The variability of emotions, physical complaints, intention, and self-efficacy: an ecological momentary assessment study in older adults

Q: What is the clinical evidence from this study?

Study design: Observational. Population: Healthy aging / physical activity determinants in older adults (n=64). Intervention: Ecological Momentary Assessment (EMA) of time-dependent variability in emotions, physical complaints, intention, and self-efficacy. Primary outcome: Time-dependent within-subject and between-subject variance in emotions, physical complaints, intention, and self-efficacy.

Q: What does this research mean for the field?

In older adults, individual-level health behavior determinants including intention, self-efficacy, fatigue, and negative emotions exhibit substantial time-dependent within-day variability rather than functioning as stable traits. Novelty: ClaimNovelty.NOVEL_FINDING. Consensus alignment: ConsensusAlignment.NEUTRAL.

Iris Maes; Lieze Mertens; Louise Poppe; Geert Crombez; Tomáš Větrovský; Delfien Van Dyck

doi:10.7717/peerj.13234

May 19, 2022PeerJOpen Access

The variability of emotions, physical complaints, intention, and self-efficacy: an ecological momentary assessment study in older adults

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Key result

EMA shows within-day fluctuations explain ~50% of symptom and emotional variance in older adults.

n=64

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Why the study?

Determinants of health behaviors are often treated as static, and little is known about their time-dependent fluctuations needed to personalize dynamic health behavior change interventions.

Key Points

To explore the time-dependent variability of emotions, physical complaints, intention, and self-efficacy across days and within days in older adults using ecological momentary assessment.
Older adults aged 65 and older (n=64 analyzed out of 67; mean age 72.1 ± 5.9 years) completed smartphone questionnaires prompted six times daily over seven consecutive days.
Out of 2,660 valid triggers, participants completed 2,068 assessments (77.7% response rate) measuring positive and negative emotions, physical complaints, intention, and self-efficacy on 7-point Likert scales.
Generalized linear mixed models partitioned total variance for each determinant into differences between subjects, between days within subjects, and within days within subjects.
Differences within subjects and within days explained the majority of variance (42.9% to 65.8%) for relaxation (53.9%), satisfaction (53.3%), negative emotions (42.9% to 56.4%), fatigue (51.9%), dizziness (47.2%), intention (65.8%), and self-efficacy (52.5%).
Differences between subjects explained the majority of variance (50.2% to 67.3%) for cheerfulness (50.2%), enthusiasm (53.3%), pain (54.8%), stiffness, and shortness of breath (67.3%).
More than 90% identical responses across triggers were recorded by 75.0% of participants for anxiousness, 56.3% for insecurity, 70.3% for shortness of breath, and 82.8% for dizziness, indicating low overall presence and variation for these factors.

Study Design

Type

Observational (n=64)

Multicenter

No

Structured PICO

P

Population

64 community-dwelling older adults (mean age 72.1 years, 43.7% female) without cognitive or mobility impairments, monitored six times daily for 7 consecutive days using smartphone-based Ecological Momentary Assessment.

E

Exposure

Ecological Momentary Assessment (EMA) via the Smartphone Ecological Momentary Assessment 3 (SEMA3) application triggered 6 times per day (between 9 AM and 10 PM) for 7 consecutive days (42 total triggers) assessing 8 emotions, 5 physical complaints, intention, and self-efficacy on 7-point Likert scales.

O

Outcome

Proportion of variance (intraclass correlation coefficients from intercept-only generalized linear mixed models) explained by within-subject/within-day, within-subject/between-day, and between-subject differences for emotions, physical complaints, intention, and self-efficacy over 7 days.patient reported

Behavioral determinants including intention, self-efficacy, fatigue, and most emotions fluctuate substantially within the same day in older adults, supporting the use of dynamic, just-in-time adaptive interventions to promote physical activity.

Limitations

Convenience sampling was used to recruit participants, limiting generalizability to the wider population of older adults.
Varying familiarity with smartphones among participants may have resulted in fewer completed questionnaires and missed time-dependent information.
Low overall mean values and limited presence of negative emotions and physical complaints in this specific healthy sample.
Broad age range (65 to 86 years) resulted in a relatively heterogeneous sample.
EMA questionnaire items were not specifically validated for EMA research or for the older adult target group.
Potential reactivity or influence of previous questionnaire answers on subsequent EMA responses.
Convenience sampling limits generalizability to a wider population of older adults
Lower smartphone familiarity in some participants may have reduced response rates
Low baseline prevalence and floor effects for negative emotions and physical complaints in this healthy sample
Heterogeneous age range (65 to 86 years)
EMA items were not specifically validated for EMA or older adults
Potential carry-over effects from previous EMA answers

Implication

May inform timing of activity prompts in older adults; hypothesis-generating for EMA-guided just-in-time interventions.

Abstract

Background: Many theoretical frameworks have been used in order to understand health behaviors such as physical activity, sufficient sleep, healthy eating habits, etc. In most research studies, determinants within these frameworks are assessed only once and thus are considered as stable over time, which leads to rather 'static' health behavior change interventions. However, in real-life, individual-level determinants probably vary over time (within days and from day to day), but currently, not much is known about these time-dependent fluctuations in determinants. In order to personalize health behavior change interventions in a more dynamic manner, such information is urgently needed. Objective: The purpose of this study was to explore the time-dependent variability of emotions, physical complaints, intention, and self-efficacy in older adults (65+) using Ecological Momentary Assessment (EMA). Generalized linear mixed models were used to assess the fluctuations of individual determinants within subjects and over days. The majority of the variance for relaxation, satisfaction, insecurity, anxiousness, irritation, feeling down, fatigue, dizziness, intention, and self-efficacy is explained by the within subjects and within days variance (42.9% to 65.8%). Hence, these determinants mainly differed within the same subject and within the same day. The between subjects variance explained the majority of the variance for cheerfulness, enthusiasm, pain, stiffness, and shortness of breath (50.2% to 67.3%). Hence, these determinants mainly differed between different subjects. Conclusions: This study reveals that multiple individual-level determinants are time-dependent, and are better considered as 'dynamic' or unstable behavior determinants. This study provides us with important insights concerning the development of dynamic health behavior change interventions, anticipating real-time dynamics of determinants instead of considering determinants as stable within individuals.

Discussion

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Cite This Study

Maes et al. (2022) conducted an observational in Healthy aging / physical activity determinants in older adults (n=64). Ecological Momentary Assessment (EMA) of time-dependent variability in emotions, physical complaints, intention, and self-efficacy was evaluated on Time-dependent within-subject and between-subject variance in emotions, physical complaints, intention, and self-efficacy. Ecological Momentary Assessment in older adults revealed that within-subject and within-day variance accounted for 42.9% to 65.8% of the variability in relaxation, satisfaction, negative emotions, fatigue, dizziness, intention, and self-efficacy.

synapsesocial.com/papers/6a732ac94ad168cfcf2c1778 https://doi.org/10.7717/peerj.13234

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The variability of emotions, physical complaints, intention, and self-efficacy: an ecological momentary assessment study in older adults

Figures

Key Points

Study Design

Structured PICO

Limitations

Implication

Abstract

Discussion

Cite This Study

The variability of emotions, physical complaints, intention, and self-efficacy: an ecological momentary assessment study in older adults

Figures

Key Points

Study Design

Structured PICO

Limitations

Implication

Abstract

Discussion

Cite This Study

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