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Using Ecological Momentary Assessment to Study Tobacco Behavior in Urban India: There's an App for That.

Soong A, Chen JC, Borzekowski DL - JMIR Res Protoc (2015)

Bottom Line: End-of-day survey completion was only significantly predicted by momentary survey completion.This first study of EMA in India offers promising results, although more research is needed on how to increase compliance.Compliance may also be improved by increasing the number of study visits, compliance checks, or opportunities for retraining participants before and during data collection.

View Article: PubMed Central - HTML - PubMed

Affiliation: Institute for Global Tobacco Control, Department of Health, Behavior & Society, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, United States. asoong@jhu.edu.

ABSTRACT

Background: Ecological momentary assessment (EMA) uses real-time data collection to assess participants' behaviors and environments. This paper explores the strengths and limitations of using EMA to examine social and environmental exposure to tobacco in urban India among older adolescents and adults.

Objective: Objectives of this study were (1) to describe the methods used in an EMA study of tobacco use in urban India using a mobile phone app for data collection, (2) to determine the feasibility of using EMA in the chosen setting by drawing on participant completion and compliance rates with the study protocol, and (3) to provide recommendations on implementing mobile phone EMA research in India and other low- and middle-income countries.

Methods: Via mobile phones and the Internet, this study used two EMA surveys: (1) a momentary survey, sent multiple times per day at random to participants, which asked about their real-time tobacco use (smoked and smokeless) and exposure to pro- and antitobacco messaging in their location, and 2) an end-of-day survey sent at the end of each study day. Trained participants, from Hyderabad and Kolkata, India, reported on their social and environmental exposure to tobacco over 10 consecutive days. This feasibility study examined participant compliance, exploring factors related to the successful completion of surveys and the validity of EMA data.

Results: The sample included 205 participants, the majority of whom were male (135/205, 65.9%). Almost half smoked less than daily (56/205, 27.3%) or daily (43/205, 21.0%), and 4.4% (9/205) used smokeless tobacco products. Participants completed and returned 46.87% and 73.02% of momentary and end-of-day surveys, respectively. Significant predictors of momentary survey completion included employment and completion of end-of-day surveys. End-of-day survey completion was only significantly predicted by momentary survey completion.

Conclusions: This first study of EMA in India offers promising results, although more research is needed on how to increase compliance. End-of-day survey completion, which has a lower research burden, may be the more appropriate approach to understanding behaviors such as tobacco use within vulnerable populations in challenging locations. Compliance may also be improved by increasing the number of study visits, compliance checks, or opportunities for retraining participants before and during data collection.

No MeSH data available.


Related in: MedlinePlus

Screenshot of the ecological momentary assessment (EMA) mobile app.
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figure1: Screenshot of the ecological momentary assessment (EMA) mobile app.

Mentions: For this type of study, the EMA literature supported a time-based sampling approach, in which the researcher determines the intervals and moments at which participants are prompted for data collection. This approach, as opposed to event-based monitoring, in which participants can manually initiate a survey on their own, was a better fit because “time-based sampling typically aims to characterize experience more broadly and inclusively...without a predefined focus on discrete events” [3]. The developed EMA app consisted of two surveys. The first EMA survey was a momentary survey, consisting of multiple-choice questions adapted from EMA questionnaires typically done on personal digital assistants (PDAs). Questions came from the EMA literature [5] and adapted portions of the GATS India [21]. Momentary prompts asked participants to give their general location (eg, at home, in a restaurant), social setting (eg, alone, with friends), and tobacco environment (eg, do they see smokers or tobacco advertisements?). Figure 1 presents a screenshot of the first question of the momentary survey. We excluded fill-in responses in the momentary survey to maximize efficiency for survey completion time as well as data analysis, as per recommendations from an EMA field consultant (personal communication, S Shiffman, August 2012).


Using Ecological Momentary Assessment to Study Tobacco Behavior in Urban India: There's an App for That.

