Using Mobile-Technology-Based Ecological Momentary Assessment (EMA) Methods With Youth: A Systematic Review and Recommendations.

Capturing the momentary decisions and actions made by construction workers in response to workflow disruptions is challenging because, until now, there has not been a minimally disruptive data collection method that allows workers to identify their decision process ‘in the moment’. However, an Ecological Momentary Assessment (EMA) method—designed to capture momentary work experiences in natural settings—can provide researchers with detailed information about the daily challenges experienced by workers during the course of performing their tasks. An explanation of the method is provided, along with examples of the types of research questions that can be addressed and appropriate analysis techniques. The EMA method is being used on a federally funded research programme in the United States that is investigating how construction workers adapt to workflow disruptions by improvising their decisions and actions. Consequently, this article demonstrates the use of the method by presenting an idiographic study of William, an electrical construction worker. The evaluation of William’s disruptions, decisions and actions elucidated an important relationship: every one of William’s disruptions required an improvisational action in order for him to continue working. The EMA method opens the door to the development of new theories about rapid decisions and subsequent actions on construction sites.

Objective: Ecological momentary assessment (EMA) methods have provided a rich assessment of the contextual factors associated with a wide range of behaviors including alcohol use, eating, physical activity, and smoking. Despite this rich database, this information has not been linked to specific locations in space. Such location information, which can now be easily acquired from global positioning system (GPS) tracking devices, could provide unique information regarding the space-time distribution of behaviors and new insights into their determinants. In a proof of concept study, we assessed the acceptability and feasibility of acquiring and combining EMA and GPS data from adult smokers with attention deficit hyperactivity disorder (ADHD). Methods: Participants were adults with ADHD who were enrolled in a larger EMA study on smoking and psychiatric symptoms. Among those enrolled in the latter study who were approached to participate (N = 11), 10 consented, provided daily EMA entries, and carried a GPS device with them during a 7-day assessment period to assess aspects of their smoking behavior. Results: The majority of those eligible to participate were willing to carry a GPS device and signed the consent (10 out of 11, 91%). Of the 10 who consented, 7 participants provided EMA entries and carried the GPS device with them daily for at least 70% of the sampling period. Data are presented on the spatial distribution of smoking episodes and ADHD symptoms on a subset of the sample to demonstrate applications of GPS data. Conclusions: We conclude by discussing how EMA and GPS might be used to study the ecology of smoking and make recommendations for future research and analysis.

BackgroundCharacterizing dementia risk is difficult with traditional neuropsychological testing. Ecological Momentary Cognitive Testing (EMCT) uses ecological momentary assessment (EMA) methods to sample daily life cognition. The current study examined how daily activities were related to EMCT performance and explored whether associations remained when stratifying by amyloid‐beta (Aβ) status.MethodOlder adults without dementia underwent Pib‐PET imaging and a 10‐day EMA and EMCT protocol using the NeuroUX platform. EMCT measures included verbal memory (12‐item Memory List accuracy), spatial memory (Memory Matrix accuracy), inhibitory control (Color Trick reaction time [RT]), and visual search/processing speed (Matching Pair RT). We examined EMCT in relation to concurrent and previous day activities reported by EMA: 1) work/volunteer activities and 2) physical leisure activities (e.g., exercising or gardening). EMCT task performance was calculated by intraindividual mean and variability, assuming higher mean accuracy and lower variability indicated better cognition. We jointly modeled the mean function and log transformed intraindividual variability for each EMCT task in relation to concurrent and previous day activity, controlling for age, education, and protocol day. We then explored associations stratified by Aβ status.ResultForty participants (age = 73.6 years [67‐91]; education = 15 years [10‐19]; 21 female; 77% white; 7 Aβ+) completed the protocol. For instance, concurrent physical leisure (β = ‐.15, p = .011) or work activities (β = ‐.15, p = .012) was associated with lower Color Trick RT variability and this association held in Aβ+ individuals (β = ‐.69, p<.01; β = ‐.39, p = .01). Concurrent physical activities were associated with higher Memory List mean accuracy (β = .67, p = .05) and concurrent work activities was associated with lower Memory List variability (b = ‐.15, p = .04). Conversely, concurrent physical leisure activities were associated with higher Matching Pair RT variability (β = .15, p = .02) but only in Aβ‐ individuals. When looking at previous day activities, physical leisure (β = ‐.13, p = .05) and work (β = ‐.16, p = .02) activities were associated with less next‐day Memory Matrix variability, in both Aβ+ and Aβ‐ individuals.ConclusionDaily cognitive performance (i.e., EMCT) is sensitive to daily activities, with possible differences by Aβ status. Ongoing work is further examining these patterns (K23AG076663).

