior, while also capturing infrequent risk behaviors such as sex in exchange for goods or services. For the qualitative arm, a purposive subsample of participants who indicated engaging in risky behaviors are asked to complete an in-depth qualitative interview using an interactive, personalized geospatial map rendering of EMA responses. Results: Recruitment began in June of 2017. To date, 170 participants enrolled in the study. Compliance with EMA and daily diary surveys was generally high. In-depth qualitative follow-ups have been conducted with 15 participants. We expect to recruit 50 additional participants and complete analyses by September of 2019. Conclusions: Mixing the quantitative and qualitative arms in this study will provide a more complete understanding of differences in risk environments between homeless and housed young adults. Furthermore, this approach can improve recall bias and enhance ecological validity. International Registered Report Identifier (IRRID): DERR1-10.2196/12112 UR - http://www.researchprotocols.org/2019/1/e12112/ UR - http://dx.doi.org/10.2196/12112 UR - http://www.ncbi.nlm.nih.gov/pubmed/30632969 ID - info:doi/10.2196/12112 ER - TY - JOUR AU - Schembre, M. Susan AU - Liao, Yue AU - O'Connor, G. Sydney AU - Hingle, D. Melanie AU - Shen, Shu-En AU - Hamoy, G. Katarina AU - Huh, Jimi AU - Dunton, F. Genevieve AU - Weiss, Rick AU - Thomson, A. Cynthia AU - Boushey, J. Carol PY - 2018/11/20 TI - Mobile Ecological Momentary Diet Assessment Methods for Behavioral Research: Systematic Review JO - JMIR Mhealth Uhealth SP - e11170 VL - 6 IS - 11 KW - diet surveys KW - diet records KW - mobile phone KW - mobile apps KW - ecological momentary assessment N2 - Background: New 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. Objective: The 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. Methods: Studies 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. Results: The 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. Conclusions: This 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. UR - http://mhealth.jmir.org/2018/11/e11170/ UR - http://dx.doi.org/10.2196/11170 UR - http://www.ncbi.nlm.nih.gov/pubmed/30459148 ID - info:doi/10.2196/11170 ER - TY - JOUR AU - Gower, D. Aubrey AU - Moreno, A. Megan PY - 2018/11/19 TI - A Novel Approach to Evaluating Mobile Smartphone Screen Time for iPhones: Feasibility and Preliminary Findings JO - JMIR Mhealth Uhealth SP - e11012 VL - 6 IS - 11 KW - smartphone KW - youth KW - mobile apps KW - mobile phone KW - screenshot N2 - Background: Increasingly high levels of smartphone ownership and use pose the potential risk for addictive behaviors and negative health outcomes, particularly among younger populations. Previous methodologies to understand mobile screen time have relied on self-report surveys or ecological momentary assessments (EMAs). Self-report is subject to bias and unreliability, while EMA can be burdensome to participants. Thus, a new methodology is needed to advance the understanding of mobile screen time. Objective: The objective of this study was to test the feasibility of a novel methodology to record and evaluate mobile smartphone screen time and use: battery use screenshot (BUS). Methods: The BUS approach, defined for this study as uploading a mobile phone screenshot of a specific page within a smartphone, was utilized within a Web-based cross-sectional survey of adolescents aged 12-15 years through the survey platform Qualtrics. Participants were asked to provide a screenshot of their battery use page, a feature within an iPhone, to upload within the Web-based survey. Feasibility was assessed by smartphone ownership and response rate to the BUS upload request. Data availability was evaluated as apps per BUS, completeness of data within the screenshot, and five most used apps based on battery use percentage. Results: Among those surveyed, 26.73% (309/1156) indicated ownership of a smartphone. A total of 105 screenshots were evaluated. For data availability, screenshots contained an average of 10.2 (SD 2.0) apps per screenshot and over half (58/105, 55.2%) had complete data available. The most common apps or functions included Safari and Home and Lock Screen. Conclusions: Study findings describe the BUS as a novel approach for real-time data collection focused on iPhone screen time and use among young adolescents. Although feasibility showed some challenges in the upload capacity of young teens, data availability was generally strong across this large dataset. These data from screenshots have the potential to provide key insights into precise mobile smartphone screen use and time spent per mobile app. Future studies could explore the use of the BUS methodology on other mobile smartphones such as Android phones to correlate mobile smartphone screen time with health outcomes. UR - http://mhealth.jmir.org/2018/11/e11012/ UR - http://dx.doi.org/10.2196/11012 UR - http://www.ncbi.nlm.nih.gov/pubmed/30455163 ID - info:doi/10.2196/11012 ER - TY - JOUR AU - Teufel II, John Ronald AU - Patel, K. Sachin AU - Shuler, B. Anita AU - Andrews, L. Anne AU - Nichols, Michelle AU - Ebeling, D. Myla AU - Dawley, Erin AU - Mueller, Martina AU - Ruggiero, J. Kenneth AU - Treiber, A. Frank PY - 2018/10/5 TI - Smartphones for Real-time Assessment of Adherence Behavior and Symptom Exacerbation for High-Risk Youth with Asthma: Pilot Study JO - JMIR Pediatr Parent SP - e8 VL - 1 IS - 2 KW - children KW - ecological momentary assessment KW - medication adherence KW - medication monitoring device KW - mHealth KW - mobile phone KW - symptoms KW - youth N2 - Background: Youth with asthma who have poor medication adherence, have limited access to care, and are frequently seen in the acute care setting are often termed ?high risk.? Objective: This study aimed to design and test the feasibility of using smartphone technology to assess contextual factors that may impact changes in daily medication adherence and to identify new symptom episodes among high-risk youth with asthma in their home environment. Methods: Youth aged 8-17 years with high-risk asthma from 2 children?s hospitals were eligible for the 2-month study. An app was downloaded on participants? phones at enrollment. Daily text message (short message service) reminders were sent to complete ecological momentary assessment of asthma symptoms and other contextual factors such as emotional state using the app. Bluetooth inhaler devices were used to record timestamps of inhaler use with the ability to review and manually enter data. The acceptability was assessed with surveys, key informant interviews (KII), and frequency of days with asthma data. KII data were used in an iterative design approach to identify challenges, strengths, and suggestions for maximizing use. Generalized linear mixed modeling was used to preliminarily explore contextual factors associated with changes in daily adherence. Results: We enrolled 14 children aged 8-16 years (13/14, 93% were African Americans). Over the 2-month study period, participants reported coughing (42/110, 38%), wheezing (8/111, 7%), chest tightness (9/109, 8%), boredom (57/109, 52%), and 10 new asthma symptom episodes. The controller medication adherence was 30%, which increased significantly on days with asthma symptoms or boredom. Data were received on 89% (606/681) of study days. Surveys and KIIs suggest acceptability among youth and their caregivers. Challenges reported during the study included lost or damaged phones and available memory. Conclusions: Youth and their caregivers reported the acceptability of using smartphones for real-time asthma monitoring. Overall, the controller medication adherence was low but increased significantly on days with reported asthma symptoms or boredom, suggesting that daily contextual factors may be associated with a change in the adherence behavior. UR - http://pediatrics.jmir.org/2018/2/e8/ UR - http://dx.doi.org/10.2196/pediatrics.9796 UR - http://www.ncbi.nlm.nih.gov/pubmed/31518299 ID - info:doi/10.2196/pediatrics.9796 ER - TY - JOUR AU - Swendeman, Dallas AU - Comulada, Scott Warren AU - Koussa, Maryann AU - Worthman, M. Carol AU - Estrin, Deborah AU - Rotheram-Borus, Jane Mary AU - Ramanathan, Nithya PY - 2018/9/21 TI - Longitudinal Validity and Reliability of Brief Smartphone Self-Monitoring of Diet, Stress, and Physical Activity in a Diverse Sample of Mothers JO - JMIR Mhealth Uhealth SP - e176 VL - 6 IS - 9 KW - self-monitoring KW - mHealth KW - diet KW - physical activity KW - stress KW - multi-method KW - mobile phones KW - C-reactive protein N2 - Background: Multiple strategies can be used when self-monitoring diet, physical activity, and perceived stress, but no gold standards are available. Although self-monitoring is a core element of self-management and behavior change, the success of mHealth behavioral tools depends on their validity and reliability, which lack evidence. African American and Latina mothers in the United States are high-priority populations for apps that can be used for self-monitoring of diet, physical activity, and stress because the body mass index (BMI) of mothers typically increases for several years after childbirth and the risks of obesity and its? sequelae diseases are elevated among minority populations. Objective: To examine the intermethod reliability and concurrent validity of smartphone-based self-monitoring via ecological momentary assessments (EMAs) and use of daily diaries for diet, stress, and physical activity compared with brief recall measures, anthropometric biomeasures, and bloodspot biomarkers. Methods: A purposive sample (n=42) of primarily African American (16/42, 39%) and Latina (18/42, 44%) mothers was assigned Android smartphones for using Ohmage apps to self-monitor diet, perceived stress, and physical activity over 6 months. Participants were assessed at 3- and 6-month follow-ups. Recall measures included brief food frequency screeners, physical activity assessments adapted from the National Health and Nutrition Examination Survey, and the nine-item psychological stress measure. Anthropometric biomeasures included BMI, body fat, waist circumference, and blood pressure. Bloodspot assays for Epstein?Barr virus and C-reactive protein were used as systemic load and stress biomarkers. EMAs and daily diary questions assessed perceived quality and quantity of meals, perceived stress levels, and moderate, vigorous, and light physical activity. Units of analysis were follow-up assessments (n=29 to n=45 depending on the domain) of the participants (n=29 with sufficient data for analyses). Correlations, R2 statistics, and multivariate linear regressions were used to assess the strength of associations between variables. Results: Almost all participants (39/42, 93%) completed the study. Intermethod reliability between smartphone-based EMAs and diary reports and their corresponding recall reports was highest for stress and diet; correlations ranged from .27 to .52 (P<.05). However, it was unexpectedly low for physical activity; no significant associations were observed. Concurrent validity was demonstrated for diet EMAs and diary reports on systolic blood pressure (r=?.32), C-reactive protein level (r=?.34), and moderate and vigorous physical activity recalls (r=.35 to.48), suggesting a covariation between healthy diet and physical activity behaviors. EMAs and diary reports on stress were not associated with Epstein?Barr virus and C-reactive protein level. Diary reports on moderate and vigorous physical activity were negatively associated with BMI and body fat (r=?.35 to ?.44, P<.05). Conclusions: Brief smartphone-based EMA use may be valid and reliable for long-term self-monitoring of diet, stress, and physical activity. Lack of intermethod reliability for physical activity measures is consistent with prior research, warranting more research on the efficacy of smartphone-based self-monitoring of self-management and behavior change support. UR - http://mhealth.jmir.org/2018/9/e176/ UR - http://dx.doi.org/10.2196/mhealth.9378 UR - http://www.ncbi.nlm.nih.gov/pubmed/30249576 ID - info:doi/10.2196/mhealth.9378 ER - TY - JOUR AU - Baker, W. Amanda AU - Losiewicz, M. Olivia AU - Hellberg, N. Samantha AU - Simon, M. Naomi PY - 2018/09/17 TI - Integrating Technology into Clinical Care to Improve Outcomes in Panic Disorder: Use of Safety Behaviors and Resulting Anxiety as Assessed by Smartphone-Based Experience Sampling Methods JO - iproc SP - e11788 VL - 4 IS - 2 KW - anxiety KW - anxiety disorders KW - ecological momentary assessment KW - panic disorder KW - smartphone KW - treatment N2 - Background: Research in mental health conditions such as panic disorder suffers from issues related to the means of assessing the condition and its contributing factors by self-report in the office setting. The integration of real time technologies into research is critically needed. Panic disorder is the fifth leading cause of missed work days across all chronic medical conditions, and anxiety disorders are estimated to cost more than $40 billion annually in the United States (Greenberg et al, 1999). Panic attacks occur in approximately 23% of the general population (Kessler et al, 2006) and cause substantial functional and social impairment, as well as significant financial burden on the health care system. While effective treatments for panic disorder exist, more than half of patients do not improve, remain symptomatic post-treatment, or return to treatment within two years (Brown & Barlow, 1995; Gloster et al, 2013). Very little is known about what treatment will work for each patient and why. New technologies allow us to identify individual factors that may be important to treatment outcomes. This pilot study aimed to bridge the gap between the human element and technology using smartphones to more efficiently investigate a factor that may contribute to lack of remission in panic disorder, the use of safety behaviors. Safety behaviors represent ineffective attempts to reduce or eliminate anxiety (eg, carrying a water bottle to reduce physiological sensations that arise during anxiety; Helbig-Lang & Petermann, 2010). They are hypothesized with mixed evidence to play a central role in the etiology and maintenance of anxiety disorders, including panic disorder. Existing studies are limited in their temporal conclusions and ecological validity. New technologies such as smartphones permit time-intensive investigation of these phenomena in the natural environment in which they occur, thus improving external validity. Objective: To examine the effect of safety behavior use on anxiety response in panic disorder using smartphone-based ecological momentary assessment. Methods: Participants (N=13) were adults with panic disorder. For 14 days, participants answered a brief smartphone-based questionnaire of panic symptom severity and safety behavior use 5 times a day. Results: Analyses were conducted using N=910 data points from participants (N=13). Safety behavior use was highly correlated with anxiety and predictive of later anxiety level. Increased safety behavior use at time 1 predicted increased anxiety at times 2, 3, 4, and 5 (t[1,100] values > 4.26; P values <.001). Safety behavior use at time 1 was a significant predictor of anxiety at time 2, even when controlling for anxiety at time 1 (t[2,103]=2.83; P=.006). Conclusions: This study was novel in its approach to combine smartphone-based ecological momentary assessment with traditional clinical report, overcoming challenges in later retrospective reporting such as temporality and recall biases. In line with theoretical conceptualizations of panic disorder, our findings support that individuals engage in safety behaviors when anxious and that safety behavior use then robustly maintains and even heightens anxiety. Future directions for novel technological, statistical, and personalized approaches to expand our understanding of safety behaviors in anxiety disorders and implications for treatment will be discussed. UR - http://www.iproc.org/2018/2/e11788/ UR - http://dx.doi.org/10.2196/11788 UR - http://www.ncbi.nlm.nih.gov/pubmed/ ID - info:doi/10.2196/11788 ER - TY - JOUR AU - Goodspeed, Robert AU - Yan, Xiang AU - Hardy, Jean AU - Vydiswaran, Vinod V. G. AU - Berrocal, J. Veronica AU - Clarke, Philippa AU - Romero, M. Daniel AU - Gomez-Lopez, N. Iris AU - Veinot, Tiffany PY - 2018/08/13 TI - Comparing the Data Quality of Global Positioning System Devices and Mobile Phones for Assessing Relationships Between Place, Mobility, and Health: Field Study JO - JMIR Mhealth Uhealth SP - e168 VL - 6 IS - 8 KW - urban population KW - spatial behavior KW - mobile phone KW - environment and public health KW - data accuracy N2 - Background: Mobile devices are increasingly used to collect location-based information from individuals about their physical activities, dietary intake, environmental exposures, and mental well-being. Such research, which typically uses wearable devices or mobile phones to track location, benefits from the growing availability of fine-grained data regarding human mobility. However, little is known about the comparative geospatial accuracy of such devices. Objective: In this study, we compared the data quality of location information collected from two mobile devices that determine location in different ways?a global positioning system (GPS) watch and a mobile phone with Google?s Location History feature enabled. Methods: A total of 21 chronically ill participants carried both devices, which generated digital traces of locations, for 28 days. A mobile phone?based brief ecological momentary assessment (EMA) survey asked participants to manually report their location at 4 random times throughout each day. Participants also took part in qualitative interviews and completed surveys twice during the study period in which they reviewed recent mobile phone and watch trace data to compare the devices? trace data with their memory of their activities on those days. Trace data from the devices were compared on the basis of (1) missing data days, (2) reasons for missing data, (3) distance between the route data collected for matching day and the associated EMA survey locations, and (4) activity space total area and density surfaces. Results: The watch resulted in a much higher proportion of missing data days (P<.001), with missing data explained by technical differences between the devices as well as participant behaviors. The mobile phone was significantly more accurate in detecting home locations (P=.004) and marginally more accurate (P=.07) for all types of locations combined. The watch data resulted in a smaller activity space area and more accurately recorded outdoor travel and recreation. Conclusions: The most suitable mobile device for location-based health research depends on the particular study objectives. Furthermore, data generated from mobile devices, such as GPS phones and smartwatches, require careful analysis to ensure quality and completeness. Studies that seek precise measurement of outdoor activity and travel, such as measuring outdoor physical activity or exposure to localized environmental hazards, would benefit from the use of GPS devices. Conversely, studies that aim to account for time within buildings at home or work, or those that document visits to particular places (such as supermarkets, medical facilities, or fast food restaurants), would benefit from the greater precision demonstrated by the mobile phone in recording indoor activities. UR - http://mhealth.jmir.org/2018/8/e168/ UR - http://dx.doi.org/10.2196/mhealth.9771 UR - http://www.ncbi.nlm.nih.gov/pubmed/30104185 ID - info:doi/10.2196/mhealth.9771 ER - TY - JOUR AU - Zulueta, John AU - Piscitello, Andrea AU - Rasic, Mladen AU - Easter, Rebecca AU - Babu, Pallavi AU - Langenecker, A. Scott AU - McInnis, Melvin AU - Ajilore, Olusola AU - Nelson, C. Peter AU - Ryan, Kelly AU - Leow, Alex PY - 2018/07/20 TI - Predicting Mood Disturbance Severity with Mobile Phone Keystroke Metadata: A BiAffect Digital Phenotyping Study JO - J Med Internet Res SP - e241 VL - 20 IS - 7 KW - digital phenotype KW - mHealth KW - ecological momentary assessment KW - keystroke dynamics KW - bipolar disorder KW - depression KW - mania KW - mobile phone N2 - Background: Mood disorders are common and associated with significant morbidity and mortality. Better tools are needed for their diagnosis and treatment. Deeper phenotypic understanding of these disorders is integral to the development of such tools. This study is the first effort to use passively collected mobile phone keyboard activity to build deep digital phenotypes of depression and mania. Objective: The objective of our study was to investigate the relationship between mobile phone keyboard activity and mood disturbance in subjects with bipolar disorders and to demonstrate the feasibility of using passively collected mobile phone keyboard metadata features to predict manic and depressive signs and symptoms as measured via clinician-administered rating scales. Methods: Using a within-subject design of 8 weeks, subjects were provided a mobile phone loaded with a customized keyboard that passively collected keystroke metadata. Subjects were administered the Hamilton Depression Rating Scale (HDRS) and Young Mania Rating Scale (YMRS) weekly. Linear mixed-effects models were created to predict HDRS and YMRS scores. The total number of keystrokes was 626,641, with a weekly average of 9791 (7861), and that of accelerometer readings was 6,660,890, with a weekly average 104,076 (68,912). Results: A statistically significant mixed-effects regression model for the prediction of HDRS-17 item scores was created: conditional R2=.63, P=.01. A mixed-effects regression model for YMRS scores showed the variance accounted for by random effect was zero, and so an ordinary least squares linear regression model was created: R2=.34, P=.001. Multiple significant variables were demonstrated for each measure. Conclusions: Mood states in bipolar disorder appear to correlate with specific changes in mobile phone usage. The creation of these models provides evidence for the feasibility of using passively collected keyboard metadata to detect and monitor mood disturbances. UR - http://www.jmir.org/2018/7/e241/ UR - http://dx.doi.org/10.2196/jmir.9775 UR - http://www.ncbi.nlm.nih.gov/pubmed/30030209 ID - info:doi/10.2196/jmir.9775 ER - TY - JOUR AU - Wright, Cassandra AU - Dietze, M. Paul AU - Agius, A. Paul AU - Kuntsche, Emmanuel AU - Livingston, Michael AU - Black, C. Oliver AU - Room, Robin AU - Hellard, Margaret AU - Lim, SC Megan PY - 2018/07/20 TI - Mobile Phone-Based Ecological Momentary Intervention to Reduce Young Adults? Alcohol