Factors associated with adherence to an e-health ecological momentary assessment protocol in distressed young people.

Abstract

Background. Monitoring mental-health symptoms in young people informs early interventions and promotes positive long-term health outcomes. One promising e-health methodology that enables such monitoring is Ecological Momentary Assessment (EMA), which captures everyday mood fluctuations and other mental-health symptoms in natural settings. However, low adherence rates threaten the efficacy of EMA. This study aimed to explore practically relevant factors that reveal who adheres to EMA protocols and possible reasons why. Methods. Young people (N=130, 16-27 years) were previously recruited from the ReachOut mental-health support website. Of the 65 who commenced a recommended 14-day EMA protocol, 49 (75.4%) responded to this follow-up study. Individual differences of personality and demographics, and two theoretically proposed predictors of adherence – motivational orientation and habit-formation – were examined using a mixed methods approach. Results. Participants in the EMA protocol were younger and reported lower stress and anxiety. The most efficient model (F(9, 36)=2.93, p=.01) explained 42.3% of the variance in adherence to EMA. Identifying with the integrated form of extrinsic motivation and an agreeable personality significantly predicted adherence (B=3.01, p=.009 and B=1.28, p=.029 respectively). Participants indicated that they valued and were interested in the EMA, however, repetitiveness of EMA items and forgetfulness inhibited adherence. Conclusions. The results distinguish who might adhere to and benefit from EMA, although additional research is required to characterise non-adherence. To realise the potential of EMA in managing young people’s mental-health, this study informs e-health design strategies that might improve adherence by bringing attention to aspects of motivational theory.