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Dear Diary,
I have been struggling with an eating disorder for the past few years. I am afraid to eat and afraid I will gain weight. The fear is unjustified as I was never overweight. I have weighed the same since I was 12 years old, and I am currently nearing my 25th birthday. Yet, when I see my reflection, I see somebody who is much larger than reality.
I told my therapist that I thought I was fat. She said it was 'body dysmorphia'.
She explained this as a mental health condition where a person is apprehensive about their appearance and suggested I visit a nutritionist. She also told me that this condition was associated with other anxiety disorders and eating disorders. I did not understand what she was saying as I was in denial; I had a problem, to begin with. I wanted a solution without having to address my issues.
Upon visiting my nutritionist, he conducted an in-body scan and told me my body weight was dangerously low.
I disagreed with him.
I felt he was speaking about a different person than the person I saw in the mirror. I felt like the elephant in the room- both literally and figuratively. He then made the simple but revolutionary suggestion to keep a food diary to track what I was eating.
This was a clever way for my nutritionist and me to be on the same page. By recording all my meals, drinks, and snacks, I was able to see what I was eating versus what I was supposed to be eating. Keeping a meal diary was a powerful and non-invasive way for my nutritionist to walk in my shoes for a specific time and understand my eating (and thinking) habits.
No other methodology would have allowed my nutritionist to capture so much contextual and behavioural information on my eating patterns other than a daily detailed food diary.
However, by using a paper and pen, I often forgot (or intentionally did not enter my food entries) as I felt guilty reading what I had eaten or that I had eaten at all.
I also did not have the visual flexibility to express myself through using photos, videos, voice recordings, and screen recordings. The usage of multiple media sources would have allowed my nutritionist to observe my behaviour in real-time and gain a holistic view of my physical and emotional needs.
I confessed to my therapist my deliberate dishonesty in completing the physical food diary and why I had been reluctant to participate in the exercise. My therapist then suggested to my nutritionist and me to transition to a mobile diary study.
Whilst I used a physical diary (paper and pen), a mobile diary study app would have helped my nutritionist and me reach a common ground (and to be on the same page) sooner rather than later.
As a millennial, I wanted to feel like journaling was as easy as Tweeting or posting a picture on Instagram. But at the same time, I wanted to know that the information I provided in a digital diary would be as safe and private as it would have been as my handwritten diary locked in my bedroom cabinet.
Further, a digital food diary study platform with push notifications would have served as a constant reminder to log in my food entries as I constantly check my phone. It would have also made the task of writing a food diary less momentous by transforming my journaling into micro-journaling by allowing me to enter one bite at a time rather than the whole day's worth of meals at once.
Mainly, the digital food diary could help collect the evidence that I was not the elephant in the room, but rather that the elephant in the room was my denied eating disorder.
Sincerely,
The elephant in the room
Measuring experiences poses two fascinating challenges for researchers, first an experience is subjective, it's how we feel, and second, it can change moment to moment. If you are to ask your neighbour "how optimistic are you of your day ahead?", their feeling about it may be different at 6:30 AM when the alarm goes off than at the end of the day, after they have gone for a run.
If an experience is so momentary yet can hold so many insights, how to conduct research that seeks to understand how people think or feel during their daily lives? The answer to that question is a research methodology called "experience sampling method".
In this guide, we will dive into this method of data collection, the kind of features a survey software should for experience sampling studies and what mobile apps you can use to start gathering in the moment data.
Experience Sampling Method (ESM) is a research procedure where participants are asked to provide self-reports of their emotions, symptoms or environment, at different moments during their daily lives. The key to experience sampling is gathering data at the moment and situational, in other words: right then and there.
This type of research studies, also referred to as Ecological Momentary Assessment (EMA), Daily Diary Method or Ambulatory Assessment, are characterized by intensive longitudinal data collection. For that reason, ESM studies tend to rely on some automatic reminding system for participants to be notified when to answer a set of questions. This research method's main benefit is that since participants collect the data in situ and as an experience occurs, it minimizes the bias of recollecting past events and memory.
Experience sampling was invented in 1983 by two psychologists: Reed W. Larson and Mihaly Csikszentmihalyi. The first studies of this kind aimed to study adolescents, particularly the relationship between their emotions and their world around them. They sought to answer questions like "how do these adolescents spend their time?" or "what do they usually feel like when engaged in various activities, like doing schoolwork or being with their friends?" and "how do they feel when they are in solitude?", among others.
One of the most complex challenges that these sorts of studies faced in their beginnings were a practical one: how to engage participants during their daily and private lives "without disrupting the phenomena to be observed". To accomplish that goal, participants were asked to carry electronic pagers. These devices would beep at a random schedule, which would signal the participant that it was time for a paper questionnaire to be completed.
Larson and Csikszentmihalyi came up with an exceptional procedure to do research, little did they know then, what four decades later we would all be carrying in our pockets — every moment of the day.