Use in the Event: A Three-Armed Randomized Controlled Trial JO - JMIR Mhealth Uhealth SP - e149 VL - 6 IS - 7 KW - alcohol KW - brief intervention KW - ecological momentary assessment KW - randomized controlled trial KW - mHealth KW - mobile phone KW - young adults N2 - Background: Real-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. Objective: We 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. Methods: We 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. Results: A 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. Conclusions: With 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 Registration: Australian 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) UR - http://mhealth.jmir.org/2018/7/e149/ UR - http://dx.doi.org/10.2196/mhealth.9324 UR - http://www.ncbi.nlm.nih.gov/pubmed/30030211 ID - info:doi/10.2196/mhealth.9324 ER - TY - JOUR AU - Boukhechba, Mehdi AU - Chow, Philip AU - Fua, Karl AU - Teachman, A. Bethany AU - Barnes, E. Laura PY - 2018/07/04 TI - Predicting Social Anxiety From Global Positioning System Traces of College Students: Feasibility Study JO - JMIR Ment Health SP - e10101 VL - 5 IS - 3 KW - mental health KW - mHealth KW - mobility KW - GPS KW - social anxiety disorder N2 - Background: Social anxiety is highly prevalent among college students. Current methodologies for detecting symptoms are based on client self-report in traditional clinical settings. Self-report is subject to recall bias, while visiting a clinic requires a high level of motivation. Assessment methods that use passively collected data hold promise for detecting social anxiety symptoms and supplementing self-report measures. Continuously collected location data may provide a fine-grained and ecologically valid way to assess social anxiety in situ. Objective: The objective of our study was to examine the feasibility of leveraging noninvasive mobile sensing technology to passively assess college students? social anxiety levels. Specifically, we explored the different relationships between mobility and social anxiety to build a predictive model that assessed social anxiety from passively generated Global Positioning System (GPS) data. Methods: We recruited 228 undergraduate participants from a Southeast American university. Social anxiety symptoms were assessed using self-report instruments at a baseline laboratory session. An app installed on participants? personal mobile phones passively sensed data from the GPS sensor for 2 weeks. The proposed framework supports longitudinal, dynamic tracking of college students to evaluate the relationship between their social anxiety and movement patterns in the college campus environment. We first extracted the following mobility features: (1) cumulative staying time at each different location, (2) the distribution of visits over time, (3) the entropy of locations, and (4) the frequency of transitions between locations. Next, we studied the correlation between these features and participants? social anxiety scores to enhance the understanding of how students? social anxiety levels are associated with their mobility. Finally, we used a neural network-based prediction method to predict social anxiety symptoms from the extracted daily mobility features. Results: Several mobility features correlated with social anxiety levels. Location entropy was negatively associated with social anxiety (during weekdays, r=?0.67; and during weekends, r=?0.51). More (vs less) socially anxious students were found to avoid public areas and engage in less leisure activities during evenings and weekends, choosing instead to spend more time at home after school (4 pm-12 am). Our prediction method based on extracted mobility features from GPS trajectories successfully classified participants as high or low socially anxious with an accuracy of 85% and predicted their social anxiety score (on a scale of 0-80) with a root-mean-square error of 7.06. Conclusions: Results indicate that extracting and analyzing mobility features may help to reveal how social anxiety symptoms manifest in the daily lives of college students. Given the ubiquity of mobile phones in our society, understanding how to leverage passively sensed data has strong potential to address the growing needs for mental health monitoring and treatment. UR - http://mental.jmir.org/2018/3/e10101/ UR - http://dx.doi.org/10.2196/10101 UR - http://www.ncbi.nlm.nih.gov/pubmed/29973337 ID - info:doi/10.2196/10101 ER - TY - JOUR AU - Zink, Jennifer AU - Belcher, R. Britni AU - Dzubur, Eldin AU - Ke, Wangjing AU - O'Connor, Sydney AU - Huh, Jimi AU - Lopez, Nanette AU - Maher, P. Jaclyn AU - Dunton, F. Genevieve PY - 2018/06/28 TI - Association Between Self-Reported and Objective Activity Levels by Demographic Factors: Ecological Momentary Assessment Study in Children JO - JMIR Mhealth Uhealth SP - e150 VL - 6 IS - 6 KW - sedentary behavior KW - physical activity KW - measurement KW - mobile devices KW - children N2 - Background: To address the limitations of the retrospective self-reports of activity, such as its susceptibility to recall bias, researchers have shifted toward collecting real-time activity data on mobile devices via ecological momentary assessment (EMA). Although EMA is becoming increasingly common, it is not known how EMA self-reports of physical activity and sedentary behaviors relate to the objective measures of activity or whether there are factors that may influence the strength of association between these two measures. Understanding the relationship between EMA and accelerometry can optimize future instrument selection in studies assessing activity and health outcomes. Objective: The aim of this study was to examine the associations between EMA-reported sports or exercise using the accelerometer-measured moderate-to-vigorous physical activity (MVPA) and EMA-reported TV, videos, or video games with the accelerometer-measured sedentary time (ST) in children during matched 2-h windows and test potential moderators. Methods: Children (N=192; mean age 9.6 years; 94/192, 49.0% male; 104/192, 54.2% Hispanic; and 73/192, 38.0% overweight or obese) wore an accelerometer and completed up to 7 EMA prompts per day for 8 days during nonschool time, reporting on past 2-h sports or exercise and TV, videos, or video games. Multilevel models were used to assess the relationship between the accelerometer-measured ST and EMA-reported TV, videos, or video games. Given the zero-inflated distribution of MVPA, 2-part models were used assess the relationship between the accelerometer-measured MVPA and EMA-reported sports or exercise. Results: EMA-reported TV, videos, or video games were associated with a greater accelerometer-measured ST (beta=7.3, 95% CI 5.5 to 9.0, P<.001). This relationship was stronger in boys (beta=9.9, 95% CI 7.2 to 12.6, P<.001) than that in girls (beta=4.9, 95% CI 2.6 to 7.2, P?.001). EMA-reported sports or exercise was associated with a greater accelerometer-measured MVPA (zero portion P<.001; positive portion P<.001). This relationship was stronger on weekends, in older children, and in non-Hispanic children (zero portion all P values<.001; positive portion all P values<.001). Conclusions: EMA reports highly relate to accelerometer measures. However, the differences in the strength of association depending on various demographic characteristics suggest that future research should use both EMA and accelerometers to measure activity to collect complementary activity data. UR - http://mhealth.jmir.org/2018/6/e150/ UR - http://dx.doi.org/10.2196/mhealth.9592 UR - http://www.ncbi.nlm.nih.gov/pubmed/29954723 ID - info:doi/10.2196/mhealth.9592 ER - TY - JOUR AU - Riordan, C. Benjamin AU - Moradi, Saleh AU - Carey, B. Kate AU - Conner, S. Tamlin AU - Jang, Kyungho AU - Reid, E. Kelly AU - Scarf, Damian PY - 2018/05/15 TI - Effectiveness of a Combined Web-Based and Ecological Momentary Intervention for Incoming First-Year University Students: Protocol for a 3-Arm Randomized Controlled Trial JO - JMIR Res Protoc SP - e10164 VL - 7 IS - 5 KW - alcohol drinking in college KW - clinical trial KW - smartphone KW - internet N2 - Background: Alcohol use among university students is common, and those who drink often choose to drink heavily (ie, 4 or more drinks per session for women or 5 or more for men). Web-based interventions (WBIs), in which students complete assessments and receive personalized feedback about their alcohol use, and ecological momentary interventions (EMIs), which use mobile devices as a method of delivering intervention information, are 2 methods that have had some success in reducing alcohol use among university students. Objective: The aim of this study was to investigate the effectiveness of a combined WBI and EMI intervention to reduce alcohol use among university students. Methods: The study is a 3-arm randomized controlled trial. Participants will be randomized into either a WBI+EMI condition, a WBI-only condition, or an assessment-only control. Our sample will consist of first-year university students, recruited through 5 residential colleges at the University of Otago, New Zealand. All participants will complete an online survey at baseline (ie, before Orientation Week); those in the WBI-only and WBI+EMI conditions will immediately receive personalized feedback (ie, the WBI), whereas participants in the assessment-only condition will receive no feedback. In addition, participants randomized into the WBI+EMI, but not those in the WBI-only or assessment-only groups, will receive 8 Orientation Week (2 per day on nights with large social events) and 6 academic year EMIs (delivered fortnightly). Participants in all conditions will complete brief surveys at the end of the first and second semester and report their weekend alcohol use fortnightly throughout each semester via ecological momentary assessments. Results: The primary hypothesis is that participants in the WBI+EMI group will consume significantly fewer drinks during weekends in their first semester at university compared with WBI-only and assessment-only groups. Secondary hypotheses are that, when compared with the WBI-only and assessment-only groups, the WBI+EMI group will report consuming fewer drinks during Orientation Week, report experiencing fewer negative alcohol-related consequences after first semester, and report lower Alcohol Use Disorder Identification Test-Consumption scores following their first semester. Conclusions: This study adds to a growing body of work investigating the utility of WBIs and EMIs in curbing alcohol consumption. In addition, the study will help to inform policy approaches aimed at curbing alcohol consumption and alcohol-related harm in university students. Trial Registration: Australian New Zealand Clinical Trials Registry ACTRN12618000015246; https://www.anzctr.org.au/Trial/Registration/TrialReview.aspx?id=374104&isReview=true (Archived by WebCite at http://www.webcitation.org/6z9jRLTz6) Registered Report Identifier: RR1-10.2196/10164 UR - http://www.researchprotocols.org/2018/5/e10164/ UR - http://dx.doi.org/10.2196/10164 UR - http://www.ncbi.nlm.nih.gov/pubmed/29764803 ID - info:doi/10.2196/10164 ER - TY - JOUR AU - Paolillo, W. Emily AU - Tang, Bin AU - Depp, A. Colin AU - Rooney, S. Alexandra AU - Vaida, Florin AU - Kaufmann, N. Christopher AU - Mausbach, T. Brent AU - Moore, J. David AU - Moore, C. Raeanne PY - 2018/05/14 TI - Temporal Associations Between Social Activity and Mood, Fatigue, and Pain in Older Adults With HIV: An Ecological Momentary Assessment Study JO - JMIR Ment Health SP - e38 VL - 5 IS - 2 KW - AIDS KW - ecological momentary assessment KW - social isolation KW - happiness KW - quality of life N2 - Background: Social isolation is associated with an increased risk for mental and physical health problems, especially among older persons living with HIV (PLWH). Thus, there is a need to better understand real-time temporal associations between social activity and mood- and health-related factors in this population to inform possible future interventions. Objective: This study aims to examine real-time relationships between social activity and mood, fatigue, and pain in a sample of older PLWH. Methods: A total of 20 older PLWH, recruited from the University of California, San Diego HIV Neurobehavioral Research Program in 2016, completed smartphone-based ecological momentary assessment (EMA) surveys 5 times per day for 1 week. Participants reported their current social activity (alone vs not alone and number of social interactions) and levels of mood (sadness, happiness, and stress), fatigue, and pain. Mixed-effects regression models were used to analyze concurrent and lagged associations among social activity, mood, fatigue, and pain. Results: Participants (mean age 58.8, SD 4.3 years) reported being alone 63% of the time, on average, (SD 31.5%) during waking hours. Being alone was related to lower concurrent happiness (beta=?.300; 95% CI ?.525 to ?.079; P=.008). In lagged analyses, social activity predicted higher levels of fatigue later in the day (beta=?1.089; 95% CI ?1.780 to ?0.396; P=.002), and higher pain levels predicted being alone in the morning with a reduced likelihood of being alone as the day progressed (odds ratio 0.945, 95% CI 0.901-0.992; P=.02). Conclusions: The use of EMA elucidated a high rate of time spent alone among older PLWH. Promoting social activity despite the presence of pain or fatigue may improve happiness and psychological well-being in this population. UR - http://mental.jmir.org/2018/2/e38/ UR - http://dx.doi.org/10.2196/mental.9802 UR - http://www.ncbi.nlm.nih.gov/pubmed/29759960 ID - info:doi/10.2196/mental.9802 ER - TY - JOUR AU - Santa Maria, Diane AU - Padhye, Nikhil AU - Yang, Yijiong AU - Gallardo, Kathryn AU - Businelle, Michael PY - 2018/05/07 TI - Correction: Predicting Sexual Behaviors Among Homeless Young Adults: Ecological Momentary Assessment Study JO - JMIR Public Health Surveill SP - e10806 VL - 4 IS - 2 UR - http://publichealth.jmir.org/2018/2/e10806/ UR - http://dx.doi.org/10.2196/10806 UR - http://www.ncbi.nlm.nih.gov/pubmed/30578237 ID - info:doi/10.2196/10806 ER - TY - JOUR AU - MacDonell, Karen AU - Naar, Sylvie AU - Gibson-Scipio, Wanda AU - Bruzzese, Jean-Marie AU - Wang, Bo AU - Brody, Aaron PY - 2018/05/07 TI - The Detroit Young Adult Asthma Project: Proposal for a Multicomponent Technology Intervention for African American Emerging Adults With Asthma JO - JMIR Res Protoc SP - e98 VL - 7 IS - 5 KW - asthma KW - telemedicine KW - medication adherence KW - young adults KW - health equity N2 - Background: Racial and ethnic minority youth have poorer asthma status than white youth, even after controlling for socioeconomic variables. Proper use of asthma controller medications is critical in reducing asthma mortality and morbidity. The clinical consequences of poor asthma management include increased illness complications, excessive functional morbidity, and fatal asthma attacks. There are significant limitations in research on interventions to improve asthma management in racial minority populations, particularly minority adolescents and young adults, although illness management tends to deteriorate after adolescence during emerging adulthood, the unique developmental period beyond adolescence but before adulthood. Objective: The objective of the pilot study was to test the feasibility, acceptability, and signals of efficacy of an intervention targeting adherence to controller medication in African American youth (ages 18-29) with asthma. All elements of the protocol were piloted in a National Heart, Lung, and Blood Institute (NHLBI)?funded pilot study (1R34HL107664 MacDonell). Results suggested feasibility and acceptability of the protocol as well as proof of concept. We are now ready to test the intervention in a larger randomized clinical trial. Methods: The proposed study will include 192 African American emerging adults with moderate to severe persistent asthma and low controller medication adherence recruited from clinic, emergency department, and community settings. Half of the sample will be randomized to receive a multicomponent technology-based intervention targeting adherence to daily controller medication. The multicomponent technology-based intervention consists of 2 components: (1) 2 sessions of computer-delivered motivational interviewing targeting medication adherence and (2) individualized text messaging focused on medication adherence between the sessions. Text messages will be individualized based on ecological momentary assessment. The remaining participants will complete a series of computer-delivered asthma education modules matched for length, location, and method of delivery of the intervention session. Control participants will also receive text messages between intervention sessions. Message content will be the same for all control participants and contain general facts about asthma (not tailored). Results: It is hypothesized that youth randomized to multicomponent technology-based intervention will show improvements in medication adherence (primary outcome) and asthma control (secondary outcome) compared with comparison condition at all postintervention follow-ups (3, 6, 9, and 12 months). The proposed study was funded by NHLBI from September 1, 2016 through August 31, 2021. Conclusions: This project will test a brief, technology-based intervention specifically targeting adherence to asthma controller medications in an under-researched population, African American emerging adults. If successful, our multicomponent technology-based intervention aimed at improving adherence to asthma medications has the potential to improve quality of life of minority emerging adults with asthma at relatively low cost. It could eventually be integrated into clinical settings and practice to reach a large number of emerging adults with asthma. Trial Registration: ClinicalTrials.gov NCT03121157; https://clinicaltrials.gov/ct2/show/NCT03121157 (Archived by WebCite at http://www.webcitation.org/6wq4yWHPv) UR - http://www.researchprotocols.org/2018/5/e98/ UR - http://dx.doi.org/10.2196/resprot.8872 UR - http://www.ncbi.nlm.nih.gov/pubmed/29735474 ID - info:doi/10.2196/resprot.8872 ER - TY - JOUR AU - Santa Maria, Diane AU - Padhye, Nikhil AU - Yang, Yijiong AU - Gallardo, Kathryn AU - Businelle, Michael PY - 2018/04/10 TI - Predicting Sexual Behaviors Among Homeless Young Adults: Ecological Momentary Assessment Study JO - JMIR Public Health Surveill SP - e39 VL - 4 IS - 2 KW - homeless youth KW - sexual behaviors KW - ecological momentary assessment N2 - Background: Homeless youth continue to be disproportionately affected by HIV compared with their housed peers, with prevalence rates as high as 13%. Yet, HIV prevention in this high-risk population has been only marginally effective. Objective: The aim of this study was to use ecological momentary assessments to examine real-time factors to determine the predictors of sexual activity among homeless youth. Methods: Youth experiencing homelessness aged between 18 and 24 years were recruited from a drop-in center in Houston, Texas, between August 2015 and May 2016. All the participants received a study-issued mobile phone that prompted brief ecological momentary assessments (EMAs) 5 times a day for 21 days. EMA items assessed near real-time sexual behaviors, cognitions, stress, affect, environmental factors, and environmental circumstances. Results: Participants (N=66) were predominantly male (41/66, 64%) and black (43/66, 66%) with a median age of 20 years. The mean number of EMAs completed by each participant was 45 out of 105 possible observations. During the study, 70% (46/66) of participants were sexually active and reported condomless sex in 102 of the 137 cases of sexual intercourse (74.5%). In total, 82% (38/46) of the youth who reported having sex during the 3 weeks of data collection also reported engaging in high-risk sexual activities, including having condomless sex (24/46, 53%), having multiple sexual partners on the same day (12/46, 26%), trading sex (7/46, 16%), and sharing needles while injecting drugs (1/46, 3%). Of those, 71% (27/38) were engaged in multiple sexual risk behaviors. The predictive model was based on observations from 66 subjects who reported 137 cases of sexual intercourse over 811 days; sexual orientation, race, mental health, drug use, and sexual urge were included as predictors in the parsimonious generalized linear mixed model selected on the basis of the Akaike information criterion. The estimated odds ratios (ORs) were notable for same-day drug use (OR 8.80, 95% CI 4.48-17.31; P<.001) and sexual urge (OR 4.23, 95% CI 1.60-11.28; P=.004). The performance of the risk estimator was satisfactory, as indicated by the value of 0.834 for the area under the receiver operating characteristic curve. Conclusions: Real-time EMA data can be used to predict sexual intercourse among a sample of high-risk, predominately unsheltered homeless youth. Sexual urge and drug use accounts for increased odds of engaging in sexual activity on any given day. Interventions targeting sexual urge and drug use may help predict sexual activity among a population at high risk of HIV. UR - http://publichealth.jmir.org/2018/2/e39/ UR - http://dx.doi.org/10.2196/publichealth.9020 UR - http://www.ncbi.nlm.nih.gov/pubmed/29636318 ID - info:doi/10.2196/publichealth.9020 ER - TY - JOUR AU - Katapally, Reddy Tarun AU - Bhawra, Jasmin AU - Leatherdale, T. Scott AU - Ferguson, Leah AU - Longo, Justin AU - Rainham, Daniel AU - Larouche, Richard AU - Osgood, Nathaniel PY - 2018/03/27 TI - The SMART Study, a Mobile Health and Citizen Science Methodological Platform for Active Living Surveillance, Integrated Knowledge Translation, and Policy Interventions: Longitudinal Study JO - JMIR Public Health Surveill SP - e31 VL - 4 IS - 1 KW - exercise KW - sedentary lifestyle KW - smartphone KW - ecological momentary assessments KW - epidemiological monitoring KW - translational medical research KW - health policy N2 - Background: Physical inactivity is the fourth leading cause of death worldwide, costing approximately US $67.5 billion per year to health care systems. To curb the physical inactivity pandemic, it is time to move beyond traditional approaches and engage citizens by repurposing sedentary behavior (SB)?enabling ubiquitous tools (eg, smartphones). Objective: The primary objective of the Saskatchewan, let?s move and map our activity (SMART) Study was to develop a mobile and citizen science methodological platform for active living surveillance, knowledge translation, and policy interventions. This methodology paper enumerates the SMART Study platform?s