Development and Acceptability of a Method to Investigate Prescription Drug Misuse in Daily Life: Ecological Momentary Assessment Study

Abstract

Background Prescription drug misuse and abuse is an established public health challenge, and young adults are particularly affected. There is a striking lack of real-time, naturalistic data collection assessing intentions to misuse and other precipitating factors at the time of actual misuse, leaving the conditions under which individuals are most likely to misuse prescription medications unknown. Ecological momentary assessment (EMA) apps and protocols designed to capture this information would accelerate and expand the knowledge base and could directly contribute to prevention and treatment efforts. Objective The objectives of this study are to describe the development and administration of a mobile app and the EMA protocol designed to collect real-time factors associated with college students’ prescription drug misuse intentions and behaviors in daily life; present completion rates, compliance, acceptability, and reactivity associated with the EMA protocol for participants who endorsed recent prescription drug misuse at screening (ie, risk group; n=300) and those who did not (ie, nonrisk group; n=55); and establish initial construct validity by linking the reports of misuse behaviors in daily life collected via the EMA app to prescription drug misuse reported on a standard survey. Methods An EMA data collection app and protocol were designed specifically to capture hypothesized contextual factors along with prescription drug misuse intentions and behaviors in daily life. Using this protocol, young adult college students (N=352) completed signal- and event-contingent reports over a 28-day period. When the intention to misuse a prescription drug was endorsed, a brief follow-up prompt was sent 15 min later to collect participants’ indications of whether or not misuse had occurred. Results Risk-group participants were significantly more likely than nonrisk counterparts to endorse any prescription drug misuse intentions in daily life (P<.001), to complete one or more follow-up reports (P<.001), and to endorse any prescription drug misuse behavior in daily life on the follow-ups (P<.001). Overall, participants demonstrated consistent engagement with the EMA procedures and returned an average of 74.5 (SD 23.82; range 10-122) reports. Participants in the risk and nonrisk groups did not differ in the number of reports they completed (P=.12), the number of their reporting days (P=.32), or their average completion rates (P=.14). The results indicated some evidence of reactivity to the momentary reporting procedure. Participants reported uniformly positive experiences and remained highly engaged throughout the reporting protocol and broader study. Conclusions The novel EMA app and protocol provide an effective way to assess real-time factors associated with prescription drug misuse intentions and behaviors in daily life. The resulting investigations offer the potential to provide highly translatable information for research and prevention efforts.

College-based social and situational predictors of real-time prescription drug misuse in daily life

“…Indeed, there were instances (albeit infrequent) in which participants indicated they intended to misuse a medication on the EMA prompt and then reported they did not misuse any medications. Of note, we found minimal evidence of reactivity (i.e., whether misuse behavior increased/decreased during the reporting period; Papp, Barringer, et al, 2020). Further, among participants who reported misuse intentions but did not actually misuse, 59% indicated misuse on a subsequent report; thus, any potential preventive effect of completing the EMA protocol (if occurring) appears to have been short-lived.…”

“…Midwestern university were enrolled into a longitudinal study on behaviors and health in daily life. The current study is drawn from its baseline phase (Papp, Barringer, et al, 2020). Inclusion criteria included (a) being enrolled as 1 st and 2 nd year college students (verified via campus Registrar) and (b) being 18 to 21 years of age.…”

“…Given the main objective of capturing prescription drug misuse in daily life, we oversampled participants who endorsed recent misuse (see also Papp, Barringer, et al, 2020).…”

“…Descriptive information on the distribution of misuse by time of day and day of the week are presented in Figure 1. Additional descriptive information about the data can be found in Papp, Barringer, et al (2020).…”

“…Providing a separate device for EMA data collection increased confidentially, but having to carry a separate device may have inadvertently resulted in missed reports. Notably, the most frequently reported reason for missing a report was not being awake for the morning report (Papp, Barringer, et al, 2020). Additionally, participants CONTEXTS OF PRESCRIPTION DRUG MISUSE with higher completion rates were more likely to misuse prescription medication (although completion was not associated with the number of misuse instances), indicating that participants felt comfortable reporting substance use.…”