In the last decade, the smartphone revolution has opened a whole new world for Experience Sampling studies. Offline-friendly mobile forms make it easy for researchers to directly collect qualitative and quantitative data from subjects, regardless of whether they are. Additionally, push notifications on smartphones can remind a participant if a required set of questions has not been completed.
Smartphones and tablets have opened the door to a whole new realm of possibilities for experience sampling research. Today, mobile devices are ubiquitous, relatively affordable, and provide the right combination of features for "in the moment" questionnaires.
Below we will break down what those features are that make a survey or data collection software suitable for this kind of research:
A must-have feature for any software for experience sampling research is a survey or form builder. A survey builder allows researchers to design a digital questionnaire with different field types such as text, number, multiple choice; rich multimedia, audio, video or images, and the possibility to collect GPS coordinates to have precise knowledge of where the subject was at that moment.
Additionally, by using branching logic, a researcher can change what questions a respondent will see based on how they answer a previous question. Branching logic is a powerful feature in experience sampling software. It shows the respondent just the fields they should see and makes a set of questions as short as possible, ultimately improving the measurement's completion rate.
A reminding system is the cornerstone of an experience sampling procedure. The data's value increases when a participant captures it in real-time and at specific moments.
The reminding logic is the central brain of experience sampling procedure
Studies may have different reminding procedures, and hence an ecological assessment software should be flexible enough to support diverse reminding requirements.
A type of sequence where the patient is reminded based on rolling bases, for example:
A type of reminding sequence where the software asks the participant to answer a set of questions on fixed dates:
In certain study types researchers will choose to remind participants at random intervals within a day:
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While the reminding logic is the brains of an experience sampling study, it's not what the user will see or hear. The actual cue that informs the user to answer a set of questions at a defined interval is a smartphone or push notification.
Mobile notifications are incredibly powerful but quickly can feel invasive and irritating. The rule of thumb: Less is more.
A push notification is a mobile alert visible on the locked screen of a smartphone or tablet. Smartphones use notifications for different use cases, such as alerting you when you have received a message or when someone sent you a friend request on a social media platform. Mobile devices can also, together with a notification, trigger a sound or vibration.
Push notifications are an excellent solution to researchers doing experience sampling since they can:
A push notification can be received from a server or work locally on the device (offline). Offline notifications mean the patient or participant will be reminded to answer a set of questions even if they don't have an internet connection at that moment on their mobile device.
The message that appears in a push notification can be customized by the researcher, potentially increasing engagement with the subject.
When tapped, a push notification can direct the user to a specific page in a mobile application, for example, a set of ready-answer questions.
One of the biggest strengths of mobile apps is the possibility to work offline; in other words, without an internet connection. This technology opens the door to experience sampling studies in places with slow or no internet connection or areas where the cost of mobile internet is too high.
Data collection apps that support offline data entry store the data in the local memory of the device and synchronize it to a server once an internet connection is available. Want to read more on how offline data collection works? Don't miss our best practices for offline data collection.
When doing daily diary studies, sensitive personal data, and possibly even medical data, will be collected. Hence, essential questions must address beforehand: what happens in the unfortunate event that a participant loses their mobile device or has it stolen, can someone access that sensitive information? Also, how can we trust that the data entered will be safe from tampering or unauthorized access?
While forms or surveys may be relatively easy to build for a developer, fundamental security measures must be taken when developing a solution that will store sensitive information:
Storing data on a mobile device comes hand in hand with support for offline data collection. In other words, for an app to support the storage of data without the internet, it has to keep it locally on the memory of the device until the device regains an internet connection.
When a mobile app stores data locally, it means that if someone physically has a mobile device in their possession, they can access its memory card and hence data. For this, local data encryption is a must when handling sensitive data. This kind of encryption is also referred to as "data at rest encryption" you can read more on it in our article about data security in mobile forms.
If a user would lose their device, there should exist a mechanism to remotely sign out the user on that mobile application and remove access to the data.
Most users have an automatic screen lock on their mobile device, to unlock their phone they must enter a number or use their fingerprint.
Although this is a recommended setting on Android or iOS devices, what happens if a device is stolen, or lost, and the owner has not enabled a screen lock? Then anyone could unlock the phone and quickly gain access to any stored sensitive data. For this reason, banking and medical apps have a passcode screen that is specific to that mobile application and acts as an extra safeguard against unauthorized access to sensitive information.
Mistakes happen all the time when entering data and experience sample studies are not an exception to this. A data collection app may allow users to go back to previously saved entries and fix a mistake. Going back and correcting an error is useful for both the participant and the researcher who needs the highest quality data possible. Still, it raises the question, how do you know when a change occurred, if it was during a particular time interval and if it can be indeed attributed to that user?
Those questions can be answered by what is often referred to as an Audit trail or Revision History. An audit trail is a type of report that shows the complete history of when data was created, or modified when that occurred and who did it.
An audit trail, or revision history, is a must-have feature if the experience sampling software permits data changes.
Diego
If appropriately used in the 21st century, data could save us from lots of failed interventions and enable us to provide evidence-based solutions towards tackling malaria globally. This is also part of what makes the ALMA scorecard generated by the African Leaders Malaria Alliance an essential tool for tracking malaria intervention globally.
