Examining Participant Preferences, Expectancies, and Perceptions of Ecological Momentary Assessment for Substance Use and Mental Health: A Mixed-Methods Analysis

Clinical researchers using ecological momentary assessment (EMA) typically aim to maximize assessment richness and minimize burden, often sacrificing the scope, temporal granularity, and observational power of resultant data, based on limited empirical evidence. The present mixed-methods study queried participant preferences on EMA design and expectancies prior to completing an EMA protocol (Sample 1, N = 1495). We collected survey and qualitative interview data assessing implementation outcomes from a subset of individuals reporting clinical levels of anxiety/stress and frequent alcohol use who enrolled and completed at least two weeks EMA (Sample 2; n = 59). Participants completed three EMA surveys for up to 112 days (M = 76.8 days, SD = 37.88) with an average compliance of 73.8% (SD = 17.18). Descriptive statistics and a hybrid inductive-deductive coding approach were used to analyzed quantitative and qualitative data, respectively. Participants perceived daily variability in most health-related domains (e.g., mental health symptoms, rest), and frequently reported positive expectations for EMA (e.g., anticipated increased awareness). Most participants reported that completing EMA surveys helped them gain awareness of their daily patterns (n = 37, 62.7%) but that study protocols were long and burdensome (n = 44, 74.6%). Qualitative themes of acceptability, adoption, appropriateness, feasibility, and fidelity were identified; the nature and frequency of themes varied by level of average compliance. Results help to scaffold ways to leverage preferences for protocol design, expectations for tracking using EMA, and experiences during EMA to guide future work in EMA protocol design, ultimately improving momentary assessment of complex behaviors.