title: Ecological Momentary Assessment in Behavioral Research: Addressing Technological and Human Participant Challenges.
abstract: Ecological momentary assessment (EMA) assesses individuals' current experiences, behaviors, and moods as they occur in real time and in their natural environment. EMA studies, particularly those of longer duration, are complex and require an infrastructure to support the data flow and monitoring of EMA completion.
  
  
  
  Our objective is to provide a practical guide to developing and implementing an EMA study, with a focus on the methods and logistics of conducting such a study.
  
  
  
  The EMPOWER study was a 12-month study that used EMA to examine the triggers of lapses and relapse following intentional weight loss. We report on several studies that informed the implementation of the EMPOWER study: (1) a series of pilot studies, (2) the EMPOWER study's infrastructure, (3) training of study participants in use of smartphones and the EMA protocol and, (4) strategies used to enhance adherence to completing EMA surveys.
  
  
  
  The study enrolled 151 adults and had 87.4% (132/151) retention rate at 12 months. Our learning experiences in the development of the infrastructure to support EMA assessments for the 12-month study spanned several topic areas. Included were the optimal frequency of EMA prompts to maximize data collection without overburdening participants; the timing and scheduling of EMA prompts; technological lessons to support a longitudinal study, such as proper communication between the Android smartphone, the Web server, and the database server; and use of a phone that provided access to the system's functionality for EMA data collection to avoid loss of data and minimize the impact of loss of network connectivity. These were especially important in a 1-year study with participants who might travel. It also protected the data collection from any server-side failure. Regular monitoring of participants' response to EMA prompts was critical, so we built in incentives to enhance completion of EMA surveys. During the first 6 months of the 12-month study interval, adherence to completing EMA surveys was high, with 88.3% (66,978/75,888) completion of random assessments and around 90% (23,411/25,929 and 23,343/26,010) completion of time-contingent assessments, despite the duration of EMA data collection and challenges with implementation.
  
  
  
  This work informed us of the necessary preliminary steps to plan and prepare a longitudinal study using smartphone technology and the critical elements to ensure participant engagement in the potentially burdensome protocol, which spanned 12 months. While this was a technology-supported and -programmed study, it required close oversight to ensure all elements were functioning correctly, particularly once human participants became involved.
authors.affiliation: Department of Health & Community Systems, University of Pittsburgh School of Nursing, Pittsburgh, PA, United States.|Department of Epidemiology, University of Pittsburgh Graduate School of Public Health, Pittsburgh, PA, United States.
authors.forename: Lora E
authors.identifier: 0000-0003-2434-9867
authors.initials: LE
authors.lastname: Burke
authors.affiliation: University of Pittsburgh School of Medicine, Pittsburgh, PA, United States.
authors.forename: Saul
authors.identifier: 0000-0002-9639-490X
authors.initials: S
authors.lastname: Shiffman
authors.affiliation: Department of Health & Community Systems, University of Pittsburgh School of Nursing, Pittsburgh, PA, United States.|University of Pittsburgh School of Medicine, Pittsburgh, PA, United States.
authors.forename: Edvin
authors.identifier: 0000-0002-6248-3015
authors.initials: E
authors.lastname: Music
authors.affiliation: Department of Health & Community Systems, University of Pittsburgh School of Nursing, Pittsburgh, PA, United States.|University of Pittsburgh School of Medicine, Pittsburgh, PA, United States.
authors.forename: Mindi A
authors.identifier: 0000-0002-1923-7695
authors.initials: MA
authors.lastname: Styn
authors.affiliation: Department of Epidemiology, University of Pittsburgh Graduate School of Public Health, Pittsburgh, PA, United States.
authors.forename: Andrea
authors.identifier: 0000-0002-3522-0869
authors.initials: A
authors.lastname: Kriska
authors.affiliation: Institute for Complex Engineered Systems, Carnegie Mellon University, Pittsburgh, PA, United States.
authors.forename: Asim
authors.identifier: 0000-0001-8524-997X
authors.initials: A
authors.lastname: Smailagic
authors.affiliation: Human Computer Interaction Institute, Carnegie Mellon University, Pittsburgh, PA, United States.
authors.forename: Daniel
authors.identifier: 0000-0001-6644-3929
authors.initials: D
authors.lastname: Siewiorek
authors.affiliation: University of Pittsburgh School of Medicine, Pittsburgh, PA, United States.
authors.forename: Linda J
authors.identifier: 0000-0003-2558-4121
authors.initials: LJ
authors.lastname: Ewing
authors.affiliation: Department of Health & Community Systems, University of Pittsburgh School of Nursing, Pittsburgh, PA, United States.
authors.forename: Eileen
authors.identifier: 0000-0002-7233-1269
authors.initials: E
authors.lastname: Chasens
authors.affiliation: Department of Epidemiology and Biostatistics, University of Georgia College of Public Health, Athens, GA, United States.
authors.forename: Brian
authors.identifier: 0000-0002-6173-5321
authors.initials: B
authors.lastname: French
authors.affiliation: University of Pittsburgh School of Medicine, Pittsburgh, PA, United States.
authors.forename: Juliet
authors.identifier: 0000-0002-7617-8521
authors.initials: J
authors.lastname: Mancino
authors.affiliation: Department of Epidemiology, University of Pittsburgh Graduate School of Public Health, Pittsburgh, PA, United States.
authors.forename: Dara
authors.identifier: 0000-0003-3999-1991
authors.initials: D
authors.lastname: Mendez
authors.affiliation: University of Pittsburgh School of Medicine, Pittsburgh, PA, United States.
authors.forename: Patrick
authors.identifier: 0000-0002-2065-9641
authors.initials: P
authors.lastname: Strollo
authors.affiliation: Department of Epidemiology and Biostatistics, University of Georgia College of Public Health, Athens, GA, United States.
authors.forename: Stephen L
authors.identifier: 0000-0002-4704-5316
authors.initials: SL
authors.lastname: Rathbun
mesh_terms: D000328:Adult; D035841:Behavioral Research / Q000379:methods*; D000072860:Ecological Momentary Assessment; D005260:Female; D006801:Humans; D008297:Male; D000068997:Smartphone; D061217:Weight Reduction Programs / Q000379:methods
keywords: adherence; eating behavior; ecological momentary assessment; obesity; relapse; smartphone