While much of the health research around men who have sex with men (MSM) involves HIV, these communities are at increased risk for other health problems including certain types of cancer, substance use and mental health issues. A new scoping review by VCU School of Medicine and Massey Cancer Center researchers finds that a specific type of data collection methodology called ecological momentary assessment (EMA), alongside of or as an intervention itself, could be particularly effective in supporting these populations.
EMA is a research method that repeatedly samples subjects in their natural environment to better understand their experiences over a period of time. It has the potential to create a rich dataset allowing researchers and clinicians to identify behavioral trends and contributing factors. This contrasts with other types of health behavior research that rely on retrospective feedback given directly to researchers or clinicians at a single point in time. EMAs minimize recall bias and can improve engagement among participants.
A scoping review provides an overview of available research evidence relative to a specific subject matter.
The authors first identified an initial set of 129 studies in their preliminary search, of which 15 met their eligibility criteria for the scoping review. The eligible studies included a total of 952 participants, with the smallest sample size being 12 and the largest being 120. They found that EMA methodology is both feasible and acceptable at high rates among MSM, especially when examining psychological and behavioral outcomes such as negative or positive affect, risky sexual behavior and substance use.
Ecological momentary assessment is a relatively novel approach to health behavior research, so I wanted to see what had been done, what were the best practices and what gaps existed in the research in order to inform future studies as well as behavioral and therapeutic interventions for MSM and other populations. We found strong support for EMAs, but we also found many of the study designs to be lacking best practices and a tendency for the research to focus on stigmatized behaviors such as substance abuse and unprotected sex."
Viktor Clark, M.S., lead author on the study and doctoral student in the Department of Health Behavior and Policy at VCU School of Medicine
Clark conceived of the scoping review while taking a research methodology class led by Sunny Jung Kim, Ph.D., assistant professor in the Department of Health Behavior and Policy at VCU School of Medicine and Harrison Scholar and member of the Cancer Prevention and Control research program at VCU Massey Cancer Center. Kim's class covered experience-sampling methods, including EMAs, and Clark felt they could be uniquely applied to benefit MSM, a collection of populations they had previously studied.
"EMAs have traditionally used methods such as written diaries and phone calls to sample participants over a period of time. 85 percent of Americans now own a smart phone, so there is great potential for EMAs to evolve with advances in technology," says Kim. "Short, micro surveys delivered through text messages or apps have the ability to collect extensive longitudinal data over time to better understand patterns and changes in behavior. They even have the potential to help health care professionals predict and intervene to prevent negative health outcomes in a variety of populations."
The review evaluated the different studies based on the Center for Disease Control's compendium of evidence-based interventions and best practices for HIV prevention. Most studies did not meet the full criteria for best standards defined by the CDC's recommendations. Kim and Clark stress the importance of developing evidence-based best practices for designing future EMAs, especially when delivered via smartphone or computer as there are unique challenges and opportunities associated with these platforms.
"I hope to continue this line of research into my Ph.D. dissertation. I have submitted a grant application to fund a study to test a conceptual model for interactions between health care providers and gender-and sexual-minority patients to identify points where EMA methodology could add further depth to findings," says Clark. "The goal is to make the patient-provider relationship better with communication and technology in order to improve things like medicine adherence and overall health outcomes."
Kim has also submitted a grant application to fund an EMA-based intervention study for cancer survivors. She plans to conduct research to identify factors, barriers and themes related to pain management and quality of life, and then use that information to design and deliver a technology-based intervention that distills scientific evidence into easy-to-understand messages that help support patient care.
Both authors stress the importance of an open science framework in which methods and results can be widely shared.
Clark, V & Kim, S.J., (2021) Ecological Momentary Assessment and mHealth Interventions Among Men Who Have Sex With Men: Scoping Review. Journal of Medical Internet Research. doi.org/10.2196/27751.