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Chua XH, Edney SM, Müller AM, Petrunoff NA, Whitton C, Tay Z, Goh CMJL, Chen B, Park SH, Rebello SA, Low A, Chia J, Koek D, Cheong K, van Dam RM, Müller-Riemenschneider F. Rationale, Design, and Baseline Characteristics of Participants in the Health@NUS mHealth Augmented Cohort Study Examining Student-to-Work Life Transition: Protocol for a Prospective Cohort Study. JMIR Res Protoc 2024; 13:e56749. [PMID: 39018103 DOI: 10.2196/56749] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/28/2024] [Revised: 04/18/2024] [Accepted: 04/18/2024] [Indexed: 07/18/2024] Open
Abstract
BACKGROUND Integration of mobile health data collection methods into cohort studies enables the collection of intensive longitudinal information, which gives deeper insights into individuals' health and lifestyle behavioral patterns over time, as compared to traditional cohort methods with less frequent data collection. These findings can then fill the gaps that remain in understanding how various lifestyle behaviors interact as students graduate from university and seek employment (student-to-work life transition), where the inability to adapt quickly to a changing environment greatly affects the mental well-being of young adults. OBJECTIVE This paper aims to provide an overview of the study methodology and baseline characteristics of participants in Health@NUS, a longitudinal study leveraging mobile health to examine the trajectories of health behaviors, physical health, and well-being, and their diverse determinants, for young adults during the student-to-work life transition. METHODS University students were recruited between August 2020 and June 2022 in Singapore. Participants would complete biometric assessments and questionnaires at 3 time points (baseline, 12-, and 24-month follow-up visits) and use a Fitbit smartwatch and smartphone app to continuously collect physical activity, sedentary behavior, sleep, and dietary data over the 2 years. Additionally, up to 12 two-week-long bursts of app-based ecological momentary surveys capturing lifestyle behaviors and well-being would be sent out among the 3 time points. RESULTS Interested participants (n=1556) were screened for eligibility, and 776 participants were enrolled in the study between August 2020 and June 2022. Participants were mostly female (441/776, 56.8%), of Chinese ethnicity (741/776, 92%), undergraduate students (759/776, 97.8%), and had a mean BMI of 21.9 (SD 3.3) kg/m2, and a mean age of 22.7 (SD 1.7) years. A substantial proportion were overweight (202/776, 26.1%) or obese (42/776, 5.4%), had indicated poor mental well-being (World Health Organization-5 Well-Being Index ≤50; 291/776, 37.7%), or were at higher risk for psychological distress (Kessler Psychological Distress Scale ≥13; 109/776, 14.1%). CONCLUSIONS The findings from this study will provide detailed insights into the determinants and trajectories of health behaviors, health, and well-being during the student-to-work life transition experienced by young adults. TRIAL REGISTRATION ClinicalTrials.gov NCT05154227; https://clinicaltrials.gov/study/NCT05154227. INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID) DERR1-10.2196/56749.
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Affiliation(s)
- Xin Hui Chua
- Saw Swee Hock School of Public Health, National University of Singapore and National University Health System, Singapore, Singapore
| | - Sarah Martine Edney
- Saw Swee Hock School of Public Health, National University of Singapore and National University Health System, Singapore, Singapore
| | - Andre Matthias Müller
- Saw Swee Hock School of Public Health, National University of Singapore and National University Health System, Singapore, Singapore
| | - Nicholas A Petrunoff
- Saw Swee Hock School of Public Health, National University of Singapore and National University Health System, Singapore, Singapore
| | - Clare Whitton
- School of Medical and Health Sciences, Edith Cowan University, Joondalup, Australia
| | - Zoey Tay
- Saw Swee Hock School of Public Health, National University of Singapore and National University Health System, Singapore, Singapore
| | - Claire Marie Jie Lin Goh
- Saw Swee Hock School of Public Health, National University of Singapore and National University Health System, Singapore, Singapore
| | - Bozhi Chen
- Saw Swee Hock School of Public Health, National University of Singapore and National University Health System, Singapore, Singapore
| | - Su Hyun Park
- Saw Swee Hock School of Public Health, National University of Singapore and National University Health System, Singapore, Singapore
| | - Salome A Rebello
- Saw Swee Hock School of Public Health, National University of Singapore and National University Health System, Singapore, Singapore
| | - Alicia Low
- Health Promotion Board, Singapore Government, Singapore, Singapore
| | - Janelle Chia
- Health Promotion Board, Singapore Government, Singapore, Singapore
| | - Daphne Koek
- Health Promotion Board, Singapore Government, Singapore, Singapore
| | - Karen Cheong
- Health Promotion Board, Singapore Government, Singapore, Singapore
| | - Rob M van Dam
- Saw Swee Hock School of Public Health, National University of Singapore and National University Health System, Singapore, Singapore
- Departments of Exercise and Nutrition Sciences and Epidemiology, Milken Institute of Public Health, The George Washington University, Washington, DC, United States
| | - Falk Müller-Riemenschneider
- Saw Swee Hock School of Public Health, National University of Singapore and National University Health System, Singapore, Singapore
- Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore
- Digital Health Center, Berlin Institute of Health, Charité-Universitätsmedizin Berlin, Berlin, Germany
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Zhang Y, Li D, Li X, Zhou X, Newman G. The integration of geographic methods and ecological momentary assessment in public health research: A systematic review of methods and applications. Soc Sci Med 2024; 354:117075. [PMID: 38959816 DOI: 10.1016/j.socscimed.2024.117075] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/14/2023] [Revised: 06/16/2024] [Accepted: 06/23/2024] [Indexed: 07/05/2024]
Abstract
With the widespread prevalence of mobile devices, ecological momentary assessment (EMA) can be combined with geospatial data acquired through geographic techniques like global positioning system (GPS) and geographic information system. This technique enables the consideration of individuals' health and behavior outcomes of momentary exposures in spatial contexts, mostly referred to as "geographic ecological momentary assessment" or "geographically explicit EMA" (GEMA). However, the definition, scope, methods, and applications of GEMA remain unclear and unconsolidated. To fill this research gap, we conducted a systematic review to synthesize the methodological insights, identify common research interests and applications, and furnish recommendations for future GEMA studies. We followed the Preferred Reporting Items for Systematic Reviews and Meta-Analysis guidelines to systematically search peer-reviewed studies from six electronic databases in 2022. Screening and eligibility were conducted following inclusion criteria. The risk of bias assessment was performed, and narrative synthesis was presented for all studies. From the initial search of 957 publications, we identified 47 articles included in the review. In public health, GEMA was utilized to measure various outcomes, such as psychological health, physical and physiological health, substance use, social behavior, and physical activity. GEMA serves multiple research purposes: 1) enabling location-based EMA sampling, 2) quantifying participants' mobility patterns, 3) deriving exposure variables, 4) describing spatial patterns of outcome variables, and 5) performing data linkage or triangulation. GEMA has advanced traditional EMA sampling strategies and enabled location-based sampling by detecting location changes and specified geofences. Furthermore, advances in mobile technology have prompted considerations of additional sensor-based data in GEMA. Our results highlight the efficacy and feasibility of GEMA in public health research. Finally, we discuss sampling strategy, data privacy and confidentiality, measurement validity, mobile applications and technologies, and GPS accuracy and missing data in the context of current and future public health research that uses GEMA.
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Affiliation(s)
- Yue Zhang
- Department of Landscape Architecture and Urban Planning, Texas A&M University, College Station, TX, USA.
| | - Dongying Li
- Department of Landscape Architecture and Urban Planning, Texas A&M University, College Station, TX, USA
| | - Xiaoyu Li
- Department of Landscape Architecture and Urban Planning, Texas A&M University, College Station, TX, USA
| | - Xiaolu Zhou
- Department of Geography, Texas Christian University, Fort Worth, Texas, USA
| | - Galen Newman
- Department of Landscape Architecture and Urban Planning, Texas A&M University, College Station, TX, USA
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Monnaatsie M, Mielke GI, Biddle SJH, Kolbe-Alexander TL. Ecological momentary assessment of physical activity and sedentary behaviour in shift workers and non-shift workers: Validation study. J Sports Sci 2024:1-10. [PMID: 38899730 DOI: 10.1080/02640414.2024.2369443] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/29/2023] [Accepted: 06/11/2024] [Indexed: 06/21/2024]
Abstract
This study examined the criterion validity of an ecological momentary assessment (EMA)-reported physical activity and sedentary time compared with accelerometry in shift workers and non-shift workers. Australian workers (n = 102) received prompts through a mobile EMA app and wore the Actigraph accelerometer on the right hip for 7-10 days. Participants received five EMA prompts per day at 3-hour intervals on their mobile phones. EMA prompts sent to shift workers (SW-T) were tailored according to their work schedule. Non-shift workers (NSW-S) received prompts at standardised times. To assess criterion validity, the association of EMA-reported activities and the Actigraph accelerometer activity counts and number of steps were used. Participants were 36 ± 11 years and 58% were female. On occasions where participants reported physical activity, acceleration counts per minute (CPM) and steps were significantly higher (β = 1184 CPM, CI 95%: 1034, 1334; β = 20.9 steps, CI 95%: 18.2, 23.6) than each of the other EMA activities. Acceleration counts and steps were lower when sitting was reported than when no sitting was reported by EMA. Our study showed that EMA-reported physical activity and sedentary time was significantly associated with accelerometer-derived data. Therefore, EMA can be considered to assess shift workers' movement-related behaviours with accelerometers to provide rich contextual data.
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Affiliation(s)
- Malebogo Monnaatsie
- School of Health and Medical Sciences, Faculty of Health, Engineering and Sciences, University of Southern Queensland, Ipswich, Queensland, Australia
- Centre for Health Research, University of Southern Queensland, Springfield, Queensland, Australia
- Department of Sport Science, Faculty of Education, University of Botswana, Gaborone, Botswana
| | - Gregore I Mielke
- School of Public Health, University of Queensland, Brisbane, Australia
| | - Stuart J H Biddle
- Centre for Health Research, University of Southern Queensland, Springfield, Queensland, Australia
- Faculty of Sport & Health Sciences, University of Jyväskylä, Jyväskylä, Finland
| | - Tracy L Kolbe-Alexander
- School of Health and Medical Sciences, Faculty of Health, Engineering and Sciences, University of Southern Queensland, Ipswich, Queensland, Australia
- Centre for Health Research, University of Southern Queensland, Springfield, Queensland, Australia
- Division of Exercise Science and Sports Medicine, Department of Human Biology, Faculty of Health Sciences, University of Cape Town, Cape Town, South Africa
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Timm I, Giurgiu M, Ebner-Priemer U, Reichert M. The Within-Subject Association of Physical Behavior and Affective Well-Being in Everyday Life: A Systematic Literature Review. Sports Med 2024; 54:1667-1705. [PMID: 38705972 PMCID: PMC11239742 DOI: 10.1007/s40279-024-02016-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/01/2024] [Indexed: 05/07/2024]
Abstract
BACKGROUND The interplay of physical activity (PA) with affective well-being (AWB) is highly critical to both health behaviors and health outcomes. Current prominent theories presume AWB to be crucial for PA maintenance, and PA is evidenced to foster mental health. However, thus far, PA-AWB associations have mainly been researched in laboratory settings and with interventional designs, but the everyday life perspective had not been focused on, mostly due to technological limitations. In the course of digitization, the number of studies using device-based methods to research the within-subject association of physical activity and affective well-being (PA-AWB) under ecological valid conditions increased rapidly, but a recent comprehensive systematic review of evidence across populations, age groups, and distinct AWB components remained inconclusive. OBJECTIVES Therefore, we aimed to firstly review daily-life studies that assessed intensive longitudinal device-based (e.g., electronic smartphone diaries and accelerometry) and real-time PA-AWB data, secondly to develop and apply a quality assessment tool applicable to those studies, and thirdly to discuss findings and draw implications for research and practice. METHODS To this end, the literature was searched in three databases (Web of Science, PubMed, Scopus) up to November 2022. The systematic review followed the PRISMA guidelines and had been pre-registered (PROSPERO id: CRD42021277327). A modified quality assessment tool was developed to illustrate the risk of bias of included studies. RESULTS The review of findings showed that, in general, already short PA bouts in everyday life, which clearly differ from structured exercise sessions, are positively associated with AWB. In particular, feelings of energy relate to incidental (non-exercise and unstructured) activity, and PA-AWB associations depend on population characteristics. The quality assessment revealed overall moderate study quality; however, the methods applied were largely heterogeneous between investigations. Overall, the reviewed evidence on PA-AWB associations in everyday life is ambiguous; for example, no clear patterns of directions and strengths of PA-AWB relationships depending on PA and AWB components (such as intensity, emotions, affect, mood) emerged. CONCLUSIONS The reviewed evidence can fuel discussions on whether the World Health Organization's notion "every move counts" may be extended to everyday life AWB. Concurrently, the PA-AWB relationship findings endorse prominent theories highlighting the critical role of AWB in everyday PA engagement and maintenance. However, the review also clearly highlights the need to advance and harmonize methodological approaches for more fine-grained investigations on which specific PA/AWB characteristics, contextual factors, and biological determinants underly PA-AWB associations in everyday life. This will enable the field to tackle pressing challenges such as the issue of causality of PA-AWB associations, which will help to shape and refine existing theories to ultimately predict and improve health behavior, thereby feeding into precision medicine approaches.
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Affiliation(s)
- Irina Timm
- Mental mHealth Lab, Institute of Sports and Sports Science, Karlsruhe Institute of Technology, Hertzstr. 16, 76187, Karlsruhe, Germany.
| | - Marco Giurgiu
- Mental mHealth Lab, Institute of Sports and Sports Science, Karlsruhe Institute of Technology, Hertzstr. 16, 76187, Karlsruhe, Germany
- Department of Psychiatry and Psychotherapy, Central Institute of Mental Health, Medical Faculty Mannheim/Heidelberg University, Mannheim, Germany
| | - Ulrich Ebner-Priemer
- Mental mHealth Lab, Institute of Sports and Sports Science, Karlsruhe Institute of Technology, Hertzstr. 16, 76187, Karlsruhe, Germany
- Department of Psychiatry and Psychotherapy, Central Institute of Mental Health, Medical Faculty Mannheim/Heidelberg University, Mannheim, Germany
- German Center for Mental Health (DZPG), partner site Mannheim, Mannheim, Germany
| | - Markus Reichert
- Mental mHealth Lab, Institute of Sports and Sports Science, Karlsruhe Institute of Technology, Hertzstr. 16, 76187, Karlsruhe, Germany.
- Department of Psychiatry and Psychotherapy, Central Institute of Mental Health, Medical Faculty Mannheim/Heidelberg University, Mannheim, Germany.
- Department of eHealth and Sports Analytics, Faculty of Sport Science, Ruhr University Bochum, Gesundheitscampus-Nord 10, 44801, Bochum, Germany.
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Edwards K, Croker H, Farrow C, Haycraft E, Herle M, Llewellyn C, Pickard A, Blissett J. 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. JMIR Res Protoc 2024; 13:e55193. [PMID: 38502178 PMCID: PMC10988368 DOI: 10.2196/55193] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/05/2023] [Revised: 02/12/2024] [Accepted: 02/13/2024] [Indexed: 03/20/2024] Open
Abstract
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.