Stress is omnipresent in our everyday lives and a key risk factor for our physical and mental health. Yet little is known about the impact of geographic life environments, linked to our daily activities and mobility patterns, on our momentary and daily stress levels.We propose this review to gather evidence on the spatio-temporal determinants of momentary or daily stress in studies using ecological momentary assessment (EMA) or experience sampling methods (ESM) in addition to global positioning systems (GPS) tracking. We will focus on the spatio-temporal definition and modelling of environmental exposures accounting for participant daily activities and mobility patterns and their association with stress. This scoping review will follow the Preferred Reporting Items for Systematic Reviews and Meta-Analyses framework for scoping reviews (2018). We will search the PubMed/Medline, Web of Science, PsycInfo and Scopus databases. We will include papers using EMA or ESM and GPS measuring chronic, daily or momentary stress as an outcome; these methods are also referred to as geographically-explicit ecological momentary assessment.Articles published from January 2000-June 2025 will be screened. Two independent reviewers will screen titles and abstracts to agree on the inclusion of articles. No geographical or population limitation will be imposed. This study is a scoping review based on previously published and publicly available literature. It does not involve the collection of primary data, human participants, or the processing of personal or sensitive information. Therefore, ethical approval is not required in accordance with institutional and international research ethics guidelines. The results will be submitted in peer-reviewed journals and presented at international conferences.

Binge eating is a common problem among overweight people and may complicate weight loss treatment. Addressing binge eating in treatment requires an understanding of the factors that trigger these episodes. Forty‐two women were selected from a community sample that expressed interest in the study. An Ecological Momentary Assessment (EMA) method was used that enabled participants to monitor their eating, feelings and behaviours for 14 days, using programmable wristwatches, at random times, before all eating episodes and just after binge eating episodes. Of these, 18 BED women and 17 women with no BED (NBED) were retained for the statistical analyses. The most important finding was that BED and NBED subjects reported similar levels of binge eating when studied in this way. Negative affect, restraint and lower levels of positive affect were noted as antecedents for binge eating in both BED and NBED participants. Stress and desire to binge, however, were higher for BED participants, compared to NBED participants, prior to normal eating and binge eating episodes. EMA was a valuable method to make assessments of binge eating behaviours in participants' natural environment. BED and NBED participants showed more similarities than differences in terms of the frequency of binge eating as well as binge antecedents. Both EMA as well as the similarities between BED and NBED participants may have implications for the diagnosis of BED. Copyright © 2001 John Wiley & Sons, Ltd and Eating Disorders Association.

