Accepted for/Published in: JMIR mHealth and uHealth
Date Submitted: Jul 26, 2020
Date Accepted: Jul 26, 2021
Date Submitted to PubMed: Nov 22, 2021
Warning: This is an author submission that is not peer-reviewed or edited. Preprints - unless they show as "accepted" - should not be relied on to guide clinical practice or health-related behavior and should not be reported in news media as established information.
Smartphone-delivered Ecological Momentary Interventions (EMI) based on Ecological Momentary Assessment (EMA) to promote health behaviours: systematic review and adapted checklist for reporting EMA and EMI studies (CREMAIs)
ABSTRACT
Background:
Healthy behaviours are crucial to maintain a person’s health and wellbeing. The effects of health behaviour interventions are mediated by individual and contextual factors that vary over time. Recently emerging smartphone-based ecological momentary interventions (EMIs) can employ real-time user reports (ecological momentary assessments, EMA) to trigger appropriate support when needed, in daily life.
Objective:
This study aimed to systematically assess user perceptions and the effects on health behaviours of smartphone-delivered EMIs employing self-reported EMA.
Methods:
We searched Medline, Embase, PsycInfo and CINAHL in June 2019 and updated the search in March 2020. We included experimental studies that incorporated EMIs based on EMA, delivered through smartphone applications, to promote health behaviours in any health domain. Studies were independently screened. PRISMA guidelines were followed. We performed a narrative analysis of intervention designs, user perceptions and intervention effects.
Results:
We included 19 articles describing 17 unique studies, comprising 652 participants. The majority of the studies were quasi-experimental (n=13), had small sample sizes, and great heterogeneity in intervention designs and measurements. EMIs were most popular in the mental health domain (n=8), followed by substance abuse (n=3), diet and physical activity (n=4), and smoking (n=2). The four included randomised controlled trials reported non-statistically significant effects on health behaviours. Four quasi-experimental studies reported statistically significant pre-post improvements in self-reported primary outcomes, namely depressive (P<0.001) and psychotic symptoms (P=0.03), drinking frequency (P<0.001), and eating patterns (P=0.01). Generally, users perceived EMIs as helpful. Common suggestions for improvement included enhancing personalisation, reducing technological issues, and lowering EMA reporting burden. EMI and EMA components were rarely and inconsistently reported in included studies, hampering progress in this field. A reporting checklist was developed to facilitate interpretation and comparison of findings and enhance transparency and replicability of future studies using EMA and EMI.
Conclusions:
The use of smartphone-delivered EMI utilising self-reported EMA to promote behaviour change is an emerging area of research, with few studies evaluating efficacy. Future research should follow reporting checklists and explore the use of personalisation and the effects of different EMA data collection methods on user burden, engagement, and efficacy. Use of EMI capitalising on EMA data could present an opportunity to enhance health in individuals but needs further assessment in larger participant cohorts coupled with well-designed evaluations. Clinical Trial: PROSPERO (CRD42019138739)
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