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Affiliation(s)
- Katie Edwards
- School of Psychology and Institute of Health and Neurodevelopment, Aston University, Birmingham, United Kingdom
| | - Helen Croker
- World Cancer Research Fund International, London, United Kingdom
| | - Claire Farrow
- School of Psychology and Institute of Health and Neurodevelopment, Aston University, Birmingham, United Kingdom
| | - Emma Haycraft
- School of Sport, Exercise and Health Sciences, Loughborough University, Loughborough, United Kingdom
| | - Moritz Herle
- Social, Genetic & Developmental Psychiatry Centre, Institute of Psychiatry, Psychology & Neuroscience, King's College London, London, United Kingdom
| | - Clare Llewellyn
- Research Department of Behavioural Science and Health, Institute of Epidemiology and Health Care, University College London, London, United Kingdom
| | - Abigail Pickard
- School of Psychology and Institute of Health and Neurodevelopment, Aston University, Birmingham, United Kingdom
| | - Jacqueline Blissett
- School of Psychology and Institute of Health and Neurodevelopment, Aston University, Birmingham, United Kingdom
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De la Barrera U, Arrigoni F, Monserrat C, Montoya-Castilla I, Gil-Gómez JA. Using ecological momentary assessment and machine learning techniques to predict depressive symptoms in emerging adults. Psychiatry Res 2024; 332:115710. [PMID: 38194800 DOI: 10.1016/j.psychres.2023.115710] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/04/2023] [Revised: 12/28/2023] [Accepted: 12/30/2023] [Indexed: 01/11/2024]
Abstract
The objective of this study was to predict the level of depressive symptoms in emerging adults by analyzing sociodemographic variables, affect, and emotion regulation strategies. Participants were 33 emerging adults (M = 24.43; SD = 2.80; 56.3 % women). They were asked to assess their current emotional state (positive or negative affect), recent events that may relate to that state, and emotion regulation strategies through ecological momentary assessment. Participants were prompted randomly by an app 6 times per day between 10 am and 10 pm for a seven-day period. They answered 1233 of the 2058 surveys (beeps), collectively. The analysis of observations, using Machine Learning (ML) techniques, showed that the Random Forest algorithm yields significantly better predictions than other models. The algorithm used 13 out of the 36 variables adopted in the study. Furthermore, the study revealed that age, emotion of worried and a specific emotion regulation strategy related to social exchange were the most accurate predictors of severe depressive symptoms. By carefully selecting predictors and utilizing appropriate sorting techniques, these findings may provide valuable supplementary information to traditional diagnostic methods and psychological assessments.
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Affiliation(s)
- Usue De la Barrera
- Departamento de Psicología Evolutiva y de la Educación, Facultad de Psicología y Logopedia, Universitat de València, Spain
| | - Flavia Arrigoni
- Departamento de Psicología, Facultad de Ciencias de la Educación, Universidad de Cádiz, Spain
| | - Carlos Monserrat
- Valencian Research Institute for Artificial Intelligence, Universitat Politècnica de València, Spain
| | - Inmaculada Montoya-Castilla
- Departamento de Personalidad, Evaluación y Tratamientos Psicológicos, Facultad de Psicología y Logopedia, Universitat de València, Spain
| | - José-Antonio Gil-Gómez
- Instituto Universitario de Automática e Informática Industrial, Universitat Politècnica de València, Camino de Vera s/n, 46022, Valencia, Spain.
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Chen ST, Yang CH, Hyun J, Ku PW. The association between morning pleasant anticipation and daily positive incidental affect on adults' daily steps: An ecological momentary assessment study. PSYCHOLOGY OF SPORT AND EXERCISE 2024; 70:102561. [PMID: 37951452 DOI: 10.1016/j.psychsport.2023.102561] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/26/2023] [Revised: 11/05/2023] [Accepted: 11/06/2023] [Indexed: 11/14/2023]
Abstract
OBJECTIVE This study investigated the association between morning pleasant anticipation (i.e., how pleasant will the day be?) and daily positive incidental affect (PIA, e.g., feeling enjoyable, energetic) on daily steps as measured by ecological momentary assessment (EMA) and accelerometry. METHODS A total of 152 adults in Taiwan (female = 67.1 %, age range = 18-59, M = 24.97) completed smartphone-based surveys upon waking and at three quasi-random times during the day for seven days during the COVID-19 outbreak (February-July 2022). They also wore accelerometers for the same seven days to measure physical activity (daily steps). The morning survey asked participants to self-report pleasant anticipation throughout the day, and the three quasi-random time surveys assessed current PIA. Multilevel modeling was used to examine day-level associations between morning pleasant anticipation, PIA, and daily steps. A list of key covariates (i.e., age, sex, educational attainment, marital status, living arrangement, chronic disease, body mass index [BMI], smoking, drinking, wellbeing, daily sleep quality, daily sleep hours, and accelerometer wear time) were included in the models to adjust for the covariates' potential effects on the study outcomes. RESULTS The study sample consisted of 989 morning observations and 2714 quasi-random time observations (EMA response rate = 87.01 %). Findings suggest that higher-than-usual levels of pleasant anticipation in the morning were significantly associated with more same-day daily steps (b = 0.03, SD = 0.01, p = .03) after adjusting for covariates. In addition, daily PIA was a significant moderator between morning pleasant anticipation and daily steps (b = 0.02, SD = 0.01, p < .01), such that higher levels of daily PIA were associated with greater increases in daily steps in response to higher levels of morning pleasant anticipation. CONCLUSION On days when participants had higher levels of pleasant anticipation in the morning, they took more steps per day. In addition, the association between morning pleasant anticipation and steps per day was stronger on days when participants had higher levels of PIA. These findings have practical implications for future EMA studies investigating the "anticipatory" affective processes on movement behaviors with the goal of promoting physical activity in daily life.
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Affiliation(s)
- Shang-Ti Chen
- Department of Tourism, Recreation, and Leisure Studies, National Dong Hwa University, Taiwan.
| | - Chih-Hsiang Yang
- Department of Exercise Science and TecHealth Center, Arnold School of Public Health, University of South Carolina, USA
| | - Jinshil Hyun
- The Saul R. Korey Department of Neurology, Albert Einstein College of Medicine, USA
| | - Po-Wen Ku
- Graduate Institute of Sports and Health Management, National Chung Hsing University, Taiwan; Department of Kinesiology, National Tsing Hua University, Taiwan
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Delobelle J, Lebuf E, Dyck DV, Compernolle S, Janek M, Backere FD, Vetrovsky T. Fitbit's accuracy to measure short bouts of stepping and sedentary behaviour: validation, sensitivity and specificity study. Digit Health 2024; 10:20552076241262710. [PMID: 38894943 PMCID: PMC11185038 DOI: 10.1177/20552076241262710] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/05/2024] [Accepted: 06/01/2024] [Indexed: 06/21/2024] Open
Abstract
Objective This study aims to assess the suitability of Fitbit devices for real-time physical activity (PA) and sedentary behaviour (SB) monitoring in the context of just-in-time adaptive interventions (JITAIs) and event-based ecological momentary assessment (EMA) studies. Methods Thirty-seven adults (18-65 years) and 32 older adults (65+) from Belgium and the Czech Republic wore four devices simultaneously for 3 days: two Fitbit models on the wrist, an ActiGraph GT3X+ at the hip and an ActivPAL at the thigh. Accuracy measures included mean (absolute) error and mean (absolute) percentage error. Concurrent validity was assessed using Lin's concordance correlation coefficient and Bland-Altman analyses. Fitbit's sensitivity and specificity for detecting stepping events across different thresholds and durations were calculated compared to ActiGraph, while ROC curve analyses identified optimal Fitbit thresholds for detecting sedentary events according to ActivPAL. Results Fitbits demonstrated validity in measuring steps on a short time scale compared to ActiGraph. Except for stepping above 120 steps/min in older adults, both Fitbit models detected stepping bouts in adults and older adults with sensitivities and specificities exceeding 87% and 97%, respectively. Optimal cut-off values for identifying prolonged sitting bouts achieved sensitivities and specificities greater than 93% and 89%, respectively. Conclusions This study provides practical insights into using Fitbit devices in JITAIs and event-based EMA studies among adults and older adults. Fitbits' reasonable accuracy in detecting short bouts of stepping and SB makes them suitable for triggering JITAI prompts or EMA questionnaires following a PA or SB event of interest.
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Affiliation(s)
- Julie Delobelle
- Physical Activity & Health, Department of Movement and Sports Sciences, Ghent University, Ghent, Belgium
- Research Foundation Flanders (FWO), Brussels, Belgium
| | - Elien Lebuf
- Physical Activity & Health, Department of Movement and Sports Sciences, Ghent University, Ghent, Belgium
- Research Foundation Flanders (FWO), Brussels, Belgium
| | - Delfien Van Dyck
- Physical Activity & Health, Department of Movement and Sports Sciences, Ghent University, Ghent, Belgium
| | - Sofie Compernolle
- Physical Activity & Health, Department of Movement and Sports Sciences, Ghent University, Ghent, Belgium
- Research Foundation Flanders (FWO), Brussels, Belgium
| | - Michael Janek
- Faculty of Physical Education and Sport, Charles University, Prague, Czech Republic
| | - Femke De Backere
- Faculty of Engineering and Architecture, Department of Information Technology, Ghent University, Ghent, Belgium
| | - Tomas Vetrovsky
- Faculty of Physical Education and Sport, Charles University, Prague, Czech Republic
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Paterson C, Armitage L, Turner M. Current Landscape of Ecological Momentary Assessment (Real-Time Data) Methodology in Cancer Research: A Systematic Review. Semin Oncol Nurs 2023; 39:151514. [PMID: 37865555 DOI: 10.1016/j.soncn.2023.151514] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/02/2023] [Revised: 09/18/2023] [Accepted: 09/20/2023] [Indexed: 10/23/2023]
Abstract
OBJECTIVE To critically synthesize and describe the use and methods of ecological momentary assessment (EMA) in cancer research. DATA SOURCES A systematic review was conducted and has been reported according to the Preferred Reporting Items for Systematic Reviews and Meta-analysis (PRISMA) Guideline. Electronic databases (APA PsycINFO, CINAHL, Cochrane Central Register of Controlled Trials, MEDLINE, Scopus, and Web of Science Core Collection) were searched using a variety of keywords and subject headings by an expert systematic review librarian. All publications were double screened by two reviewers using predetermined exclusion and inclusion criteria throughout the full review process. The review used Covidence Systematic Review Software. Methodological quality assessment and data extraction were performed. A narrative synthesis was conducted to examine the aim for EMA, the characteristics of the study samples, the EMA sampling procedures, EMA completion rates, outcome measures, and any implications of findings for survivorship care. CONCLUSION A total of 42 EMA studies in cancer were included. Most studies used an electronic mobile device to capture EMA data apart from several that used paper diaries. Existing studies were found to have significant heterogeneity in methods and widely varying approaches to design and self-report measurements. While EMA in cancer research holds significant promise to advance cancer care research into the future by increasing ecological validity and reducing retrospective bias and can capture the unique idiographic within-person change over time, in real-time, further research is needed to develop standardized EMA self-report questionnaires. IMPLICATIONS FOR NURSING PRACTICE This is the first comprehensive systematic review to describe the use and methods of EMA in cancer research. There is significant heterogeneity in methods and widely varying approaches to design and self-report measurements in EMA cancer research. People affected by cancer found taking part in EMA studies reported benefit from the experience. However, researchers must engage with cancer survivors in the development and co-design of future EMA questionnaires to ensure relevant and acceptability of EMA data collection protocols.
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Affiliation(s)
- C Paterson
- Caring Futures Institute, Flinders University, Australia; Central Adelaide Local Health Network, Adelaide; Robert Gordon University, Aberdeen, Scotland, UK; Faculty of Health, University of Canberra, Bruce, ACT, Australia.
| | - L Armitage
- Faculty of Health, University of Canberra, Bruce, ACT, Australia
| | - M Turner
- Faculty of Health, University of Canberra, Bruce, ACT, Australia
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Sequeira M, Pereira C, Alvarez MJ. Predicting Physical Activity in Survivors of Breast Cancer: the Health Action Process Approach at the Intrapersonal Level. Int J Behav Med 2023; 30:777-789. [PMID: 36352277 DOI: 10.1007/s12529-022-10140-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/25/2022] [Indexed: 11/11/2022]
Abstract
BACKGROUND Benefits have been established for regular physical activity (PA) and exercise after breast cancer, but a decline of PA has also been a reported result of breast cancer diagnosis and treatments. The Health Action Process Approach (HAPA) model has been shown to predict various health behaviors, but few studies have tested it at the intrapersonal level. The aim of the present study was to test whether the HAPA constructs that are well confirmed at the interpersonal level also hold at the intrapersonal level in a group of women survivors of breast cancer. METHOD PA behaviors (N = 338) by nine survivors of breast cancer were observed for 6 weeks, and the associations between the HAPA constructs and PA over time were examined. Participants completed a questionnaire with the HAPA constructs related to PA behavior (direct step count and self-reported). RESULTS A multilevel model of behavior prediction found that optimistic beliefs about ability to initiate and maintain PA (self-efficacy) were positively related to intentions to be active, and these intentions predicted plans to be active. PA was directly and positively predicted by planning and by confidence in the ability to resume PA after a break. CONCLUSION Self-efficacy and planning are associated with PA behavior within women survivors of breast cancer over time, which was not the case for the outcome expectancies, social support, and action control at this intrapersonal level. A multilevel approach for psychological predictors of PA can be useful in grounding interventions for survivors of breast cancer.
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Affiliation(s)
- Margarida Sequeira
- CICPSI, Faculdade de Psicologia, Universidade de Lisboa, Lisbon, Portugal.
- CIIAS, Escola Superior de Saúde, Instituto Politécnico de Setúbal, Setubal, Portugal.
| | - Cícero Pereira
- ICS, Instituto de Ciências Sociais da Universidade de Lisboa, Lisbon, Portugal
| | - Maria-João Alvarez
- CICPSI, Faculdade de Psicologia, Universidade de Lisboa, Lisbon, Portugal
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Jia SS, Allman-Farinelli M, Roy R, Phongsavan P, Hyun K, Gibson AA, Partridge SR. Using Mobile Ecological Momentary Assessment to Understand Consumption and Context Around Online Food Delivery Use: Pilot Feasibility and Acceptability Study. JMIR Mhealth Uhealth 2023; 11:e49135. [PMID: 38019563 PMCID: PMC10719819 DOI: 10.2196/49135] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/22/2023] [Revised: 10/18/2023] [Accepted: 11/05/2023] [Indexed: 11/30/2023] Open
Abstract
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.