As part of a larger clinical trial, this ecological momentary assessment (EMA) study pursued the main goal of demonstrating that the EMA method is sensitive to treatment effects of detached mindfulness and cognitive restructuring for obsessive-compulsive disorder (OCD). A second goal was to provide a descriptive analysis of OCD symptoms and influencing factors in participants' everyday lives. Thirty-nine participants were included in the final analyses. EMA sampling involved a smartphone and comprised 4 days with 10 random prompts per day both before (Pre-Treatment EMA) and after the completion of a 2-week clinical intervention of either detached mindfulness or cognitive restructuring (Post-Treatment EMA) that participants had been randomly allocated to. The EMA questionnaire included items on the frequency of obsessions, subjective burden due to obsessions, perceived current stress, emotions, and on the frequency of compulsions and other dysfunctional behaviors. Descriptive Pre-Treatment EMA results highlight the importance of compulsions and emotional states of tension/discomfort in OCD. Pre-Post comparisons showed a significant reduction of avoidance behavior, obsessions, and burden due to obsessions, with a nonsignificant trend also indicating a reduction of compulsions. There was no pre to post effect concerning emotions. This study adds to the existing research on OCD symptoms and offers further evidence in confirmation of established theoretical models of OCD. Also, our results can be taken as evidence for treatment sensitivity of the EMA method in OCD. Further research is needed to replicate, broaden, and generalize our results.

Research on alcohol use presents several ethical challenges, and therefore, training of ethical alcohol researchers is particularly important. While the Helsinki Declaration (World Medical Association, 2001), Belmont Report (National Commission for the Protection of Human Subjects of Biomedical and Behavioral Research, 1978), and American Psychological Association's (APA) Ethics Code (2002) provide ethical guidelines and aspirational principles for researchers, there are a number of areas in which these principles allow for judgment. For trainees in particular, this ambiguity may be disconcerting. Along with these broader principles, there are also specific considerations for training alcohol researchers in the responsible conduct of research, which may further complicate matters for trainees. Although alcohol research is an important avenue for understanding a large public health concern and investigating risk and protective factors associated with use, it also presents a number of ethical and legal challenges for researchers. Working with high-risk drinking populations presents unique ethical and legal challenges in the areas of informed consent, confidentiality, compensation, and risk-benefit ratios. Additionally, alcohol administration studies present challenges for those supervising, as well as conducting, such experiments. New technology, such as the use of ecological momentary assessment (EMA) or other ambulatory assessment methods to examine risky and illegal behaviors, also presents new ethical challenges that are likely to continue to evolve in the coming years for trainees. Specific recommendations for handling a variety of concerns that may arise when conducting alcohol research are provided. Additionally, suggestions for improving the training of ethical alcohol researchers are discussed.

BackgroundSelf-report is the most common method of measuring medication adherence but is influenced by recall error and response bias, and it typically does not provide insight into the causes of poor adherence. Ecological momentary assessment (EMA) of health behaviors using mobile phones offers a promising alternative to assessing adherence and collecting related data that can be clinically useful for adherence problem solving.ObjectiveTo determine the feasibility of using EMA via mobile phones to assess adolescent asthma medication adherence and identify contextual characteristics of adherence decision making.MethodsWe utilized a descriptive and correlational study design to explore a mobile method of symptom and adherence assessment using an interactive voice response system. Adolescents aged 12-18 years with a diagnosis of asthma and prescribed inhalers were recruited from an academic medical center. A survey including barriers to mobile phone use, the Illness Management Survey, and the Pediatric Asthma Quality of Life Questionnaire were administered at baseline. Quantitative and qualitative assessment of asthma symptoms and adherence were conducted with daily calls to mobile phones for 1 month. The Asthma Control Test (ACT) was administered at 2 study time points: baseline and 1 month after baseline.ResultsThe sample consisted of 53 adolescents who were primarily African American (34/53, 64%) and female (31/53, 58%) with incomes US$40K/year or lower (29/53, 55%). The majority of adolescents (37/53, 70%) reported that they carried their phones with them everywhere, but only 47% (25/53) were able to use their mobile phone at school. Adolescents responded to an average of 20.1 (SD 8.1) of the 30 daily calls received (67%). Response frequency declined during the last week of the month (b=-0.29, P<.001) and was related to EMA-reported levels of rescue inhaler adherence (r= 0.33, P=.035). Using EMA, adolescents reported an average of 0.63 (SD 1.2) asthma symptoms per day and used a rescue inhaler an average of 70% of the time (SD 35%) when they experienced symptoms. About half (26/49, 53%) of the instances of nonadherence took place in the presence of friends. The EMA-measured adherence to rescue inhaler use correlated appropriately with asthma control as measured by the ACT (r=-0.33, P=.034).ConclusionsMobile phones provided a feasible method to assess asthma symptoms and adherence in adolescents. The EMA method was consistent with the ACT, a widely established measure of asthma control, and results provided valuable insights regarding the context of adherence decision making that could be used clinically for problem solving or as feedback to adolescents in a mobile or Web-based support system.

