Perceived Impacts, Acceptability, and Recommendations for Ecological Momentary Assessment Among Youth Experiencing Homelessness: Qualitative Study

Abstract

Background The use of ecological momentary assessment (EMA) to study youth experiencing homelessness (YEH) behaviors is an emerging area of research. Despite high rates of participation and potential clinical utility, few studies have investigated the acceptability and recommendations for EMA from the YEH perspective. Objective This study aimed to describe the perceived benefits, usability, acceptability, and barriers to the use of EMA from the homeless youth perspective. Methods YEH were recruited from a larger EMA study. Semistructured exit interviews were performed using an interview guide that focused on the YEH experience with the EMA app, and included perceived barriers and recommendations for future studies. Data analyses used an inductive approach with thematic analysis to identify major themes and subthemes. Results A total of 18 YEH aged 19-24 years participated in individual and group exit interviews. The EMA was highly acceptable to YEH and they found the app and EMA surveys easy to navigate. Perceived benefits included increased behavioral and emotional awareness with some YEH reporting a decrease in their high-risk behaviors as a result of participation. Another significant perceived benefit was the ability to use the phones for social support and make connections to family, friends, and potential employers. Barriers were primarily survey and technology related. Survey-related barriers included the redundancy of questions, the lack of customizable responses, and the timing of survey prompts. Technology-related barriers included the “freezing” of the app, battery charge, and connectivity issues. Recommendations for future studies included the need to provide real-time mental health support for symptomatic youth, to create individually customized questions, and to test the use of personalized motivational messages that respond to the EMA data in real time. Conclusions YEH are highly receptive to the use of EMA in studies. Further studies are warranted to understand the impact of EMA on YEH behaviors. Incorporating the YEH perspective into the design and implementation of EMA studies may help minimize barriers, increase acceptability, and improve participation rates in this hard-to-reach, disconnected population.

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

“…The study’s implications include support for using intensive longitudinal methods such as EMA with housed and unhoused young adults. Acorda et al [ 26 ] explored the impact and acceptability of EMA among 18 youths experiencing homelessness, making recommendations for use with young people who are actively homeless. The results produced by Acorda et al [ 26 ] reinforce the findings of this study, most notably the effects of increased self-awareness and the potential for behavior change as a result of EMA.…”

“…Acorda et al [ 26 ] explored the impact and acceptability of EMA among 18 youths experiencing homelessness, making recommendations for use with young people who are actively homeless. The results produced by Acorda et al [ 26 ] reinforce the findings of this study, most notably the effects of increased self-awareness and the potential for behavior change as a result of EMA. Given the discussion regarding perceived behavioral change and behavioral intentions, EMA also presents possible opportunities for intervention work.…”

“…The literature has generally found low reactivity when using EMA [ 19 - 23 ], including in college and clinical samples [ 24 , 25 ]. Acorda et al [ 26 ] found that young people experiencing homelessness were highly receptive to EMA but may have experienced limitations regarding the use of technology and that the repetition of EMA prompts may have affected some behaviors of those participating. However, the extent to which EMA may affect the attitudes or behaviors of young adults experiencing homelessness during a time of identity formation and instability, especially when examining risk behaviors, including sex risk and substance use, has not been well investigated.…”

Twenty-Six Veterans: A Longitudinal Case Study of Veterans Experiencing Homelessness in Los Angeles, 2019–2020

“…Longer recall periods, such as those occurring over 30 days, may not provide granular detail on behavior that occurs more frequently or feeling states that change throughout a single day. Research with other vulnerable unstably housed populations, such as homeless young adults (Acorda, Businelle, and Santa Maria, 2021;Linnemayr et al, 2021) has found EMA to be acceptable and feasible, yet we are not aware of any study that has examined the acceptability and feasibility of phone-based EMA with VEH.…”

“…While our main study collected longitudinal data on a monthly basis, measurement points for certain variables such as emotional states or mental health symptoms could be considered infrequent and affected by recall biases. EMA is a sampling strategy that can leverage the ubiquity of smartphone technology to measure behavior in the moment, thus improving ecological validity (Acorda, Businelle, and Santa Maria, 2021;. EMA is especially well suited to study aspects of daily life including affect, hunger, sleep, and psychological distress.…”