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Affiliation(s)
- Si Si Jia
- School of Health Sciences, Faculty of Medicine and Health, The University of Sydney, Sydney, Australia
| | - Margaret Allman-Farinelli
- Nutrition and Dietetics, Sydney School of Nursing, The University of Sydney, Sydney, Australia
- Charles Perkins Centre, The University of Sydney, Sydney, Australia
| | - Rajshri Roy
- Discipline of Nutrition and Dietetics, Faculty of Medical and Health Sciences, The University of Auckland, Auckland, New Zealand
| | - Philayrath Phongsavan
- Charles Perkins Centre, The University of Sydney, Sydney, Australia
- Prevention Research Collaboration, Sydney School of Public Health, The University of Sydney, Sydney, Australia
| | - Karice Hyun
- School of Health Sciences, Faculty of Medicine and Health, The University of Sydney, Sydney, Australia
- Concord Hospital, ANZAC Research Institute, The University of Sydney, Sydney, Australia
| | - Alice Anne Gibson
- Charles Perkins Centre, The University of Sydney, Sydney, Australia
- Menzies Centre for Health Policy and Economics, The University of Sydney, Sydney, Australia
| | - Stephanie Ruth Partridge
- School of Health Sciences, Faculty of Medicine and Health, The University of Sydney, Sydney, Australia
- Charles Perkins Centre, The University of Sydney, Sydney, Australia
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Sick K, Gilchrist J, Bourke M, Pila E. Body-related emotions and subsequent physical activity behaviour: An ecological momentary assessment. PSYCHOLOGY OF SPORT AND EXERCISE 2023; 69:102496. [PMID: 37665931 DOI: 10.1016/j.psychsport.2023.102496] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/11/2023] [Revised: 07/17/2023] [Accepted: 07/18/2023] [Indexed: 09/06/2023]
Abstract
Body-related shame and guilt are theorized to be time-varying affective determinants of physical activity, yet research has predominantly relied on self-report measures of physical activity and between-person associations. To address these limitations, the present study used ecological momentary assessment to examine within- and between-person associations between body-related shame and guilt, and subsequent time spent in moderate-to-vigorous physical activity (MVPA) measured by continuously worn accelerometers. University students (n = 98; 79.6% female; mage = 19.45) were prompted 49 times over seven days to report body-related shame and guilt, and wore activPAL accelerometers to monitor movement behaviours. Higher levels of within-person body-related guilt, but not shame, were associated with increased subsequent time spent in MVPA. Contrary to existing literature, neither body-related shame nor guilt demonstrated a significant association with average levels of MVPA between individuals. These findings support theoretical propositions that body-related guilt may impact engagement in physical activity in daily life.
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Affiliation(s)
- Kelsey Sick
- School of Kinesiology, Faculty of Health Sciences, Western University, Canada
| | | | - Matthew Bourke
- School of Occupational Therapy, Faculty of Health Sciences, Western University, Canada
| | - Eva Pila
- School of Kinesiology, Faculty of Health Sciences, Western University, Canada.
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Edney S, Goh CM, Chua XH, Low A, Chia J, S Koek D, Cheong K, van Dam R, Tan CS, Müller-Riemenschneider F. Evaluating the Effects of Rewards and Schedule Length on Response Rates to Ecological Momentary Assessment Surveys: Randomized Controlled Trials. J Med Internet Res 2023; 25:e45764. [PMID: 37856188 PMCID: PMC10623229 DOI: 10.2196/45764] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/16/2023] [Revised: 05/31/2023] [Accepted: 07/28/2023] [Indexed: 10/20/2023] Open
Abstract
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.
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Affiliation(s)
- Sarah Edney
- Physical Activity and Nutrition Determinants in Asia Programme, Saw Swee Hock School of Public Health, National University of Singapore and National University Health System, Singapore, Singapore
| | - Claire Marie Goh
- Physical Activity and Nutrition Determinants in Asia Programme, Saw Swee Hock School of Public Health, National University of Singapore and National University Health System, Singapore, Singapore
| | - Xin Hui Chua
- Physical Activity and Nutrition Determinants in Asia Programme, Saw Swee Hock School of Public Health, National University of Singapore and National University Health System, Singapore, Singapore
| | - Alicia Low
- Singapore Health Promotion Board, Singapore Government, Singapore, Singapore
| | - Janelle Chia
- Singapore Health Promotion Board, Singapore Government, Singapore, Singapore
| | - Daphne S Koek
- Singapore Health Promotion Board, Singapore Government, Singapore, Singapore
| | - Karen Cheong
- Singapore Health Promotion Board, Singapore Government, Singapore, Singapore
| | - Rob van Dam
- Physical Activity and Nutrition Determinants in Asia Programme, Saw Swee Hock School of Public Health, National University of Singapore and National University Health System, Singapore, Singapore
- Department of Exercise and Nutrition Sciences and Epidemiology, Milken Institute of Public Health, The George Washington University, Washington DC, VA, United States
| | - Chuen Seng Tan
- Saw Swee Hock School of Public Health, National University of Singapore and National University Health System, Singapore, Singapore
| | - Falk Müller-Riemenschneider
- Physical Activity and Nutrition Determinants in Asia Programme, Saw Swee Hock School of Public Health, National University of Singapore and National University Health System, Singapore, Singapore
- Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore
- Digital Health Center, Berlin Institute of Health, Charité-Universitätsmedizin Berlin, Berlin, Germany
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Heron KE, Dawson CA, Sandoval CM, Butler LV, Braitman AL, Cerezo A, Lewis RJ. Refining an ecological momentary assessment study of binge eating among sexual minority and heterosexual young women: a mixed methods pilot study. Mhealth 2023; 9:33. [PMID: 38023776 PMCID: PMC10643268 DOI: 10.21037/mhealth-23-16] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/01/2023] [Accepted: 08/18/2023] [Indexed: 12/01/2023] Open
Abstract
Background Ecological momentary assessment (EMA) is used to capture daily lived experiences, states, and environments. Although EMA is commonly used in behavioral health research, there remains a dearth of literature on how researchers account for design considerations of EMA techniques when designing studies. The goal of this formative mixed methods study was to elicit feedback on EMA study procedures and materials from the target populations for a larger study about binge eating among sexual minority and heterosexual young women, in which data are collected entirely remotely. Methods Sexual minority (n=12) and heterosexual (n=9) women ages 18-30 who binge ate took part in a pilot EMA study and exit interview and survey. As part of the consent and orientation process, participants reviewed video and written materials describing the study purpose and procedures. Using a smartphone app, for seven consecutive days they completed a survey each morning, 5 random surveys per day, and self-initiated a survey each time they binge ate. Participants then provided feedback on the study via a 1-hour virtual interview and online survey. Interviews were transcribed and reviewed by two coders to identify themes on the acceptability and feasibility of the EMA procedures with a focus on: (I) the training and study description materials; (II) general smartphone app and survey preferences; and (III) specific EMA survey question content and wording. Results The qualitative and quantitative data converged to suggest participants were able to easily download and use the app to complete surveys and report on binge eating events. Participants provided feedback that was incorporated into revisions on general study procedures, the training video content, and EMA question content for binge eating, identity-related stressors, and appearance-related pressures. No systematic themes in the quantitative or qualitative data emerged to suggest questions were perceived differently by sexual minority and heterosexual young women. Conclusions These findings provide evidence for the feasibility of conducting a remote EMA study to assess young women's experiences around binge eating. This formative study provides an example of how a mixed methods approach can be used to refine EMA study methods and questions to improve study design.
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Affiliation(s)
- Kristin E. Heron
- Department of Psychology, Old Dominion University, Norfolk, VA, USA
- Virginia Consortium Program in Clinical Psychology, Norfolk, VA, USA
| | | | | | - Lauren V. Butler
- Department of Psychology, Old Dominion University, Norfolk, VA, USA
- Department of Psychology, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | - Abby L. Braitman
- Department of Psychology, Old Dominion University, Norfolk, VA, USA
- Virginia Consortium Program in Clinical Psychology, Norfolk, VA, USA
| | - Alison Cerezo
- Department of Counseling, University of California Santa Barbara, Clinical, & School Psychology, Santa Barbara, CA, USA
| | - Robin J. Lewis
- Department of Psychology, Old Dominion University, Norfolk, VA, USA
- Virginia Consortium Program in Clinical Psychology, Norfolk, VA, USA
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15
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El-Toukhy S, Pike JR, Zuckerman G, Hegeman P. Decision Trade-Offs in Ecological Momentary Assessments and Digital Wearables Uptake: Protocol for a Discrete Choice Experiment. JMIR Res Protoc 2023; 12:e47567. [PMID: 37747771 PMCID: PMC10562974 DOI: 10.2196/47567] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/24/2023] [Revised: 08/05/2023] [Accepted: 08/07/2023] [Indexed: 09/26/2023] Open
Abstract
BACKGROUND Ecological momentary assessments (EMAs) and digital wearables (DW) are commonly used remote monitoring technologies that capture real-time data in people's natural environments. Real-time data are core to personalized medical care and intensively adaptive health interventions. The utility of such personalized care is contingent on user uptake and continued use of EMA and DW. Consequently, it is critical to understand user preferences that may increase the uptake of EMA and DW. OBJECTIVE The study aims to quantify users' preferences of EMA and DW, examine variations in users' preferences across demographic and behavioral subgroups, and assess the association between users' preferences and intentions to use EMA and DW. METHODS We will administer 2 discrete choice experiments (DCEs) paired with self-report surveys on the internet to a total of 3260 US adults through Qualtrics. The first DCE will assess participants' EMA preferences using a choice-based conjoint design that will ask participants to compare the relative importance of prompt frequency, number of questions per prompt, prompt type, health topic, and assessment duration. The second DCE will measure participants' DW preferences using a maximum difference scaling design that will quantify the relative importance of device characteristics, effort expectancy, social influence, and facilitating technical, health care, and market factors. Hierarchical Bayesian multinomial logistic regression models will be used to generate subject-specific preference utilities. Preference utilities will be compared across demographic (ie, sex, age, race, and ethnicity) and behavioral (ie, substance use, physical activity, dietary behavior, and sleep duration) subgroups. Regression models will determine whether specific utilities are associated with attitudes toward or intentions to use EMA and DW. Mixture models will determine the associations of attitudes toward and intentions to use EMA and DW with latent profiles of user preferences. RESULTS The institutional review board approved the study on December 19, 2022. Data collection started on January 20, 2023, and concluded on May 4, 2023. Data analysis is currently underway. CONCLUSIONS The study will provide evidence on users' preferences of EMA and DW features that can improve initial uptake and potentially continued use of these remote monitoring tools. The sample size and composition allow for subgroup analysis by demographics and health behaviors and will provide evidence on associations between users' preferences and intentions to uptake EMA and DW. Limitations include the cross-sectional nature of the study, which limits our ability to measure direct behavior. Rather, we capture behavioral intentions for EMA and DW uptake. The nonprobability sample limits the generalizability of the results and introduces self-selection bias related to the demographic and behavioral characteristics of participants who belong to web-based survey panels. INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID) DERR1-10.2196/47567.
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Affiliation(s)
- Sherine El-Toukhy
- Division of Intramural Research, National Institute on Minority Health and Health Disparities, National Institutes of Health, Rockville, MD, United States
| | - James Russell Pike
- Department of Epidemiology, Bloomberg School of Public Health, Johns Hopkins University, Baltimore, MD, United States
| | - Gabrielle Zuckerman
- Division of Intramural Research, National Institute on Minority Health and Health Disparities, National Institutes of Health, Rockville, MD, United States
| | - Phillip Hegeman
- Division of Intramural Research, National Institute on Minority Health and Health Disparities, National Institutes of Health, Rockville, MD, United States
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16
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Nechita DM, David D. Shame facets as predictors of problematic eating behaviors: An ecological momentary assessment study. Behav Res Ther 2023; 168:104381. [PMID: 37542804 DOI: 10.1016/j.brat.2023.104381] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/15/2022] [Revised: 07/09/2023] [Accepted: 07/28/2023] [Indexed: 08/07/2023]
Abstract
It is well-established that negative affect acts as predictor and maintenance factor of problematic eating behaviors. However, the relevance of different facets of negative affect is unclear. While guilt was consistently shown as having a relevant contribution in relation with problematic eating patterns, shame might play a similar role. The current study used an ecological momentary assessment design to assess associations between facets of shame and subsequent disturbed eating behaviors. The study included 57 females with high levels of eating disorders (ED) symptomatology who completed five surveys per day for 14 consecutive days. Participants completed measures of facets of shame (i.e., general shame, body shame, shame around eating), negative affect and problematic eating behaviors (i.e., binge eating, restriction, weighting, body checking, purging, taking laxative/diuretics and excessive exercise). Data were analyzed using multilevel models. In general, between-subjects facets of shame were associated with more disturbed eating behaviors, with shame explaining a significantly and clinically relevant percent of the variance of these problematic eating behaviors. At the within-subject level, facets of shame predicted subsequent binge eating, body checking and excessive exercise. These findings support the role of shame in ED symptomatology and the relevance of directly tackling shame in psychological treatments.
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Affiliation(s)
- Diana-Mirela Nechita
- Department of Clinical Psychology and Psychotherapy, Babeş-Bolyai University, 37 Republicii Street, 400015, Cluj-Napoca, Romania; International Institute for the Advanced Studies of Psychotherapy and Applied Mental Health, Babeş-Bolyai University, 37 Republicii Street, 400015, Cluj-Napoca, Romania
| | - Daniel David
- International Institute for the Advanced Studies of Psychotherapy and Applied Mental Health, Babeş-Bolyai University, 37 Republicii Street, 400015, Cluj-Napoca, Romania.
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Phillips SM, Summerbell C, Hesketh KR, Saxena S, Hillier-Brown FC. Co-design and content validity of the movement measurement in the early years (MoveMEY) tool for assessing movement behaviour of pre-school aged children. Int J Behav Nutr Phys Act 2023; 20:95. [PMID: 37542295 PMCID: PMC10401865 DOI: 10.1186/s12966-023-01486-2] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/27/2022] [Accepted: 06/27/2023] [Indexed: 08/06/2023] Open
Abstract
BACKGROUND Movement behaviours (physical activity, sedentary behaviour, and sleep) are important for pre-school children's health and development. Currently, no tools with appropriate content validity exist that concurrently capture these movement behaviours in young children. The aim of this study was to co-design and assess the content validity of a novel tool to concurrently measure movement behaviours in pre-school aged children (aged 3-4 years). METHODS We followed four distinct steps to develop and assess the content validity of Movement Measurement in the Early Years (MoveMEY): (1) We conducted an extensive literature search, to identify pre-existing proxy measurement tools (questionnaires and diaries) to inform the design of a novel tool, which aimed to effectively capture movement behaviour guidelines of pre-school aged children. (2) We facilitated focus group discussions with parents and carers of pre-school aged children (n = 11) and (3) a qualitative survey with free text responses was completed by topic relevant researchers (n = 6), to co-design the measurement tool. (4) We assessed the content validity of the developed tool, MoveMEY, through interviews with parents of pre-school aged children (n = 12) following piloting of the tool. RESULTS We developed an initial version of MoveMEY based on the format of an existing questionnaire and by mapping the content of questions to the guidelines. Co-design of MoveMEY resulted in changes to the format (e.g. short questionnaire to a seven-day diary) and content (e.g. inclusion of 'general information' questions on illness, disabilities and sleep disturbances; question on screen time before bed). Content validity assessment demonstrated that the items of MoveMEY were relevant and comprehensive for the assessment of children's movement behaviours. MoveMEY was felt to be comprehensible, however, parental suggestions were implemented to finalise and improve MoveMEY (e.g. adding examples to questions aiming to detect moderate to vigorous physical activity). CONCLUSION MoveMEY is the first co-designed measurement tool that has relevance for assessing the movement behaviour guidelines of pre-school aged children. Parent/carer and topic relevant researcher involvement throughout the development process resulted in a seven-day daily reported activity diary that is comprehensive of children's movement behaviours and comprehensible to parents and carers.
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Affiliation(s)
- Sophie M Phillips
- Department of Sport and Exercise Sciences, Durham University, Durham City, UK.
