Rationale and Design of the Women’s Health And Daily Experiences Project: Protocol for an Ecological Momentary Assessment Study to Identify Real-Time Predictors of Midlife Women’s Physical Activity

Abstract

Background Midlife women are at an elevated risk for cardiovascular disease (CVD) and associated mortality. Those who have additional risk conditions such as obesity or hypertension report specific barriers to engaging in cardioprotective behaviors such as physical activity (PA). Considerable effort has been devoted to understanding PA determinants and designing interventions for midlife women, although with suboptimal success, as increasing PA could meaningfully attenuate CVD risk. An updated approach to understanding PA among midlife women could improve upon existing resources by focusing on novel psychosocial influences on PA in this population (ie, body satisfaction, social interactions, social comparisons, mood state) and within-person relations between these influences and PA in the natural environment. Objective The overarching goal of Project WHADE (Women’s Health And Daily Experiences) is to use an ecological momentary assessment (EMA) approach to capture ecologically valid relations between midlife women’s psychosocial experiences and PA as they engage in their normal daily activities. The primary aim of the study is to identify within-person psychosocial predictors of variability in PA (ie, experiences associated with higher vs lower PA for a given individual). Methods Midlife women (aged 40-60 years) with one or more additional risk markers for CVD (eg, hypertension) will be recruited from primary care clinics and the general community (target n=100). Eligible women will complete an initial survey and a face-to-face baseline session before engaging in a 10-day EMA protocol. Psychosocial experiences will be assessed using a brief self-report via a smartphone 5 times per day, and PA will be assessed throughout waking hours using a research-grade monitor. Participants will return for a brief exit interview at the end of 10 days. Multilevel models that address the nested structure of EMA data will be used to evaluate the study aims. Results Recruitment and enrollment are ongoing, and a total of 75 women have completed the protocol to date. Data collection is expected to be completed in Fall 2020. Conclusions Project WHADE is designed to identify naturally occurring psychosocial experiences that predict short-term variability in midlife women’s PA. As such, the results of this study should advance the current understanding of PA among midlife women by providing further insight into within-person psychosocial influences on PA in this group. In the future, this information could help inform the design of interventions for this population. International Registered Report Identifier (IRRID) DERR1-10.2196/19044

A scoping review of behavior change techniques used to promote physical activity among women in midlife

“…Finally, BCTs and intervention features that were described as activating BCTs were extracted. An initial set of BCTs were selected for extraction based on the authors' familiarity with physical activity intervention research (specific to women in midlife and more broadly; Arigo, 2015 ; Butryn et al, 2016 ; Arigo et al, 2020a , b ). These BCTs included the following [with Michie et al ( 2013 ) associated numeric codes]: goal setting (proximal behavior [1.1] and/or distal outcome [1.3]), self-monitoring (proximal behavior [2.3] and/or distal outcome [2.4]), providing feedback (2.2), problem-solving and/or planning (1.4 and 1.2, respectively), social support (3.1–3.3), social comparison (6.2), and behavioral modeling (6.1).…”

Development and Initial Testing of a Personalized, Adaptive, and Socially Focused Web Tool to Support Physical Activity Among Women in Midlife: Multidisciplinary and User-Centered Design Approach

“…Despite these delays, this study had several strengths, including a base of foundational work with the population of interest [ 32 , 37 , 60 , 61 , 69 ], adherence to widely recommended UCD principles [ 51 , 73 ], emphasis on recruiting women from racial or ethnic minority backgrounds to maximize diversity in small samples, and collaboration between flexible researchers who are committed to the project. This process also benefited from multiple phases of internal testing, including a range of testers who were familiar with and those who were naïve to the web application specifications and phases of both positive and negative testing.…”

“…Although we considered a stand-alone mobile app as the outcome, we selected a web application owing to its versatility and ease of access across devices and platforms. During this time, the first author built on her previous studies with the population of interest [ 37 , 39 , 59 ] by conducting additional observational and qualitative studies [ 32 , 33 , 60 , 61 ] and collecting preliminary data to assess their needs and preferences. Insights from previous studies, discussions between investigators, and new participant responses informed the refinement of the goals of the new tool.…”

A multi-study approach to refining ecological momentary assessment measures for use among midlife women with elevated risk for cardiovascular disease

“…For example, identifying women for whom certain social perceptions are associated with low engagement in physical activity could help to target appropriate interventions toward this subgroup of women. In contrast, identifying when or in what contexts certain social perceptions are associated with decreases in women's physical activity could help to identify the appropriate timing or circumstances for exposure to intervention content or reminders about using specific behavioral skills (31). Previous work has shown that intensive assessment (specifically, EMA) is feasible and acceptable among midlife women for capturing self-perceptions [e.g., of self-efficacy or physical activity engagement (32)].…”

“…With these points in mind, the present series of studies was designed to inform refinements to intensive assessment items for use with midlife women experiencing elevated CVD risk. The ultimate goal of this work is to investigate between-and within-person relations between social perceptions and physical activity in this population, using an EMA design (31). In Study 1, we used EMA to pilot items with this population for seven days and collected feedback about their experiences with these items.…”