Soong A, Chen JC, Borzekowski DL - JMIR Res Protoc (2015)

Screenshot of the ecological momentary assessment (EMA) mobile app.
© Copyright Policy - open-access
Related In: Results  -  Collection

License
Show All Figures
getmorefigures.php?uid=PMC4526962&req=5

figure1: Screenshot of the ecological momentary assessment (EMA) mobile app.
Mentions: For this type of study, the EMA literature supported a time-based sampling approach, in which the researcher determines the intervals and moments at which participants are prompted for data collection. This approach, as opposed to event-based monitoring, in which participants can manually initiate a survey on their own, was a better fit because “time-based sampling typically aims to characterize experience more broadly and inclusively...without a predefined focus on discrete events” [3]. The developed EMA app consisted of two surveys. The first EMA survey was a momentary survey, consisting of multiple-choice questions adapted from EMA questionnaires typically done on personal digital assistants (PDAs). Questions came from the EMA literature [5] and adapted portions of the GATS India [21]. Momentary prompts asked participants to give their general location (eg, at home, in a restaurant), social setting (eg, alone, with friends), and tobacco environment (eg, do they see smokers or tobacco advertisements?). Figure 1 presents a screenshot of the first question of the momentary survey. We excluded fill-in responses in the momentary survey to maximize efficiency for survey completion time as well as data analysis, as per recommendations from an EMA field consultant (personal communication, S Shiffman, August 2012).

Bottom Line: End-of-day survey completion was only significantly predicted by momentary survey completion.This first study of EMA in India offers promising results, although more research is needed on how to increase compliance.Compliance may also be improved by increasing the number of study visits, compliance checks, or opportunities for retraining participants before and during data collection.

View Article: PubMed Central - HTML - PubMed

Affiliation: Institute for Global Tobacco Control, Department of Health, Behavior & Society, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, United States. asoong@jhu.edu.

ABSTRACT

Background: Ecological momentary assessment (EMA) uses real-time data collection to assess participants' behaviors and environments. This paper explores the strengths and limitations of using EMA to examine social and environmental exposure to tobacco in urban India among older adolescents and adults.

Objective: Objectives of this study were (1) to describe the methods used in an EMA study of tobacco use in urban India using a mobile phone app for data collection, (2) to determine the feasibility of using EMA in the chosen setting by drawing on participant completion and compliance rates with the study protocol, and (3) to provide recommendations on implementing mobile phone EMA research in India and other low- and middle-income countries.

Methods: Via mobile phones and the Internet, this study used two EMA surveys: (1) a momentary survey, sent multiple times per day at random to participants, which asked about their real-time tobacco use (smoked and smokeless) and exposure to pro- and antitobacco messaging in their location, and 2) an end-of-day survey sent at the end of each study day. Trained participants, from Hyderabad and Kolkata, India, reported on their social and environmental exposure to tobacco over 10 consecutive days. This feasibility study examined participant compliance, exploring factors related to the successful completion of surveys and the validity of EMA data.

Results: The sample included 205 participants, the majority of whom were male (135/205, 65.9%). Almost half smoked less than daily (56/205, 27.3%) or daily (43/205, 21.0%), and 4.4% (9/205) used smokeless tobacco products. Participants completed and returned 46.87% and 73.02% of momentary and end-of-day surveys, respectively. Significant predictors of momentary survey completion included employment and completion of end-of-day surveys. End-of-day survey completion was only significantly predicted by momentary survey completion.

Conclusions: This first study of EMA in India offers promising results, although more research is needed on how to increase compliance. End-of-day survey completion, which has a lower research burden, may be the more appropriate approach to understanding behaviors such as tobacco use within vulnerable populations in challenging locations. Compliance may also be improved by increasing the number of study visits, compliance checks, or opportunities for retraining participants before and during data collection.

No MeSH data available.


Related in: MedlinePlus