- The Centre for Translational Research in Public Health (Fuse), Newcastle Upon Tyne, UK.
| | - Carolyn Summerbell
- Department of Sport and Exercise Sciences, Durham University, Durham City, UK
- The Centre for Translational Research in Public Health (Fuse), Newcastle Upon Tyne, UK
| | - Kathryn R Hesketh
- MRC Epidemiology Unit, University of Cambridge, Cambridge, UK
- Population Policy & Practice Research and Teaching Department, UCL Great Ormond Street Institute of Child Health, London, UK
| | - Sonia Saxena
- School of Public Health, Imperial College London, London, UK
| | - Frances C Hillier-Brown
- The Centre for Translational Research in Public Health (Fuse), Newcastle Upon Tyne, UK
- Population Health Sciences Institute, Newcastle University, Newcastle upon Tyne, UK
- Human Nutrition Research Centre, Newcastle University, Newcastle upon Tyne, UK
- Newcastle University Centre of Research Excellence in Healthier Lives, Newcastle University, Newcastle upon Tyne, UK
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18
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Gérain P, Wawrziczny E, Antoine P. A scoping review of intensive longitudinal methods in informal caregivers of people with dementia. BMC Geriatr 2023; 23:456. [PMID: 37488491 PMCID: PMC10367249 DOI: 10.1186/s12877-023-04123-6] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/02/2023] [Accepted: 06/21/2023] [Indexed: 07/26/2023] Open
Abstract
BACKGROUND The daily life of informal caregivers assisting individuals with dementia widely varies throughout the day and week. As an answer, an increasing number of researchers have used intensive longitudinal methods (ILMs) such as diary studies, experience sampling methods, or ecological momentary assessment. OBJECTIVES AND METHODS The present scoping review aims at synthesizing the use of ILMs in informal dementia caregivers to clarify what is currently done and how, as well as what remains unaddressed. RESULTS The screening process identified 48 studies from 22 different datasets. Synthesis of these studies showed the diversity of devices and uses of ILMs in informal care, including the exploration of associations between variables or accompanying an intervention. ILMs showed the important variability of caregiving phenomena, as well as the important association of momentary stress and well-being. Gaps were nevertheless identified, such as transparency in the construction of the tool or the absence of focus on emotions and dyads. CONCLUSIONS For now, this field of research remains in its infancy and does not seem to have reached its full potential as it has in other fields. Nevertheless, it appears that ILMs are promising tools for informal dementia caregivers as they contribute to understanding the complexity of their daily life, with changing resources and challenges. Future directions include focusing more on (emotion) regulation, temporal lags, and the use of ILMs in interventional designs. TRIAL REGISTRATION The present review was registered on OSF (osf.io/b2qr4).
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Affiliation(s)
- P Gérain
- Department of Psychology, Faculty of Educational and Psychological Sciences, Vrije Universiteit Brussel, Pleinlaan 2, 1050, Brussels, Belgium.
- SCALAB - UMR 9193, University of Lille, Lille, France.
| | - E Wawrziczny
- SCALAB - UMR 9193, University of Lille, Lille, France
| | - P Antoine
- SCALAB - UMR 9193, University of Lille, Lille, France
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Hartson KR, Huntington-Moskos L, Sears CG, Genova G, Mathis C, Ford W, Rhodes RE. Use of Electronic Ecological Momentary Assessment Methodologies in Physical Activity, Sedentary Behavior, and Sleep Research in Young Adults: Systematic Review. J Med Internet Res 2023; 25:e46783. [PMID: 37384367 PMCID: PMC10365632 DOI: 10.2196/46783] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2023] [Revised: 05/15/2023] [Accepted: 05/23/2023] [Indexed: 06/30/2023] Open
Abstract
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.
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Affiliation(s)
- Kimberly R Hartson
- School of Nursing, University of Louisville, Louisville, KY, United States
| | | | - Clara G Sears
- Christina Lee Brown Envirome Institute, University of Louisville, Louisville, KY, United States
| | - Gina Genova
- Kornhauser Health Sciences Library, University of Louisville, Louisville, KY, United States
| | - Cara Mathis
- School of Nursing, University of Louisville, Louisville, KY, United States
| | - Wessly Ford
- School of Nursing, University of Louisville, Louisville, KY, United States
| | - Ryan E Rhodes
- School of Exercise Science, Physical and Health Education, University of Victoria, Victoria, BC, Canada
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Schuler T, King C, Matsveru T, Back M, Clark K, Chin D, Lilian R, Gallego B, Coiera E, Currow DC. Wearable-Triggered Ecological Momentary Assessments Are Feasible in People With Advanced Cancer and Their Family Caregivers: Feasibility Study from an Outpatient Palliative Care Clinic at a Cancer Center. J Palliat Med 2023. [PMID: 37134212 DOI: 10.1089/jpm.2022.0535] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/05/2023] Open
Abstract
Background: Emerging digital health approaches could play a role in better personalized palliative care. Aim: We conducted a feasibility study testing wearable sensor (WS)-triggered ecological momentary assessments (EMAs) and electronic patient-reported outcomes in community palliative care with patient-caregiver dyads. Design: All wore consumer-grade WS for five weeks. Sensor-detected "stress" (heart rate variability algorithm) that passed individualized thresholds triggered a short smartphone survey. Daily sleep surveys, weekly symptom surveys (Integrated Palliative care Outcome Scale), and a poststudy experience survey were conducted. Setting/Participants: Fifteen dyads (n = 30) were recruited from an outpatient palliative care clinic for people with cancer. Results: Daytime sensor wear-time had 73% adherence. Participants perceived value in this support. Quantity and severity of "stress" events were higher in patients. Sleep disturbance was similar but for different reasons: patients (physical symptoms) and caregivers (worrying about the patient). Conclusions: EMAs are feasible and valued in community palliative care.
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Affiliation(s)
- Thilo Schuler
- Department of Radiation Oncology, Northern Sydney Cancer Centre, Royal North Shore Hospital, Sydney, New South Wales, Australia
- Centre for Health Informatics, Australian Institute of Health Innovation, Macquarie University, Sydney, New South Wales, Australia
| | - Claire King
- Department of Radiation Oncology, Northern Sydney Cancer Centre, Royal North Shore Hospital, Sydney, New South Wales, Australia
| | - Teresia Matsveru
- NSLHD Supportive and Palliative Care Network, Royal North Shore Hospital, Sydney, New South Wales, Australia
| | - Michael Back
- Department of Radiation Oncology, Northern Sydney Cancer Centre, Royal North Shore Hospital, Sydney, New South Wales, Australia
- Northern Clinical School, University of Sydney, Sydney, New South Wales, Australia
| | - Katherine Clark
- NSLHD Supportive and Palliative Care Network, Royal North Shore Hospital, Sydney, New South Wales, Australia
- Northern Clinical School, University of Sydney, Sydney, New South Wales, Australia
| | - Dylan Chin
- Department of Radiation Oncology, Northern Sydney Cancer Centre, Royal North Shore Hospital, Sydney, New South Wales, Australia
| | - Ruth Lilian
- Sydney Partnership for Health, Education, Research and Enterprise, Sydney, New South Wales, Australia
| | - Blanca Gallego
- Centre for Health Informatics, Australian Institute of Health Innovation, Macquarie University, Sydney, New South Wales, Australia
- Centre for Big Data Research in Health, University of New South Wales, Sydney, New South Wales, Australia
| | - Enrico Coiera
- Centre for Health Informatics, Australian Institute of Health Innovation, Macquarie University, Sydney, New South Wales, Australia
| | - David C Currow
- Faculty of Science, Medicine and Health, University of Wollongong, Wollongong, New South Wales, Australia
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21
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Evans ME, Herrick KA, Regan KS, Shams-White MM, Vargas AJ, Reedy J. A Decade of Dietary Assessment Methodology Research at the National Institutes of Health, 2012-2021. J Nutr 2023; 153:1627-1635. [PMID: 36921805 PMCID: PMC10196585 DOI: 10.1016/j.tjnut.2023.02.030] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/06/2023] [Revised: 02/10/2023] [Accepted: 02/23/2023] [Indexed: 03/16/2023] Open
Abstract
BACKGROUND Assessment of individual and population-level dietary intake is critical for public health surveillance, epidemiology, and dietary intervention research. In recognition of that need, the National Insitutes of Health (NIH) has a history of funding research projects designed to support the development, implementation, and refinement of tools to assess dietary intake in humans. OBJECTIVES This report provides data and information on NIH-funded dietary intake assessment methodological research over the period of 2012-2021. METHODS Data were extracted from an internal NIH data system using the Research, Condition, and Disease Categorization (RCDC) spending category for Nutrition. Data were then examined to identify research focused on dietary assessment tools or methods to capture or analyze dietary intake. RESULTS Over the decade of 2012-2021, NIH supported 46 grants and 2 large contracts specific to dietary assessment methods development. The top 6 Institutes and Offices funding dietary assessment methods research were identified. Most projects were limited to adults. Projects ranged from novel methods to capture dietary intake, and refinement of analytical methods, to biomarkers of dietary intake. One key contract supported the automated self-administered 24-h dietary assessment tool (ASA24), a widely used, free tool available to the research community for assessing dietary intake. CONCLUSIONS NIH's support for dietary assessment methods development over this 10-y period was small but grew over time with an expanding number and variety of methods, data sources, and technological advancements in the assessment of dietary intake. NIH remains committed to supporting research seeking to advance the field of dietary assessment methods research.
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Affiliation(s)
- Mary E Evans
- National Institute of Diabetes and Digestive and Kidney Diseases, National Institutes of Health, Bethesda, MD, United States.
| | - Kirsten A Herrick
- National Cancer Institute, National Institutes of Health, Bethesda, MD, United States
| | - Karen S Regan
- Office of Dietary Supplements, National Institutes of Health, Bethesda, MD, United States
| | - Marissa M Shams-White
- National Cancer Institute, National Institutes of Health, Bethesda, MD, United States
| | - Ashley J Vargas
- Eunice Kennedy Shriver National Institute of Child Health and Human Development, National Institutes of Health, Bethesda, MD, United States
| | - Jill Reedy
- National Cancer Institute, National Institutes of Health, Bethesda, MD, United States
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22
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Schroé H, Carlier S, Van Dyck D, De Backere F, Crombez G. Towards more personalized digital health interventions: a clustering method of action and coping plans to promote physical activity. BMC Public Health 2022; 22:2325. [PMID: 36510181 PMCID: PMC9746174 DOI: 10.1186/s12889-022-14455-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/15/2022] [Accepted: 10/12/2022] [Indexed: 12/14/2022] Open
Abstract
BACKGROUND Despite effectiveness of action and coping planning in digital health interventions to promote physical activity (PA), attrition rates remain high. Indeed, support to make plans is often abstract and similar for each individual. Nevertheless, people are different, and context varies. Tailored support at the content level, involving suggestions of specific plans that are personalized to the individual, may reduce attrition and improve outcomes in digital health interventions. The aim of this study was to investigate whether user information relates toward specific action and coping plans using a clustering method. In doing so, we demonstrate how knowledge can be acquired in order to develop a knowledge-base, which might provide personalized suggestions in a later phase. METHODS To establish proof-of-concept for this approach, data of 65 healthy adults, including 222 action plans and 204 coping plans, were used and were collected as part of the digital health intervention MyPlan 2.0 to promote PA. As a first step, clusters of action plans, clusters of coping plans and clusters of combinations of action plans and barriers of coping plans were identified using hierarchical clustering. As a second step, relations with user information (i.e. gender, motivational stage, ...) were examined using anova's and chi2-tests. RESULTS First, three clusters of action plans, eight clusters of coping plans and eight clusters of the combination of action and coping plans were identified. Second, relating these clusters to user information was possible for action plans: 1) Users with a higher BMI related more to outdoor leisure activities (F = 13.40, P < .001), 2) Women, users that didn't perform PA regularly yet, or users with a job related more to household activities (X2 = 16.92, P < .001; X2 = 20.34, P < .001; X2 = 10.79, P = .004; respectively), 3) Younger users related more to active transport and different sports activities (F = 14.40, P < .001). However, relating clusters to user information proved difficult for the coping plans and combination of action and coping plans. CONCLUSIONS The approach used in this study might be a feasible approach to acquire input for a knowledge-base, however more data (i.e. contextual and dynamic user information) from possible end users should be acquired in future research. This might result in a first type of context-aware personalized suggestions on the content level. TRIAL REGISTRATION The digital health intervention MyPlan 2.0 was preregistered as a clinical trial (ID:NCT03274271). Release date: 6-September-2017.
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Affiliation(s)
- Helene Schroé
- grid.5342.00000 0001 2069 7798Department of Experimental-Clinical and Health Psychology, Faculty of Psychology and Educational Sciences, Ghent University, Ghent, Belgium ,grid.5342.00000 0001 2069 7798Department of Movement and Sports Sciences, Faculty of Medicine and Health, Research Group Physical Activity and Health, Ghent University, Watersportlaan 2, 9000 Ghent, Belgium
| | - Stéphanie Carlier
- grid.5342.00000 0001 2069 7798IDLab, Department of Information Technology, Ghent University—imec, Technologiepark-Zwijnaarde 126, 9052 Ghent, Belgium
| | - Delfien Van Dyck
- grid.5342.00000 0001 2069 7798Department of Movement and Sports Sciences, Faculty of Medicine and Health, Research Group Physical Activity and Health, Ghent University, Watersportlaan 2, 9000 Ghent, Belgium
| | - Femke De Backere
- grid.5342.00000 0001 2069 7798IDLab, Department of Information Technology, Ghent University—imec, Technologiepark-Zwijnaarde 126, 9052 Ghent, Belgium
| | - Geert Crombez
- grid.5342.00000 0001 2069 7798Department of Experimental-Clinical and Health Psychology, Faculty of Psychology and Educational Sciences, Ghent University, Ghent, Belgium
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23
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Perski O, Keller J, Kale D, Asare BYA, Schneider V, Powell D, Naughton F, ten Hoor G, Verboon P, Kwasnicka D. Understanding health behaviours in context: A systematic review and meta-analysis of ecological momentary assessment studies of five key health behaviours. Health Psychol Rev 2022; 16:576-601. [PMID: 35975950 PMCID: PMC9704370 DOI: 10.1080/17437199.2022.2112258] [Citation(s) in RCA: 18] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/06/2023]
Abstract
Ecological Momentary Assessment (EMA) involves repeated, real-time sampling of health behaviours in context. We present the state-of-knowledge in EMA research focused on five key health behaviours (physical activity and sedentary behaviour, dietary behaviour, alcohol consumption, tobacco smoking, sexual health), summarising theoretical (e.g., psychological and contextual predictors) and methodological aspects (e.g., study characteristics, EMA adherence). We searched Ovid MEDLINE, Embase, PsycINFO and Web of Science until February 2021. We included studies focused on any of the aforementioned health behaviours in adult, non-clinical populations that assessed ≥1 psychological/contextual predictor and reported a predictor-behaviour association. A narrative synthesis and random-effects meta-analyses of EMA adherence were conducted. We included 633 studies. The median study duration was 14 days. The most frequently assessed predictors were 'negative feeling states' (21%) and 'motivation and goals' (16.5%). The pooled percentage of EMA adherence was high at 81.4% (95% CI = 80.0%, 82.8%, k = 348) and did not differ by target behaviour but was somewhat higher in student (vs. general population) samples, when EMAs were delivered via mobile phones/smartphones (vs. handheld devices), and when event contingent (vs. fixed) sampling was used. This review showcases how the EMA method has been applied to improve understanding and prediction of health behaviours in context.
