Department of Movement and Sport Sciences, Faculty of Medicine and Health Sciences, Ghent University, Watersportlaan 2 Ghent, Ghent, B-9000, Belgium.
Research Foundation Flanders (FWO), Brussels, Belgium.
Int J Behav Nutr Phys Act. 2024 Aug 26;21(1):92. doi: 10.1186/s12966-024-01629-z.
Mobile Ecological Momentary Assessment (EMA) is increasingly used to gather intensive, longitudinal data on behavioral nutrition, physical activity and sedentary behavior and their underlying determinants. However, a relevant concern is the risk of non-random non-compliance with mobile EMA protocols, especially in older adults. This study aimed to examine older adults' compliance with mobile EMA in health behavior studies according to participant characteristics, and prompt timing, and to provide recommendations for future EMA research.
Data of four intensive longitudinal observational studies employing mobile EMA to understand health behavior, involving 271 community-dwelling older adults (M = 71.8 years, SD = 6.8; 52% female) in Flanders, were pooled. EMA questionnaires were prompted by a smartphone application during specific time slots or events. Data on compliance (i.e. information whether a participant answered at least one item following the prompt), time slot (morning, afternoon or evening) and day (week or weekend day) of each prompt were extracted from the EMA applications. Participant characteristics, including demographics, body mass index, and smartphone ownership, were collected via self-report. Descriptive statistics of compliance were computed, and logistic mixed models were run to examine inter- and intrapersonal variability in compliance.
EMA compliance averaged 77.5%, varying from 70.0 to 86.1% across studies. Compliance differed among subgroups and throughout the day. Age was associated with lower compliance (OR = 0.96, 95%CI = 0.93-0.99), while marital/cohabiting status and smartphone ownership were associated with higher compliance (OR = 1.83, 95%CI = 1.21-2.77, and OR = 4.43, 95%CI = 2.22-8.83, respectively). Compliance was lower in the evening than in the morning (OR = 0.82, 95%CI = 0.69-0.97), indicating non-random patterns that could impact study validity.
The findings of this study shed light on the complexities surrounding compliance with mobile EMA protocols among older adults in health behavior studies. Our analysis revealed that non-compliance within our pooled dataset was not completely random. This non-randomness could introduce bias into study findings, potentially compromising the validity of research findings. To address these challenges, we recommend adopting tailored approaches that take into account individual characteristics and temporal dynamics. Additionally, the utilization of Directed Acyclic Graphs, and advanced statistical techniques can help mitigate the impact of non-compliance on study validity.
移动生态瞬时评估（EMA）越来越多地用于收集行为营养、身体活动和久坐行为及其潜在决定因素的密集、纵向数据。然而，一个相关的问题是移动 EMA 协议不遵守的风险，尤其是在老年人中。本研究旨在根据参与者特征、提示时机和未来 EMA 研究，检查老年人在健康行为研究中对移动 EMA 的遵守情况，并提供建议。
本研究汇总了四项使用移动 EMA 了解健康行为的密集纵向观察研究的数据，涉及 271 名居住在弗拉芒社区的老年人（M=71.8 岁，SD=6.8；52%为女性）。智能手机应用程序会在特定时间段或事件中提示 EMA 问卷。从 EMA 应用程序中提取了每个提示的依从性（即参与者是否按照提示回答了至少一个项目）、时间（上午、下午或晚上）和日期（周或周末）的数据。参与者特征，包括人口统计学、体重指数和智能手机拥有情况，通过自我报告收集。计算了依从性的描述性统计数据，并运行了逻辑混合模型来检查依从性的个体间和个体内变异性。
EMA 依从性平均为 77.5%，四项研究中的依从性从 70.0%到 86.1%不等。依从性在亚组之间和全天有所不同。年龄与较低的依从性相关（OR=0.96，95%CI=0.93-0.99），而婚姻/同居状况和智能手机拥有与较高的依从性相关（OR=1.83，95%CI=1.21-2.77，OR=4.43，95%CI=2.22-8.83）。晚上的依从性低于早上（OR=0.82，95%CI=0.69-0.97），表明存在非随机模式，这可能会影响研究的有效性。
本研究结果揭示了老年人在健康行为研究中对移动 EMA 协议遵守的复杂性。我们的分析表明，我们的汇总数据集中的不遵守并不完全是随机的。这种非随机性可能会给研究结果带来偏差，从而影响研究结果的有效性。为了解决这些挑战，我们建议采用考虑个体特征和时间动态的定制方法。此外，使用有向无环图和先进的统计技术可以帮助减轻不遵守对研究有效性的影响。
