Department of Psychology, University of California San Diego, La Jolla, CA, United States.
Department of Psychiatry, School of Medicine, University of California San Diego, La Jolla, CA, United States.
JMIR Mhealth Uhealth. 2021 Feb 10;9(2):e24472. doi: 10.2196/24472.
Longitudinal studies of many health behaviors often rely on infrequent self-report assessments. The measurement of psychoactive substance use among youth is expected to improve with more frequent mobile assessments, which can reduce recall bias. Researchers have used mobile devices for longitudinal research, but studies that last years and assess youth continuously at a fine-grained, temporal level (eg, weekly) are rare. A tailored mobile app (mNCANDA [mobile National Consortium on Alcohol and Neurodevelopment in Adolescence]) and a brief assessment protocol were designed specifically to provide a feasible platform to elicit responses to health behavior assessments in longitudinal studies, including NCANDA (National Consortium on Alcohol and Neurodevelopment in Adolescence).
This study aimed to determine whether an acceptable mobile app system could provide repeatable and valid assessment of youth's health behaviors in different developmental stages over extended follow-up.
Participants were recruited (n=534; aged 17-28 years) from a larger longitudinal study of neurodevelopment. Participants used mNCANDA to register reports of their behaviors for up to 18 months. Response rates as a function of time measured using mNCANDA and participant age were modeled using generalized estimating equations to evaluate response rate stability and age effects. Substance use reports captured using mNCANDA were compared with responses from standardized interviews to assess concurrent validity. Reactivity was assessed by evaluating patterns of change in substance use after participants initiated weekly reports via mNCANDA. Quantitative feedback about the app was obtained from the participants. Qualitative interviews were conducted with a subset of participants who used the app for at least one month to obtain feedback on user experience, user-derived explanations of some quantitative results, and suggestions for system improvements.
The mNCANDA protocol adherence was high (mean response rate 82%, SD 27%) and stable over time across all age groups. The median time to complete each assessment was 51 s (mean response time 1.14, SD 1.03 min). Comparisons between mNCANDA and interview self-reports on recent (previous 30 days) alcohol and cannabis use days demonstrate close agreement (eg, within 1 day of reported use) for most observations. Models used to identify reactivity failed to detect changes in substance use patterns subsequent to enrolling in mNCANDA app assessments (P>.39). Most participants (64/76, 84%) across the age range reported finding the mNCANDA system acceptable. Participants provided recommendations for improving the system (eg, tailoring signaling times).
mNCANDA provides a feasible, multi-year, continuous, fine-grained (eg, weekly) assessment of health behaviors designed to minimize respondent burden and provides acceptable regimes for long-term self-reporting of health behaviors. Fine-grained characterization of variability in behaviors over relatively long periods (eg, up to 18 months) may, through the use of mNCANDA, improve our understanding of the relationship between substance use exposure and neurocognitive development.
许多健康行为的纵向研究通常依赖于不频繁的自我报告评估。预计通过更频繁的移动评估可以改善青少年精神活性物质使用的测量，这可以减少回忆偏差。研究人员已经使用移动设备进行纵向研究，但持续多年并以精细的时间粒度（例如每周）连续评估青少年的研究很少。专门设计了一个定制的移动应用程序（mNCANDA[移动国家青少年酒精和神经发育联合研究]）和一个简短的评估方案，旨在提供一个可行的平台，以在纵向研究中引出对健康行为评估的反应，包括 NCANDA（国家青少年酒精和神经发育联合研究）。
本研究旨在确定一个可接受的移动应用系统是否可以在长期随访中提供不同发育阶段的青少年健康行为的可重复和有效的评估。
从一项较大的神经发育纵向研究中招募了参与者（n=534；年龄 17-28 岁）。参与者使用 mNCANDA 最多 18 个月登记他们的行为报告。使用广义估计方程来模拟使用 mNCANDA 测量的时间和参与者年龄的功能，以评估响应率稳定性和年龄效应。使用 mNCANDA 捕获的物质使用报告与标准化访谈中的反应进行比较，以评估同时效度。通过评估参与者开始通过 mNCANDA 进行每周报告后物质使用模式的变化来评估反应性。从参与者那里获得了关于应用程序的定量反馈。对使用该应用程序至少一个月的一部分参与者进行了定性访谈，以获取关于用户体验、用户对某些定量结果的解释以及系统改进建议的反馈。
mNCANDA 协议的遵守率很高（平均响应率为 82%，SD 27%），并且在所有年龄组中随着时间的推移保持稳定。完成每次评估的中位数时间为 51 秒（平均响应时间为 1.14，SD 1.03 分钟）。mNCANDA 与访谈自我报告之间关于最近（过去 30 天）酒精和大麻使用天数的比较表明，对于大多数观察结果，接近一致（例如，报告使用的前一天）。用于识别反应性的模型未能检测到注册 mNCANDA 应用程序评估后物质使用模式的变化（P>.39）。大多数参与者（64/76，84%）在整个年龄范围内报告发现 mNCANDA 系统可以接受。参与者提供了改进系统的建议（例如，调整信号发送时间）。
mNCANDA 提供了一种可行的、多年的、连续的、精细的（例如，每周）健康行为评估，旨在最大限度地减少受访者的负担，并为长期自我报告健康行为提供可接受的方案。通过使用 mNCANDA，可以对相对较长时间内（例如，长达 18 个月）行为变化的细微特征进行精细描述，从而提高我们对物质使用暴露与神经认知发展之间关系的理解。
