Ecological momentary assessment (EMA) is a mHealth method of real-time data collection in which people report on behavior and the context of the behavior at multiple time points in their natural environment. It is an innovative counterpart to traditional research methods that have relied on retrospective measures. The aim of this systematic review is to describe EMA methodology that has been used in studies of diabetes self-management. PubMed, CINAHL, PsycINFO, and EMBASE were searched for studies published between January 2000 and December 2018. We identified six studies that met the inclusion criteria. We evaluated the following areas of EMA methodology: 1) sampling and study design, 2) primary measures, 3) delivery technology, 4) EMA schedule and prompting strategy, and 5) EMA compliances. Five out of six studies were conducted in the U.S. with adolescents with type 1 diabetes. One study was conducted in Japan with adults with type 2 diabetes. Four studies used a prospective observational study design with a monitoring period ranging from 3 to 14 days (a total 1,000 to 2,128 observations:). Two studies were integrated with ecological momentary interventions (30 days and 6 months) with real-time biobehavioral feedbacks. All studies assessed diabetes self-management behaviors via EMA surveys. Most studies (78%) reported the relationship among psychosocial contexts, mood, affect, eating, and glucose monitoring. Three studies used handheld computers; two used automated telephone response systems; and one used a smartphone app. The prompt frequency ranged from twice a day to 1-2 times per hour using interval-contingent prompting strategy. Most studies failed to report EMA compliance rates. For those who reported, compliance rates ranged 59-96%. There has been limited research using EMA methodology to assess diabetes self-management and contextual factors. More research with standardized EMA reporting may help to develop personalized diabetes intervention.


S. Nam: None. R. Whittemore: None. D. Vlahov: None. G. Dunton: None.

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