Feasibility and Acceptability of Smartphone-Based Ecological Momentary Assessment of Alcohol Use Among African American Men Who Have Sex With Men in Baltimore

Abstract

BackgroundAlcohol use is a risk factor for the acquisition of human immunodeficiency virus (HIV) among African American men who have sex with men (MSM). Mobile phone-based ecological momentary assessments (EMA) could minimize bias due to retrospective recall and thus provide a better understanding of the social and structural context of alcohol use and its relationship with HIV-related risk behaviors in this population as well as other highly stigmatized populations.ObjectiveWe describe the study design and the implementation, feasibility, reactivity, and acceptability of an EMA study of alcohol use and HIV-related behaviors among African American MSM in Baltimore.MethodsParticipants were recruited through flyers and word-of-mouth in Baltimore from September 2013 to November 2014. Each participant was loaned an Android smartphone and instructed to respond to multiple prompts from the mobile app for 4 weeks. Data were collected through (1) random prompts delivered three times daily assessing participants’ location, activity, mood, and social context, (2) daily prompts capturing drinking and sex events occurring in the past 24 hours, and (3) event-contingent responses collecting participants’ self-reported episodes of drinking.ResultsA total of 16 participants enrolled in the study. The current analyses focused on 15 participants who completed at least 24 days of follow-up (mean follow-up time 29 days; range 24-35 days). Study participants (N=15) were a median 38 years of age (range 27-62 years) with low levels of income and educational attainment. Ten individuals self-reported living with HIV/AIDS, over half reported drinking alcohol at least 2-3 times a week, and a third reported binge drinking (ie, 6 or more drinks on one occasion) on a weekly basis. Based on the Alcohol Use Disorders Identification Test (AUDIT) score, nearly half were classified as hazardous drinkers (score 8-15) and a fifth were likely dependent (score ≥16). A total of 140 participant-initiated events were reported, and 75% of 1308 random prompts and 81% of 436 daily prompts delivered were answered. Of seven devices used during the study, five were reported lost by participants. We did not observe strong reactivity effects, and self-reported acceptability to study procedures was uniformly favorable.ConclusionsThis study provides evidence to support the feasibility and acceptability of using EMA methods for collecting data on alcohol use among African American men who have sex with men living in urban settings. These data provide the basis for future studies of EMA-informed mHealth interventions to promote the reduction of substance use and HIV risk-taking behaviors among African American MSM living in urban settings.

Acceptability of ecological momentary assessment among young men who have sex with men

“…survey prompts thru a smartphone app) to assess alcohol use among a small sample of Black MSM in Baltimore, who ranged from 27 to 62 years of age ( n =15) (Yang et al, 2015). In addition, another recent study implemented a EMA protocol among a racially/ethnically diverse sample of 30 substance-using MSM in San Francisco with a mean age of 43 (standard deviation 9.3) ( n =30) (Rowe et al, 2016).…”

“…In addition, sexual minority individuals, in particular sexual minority youth, are at increased risk for substance use and misuse compared to their heterosexual peers (Hughes & Eliason, 2002). EMA approaches have been used successfully with older MSM to measure alcohol and other drug use (Turner et al, 2017; Yang et al, 2015), but none of these studies have been conducted with younger populations. As such, there is a need to assess the acceptability of these approaches prior to implementation in pilot projects.…”

Race/ethnicity, education, and age are associated with engagement in ecological momentary assessment text messaging among substance-using MSM in San Francisco

“…However, it may prove useful for capturing the “situational cues and social contexts” that influence substance use behavior (Shiffman, 2009). Although researchers are concerned that compliance with EMA is questionable among substance-using populations, studies have demonstrated that this is not the case (Yang et al, 2015; Serre et al, 2012; Freedman et al, 2006; Hopper et al 2006; Collins et al, 2003). Recent studies have also shown that there is no strong correlation between EMA and change in behaviors over time, allaying concerns that reporting behaviors on a day-to-day basis in EMA could lead to assessment reactivity (Cook et al 2010; Rowan et al, 2007; Hufford et al, 2002).…”

Using Ecological Momentary Assessment (EMA) to Study Sex Events Among Very High-Risk Men Who Have Sex with Men (MSM)

“…To date, only one study has explored the acceptability and feasibility of collecting such intensive longitudinal data, and did so in a sample of 16 African American MSM [40]. For 30 days, participants were asked to complete a signal-prompted daily diary survey each day at 9 a.m., 3 experience sampling prompts per day (between 10 a.m. and 10 p.m.), and event-contingent assessments that were to be initiated by participants after finishing a “cluster of alcohol use in one sitting.” Of those approached, 94 % agreed to participate, and participants completed 81 % of daily prompts and 75 % of random prompts, providing evidence of acceptability and feasibility.…”