conceptualization, design, implementation, data collection procedures, analytical strategies, and potential for informing policy interventions. Methods: This longitudinal investigation was designed to engage participants (ie, citizen scientists) in Regina and Saskatoon, Saskatchewan, Canada, in four different seasons across 3 years. In spring 2017, pilot data collection was conducted, where 317 adult citizen scientists (?18 years) were recruited in person and online. Citizen scientists used a custom-built smartphone app, Ethica (Ethica Data Services Inc), for 8 consecutive days to provide a complex series of objective and subjective data. Citizen scientists answered a succession of validated surveys that were assigned different smartphone triggering mechanisms (eg, user-triggered and schedule-triggered). The validated surveys captured physical activity (PA), SB, motivation, perception of outdoor and indoor environment, and eudaimonic well-being. Ecological momentary assessments were employed on each day to capture not only PA but also physical and social contexts along with barriers and facilitators of PA, as relayed by citizen scientists using geo-coded pictures and audio files. To obtain a comprehensive objective picture of participant location, motion, and compliance, 6 types of sensor-based (eg, global positioning system and accelerometer) data were surveilled for 8 days. Initial descriptive analyses were conducted using geo-coded photographs and audio files. Results: Pictures and audio files (ie, community voices) showed that the barriers and facilitators of active living included intrinsic or extrinsic motivations, social contexts, and outdoor or indoor environment, with pets and favorable urban design featuring as the predominant facilitators, and work-related screen time proving to be the primary barrier. Conclusions: The preliminary pilot results show the flexibility of the SMART Study surveillance platform in identifying and addressing limitations based on empirical evidence. The results also show the successful implementation of a platform that engages participants to catalyze policy interventions. Although SMART Study is currently geared toward surveillance, using the same platform, active living interventions could be remotely implemented. SMART Study is the first mobile, citizen science surveillance platform utilizing a rigorous, longitudinal, and mixed-methods investigation to temporally capture behavioral data for knowledge translation and policy interventions. UR - http://publichealth.jmir.org/2018/1/e31/ UR - http://dx.doi.org/10.2196/publichealth.8953 UR - http://www.ncbi.nlm.nih.gov/pubmed/29588267 ID - info:doi/10.2196/publichealth.8953 ER - TY - JOUR AU - Han, Hui AU - Zhang, Ying Jing AU - Hser, Yih-Ing AU - Liang, Di AU - Li, Xu AU - Wang, Shan Shan AU - Du, Jiang AU - Zhao, Min PY - 2018/02/27 TI - Feasibility of a Mobile Phone App to Support Recovery From Addiction in China: Secondary Analysis of a Pilot Study JO - JMIR Mhealth Uhealth SP - e46 VL - 6 IS - 2 KW - mHealth KW - substance use KW - heroin dependence KW - amphetamine-type stimulant (ATS) dependence KW - mobile app KW - China N2 - Background: Mobile health technologies have been found to improve the self-management of chronic diseases. However, there is limited research regarding their feasibility in supporting recovery from substance use disorders (SUDs) in China. Objective: The objective of this study was to examine the feasibility of a mobile phone-based ecological momentary assessment (EMA) app by testing the concordance of drug use assessed by the EMA, urine testing, and a life experience timeline (LET) assessment. Methods: A total of 75 participants dependent on heroin or amphetamine-type stimulant (ATS) in Shanghai were recruited to participate in a 4-week pilot study. Of the participants, 50 (67% [50/75]) were randomly assigned to the experimental group and 25 (33% [25/75]) were assigned to the control group. The experimental group used mobile health (mHealth) based EMA technology to assess their daily drug use in natural environments and received 2 short health messages each day, whereas the control group only received 2 short health messages each day from the app. Urine tests and LET assessments were conducted each week and a post-intervention survey was administered to both groups. The correlations among the EMA, the LET assessment, and the urine test were investigated. Results: The mean age of the participants was 41.6 (SD 8.0) years, and 71% (53/75) were male. During the 4 weeks of observation, 690 daily EMA survey data were recorded, with a response rate of 49.29% (690/1400). With respect to drug use, the percent of agreement between the EMA and the LET was 66.7%, 79.2%, 72.4%, and 85.8%, respectively, for each of the 4 weeks, whereas the percent of agreement between the EMA and the urine test was 51.2%, 65.1%, 61.9%, and 71.5%, respectively. The post-intervention survey indicated that 46% (32/70) of the participants preferred face-to-face interviews rather than the mHealth app. Conclusions: This study demonstrated poor agreement between the EMA data and the LET and found that the acceptance of mHealth among individuals with SUDs in China was not positive. Hence, greater efforts are needed to improve the feasibility of mHealth in China. UR - http://mhealth.jmir.org/2018/2/e46/ UR - http://dx.doi.org/10.2196/mhealth.8388 UR - http://www.ncbi.nlm.nih.gov/pubmed/29487040 ID - info:doi/10.2196/mhealth.8388 ER - TY - JOUR AU - Kumar, Divya AU - Tully, M. Laura AU - Iosif, Ana-Maria AU - Zakskorn, N. Lauren AU - Nye, E. Kathleen AU - Zia, Aqsa AU - Niendam, Ann Tara PY - 2018/02/27 TI - A Mobile Health Platform for Clinical Monitoring in Early Psychosis: Implementation in Community-Based Outpatient Early Psychosis Care JO - JMIR Ment Health SP - e15 VL - 5 IS - 1 KW - mHealth KW - schizophrenia KW - smartphone KW - ecological momentary assessment KW - experience sampling N2 - Background: A growing body of literature indicates that smartphone technology is a feasible add-on tool in the treatment of individuals with early psychosis (EP) . However, most studies to date have been conducted independent of outpatient care or in a research clinic setting, often with financial incentives to maintain user adherence to the technology. Feasibility of dissemination and implementation of smartphone technology into community mental health centers (CMHCs) has yet to be tested, and whether young adults with EP will use this technology for long periods of time without incentive is unknown. Furthermore, although EP individuals willingly adopt smartphone technology as part of their treatment, it remains unclear whether providers are amenable to integrating smartphone technology into treatment protocols. Objective: This study aimed to establish the feasibility of implementing a smartphone app and affiliated Web-based dashboard in 4 community outpatient EP clinics in Northern California. Methods: EP individuals in 4 clinics downloaded an app on their smartphone and responded to daily surveys regarding mood and symptoms for up to 5 months. Treatment providers at the affiliated clinics viewed survey responses on a secure Web-based dashboard in sessions with their clients and between appointments. EP clients and treatment providers filled out satisfaction surveys at study end regarding usability of the app. Results: Sixty-one EP clients and 20 treatment providers enrolled in the study for up to 5 months. Forty-one EP clients completed the study, and all treatment providers remained in the study for their duration in the clinic. Survey completion for all 61 EP clients was moderate: 40% and 39% for daily and weekly surveys, respectively. Completion rates were slightly higher in the participants who completed the study: 44% and 41% for daily and weekly surveys, respectively. Twenty-seven of 41 (66%) EP clients who completed the study and 11 of 13 (85%) treatment providers who responded to satisfaction surveys reported they would continue to use the app as part of treatment services. Six (15%; 6/41) clients and 3 providers (23%; 3/13) stated that technological glitches impeded their engagement with the platform. Conclusions: EP clients and treatment providers in community-based outpatient clinics are responsive to integrating smartphone technology into treatment services. There were logistical and technical challenges associated with enrolling individuals in CMHCs. To be most effective, implementing smartphone technology in CMHC EP care necessitates adequate technical staff and support for utilization of the platform. UR - http://mental.jmir.org/2018/1/e15/ UR - http://dx.doi.org/10.2196/mental.8551 UR - http://www.ncbi.nlm.nih.gov/pubmed/29487044 ID - info:doi/10.2196/mental.8551 ER - TY - JOUR AU - Suffoletto, Brian AU - Chung, Tammy AU - Muench, Frederick AU - Monti, Peter AU - Clark, B. Duncan PY - 2018/02/16 TI - A Text Message Intervention with Adaptive Goal Support to Reduce Alcohol Consumption Among Non-Treatment-Seeking Young Adults: Non-Randomized Clinical Trial with Voluntary Length of Enrollment JO - JMIR Mhealth Uhealth SP - e35 VL - 6 IS - 2 KW - binge drinking KW - young adult KW - text messaging N2 - Background: Stand-alone text message?based interventions can reduce binge drinking episodes (?4 drinks for women and ?5 drinks for men) among nontreatment-seeking young adults, but may not be optimized. Adaptive text message support could enhance effectiveness by assisting context-specific goal setting and striving, but it remains unknown how to best integrate it into text message interventions. Objective: The objective of this study was to evaluate young adults? engagement with a text message intervention, Texting to Reduce Alcohol Consumption 2 (TRAC2), which focuses on reducing weekend alcohol consumption. TRAC2 incorporated preweekend drinking-limit goal-commitment ecological momentary assessments (EMA) tailored to past 2-week alcohol consumption, intraweekend goal reminders, self-efficacy EMA with support tailored to goal confidence, and maximum weekend alcohol consumption EMA with drinking limit goal feedback. Methods: We enrolled 38 nontreatment-seeking young adults (aged 18 to 25 years) who screened positive for hazardous drinking in an urban emergency department. Following a 2-week text message assessment-only run-in, subjects were given the opportunity to enroll in 4-week intervention blocks. We examined patterns of EMA responses and voluntary re-enrollment. We then examined how goal commitment and goal self-efficacy related to event-level alcohol consumption. Finally, we examined the association of length of TRAC2 exposure with alcohol-related outcomes from baseline to 3-month follow-up. Results: Among a diverse sample of young adults (56% [28/50] female, 54% [27/50] black, 32% [12/50] college enrolled), response rates to EMA queries were, on average, 82% for the first 4-week intervention block, 75% for the second 4-week block, and 73% for the third 4-week block. In the first 4 weeks of the intervention, drinking limit goal commitment was made 68/71 times it was prompted (96%). The percentage of subjects being prompted to commit to a drinking limit goal above the binge threshold was 52% (15/29) in week 1 and decreased to 0% (0/15) by week 4. Subjects met their goal 130/146 of the times a goal was committed to (89.0%). There were lower rates of goal success when subjects reported lower confidence (score <4) in meeting the goal (76% [32/42 weekends]) compared with that when subjects reported high confidence (98% [56/57 weekends]; P=.001). There were reductions in alcohol consumption from baseline to 3 months, but reductions were not different by length of intervention exposure. Conclusions: Preliminary evidence suggests that nontreatment-seeking young adults will engage with a text message intervention incorporating self-regulation support features, resulting in high rates of weekend drinking limit goal commitment and goal success. UR - http://mhealth.jmir.org/2018/2/e35/ UR - http://dx.doi.org/10.2196/mhealth.8530 UR - http://www.ncbi.nlm.nih.gov/pubmed/29453191 ID - info:doi/10.2196/mhealth.8530 ER - TY - JOUR AU - Berrouiguet, Sofian AU - Perez-Rodriguez, M. Mercedes AU - Larsen, Mark AU - Baca-García, Enrique AU - Courtet, Philippe AU - Oquendo, Maria PY - 2018/01/03 TI - From eHealth to iHealth: Transition to Participatory and Personalized Medicine in Mental Health JO - J Med Internet Res SP - e2 VL - 20 IS - 1 KW - data mining KW - decision making KW - mobile phone KW - Web app KW - mental health UR - http://www.jmir.org/2018/1/e2/ UR - http://dx.doi.org/10.2196/jmir.7412 UR - http://www.ncbi.nlm.nih.gov/pubmed/29298748 ID - info:doi/10.2196/jmir.7412 ER - TY - JOUR AU - Cole, A. Casey AU - Anshari, Dien AU - Lambert, Victoria AU - Thrasher, F. James AU - Valafar, Homayoun PY - 2017/12/13 TI - Detecting Smoking Events Using Accelerometer Data Collected Via Smartwatch Technology: Validation Study JO - JMIR Mhealth Uhealth SP - e189 VL - 5 IS - 12 KW - machine learning KW - neural networks KW - automated pattern recognition KW - smoking cessation KW - ecological momentary assessment KW - digital signal processing KW - data mining N2 - Background: Smoking is the leading cause of preventable death in the world today. Ecological research on smoking in context currently relies on self-reported smoking behavior. Emerging smartwatch technology may more objectively measure smoking behavior by automatically detecting smoking sessions using robust machine learning models. Objective: This study aimed to examine the feasibility of detecting smoking behavior using smartwatches. The second aim of this study was to compare the success of observing smoking behavior with smartwatches to that of conventional self-reporting. Methods: A convenience sample of smokers was recruited for this study. Participants (N=10) recorded 12 hours of accelerometer data using a mobile phone and smartwatch. During these 12 hours, they engaged in various daily activities, including smoking, for which they logged the beginning and end of each smoking session. Raw data were classified as either smoking or nonsmoking using a machine learning model for pattern recognition. The accuracy of the model was evaluated by comparing the output with a detailed description of a modeled smoking session. Results: In total, 120 hours of data were collected from participants and analyzed. The accuracy of self-reported smoking was approximately 78% (96/123). Our model was successful in detecting 100 of 123 (81%) smoking sessions recorded by participants. After eliminating sessions from the participants that did not adhere to study protocols, the true positive detection rate of the smartwatch based-detection increased to more than 90%. During the 120 hours of combined observation time, only 22 false positive smoking sessions were detected resulting in a 2.8% false positive rate. Conclusions: Smartwatch technology can provide an accurate, nonintrusive means of monitoring smoking behavior in natural contexts. The use of machine learning algorithms for passively detecting smoking sessions may enrich ecological momentary assessment protocols and cessation intervention studies that often rely on self-reported behaviors and may not allow for targeted data collection and communications around smoking events. UR - http://mhealth.jmir.org/2017/12/e189/ UR - http://dx.doi.org/10.2196/mhealth.9035 UR - http://www.ncbi.nlm.nih.gov/pubmed/29237580 ID - info:doi/10.2196/mhealth.9035 ER - TY - JOUR AU - Marquet, Oriol AU - Alberico, Claudia AU - Adlakha, Deepti AU - Hipp, Aaron J. PY - 2017/10/24 TI - Examining Motivations to Play Pokémon GO and Their Influence on Perceived Outcomes and Physical Activity JO - JMIR Serious Games SP - e21 VL - 5 IS - 4 KW - Pokémon GO KW - physical activity KW - excercise KW - exergames KW - gaming outcomes KW - games, recreational KW - motivation N2 - Background: Pokémon GO is the most played augmented reality game in history. With more than 44 million players at the peak of its popularity, the game has sparked interest on its effects on the young population?s health. Objective: This pilot study examined motivations to start playing Pokémon GO among a sample of US college students, and how motivations were associated with perceived outcomes of the playing experience and physical activity derived while playing. Methods: In November 2016, we asked a sample of 47 US college students (all Pokémon GO players) to complete online surveys and install an ecological momentary assessment (EMA) tool and step counter on their smartphones. The EMA tool prompted a set of questions on playing behavior and physical activity, 3 times per day (12:00 PM, 7:00 PM, and 10:00 PM), for 7 days. We used a factorial analysis to identify 3 distinctive groups of players based on their motivations to start playing Pokémon GO. We tested differences across motivation groups related to 5 unique outcomes using 1-way analysis of variance. Results: We extracted 3 interpretable factors from the clustering of motivations to start playing Pokémon GO: Pokémon and video game fans (n=26, 55% of the sample), physical activity seekers (n=8, 17%), and curious & social (n=13, 28%). The clusters differed significantly on the enjoyment of different aspects of the game, particularly battling, discovering new places, and meeting new people, as well as differences in agreement that playing improved mood and made them more social. Days when playing Pokémon GO were associated with higher number of steps reported at the end of the day, especially among physical activity seekers, but also for Pokémon and video game fans. All groups perceived traffic as a major threat to playing. Conclusions: Days during which Pokémon GO was played were positively associated with a set of beneficial health behaviors, including higher physical activity levels, more socialization, and better mood. Results, however, depended on personal motivations and expectations when joining the game. These results highlight the importance of taking motivation into account when attempting to extract conclusions from the Pokémon GO phenomenon to enhance future exergames? designs or health interventions. UR - http://games.jmir.org/2017/4/e21/ UR - http://dx.doi.org/10.2196/games.8048 UR - http://www.ncbi.nlm.nih.gov/pubmed/29066423 ID - info:doi/10.2196/games.8048 ER - TY - JOUR AU - Pedrelli, Paola AU - Howe, Esther AU - Mischoulon, David AU - Picard, Rosalind AU - Ghandeharioun, Asma AU - Fedor, Szymon PY - 2017/09/22 TI - Integrating Ema, Clinical Assessment and Wearable Sensors to Examine the Association between Major Depressive Disorder (MDD) and Alcohol Use JO - iproc SP - e51 VL - 3 IS - 1 KW - alcohol KW - Depression KW - ecological momentary assessment KW - sensors N2 - Background: Depression is the leading cause of disability worldwide. Heavy drinking often co-occurs with Major Depressive Disorder (MDD), preventing the amelioration of symptoms and increasing disability. New technology-based assessment tools such as ecological momentary assessment (EMA) and wearable sensors provide the opportunity for a more detailed examination of the interplay between these two conditions. While the association between low mood and heavy drinking has been extensively examined, multi-method assessments including EMA, sensors and clinician-rated measures have not been utilized to study the association between depression and heavy alcohol use. Objective: To examine the association between depressive symptoms and alcohol consumption by integrating multiple sources of data including EMA, clinical assessment, and wearable sensors. Methods: Individuals with MDD complete an 8-week protocol that involves tracking depressive symptoms and alcohol consumption daily through an EMA. Mood is captured via surveys delivered twice daily that include 10 items of the Positive and Negative Affect Scale (PANAS) assessing negative affect (NA) and positive affect (PA). Participants wear Empatica E4 wristband sensors that track electrodermal activity (EDA) and accelerometer data 23 hours/day. The clinician-rated Hamilton Depression Rating Scale (HDRS) is administered biweekly to assess depressive symptoms. MovisensXS, the app delivering the EMA, tracks text messages, phone calls, location, app usage, and screen on/off behavior. Results: To date, 16 of 30 projected participants have completed the study. All participants are expected to complete the study by 10/2017. Preliminary analyses confirmed the accuracy of the daily mood ratings. There was a significant linear relationship between NA/PA ratio from EMA ratings and the clinician-based ratings (P=1.3e-6). To focus on the association of low mood and drinking behavior, we solely included instances where NA>=PA and observed a significant association (P=0.001) between low mood (as a ratio of total NA divided by PA) and higher alcohol use. Analyses will be repeated for all 30 participants. E4 accelerometer data and location data will help elucidate whether mobility moderates the association between mood and depression, such that individuals who drink at home may exhibit greater depressive symptomatology. Finally, the association between EDA and alcohol use will be examined. Final results will be presented at the Connected Health Conference. Conclusions: To date, results show a significant association between low mood and alcohol consumption. Results of planned analyses will further clarify the temporal association between mood and alcohol use among depressed patients, and possible moderators and mediators of this relationship. A precise understanding of the association between low mood, physiological states and heavy drinking will facilitate the development of ?just-in-time? ecological momentary interventions for both reduction of depressed mood and heavy drinking. UR - http://www.iproc.org/2017/1/e51/ UR - http://dx.doi.org/10.2196/iproc.8584 UR - http://www.ncbi.nlm.nih.gov/pubmed/ ID - info:doi/10.2196/iproc.8584 ER - TY - JOUR AU - Dogan, Ezgi AU - Sander, Christian AU - Wagner, Xenija AU - Hegerl, Ulrich AU - Kohls, Elisabeth PY - 2017/07/24 TI - Smartphone-Based Monitoring of Objective and Subjective Data in Affective Disorders: Where Are We and Where Are We Going? Systematic Review JO - J Med Internet Res SP - e262 VL - 19 IS - 7 KW - review KW - mood disorders KW - smartphone KW - ecological momentary assessment N2 - Background: Electronic mental health interventions for mood disorders have increased rapidly over the past decade, most recently in the form of various systems and apps that are delivered via smartphones. Objective: We aim to provide an overview of studies on smartphone-based systems that combine subjective ratings