Mobile Assessment and Monitoring of Daily Experiences
This study aims to identify contextual and dynamic risk factors for meth use and anti-retroviral therapy (ART) nonadherence among HIV+ individuals with comorbid meth use. The study utilizes individual interviews, deliver twice-daily smartphone-based ecological momentary assessment (EMA) surveys, and collect smartphone sensor data (GPS location and activity).
1 Rating
Source: Elizabeth Pasipanodya, PhD
Category: Research Protocol
Protocol Sections: Research Design and Methods
Institution (where approved): University of California San Diego
Created on: November 11, 2017
Overview:
Our overall objective is to identify the contextual and dynamic risk factors associated with meth use and Antiretroviral Therapy (ART) nonadherence and to develop a machine learning algorithm to help define windows of opportunity to deliver interventions promoting relapse prevention and ART adherence in later studies. In order to identify the risk factors to ART nonadherence and meth use, we shall use a mixed methods approach. In particular, 50 People Living with HIV (PLWH) with comorbid meth use shall participate in individual interviews, complete baseline assessment questionnaires, provide daily responses to brief smartphone surveys over a period of 4 weeks, and provide location and movement data passively collected through electronic GPS devices over the 4-week survey period.
One obstacle to establishing a full understanding of the temporal associations and potential mechanisms between variables, such as meth use, ART adherence, and daily events, has been limitations in observing daily life “as it is lived”. As such, ecological momentary assessment (EMA) has been proposed as an ambulatory data collection technique that, through querying present moment experience multiple times throughout the day, researchers are more closely able to assess temporal relationships between daily life experiences, thoughts, feelings, and behaviors. Consequently, we propose to use EMA via smartphone-delivered surveys to more accurately record the daily events of HIV+ individuals, their experience of stressors, mood, and cravings for substance use and determine their associations with risk for meth use and nonadherence.
Furthermore, with the use of electronic GPS devices, we propose to use contextual data, such as location and activity, to understand how location and spatial patterns of movement are associated with risk for meth use and nonadherence. The novel use of global positioning system (GPS) technology overcomes conceptual and logistical challenges faced by relying on static representations of context, such as a residential address, or inaccurate self-reporting of daily movements when examining the relationship between context and health. Indeed, examinations of GPS information has already begun to elucidate important relationships in studies of HIV and drug use [4, 5].
In this study, variables, such as the number of walking trips taken and time spent at home shall be derived from GPS data. These environmental measures created from GPS analysis will be used in statistical modeling at the group level only, and will not be individually mapped or visualized.
Study Components:
I. Screening Interview
Recruitment staff will conduct a brief phone screen to determine preliminary eligibility. A phone screen is detailed in the attached documents in this IRB application for participants who have previously participated in a research study at the HIV Neurobehavioral Research Program (HNRP) (IRB #081375, #091062, #110089, #160075, #171024). These participants indicated in their signed consent document that they wished to be considered for future research studies.
II. Initial Visit and Individual Interview (up to 3 hours):
The initial visit at the HNRP shall include the completion consent documents, collection of background information, and completion of standard psychosocial measures (many of which are standard at the HNRP and have previously been used in other studies. Specifically, the initial visit battery shall include some of the following measures:
Demographics and social background, the MacArthur scale of subjective social status, Ira Wilson Questionnaire, Beliefs related to medications, Supports and barriers to adherence, Promis measures of self-efficacy for managing medications, self-efficacy for managing emotions, and social support, the Perceived stress scale, Meth Reasons for Using, Meth Outcome Expectancies, the Risk assessment battery, the DAST-10, the Functional Assessment of Health Inventory (FAHI), Beck anxiety index (BAI), Beck depression index (BDI), the Adult Hope Scale, the HIV Stigma Scale, and the Smartphone operability scale.
These assessments shall take 1 hour to complete and are included as appendices to this application. This visit shall also include participation in a recorded individual interview, covering topics such as supports and barriers to ART adherence and sobriety, lasting about 1 hour. The script for the individual interview is also included as an attachment to this application.
Additionally, participants shall be oriented to the daily survey phase of the study (which shall involve the completion of two daily smartphone surveys and location/activity tracking) and be familiarized with use of cellphones for daily surveys.
III. Daily EMA Surveys and Passive Collection of Location Data (4 weeks)
Participants will complete two brief daily EMA surveys using either their own mobile phones or provided study smartphones over a period of 4 weeks. Survey links shall be sent out to participants twice daily (morning and evening) at times set to the participants’ preferences. Surveys shall be delivered to the smartphones via a text message link which, when followed, directs to a secure online survey created and run on the SurveyMonkey platform.
These weblinks, delivered by text message, shall be generated to be specific to each participant and data collected through SurveyMonkey shall only have study ID as a participant identifier (participants will also have to enter a unique study id in order to access the surveys). As such, participant responses shall be stored without any identifying information and IP addresses shall not be collected.
The first daily survey shall be completed in the morning and the second in the evening. The morning survey shall take 3 minutes to complete and shall include questions on sleep quality, sleep duration, and mood. The evening survey shall take 5 minutes to complete and shall briefly assess mood, recent meth and other substance use, cravings, daily events, sexual risk behaviors, and ART adherence. As the daily surveys shall be completed online through a secure survey-site, participant responses (including their responses of substance use) shall not be stored locally on the mobile phones. The daily survey items are included as attachments to this IRB application.
In addition to daily surveys, we shall also collect information on activity and GPS location, measured by an electronic GPS device. Participants shall be instructed to wear a GPS device, similar in size and weight to a small cell phone (the QStarz BT-Q1000XT) on a belt around their waist during waking hours (except while bathing or swimming) and to recharge the devices while sleeping. This GPS device shall collect latitude and longitude coordinates as well as the date and time of measurements. To minimize intrusion into daily life and potential embarrassment, participants will be told that they can wear the GPS device under or over their clothing. Such GPS devices have been used by other researchers at UCSD interested in studying the effect of geographical context on physical activity (IRB Protocol #140510 and #150336) and by researchers at other institutions interested in exploring the role of location and movement on substance abuse risk [5].
The daily surveys shall enquire about illicit substance use and location data may capture where substances are obtained/used; however, as these two forms of data shall be collected using separate strategies, in the unlikely event that data are intercepted, these data cannot be linked to each other by third parties. Any potential risk of embarrassment or loss of privacy due to analysis with GPS data shall be mitigated by deriving variables from the GPS data, like the number of places visited or time spent at home. Additionally, environmental measures created from the GPS analysis will be used in statistical modeling at the group level only, and will not be individually mapped or visualized for publication purposes. Furthermore, GPS coordinate data shall not be analyzed at a level finer than that of the census tract. Study variables to be created from GPS data are included in the appendices to this application. The risks of loss of privacy posed by completion of daily surveys and location tracking are anticipated to be no greater than those inherent to daily use of the Internet and of use of GPS devices or devices that allow location services.
IV. Follow-up Visit (1 hour)
Participants will return for a second and final visit at the HNRP after the 4-week survey period. During this visit, participants will complete the feedback questionnaire and return the GPS devices as well as any loaned study phones.
Sign Up for More Resources