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Affiliation(s)
- Olga Perski
- Department of Behavioural Science and Health, University College London, London, United Kingdom, Olga Perski
| | - Jan Keller
- Department of Education and Psychology, Freie Universität Berlin, Berlin, Germany
| | - Dimitra Kale
- Department of Behavioural Science and Health, University College London, London, United Kingdom
| | - Bernard Yeboah-Asiamah Asare
- Curtin School of Population Health, Curtin University, Perth, Australia,Health Psychology, Institute of Applied Health Sciences, University of Aberdeen, Aberdeen, United Kingdom
| | - Verena Schneider
- Department of Behavioural Science and Health, University College London, London, United Kingdom
| | - Daniel Powell
- Health Psychology, Institute of Applied Health Sciences, University of Aberdeen, Aberdeen, United Kingdom,Rowett Institute, University of Aberdeen, Aberdeen, United Kingdom
| | - Felix Naughton
- Behavioural and Implementation Science Research Group, School of Health Sciences, University of East Anglia, Norwich, United Kingdom
| | - Gill ten Hoor
- Department of Work and Social Psychology, Faculty of Psychology and Neurosciences, Maastricht University, Maastricht, The Netherlands
| | - Peter Verboon
- Faculty of Psychology, Open University, Heerlen, The Netherlands
| | - Dominika Kwasnicka
- Faculty of Psychology, SWPS University of Social Sciences and Humanities, Wroclaw, Poland,NHMRC CRE in Digital Technology to Transform Chronic Disease Outcomes, Melbourne School of Population and Global Health, University of Melbourne, Melbourne, Australia
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24
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König LM, Allmeta A, Christlein N, Van Emmenis M, Sutton S. A systematic review and meta-analysis of studies of reactivity to digital in-the-moment measurement of health behaviour. Health Psychol Rev 2022; 16:551-575. [PMID: 35264084 DOI: 10.1080/17437199.2022.2047096] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/05/2023]
Abstract
Self-report measures of health behaviour have several limitations including measurement reactivity, i.e., changes in people's behaviour, cognitions or emotions due to taking part in research. This systematic review investigates whether digital in-the-moment measures induce reactivity to a similar extent and why it occurs. Four databases were searched in December 2020. All observational or experimental studies investigating reactivity to digital in-the-moment measurement of a range of health behaviours were included if they were published in English in 2008 or later. Of the 11,723 records initially screened, 30 publications reporting on 31 studies were included in the qualitative synthesis/ 7 studies in the quantitative synthesis. Eighty-one percent of studies focused on reactivity to the measurement of physical activity indicators; small but meaningful pooled effects were found (Cohen's ds: 0.27-0.30). Only a small number of studies included other behaviours, yielding mixed results. Digital in-the-moment measurement of behaviour thus may be as prone to reactivity as self-reports in questionnaires. Measurement reactivity may be amplified by (1) ease of changing the behaviour (2) awareness of being measured and social desirability, and (3) resolving discrepancies between actual and desired behaviour through self-regulation.
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Affiliation(s)
- Laura M König
- Faculty of Life Sciences: Food, Nutrition and Health, University of Bayreuth, Kulmbach, Germany.,Behavioural Science Group, Primary Care Unit, Department of Public Health and Primary Care, University of Cambridge, Cambridge, UK
| | - Anila Allmeta
- Faculty of Life Sciences: Food, Nutrition and Health, University of Bayreuth, Kulmbach, Germany
| | - Nora Christlein
- Faculty of Life Sciences: Food, Nutrition and Health, University of Bayreuth, Kulmbach, Germany
| | - Miranda Van Emmenis
- Behavioural Science Group, Primary Care Unit, Department of Public Health and Primary Care, University of Cambridge, Cambridge, UK
| | - Stephen Sutton
- Behavioural Science Group, Primary Care Unit, Department of Public Health and Primary Care, University of Cambridge, Cambridge, UK
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25
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Lenferink LIM, van Eersel JHW, Franzen M. Is it acceptable and feasible to measure prolonged grief disorder symptoms in daily life using experience sampling methodology? Compr Psychiatry 2022; 119:152351. [PMID: 36341747 DOI: 10.1016/j.comppsych.2022.152351] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/25/2022] [Revised: 10/07/2022] [Accepted: 10/16/2022] [Indexed: 01/31/2023] Open
Abstract
INTRODUCTION Current grief research is dominated by cross-sectional studies assessing prolonged grief disorder (PGD) symptoms retrospectively. Examining grief in daily life, using Experience Sampling Methodology (ESM), may advance the field. Because of the lack of ESM-research on PGD, we evaluated the acceptability and feasibility of assessing PGD symptoms in daily life of bereaved people. MATERIALS AND METHODS ESM-items assessing PGD symptoms were developed using cognitive interviewing with five ESM/grief experts. Eighty bereaved adults completed these ESM-items five times a day for two weeks. Before and after this ESM-phase, interviews were administered assessing PGD retrospectively (using the Traumatic Grief Inventory-Clinical Administered). t-tests were performed comparing symptom severity of aggregated moment-to-moment recall (using ESM-items) with retrospective recall (based on interviews) of PGD symptoms. Acceptability of participating in ESM-research (assessed with the Reactions to Research Participation Questionnaire) was examined using descriptive statistics. Feasibility was evaluated by reporting compliance and retention rates. RESULTS Minor changes were made to the ESM-items based on expert interviews. Average levels of aggregated moment-to-moment recall of the symptoms "yearning" (d = -1.04), "preoccupation with the deceased" (d = -0.91), "marked sense of disbelief" (d = -0.43), and "intense loneliness" (d = -0.28) were lower compared with retrospective recalling these symptoms. On average, bereaved people were neutral about personal benefits gained through participation in this EMS-study. They indicated that participation did not raise emotional reactions. Compliance and retention rates were 60% and 65%, respectively. DISCUSSION Our findings indicate that whereas compliance and retention is challenging, using ESM to study PGD symptoms in daily life might be useful. Nevertheless, more research is needed.
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Affiliation(s)
- L I M Lenferink
- Department of Psychology, Health & Technology, Faculty of Behavioural Management and Social Sciences, University of Twente, P.O. Box 217, 7500 AE Enschede, the Netherlands; Department of Clinical Psychology, Faculty of Social and Behavioural Sciences, Utrecht University, P.O. Box 80140, 3508 TC Utrecht, the Netherlands; Department of Clinical Psychology and Experimental Psychopathology, Faculty of Behavioral and Social Sciences, University of Groningen, Grote Kruisstraat 2/1, 9712 TS Groningen, the Netherlands.
| | - J H W van Eersel
- Department of Clinical Psychology, Faculty of Social and Behavioural Sciences, Utrecht University, P.O. Box 80140, 3508 TC Utrecht, the Netherlands
| | - M Franzen
- Department of Clinical Psychology and Experimental Psychopathology, Faculty of Behavioral and Social Sciences, University of Groningen, Grote Kruisstraat 2/1, 9712 TS Groningen, the Netherlands; Department of Psychology, Education & Child Studies, Erasmus School of Social and Behavioural Sciences, Erasmus University Rotterdam, 3062 PA Rotterdam, the Netherlands
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Battaglia B, Lee L, Jia SS, Partridge SR, Allman-Farinelli M. The Use of Mobile-Based Ecological Momentary Assessment (mEMA) Methodology to Assess Dietary Intake, Food Consumption Behaviours and Context in Young People: A Systematic Review. Healthcare (Basel) 2022; 10:healthcare10071329. [PMID: 35885855 PMCID: PMC9321045 DOI: 10.3390/healthcare10071329] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/21/2022] [Revised: 07/13/2022] [Accepted: 07/13/2022] [Indexed: 11/30/2022] Open
Abstract
Mobile-based ecological momentary assessment (mEMA) offers a novel method for dietary assessment and may reduce recall bias and participant burden. This review evaluated mEMA methodology and the feasibility, acceptability and validity as a dietary assessment method in young people. Five databases were searched from January 2008 to September 2021 for studies including healthy young people aged 16–30 years and used mEMA for obtaining dietary intake data, food consumption behaviours and/or contextual factors. Data on the method used to administer mEMA, compliance with recording and validation were extracted. A total of 46 articles from 39 independent studies were included, demonstrating a wide variation in mEMA methods. Signal-contingent prompting (timed notification to record throughout the day) was used in 26 studies, 9 used event-contingent (food consumption triggered recordings), while 4 used both. Monitoring periods varied and most studies reported a compliance rate of 80% or more. Two studies found mEMA to be burdensome and six reported mEMA as easy to use. Most studies (31/39) reported using previously validated questions. mEMA appears to be a feasible and acceptable methodology to assess dietary intake and food consumption in near real time.
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Affiliation(s)
- Brigitte Battaglia
- Charles Perkins Centre, Sydney Nursing School, Faculty of Medicine and Health, The University of Sydney, Sydney, NSW 2006, Australia; (B.B.); (L.L.); (M.A.-F.)
| | - Lydia Lee
- Charles Perkins Centre, Sydney Nursing School, Faculty of Medicine and Health, The University of Sydney, Sydney, NSW 2006, Australia; (B.B.); (L.L.); (M.A.-F.)
| | - Si Si Jia
- Engagement and Co-Design Research Hub, School of Health Sciences, Faculty of Medicine and Health, The University of Sydney, Sydney, NSW 2006, Australia;
- Correspondence:
| | - Stephanie Ruth Partridge
- Engagement and Co-Design Research Hub, School of Health Sciences, Faculty of Medicine and Health, The University of Sydney, Sydney, NSW 2006, Australia;
- Prevention Research Collaboration, Sydney School of Public Health, Faculty of Medicine and Health, The University of Sydney, Sydney, NSW 2006, Australia
| | - Margaret Allman-Farinelli
- Charles Perkins Centre, Sydney Nursing School, Faculty of Medicine and Health, The University of Sydney, Sydney, NSW 2006, Australia; (B.B.); (L.L.); (M.A.-F.)
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27
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Maes I, Mertens L, Poppe L, Crombez G, Vetrovsky T, Van Dyck D. The variability of emotions, physical complaints, intention, and self-efficacy: an ecological momentary assessment study in older adults. PeerJ 2022; 10:e13234. [PMID: 35611175 PMCID: PMC9124457 DOI: 10.7717/peerj.13234] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/14/2021] [Accepted: 03/17/2022] [Indexed: 01/13/2023] Open
Abstract
Background Many theoretical frameworks have been used in order to understand health behaviors such as physical activity, sufficient sleep, healthy eating habits, etc. In most research studies, determinants within these frameworks are assessed only once and thus are considered as stable over time, which leads to rather 'static' health behavior change interventions. However, in real-life, individual-level determinants probably vary over time (within days and from day to day), but currently, not much is known about these time-dependent fluctuations in determinants. In order to personalize health behavior change interventions in a more dynamic manner, such information is urgently needed. Objective The purpose of this study was to explore the time-dependent variability of emotions, physical complaints, intention, and self-efficacy in older adults (65+) using Ecological Momentary Assessment (EMA). Methods Observational data were collected in 64 healthy older adults (56.3% men; mean age 72.1 ± 5.6 years) using EMA. Participants answered questions regarding emotions (i.e., cheerfulness, relaxation, enthusiasm, satisfaction, insecurity, anxiousness, irritation, feeling down), physical complaints (i.e., fatigue, pain, dizziness, stiffness, shortness of breath), intention, and self-efficacy six times a day for seven consecutive days using a smartphone-based questionnaire. Generalized linear mixed models were used to assess the fluctuations of individual determinants within subjects and over days. Results A low variability is present for the negative emotions (i.e., insecurity, anxiousness, irritation, feeling down) and physical complaints of dizziness and shortness of breath. The majority of the variance for relaxation, satisfaction, insecurity, anxiousness, irritation, feeling down, fatigue, dizziness, intention, and self-efficacy is explained by the within subjects and within days variance (42.9% to 65.8%). Hence, these determinants mainly differed within the same subject and within the same day. The between subjects variance explained the majority of the variance for cheerfulness, enthusiasm, pain, stiffness, and shortness of breath (50.2% to 67.3%). Hence, these determinants mainly differed between different subjects. Conclusions This study reveals that multiple individual-level determinants are time-dependent, and are better considered as 'dynamic' or unstable behavior determinants. This study provides us with important insights concerning the development of dynamic health behavior change interventions, anticipating real-time dynamics of determinants instead of considering determinants as stable within individuals.
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Affiliation(s)
- Iris Maes
- Department of Movement and Sports Sciences, Ghent University, Gent, Belgium
| | - Lieze Mertens
- Department of Movement and Sports Sciences, Ghent University, Gent, Belgium,Department of Public Health and Primary Care, Ghent University, Gent, Belgium,Fund for Scientific Research Flanders (FWO), Brussels, Belgium
| | - Louise Poppe
- Department of Public Health and Primary Care, Ghent University, Gent, Belgium,Fund for Scientific Research Flanders (FWO), Brussels, Belgium
| | - Geert Crombez
- Department of Experimental-clinical and health psychology, Ghent Univeristy, Gent, Belgium
| | - Tomas Vetrovsky
- Faculty of Physical Education and Sport, Charles University Prague, Prague, Czech Republic
| | - Delfien Van Dyck
- Department of Movement and Sports Sciences, Ghent University, Gent, Belgium
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28
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Stinson L, Liu Y, Dallery J. Ecological Momentary Assessment: A Systematic Review of Validity Research. Perspect Behav Sci 2022; 45:469-493. [PMID: 35719870 PMCID: PMC9163273 DOI: 10.1007/s40614-022-00339-w] [Citation(s) in RCA: 13] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/25/2022] [Indexed: 01/23/2023] Open
Abstract
Ecological momentary assessment (EMA) is a self-report method that involves intensive longitudinal assessment of behavior and environmental conditions during everyday activities. EMA has been used extensively in health and clinical psychology to investigate a variety of health behaviors, including substance use, eating, medication adherence, sleep, and physical activity. However, it has not been widely implemented in behavior analytic research. This is likely an example of the empirically based skepticism with which behavioral scientists view self-report measures. We reviewed studies comparing electronic, mobile EMA (mEMA) to more objective measures of health behavior to explore the validity of mEMA as a measurement tool, and to identify procedures and factors that may promote the accuracy of mEMA. We identified 32 studies that compared mEMA to more objective measures of health behavior or environmental events (e.g., biochemical measures or automated devices such as accelerometers). Results showed that the correspondence rates varied considerably across individuals, behavior, and studies (agreement rates ranged from 1.8%-100%), and no unifying variables could be identified across the studies that found high correspondence. The findings suggest that mEMA can be an accurate measurement tool, but further research should be conducted to identify procedures and variables that promote accurate responding.