with objectively measured data for longitudinal monitoring of patients with affective disorders. Specifically, we aim to examine current knowledge on: (1) the feasibility of, and adherence to, such systems; (2) the association of monitored data with mood status; and (3) the effects of monitoring on clinical outcomes. Methods: We systematically searched PubMed, Web of Science, PsycINFO, and the Cochrane Central Register of Controlled Trials for relevant articles published in the last ten years (2007-2017) by applying Boolean search operators with an iterative combination of search terms, which was conducted in February 2017. Additional articles were identified via pearling, author correspondence, selected reference lists, and trial protocols. Results: A total of 3463 unique records were identified. Twenty-nine studies met the inclusion criteria and were included in the review. The majority of articles represented feasibility studies (n=27); two articles reported results from one randomized controlled trial (RCT). In total, six different self-monitoring systems for affective disorders that used subjective mood ratings and objective measurements were included. These objective parameters included physiological data (heart rate variability), behavioral data (phone usage, physical activity, voice features), and context/environmental information (light exposure and location). The included articles contained results regarding feasibility of such systems in affective disorders, showed reasonable accuracy in predicting mood status and mood fluctuations based on the objectively monitored data, and reported observations about the impact of monitoring on clinical state and adherence of patients to the system usage. Conclusions: The included observational studies and RCT substantiate the value of smartphone-based approaches for gathering long-term objective data (aside from self-ratings to monitor clinical symptoms) to predict changes in clinical states, and to investigate causal inferences about state changes in patients with affective disorders. Although promising, a much larger evidence-base is necessary to fully assess the potential and the risks of these approaches. Methodological limitations of the available studies (eg, small sample sizes, variations in the number of observations or monitoring duration, lack of RCT, and heterogeneity of methods) restrict the interpretability of the results. However, a number of study protocols stated ambitions to expand and intensify research in this emerging and promising field. UR - http://www.jmir.org/2017/7/e262/ UR - http://dx.doi.org/10.2196/jmir.7006 UR - http://www.ncbi.nlm.nih.gov/pubmed/28739561 ID - info:doi/10.2196/jmir.7006 ER - TY - JOUR AU - Knell, Gregory AU - Gabriel, Pettee Kelley AU - Businelle, S. Michael AU - Shuval, Kerem AU - Wetter, W. David AU - Kendzor, E. Darla PY - 2017/07/18 TI - Ecological Momentary Assessment of Physical Activity: Validation Study JO - J Med Internet Res SP - e253 VL - 19 IS - 7 KW - accelerometry KW - behavioral risk factor surveillance system KW - ecological momentary assessment KW - self-report KW - data accuracy N2 - Background: Ecological momentary assessment (EMA) may elicit physical activity (PA) estimates that are less prone to bias than traditional self-report measures while providing context. Objectives: The objective of this study was to examine the convergent validity of EMA-assessed PA compared with accelerometry. Methods: The participants self-reported their PA using International Physical Activity Questionnaire (IPAQ) and Behavioral Risk Factor Surveillance System (BRFSS) and wore an accelerometer while completing daily EMAs (delivered through the mobile phone) for 7 days. Weekly summary estimates included sedentary time and moderate-, vigorous-, and moderate-to vigorous-intensity physical activity (MVPA). Spearman coefficients and Lin?s concordance correlation coefficients (LCC) examined the linear association and agreement for EMA and the questionnaires as compared with accelerometry. Results: Participants were aged 43.3 (SD 13.1) years, 51.7% (123/238) were African American, 74.8% (178/238) were overweight or obese, and 63.0% (150/238) were low income. The linear associations of EMA and traditional self-reports with accelerometer estimates were statistically significant (P<.05) for sedentary time (EMA: ?=.16), moderate-intensity PA (EMA: ?=.29; BRFSS: ?=.17; IPAQ: ?=.24), and MVPA (EMA: ?=.31; BRFSS: ?=.17; IPAQ: ?=.20). Only EMA estimates of PA were statistically significant compared with accelerometer for agreement. Conclusions: The mobile EMA showed better correlation and agreement to accelerometer estimates than traditional self-report methods. These findings suggest that mobile EMA may be a practical alternative to accelerometers to assess PA in free-living settings. UR - http://www.jmir.org/2017/7/e253/ UR - http://dx.doi.org/10.2196/jmir.7602 UR - http://www.ncbi.nlm.nih.gov/pubmed/28720556 ID - info:doi/10.2196/jmir.7602 ER - TY - JOUR AU - Leonard, Regina Noelle AU - Silverman, Michelle AU - Sherpa, Phuti Dawa AU - Naegle, A. Madeline AU - Kim, Hyorim AU - Coffman, L. Donna AU - Ferdschneider, Marcy PY - 2017/07/07 TI - Mobile Health Technology Using a Wearable Sensorband for Female College Students With Problem Drinking: An Acceptability and Feasibility Study JO - JMIR Mhealth Uhealth SP - e90 VL - 5 IS - 7 KW - wearable sensors KW - ecological momentary intervention KW - college students KW - alcohol use KW - feasibility studies KW - acceptability studies N2 - Background: An increasing number of mobile app interventions have been developed for problem drinking among college students; however, few studies have examined the integration of a mobile app with continuous physiological monitoring and alerting of affective states related to drinking behaviors. Objective: The aim of this paper was to evaluate the acceptability and feasibility of Mind the Moment (MtM), a theoretically based intervention for female college students with problem drinking that combines brief, in-person counseling with ecological momentary intervention (EMI) on a mobile app integrated with a wearable sensorband. Methods: We recruited 10 non-treatment seeking, female undergraduates from a university health clinic who scored a 3 or higher on the Alcohol Use Disorders Identification Test?Consumption (AUDIT-C) to participate in this pilot study. Study activities involved an in-person baseline intake and 1 follow-up assessment, 2 in-person alcohol brief intervention counseling sessions, and use of MtM technology components (sensorband and EMI on a mobile app) for approximately 3-4 weeks. The intervention used motivational interviewing (MI) and cognitive behavioral therapy (CBT) strategies for reducing risks associated with drinking. We used both qualitative and quantitative assessments to measure acceptability of the intervention and feasibility of delivery. Use patterns of the sensorband and mobile app were also collected. Results: Quantitative and qualitative data indicated high levels of acceptability for the MtM intervention. Altogether, participants made reports on the app on 26.7% (78/292) the days the technology was available to them and completed a total of 325 reports with wide variation between participants. Qualitative findings indicated that sensorband-elicited alerts promoted an increase in awareness of thoughts, feelings, and behaviors related to current environmental stressors and drinking behaviors in theoretically meaningful ways. Specific challenges related to functionality and form of the sensorband were identified. Conclusions: Delivering intervention material ?just-in-time,? at the moment participants need to use behavioral strategies has great potential to individualize behavioral interventions for reducing problem drinking and other health behaviors. These findings provide initial evidence for the promise of wearable sensors for increasing potency of theoretically grounded mobile health interventions and point to directions for future research and uptake of these technologies. UR - http://mhealth.jmir.org/2017/7/e90/ UR - http://dx.doi.org/10.2196/mhealth.7399 UR - http://www.ncbi.nlm.nih.gov/pubmed/28687533 ID - info:doi/10.2196/mhealth.7399 ER - TY - JOUR AU - Bedard, Chloe AU - King-Dowling, Sara AU - McDonald, Madeline AU - Dunton, Genevieve AU - Cairney, John AU - Kwan, Matthew PY - 2017/05/31 TI - Understanding Environmental and Contextual Influences of Physical Activity During First-Year University: The Feasibility of Using Ecological Momentary Assessment in the MovingU Study JO - JMIR Public Health Surveill SP - e32 VL - 3 IS - 2 KW - exercise KW - compliance KW - feasibility studies KW - young adult KW - students N2 - Background: It is well established that drastic declines in physical activity (PA) occur during young adults? transition into university; however, our understanding of contextual and environmental factors as it relates to young adults? PA is limited. Objective: The purpose of our study was to examine the feasibility of using wrist-worn accelerometers and the use of ecological momentary assessment (EMA) to assess the context and momentary correlates of PA on multiple occasions each day during first-year university. Methods: First-year university students were asked to participate in the study. The participants completed a brief questionnaire and were subsequently asked to wear an ActiGraph GT9X-Link accelerometer and respond to a series of EMA prompts (7/day) via their phones for 5 consecutive days. Results: A total of 96 first-year university students with smartphones agreed to participate in the study (mean age 18.3 [SD 0.51]; n=45 females). Overall, there was good compliance for wearing the accelerometers, with 91% (78/86) of the participants having ?2 days of ?10 hours of wear time (mean=3.53 valid days). Students were generally active, averaging 10,895 steps/day (SD 3413) or 1123.23 activity counts/min (SD 356.10). Compliance to EMA prompts was less desirable, with 64% (55/86) of the participants having usable EMA data (responding to a minimum of ?3 days of 3 prompts/day or ?4 days of 2 prompts/day), and only 47% (26/55) of these participants were considered to have excellent EMA compliance (responding to ?5 days of 4 prompts/day or ? 4 days of 5 prompts/day). Conclusions: This study represents one of the first studies to use an intensive real-time data capture strategy to examine time-varying correlates of PA among first-year university students. These data will aim to describe the physical and social contexts in which PA occurs and examine the relationships between momentary correlates of PA among the first-year university students. Overall, current results suggest that wrist-worn accelerometers and EMA are feasible methods for data collection among the young adult population; however, more work is needed to understand how to improve upon compliance to a real-time data capture method such as EMA. UR - http://publichealth.jmir.org/2017/2/e32/ UR - http://dx.doi.org/10.2196/publichealth.7010 UR - http://www.ncbi.nlm.nih.gov/pubmed/28566264 ID - info:doi/10.2196/publichealth.7010 ER - TY - JOUR AU - Pearson, L. Jennifer AU - Elmasry, Hoda AU - Das, Babita AU - Smiley, L. Sabrina AU - Rubin, F. Leslie AU - DeAtley, Teresa AU - Harvey, Emily AU - Zhou, Yitong AU - Niaura, Raymond AU - Abrams, B. David PY - 2017/05/29 TI - Comparison of Ecological Momentary Assessment Versus Direct Measurement of E-Cigarette Use With a Bluetooth-Enabled E-Cigarette: A Pilot Study JO - JMIR Res Protoc SP - e84 VL - 6 IS - 5 KW - smoking KW - humans KW - tobacco products/utilization KW - electronic cigarettes KW - observational study KW - United States N2 - Background: Assessing the frequency and intensity of e-cigarette use presents special challenges beyond those posed by cigarette use. Accurate measurement of e-cigarette consumption, puff duration, and the stability of these measures over time will be informative for estimating the behavioral and health effects of e-cigarette use. Objective: The purpose of this pilot study was to compare the accuracy of self-reported e-cigarette puff counts collected via ecological momentary assessment (EMA) to objective puff count data collected by a Bluetooth-enabled e-cigarette device and to examine the feasibility and acceptability of using a second-generation e-cigarette among adult smokers. Methods: A total of 5 adult smokers were enrolled in a longitudinal parent study assessing how e-cigarette use affects cigarette use among e-cigarette?naïve smokers. Using a text message?based EMA system, participants reported e-cigarette puffs for 2 weeks. Participants were also given a Bluetooth-enabled e-cigarette (Smokio) that passively collected puff counts and puff duration. Comparisons between mean reports of Smokio (device-report) and EMA (self-report) use were evaluated using paired t tests. Correlation and agreement between device- and self-reports were evaluated using Pearson correlation and the concordance correlation coefficient (CCC), respectively. A linear mixed effect model was used to determine the fixed effect of timing and Smokio-reported daily puffs on report accuracy. We examined the relationship between time of day and reporting accuracy using Tukey's test for multiple pairwise comparisons. Results: A total of 5 African American participants, 4 men and 1 woman, who ranged in age from 24 to 59 years completed the study, resulting in 5180 observations (device-report) of e-cigarette use. At baseline, participants reported smoking for 5 to 25 years and consumed a mean of 7 to 13 cigarettes per day (CPD); 4 smoked within 30 minutes of waking. At the 30-day follow-up, CPD range decreased to 1 to 3 cigarettes; 4 participants reported past 7-day e-cigarette use, and 1 participant reported no cigarette smoking in the past 7 days. Over 2 weeks of e-cigarette use, participants took an average of 1074 e-cigarette (SD 779.0) puffs per person as captured by the device reports. Each participant took a mean of 75.0 (SD 58.8) puffs per day, with each puff lasting an average of 3.6 (SD 2.4) seconds. Device reports captured an average of 33.3 (SD 47.8) more puffs per person per day than the self-reported e-cigarette puffs. In 87% of days, participants underestimated the number of puffs they had taken on the Smokio. There was significant moderate correlation (r=.47, P<.001) but poor agreement (pc=0.31, 95% CI 0.15-0.46) between the device- and self-reported data. Reporting accuracy was affected by amount and timing of e-cigarette use. Conclusions: Compared to self-reported e-cigarette use, the Bluetooth-enabled device captured significantly more e-cigarette use and allowed for examination of puff duration in addition to puff counts. A Bluetooth-enabled e-cigarette is a powerful and feasible tool for objective collection of e-cigarette use behavior in the real world. UR - http://www.researchprotocols.org/2017/5/e84/ UR - http://dx.doi.org/10.2196/resprot.6501 UR - http://www.ncbi.nlm.nih.gov/pubmed/28554877 ID - info:doi/10.2196/resprot.6501 ER - TY - JOUR AU - Wright, JC Cassandra AU - Dietze, M. Paul AU - Agius, A. Paul AU - Kuntsche, Emmanuel AU - Room, Robin AU - Livingston, Michael AU - Hellard, Margaret AU - Lim, SC Megan PY - 2017/05/25 TI - An Ecological Momentary Intervention to Reduce Alcohol Consumption in Young Adults Delivered During Drinking Events: Protocol for a Pilot Randomized Controlled Trial JO - JMIR Res Protoc SP - e95 VL - 6 IS - 5 KW - alcohol drinking KW - young adult KW - mHealth KW - text messaging KW - ecological momentary intervention N2 - Background: Risky drinking is a significant public health issue in young Australian adults. Brief interventions are one of few effective methods of reducing risky drinking but are time and cost intensive; innovative methods of delivery are therefore of interest. Mobile phones offer new opportunities to collect data and intervene during risky drinking events. Mobile phones have successfully been used for delivery of alcohol-related brief interventions and data collection but not in combination with or during drinking events. Objective: This pilot study will investigate the efficacy of an ecological momentary intervention (EMI), with combined ecological momentary assessment (EMA) and brief intervention delivered by mobile phones to young adults during risky drinking events. Methods: We will use a 3-armed randomized controlled trial to investigate the efficacy of the intervention for reducing peak single occasion drinking. Our sample is recruited from an observational cohort study of young, risky drinkers. Participants will be randomized into 1 of 3 intervention arms. On 6 nights across a 12-week study period, EMI and EMA groups will complete hourly EMA surveys on their mobile phone. EMI participants will receive tailored feedback short message service (SMS) texts corresponding to their EMA survey responses. The EMI participants will not receive feedback SMS. A third group will have no contact (no-contact control). All groups will then be contacted for a follow-up interview within 4 weeks of the 12-week study period ending. Results: The primary outcome is mean reduction in standard drinks consumed during their most recent heavy drinking occasion as measured at follow-up. Secondary outcomes include alcohol consumption over the previous 6 months, experiences of alcohol-related harms, attitudes toward drinking and drunkenness, hazardous drinking and use of tobacco and illicit drugs. A random effects mixed modelling approach using maximum likelihood estimation will be used to provide estimates of differences in mean drinking levels between those receiving the intervention and control participants. Conclusions: This study is novel in that, unlike previous work, it will intervene repeatedly during single occasion drinking events. Further, it extends previous research in this area, which has applied limited tailoring of message content for SMS-based brief interventions. The findings of this study will contribute to the growing body of evidence to inform the use of mobile health interventions for reducing alcohol consumption and harms. Trial Registration: Australian New Zealand Clinical Trials ACTRN12616001323415; https://www.anzctr.org.au/ Trial/Registration/TrialReview.aspx?id=369534 (Archived by WebCite at http://www.webcitation.org/ 6qDqBZV9b) UR - http://www.researchprotocols.org/2017/5/e95/ UR - http://dx.doi.org/10.2196/resprot.6760 UR - http://www.ncbi.nlm.nih.gov/pubmed/28546136 ID - info:doi/10.2196/resprot.6760 ER - TY - JOUR AU - Wen, Fred Cheng K. AU - Schneider, Stefan AU - Stone, A. Arthur AU - Spruijt-Metz, Donna PY - 2017/04/26 TI - Compliance With Mobile Ecological Momentary Assessment Protocols in Children and Adolescents: A Systematic Review and Meta-Analysis JO - J Med Internet Res SP - e132 VL - 19 IS - 4 KW - ecological momentary assessment KW - compliance KW - youth KW - mHealth N2 - Background: Mobile device-based ecological momentary assessment (mobile-EMA) is increasingly used to collect participants' data in real-time and in context. Although EMA offers methodological advantages, these advantages can be diminished by participant noncompliance. However, evidence on how well participants comply with mobile-EMA protocols and how study design factors associated with participant compliance is limited, especially in the youth literature. Objective: To systematically and meta-analytically examine youth?s compliance to mobile-EMA protocols and moderators of participant compliance in clinical and nonclinical settings. Methods: Studies using mobile devices to collect EMA data among youth (age ?18 years old) were identified. A systematic review was conducted to describe the characteristics of mobile-EMA protocols and author-reported factors associated with compliance. Random effects meta-analyses were conducted to estimate the overall compliance across studies and to explore factors associated with differences in youths? compliance. Results: This review included 42 unique studies that assessed behaviors, subjective experiences, and contextual information. Mobile phones were used as the primary mode of EMA data collection in 48% (20/42) of the reviewed studies. In total, 12% (5/42) of the studies used wearable devices in addition to the EMA data collection platforms. About half of the studies (62%, 24/42) recruited youth from nonclinical settings. Most (98%, 41/42) studies used a time-based sampling protocol. Among these studies, most (95%, 39/41) prompted youth 2-9 times daily, for a study length ranging from 2-42 days. Sampling frequency and study length did not differ between studies with participants from clinical versus nonclinical settings. Most (88%, 36/41) studies with a time-based sampling protocol defined compliance as the proportion of prompts to which participants responded. In these studies, the weighted average compliance rate was 78.3%. The average compliance rates were not different between studies with clinical (76.9%) and nonclinical (79.2%; P=.29) and studies that used only a mobile-EMA platform (77.4%) and mobile platform plus additional wearable devices (73.0%, P=.36). Among clinical studies, the mean compliance rate was significantly lower in studies that prompted participants 2-3 times (73.5%) or 4-5 times (66.9%) compared with studies with a higher sampling frequency (6+ times: 89.3%). Among nonclinical studies, a higher average compliance rate was observed in studies that prompted participants 2-3 times daily (91.7%) compared with those that prompted participants more frequently (4-5 times: 77.4%; 6+ times: 75.0%). The reported compliance rates did not differ by duration of EMA period among studies from either clinical or nonclinical settings. Conclusions: The compliance rate among mobile-EMA studies in youth is moderate but suboptimal. Study design may affect protocol compliance differently between clinical and nonclinical participants; including additional wearable devices did not affect participant compliance. A more consistent compliance-related result reporting practices can facilitate understanding and improvement of participant compliance with EMA data collection among youth. UR - http://www.jmir.org/2017/4/e132/ UR - http://dx.doi.org/10.2196/jmir.6641 UR - http://www.ncbi.nlm.nih.gov/pubmed/28446418 ID - info:doi/10.2196/jmir.6641 ER - TY - JOUR AU - Nahum, Mor AU - Van Vleet, M. Thomas AU - Sohal, S. Vikaas AU - Mirzabekov, J. Julie AU - Rao, R. Vikram AU - Wallace, L. Deanna AU - Lee, B. Morgan AU - Dawes, Heather AU - Stark-Inbar, Alit AU - Jordan, Thomas Joshua AU - Biagianti, Bruno AU - Merzenich, Michael AU - Chang, F. Edward PY - 2017/04/12 TI - Immediate Mood Scaler: