Investigating Health Risk Environments in Housing Programs for Young Adults: Protocol for a Geographically Explicit Ecological Momentary Assessment Study

Abstract

BackgroundYoung adults who experience homelessness are exposed to environments that contribute to risk behavior. However, few studies have examined how access to housing may affect the health risk behaviors of young adults experiencing homelessness.ObjectiveThis paper describes the Log My Life study that uses an innovative, mixed-methods approach based on geographically explicit ecological momentary assessment (EMA) through cell phone technology to understand the risk environment of young adults who have either enrolled in housing programs or are currently homeless.MethodsFor the quantitative arm, study participants age 18-27 respond to momentary surveys via a smartphone app that collects geospatial information repeatedly during a 1-week period. Both EMAs (up to 8 per day) and daily diaries are prompted to explore within-day and daily variations in emotional affect, context, and health risk behavior, while also capturing infrequent risk behaviors such as sex in exchange for goods or services. For the qualitative arm, a purposive subsample of participants who indicated engaging in risky behaviors are asked to complete an in-depth qualitative interview using an interactive, personalized geospatial map rendering of EMA responses.ResultsRecruitment began in June of 2017. To date, 170 participants enrolled in the study. Compliance with EMA and daily diary surveys was generally high. In-depth qualitative follow-ups have been conducted with 15 participants. We expect to recruit 50 additional participants and complete analyses by September of 2019.ConclusionsMixing the quantitative and qualitative arms in this study will provide a more complete understanding of differences in risk environments between homeless and housed young adults. Furthermore, this approach can improve recall bias and enhance ecological validity.International Registered Report Identifier (IRRID)DERR1-10.2196/12112

Feasibility and Acceptability of Ecological Momentary Assessment With Young Adults Who Are Currently or Were Formerly Homeless: Mixed Methods Study

“…Specifically, as described in a previously published research protocol paper, young adults participated in a study on health risk behaviors using geographic EMA through a smartphone app that allowed for the collection of time-stamped geographic location data along with EMA behavioral data. Consistent with previous literature [ 15 - 17 ], high compliance with completing EMA prompts (80.2% across the entire sample) over a 1-week study period for the combined sample has already been reported [ 31 ]. For this study, we first compared the feedback of housed and unhoused participants regarding their experiences of participating in the EMA week.…”

“…All protocols and procedures were approved by the institutional review board at the University of Southern California (review number: UP-16-00046) [ 31 ].…”

“…Daily surveys were programmed to send push notifications at 3 time points during the day; however, they could be answered at any point within the day; when answering the daily surveys, participants reported on the prior waking day. The complete study methods are available for further review elsewhere [ 31 ] (see Multimedia Appendix 1 for the complete EMA questionnaire and Multimedia Appendix 2 for the daily survey questions).…”

Examining HIV Risk and Exchange Sex Among Current and Formerly Homeless Young Adults

“…Through the use of an app developed for the study, participants could self-initiate and complete a previous day diary or would be prompted to do so at three points each day (e.g., 9 a.m., 12 p.m., 2 p.m.) that they select at the beginning of the week until that day’s diary was completed. The full protocol for this study is available elsewhere [ 42 ]. All protocols were approved by the Institutional Review Board at the University of Southern California.…”

Construct, concurrent, and real-world predictive validity of the Difficulties in Emotion Regulation (DERS-18) among young adults with history of homelessness.

“…Prompts asked about behaviors, feelings, and events during the past 2 hr. Participants were compensated up to $110 in addition to baseline compensation for participation in the EMA portion of the study (for further details on the methods, see Henwood et al, 2019).…”