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Affiliation(s)
- Lesleigh Stinson
- Department of Psychology, University of Florida, 945 Center Drive, Gainesville, FL 32601 USA
| | - Yunchao Liu
- Department of Psychology, University of Florida, 945 Center Drive, Gainesville, FL 32601 USA
| | - Jesse Dallery
- Department of Psychology, University of Florida, 945 Center Drive, Gainesville, FL 32601 USA
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Ojo SO, Bailey DP, Chater AM, Hewson DJ. Workplace Intervention for Reducing Sitting Time in Sedentary Workers: Protocol for a Pilot Study Using the Behavior Change Wheel. Front Public Health 2022; 10:832374. [PMID: 35493386 PMCID: PMC9039234 DOI: 10.3389/fpubh.2022.832374] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/09/2021] [Accepted: 02/03/2022] [Indexed: 11/13/2022] Open
Abstract
The workplace is a major contributor to excessive sitting in office workers. There are a wide array of adverse effects of high volumes of sitting time, including an increased risk of type 2 diabetes and depression. Active workstations can be used in effective interventions to decrease workplace sitting. However, there are a lack of interventions that have been developed using a systematic process that is informed by participant needs and a framework for identifying the most appropriate content for the intervention. Applying these methods could increase adherence and potential effectiveness of the intervention. Therefore, the purpose of this pilot study is to examine the feasibility, acceptability, and efficacy of a tailored workplace intervention to reduce and break up sitting in office workers that has been developed using the Behavior Change Wheel and the APEASE (Acceptability, Practicability, Effectiveness/cost-effectiveness, Affordability, Safety/side-effects, Equity) criteria. This article reports the protocol for this study that is currently ongoing. Participants will be cluster-randomized (by offices) to control and intervention groups. The evaluation of the intervention includes determining feasibility by assessing participant recruitment, retention and data completion rates. Adherence to the intervention will be assessed based on daily sitting and standing time relative to guidelines provided to participants as part of the intervention. Outcome measures also include productivity measured using Ecological Momentary Assessment, absenteeism, presenteeism, cardiometabolic risk markers, and wellbeing. The findings of this study will inform the effective design and implementation of interventions for reducing and breaking up sitting in office workers.
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Affiliation(s)
- Samson O Ojo
- Institute for Health Research, University of Bedfordshire, Luton, United Kingdom.,Quality Improvement, Northampton General Hospital NHS Trust, Northampton, United Kingdom
| | - Daniel P Bailey
- Institute for Sport and Physical Activity Research, Centre for Health, Wellbeing and Behaviour Change, University of Bedfordshire, Bedford, United Kingdom.,Division of Sport, Health and Exercise Sciences, Department of Life Sciences, Brunel University London, Uxbridge, United Kingdom.,Centre for Physical Activity in Health and Disease, Brunel University London, Uxbridge, United Kingdom
| | - Angel M Chater
- Institute for Sport and Physical Activity Research, Centre for Health, Wellbeing and Behaviour Change, University of Bedfordshire, Bedford, United Kingdom.,Centre for Behaviour Change, University College London, London, United Kingdom
| | - David J Hewson
- Institute for Health Research, University of Bedfordshire, Luton, United Kingdom
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Mölsä ME, Lax M, Korhonen J, Gumpel TP, Söderberg P. The Experience Sampling Method in Monitoring Social Interactions Among Children and Adolescents in School: A Systematic Literature Review. Front Psychol 2022; 13:844698. [PMID: 35444596 PMCID: PMC9013852 DOI: 10.3389/fpsyg.2022.844698] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/28/2021] [Accepted: 03/11/2022] [Indexed: 11/16/2022] Open
Abstract
Background The experience sampling method (ESM) is an increasingly popular data collection method to assess interpersonal dynamics in everyday life and emotions contextualized in real-world settings. As primary advantages of ESM sampling strategies include minimization of memory biases, maximization of ecological validity, and hypothesis testing at the between- and within-person levels, ESM is suggested to be appropriate for studying the daily lives of educational actors. However, ESM appears to be underutilized in education research. We, thus, aimed to systematically evaluate the methodological characteristics and quality of published ESM studies of social interactions among children and adolescents in school settings, as well as to explore how much variance in social interaction variables could be attributed to the within-person level. Method Using Academic Search Complete, APA PsycINFO, APA PsycArticles, ProQuest, Web of Science, Wiley Online Library, and SAGE Journals, and in accordance with PRISMA guidelines and pre-defined eligibility criteria, we conducted a systematic literature search of experience sampling studies up to November 2020. To assess methodological quality, we used a modified checklist for reporting of ESM studies. Results Of the originally 2 413 identified studies, a final 52 experience sampling studies were included in the present review. Findings on sample and study design characteristics generally revealed wide variability. Even if high-quality studies were associated with higher scores on the training of participants in using the ESM procedure, and use of incentives, these design strategies did not reveal a statistically significant impact on compliance. The intraclass correlation coefficient was reported in nine studies and on average 58% of the variance in social interaction variables could be attributed to within-person fluctuation between timepoints. Conclusion The current study is the first to systematically review ESM-based studies on social interactions among children and adolescents in the school context. These observations suggest that ESM is a potentially favorable technique for extracting complex social phenomena in real-world settings. We hope that this review will contribute to improving the quality assessment of ESM studies as well as to inform and guide future experience sampling studies, particularly regarding social phenomena with children and adolescents in educational settings.
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Affiliation(s)
- Martina E Mölsä
- Department of Developmental Psychology, Faculty of Education and Welfare Studies, Åbo Akademi University, Vaasa, Finland
| | - Mikael Lax
- Department of Developmental Psychology, Faculty of Education and Welfare Studies, Åbo Akademi University, Vaasa, Finland
| | - Johan Korhonen
- Department of Developmental Psychology, Faculty of Education and Welfare Studies, Åbo Akademi University, Vaasa, Finland
| | - Thomas P Gumpel
- School of Education, The Hebrew University of Jerusalem, Jerusalem, Israel
| | - Patrik Söderberg
- Department of Developmental Psychology, Faculty of Education and Welfare Studies, Åbo Akademi University, Vaasa, Finland
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31
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General and body-related self-conscious emotions predict facets of restrictive eating in undergraduate women. Eat Behav 2022; 45:101624. [PMID: 35334287 DOI: 10.1016/j.eatbeh.2022.101624] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/05/2021] [Revised: 03/02/2022] [Accepted: 03/06/2022] [Indexed: 11/24/2022]
Abstract
It is well understood that mood intolerance is a predictor of eating disorder (ED) symptoms. However, it is unclear whether intolerance of specific emotional experiences predicts ED symptoms. The current study used an ecological momentary assessment design to assess associations between the intensity and intolerance of general and body-related self-conscious emotions and facets of restrictive eating. Participants were 151 female undergraduate students (Mage = 18.99, SD = 1.30 years) who completed six surveys per day for 10 consecutive days. Participants reported on the intensity and intolerance of general and body-related shame, guilt, envy, and embarrassment and cognitive restraint (thoughts about restrictive eating) and behavioral restriction (act of restrictive eating) facets of restrictive eating. Data were analyzed using multilevel modeling. Based on the between-person findings, participants higher on intensity and intolerance of general and body-related self-conscious emotions experienced higher levels of cognitive restraint and behavioral restriction relative to individuals with lower levels of the emotion intensity and intolerance predictors on average. Based on the within-person findings, experiencing a higher intolerance of body-related self-conscious emotions compared to one's average was particularly important when examining behavioral restriction. Experiencing a higher intolerance of body-related envy was able to predict increased behavioral restriction at the time of the next report. These findings may inform tailored treatment targets for mood intolerance and restrictive eating.
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32
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Edney S, Chua XH, Müller AM, Kui KY, Müller-Riemenschneider F. mHealth interventions targeting movement behaviors in Asia: A scoping review. Obes Rev 2022; 23:e13396. [PMID: 34927346 DOI: 10.1111/obr.13396] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/03/2021] [Revised: 09/05/2021] [Accepted: 10/28/2021] [Indexed: 11/27/2022]
Abstract
mHealth interventions can promote healthy movement behaviors (physical activity, sedentary behavior, and sleep). However, recent reviews include few studies from Asia, despite it being home to over 60% of the world population. The aim is to map the current evidence for mHealth interventions targeting movement behaviors in Asia. Six databases were searched up until August 2021. Included studies described an mHealth intervention targeting one or more movement behaviors, delivered in a country/territory in Asia, to a general population. A total of 3986 unique records were screened for eligibility in duplicate. Eighty studies with 1,413,652 participants were included. Most were randomized (38.8%) or quasi-experimental (27.5%) trials. Studies were from 17 countries/territories (out of 55); majority were high- (65.0%) or upper middle-income (28.7%). Physical activity was targeted most often (93.8%), few targeted sedentary behavior (7.5%), or sleep (8.8%). Most targeted one movement behavior (90.0%), and none targeted all three together. Interventions typically incorporated a single mHealth component (70.0%; app, pedometer, text messages, wearable) and were delivered remotely (66.3%). The average intervention length was 121.8 (SD 127.6) days. mHealth interventions in Asia have primarily targeted physical activity in high- and upper middle-income countries. There are few interventions targeting sedentary behavior or sleep, and no interventions in low-income countries.
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Affiliation(s)
- Sarah Edney
- Saw Swee Hock School of Public Health, National University of Singapore and National University Health System, Singapore, Singapore
| | - Xin Hui Chua
- Saw Swee Hock School of Public Health, National University of Singapore and National University Health System, Singapore, Singapore
| | - Andre Matthias Müller
- Saw Swee Hock School of Public Health, National University of Singapore and National University Health System, Singapore, Singapore
| | - Kiran Yan Kui
- Saw Swee Hock School of Public Health, National University of Singapore and National University Health System, Singapore, Singapore
| | - Falk Müller-Riemenschneider
- Saw Swee Hock School of Public Health, National University of Singapore and National University Health System, Singapore, Singapore.,Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore.,Digital Health Center, Berlin Institute of Health, Charité-Universitätsmedizin Berlin, Berlin, Germany
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Jago R, Tibbitts B, Willis K, Sanderson E, Kandiyali R, Reid T, MacNeill S, Kipping R, Campbell R, Sebire SJ, Hollingworth W. Peer-led physical activity intervention for girls aged 13 to 14 years: PLAN-A cluster RCT. PUBLIC HEALTH RESEARCH 2022. [DOI: 10.3310/zjqw2587] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
Background
Increasing physical activity among girls is a public health priority. Peers play a central role in influencing adolescent behaviour. Peer-led interventions may increase physical activity in adolescent girls, and a feasibility trial had shown that PLAN-A (Peer-led physical Activity iNtervention for Adolescent girls) had evidence of promise to increase physical activity in adolescent girls.
Objective
The objective was to test whether or not PLAN-A can increase adolescent girls’ physical activity, relative to usual practice, and be cost-effective.
Design
This was a two-arm, cluster-randomised controlled trial, including an economic evaluation and a process evaluation.
Participants
State-funded secondary schools in the UK with girls in Year 9 (aged 13–14 years) participated in the trial. All Year 9 girls in participating schools were eligible.
Randomisation
Schools were the unit of allocation. They were randomised by an independent statistician, who was blinded to school identities, to the control or intervention arm, stratified by region and the England Index of Multiple Deprivation score.
Intervention
The intervention comprised peer nomination (i.e. identification of influential girls), train the trainers (i.e. training the instructors who delivered the intervention), peer supporter training (i.e. training the peer-nominated girls in techniques and strategies underpinned by motivational theory to support peer physical activity increases) and a 10-week diffusion period.
Outcomes
The primary outcome was accelerometer-assessed mean weekday minutes of moderate to vigorous physical activity among Year 9 girls. The follow-up measures were conducted 5–6 months after the 10-week intervention, when the girls were in Year 10 (which was also 12 months after the baseline measures). Analysis used a multivariable, mixed-effects, linear regression model on an intention-to-treat basis. Secondary outcomes included weekend moderate to vigorous physical activity, and weekday and weekend sedentary time. Intervention delivery costs were calculated for the economic evaluation.
Results
A total of 33 schools were approached; 20 schools and 1558 pupils consented. Pupils in the intervention arm had higher Index of Multiple Deprivation scores than pupils in the control arm. The numbers randomised were as follows: 10 schools (n = 758 pupils) were randomised to the intervention arm and 10 schools (n = 800 pupils) were randomised to the control arm. For analysis, a total of 1219 pupils provided valid weekday accelerometer data at both time points (intervention, n = 602; control, n = 617). The mean weekday moderate to vigorous physical activity was similar between groups at follow-up. The central estimate of time spent engaging in moderate to vigorous physical activity was 2.84 minutes lower in the intervention arm than in the control arm, after adjustment for baseline mean weekday moderate to vigorous physical activity, the number of valid days of data and the stratification variables; however, this difference was not statistically significant (95% confidence interval –5.94 to 0.25; p = 0.071). There were no between-arm differences in the secondary outcomes. The intervention costs ranged from £20.85 to £48.86 per pupil, with an average cost of £31.16.
Harms
None.
Limitations
The trial was limited to south-west England.
Conclusions
There was no evidence that PLAN-A increased physical activity in Year 9 girls compared with usual practice and, consequently, it was not cost-effective.
Future work
Future work should evaluate the utility of whole-school approaches to promote physical activity in schools.
Trial registration
This trial is registered as ISRCTN14539759.
Funding
This project was funded by the National Institute for Health Research (NIHR) Public Health Research programme and will be published in full in Public Health Research; Vol. 10, No. 6. See the NIHR Journals Library website for further project information. This trial was designed and delivered in collaboration with the Bristol Randomised Trials Collaboration (BRTC), a United Kingdom Clinical Research Commission (UKCRC)-registered Clinical Trials Unit that, as part of the Bristol Trials Centre, is in receipt of NIHR Clinical Trials Unit support funding. The sponsor of this trial was University of Bristol, Research and Enterprise Development www.bristol.ac.uk/red/. The costs of delivering the intervention were funded by Sport England.
