Understanding health behaviours in context: A systematic review and meta-analysis of ecological momentary assessment studies of five key health behaviours

ABSTRACT

Ecological Momentary Assessment (EMA) involves repeated, real-time sampling of health behaviours in context. We present the state-of-knowledge in EMA research focused on five key health behaviours (physical activity and sedentary behaviour, dietary behaviour, alcohol consumption, tobacco smoking, sexual health), summarising theoretical (e.g., psychological and contextual predictors) and methodological aspects (e.g., study characteristics, EMA adherence). We searched Ovid MEDLINE, Embase, PsycINFO and Web of Science until February 2021. We included studies focused on any of the aforementioned health behaviours in adult, non-clinical populations that assessed ≥1 psychological/contextual predictor and reported a predictor-behaviour association. A narrative synthesis and random-effects meta-analyses of EMA adherence were conducted. We included 633 studies. The median study duration was 14 days. The most frequently assessed predictors were ‘negative feeling states’ (21%) and ‘motivation and goals’ (16.5%). The pooled percentage of EMA adherence was high at 81.4% (95% CI = 80.0%, 82.8%, k = 348) and did not differ by target behaviour but was somewhat higher in student (vs. general population) samples, when EMAs were delivered via mobile phones/smartphones (vs. handheld devices), and when event contingent (vs. fixed) sampling was used. This review showcases how the EMA method has been applied to improve understanding and prediction of health behaviours in context.

KEYWORDS:

• Ambulatory assessment
• ecological momentary assessment
• experience sampling
• health psychology
• systematic review
• meta-analysis

Disclosure statement

No potential conflict of interest was reported by the author(s).

Author contributions

DKw, OP, DP and FN conceived the project. DKw and OP are the project leads and coordinators. All authors have made conceptual contributions to the project design and procedures. All authors have contributed to the data extraction. OP conducted the statistical analyses and wrote the first draft of the manuscript. All authors have read, edited, and approved the final version of the manuscript.

Acknowledgments

The review team would like to thank Dr. David Simons for his help with the R code, as well as Dr. Pierre Gerain, Sally Di Maio, Rike Panse, Noemi Lorbeer, Malte Stollwerck, Dr. Paul Gellert, and Dr. Ann DeSmet for their contributions to the data extraction.

Competing interests

The authors have no competing interests to declare.

Data availability

The data underpinning the analyses are openly available via Zenodo: https://doi.org/10.5281/zenodo.5701127. The R code used for the analyses is openly available via GitHub: https://github.com/OlgaPerski/EMA_systematic_review

Additional information

Funding

Olga Perski and Dimitra Kale receive salary support from Cancer Research UK (C1417/A22962). Daniel Powell is funded by the Scottish Government’s Rural and Environment Science and Analytical Services (RESAS) and by the School of Medicine, Medical Sciences, and Nutrition (SMMSN) at the University of Aberdeen. Felix Naughton’s salary is covered by the Faculty of Medicine and Health Sciences at the University of East Anglia. Dominika Kwasnicka’s work is carried out within the HOMING program of the Foundation for Polish Science co-financed by the European Union under the European Regional Development Fund (grant number POIR.04.04.00-00-5CF3/18-00; HOMING 5/2018) and she is also funded by the NHMRC CRE in Digital Technology to Transform Chronic Disease Outcomes, Australia.