Abstract

Background Mobile-phone ecological momentary assessment (EMA) methods are a well-established measure of eating and drinking behaviours, but compliance can be poor. Micro-EMA (μEMA), which collects information with single tap response to brief questions on smartwatches, offers a novel application that may improve response rates. To our knowledge, there is no data evaluating μEMA to measure eating habits in children or in low-to-middle income countries.

Objective We investigated the feasibility of micro-EMA to measure eating patterns in Malaysian children and adolescents.

Methods We invited 100 children and adolescents aged 7-18 in Segamat, Malaysia to participate in 2021-2022. Smartwatches were distributed to 83 children and adolescents who agreed to participate. Participants were asked to wear the smartwatch for 8 days and respond to 12 prompts hourly from 8am to 8pm, asking for information on their meals, snacks and drinks consumed. A questionnaire captured their experiences using the smartwatch and μEMA interface. Response rate (proportion of prompts responded to) assessed participants’ adherence. We explored associations between response rate with time of day, across days, age and sex using multi-level binomial logistic regression modelling.

Results Eighty-two participants provided usable smartwatch data. The median number (inter-quartile range) of meals, drinks and snacks per day were 2 (2 - 4), 3 (1 - 5) and 1 (0 - 2) respectively on the first day of the study. The median response rate across the study was 68% (quartiles: [50, 83]). The response rate decreased across study days from 74% (68, 78) on day 1 to 40% (30, 50) on day 7 (odds ratio [OR] per study day: 0.73 [95% confidence interval [CI]: 0.64, 0.83]). Response rate was lowest at the start of the day, and highest between the hours of 12:00-14:00. Female participants responded to more prompts than male participants (OR: 1.72 95% CI: [1.03, 2.86). There was no evidence of differential response by age (OR: 0.73 95% CI: [0.41, 1.28]). Most participants (65%) rated their experience using the smartwatch positively, with 33% saying they were happy to participate in future studies using the smartwatch. For children that didn’t wear the smartwatch for the full study duration (n=22), discomfort was the most common complaint (41%).

Conclusions In this study of the feasibility of μEMA on smartwatches to measure eating in Malaysian children we found the method was acceptable. However, response rates declined across study days resulting in substantial missingness. Future studies (e.g. through focus groups) should explore approaches to improving response to event prompts, trial alternative devices to increase children’s comfort and evaluate revised protocols for reporting of intake events.

Competing Interest Statement

The authors have declared no competing interest.

Funding Statement

The Medical Research Council (MR/T018984/1) and the Ministry of Higher Education/UK-MY Joint Partnership on Non-Communicable Diseases (2019/MR/T018984/), both provided funding in support of this research. The SEACO health and demographic surveillance system is supported by Monash University. The study's funders played no part in the study's planning, gathering, analysing, or interpreting data, or in the report's preparation. Sophia M. Brady is funded by the National Institute for Health and Care Research (NIHR) Applied Research Collaboration (ARC) North East and North Cumbria (NENC) (NIHR200173). The NIHR Bristol Biomedical Research Centre funds Miranda E.G. Armstrong (NIHR203315). The views expressed are those of the authors and not necessarily those of the NIHR or the Department of Health and Social Care.

Author Declarations

I confirm all relevant ethical guidelines have been followed, and any necessary IRB and/or ethics committee approvals have been obtained.

Yes

The details of the IRB/oversight body that provided approval or exemption for the research described are given below:

Ethical approval was obtained from the Monash University Human Research Ethics Committee on 17/03/2020 (Project ID: 23271) and University of Bristol REC Case no. 2020 - 4208(ID nr.: 1304255).

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Data Availability

Data cannot be shared publicly for confidentiality and ethical reasons. De-identified data are available and can be freely requested from the South East Asia Community Observatory, Monash University Malaysia Institutional Data Access at “mum.seacomonash.edu“ for researchers who meet the criteria for access to confidential data. For more information, please refer to https://www.monash.edu.my/seaco/research-and-training/how-to-collaborate-with-seaco.

AbbreviationsμEMAMicro-interaction Ecological Momentary AssessmentEMAecological momentary assessmentmEMAmobile ecological momentary assessmentSEACOSouth East Asia Community ObservatorySEACO-CH20SEACO Child Health 2020