A cross-diagnostic study of adherence to ecological momentary assessment: Comparisons across study length and daily survey frequency find that early adherence is a potent predictor of study-long adherence

Jones, Sara; Moore, Raeanne C.; Pinkham, Amy E.; Depp, Colin A.; Granholm, Eric; Harvey, Philip D.

doi:10.1016/j.pmip.2021.100085

Cited by 12 publications

(15 citation statements)

References 30 publications

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“…When designing EMCT protocols there is always a frequency and duration trade-off when considering participant burden and capturing outcomes of interest. Our prior work has shown that a 14-day period is sufficient to capture cognition and mood data across various contexts (e.g., [31][32][33][34][35], and other groups have demonstrated strong feasibility and psychometric properties for measuring cognition in as few as 7-8 days (e.g., 14,16). In general, the 30-day EMCT protocol in this study was largely well tolerated and provides further support for the feasibility of remote, smartphone-based cognitive testing among older adults.…”

Section: Discussionmentioning

confidence: 99%

Feasibility and validity of ecological momentary cognitive testing among older adults with mild cognitive impairment

Moore

Ackerman²,

Russell³

et al. 2022

Front. Digit. Health

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It is critical to intervene early in the mild cognitive impairment (MCI) stage of the Alzheimer's disease trajectory, but traditional cognitive testing methods are costly, burdensome, and difficult to access. We examined adherence and validity data to a 30-day self-administered ecological momentary cognitive testing protocol among a sample of older adults with MCI and cognitively normal controls to evaluate feasibility, tolerability, and initial validity in comparison to standard neuropsychological tests. Participants included 48 participants with MCI (Mean age = 72 years, SD = 7 years) and 46 demographically-matched cognitively normal (NC) control participants (Mean age = 70 years, SD = 7 years). Participants completed traditional neuropsychological testing to determine MCI status, followed by 30 days of remote ecological momentary cognitive testing. Ecological momentary assessment (EMA) surveys were administered 3 times per day for 30 days (possible total = 90), and mobile cognitive tests were administered every other day (for a total of 15 administrations). Mobile cognitive tests included the Variable Difficulty List Memory Test (VLMT; measure of learning and memory), Memory Matrix (measure of visual working memory), and the Color Trick Test (measure of executive function). EMA and mobile cognitive test adherence, fatigue effects, mobile cognitive test performance and group differences, and psychometrics (reliability, convergent validity, ceiling effects, and practice effects) were examined. Overall mean-level adherence to the mobile cognitive tests was 85% and did not differ by MCI status. The reliability of stable between-person individual differences for the VLMT and Memory Matrix were very high. Moreover, although the reliability of within-person change for Memory Matrix was adequate, the corresponding reliability for VLMT was somewhat low. Averaged performance on the mobile cognitive tests was correlated with lab-based tests measuring the same construct. Participants with MCI performed worse than NCs on the VLMT and Color Trick Test, and there was no evidence of fatigue effects for these two tests. These findings support the feasibility and potential for ecological momentary cognitive testing to support clinical trials and for measuring cognitive changes over time in persons with increased risk for Alzheimer's disease such as those with MCI.

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Section: Discussionmentioning

confidence: 99%

Feasibility and validity of ecological momentary cognitive testing among older adults with mild cognitive impairment

Moore

Ackerman²,

Russell³

et al. 2022

Front. Digit. Health

Self Cite

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“…EMA adherence in BD, depression, and schizophrenia has varied across studies, with most reporting rates of at least 65% and sometimes >90% [24,[27][28][29][30][31]. This study included both EMA and mobile cognitive testing (EMCT) as opposed to EMA only, which could have affected the participants' engagement.…”

Section: Objectivesmentioning

confidence: 99%

“…This study included both EMA and mobile cognitive testing (EMCT) as opposed to EMA only, which could have affected the participants’ engagement. Meta-analytic studies of compliance with EMA protocols [ 30 , 32 , 33 ] range from median adherence rates of 75% to 80%. It is important to note that approximately 10% of participants in EMA studies have significantly lower adherence (approximately 45% [ 30 ]), which lowers the mean adherence rates.…”

Section: Introductionmentioning

confidence: 99%

“…Meta-analytic studies of compliance with EMA protocols [ 30 , 32 , 33 ] range from median adherence rates of 75% to 80%. It is important to note that approximately 10% of participants in EMA studies have significantly lower adherence (approximately 45% [ 30 ]), which lowers the mean adherence rates. We aimed for a benchmark of 70% mean adherence in our sample given the extra time commitment needed to complete EMA surveys and mobile cognitive tests in each session.…”

Section: Introductionmentioning

confidence: 99%

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Initial Psychometric Properties of 7 NeuroUX Remote Ecological Momentary Cognitive Tests Among People With Bipolar Disorder: Validation Study