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Affiliation(s)
- Russell Jago
- Centre for Exercise, Nutrition and Health Sciences, School for Policy Studies, University of Bristol, Bristol, UK
- National Institute for Health Research Applied Research Collaboration West at University Hospitals Bristol NHS Foundation Trust, Bristol, UK
| | - Byron Tibbitts
- Centre for Exercise, Nutrition and Health Sciences, School for Policy Studies, University of Bristol, Bristol, UK
| | - Kathryn Willis
- Centre for Exercise, Nutrition and Health Sciences, School for Policy Studies, University of Bristol, Bristol, UK
| | - Emily Sanderson
- School of Social and Community Medicine, University of Bristol, Bristol, UK
- Bristol Randomised Trials Collaboration, Bristol Trials Centre, University of Bristol, Bristol, UK
| | - Rebecca Kandiyali
- School of Social and Community Medicine, University of Bristol, Bristol, UK
| | - Tom Reid
- Centre for Exercise, Nutrition and Health Sciences, School for Policy Studies, University of Bristol, Bristol, UK
| | - Stephanie MacNeill
- School of Social and Community Medicine, University of Bristol, Bristol, UK
- Bristol Randomised Trials Collaboration, Bristol Trials Centre, University of Bristol, Bristol, UK
| | - Ruth Kipping
- School of Social and Community Medicine, University of Bristol, Bristol, UK
| | - Rona Campbell
- School of Social and Community Medicine, University of Bristol, Bristol, UK
| | - Simon J Sebire
- Centre for Exercise, Nutrition and Health Sciences, School for Policy Studies, University of Bristol, Bristol, UK
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Reesor-Oyer L, Parker H, Burkart S, Smith MT, Dugger R, von Klinggraeff L, Weaver RG, Beets MW, Armstrong B. Measuring Micro Temporal Processes Underlying Preschoolers Screen Use and Behavioral Health: Protocol for the Tots & Tech Study (Preprint). JMIR Res Protoc 2022; 11:e36240. [PMID: 36169993 PMCID: PMC9557980 DOI: 10.2196/36240] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/07/2022] [Revised: 08/10/2022] [Accepted: 08/29/2022] [Indexed: 12/19/2022] Open
Abstract
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
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Affiliation(s)
- Layton Reesor-Oyer
- Department of Exercise Science, University of South Carolina, Columbia, SC, United States
| | - Hannah Parker
- Department of Exercise Science, University of South Carolina, Columbia, SC, United States
| | - Sarah Burkart
- Department of Exercise Science, University of South Carolina, Columbia, SC, United States
| | - Michal T Smith
- Department of Exercise Science, University of South Carolina, Columbia, SC, United States
| | - Roddrick Dugger
- Department of Exercise Science, University of South Carolina, Columbia, SC, United States
| | - Lauren von Klinggraeff
- Department of Exercise Science, University of South Carolina, Columbia, SC, United States
| | - R Glenn Weaver
- Department of Exercise Science, University of South Carolina, Columbia, SC, United States
| | - Michael W Beets
- Department of Exercise Science, University of South Carolina, Columbia, SC, United States
| | - Bridget Armstrong
- Department of Exercise Science, University of South Carolina, Columbia, SC, United States
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Edney SM, Park SH, Tan L, Chua XH, Dickens BSL, Rebello SA, Petrunoff N, Müller AM, Tan CS, Müller-Riemenschneider F, van Dam RM. Advancing understanding of dietary and movement behaviours in an Asian population through real-time monitoring: Protocol of the Continuous Observations of Behavioural Risk Factors in Asia study (COBRA). Digit Health 2022; 8:20552076221110534. [PMID: 35795338 PMCID: PMC9251970 DOI: 10.1177/20552076221110534] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/07/2022] [Accepted: 06/13/2022] [Indexed: 11/17/2022] Open
Abstract
Background Modifiable risk factors for non-communicable diseases, including eating an unhealthy diet and being physically inactive, are influenced by complex and dynamic interactions between people and their social and physical environment. Therefore, understanding patterns and determinants of these risk factors as they occur in real life is essential to enable the design of precision public health interventions. Objective This paper describes the protocol for the Continuous Observations of Behavioural Risk Factors in Asia study (COBRA). The study uses real-time data capture methods to gain a comprehensive understanding of eating and movement behaviours, including how these differ by socio-demographic characteristics and are shaped by people's interaction with their social and physical environment. Methods COBRA is an observational study in free-living conditions. We will recruit 1500 adults aged 21-69 years from a large prospective cohort study. Real-time data capture methods will be used for nine consecutive days: an ecological momentary assessment app with a global positioning system enabled to collect location data, accelerometers to measure movement, and wearable sensors to monitor blood glucose levels. Participants receive six EMA surveys per day between 8 a.m. and 9.30 p.m. to capture information on behavioural risk factors including eating behaviours and diet composition movement behaviours (physical activity, sedentary behaviour, sleep), and related contextual factors. The second wave of ecological momentary assessment surveys with a global positioning system enabled will be sent 6 months later. Data will be analysed using generalised linear models to examine associations between behavioural risk factors and contextual determinants. Discussion Findings from this study will advance our understanding of dietary and movement behaviours as they occur in real-life and inform the development of personalised interventions to prevent chronic diseases.
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Affiliation(s)
- Sarah Martine Edney
- Saw Swee Hock School of Public Health, National University of Singapore and National University Health System, Singapore, Singapore
| | - Su Hyun Park
- Saw Swee Hock School of Public Health, National University of Singapore and National University Health System, Singapore, Singapore
| | - Linda Tan
- Saw Swee Hock School of Public Health, National University of Singapore and National University Health System, Singapore, Singapore
| | - Xin Hui Chua
- Saw Swee Hock School of Public Health, National University of Singapore and National University Health System, Singapore, Singapore
| | - Borame Sue Lee Dickens
- Saw Swee Hock School of Public Health, National University of Singapore and National University Health System, Singapore, Singapore
| | - Salome A Rebello
- Saw Swee Hock School of Public Health, National University of Singapore and National University Health System, Singapore, Singapore
| | - Nick Petrunoff
- Saw Swee Hock School of Public Health, National University of Singapore and National University Health System, Singapore, Singapore
| | - Andre Matthias Müller
- Saw Swee Hock School of Public Health, National University of Singapore and National University Health System, Singapore, Singapore
| | - Cheun Seng Tan
- Saw Swee Hock School of Public Health, National University of Singapore and National University Health System, Singapore, Singapore
| | - Falk Müller-Riemenschneider
- Saw Swee Hock School of Public Health, National University of Singapore and National University Health System, Singapore, Singapore
- Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore
- Digital Health Center, Berlin Institute of Health, Charité-Universitätsmedizin Berlin, Berlin, Germany
| | - Rob M van Dam
- Saw Swee Hock School of Public Health, National University of Singapore and National University Health System, Singapore, Singapore
- Departments of Exercise and Nutrition Sciences and Epidemiology, Milken Institute of Public Health, The George Washington University, Washington, DC, USA
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Elavsky S, Blahošová J, Lebedíková M, Tkaczyk M, Tancos M, Plhák J, Sotolář O, Smahel D. Researching the Links between Smartphone Behavior and Adolescent Wellbeing: The Study Protocol for the FUTURE (WP4) Ecological Momentary Assessment Study (Preprint). JMIR Res Protoc 2021; 11:e35984. [PMID: 35258467 PMCID: PMC8941440 DOI: 10.2196/35984] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/26/2021] [Revised: 12/31/2021] [Accepted: 01/02/2022] [Indexed: 11/16/2022] Open
Abstract
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
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Affiliation(s)
- Steriani Elavsky
- Faculty of Informatics, Masaryk University, Brno, Czech Republic
| | - Jana Blahošová
- Faculty of Informatics, Masaryk University, Brno, Czech Republic
| | | | - Michał Tkaczyk
- Faculty of Informatics, Masaryk University, Brno, Czech Republic
| | - Martin Tancos
- Faculty of Informatics, Masaryk University, Brno, Czech Republic
| | - Jaromír Plhák
- Faculty of Informatics, Masaryk University, Brno, Czech Republic
| | - Ondřej Sotolář
- Faculty of Informatics, Masaryk University, Brno, Czech Republic
| | - David Smahel
- Faculty of Informatics, Masaryk University, Brno, Czech Republic
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Dao KP, De Cocker K, Tong HL, Kocaballi AB, Chow C, Laranjo L. 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. JMIR Mhealth Uhealth 2021; 9:e22890. [PMID: 34806995 PMCID: PMC8663593 DOI: 10.2196/22890] [Citation(s) in RCA: 29] [Impact Index Per Article: 9.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/26/2020] [Revised: 11/06/2020] [Accepted: 07/26/2021] [Indexed: 01/20/2023] Open
Abstract
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
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Affiliation(s)
- Kim Phuong Dao
- Westmead Applied Research Centre, Faculty of Medicine and Health, The University of Sydney, Sydney, Australia.,Capital Health Network, Canberra, Australia
| | - Katrien De Cocker
- Institute for Resilient Regions, Centre for Health Research, University of Southern Queensland, Springfield Central, Australia
| | - Huong Ly Tong
- Westmead Applied Research Centre, Faculty of Medicine and Health, The University of Sydney, Sydney, Australia
| | - A Baki Kocaballi
- School of Computer Science, Faculty of Engineering & Information Technology, University of Technology Sydney, Sydney, Australia
| | - Clara Chow
- Westmead Applied Research Centre, Faculty of Medicine and Health, The University of Sydney, Sydney, Australia
| | - Liliana Laranjo
- Westmead Applied Research Centre, Faculty of Medicine and Health, The University of Sydney, Sydney, Australia
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Katapally TR, Hammami N, Chu LM. A randomized community trial to advance digital epidemiological and mHealth citizen scientist compliance: A smart platform study. PLoS One 2021; 16:e0259486. [PMID: 34723987 PMCID: PMC8559921 DOI: 10.1371/journal.pone.0259486] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/10/2020] [Accepted: 10/21/2021] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND This study aims to understand how participants' compliance and response rates to both traditional validated surveys and ecological momentary assessments (EMAs) vary across 4 cohorts who participated in the same mHealth study and received the same surveys and EMAs on their smartphones, however with cohort-specific time-triggers that differed across the 4 cohorts. METHODS As part of the Smart Platform, adult citizen scientists residing in Regina and Saskatoon, Canada, were randomly assigned to 4 cohorts in 2018. Citizen Scientists provided a complex series of subjective and objective data during 8 consecutive days using a custom-built smartphone application. All citizen scientists responded to both validated surveys and EMAs that captured physical activity. However, using Smart Platform, we varied the burden of responding to validated surveys and EMAs across cohorts by using different time-triggered push notifications. Participants in Cohort 1 (n = 10) received the full baseline 209-item validated survey on day 1 of the study; whereas participants in cohorts 2 (n = 26), 3 (n = 10), and 4 (n = 25) received the same survey in varied multiple sections over a period of 4 days. We used weighted One-way Analysis of Variance (ANOVA) tests and weighted, linear regression models to assess for differences in compliance rate across the cohort groups controlling for age, gender, and household income. RESULTS Compliance to EMAs that captured prospective physical activity varied across cohorts 1 to 4: 50.0% (95% Confidence Interval [C.I.] = 31.4, 68.6), 63.0% (95% C.I. = 50.7, 75.2), 37.5% (95% C.I. = 18.9, 56.1), and 61.2% (95% C.I. = 47.4, 75.0), respectively. The highest completion rate of physical activity validated surveys was observed in Cohort 4 (mean = 97.9%, 95% C.I. = 95.5, 100.0). This was also true after controlling for age, gender, and household income. The regression analyses showed that citizen scientists in Cohorts 2, 3, and 4 had significantly higher compliance with completing the physical activity validated surveys relative to citizen scientists in cohort group 1 who completed the full survey on the first day. CONCLUSIONS & SIGNIFICANCES The findings show that maximizing the compliance rates of research participants for digital epidemiological and mHealth studies requires a balance between rigour of data collection, minimization of survey burden, and adjustment of time- and user-triggered notifications based on citizen or patient input.
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Affiliation(s)
- Tarun Reddy Katapally
- Johnson Shoyama Graduate School of Public Policy, University of Regina, Regina, Canada
- Johnson Shoyama Graduate School of Public Policy, University of Saskatchewan, Saskatoon, Canada
- College of Medicine, Health Science Building, University of Saskatchewan, Saskatoon, Canada
| | - Nour Hammami
- Johnson Shoyama Graduate School of Public Policy, University of Regina, Regina, Canada
- Institute for Health and Social Policy, McGill University, Montreal, Canada
| | - Luan Manh Chu
- College of Medicine, Health Science Building, University of Saskatchewan, Saskatoon, Canada
- Canadian Centre for Health and Safety in Agriculture, University of Saskatchewan, Saskatoon, Canada
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Khobragade SY, Soe HHK, Khobragade YS, Abas ALB. Virtual learning during the COVID-19 pandemic: What are the barriers and how to overcome them? JOURNAL OF EDUCATION AND HEALTH PROMOTION 2021; 10:360. [PMID: 34761046 PMCID: PMC8552260 DOI: 10.4103/jehp.jehp_1422_20] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 10/20/2020] [Accepted: 02/27/2021] [Indexed: 06/13/2023]
Abstract
CONTEXT Virtual learning is not without challenges. It can cause stress, lack of motivation, and social isolation. Due to COVID-19 pandemic, our college shifted from face-to-face to virtual teaching-learning style. the aim was to find out the barriers in virtual learning among medical students and provide solutions to overcome them. MATERIALS AND METHODS This cross-sectional study was conducted among 3rd- and 4th-year Bachelor of Medicine and Bachelor of Surgery students in 2020. Prevalidated electronic survey forms on institutional barrier, technical barrier, and individual barrier were sent to students, 160 students responded. SPSS version 12 was used to calculate descriptive statistics and independent t-test. RESULTS The students had the highest mean score in individual barrier (mean: 2.82 [standard deviation (SD): 0.72]) followed by institutional barrier (mean: 2.79 [SD: 0.74]) and technological barrier (mean: 2.72 [SD: 0.75]). Regarding technological barriers, 38.6% of the students agreed difficulty in procurement of the laptop and 66.4% faced slow Internet connection. Regarding institutional barriers, 75.9% were stressed to join one lecture to another lecture as the lectures were continuous, 69.6% had limited opportunity to interact with lecturers, and 62.7% had poor communication between lecturers and students. Regarding individual barriers, 74.1% of the students were not motivated for online learning, 71.5% of the students could not learn as well as they were in the classroom, and 58.2% disagreed taking online courses in future. CONCLUSION Low motivation, communication, Internet connectivity, and technical problems were the main barriers. Smaller size class, highly motivated and well-trained lecturers, and interactive lectures may help in breaking the barriers of virtual learning.
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Affiliation(s)
| | - Htoo Htoo Kyaw Soe
- Department of Community Medicine, Melaka-Manipal Medical College, Melaka, Malaysia
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Kwasnicka D, Kale D, Schneider V, Keller J, Yeboah-Asiamah Asare B, Powell D, Naughton F, Ten Hoor GA, Verboon P, Perski O. Systematic review of ecological momentary assessment (EMA) studies of five public health-related behaviours: review protocol. BMJ Open 2021; 11:e046435. [PMID: 34272218 PMCID: PMC8287614 DOI: 10.1136/bmjopen-2020-046435] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/09/2022] Open
Abstract
INTRODUCTION Ecological momentary assessment (EMA) involves repeated, real-time assessments of phenomena (eg, cognitions, emotions, behaviours) over a period of time in naturalistic settings. EMA is increasingly used to study both within-person and between-person processes. We will review EMA studies investigating key health behaviours and synthesise: (1) study characteristics (eg, frequency of assessments, adherence, incentives), (2) associations between psychological predictors and behaviours and (3) moderators of adherence to EMA protocols. METHODS AND ANALYSIS This review will focus on EMA studies conducted across five public health behaviours in adult, non-clinical populations: movement behaviour (including physical activity and sedentary behaviour), dietary behaviour, alcohol consumption, tobacco smoking and preventive sexual health behaviours. Studies need to have assessed at least one psychological or contextual predictor of these behaviours. Studies reporting exclusively on physiological outcomes (eg, cortisol) or those not conducted under free-living conditions will be excluded. We will search OVID MEDLINE, Embase, PsycINFO and Web of Science using terms relevant to EMA and the selected health behaviours. Reference lists of existing systematic reviews of EMA studies will be hand searched. Identified articles will be screened by two reviewers. This review is expected to provide a comprehensive summary of EMA studies assessing psychological or contextual predictors of five public health behaviours. ETHICS AND DISSEMINATION The results will be disseminated through peer-reviewed publications and presentations. Data from included studies will be made available to other researchers. No ethics are required. PROSPERO REGISTRATION NUMBER CRD42020168314.
