Tobacco & Nicotine Products
IN THE MOMENT: COMPLIANCE WITH AN ECOLOGICAL MOMENTARY ASSESSMENT (EMA) IN GLOBAL TOBACCO CONTROL RESEARCH
(School of Public Health (UMD) Behavioral and Community Health Doctoral Student)
BACKGROUND: Ecological momentary assessment (EMA) collects real-time data from individuals in natural environment by sending brief surveys via a mobile device. Tobacco-related EMA studies in western countries have been conducted with high participant compliance, but have yet to be implemented in low- and middle-income countries (LMIC) where tobacco use remains high. This study examined the compliance to an EMA protocol assessing tobacco use and its social and environmental cues in India. METHODS: Two types of surveys—momentary prompt (MP) and end of day (EOD) —were employed using a smartphone application in urban India for 10 days. The MP survey was sent 5-8 times per day during waking hours asking about real-time tobacco use and its social and environmental cues; the EOD survey was sent at 10pm each day, recounting the same events and exposures from that day. Compliance rates, the proportion of surveys completed against the total sent, were calculated for MP and EOD. Linear regression models predicted MP and EOD compliance using demographic and tobacco-related variables. Pairwise correlation tests analyzed convergent validity between MP and EOD assessments. RESULTS: The sample (N=205) was mostly male (N=135, 65.9%) with age’s ranging between 16 and 40; almost half were tobacco users (N=99, 49.3%). MP and EOD compliance rates were 0.46 (SD=0.21) and 0.72 (SD=0.27), respectively. On average, participants spent 3.78 (SD=2.18) and 3.63 (SD=2.78) minutes completing the MP and EOD surveys, respectively. Being employed (β=0.11, p< .01) and seeing fewer anti-tobacco messages (β=-0.14, p< .05) predicted higher MP compliance. However, none of the variables predicted EOD compliance. Satisfactory convergent validity was found through significant correlations (r= .17 to .55, p< .05) among each pair of MP and EOD assessments. CONCLUSIONS: More research is needed on how to increase LMIC participant compliance with an EMA protocol, as rates were lower compared to those in western countries. Future studies in an LMIC can use the EOD survey as a proxy measure for the MP survey since it is easier to employ and has a higher compliance rate than the MP survey.
Importance to public health: