JMIR Publications

ABSTRACT

Background:

Digital-Ecological Momentary Assessment (EMA) collects data on behaviors, experiences, and physiological states as they occur in daily life. It offers a valuable method for capturing dynamic, context-sensitive experiences often missed by retrospective reporting. While EMA shows promise for pediatric health research, pre-adolescent children have distinct socio-emotional and cognitive characteristics likely to affect engagement with EMA. Existing reviews have not focused on the acceptability and feasibility of EMA protocols with this distinct age-group.

Objective:

This systematic review aimed to examine digital-EMA protocols used with children aged 5–11 years across health domains, focusing on protocol characteristics, acceptability, and feasibility. We address three research questions: (1) What are the characteristics of these protocols; (2) What is the feasibility and acceptability of these protocols; and (3) What are the characteristics of high and low response rate protocols?

Methods:

We searched 10 databases (CINAHL, Embase, ACM Digital Library, IEEE Xplore, Cochrane Library, PsycINFO, Web of Science, PubMed, Scopus, and MEDLINE) for peer-reviewed studies published up to December 2024. Eligible studies used EMA with children aged 5–11 to collect health data via digital devices. Two researchers independently screened studies. One researcher conducted a quality assessment and data extraction. Findings were narratively synthesized.

Results:

We identified 15 distinct EMA protocols across 35 studies. (RQ1) Most targeted non-clinical populations, used handheld devices, spanned 3–28 days, and applied interval-contingent prompting. (RQ2) Response rates and dropout rates were inconsistently reported or unavailable (both n=9/15). Where possible to calculate ranged from 48%–92% (x̄ = 71%; SD = 15%). Six protocols (43%) met the high-adherence threshold (≥ 80%), eight fell below (48–78%), with five under 65%. When reported, dropout rates were between 0%–30%. Facilitators included uncomplicated technology, being generally engaging, reminders, and caregiver involvement. Barriers included device burden, restricted device access, difficulty with accurate reporting, stigma, limited device awareness, and insufficient caregiver support. (RQ3) High-response protocols (≥80%) often involved older children or clinical groups (eg, ADHD), ≥3-week duration, fixed schedules (≥20 items per prompt, 3/4 times per day), timing customization, and incentives.

Conclusions:

The acceptability and feasibility of EMA protocols with children aged 5–11 remains unclear due to inconsistent or unavailable reporting. Future EMA research should consider perceived ease of use (eg, predictable prompting schedules, simplified response formats, and flexibility to fit daily routines) and perceived usefulness (eg, immediate rewards, personally relevant activities, clear explanations of purpose, and attention to stigma) in line with the Technology Acceptance Model. Further, children’s dependence on caregivers and teachers means the involvement of these adults is likely to support both perceived ease of use (eg, assisting with prompts, ensuring access to charged and available devices) and perceived usefulness (eg, explaining relevance, reinforcing engagement, and addressing social dynamics). Clinical Trial: Prospero ref - CRD42022373812