Accepted for/Published in: JMIR Formative Research
Date Submitted: Jul 5, 2023
Open Peer Review Period: Jul 5, 2023 - Aug 30, 2023
Date Accepted: Oct 11, 2023
(closed for review but you can still tweet)
Acceptability and Feasibility of a Smartphone-based Real-time Assessment of Suicide among Black Men: A Mixed Methods Pilot Study
ABSTRACT
Background:
Recently, suicide rates in the United States have increased among Black men. Smartphone-based ecological momentary assessment (EMA) platforms are a promising way to collect dynamic, real-time data that can help improve suicide prevention efforts. Despite the promise of this methodology, little is known about its suitability in detecting experiences related to suicidal thoughts and behavior (STB) among Black men.
Objective:
This study aims to clarify the acceptability and feasibility of smartphone-based EMA pilot study and assess the user experience for Black men.
Methods:
We recruited Black men ages 18 and older using MyChart patient portal messaging (patient-facing side of Epic Electronic Medical Record system) and outpatient provider referrals. Eligible participants completed a 7-day smartphone-based EMA study and received a prompt four times per day to complete a brief survey detailing their suicidal thoughts and behaviors, as well as proximal risk factors, such as depression, social isolation, and feeling like a burden to others. At the conclusion of each day, participants also received a daily diary survey detailing their sleep quality and their daily experiences of discrimination. Participants completed a semi-structured exit interview at the study conclusion.
Results:
Eight eligible participants completed 123 EMA surveys and 28 daily diary entries. Seven participants completed 25% or more EMA surveys, with three of the seven participants completing 75% or more. The average completion rate was 54% (min: 17%, max: 100%). Three (37.5%) participants completed daily diary entries for the full week pilot. No safety-related incidents were reported. On average, participants took 1.57 minutes to complete EMA prompts and 2.90 minutes for daily diary surveys. Qualitative results generally affirm the acceptability and feasibility of the study procedures, but participants noted technology difficulties and redundancy of survey questions. Emerging themes also addressed issues of reduced EMA survey compliance and iatrogenic effects of repeated suicide assessments.
Conclusions:
Findings from this study will be used to clarify the suitability of ecological momentary assessment for Black adult men. Overall, intensive EMA designs demonstrated mixed feasibility and acceptability when delivered through smartphone-based applications and to Black men. Specific recommendations are provided for managing safety within these study designs, and for refinements in future intervention and implementation science research.
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