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Does Active Substance Use Interfere with Response to Mobile Survey Prompts?: A Within-Person Analysis of Ecological Momentary Assessment Compliance Among People Who Use Opioids
ABSTRACT
Background:
Smartphone-delivered ecological momentary assessment (EMA) is increasingly used as a mobile health (mHealth) tool to characterize substance use in real time, but its validity depends on survey completion being independent of the behaviors under study. If active substance use reduces the likelihood of responding to a mobile survey prompt, EMA-derived estimates may be biased.
Objective:
This study aimed to test whether momentary substance use was associated with survey-level noncompliance in a smartphone-delivered EMA protocol among people who use opioids.
Methods:
People who use opioids and other illicit drugs in Oakland, California (N=110) completed three EMA surveys daily for 28 days, recalling substance use since the prior survey prompt. Because each survey remained open until shortly before the next, reported use overlapped the previous response window. We identified 5,975 relevant survey pairs and used mixed effects modified Poisson models to estimate within and between person associations between substance use and missing the preceding survey.
Results:
On average, 87% of completed surveys included reports of substance use during the last survey’s response window. Within individuals, momentary polysubstance use was not associated with survey-level noncompliance. Only concurrent stimulant–alcohol use predicted within person noncompliance, which was associated with lower risk for noncompliance (RR 0.71; 95% CI 0.53, 0.96) compared to other substance use. Between individuals, those who used more types of substances on average were more likely to miss a survey.
Conclusions:
Active substance use did not impede survey completion at the momentary level, supporting the validity of smartphone-based EMA in this population. Participants with more extensive polysubstance use profiles in general had higher noncompliance risk. Designers and analysts of mobile EMA protocols for substance-using populations should consider differential response rates linked to polysubstance-use severity and plan reminder schedules, incentive structures, or analytic adjustments accordingly.
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Copyright
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