JMIR Publications

ABSTRACT

Background:

Ecological Momentary Assessment (EMA) is a promising method for capturing real-time data on daily experiences and behaviors. However, its feasibility in large, multi-site studies involving older adults remains underexplored.

Objective:

This study aims to assess the feasibility of implementing EMA surveys in a large, geographically diverse cohort of older adults participating in the Multi-Ethnic Study of Atherosclerosis (MESA) Stress Reactivity Ancillary Study.

Methods:

A total of 1,283 participants (mean age: 75.96 years) were enrolled across 6 U.S. field sites. Each participant was scheduled to receive 1 automated phone survey per day for 7 days following a clinic visit. Survey delivery was managed via the Twilio Voice platform and completion was monitored using REDCap and Smartsheet. Feasibility was assessed through indicators of operational accuracy (scheduling errors), participant adherence (number of surveys completed), and participant-initiated cancellations.

Results:

Of the 1,272 participants who received at least 1 survey, the majority (1041/1272, 81.84%) completed between 5 and 7 surveys, indicating strong adherence. Only 7 participants (7/1283, 0.55%) were affected by technician scheduling errors that resulted in them not receiving any phone surveys and accounting for 37 undelivered surveys out of 8,835 scheduled (37/8835, 0.42%). Participant-initiated cancellations that resulted in participants receiving 0 phone surveys were also rare (4/1283, 0.31%) and were primarily associated with inability to comply with other aspects of the study rather than issues with the phone surveys themselves. Among participants who received at least 1 phone survey, 66 (66/1272, 5.19%) never responded to any. Common reasons included reports of not receiving the phone surveys, hearing difficulties, or phone-related issues.

Conclusions:

Automated phone-based EMA is a feasible and scalable method for collecting real-time data from older adults, even in large, multi-site research settings. Low scheduling errors, high completion rates, and limited participant withdrawal support its use in aging research. Future work should explore strategies to improve accessibility for subgroups with lower completion rates, including participants with hearing difficulties, unreliable phone access, or limited familiarity with call-based technology.