Tracking Symptoms of Depression and Anxiety Using a Novel Mobile Mood Scale JO - JMIR Mhealth Uhealth SP - e44 VL - 5 IS - 4 KW - mood disorders KW - mobile KW - ecological momentary assessment KW - depression KW - anxiety N2 - Background: Mood disorders are dynamic disorders characterized by multimodal symptoms. Clinical assessment of symptoms is currently limited to relatively sparse, routine clinic visits, requiring retrospective recollection of symptoms present in the weeks preceding the visit. Novel advances in mobile tools now support ecological momentary assessment of mood, conducted frequently using mobile devices, outside the clinical setting. Such mood assessment may help circumvent problems associated with infrequent reporting and better characterize the dynamic presentation of mood symptoms, informing the delivery of novel treatment options. Objectives: The aim of our study was to validate the Immediate Mood Scaler (IMS), a newly developed, iPad-deliverable 22-item self-report tool designed to capture current mood states. Methods: A total of 110 individuals completed standardized questionnaires (Patient Health Questionnaire, 9-item [PHQ-9]; generalized anxiety disorder, 7-Item [GAD-7]; and rumination scale) and IMS at baseline. Of the total, 56 completed at least one additional session of IMS, and 17 completed one additional administration of PHQ-9 and GAD-7. We conducted exploratory Principal Axis Factor Analysis to assess dimensionality of IMS, and computed zero-order correlations to investigate associations between IMS and standardized scales. Linear Mixed Model (LMM) was used to assess IMS stability across time and to test predictability of PHQ-9 and GAD-7 score by IMS. Results: Strong correlations were found between standard mood scales and the IMS at baseline (r=.57-.59, P<.001). A factor analysis revealed a 12-item IMS (?IMS-12?) with two factors: a ?depression? factor and an ?anxiety? factor. IMS-12 depression subscale was more strongly correlated with PHQ-9 than with GAD-7 (z=1.88, P=.03), but the reverse pattern was not found for IMS-12 anxiety subscale. IMS-12 showed less stability over time compared with PHQ-9 and GAD-7 (.65 vs .91), potentially reflecting more sensitivity to mood dynamics. In addition, IMS-12 ratings indicated that individuals with mild to moderate depression had greater mood fluctuations compared with individuals with severe depression (.42 vs .79; P=.04). Finally, IMS-12 significantly contributed to the prediction of subsequent PHQ-9 (beta=1.03, P=.02) and GAD-7 scores (beta =.93, P=.01). Conclusions: Collectively, these data suggest that the 12-item IMS (IMS-12) is a valid tool to assess momentary mood symptoms related to anxiety and depression. Although IMS-12 shows good correlation with standardized scales, it further captures mood fluctuations better and significantly adds to the prediction of the scales. Results are discussed in the context of providing continuous symptom quantification that may inform novel treatment options and support personalized treatment plans. UR - http://mhealth.jmir.org/2017/4/e44/ UR - http://dx.doi.org/10.2196/mhealth.6544 UR - http://www.ncbi.nlm.nih.gov/pubmed/28404542 ID - info:doi/10.2196/mhealth.6544 ER - TY - JOUR AU - Burke, E. Lora AU - Shiffman, Saul AU - Music, Edvin AU - Styn, A. Mindi AU - Kriska, Andrea AU - Smailagic, Asim AU - Siewiorek, Daniel AU - Ewing, J. Linda AU - Chasens, Eileen AU - French, Brian AU - Mancino, Juliet AU - Mendez, Dara AU - Strollo, Patrick AU - Rathbun, L. Stephen PY - 2017/03/15 TI - Ecological Momentary Assessment in Behavioral Research: Addressing Technological and Human Participant Challenges JO - J Med Internet Res SP - e77 VL - 19 IS - 3 KW - ecological momentary assessment KW - relapse KW - obesity KW - smartphone KW - eating behavior KW - adherence N2 - Background: Ecological momentary assessment (EMA) assesses individuals? current experiences, behaviors, and moods as they occur in real time and in their natural environment. EMA studies, particularly those of longer duration, are complex and require an infrastructure to support the data flow and monitoring of EMA completion. Objective: Our objective is to provide a practical guide to developing and implementing an EMA study, with a focus on the methods and logistics of conducting such a study. Methods: The EMPOWER study was a 12-month study that used EMA to examine the triggers of lapses and relapse following intentional weight loss. We report on several studies that informed the implementation of the EMPOWER study: (1) a series of pilot studies, (2) the EMPOWER study?s infrastructure, (3) training of study participants in use of smartphones and the EMA protocol and, (4) strategies used to enhance adherence to completing EMA surveys. Results: The study enrolled 151 adults and had 87.4% (132/151) retention rate at 12 months. Our learning experiences in the development of the infrastructure to support EMA assessments for the 12-month study spanned several topic areas. Included were the optimal frequency of EMA prompts to maximize data collection without overburdening participants; the timing and scheduling of EMA prompts; technological lessons to support a longitudinal study, such as proper communication between the Android smartphone, the Web server, and the database server; and use of a phone that provided access to the system?s functionality for EMA data collection to avoid loss of data and minimize the impact of loss of network connectivity. These were especially important in a 1-year study with participants who might travel. It also protected the data collection from any server-side failure. Regular monitoring of participants? response to EMA prompts was critical, so we built in incentives to enhance completion of EMA surveys. During the first 6 months of the 12-month study interval, adherence to completing EMA surveys was high, with 88.3% (66,978/75,888) completion of random assessments and around 90% (23,411/25,929 and 23,343/26,010) completion of time-contingent assessments, despite the duration of EMA data collection and challenges with implementation. Conclusions: This work informed us of the necessary preliminary steps to plan and prepare a longitudinal study using smartphone technology and the critical elements to ensure participant engagement in the potentially burdensome protocol, which spanned 12 months. While this was a technology-supported and -programmed study, it required close oversight to ensure all elements were functioning correctly, particularly once human participants became involved. UR - http://www.jmir.org/2017/3/e77/ UR - http://dx.doi.org/10.2196/jmir.7138 UR - http://www.ncbi.nlm.nih.gov/pubmed/28298264 ID - info:doi/10.2196/jmir.7138 ER - TY - JOUR AU - Smiley, L. Sabrina AU - Elmasry, Hoda AU - Webb Hooper, Monica AU - Niaura, S. Raymond AU - Hamilton, B. Alison AU - Milburn, G. Norweeta PY - 2017/02/02 TI - Feasibility of Ecological Momentary Assessment of Daily Sexting and Substance Use Among Young Adult African American Gay and Bisexual Men: A Pilot Study JO - JMIR Res Protoc SP - e9 VL - 6 IS - 2 KW - ecological momentary assessment KW - mobile phone KW - text messaging KW - sexting KW - marijuana KW - alcohol KW - young adult KW - gay and bisexual KW - African American men N2 - Background: Recent evidence suggests that sexualized text communication (?sexting?) is associated with substance use and sexual risk behaviors among young adults, yet little is known about this relationship among young adult African American gay and bisexual men, a population disproportionately impacted by HIV in the United States. Rapid advances in mobile phone technology indicate a clear need for research using mobile health (mHealth) methods such as ecological momentary assessment (EMA) to serve as a viable counterpart to retrospective evaluation methods by using real-time data collection to assess sexting and substance use among this population. Objective: The objective of this pilot study was to (1) describe the EMA study design and protocol, (2) characterize the study population, and (3) assess the feasibility of a random prompt text message-based thrice-daily EMA over 14 days, as a means of prospectively studying sexting, marijuana, and alcohol use among a sample of young adult African American gay and bisexual men ages 21 to 25. Methods: Participants were recruited through flyers and snowball sampling during spring and summer 2015 at a community-based HIV/AIDS prevention, care, and support organization in Washington, DC. Eligible participants were enrolled in a one-time in-person study visit that consisted of informed written consent to participate in the study, a self-administered survey, a semi-structured interview, and enrollment and training in EMA data collection. Commencing the day after the study visit, a random prompt survey was texted to participants on their personal mobile phones 3 times a day over a 14-day data collection period assessing mood, texts sent, texts received, sexts sent, sexts received, marijuana want, marijuana use, and alcohol use. Results: EMA feasibility was tested with 25 self-identified African American gay (n=16) and bisexual (n=9) men (mean age of 23.48 years, SD 1.5). Each random prompt survey had 8 questions with responses including yes/no and Likert scale options. There were 104 total days of EMA observation, and the retention rate was 72% (18 out of 25 participants). Participants responded to the random prompt surveys with a 57.3% compliance rate providing a total of 544 completed surveys out of 949 surveys. The overall mean response time to complete a survey was 6.1 minutes. There were significant positive associations between EMA texts sent and received questions (? 0.84, P<.001) as well as sexts sent and received queries (? 0.72, P<.001). Conclusions: The use of an EMA protocol has the potential to be a very useful research tool for understanding episodic behaviors such as sexting and substance use in this relatively understudied and underserved population, and has implications for practice. Additional research is needed on how to maximize survey compliance. UR - http://www.researchprotocols.org/2017/2/e9/ UR - http://dx.doi.org/10.2196/resprot.6520 UR - http://www.ncbi.nlm.nih.gov/pubmed/28153816 ID - info:doi/10.2196/resprot.6520 ER - TY - JOUR AU - Businelle, S. Michael AU - Ma, Ping AU - Kendzor, E. Darla AU - Frank, G. Summer AU - Vidrine, J. Damon AU - Wetter, W. David PY - 2016/12/12 TI - An Ecological Momentary Intervention for Smoking Cessation: Evaluation of Feasibility and Effectiveness JO - J Med Internet Res SP - e321 VL - 18 IS - 12 KW - smartphone KW - mobile applications KW - smoking cessation KW - low income population N2 - Background: Despite substantial public health progress in reducing the prevalence of smoking in the United States overall, smoking among socioeconomically disadvantaged adults remains high. Objective: To determine the feasibility and preliminary effectiveness of a novel smartphone-based smoking cessation app designed for socioeconomically disadvantaged smokers. Methods: Participants were recruited from a safety-net hospital smoking cessation clinic in Dallas, Texas, and were followed for 13 weeks. All participants received standard smoking cessation clinic care (ie, group counseling and cessation pharmacotherapy) and a smartphone with a novel smoking cessation app (ie, Smart-T). The Smart-T app prompted 5 daily ecological momentary assessments (EMAs) for 3 weeks (ie, 1 week before cessation and 2 weeks after cessation). During the precessation period, EMAs were followed by messages that focused on planning and preparing for the quit attempt. During the postcessation period, participant responses to EMAs drove an algorithm that tailored messages to the current level of smoking lapse risk and currently present lapse triggers (eg, urge to smoke, stress). Smart-T offered additional intervention features on demand (eg, one-click access to the tobacco cessation quitline; ?Quit Tips? on coping with urges to smoke, mood, and stress). Results: Participants (N=59) were 52.0 (SD 7.0) years old, 54% (32/59) female, and 53% (31/59) African American, and 70% (40/57) had annual household income less than US $16,000. Participants smoked 20.3 (SD 11.6) cigarettes per day and had been smoking for 31.6 (SD 10.9) years. Twelve weeks after the scheduled quit date, 20% (12/59) of all participants were biochemically confirmed abstinent. Participants responded to 87% of all prompted EMAs and received approximately 102 treatment messages over the 3-week EMA period. Most participants (83%, 49/59) used the on-demand app features. Individuals with greater nicotine dependence and minority race used the Quit Tips feature more than their counterparts. Greater use of the Quit Tips feature was linked to nonabstinence at the 2 (P=.02), 4 (P<.01), and 12 (P=.03) week follow-up visits. Most participants reported that they actually used or implemented the tailored app-generated messages and suggestions (83%, 49/59); the app-generated messages were helpful (97%, 57/59); they would like to use the app in the future if they were to lapse (97%, 57/59); and they would like to refer friends who smoke to use the Smart-T app (85%, 50/59). A minority of participants (15%, 9/59) reported that the number of daily assessments (ie, 5) was ?too high.? Conclusions: This novel just-in-time adaptive intervention delivered an intensive intervention (ie, 102 messages over a 3-week period), was well-liked, and was perceived as helpful and useful by socioeconomically disadvantaged adults who were seeking smoking cessation treatment. Smartphone apps may be used to increase treatment exposure and may ultimately reduce tobacco-related health disparities among socioeconomically disadvantaged adults. UR - http://www.jmir.org/2016/12/e321/ UR - http://dx.doi.org/10.2196/jmir.6058 UR - http://www.ncbi.nlm.nih.gov/pubmed/27956375 ID - info:doi/10.2196/jmir.6058 ER - TY - JOUR AU - Kenny, Rachel AU - Dooley, Barbara AU - Fitzgerald, Amanda PY - 2016/11/29 TI - Ecological Momentary Assessment of Adolescent Problems, Coping Efficacy, and Mood States Using a Mobile Phone App: An Exploratory Study JO - JMIR Ment Health SP - e51 VL - 3 IS - 4 KW - adolescent KW - affect KW - ecological momentary assessment KW - mobile apps N2 - 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). UR - http://mental.jmir.org/2016/4/e51/ UR - http://dx.doi.org/10.2196/mental.6361 UR - http://www.ncbi.nlm.nih.gov/pubmed/27899340 ID - info:doi/10.2196/mental.6361 ER - TY - JOUR AU - Businelle, S. Michael AU - Ma, Ping AU - Kendzor, E. Darla AU - Frank, G. Summer AU - Wetter, W. David AU - Vidrine, J. Damon PY - 2016/10/17 TI - Using Intensive Longitudinal Data Collected via Mobile Phone to Detect Imminent Lapse in Smokers Undergoing a Scheduled Quit Attempt JO - J Med Internet Res SP - e275 VL - 18 IS - 10 KW - smartphone KW - mobile app KW - mhealth KW - ecological momentary assessment KW - smoking cessation KW - socioeconomic disadvantage, risk estimation N2 - Background: Mobile phone?based real-time ecological momentary assessments (EMAs) have been used to record health risk behaviors, and antecedents to those behaviors, as they occur in near real time. Objective: The objective of this study was to determine if intensive longitudinal data, collected via mobile phone, could be used to identify imminent risk for smoking lapse among socioeconomically disadvantaged smokers seeking smoking cessation treatment. Methods: Participants were recruited into a randomized controlled smoking cessation trial at an urban safety-net hospital tobacco cessation clinic. All participants completed in-person EMAs on mobile phones provided by the study. The presence of six commonly cited lapse risk variables (ie, urge to smoke, stress, recent alcohol consumption, interaction with someone smoking, cessation motivation, and cigarette availability) collected during 2152 prompted or self-initiated postcessation EMAs was examined to determine whether the number of lapse risk factors was greater when lapse was imminent (ie, within 4 hours) than when lapse was not imminent. Various strategies were used to weight variables in efforts to improve the predictive utility of the lapse risk estimator. Results: Participants (N=92) were mostly female (52/92, 57%), minority (65/92, 71%), 51.9 (SD 7.4) years old, and smoked 18.0 (SD 8.5) cigarettes per day. EMA data indicated significantly higher urges (P=.01), stress (P=.002), alcohol consumption (P<.001), interaction with someone smoking (P<.001), and lower cessation motivation (P=.03) within 4 hours of the first lapse compared with EMAs collected when lapse was not imminent. Further, the total number of lapse risk factors present within 4 hours of lapse (mean 2.43, SD 1.37) was significantly higher than the number of lapse risk factors present during periods when lapse was not imminent (mean 1.35, SD 1.04), P<.001. Overall, 62% (32/52) of all participants who lapsed completed at least one EMA wherein they reported ?3 lapse risk factors within 4 hours of their first lapse. Differentially weighting lapse risk variables resulted in an improved risk estimator (weighted area=0.76 vs unweighted area=0.72, P<.004). Specifically, 80% (42/52) of all participants who lapsed had at least one EMA with a lapse risk score above the cut-off within 4 hours of their first lapse. Conclusions: Real-time estimation of smoking lapse risk is feasible and may pave the way for development of mobile phone?based smoking cessation treatments that automatically tailor treatment content in real time based on presence of specific lapse triggers. Interventions that identify risk for lapse and automatically deliver tailored messages or other treatment components in real time could offer effective, low cost, and highly disseminable treatments to individuals who do not have access to other more standard cessation treatments. UR - http://www.jmir.org/2016/10/e275/ UR - http://dx.doi.org/10.2196/jmir.6307 UR - http://www.ncbi.nlm.nih.gov/pubmed/27751985 ID - info:doi/10.2196/jmir.6307 ER - TY - JOUR AU - Naughton, Felix AU - Hopewell, Sarah AU - Lathia, Neal AU - Schalbroeck, Rik AU - Brown, Chloë AU - Mascolo, Cecilia AU - McEwen, Andy AU - Sutton, Stephen PY - 2016/09/16 TI - A Context-Sensing Mobile Phone App (Q Sense) for Smoking Cessation: A Mixed-Methods Study JO - JMIR Mhealth Uhealth SP - e106 VL - 4 IS - 3 KW - mobile phone app KW - smoking cessation KW - context sensing KW - tailoring KW - geofence KW - just-in-time adaptive intervention KW - JITAI KW - ecological momentary intervention KW - craving N2 - Background: A major cause of lapse and relapse to smoking during a quit attempt is craving triggered by cues from a smoker's immediate environment. To help smokers address these cue-induced cravings when attempting to quit, we have developed a context-aware smoking cessation app, Q Sense, which uses a smoking episode-reporting system combined with location sensing and geofencing to tailor support content and trigger support delivery in real time. Objective: We sought to (1) assess smokers? compliance with reporting their smoking in real time and identify reasons for noncompliance, (2) assess the app's accuracy in identifying user-specific high-risk locations for smoking, (3) explore the feasibility and user perspective of geofence-triggered support, and (4) identify any technological issues or privacy concerns. Methods: An explanatory sequential mixed-methods design was used, where data collected by the app informed semistructured interviews. Participants were smokers who owned an Android mobile phone and were willing to set a quit date within one month (N=15). App data included smoking reports with context information and geolocation, end-of-day (EoD) surveys of smoking beliefs and behavior, support message ratings, and app interaction data. Interviews were undertaken and analyzed thematically (N=13). Quantitative and qualitative data were analyzed separately and findings presented sequentially. Results: Out of 15 participants, 3 (20%) discontinued use of the app prematurely. Pre-quit date, the mean number of smoking reports received was 37.8 (SD 21.2) per participant, or 2.0 (SD 2.2) per day per participant. EoD surveys indicated that participants underreported smoking on at least 56.2% of days. Geolocation was collected in 97.0% of smoking reports with a mean accuracy of 31.6 (SD 16.8) meters. A total of 5 out of 9 (56%) eligible participants received geofence-triggered support. Interaction data indicated that 50.0% (137/274) of geofence-triggered message notifications were tapped within 30 minutes of being generated, resulting in delivery of a support message, and 78.2% (158/202) of delivered messages were rated by participants. Qualitative findings identified multiple reasons for noncompliance in reporting smoking, most notably due to environmental constraints and forgetting. Participants verified the app?s identification of their smoking locations, were largely positive about the value of geofence-triggered support, and had no privacy concerns about the data collected by the app. Conclusions: User-initiated self-report is feasible for training a cessation app about an individual?s smoking behavior, although underreporting is likely. Geofencing was a reliable and accurate method of identifying smoking locations, and geofence-triggered support was regarded positively by participants. UR - http://mhealth.jmir.org/2016/3/e106/ UR - http://dx.doi.org/10.2196/mhealth.5787 UR - http://www.ncbi.nlm.nih.gov/pubmed/27637405 ID - info:doi/10.2196/mhealth.5787 ER - TY - JOUR AU - Fanning, Jason AU - Mackenzie, Michael AU - Roberts, Sarah AU - Crato, Ines AU - Ehlers, Diane AU - McAuley, Edward PY - 2016/08/31 TI - Physical Activity, Mind Wandering, Affect, and Sleep: An Ecological Momentary Assessment JO - JMIR Mhealth Uhealth SP - e104 VL - 4 IS - 3 KW - physical activity KW - mHealth KW - attention KW - sleep KW - affect N2 - Background: A considerable portion of daily thought is spent in mind wandering. This behavior has been related to positive (eg, future planning, problem solving) and negative (eg, unhappiness, impaired cognitive performance) outcomes. Objective: Based on previous research suggesting future-oriented (ie, prospective) mind wandering may support autobiographical planning and self-regulation, this study examined associations between hourly mind wandering and moderate-to-vigorous physical activity (MVPA), and the impact of affect and daily sleep on these relations. Methods: College-aged adults (N=33) participated in a mobile phone-delivered ecological momentary assessment study for 1 week. Sixteen hourly prompts assessing