Moore¹,

Parrish²,

Patten³

et al. 2022

J Med Internet Res

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Background As smartphone technology has become nearly ubiquitous, there is a growing body of literature suggesting that ecological momentary cognitive testing (EMCT) offers advantages over traditional pen-and-paper psychological assessment. We introduce a newly developed platform for the self-administration of cognitive tests in ecologically valid ways. Objective The aim of this study is to develop a Health Insurance Portability and Accountability Act–compliant EMCT smartphone-based platform for the frequent and repeated testing of cognitive abilities in everyday life. This study examines the psychometric properties of 7 mobile cognitive tests covering domains of processing speed, visual working memory, recognition memory, and response inhibition within our platform among persons with and without bipolar disorder (BD). Ultimately, if shown to have adequate psychometric properties, EMCTs may be useful in research on BD and other neurological and psychiatric illnesses. Methods A total of 45 persons with BD and 21 demographically comparable healthy volunteer participants (aged 18-65 years) completed smartphone-based EMCTs 3 times daily for 14 days. Each EMCT session lasted approximately 1.5 minutes. Only 2 to 3 tests were administered in any given session, no test was administered more than once per day, and alternate test versions were administered in each session. Results The mean adherence to the EMCT protocol was 69.7% (SD 20.5%), resulting in 3965 valid and complete tests across the full sample. Participants were significantly more likely to miss tests on later versus earlier study days. Adherence did not differ by diagnostic status, suggesting that BD does not interfere with EMCT participation. In most tests, age and education were related to EMCT performance in expected directions. The average performances on most EMCTs were moderately to strongly correlated with the National Institutes of Health Toolbox Cognition Battery. Practice effects were observed in 5 tests, with significant differences in practice effects by BD status in 3 tests. Conclusions Although additional reliability and validity data are needed, this study provides initial psychometric support for EMCTs in the assessment of cognitive performance in real-world contexts in BD.

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“…However, to best capture momentary feelings and behaviors, it is necessary for participants to answer as many surveys as possible and to stay in the study throughout its duration. Missing data due to low EMA adherence rate and, as an extreme form, study withdrawal, are important since they lead to low statistical power, response bias, and increased cost to the researchers ( 3 ). It is important to understand typical rates of withdrawal and adherence in order to power future studies to discover factors that predict adherence and withdrawal in order to devise protocols that maximize participation.…”

Section: Introductionmentioning

confidence: 99%

Mobile survey engagement by older adults is high during multiple phases of the COVID-19 pandemic and is predicted by baseline and structural factors

Klaus

Peek²,

Quynh³

et al. 2022

Front. Digit. Health

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Digital surveys, such as mobile phone ecological momentary assessment (EMA), bear the potential to assess and target individual wellbeing in a personalized, real-time approach and allow for interaction in situations when in-person contact is not possible, such as during the coronavirus pandemic. While the use of digital technology might especially benefit research in older adults who find themselves in circumstances of reduced mobility, little is known about their barriers to adherence. We investigated baseline and structural factors that predict study withdrawal and adherence from daily smartphone EMA self-report surveys in the StayWELL Study. The StayWELL study is a longitudinal, observational study on the relationship between social restrictions during the coronavirus pandemic and mental well-being in 95 community-dwelling older aged adults (67–87 years) who were participants in a randomized clinical trial using EMA. Withdrawal was associated with less research staff changes and less likely in participants that reached the study mid-point. No baseline characteristics predicted withdrawal. Main reasons for withdrawal were communication issues, i.e. staff not being able to contact participants. We found an adherence rate of 82% and no fatigue effects. Adherence was predicted by education status, study participation duration, reaching the study midpoint and time between study start and enrollment. COVID infections or supporting people in the household was not related to adherence. To conclude, it is feasible to conduct an EMA study in older people without impacting engagement during a pandemic. Furthermore, personal characteristics and smartphone operating system (Android vs. iOS) used did not relate to engagement, allowing for a broad distribution of digital health technologies. Our study adds information on single predictive variables relevant for adherence and withdrawal from EMA smartphone surveys in older people that can inform the design of future digital EMA research to maximize engagement and reliability of study results.

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A cross-diagnostic study of adherence to ecological momentary assessment: Comparisons across study length and daily survey frequency find that early adherence is a potent predictor of study-long adherence

Cited by 12 publications

References 30 publications

Feasibility and validity of ecological momentary cognitive testing among older adults with mild cognitive impairment

Feasibility and validity of ecological momentary cognitive testing among older adults with mild cognitive impairment

Initial Psychometric Properties of 7 NeuroUX Remote Ecological Momentary Cognitive Tests Among People With Bipolar Disorder: Validation Study

Mobile survey engagement by older adults is high during multiple phases of the COVID-19 pandemic and is predicted by baseline and structural factors

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