Objective: Subjective cognitive decline (SCD) is an important part of the aging process and may be a sign of neurodegenerative disease. Current measures of SCD are subject to the limits of retrospective recall of symptoms over a long span of time, which might be addressed by using ecological momentary assessment (EMA) methods. However, there are no currently available measures of SCD validated for use in EMA. Thus, our goal was to develop and pilot test the mobile Everyday Cognition Scale (mECog). Method: 31 community-dwelling older adults completed in lab measures of cognition and mental health symptoms, followed by daily mECog ratings on a smart phone for 28 days. Results: Most participants completed at least 75% of mECog assessments (n = 27, 87%), and the average number of assessments completed was 22. Further, respondents rated the mobile assessment platform and measures as easy to use and non-interfering with daily life. Test-retest reliability of mECog scores was very strong (RKRN = .99), and within-person reliability was moderate (RCN = .41). mECog scores demonstrated strong positive associations with scores from the original ECog (ρ = .62–69, p < .001) and short form ECog (ρ = .63-.69, p < .001) and non-significant associations with demographics (ρ = –0.25–.04, p = .21-.94) and mental health symptoms (ρ = –0.06-.34, p = .08–.99). mECog scores also exhibited small-to-moderate negative correlations with objective cognitive test scores, though these relationships did not reach statistical significance (ρ = –0.32 to −0.22, p = .10–.27). Conclusions: Results suggest that mobile assessment of SCD via the mECog is feasible and acceptable. Further, mECog scores demonstrated good psychometric properties, including evidence of strong reliability, convergent validity, and divergent validity.

BackgroundPatient-reported outcomes, including ecological momentary assessments (EMAs), are acquired from patients via repeated self-reports of their perceived momentary physical and emotional states before and after medical procedures. Patient-reported outcomes are used to measure health outcomes and quality of care. However, certain observable states or behaviors (eg, moods such as fatigue, hope, or medication adherence), or behaviors suggestive of health decline (eg, depression, cognitive decline), are not easily measured via self-reports in certain situations (eg, patients undergoing certain medical procedures, patients with dementia, and others). The peer-ceived momentary assessment (PeerMA) method involves support persons or peers (eg, family members and friends) to report their perception of a patient’s subjective physical and emotional states and has been validated in healthy populations.ObjectiveWe examined the value of the PeerMA method in assessing the disease progression and recovery pathways of patients undergoing liver transplantation. Herein, the PeerMA method is operationalized via the patient’s informal caregivers and the patient-based EMA, and wearable-based physical activity datasets from the patients. We report the feasibility results and human factors influencing the acceptance and reliability of the PeerMA method in a small study comprising 8 patients and support persons.MethodsWe conducted a longitudinal observational study of 6 months (autumn 2019 to spring 2020), collecting EMA/self-reports from 8 patients (at the liver transplant clinic at Stanford University Hospital, California) about their perceived levels of hope, sleep, fatigue, depression, and pain in addition to PeerMA-based reports of the same aspects from 7 caregivers. We collected physical activity records from 5 patients using a Fitbit bracelet. Participants completed pre- and poststudy surveys, contributing qualitative data. We implemented the PeerMA method using a smartphone app, making it easy to use by both patients and support persons.ResultsWe collected 1142 patient-days and 976 support person–days. On average, each patient received 103 EMAs and responded to 64 (63%) of them, while support persons received 87 PeerMAs and responded to 64 (74%) of them. We report empirical evidence about the methodological feasibility of PeerMA, showing its dual and unique information streams unavailable by EMA alone. We show examples where support person assessments and physical activity data can inform health professionals about the actual state of a patient regarding outcomes such as hope, sleep quality, fatigue, pain, and depression. We discuss human factors influencing the acceptance of the method and make methodological recommendations.ConclusionsIt is possible to leverage data acquired via the PeerMA method and a wearable activity monitor to complement EMA. The PeerMA method incorporates frequent observations from support persons in patients’ daily lives, which can be compared and analyzed next to the patient’s self-reports. Such data may help to study and assist patients during disease recovery, which is beneficial for patients recovering from an organ transplant.