mind wandering and affect were delivered daily via participants? mobile phones. Perceived sleep quality and duration was assessed during the first prompt each day, and participants wore an ActiGraph accelerometer during waking hours throughout the study week. Results: Study findings suggest present-moment mind wandering was positively associated with future MVPA (P=.03), and this relationship was moderated by affective state (P=.04). Moreover, excessive sleep the previous evening was related to less MVPA across the following day (P=.007). Further, mind wandering was positively related to activity only among those who did not oversleep (P=.007). Conclusions: Together, these results have implications for multiple health behavior interventions targeting physical activity, affect, and sleep. Researchers may also build on this work by studying these relationships in the context of other important behaviors and psychosocial factors (eg, tobacco use, depression, loneliness). UR - http://mhealth.jmir.org/2016/3/e104/ UR - http://dx.doi.org/10.2196/mhealth.5855 UR - http://www.ncbi.nlm.nih.gov/pubmed/27580673 ID - info:doi/10.2196/mhealth.5855 ER - TY - JOUR AU - Hung, Chin-Lun Galen AU - Yang, Pei-Ching AU - Chang, Chia-Chi AU - Chiang, Jung-Hsien AU - Chen, Ying-Yeh PY - 2016/08/10 TI - Predicting Negative Emotions Based on Mobile Phone Usage Patterns: An Exploratory Study JO - JMIR Res Protoc SP - e160 VL - 5 IS - 3 KW - mobile phone usage KW - depression KW - emotion KW - machine learning KW - affective computing N2 - Background: Prompt recognition and intervention of negative emotions is crucial for patients with depression. Mobile phones and mobile apps are suitable technologies that can be used to recognize negative emotions and intervene if necessary. Objective: Mobile phone usage patterns can be associated with concurrent emotional states. The objective of this study is to adapt machine-learning methods to analyze such patterns for the prediction of negative emotion. Methods: We developed an Android-based app to capture emotional states and mobile phone usage patterns, which included call logs (and use of apps). Visual analog scales (VASs) were used to report negative emotions in dimensions of depression, anxiety, and stress. In the system-training phase, participants were requested to tag their emotions for 14 consecutive days. Five feature-selection methods were used to determine individual usage patterns and four machine-learning methods were tested. Finally, rank product scoring was used to select the best combination to construct the prediction model. In the system evaluation phase, participants were then requested to verify the predicted negative emotions for at least 5 days. Results: Out of 40 enrolled healthy participants, we analyzed data from 28 participants, including 30% (9/28) women with a mean (SD) age of 29.2 (5.1) years with sufficient emotion tags. The combination of time slots of 2 hours, greedy forward selection, and Naïve Bayes method was chosen for the prediction model. We further validated the personalized models in 18 participants who performed at least 5 days of model evaluation. Overall, the predictive accuracy for negative emotions was 86.17%. Conclusion: We developed a system capable of predicting negative emotions based on mobile phone usage patterns. This system has potential for ecological momentary intervention (EMI) for depressive disorders by automatically recognizing negative emotions and providing people with preventive treatments before it escalates to clinical depression. UR - http://www.researchprotocols.org/2016/3/e160/ UR - http://dx.doi.org/10.2196/resprot.5551 UR - http://www.ncbi.nlm.nih.gov/pubmed/27511748 ID - info:doi/10.2196/resprot.5551 ER - TY - JOUR AU - Bruening, Meg AU - van Woerden, Irene AU - Todd, Michael AU - Brennhofer, Stephanie AU - Laska, N. Melissa AU - Dunton, Genevieve PY - 2016/07/27 TI - A Mobile Ecological Momentary Assessment Tool (devilSPARC) for Nutrition and Physical Activity Behaviors in College Students: A Validation Study JO - J Med Internet Res SP - e209 VL - 18 IS - 7 KW - validation study KW - ecological momentary assessment KW - nutritional status KW - physical activity KW - sedentary activity KW - emerging adults N2 - Background: The majority of nutrition and physical activity assessments methods commonly used in scientific research are subject to recall and social desirability biases, which result in over- or under-reporting of behaviors. Real-time mobile-based ecological momentary assessments (mEMAs) may result in decreased measurement biases and minimize participant burden. Objective: The aim was to examine the validity of a mEMA methodology to assess dietary and physical activity levels compared to 24-hour dietary recalls and accelerometers. Methods: This study was a pilot test of the SPARC (Social impact of Physical Activity and nutRition in College) study, which aimed to determine the mechanism by which friendship networks impact weight-related behaviors among young people. An mEMA app, devilSPARC, was developed to assess weight-related behaviors in real time. A diverse sample of 109 freshmen and community mentors attending a large southwestern university downloaded the devilSPARC mEMA app onto their personal mobile phones. Participants were prompted randomly eight times per day over the course of 4 days to complete mEMAs. During the same 4-day period, participants completed up to three 24-hour dietary recalls and/or 4 days of accelerometry. Self-reported mEMA responses were compared to 24-hour dietary recalls and accelerometry measures using comparison statistics, such as match rate, sensitivity and specificity, and mixed model odds ratios, adjusted for within-person correlation among repeated measurements. Results: At the day level, total dietary intake data reported through the mEMA app reflected eating choices also captured by the 24-hour recall. Entrées had the lowest match rate, and fruits and vegetables had the highest match rate. Widening the window of aggregation of 24-hour dietary recall data on either side of the mEMA response resulted in increased specificity and decreased sensitivity. For physical activity behaviors, levels of activity reported through mEMA differed for sedentary versus non-sedentary activity at the day level as measured by accelerometers. Conclusions: The devilSPARC mEMA app is valid for assessing eating behaviors and the presence of sedentary activity at the day level. This mEMA may be useful in studies examining real-time weight-related behaviors. UR - http://www.jmir.org/2016/7/e209/ UR - http://dx.doi.org/10.2196/jmir.5969 UR - http://www.ncbi.nlm.nih.gov/pubmed/27465701 ID - info:doi/10.2196/jmir.5969 ER - TY - JOUR AU - Connelly, Kay AU - Stein, F. Karen AU - Chaudry, Beenish AU - Trabold, Nicole PY - 2016/07/14 TI - Development of an Ecological Momentary Assessment Mobile App for a Low-Literacy, Mexican American Population to Collect Disordered Eating Behaviors JO - JMIR Public Health Surveill SP - e31 VL - 2 IS - 2 KW - feeding and eating disorders KW - health literacy KW - socioeconomic status KW - human-centered computing KW - user-computer interface KW - mobile apps N2 - Background: Ecological momentary assessment (EMA) is a popular method for understanding population health in which participants report their experiences while in naturally occurring contexts in order to increase the reliability and ecological validity of the collected data (as compared to retrospective recall). EMA studies, however, have relied primarily on text-based questionnaires, effectively eliminating low-literacy populations from the samples. Objective: To provide a case study of design of an EMA mobile app for a low-literacy population. In particular, we present the design process and final design of an EMA mobile app for low literate, Mexican American women to record unhealthy eating and weight control behaviors (UEWCBs). Methods: An iterative, user-centered design process was employed to develop the mobile app. An existing EMA protocol to measure UEWCBs in college-enrolled Mexican American women was used as the starting point for the application. The app utilizes an icon interface, with optional audio prompts, that is culturally sensitive and usable by a low-literacy population. A total of 41 women participated over the course of 4 phases of the design process, which included 2 interview and task-based phases (n=8, n=11), focus groups (n=15), and a 5-day, in situ deployment (n=7). Results: Participants? mental models of UEWCBs differed substantially from prevailing definitions found in the literature, prompting a major reorganization of the app interface. Differences in health literacy and numeracy were better identified with the Newest Vital Sign tool, as compared with the Short Assessment of Health Literacy tool. Participants had difficulty imagining scenarios in the interviews to practice recording a specific UEWCB; instead, usability was best tested in situ. Participants were able to use the EMA mobile app over the course of 5 days to record UEWCBs. Conclusions: Results suggest that the iterative, user-centered design process was essential for designing the app to be made usable by the target population. Simply taking the protocol designed for a higher-literacy population and replacing words with icons and/or audio would have been unsuccessful with this population. UR - http://publichealth.jmir.org/2016/2/e31/ UR - http://dx.doi.org/10.2196/publichealth.5511 UR - http://www.ncbi.nlm.nih.gov/pubmed/27418020 ID - info:doi/10.2196/publichealth.5511 ER - TY - JOUR AU - Versluis, Anke AU - Verkuil, Bart AU - Spinhoven, Philip AU - van der Ploeg, M. Melanie AU - Brosschot, F. Jos PY - 2016/06/27 TI - Changing Mental Health and Positive Psychological Well-Being Using Ecological Momentary Interventions: A Systematic Review and Meta-analysis JO - J Med Internet Res SP - e152 VL - 18 IS - 6 KW - mHealth KW - ecological momentary intervention KW - mental health KW - anxiety KW - depression KW - stress KW - meta-analysis KW - systematic review N2 - Background: Mental health problems are highly prevalent, and there is need for the self-management of (mental) health. Ecological momentary interventions (EMIs) can be used to deliver interventions in the daily life of individuals using mobile devices. Objectives: The aim of this study was to systematically assess and meta-analyze the effect of EMI on 3 highly prevalent mental health outcomes (anxiety, depression, and perceived stress) and positive psychological outcomes (eg, acceptance). Methods: PsycINFO and Web of Science were searched for relevant publications, and the last search was done in September 2015. Three concepts were used to find publications: (1) mental health, (2) mobile phones, and (3) interventions. A total of 33 studies (using either a within- or between-subject design) including 43 samples that received an EMI were identified (n=1301), and relevant study characteristics were coded using a standardized form. Quality assessment was done with the Cochrane Collaboration tool. Results: Most of the EMIs focused on a clinical sample, used an active intervention (that offered exercises), and in over half of the studies, additional support by a mental health professional (MHP) was given. The EMI lasted on average 7.48 weeks (SD=6.46), with 2.80 training episodes per day (SD=2.12) and 108.25 total training episodes (SD=123.00). Overall, 27 studies were included in the meta-analysis, and after removing 6 outliers, a medium effect was found on mental health in the within-subject analyses (n=1008), with g=0.57 and 95% CI (0.45-0.70). This effect did not differ as function of outcome type (ie, anxiety, depression, perceived stress, acceptance, relaxation, and quality of life). The only moderator for which the effect varied significantly was additional support by an MHP (MHP-supported EMI, g=0.73, 95% CI: 0.57-0.88; stand-alone EMI, g=0.45, 95% CI: 0.22-0.69; stand-alone EMI with access to care as usual, g=0.38, 95% CI: 0.11-0.64). In the between-subject studies, 13 studies were included, and a small to medium effect was found (g=0.40, 95% CI: 0.22-0.57). Yet, these between-subject analyses were at risk for publication bias and were not suited for moderator analyses. Furthermore, the overall quality of the studies was relatively low. Conclusions: Results showed that there was a small to medium effect of EMIs on mental health and positive psychological well-being and that the effect was not different between outcome types. Moreover, the effect was larger with additional support by an MHP. Future randomized controlled trials are needed to further strengthen the results and to determine potential moderator variables. Overall, EMIs offer great potential for providing easy and cost-effective interventions to improve mental health and increase positive psychological well-being. UR - http://www.jmir.org/2016/6/e152/ UR - http://dx.doi.org/10.2196/jmir.5642 UR - http://www.ncbi.nlm.nih.gov/pubmed/27349305 ID - info:doi/10.2196/jmir.5642 ER - TY - JOUR AU - Liao, Yue AU - Skelton, Kara AU - Dunton, Genevieve AU - Bruening, Meg PY - 2016/06/21 TI - A Systematic Review of Methods and Procedures Used in Ecological Momentary Assessments of Diet and Physical Activity Research in Youth: An Adapted STROBE Checklist for Reporting EMA Studies (CREMAS) JO - J Med Internet Res SP - e151 VL - 18 IS - 6 KW - ecological momentary assessment KW - nutrition KW - physical activity KW - youth KW - systematic review KW - reporting checklist N2 - Background: Ecological momentary assessment (EMA) is a method of collecting real-time data based on careful timing, repeated measures, and observations that take place in a participant?s typical environment. Due to methodological advantages and rapid advancement in mobile technologies in recent years, more studies have adopted EMA in addressing topics of nutrition and physical activity in youth. Objective: The aim of this systematic review is to describe EMA methodology that has been used in studies addressing nutrition and physical activity in youth and provide a comprehensive checklist for reporting EMA studies. Methods: Thirteen studies were reviewed and analyzed for the following 5 areas of EMA methodology: (1) sampling and measures, (2) schedule, (3) technology and administration, (4) prompting strategy, and (5) response and compliance. Results: Results of this review showed a wide variability in the design and reporting of EMA studies in nutrition and physical activity among youth. The majority of studies (69%) monitored their participants during one period of time, although the monitoring period ranged from 4 to 14 days, and EMA surveys ranged from 2 to 68 times per day. More than half (54%) of the studies employed some type of electronic technology. Most (85%) of the studies used interval-contingent prompting strategy. For studies that utilized electronic devices with interval-contingent prompting strategy, none reported the actual number of EMA prompts received by participants out of the intended number of prompts. About half (46%) of the studies failed to report information about EMA compliance rates. For those who reported, compliance rates ranged from 44-96%, with an average of 71%. Conclusions: Findings from this review suggest that in order to identify best practices for EMA methodology in nutrition and physical activity research among youth, more standardized EMA reporting is needed. Missing the key information about EMA design features and participant compliance might lead to misinterpretation of results. Future nutrition and physical activity EMA studies need to be more rigorous and thorough in descriptions of methodology and results. A reporting checklist was developed with the goal of enhancing reliability, efficacy, and overall interpretation of the findings for future studies that use EMAs. UR - http://www.jmir.org/2016/6/e151/ UR - http://dx.doi.org/10.2196/jmir.4954 UR - http://www.ncbi.nlm.nih.gov/pubmed/27328833 ID - info:doi/10.2196/jmir.4954 ER - TY - JOUR AU - O'Reilly-Shah, Vikas AU - Mackey, Sean PY - 2016/06/03 TI - Survalytics: An Open-Source Cloud-Integrated Experience Sampling, Survey, and Analytics and Metadata Collection Module for Android Operating System Apps JO - JMIR mHealth uHealth SP - e46 VL - 4 IS - 2 KW - experiential sampling KW - ecological momentary assessment KW - quantified self KW - analytics KW - Android KW - Amazon Web Services KW - DynamoDB KW - NoSQL KW - surveys KW - microsurveys KW - mobile surveys N2 - Background: We describe here Survalytics, a software module designed to address two broad areas of need. The first area is in the domain of surveys and app analytics: developers of mobile apps in both academic and commercial environments require information about their users, as well as how the apps are being used, to understand who their users are and how to optimally approach app development. The second area of need is in the field of ecological momentary assessment, also referred to as experience sampling: researchers in a wide variety of fields, spanning from the social sciences to psychology to clinical medicine, would like to be able to capture daily or even more frequent data from research subjects while in their natural environment. Objective: Survalytics is an open-source solution for the collection of survey responses as well as arbitrary analytic metadata from users of Android operating system apps. Methods: Surveys may be administered in any combination of one-time questions and ongoing questions. The module may be deployed as a stand-alone app for experience sampling purposes or as an add-on to existing apps. The module takes advantage of free-tier NoSQL cloud database management offered by the Amazon Web Services DynamoDB platform to package a secure, flexible, extensible data collection module. DynamoDB is capable of Health Insurance Portability and Accountability Act compliant storage of personal health information. Results: The provided example app may be used without modification for a basic experience sampling project, and we provide example questions for daily collection of blood glucose data from study subjects. Conclusions: The module will help researchers in a wide variety of fields rapidly develop tailor-made Android apps for a variety of data collection purposes. UR - http://mhealth.jmir.org/2016/2/e46/ UR - http://dx.doi.org/10.2196/mhealth.5397 UR - http://www.ncbi.nlm.nih.gov/pubmed/27261155 ID - info:doi/10.2196/mhealth.5397 ER - TY - JOUR AU - Dunton, Fridlund Genevieve AU - Dzubur, Eldin AU - Intille, Stephen PY - 2016/06/01 TI - Feasibility and Performance Test of a Real-Time Sensor-Informed Context-Sensitive Ecological Momentary Assessment to Capture Physical Activity JO - J Med Internet Res SP - e106 VL - 18 IS - 6 KW - mobile phones KW - ecological momentary assessment KW - accelerometer KW - physical activity N2 - Background: Objective physical activity monitors (eg, accelerometers) have high rates of nonwear and do not provide contextual information about behavior. Objective: This study tested performance and value of a mobile phone app that combined objective and real-time self-report methods to measure physical activity using sensor-informed context-sensitive ecological momentary assessment (CS-EMA). Methods: The app was programmed to prompt CS-EMA surveys immediately after 3 types of events detected by the mobile phone?s built-in motion sensor: (1) Activity (ie, mobile phone movement), (2) No-Activity (ie, mobile phone nonmovement), and (3) No-Data (ie, mobile phone or app powered off). In addition, the app triggered random (ie, signal-contingent) ecological momentary assessment (R-EMA) prompts (up to 7 per day). A sample of 39 ethnically diverse high school students in the United States (aged 14-18, 54% female) tested the app over 14 continuous days during nonschool time. Both CS-EMA and R-EMA prompts assessed activity type (eg, reading or doing homework, eating or drinking, sports or exercising) and contextual characteristics of the activity (eg, location, social company, purpose). Activity was also measured with a waist-worn Actigraph accelerometer. Results: The average CS-EMA + R-EMA prompt compliance and survey completion rates were 80.5% and 98.5%, respectively. More moderate-to-vigorous intensity physical activity was recorded by the waist-worn accelerometer in the 30 minutes before CS-EMA activity prompts (M=5.84 minutes) than CS-EMA No-Activity (M=1.11 minutes) and CS-EMA No-Data (M=0.76 minute) prompts (P?s<.001). Participants were almost 5 times as likely to report going somewhere (ie, active or motorized transit) in the 30 minutes before CS-EMA Activity than R-EMA prompts (odds ratio=4.91, 95% confidence interval=2.16-11.12). Conclusions: Mobile phone apps using motion sensor?informed CS-EMA are acceptable among high school students and may be used to augment objective physical activity data collected from traditional waist-worn accelerometers. UR - http://www.jmir.org/2016/6/e106/ UR - http://dx.doi.org/10.2196/jmir.5398 UR - http://www.ncbi.nlm.nih.gov/pubmed/27251313 ID - info:doi/10.2196/jmir.5398 ER - TY - JOUR AU - Rowe, Christopher AU - Hern, Jaclyn AU - DeMartini, Anna AU - Jennings, Danielle AU - Sommers, Mathew AU - Walker, John AU - Santos, Glenn-Milo PY - 2016/05/26 TI - Concordance of Text Message Ecological Momentary Assessment and Retrospective Survey Data Among Substance-Using Men Who Have Sex With Men: A Secondary Analysis of a Randomized Controlled Trial JO - JMIR mHealth uHealth SP - e44 VL - 4 IS - 2 KW - data collection KW - cell phones KW - drug users KW - drinking behavior KW - homosexuality, male N2 - Background: Alcohol and illicit drug use is more prevalent among men who have sex with men (MSM) compared to the general population and has been linked to HIV transmission in this population. Research assessing individual patterns of substance use often utilizes questionnaires or interviews that rely on retrospective self-reported information, which can be subject to recall bias. Ecological momentary assessment (EMA) is a set of methods developed to mitigate recall bias by collecting data about subjects? mental states and behaviors on a near real-time basis. EMA remains underutilized in substance use and HIV research. Objective: To assess the concordance between daily reports of substance use collected by EMA text messages (short message service, SMS) and retrospective questionnaires and identify predictors of daily concordance in a sample of MSM. Methods: We conducted a secondary analysis of EMA text responses (regarding behavior on the previous day) and audio computer-assisted self-interview (ACASI) survey data (14-day recall) from June 2013 to September 2014 as part of a randomized controlled trial assessing a pharmacologic intervention to reduce methamphetamine and alcohol use among nondependent MSM in San Francisco, California. Reports of daily methamphetamine use, alcohol use, and binge alcohol use (5 or more drinks on one occasion) were collected via EMA and ACASI and compared using McNemar?s tests. Demographic and behavioral correlates of daily concordance between EMA and ACASI were assessed for each substance, using separate multivariable logistic regression models, fit with generalized estimating equations. Results: Among 30 MSM, a total of 994 days were included in the analysis for methamphetamine use, 987 for alcohol use, and 981 for binge alcohol use. Methamphetamine (EMA 20%, ACASI 11%, P<.001) and alcohol use (EMA 40%, ACASI 35%, P=.001) were reported significantly more frequently via EMA versus ACASI. In multivariable analysis, text reporting of methamphetamine (adjusted odds ratio 0.06, 95% CI 0.04-0.10), alcohol (0.48, 0.33-0.69), and binge alcohol use (0.27, 0.17-0.42) was negatively associated with daily concordance in the reporting of each respective substance. Compared to white participants, African American participants were less likely to have daily concordance in methamphetamine (0.15, 0.05-0.43) and alcohol (0.2, 0.05-0.54) reporting, and other participants of color (ie, Asian, Hispanic, multi-racial) were less likely to have daily concordance in methamphetamine reporting (0.34, 0.12-1.00). College graduates were more likely to have daily concordance in methamphetamine reporting (6.79, 1.84-25.04) compared to those with no college experience. Conclusions: We found that methamphetamine and alcohol use were reported more frequently with daily EMA texts compared to retrospective ACASI, concordance varied among different racial/ethnic subgroups and education levels, and reported substance use by EMA text was associated with lower daily concordance with retrospective ACASI. These findings suggest that EMA methods may provide more complete reporting of frequent, discrete behaviors such as substance use. UR - http://mhealth.jmir.org/2016/2/e44/ UR - http://dx.doi.org/10.2196/mhealth.5368 UR - http://www.ncbi.nlm.nih.gov/pubmed/27230545 ID - info:doi/10.2196/mhealth.5368 ER - TY - JOUR AU - Asselbergs, Joost AU - Ruwaard, Jeroen AU - Ejdys, Michal AU - Schrader, Niels AU - Sijbrandij, Marit AU - Riper, Heleen PY - 2016/03/29 TI - Mobile Phone-Based Unobtrusive Ecological Momentary Assessment of Day-to-Day Mood: An Explorative Study JO - J Med Internet Res SP - e72 VL - 18 IS - 3 KW - affect KW - data mining KW - ecological momentary assessment KW - experience sampling KW - mobile phone sensing N2 - Background: Ecological momentary assessment (EMA) is a useful method to tap the dynamics of psychological and behavioral phenomena in real-world contexts. However, the response burden of (self-report) EMA limits its clinical utility. Objective: The aim was to explore mobile phone-based unobtrusive EMA, in which mobile phone usage logs are considered as proxy measures of clinically relevant user states and contexts. Methods: This was an uncontrolled explorative pilot study. Our study consisted of 6 weeks of EMA/unobtrusive EMA data collection in a Dutch student population (N=33), followed by a regression modeling analysis. Participants self-monitored their mood on their mobile phone (EMA) with a one-dimensional mood measure (1 to 10) and a two-dimensional circumplex measure (arousal/valence, ?2 to 2). Meanwhile, with participants? consent, a mobile phone app unobtrusively collected (meta) data from six smartphone sensor logs (unobtrusive EMA: calls/short message service (SMS) text messages, screen time, application usage, accelerometer, and phone camera events). Through forward stepwise regression (FSR), we built personalized regression models from the unobtrusive EMA variables to predict day-to-day variation in EMA mood ratings. The predictive performance of these models (ie, cross-validated mean squared error and percentage of correct predictions) was compared to naive benchmark regression models (the mean model and a lag-2 history model). Results: A total of 27 participants (81%) provided a mean 35.5 days (SD 3.8) of valid EMA/unobtrusive EMA data. The FSR models accurately predicted 55% to 76% of EMA mood scores. However, the predictive performance of these models was significantly inferior to that of naive benchmark models. Conclusions: Mobile phone-based unobtrusive EMA is a technically feasible and potentially powerful EMA variant. The method is young and positive findings may not replicate. At present, we do not recommend the application of FSR-based mood prediction in real-world clinical settings. Further psychometric studies and more advanced data mining techniques are needed to unlock unobtrusive EMA?s true potential. UR - http://www.jmir.org/2016/3/e72/ UR - http://dx.doi.org/10.2196/jmir.5505 UR - http://www.ncbi.nlm.nih.gov/pubmed/27025287 ID - info:doi/10.2196/jmir.5505 ER - TY - JOUR AU - Linas, S. Beth AU - Genz, Andrew AU - Westergaard, P. Ryan AU - Chang, W. Larry AU - Bollinger, C. Robert AU - Latkin, Carl AU - Kirk, D. Gregory PY - 2016/03/15 TI - Ecological Momentary Assessment of Illicit Drug Use Compared to Biological and Self-Reported Methods JO - JMIR mHealth uHealth SP - e27 VL - 4 IS - 1 KW - mHealth KW - ecological momentary assessment KW - illicit drug use KW - sweat patch KW - ACASI N2 - Background: The use of mHealth methods for capturing illicit drug use and associated behaviors have become more widely used in research settings, yet there is little research as to how valid these methods are compared to known measures of capturing and quantifying drug use. Objective: We examined the concordance of ecological momentary assessment (EMA) of drug use to previously validated biological and audio-computer assisted self-interview (ACASI) methods. Methods: The Exposure Assessment in Current Time (EXACT) study utilized EMA methods to assess drug use in real-time in participants? natural environments. Utilizing mobile devices, participants self-reported each time they used heroin or cocaine over a 4-week period. Each week, PharmChek sweat patch samples were collected for measurement of heroin and cocaine and participants answered an ACASI-based questionnaire to report behaviors and drug using events during the prior week. Reports of cocaine and heroin use captured through EMA were compared to weekly biological or self-report measures through percent agreement and concordance correlation coefficients to account for repeated measures. Correlates of discordance were obtained from logistic regression models. Results: A total of 109 participants were a median of 48.5 years old, 90% African American, and 52% male. During 436 person-weeks of observation, we recorded 212 (49%) cocaine and 103 (24%) heroin sweat patches, 192 (44%) cocaine and 161 (37%) heroin ACASI surveys, and 163 (37%) cocaine and 145 (33%) heroin EMA reports. The percent agreement between EMA and sweat patch methods was 70% for cocaine use and 72% for heroin use, while the percent agreement between EMA and ACASI methods was 77% for cocaine use and 79% for heroin use. Misreporting of drug use by EMA compared to sweat patch and ACASI methods were different by illicit drug type. Conclusions: Our work demonstrates moderate to good agreement of EMA to biological and standard self-report methods in capturing illicit drug use. Limitations occur with each method and accuracy may differ by type of illicit drugs used. UR - http://mhealth.jmir.org/2016/1/e27/ UR - http://dx.doi.org/10.2196/mhealth.4470 UR - http://www.ncbi.nlm.nih.gov/pubmed/26980400 ID - info:doi/10.2196/mhealth.4470 ER - TY - JOUR AU - Militello, Lisa AU - Melnyk, Mazurek Bernadette AU - Hekler, B. Eric AU - Small, Leigh AU - Jacobson, Diana PY - 2016/03/14 TI - Automated Behavioral Text Messaging and Face-to-Face Intervention for Parents of Overweight or Obese Preschool Children: Results From a Pilot Study JO - JMIR mHealth uHealth SP - e21 VL - 4 IS - 1 KW - Child KW - Obesity KW - Overweight KW - Health Behavior KW - Text Messaging/SMS KW - Mobile Health KW - Parents KW - Psychology KW - Behavior Therapy KW - Telemedicine N2 - Background: Children are 5 times more likely to be overweight at the age of 12 years if they are overweight during the preschool period. Objective: The purpose of this study was to establish the feasibility, acceptability, and preliminary effects of a cognitive behavioral intervention (TEXT2COPE) synergized with tailored mobile technology (mHealth) on the healthy lifestyle behaviors of parents of overweight and obese preschoolers delivered in a primary care setting. Methods: Fifteen preschooler-parent dyads recruited through primary care clinics completed a manualized 7-week cognitive behavioral skills building intervention. Beck?s Cognitive Theory guided the TEXT2COPE intervention content and Fogg?s Behavior Model guided the implementation. The intervention employed a combination of face-to-face clinic visits and ecological momentary interventions using text messaging (short message service, SMS). To enhance the intervention?s relevance to the family?s needs, parents dictated the wording of the text messages and also were able to adapt the frequency and timing of delivery throughout program implementation. Results: Self-reported findings indicate that the program is feasible and acceptable in this population. The intervention showed preliminary effects with significant improvements on parental knowledge about nutrition (P=.001) and physical activity (P=.012) for their children, parental beliefs (P=.001) toward healthy lifestyles, and parental behaviors (P=.040) toward engaging in healthy lifestyle choices for their children. Effect sizes were medium to large for all variables. The timing, frequency, and wording of the text messages were tailored to the individual families, with 69% of parents (9/13) increasing the frequency of the tailored SMS from being sent once weekly to as many as 5 times a week. Conclusions: Utilizing a cognitive behavioral skills intervention with SMS has great potential for supporting clinical care of overweight and obese preschool children and their families. Further exploration of the potential effects on health and behavioral outcomes is warranted. UR - http://mhealth.jmir.org/2016/1/e21/ UR - http://dx.doi.org/10.2196/mhealth.4398 UR - http://www.ncbi.nlm.nih.gov/pubmed/26976387 ID - info:doi/10.2196/mhealth.4398 ER - TY - JOUR AU - Pike, Russell James AU - Xie, Bin AU - Tan, Nasya AU - Sabado-Liwag, Dee Melanie AU - Orne, Annette AU - Toilolo, Tupou AU - Cen, Steven AU - May, Vanessa AU - Lee, Cevadne AU - Pang, Kaiwi Victor AU - Rainer, A. Michelle AU - Vaivao, S. Dorothy Etimani AU - Lepule, Tana Jonathan AU - Tanjasiri, Park Sora AU - Palmer, Healani Paula PY - 2016/01/07 TI - Developing an Internet- and Mobile-Based System to Measure Cigarette Use Among Pacific Islanders: An Ecological Momentary Assessment Study JO - JMIR mHealth uHealth SP - e2 VL - 4 IS - 1 KW - Pacific Islander KW - tobacco use KW - cigarette use KW - mobile phone KW - text message KW - ecological momentary assessment N2 - Background: Recent prevalence data indicates that Pacific Islanders living in the United States have disproportionately high smoking rates when compared to the general populace. However, little is known about the factors contributing to tobacco use in this at-risk population. Moreover, few studies have attempted to determine these factors utilizing technology-based assessment techniques. Objective: The objective was to develop a customized Internet-based Ecological Momentary Assessment (EMA) system capable of measuring cigarette use among Pacific Islanders in Southern California. This system integrated the ubiquity of text messaging, the ease of use associated with mobile phone apps, the enhanced functionality offered by Internet-based Cell phone-optimized Assessment Techniques (ICAT), and the high survey completion rates exhibited by EMA studies that used electronic diaries. These features were tested in a feasibility study designed to assess whether Pacific Islanders would respond to this method of measurement and whether the data gathered would lead to novel insights regarding the intrapersonal, social, and ecological factors associated with cigarette use. Methods: 20 young adult smokers in Southern California who self-identified as Pacific Islanders were recruited by 5 community-based organizations to take part in a 7-day EMA study. Participants selected six consecutive two-hour time blocks per day during which they would be willing to receive a text message linking them to an online survey formatted for Web-enabled mobile phones. Both automated reminders and community coaches were used to facilitate survey completion. Results: 720 surveys were completed from 840 survey time blocks, representing a completion rate of 86%. After adjusting for gender, age, and nicotine dependence, feeling happy (P=<.001) or wanting a cigarette while drinking alcohol (P=<.001) were positively associated with cigarette use. Being at home (P=.02) or being around people who are not smoking (P=.01) were negatively associated with cigarette use. Conclusions: The results of the feasibility study indicate that customized systems can be used to conduct technology-based assessments of tobacco use among Pacific Islanders. Such systems can foster high levels of survey completion and may lead to novel insights for future research and interventions. UR - http://mhealth.jmir.org/2016/1/e2/ UR - http://dx.doi.org/10.2196/mhealth.4437 UR - http://www.ncbi.nlm.nih.gov/pubmed/26743132 ID - info:doi/10.2196/mhealth.4437 ER - TY - JOUR AU - Sze, Yan Yan AU - Daniel, Oluyomi Tinuke AU - Kilanowski, K. Colleen AU - Collins, Lorraine R. AU - Epstein, H. Leonard PY - 2015/12/16 TI - Web-Based and Mobile Delivery of an Episodic Future Thinking Intervention for Overweight and Obese Families: A Feasibility Study JO - JMIR mHealth uHealth SP - e97 VL - 3 IS - 4 KW - obesity KW - ecological momentary intervention KW - episodic future thinking KW - Web-based KW - health behavior N2 - Background: The bias toward immediate gratification is associated with maladaptive eating behaviors and has been cross-sectionally and prospectively related to obesity. Engaging in episodic future thinking, which involves mental self-projection to pre-experience future events, reduces this bias and energy intake in overweight/obese adults and children. To examine how episodic future thinking can be incorporated into clinical interventions, a Web-based system was created to provide training for adults and children in their everyday lives. Objective: Our study examined the technical feasibility, usability, and acceptability of a Web-based system that is accessible by mobile devices and adapts episodic future thinking for delivery in family-based obesity interventions. Methods: We recruited 20 parent-child dyads (N=40) from the surrounding community and randomized to episodic future thinking versus a nutritional information thinking control to test the feasibility of a 4-week Web-based intervention. Parents were 44.1 (SD 7.8) years of age with BMI of 34.2 (SD 6.8) kg/m2. Children were 11.0 (SD 1.3) years of age with BMI percentile of 96.0 (SD 1.8). Families met weekly with a case manager for 4 weeks and used the system daily. Adherence was collected through the Web-based system, and perceived acceptance of the Web-based system was assessed postintervention. Measurements of body composition and dietary intake were collected at baseline and after the 4 weeks of intervention. Results: All 20 families completed the intervention and attended all sessions. Results showed parents and children had high adherence to the Web-based system and perceived it to be easy to use, useful, and helpful. No differences between conditions were found in adherence for parents (P=.65) or children (P=.27). In addition, results suggest that basic nutrition information along with episodic future thinking delivered through our Web-based system may reduce energy intake and weight. Conclusions: We showed that our Web-based system is an accepted technology and a feasible utility. Furthermore, results provide initial evidence that our system can be incorporated into family-based treatments targeting behaviors related to weight control. These results show promising utility in using our Web-based system in interventions. UR - http://mhealth.jmir.org/2015/4/e97/ UR - http://dx.doi.org/10.2196/mhealth.4603 UR - http://www.ncbi.nlm.nih.gov/pubmed/26678959 ID - info:doi/10.2196/mhealth.4603 ER - TY - JOUR AU - van der Krieke, Lian AU - Emerencia, C. Ando AU - Bos, H. Elisabeth AU - Rosmalen, GM Judith AU - Riese, Harriëtte AU - Aiello, Marco AU - Sytema, Sjoerd AU - de Jonge, Peter PY - 2015/08/07 TI - Ecological Momentary Assessments and Automated Time Series Analysis to Promote Tailored Health Care: A Proof-of-Principle Study JO - JMIR Res Protoc SP - e100 VL - 4 IS - 3 KW - ecological momentary assessment KW - time series analysis KW - vector autoregressive modeling KW - Web-based, dynamic effects, automatization KW - tailored treatment N2 - Background: Health promotion can be tailored by combining ecological momentary assessments (EMA) with time series analysis. This combined method allows for studying the temporal order of dynamic relationships among variables, which may provide concrete indications for intervention. However, application of this method in health care practice is hampered because analyses are conducted manually and advanced statistical expertise is required. Objective: This study aims to show how this limitation can be overcome by introducing automated vector autoregressive modeling (VAR) of EMA data and to evaluate its feasibility through comparisons with results of previously published manual analyses. Methods: We developed a Web-based open source application, called AutoVAR, which automates time series analyses of EMA data and provides output that is intended to be interpretable by nonexperts. The statistical technique we used was VAR. AutoVAR tests and evaluates all possible VAR models within a given combinatorial search space and summarizes their results, thereby replacing the researcher?s tasks of conducting the analysis, making an informed selection of models, and choosing the best model. We compared the output of AutoVAR to the output of a previously published manual analysis (n=4). Results: An illustrative example consisting of 4 analyses was provided. Compared to the manual output, the AutoVAR output presents similar model characteristics and statistical results in terms of the Akaike information criterion, the Bayesian information criterion, and the test statistic of the Granger causality test. Conclusions: Results suggest that automated analysis and interpretation of times series is feasible. Compared to a manual procedure, the automated procedure is more robust and can save days of time. These findings may pave the way for using time series analysis for health promotion on a larger scale. AutoVAR was evaluated using the results of a previously conducted manual analysis. Analysis of additional datasets is needed in order to validate and refine the application for general use. UR - http://www.researchprotocols.org/2015/3/e100/ UR - http://dx.doi.org/10.2196/resprot.4000 UR - http://www.ncbi.nlm.nih.gov/pubmed/26254160 ID - info:doi/10.2196/resprot.4000 ER - TY - JOUR AU - Soong, Andrea AU - Chen, Cen Julia AU - Borzekowski, LG Dina PY - 2015/06/24 TI - Using Ecological Momentary Assessment to Study Tobacco Behavior in Urban India: There?s an App for That JO - JMIR Res Protoc SP - e76 VL - 4 IS - 2 KW - ecological momentary assessment KW - tobacco control KW - cell phones KW - mobile phones KW - mHealth KW - telemedicine KW - smoking N2 - Background: Ecological momentary assessment (EMA) uses real-time data collection to assess participants? behaviors and environments. This paper explores the strengths and limitations of using EMA to examine social and environmental exposure to tobacco in urban India among older adolescents and adults. Objective: Objectives of this study were (1) to describe the methods used in an EMA study of tobacco use in urban India using a mobile phone app for data collection, (2) to determine the feasibility of using EMA in the chosen setting by drawing on participant completion and compliance rates with the study protocol, and (3) to provide recommendations on implementing mobile phone EMA research in India and other low- and middle-income countries. Methods: Via mobile phones and the Internet, this study used two EMA surveys: (1) a momentary survey, sent multiple times per day at random to participants, which asked about their real-time tobacco use (smoked and smokeless) and exposure to pro- and antitobacco messaging in their location, and 2) an end-of-day survey sent at the end of each study day. Trained participants, from Hyderabad and Kolkata, India, reported on their social and environmental exposure to tobacco over 10 consecutive days. This feasibility study examined participant compliance, exploring factors related to the successful completion of surveys and the validity of EMA data. Results: The sample included 205 participants, the majority of whom were male (135/205, 65.9%). Almost half smoked less than daily (56/205, 27.3%) or daily (43/205, 21.0%), and 4.4% (9/205) used smokeless tobacco products. Participants completed and returned 46.87% and 73.02% of momentary and end-of-day surveys, respectively. Significant predictors of momentary survey completion included employment and completion of end-of-day surveys. End-of-day survey completion was only significantly predicted by momentary survey completion. Conclusions: This first study of EMA in India offers promising results, although more research is needed on how to increase compliance. End-of-day survey completion, which has a lower research burden, may be the more appropriate approach to understanding behaviors such as tobacco use within vulnerable populations in challenging locations. Compliance may also be improved by increasing the number of study visits, compliance checks, or opportunities for retraining participants before and during data collection. UR - http://www.researchprotocols.org/2015/2/e76/ UR - http://dx.doi.org/10.2196/resprot.4408 UR - http://www.ncbi.nlm.nih.gov/pubmed/26109369 ID - info:doi/10.2196/resprot.4408 ER - TY - JOUR AU - Yang, Cui AU - Linas, Beth AU - Kirk, Gregory AU - Bollinger, Robert AU - Chang, Larry AU - Chander, Geetanjali AU - Siconolfi, Daniel AU - Braxton, Sharif