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Affiliation(s)
- Dominika Kwasnicka
- Faculty of Psychology, SWPS University of Social Sciences and Humanities, Wroclaw, Poland
- NHMRC CRE in Digital Technology to Transform Chronic Disease Outcomes, Melbourne School of Population and Global Health, University of Melbourne, Melbourne, Victoria, Australia
| | - Dimitra Kale
- Department of Behavioural Science and Health, Institute of Epidemiology and Health Care, Faculty of Population Health Sciences, University College London, London, UK
| | - Verena Schneider
- Department of Behavioural Science and Health, Institute of Epidemiology and Health Care, Faculty of Population Health Sciences, University College London, London, UK
| | - Jan Keller
- Department of Education and Psychology, Freie Universität Berlin, Berlin, Germany
| | - Bernard Yeboah-Asiamah Asare
- Curtin School of Population Health, Curtin University, Perth, Western Australia, Australia
- Health Psychology, Institute of Applied Health Sciences, University of Aberdeen, Aberdeen, UK
| | - Daniel Powell
- Health Psychology, Institute of Applied Health Sciences, University of Aberdeen, Aberdeen, UK
- Rowett Institute, University of Aberdeen, Aberdeen, UK
| | - Felix Naughton
- Behavioural and Implementation Science Group, School of Health Sciences, University of East Anglia, Norwich, UK
| | - Gill A Ten Hoor
- Department of Work and Social Psychology, Faculty of Psychology and Neurosciences, Maastricht University, Maastricht, The Netherlands
| | - Peter Verboon
- Faculty of Psychology, Open University, Heerlen, The Netherlands
| | - Olga Perski
- Department of Behavioural Science and Health, Institute of Epidemiology and Health Care, Faculty of Population Health Sciences, University College London, London, UK
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Harnas SJ, Knoop H, Booij SH, Braamse AM. Personalizing cognitive behavioral therapy for cancer-related fatigue using ecological momentary assessments followed by automated individual time series analyses: A case report series. Internet Interv 2021; 25:100430. [PMID: 34401389 PMCID: PMC8350606 DOI: 10.1016/j.invent.2021.100430] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/01/2020] [Revised: 04/29/2021] [Accepted: 07/06/2021] [Indexed: 11/01/2022] Open
Abstract
INTRODUCTION A common approach to personalizing psychological interventions is the allocation of treatment modules to individual patients based on cut-off scores on questionnaires, which are mostly based on group studies. However, this way, intraindividual variation and temporal dynamics are not taken into account. Automated individual time series analyses are a possible solution, since these can identify the factors influencing the targeted symptom in a specific individual, and associated modules can be allocated accordingly. The aim of this study was to illustrate how automated individual time series analyses can be applied to personalize cognitive behavioral therapy for cancer-related fatigue in cancer survivors and how this procedure differs from allocating modules based on questionnaires. METHODS This study was a case report series (n = 3). Patients completed ecological momentary assessments at the start of therapy, and after three treatment modules (approximately 14 weeks). Assessments were analyzed with AutoVAR, an R package that automates the process of finding optimal vector autoregressive models. The results informed the treatment plan. RESULTS Three cases were described. From the ecological momentary assessments and automated time series analyses three individual treatment plans were constructed, in which the most important predictor for cancer-related fatigue was treated first. For two patients, this led to the treatment ending after the follow-up ecological momentary assessments. One patient continued treatment until six months, the standard treatment time in regular treatment. All three treatment plans differed from the treatment plans informed by questionnaire scores. DISCUSSION This study is one of the first to apply time series analyses in systematically personalizing psychological treatment. An important strength of this approach is that it can be used for every modular cognitive behavioral intervention where each treatment module addresses specific maintaining factors. Whether or not personalized CBT is more efficacious than standard, non-personalized CBT remains to be determined in controlled studies comparing it to usual care.
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Affiliation(s)
- Susan J. Harnas
- Amsterdam University Medical Centers, University of Amsterdam, Department of Medical Psychology, Cancer Center Amsterdam, Amsterdam Public Health Research Institute, Amsterdam, the Netherlands,Corresponding author at: Amsterdam University Medical Centers, Department of Medical Psychology, Meibergdreef 9, 1105 AZ Amsterdam, the Netherlands.
| | - Hans Knoop
- Amsterdam University Medical Centers, University of Amsterdam, Department of Medical Psychology, Cancer Center Amsterdam, Amsterdam Public Health Research Institute, Amsterdam, the Netherlands
| | - Sanne H. Booij
- University of Groningen, Faculty of Behavioural and Social Sciences, Department of Developmental Psychology, Groningen, the Netherlands,Center for Integrative Psychiatry, Lentis, Groningen, the Netherlands
| | - Annemarie M.J. Braamse
- Amsterdam University Medical Centers, University of Amsterdam, Department of Medical Psychology, Cancer Center Amsterdam, Amsterdam Public Health Research Institute, Amsterdam, the Netherlands
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Poppe L, De Paepe AL, Van Ryckeghem DML, Van Dyck D, Maes I, Crombez G. The impact of mental and somatic stressors on physical activity and sedentary behaviour in adults with type 2 diabetes mellitus: a diary study. PeerJ 2021; 9:e11579. [PMID: 34178463 PMCID: PMC8216170 DOI: 10.7717/peerj.11579] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/15/2021] [Accepted: 05/19/2021] [Indexed: 11/20/2022] Open
Abstract
Background Adopting an active lifestyle is key in the management of type 2 diabetes mellitus (T2DM). Nevertheless, the majority of individuals with T2DM fails to do so. Additionally, individuals with T2DM are likely to experience mental (e.g., stress) and somatic (e.g., pain) stressors. Research investigating the link between these stressors and activity levels within this group is largely lacking. Therefore, current research aimed to investigate how daily fluctuations in mental and somatic stressors predict daily levels of physical activity (PA) and sedentary behaviour among adults with T2DM. Methods Individuals with T2DM (N = 54) were instructed to complete a morning diary assessing mental and somatic stressors and to wear an accelerometer for 10 consecutive days. The associations between the mental and somatic stressors and participants’ levels of PA and sedentary behaviour were examined using (generalized) linear mixed effect models. Results Valid data were provided by 38 participants. We found no evidence that intra-individual increases in mental and somatic stressors detrimentally affected participants’ activity levels. Similarly, levels of sedentary behaviour nor levels of PA were predicted by inter-individual differences in the mental and somatic stressors.
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Affiliation(s)
- Louise Poppe
- Department of Public Health and Primary Care, Ghent University, Ghent, Belgium
| | - Annick L De Paepe
- Department of Experimental Clinical and Health Psychology, Ghent University, Ghent, Belgium
| | - Dimitri M L Van Ryckeghem
- Department of Experimental Clinical and Health Psychology, Ghent University, Ghent, Belgium.,Section Experimental Health Psychology, Clinical Psychological Science, Maastricht University, Maastricht, The Netherlands.,Department of Behavioural and Cognitive Sciences, Faculty of Humanities, Education and Social Sciences, University of Luxembourg, Esch-sur-Alzette, Luxembourg
| | - Delfien Van Dyck
- Department of Movement and Sports Sciences, Ghent University, Ghent, Belgium
| | - Iris Maes
- Department of Movement and Sports Sciences, Ghent University, Ghent, Belgium
| | - Geert Crombez
- Department of Experimental Clinical and Health Psychology, Ghent University, Ghent, Belgium
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Grégoire S, Doucerain M, Morin L, Finkelstein-Fox L. The relationship between value-based actions, psychological distress and well-being: A multilevel diary study. JOURNAL OF CONTEXTUAL BEHAVIORAL SCIENCE 2021. [DOI: 10.1016/j.jcbs.2021.03.006] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/20/2023]
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Elavsky S, Jandačková V, Knapová L, Vašendová V, Sebera M, Kaštovská B, Blaschová D, Kühnová J, Cimler R, Vilímek D, Bosek T, Koenig J, Jandačka D. Physical activity in an air-polluted environment: behavioral, psychological and neuroimaging protocol for a prospective cohort study (Healthy Aging in Industrial Environment study - Program 4). BMC Public Health 2021; 21:126. [PMID: 33435943 PMCID: PMC7801866 DOI: 10.1186/s12889-021-10166-4] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/01/2020] [Accepted: 01/04/2021] [Indexed: 11/15/2022] Open
Abstract
Background Air pollution has been linked to increased mortality and morbidity. The Program 4 of the Healthy Aging in Industrial Environment study investigates whether the health and wellbeing benefits of physical activity (PA) can be fully realized in individuals living in highly polluted environments. Herein, we introduce the behavioral, psychological and neuroimaging protocol of the study. Methods This is a prospective cohort study of N = 1500 individuals aged 18–65 years comparing: (1) individuals living in the highly polluted, industrial region surrounding the city of Ostrava (n = 750), and (2) controls from the comparison region with relative low pollution levels in Southern Bohemia (n = 750). Quota sampling is used to obtain samples balanced on age, gender, PA status (60% active runners vs. 40% insufficiently active). Participants are screened and complete baseline assessments through online questionnaires and in-person lab-based assessments of physiological, biomechanical, neuroimaging and cognitive function parameters. Prospective 12-month intensive monitoring of air pollution and behavioral parameters (PA, inactivity, and sleep) follows, with a focus on PA-related injuries and psychological factors through fitness trackers, smartphones, and mobile apps. Subsequently, there will be a 5-year follow-up of the study cohort. Discussion The design of the study will allow for (1) the assessment of both short-term variation and long-term change in behavioral parameters, (2) evaluation of the incidence of musculoskeletal injuries and psychological factors impacting behavior and injury recovery, and (3) the impact that air pollution status (and change) has on behavior, psychological resilience, and injury recovery. Furthermore, the integration of MRI techniques and cognitive assessment in combination with data on behavioral, biological and environmental variables will provide an opportunity to examine brain structure and cognitive function in relation to health behavior and air pollution, as well as other factors affecting resilience against and vulnerability to adverse changes in brain structure and cognitive aging. This study will help inform individuals about personal risk factors and decision-makers about the impact of environmental factors on negative health outcomes and potential underlying biological, behavioral and psychological mechanisms. Challenges and opportunities stemming from the timing of the study that coincided with the COVID-19 pandemic are also discussed.
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Affiliation(s)
- S Elavsky
- Faculty of Education, University of Ostrava, Ostrava, Czech Republic. .,Faculty of Informatics, Masaryk University, Brno, Czech Republic.
| | - V Jandačková
- Faculty of Education, University of Ostrava, Ostrava, Czech Republic.,Faculty of Medicine, University of Ostrava, Ostrava, Czech Republic
| | - L Knapová
- Faculty of Education, University of Ostrava, Ostrava, Czech Republic.,Faculty of Informatics, Masaryk University, Brno, Czech Republic
| | - V Vašendová
- Faculty of Education, University of Ostrava, Ostrava, Czech Republic
| | - M Sebera
- Faculty of Education, University of Ostrava, Ostrava, Czech Republic
| | - B Kaštovská
- Faculty of Education, University of Ostrava, Ostrava, Czech Republic
| | - D Blaschová
- Faculty of Education, University of Ostrava, Ostrava, Czech Republic
| | - J Kühnová
- Faculty of Life Sciences, University of Hradec Kralove, Hradec Králové, Czech Republic
| | - R Cimler
- Faculty of Life Sciences, University of Hradec Kralove, Hradec Králové, Czech Republic
| | - D Vilímek
- Faculty of Education, University of Ostrava, Ostrava, Czech Republic.,VSB-Technical University of Ostrava, Ostrava, Czech Republic
| | - T Bosek
- Faculty of Education, University of Ostrava, Ostrava, Czech Republic
| | - J Koenig
- University Hospital of Child and Adolescent Psychiatry and Psychotherapy, University of Bern, Bern, Switzerland.,Section for Experimental Child and Adolescent Psychiatry, Department of Child and Adolescent Psychiatry, Centre for Psychosocial Medicine, University of Heidelberg, Heidelberg, Germany
| | - D Jandačka
- Faculty of Education, University of Ostrava, Ostrava, Czech Republic
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Aunger J, Wagnild J. Objective and subjective measurement of sedentary behavior in human adults: A toolkit. Am J Hum Biol 2020; 34:e23546. [PMID: 33277954 PMCID: PMC9286366 DOI: 10.1002/ajhb.23546] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/10/2020] [Revised: 11/11/2020] [Accepted: 11/19/2020] [Indexed: 02/06/2023] Open
Abstract
OBJECTIVES Objectives: Human biologists are increasingly interested in measuring and comparing physical activities in different societies. Sedentary behavior, which refers to time spent sitting or lying down while awake, is a large component of daily 24 hours movement patterns in humans and has been linked to poor health outcomes such as risk of all-cause and cardiovascular mortality, independently of physical activity. As such, it is important for researchers, with the aim of measuring human movement patterns, to most effectively use resources available to them to capture sedentary behavior. METHODS This toolkit outlines objective (device-based) and subjective (self-report) methods for measuring sedentary behavior in free-living contexts, the benefits and drawbacks to each, as well as novel options for combined use to maximize scientific rigor. Throughout this toolkit, emphasis is placed on considerations for the use of these methods in various field conditions and in varying cultural contexts. RESULTS Objective measures such as inclinometers are the gold-standard for measuring total sedentary time but they typically cannot capture contextual information or determine which specific behaviors are taking place. Subjective measures such as questionnaires and 24 hours-recall methods can provide measurements of time spent in specific sedentary behaviors but are subject to measurement error and response bias. CONCLUSIONS We recommend that researchers use the method(s) that suit the research question; inclinometers are recommended for the measurement of total sedentary time, while self-report methods are recommended for measuring time spent in particular contexts of sedentary behavior.
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Affiliation(s)
- Justin Aunger
- Health Services Management Centre, Park House, University of Birmingham, England, UK
| | - Janelle Wagnild
- Department of Anthropology, Durham University, Durham, England, UK
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Nicol GE, Ricchio AR, Metts CL, Yingling MD, Ramsey AT, Schweiger JA, Miller JP, Lenze EJ. A Smartphone-Based Technique to Detect Dynamic User Preferences for Tailoring Behavioral Interventions: Observational Utility Study of Ecological Daily Needs Assessment. JMIR Mhealth Uhealth 2020; 8:e18609. [PMID: 33055063 PMCID: PMC7695533 DOI: 10.2196/18609] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/10/2020] [Revised: 06/14/2020] [Accepted: 10/15/2020] [Indexed: 02/07/2023] Open
Abstract
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.
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Affiliation(s)
- Ginger E Nicol
- Healthy Mind Lab, Department of Psychiatry, Washington University School of Medicine, St. Louis, MO, United States
| | - Amanda R Ricchio
- Healthy Mind Lab, Department of Psychiatry, Washington University School of Medicine, St. Louis, MO, United States
| | - Christopher L Metts
- Department of Pathology and Laboratory Medicine, College of Medicine, Medical University of South Carolina, Charleston, SC, United States
| | - Michael D Yingling
- Healthy Mind Lab, Department of Psychiatry, Washington University School of Medicine, St. Louis, MO, United States
| | - Alex T Ramsey
- Department of Psychiatry, Washington University School of Medicine, St. Louis, MO, United States
| | - Julia A Schweiger
- Healthy Mind Lab, Department of Psychiatry, Washington University School of Medicine, St. Louis, MO, United States
| | - J Philip Miller
- Division of Biostatistics, Washington University School of Medicine, St. Louis, MO, United States
| | - Eric J Lenze
- Healthy Mind Lab, Department of Psychiatry, Washington University School of Medicine, St. Louis, MO, United States
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