Intensive longitudinal methods (ILMs) represent a class of longitudinal designs used to understand the flow of people's thoughts, feelings, physiology, and behaviors in their natural settings. This term encompasses daily diaries, experience sampling, ecological momentary assessment, ambulatory assessment, and related methods. Research on ILMs has grown exponentially, evolving into a core approach that complements more traditional designs. This article builds on this journal's first review on this topic, published in 2003. In the quarter-century since, there have been marked advances in design, technology, and statistical modeling. Three core ideas permeate this review: To build adequate theories of psychological functioning in natural settings, researchers must focus on (a) kinematics, (b) dynamics, and (c) heterogeneity. Kinematics answers the question, What happened? Dynamics answers the question, Why did it happen? Heterogeneity answers the question, How much do people vary in the whats and whys? ILMs can address these three goals of psychological science.

Negative urgency is a personality pathway toward impulsive behavior that increases risk for transdiagnostic psychopathology. Limited research supports the core tenant of urgency theory, that is, that individuals with high trait negative urgency act more impulsive when experiencing increased negative emotion. We hypothesized that it may not be negative emotion intensity, but difficulty in differentiating among negative emotions, that prompts impulsive behavior among individuals with elevated negative urgency. We tested this hypothesis in 200 undergraduates using both ecological momentary assessment (measured momentary undifferentiated negative affect and impulsivity) and experimental methods (manipulated emotion differentiation and measured behavioral impulsivity). Momentary undifferentiated negative affect predicted impulsivity in the specific domains of work/school and exercise, but interactions between momentary undifferentiated negative affect and negative urgency were not supported. Manipulated emotion differentiation did not impact behavioral impulsivity regardless of negative urgency scores. Inconsistent with theory, the impulsive behavior of individuals with negative urgency may not be conditional on elevated or undifferentiated negative affect.

Alcohol consumption has a well-established relationship with mood, with higher positive and negative affect predicting alcohol use. More recently, researchers have explored whether alcohol consumption occurs as a response to affect variability as an attempt to self-medicate and stabilise affect. Studies have revealed a positive association between alcohol use and intra- and inter-individual affect variability in clinical and university student samples; however not much is known of this relationship among the general community. Ecological Momentary Assessment (EMA) methods were used to investigate the relationship between affect and arousal variability and alcohol use in 53 community volunteers. Participants self-reported affect and arousal at three to five randomly timed moments throughout the day, as well as every time they drank. On a day-to-day basis, higher positive affect was associated with increased alcohol consumption. When analyses were restricted to self-reported affect prior to alcohol consumption, only increased arousal and decreased variability in arousal predicted the likelihood of alcohol consumption. Mean level of arousal was associated with the extent of alcohol consumed. In this moderate drinking sample day-to-day affect and arousal, and arousal variability, were associated with alcohol consumption. Analyses restricted to pre-drinking observations provide further evidence that self-medication accounts of alcohol consumption may explain drinking initiation but that the relationship between affect factors and drinking behaviour may change around the point of first drink.