AU - Rudolph, Abby AU - Latkin, Carl PY - 2015/06/17 TI - Feasibility and Acceptability of Smartphone-Based Ecological Momentary Assessment of Alcohol Use Among African American Men Who Have Sex With Men in Baltimore JO - JMIR mHealth uHealth SP - e67 VL - 3 IS - 2 KW - ecological momentary assessment (EMA) KW - alcohol use KW - HIV KW - African American KW - men who have sex with men (MSM) N2 - Background: Alcohol use is a risk factor for the acquisition of human immunodeficiency virus (HIV) among African American men who have sex with men (MSM). Mobile phone-based ecological momentary assessments (EMA) could minimize bias due to retrospective recall and thus provide a better understanding of the social and structural context of alcohol use and its relationship with HIV-related risk behaviors in this population as well as other highly stigmatized populations. Objective: We describe the study design and the implementation, feasibility, reactivity, and acceptability of an EMA study of alcohol use and HIV-related behaviors among African American MSM in Baltimore. Methods: Participants were recruited through flyers and word-of-mouth in Baltimore from September 2013 to November 2014. Each participant was loaned an Android smartphone and instructed to respond to multiple prompts from the mobile app for 4 weeks. Data were collected through (1) random prompts delivered three times daily assessing participants? location, activity, mood, and social context, (2) daily prompts capturing drinking and sex events occurring in the past 24 hours, and (3) event-contingent responses collecting participants? self-reported episodes of drinking. Results: A total of 16 participants enrolled in the study. The current analyses focused on 15 participants who completed at least 24 days of follow-up (mean follow-up time 29 days; range 24-35 days). Study participants (N=15) were a median 38 years of age (range 27-62 years) with low levels of income and educational attainment. Ten individuals self-reported living with HIV/AIDS, over half reported drinking alcohol at least 2-3 times a week, and a third reported binge drinking (ie, 6 or more drinks on one occasion) on a weekly basis. Based on the Alcohol Use Disorders Identification Test (AUDIT) score, nearly half were classified as hazardous drinkers (score 8-15) and a fifth were likely dependent (score ?16). A total of 140 participant-initiated events were reported, and 75% of 1308 random prompts and 81% of 436 daily prompts delivered were answered. Of seven devices used during the study, five were reported lost by participants. We did not observe strong reactivity effects, and self-reported acceptability to study procedures was uniformly favorable. Conclusions: This study provides evidence to support the feasibility and acceptability of using EMA methods for collecting data on alcohol use among African American men who have sex with men living in urban settings. These data provide the basis for future studies of EMA-informed mHealth interventions to promote the reduction of substance use and HIV risk-taking behaviors among African American MSM living in urban settings. UR - http://mhealth.jmir.org/2015/2/e67/ UR - http://dx.doi.org/10.2196/mhealth.4344 UR - http://www.ncbi.nlm.nih.gov/pubmed/26085078 ID - info:doi/10.2196/mhealth.4344 ER - TY - JOUR AU - Garcia, Carolyn AU - Hardeman, R. Rachel AU - Kwon, Gyu AU - Lando-King, Elizabeth AU - Zhang, Lei AU - Genis, Therese AU - Brady, S. Sonya AU - Kinder, Elizabeth PY - 2014/01/24 TI - Teenagers and Texting: Use of a Youth Ecological Momentary Assessment System in Trajectory Health Research With Latina Adolescents JO - JMIR Mhealth Uhealth SP - e3 VL - 2 IS - 1 KW - texting KW - data collection KW - intervention research KW - longitudinal KW - trajectory N2 - Background: Adolescent females send and receive more text messages than any others, with an average of 4050 texts a month. Despite this technological inroad among adolescents, few researchers are utilizing text messaging technology to collect real time, contextualized data. Temporal variables (ie, mood) collected regularly over a period of time could yield useful insights, particularly for evaluating health intervention outcomes. Use of text messaging technology has multiple benefits, including capacity of researchers to immediately act in response to texted information. Objective: The objective of our study was to custom build a short messaging service (SMS) or text messaging assessment delivery system for use with adolescents. The Youth Ecological Momentary Assessment System (YEMAS) was developed to collect automated texted reports of daily activities, behaviors, and attitudes among adolescents, and to examine the feasibility of YEMAS. This system was created to collect and transfer real time data about individual- and social-level factors that influence physical, mental, emotional, and social well-being. Methods: YEMAS is a custom designed system that interfaces with a cloud-based communication system to automate scheduled delivery of survey questions via text messaging; we designed this university-based system to meet data security and management standards. This was a two-phase study that included development of YEMAS and a feasibility pilot with Latino adolescent females. Relative homogeneity of participants was desired for the feasibility pilot study; adolescent Latina youth were sought because they represent the largest and fastest growing ethnic minority group in the United States. Females were targeted because they demonstrate the highest rate of text messaging and were expected to be interested in participating. Phase I involved development of YEMAS and Phase II involved piloting of the system with Latina adolescents. Girls were eligible to participate if they were attending one of the participating high schools and self-identified as Latina. We contacted 96 adolescents; of these, 24 returned written parental consent forms, completed assent processes, and enrolled in the study. Results: YEMAS was collaboratively developed and implemented. Feasibility was established with Latina adolescents (N=24), who responded to four surveys daily for two two-week periods (four weeks total). Each survey had between 12 and 17 questions, with responses including yes/no, Likert scale, and open-ended options. Retention and compliance rates were high, with nearly 18,000 texts provided by the girls over the course of the pilot period. Conclusions: Pilot results support the feasibility and value of YEMAS, an automated SMS-based text messaging data collection system positioned within a secure university environment. This approach capitalizes on immediate data transfer protocols and enables the documentation of participants? thoughts, feelings, and behaviors in real time. Data are collected using mobile devices that are familiar to participants and nearly ubiquitous in developed countries. UR - http://www.mhealth.jmir.org/2014/1/e3/ UR - http://dx.doi.org/10.2196/mhealth.2576 UR - http://www.ncbi.nlm.nih.gov/pubmed/25098355 ID - info:doi/10.2196/mhealth.2576 ER - TY - JOUR AU - Voogt, Carmen AU - Kuntsche, Emmanuel AU - Kleinjan, Marloes AU - Poelen, Evelien AU - Engels, Rutger PY - 2014/01/08 TI - Using Ecological Momentary Assessment to Test the Effectiveness of a Web-Based Brief Alcohol Intervention Over Time Among Heavy-Drinking Students: Randomized Controlled Trial JO - J Med Internet Res SP - e5 VL - 16 IS - 1 KW - intervention study KW - drinking KW - students N2 - Background: Web-based brief alcohol interventions are effective in reducing alcohol use among students when measured at limited follow-up time points. To date, no studies have tested Web-based brief alcohol intervention effectiveness over time by using a large number of measurements. Objective: Testing whether the What Do You Drink (WDYD) Web-based brief alcohol intervention can sustain a reduction in alcohol use among heavy-drinking students aged 18-24 years at 1-, 3-, and 6-month follow-up intervals. Methods: A purely Web-based, 2-arm, parallel-group randomized controlled trial applying an ecological momentary assessment approach with 30 weekly measurements was conducted in the Netherlands (2010-2011). Participants were recruited offline and online. A total of 907 participants were randomized into the experimental condition (n=456) including the single-session and fully automated WDYD intervention, or into the control condition (n=451) including assessment only. Weekly alcohol consumption and frequency of binge drinking were the self-assessed outcome measures. Results: Attrition rates of the 907 participants were 110 (12.1%), 130 (14.3%), and 162 (17.9%) at 1-, 3-, and 6-month follow-up intervals, respectively. Latent growth curve analyses according to the intention-to-treat principle revealed that participants in the experimental condition had significantly lower weekly alcohol consumption compared to participants in the control condition that was sustained at 3-month follow-up (intercept=?2.60, P<.001; slope=0.16, P=.08). Additional linear regression analyses indicated that this intercept difference resulted from significantly higher levels of alcohol units per week for participants in the control condition compared to those in the experimental condition at 1-month (beta=?2.56, SE 0.74, Cohen?s d=0.20, P=.001), 3-month (beta=?1.76, SE 0.60, Cohen?s d=0.13, P=.003), and 6-month (beta=?1.21, SE 0.58, Cohen?s d=0.09, P=.04) follow-up intervals. Latent growth curve analyses further indicated that participants in the experimental condition had a significantly lower frequency of binge drinking compared to participants in the control condition that was sustained at 6-month follow-up (intercept=?0.14, P=.01; slope=0.004, P=.19). This intercept difference resulted from higher levels in this outcome for participants in the control condition relative to participants in the experimental condition at 1-month (beta=?1.15, SE 0.06, Cohen?s d=0.16, P=.01), 3-month (beta=?0.12, SE 0.05, Cohen?s d=0.09, P=.01), and 6-month (beta=?0.09, SE 0.05, Cohen?s d=0.03, P=.045) follow-up intervals. Conclusions: The WDYD intervention was shown to be effective in preventing an increase in weekly alcohol consumption and frequency of binge drinking directly after the intervention. This effect was sustained 3 and 6 months after the intervention. Trial Registration: Netherlands Trial Register NTR2665; http://www.trialregister.nl/trialreg/admin/rctview.asp?TC=2665 (Archived by WebCite at http://webcitation.org/6LuQVn12M). UR - http://www.jmir.org/2014/1/e5/ UR - http://dx.doi.org/10.2196/jmir.2817 UR - http://www.ncbi.nlm.nih.gov/pubmed/24401555 ID - info:doi/10.2196/jmir.2817 ER - TY - JOUR AU - Spook, Eline Jorinde AU - Paulussen, Theo AU - Kok, Gerjo AU - Van Empelen, Pepijn PY - 2013/09/24 TI - Monitoring Dietary Intake and Physical Activity Electronically: Feasibility, Usability, and Ecological Validity of a Mobile-Based Ecological Momentary Assessment Tool JO - J Med Internet Res SP - e214 VL - 15 IS - 9 KW - mobile-based Ecological Momentary Assessment (mEMA) KW - feasibility KW - usability KW - ecological validity KW - dietary intake KW - physical activity N2 - Background: Despite the growing body of research on complex lifestyle behaviors (eg, Dietary Intake [DI] and Physical Activity [PA]), monitoring of these behaviors has been hampered by a lack of suitable methods. A possible solution to this deficiency is mobile-based Ecological Momentary Assessment (mEMA), which enables researchers to collect data on participants? states in real-time by means of a smartphone application. However, feasibility, usability, and ecological validity need to be anticipated and managed in order to enhance the validity of mEMA. Objective: To examine the feasibility, usability, and ecological validity of a mEMA application (app) with regard to DI and PA among Dutch vocational education students. Methods: The students (n=30) participated in the mEMA study for seven consecutive days. They downloaded the mEMA app on their smartphone. Feasibility and usability of the mEMA app were evaluated by completing an online evaluation after seven days of participation. Ecological validity was measured by assessing the degree to which the content of the mEMA app approximated the real-world setting that was being examined, through several multiple-choice questions. Results: Compliance rates, as registered by the mEMA app, declined 46% over a seven-day period, while self-reported compliance, as measured with an online evaluation questionnaire afterwards, indicated a smaller decrease in compliance (29%). The students evaluated the mEMA app as feasible and usable. Ecological validity analyses showed that all DI and almost all PA multiple-choice options were covered with the compound response categories. Conclusions: The mEMA app offers the opportunity to assess complex health behaviors (eg, DI and PA) in real-time settings, in which specifically routinized behaviors are involved. However, the mEMA app faced several challenges that needed to be overcome in order to improve its validity. Overall, the present study showed that the mEMA app is a usable and ecologically valid tool to measure DI and PA behaviors among vocational education students, but compliance is still limited. UR - http://www.jmir.org/2013/9/e214/ UR - http://dx.doi.org/10.2196/jmir.2617 UR - http://www.ncbi.nlm.nih.gov/pubmed/24067298 ID - info:doi/10.2196/jmir.2617 ER - TY - JOUR AU - Mulvaney, A. Shelagh AU - Ho, Yun-Xian AU - Cala, M. Cather AU - Chen, Qingxia AU - Nian, Hui AU - Patterson, L. Barron AU - Johnson, B. Kevin PY - 2013/07/17 TI - Assessing Adolescent Asthma Symptoms and Adherence Using Mobile Phones JO - J Med Internet Res SP - e141 VL - 15 IS - 7 KW - asthma KW - adherence KW - mobile technology KW - adolescent KW - assessment N2 - Background: Self-report is the most common method of measuring medication adherence but is influenced by recall error and response bias, and it typically does not provide insight into the causes of poor adherence. Ecological momentary assessment (EMA) of health behaviors using mobile phones offers a promising alternative to assessing adherence and collecting related data that can be clinically useful for adherence problem solving. Objective: To determine the feasibility of using EMA via mobile phones to assess adolescent asthma medication adherence and identify contextual characteristics of adherence decision making. Methods: We utilized a descriptive and correlational study design to explore a mobile method of symptom and adherence assessment using an interactive voice response system. Adolescents aged 12-18 years with a diagnosis of asthma and prescribed inhalers were recruited from an academic medical center. A survey including barriers to mobile phone use, the Illness Management Survey, and the Pediatric Asthma Quality of Life Questionnaire were administered at baseline. Quantitative and qualitative assessment of asthma symptoms and adherence were conducted with daily calls to mobile phones for 1 month. The Asthma Control Test (ACT) was administered at 2 study time points: baseline and 1 month after baseline. Results: The sample consisted of 53 adolescents who were primarily African American (34/53, 64%) and female (31/53, 58%) with incomes US$40K/year or lower (29/53, 55%). The majority of adolescents (37/53, 70%) reported that they carried their phones with them everywhere, but only 47% (25/53) were able to use their mobile phone at school. Adolescents responded to an average of 20.1 (SD 8.1) of the 30 daily calls received (67%). Response frequency declined during the last week of the month (b=-0.29, P<.001) and was related to EMA-reported levels of rescue inhaler adherence (r= 0.33, P=.035). Using EMA, adolescents reported an average of 0.63 (SD 1.2) asthma symptoms per day and used a rescue inhaler an average of 70% of the time (SD 35%) when they experienced symptoms. About half (26/49, 53%) of the instances of nonadherence took place in the presence of friends. The EMA-measured adherence to rescue inhaler use correlated appropriately with asthma control as measured by the ACT (r=-0.33, P=.034). Conclusions: Mobile phones provided a feasible method to assess asthma symptoms and adherence in adolescents. The EMA method was consistent with the ACT, a widely established measure of asthma control, and results provided valuable insights regarding the context of adherence decision making that could be used clinically for problem solving or as feedback to adolescents in a mobile or Web-based support system. UR - http://www.jmir.org/2013/7/e141/ UR - http://dx.doi.org/10.2196/jmir.2413 UR - http://www.ncbi.nlm.nih.gov/pubmed/23864345 ID - info:doi/10.2196/jmir.2413 ER - TY - JOUR AU - Schnall, Rebecca AU - Okoniewski, Anastasia AU - Tiase, Victoria AU - Low, Alexander AU - Rodriguez, Martha AU - Kaplan, Steven PY - 2013/03/06 TI - Using Text Messaging to Assess Adolescents' Health Information Needs: An Ecological Momentary Assessment JO - J Med Internet Res SP - e54 VL - 15 IS - 3 KW - text messaging KW - ecological momentary assessment KW - mobile health technology N2 - Background: Use of mobile technology has made a huge impact on communication, access, and information/resource delivery to adolescents. Mobile technology is frequently used by adolescents. Objective: The purpose of this study was to understand the health information needs of adolescents in the context of their everyday lives and to assess how they meet their information needs. Methods: We gave 60 adolescents smartphones with unlimited text messaging and data for 30 days. Each smartphone had applications related to asthma, obesity, human immunodeficiency virus, and diet preinstalled on the phone. We sent text messages 3 times per week and asked the following questions: (1) What questions did you have about your health today? (2) Where did you look for an answer (mobile device, mobile application, online, friend, book, or parent)? (3) Was your question answered and how? (4) Anything else? Results: Our participants ranged from 13-18 years of age, 37 (62%) participants were male and 22 (37%) were female. Of the 60 participants, 71% (42/60) participants identified themselves as Hispanic and 77% (46/60) were frequent users of mobile devices. We had a 90% (1935/2150) response rate to our text messages. Participants sent a total of 1935 text messages in response to the ecological momentary assessment questions. Adolescents sent a total of 421 text messages related to a health information needs, and 516 text messages related to the source of information to the answers of their questions, which were related to parents, friends, online, mobile apps, teachers, or coaches. Conclusions: Text messaging technology is a useful tool for assessing adolescents? health behavior in real-time. Adolescents are willing to use text messaging to report their health information. Findings from this study contribute to the evidence base on addressing the health information needs of adolescents. In particular, attention should be paid to issues related to diet and exercise. These findings may be the harbinger for future obesity prevention programs for adolescents. UR - http://www.jmir.org/2013/3/e54/ UR - http://dx.doi.org/10.2196/jmir.2395 UR - http://www.ncbi.nlm.nih.gov/pubmed/23467200 ID - info:doi/10.2196/jmir.2395 ER - TY - JOUR AU - Burns, Nicole Michelle AU - Begale, Mark AU - Duffecy, Jennifer AU - Gergle, Darren AU - Karr, J. Chris AU - Giangrande, Emily AU - Mohr, C. David PY - 2011/08/12 TI - Harnessing Context Sensing to Develop a Mobile Intervention for Depression JO - J Med Internet Res SP - e55 VL - 13 IS - 3 KW - Depression KW - behavior therapy KW - telemedicine KW - mobile health KW - mobile phone KW - cellular phone KW - sensors KW - data mining KW - artificial intelligence KW - context-aware systems N2 - Background: Mobile phone sensors can be used to develop context-aware systems that automatically detect when patients require assistance. Mobile phones can also provide ecological momentary interventions that deliver tailored assistance during problematic situations. However, such approaches have not yet been used to treat major depressive disorder. Objective: The purpose of this study was to investigate the technical feasibility, functional reliability, and patient satisfaction with Mobilyze!, a mobile phone- and Internet-based intervention including ecological momentary intervention and context sensing. Methods: We developed a mobile phone application and supporting architecture, in which machine learning models (ie, learners) predicted patients? mood, emotions, cognitive/motivational states, activities, environmental context, and social context based on at least 38 concurrent phone sensor values (eg, global positioning system, ambient light, recent calls). The website included feedback graphs illustrating correlations between patients? self-reported states, as well as didactics and tools teaching patients behavioral activation concepts. Brief telephone calls and emails with a clinician were used to promote adherence. We enrolled 8 adults with major depressive disorder in a single-arm pilot study to receive Mobilyze! and complete clinical assessments for 8 weeks. Results: Promising accuracy rates (60% to 91%) were achieved by learners predicting categorical contextual states (eg, location). For states rated on scales (eg, mood), predictive capability was poor. Participants were satisfied with the phone application and improved significantly on self-reported depressive symptoms (betaweek = ?.82, P < .001, per-protocol Cohen d = 3.43) and interview measures of depressive symptoms (betaweek = ?.81, P < .001, per-protocol Cohen d = 3.55). Participants also became less likely to meet criteria for major depressive disorder diagnosis (bweek = ?.65, P = .03, per-protocol remission rate = 85.71%). Comorbid anxiety symptoms also decreased (betaweek = ?.71, P < .001, per-protocol Cohen d = 2.58). Conclusions: Mobilyze! is a scalable, feasible intervention with preliminary evidence of efficacy. To our knowledge, it is the first ecological momentary intervention for unipolar depression, as well as one of the first attempts to use context sensing to identify mental health-related states. Several lessons learned regarding technical functionality, data mining, and software development process are discussed. Trial Registration: Clinicaltrials.gov NCT01107041; http://clinicaltrials.gov/ct2/show/NCT01107041 (Archived by WebCite at http://www.webcitation.org/60CVjPH0n) UR - http://www.jmir.org/2011/3/e55/ UR - http://dx.doi.org/10.2196/jmir.1838 UR - http://www.ncbi.nlm.nih.gov/pubmed/21840837 ID - info:doi/10.2196/jmir.1838 ER -