The current investigation tested whether low sensitivity to alcohol, as measured by the Self-Rating of the Effects of Alcohol (SRE) form, is associated with hangover occurrence or resistance, two potentially important predictors of later problematic drinking outcomes. Drinkers who reported using alcohol at least four times in the past month (N = 402) completed the SRE at baseline and used ecological momentary assessment methods with an electronic diary to record drinking behaviors and related experiences over 21 days. Each morning, the diary assessed prior-night drinking behaviors and the presence of current hangover. After adjustments for sex, body weight, age, and smoking status, higher SRE scores (indicating lower alcohol sensitivity) predicted hangover occurrence on postdrinking mornings (odds ratio [OR] = 1.24 per interquartile range [IQR], p = .003). However, when the number of drinks consumed in the drinking episode was covaried, SRE scores were negatively associated with hangover (OR = 0.67 per IQR, p <.001). An interaction between SRE scores and the number of drinks consumed indicated that low-sensitivity drinkers tend to be differentially resistant to hangover at a given number of drinks. Higher SRE scores were associated with consuming more drinks on average (generalized estimating equations coefficient = 2.20 per IQR, p <.001). Individuals lower in alcohol sensitivity appear to be more resistant to hangovers per unit of alcohol. However, they are also more likely to engage in excessive drinking, and this may account for their increased odds of experiencing hangover during an arbitrary monitoring period. Heavy consumption, hangover resistance, and hangover frequency may each be manifestations of low sensitivity to alcohol, an established risk factor for alcohol use disorder.

BackgroundObjective binge eating (OBE) is common among individuals with type 1 diabetes (T1D) and may have negative consequences for glycemic control. Recent studies have suggested that diabetes distress (i.e., emotional distress specific to diabetes and living with the burden of management) is a distinct emotional experience among individuals with diabetes. Preliminary studies have found diabetes distress is associated with eating disorder symptoms and poor glycemic control. The aim of the current study was to examine real-time emotional precursors and consequences of OBE in adults with T1D (i.e., general negative affect, specific emotional states and diabetes distress) using ecological momentary assessment methods. We also explore the impact of OBE on 2-h postprandial glycemic control relative to non-OBE eating episodes.MethodsAdults with T1D (N = 83) completed 3-days of ecological momentary assessment assessing mood and eating behavior using a telephone-based survey system. Participants were prompted to rate momentary affect, including level diabetes distress, at random intervals and reported on eating episodes. Participants also wore continuous glucose monitors allowing for ongoing assessment of glycemic control. Multi-level modeling was used to examine between- and within-person effects of momentary increases in emotions prior to eating on the likelihood of OBE and the impact of OBE on postprandial blood glucose. Generalized linear mixed models examined whether change in post-meal affect differed between OBE and non-OBE episodes.ResultsParticipants were predominately middle-aged (Mean = 42; SD = 12.43) Caucasian (87%) females (88%) reporting clinically significant eating disorder symptoms (76%). Nearly half of the sample (43%) reported OBE during the 3-day study period. The between-person effect for negative affect was significant (OR = 1.93, p < .05), indicating a 93% increased risk of OBE among individuals with higher negative affect compared to individuals with average negative affect. Between-person effects were also significant for guilt, frustration and diabetes distress (OR = 1.48–1.77, ps < .05). Analyses indicated that mean change in post-meal negative affect was significantly greater for OBE relative to non-OBE episodes (B = 0.44, p < .001). Blood glucose at 120 min postprandial was also higher for OBE than for non-OBE episodes (p = .03).ConclusionsFindings indicate that individuals who tend to experience negative affect and diabetes distress before eating are at increased risk of OBE at the upcoming meal. Results also suggest that engaging in binge eating may result in greater subsequent negative affect, including diabetes distress, and lead to elevated postprandial blood glucose levels. These findings add to a growing literature suggesting diabetes distress is related to eating disordered behaviors among individuals with T1D.