If we are able to know the financial resources deployed to fight malaria in an endemic country and equate it to the coverage and impact, it would be easier to strengthen accountability for malaria control and also track progress in malaria elimination across the continent of Africa and beyond.
West African Lead, ALMA Youth Advisory Council/Zero Malaria Champion
Build fully customizable data capture forms, collect data wherever you are and analyze it with a few clicks — without any training required.
Learn more Build customisable mobile forms, create flexible reminders and invite participants with a few clicks — without any training required.
Try ESM/EMA demo for freeLearn more The software landscape for researchers wanting to conduct experience sampling research has become incredibly dynamic in recent years, with a rise of different solutions, both open source and free and also commercially available.
Below is a sample (no pun intended) of six experience sampling app that researchers may consider when collecting data for daily dairy studies:
Teamscope is a secure and easy-to-use data collection app for clinical and field research.
Teamscope allows researchers to quickly build fully customizable forms which can be used on Android, iOS or any web browser.
The app supports flexible reminders that can be used in experience sample studies. Additionally, these mobile notifications work offline, meaning that users do not need an internet connection while participating in a daily diary study.
To mitigate the risk of alert fatigue Teamscope makes it easy for users to change the time they receive a reminder and only triggers a push notification when a user has not answered a set of questions within an expected time frame (e.g. every day). This approach to reminders, allows Teamscope to send the least amount of push notifications to users, making the experience as personal as possible and less intrusive.
One of Teamscope's strong points is data protection and security. When a user closes and reopens the app, it requests for a 4-digit passcode must be entered, this passcode screen acts as an extra safeguard if a phone or tablet with sensitive research data is lost or stolen.
Cost: Plans for ESM/EMA start at €250/month with a 7-day free trial.
Availability: iOS, Android and Web
Project Mycap is a mobile app developed by REDcap, a popular data collection solution for academic and medical research.
Project MyCap is a highly flexible and robust experience sampling software. It stands out among other platforms since it supports active or cognitive tasks and direct integration with Apple's Research Kit and ResearchStack.
Since MyCap works together with the REDcap platform to use it, researchers will need access to a REDcap server. If you are part of a non-profit or academic organization may be able to use REDcap on a local server.
MyCap offers an app-specific passcode lock that users can quickly unlock with an eight-digit number or a user's fingerprint. This functionality keeps data secure while at the same time, access to the app quick and easy for users.
MyCap offers a flexible reminder system with support for rolling, fixed reminders has a unique approach towards baseline dates, allowing study participants to set a custom baseline data within the app.
Cost: Comes free with REDcap.
Availability: iOS, Android and Web
MetricWire is a mobile data collection platform. It allows researchers to build complex studies online without any programming knowledge required and provides participants with the option of answering momentary questionnaires from their mobile device or tablet.
Metricwire stands out among the rest for its location targeting and geo-fencing capabilities. Geo-fencing is a virtual perimeter that is created to demarc a specific geographical area.
In the context of ecological momentary assessments, geo-fencing allows researchers to set up geomarked hotspots and trigger a set of questions when a user has entered that area or has been in proximity with another study participant.
Another powerful feature of Metricwire is the ability to notify participants through multiple communication channels: push notifications, SMS, email, and automated phone calls. Combining those different touchpoints can create an escalated reminder workflow, thus increasing the chances of engagement with participants.
Cost: Contact Metricwire for pricing details
Availability: iOS, Android and Web
ExpiWell is an online and mobile platform for gathering a person's daily experience as they experience it.
ExpiWell is geared explicitly towards experience sampling research and is used by leading organizations, such as Harvard University, Yale and the University of Virginia.
Expiwell's is incredibly unique in its support for multimedia data collection by participants, making it possible to include video, audio, and image upload within a form.
The platform's reminding system can handle complex study designs and supports rolling, random, and calendar-based (e.g. every January 1st) reminders.
Joining a study on ExpiWell is simple, with its different invite mechanisms. Researchers can invite participants with an invite-only access code or email invitation.
Cost: Basic plan is free, paid plans starting at $1,295 per year.
Availability: iOS, Android and Web
Ethica is a cross-platform solution (Android, iOS & Web) that enables researchers to collect qualitative and quantitative data on human behaviour.
Ethica leverages the power of mobile sensors and wearable technologies to provide researchers with valuable insights into their subjects' behaviour, cognitive abilities, and answer essential questions like "what is on their mind" or "what activity are you doing at this moment?"
Ethics is geared toward sensitive data collection. Thus, it provides privacy-specific features such as data anonymization, allowing participants to delete data from their device after being collected and data encryption.
Additionally, Ethica makes it possible for organizations to either use Ethica's cloud or host the data on their own local servers.
Lastly, it is flexible enough to allow changes to a study after it has started giving researchers peace of mind and adaptability.
Cost: Unlimited free trial available, contact Ethica for custom pricing.
Availability: iOS, Android and Web
LifeData is a cross-platform software for designing and conducting experience sampling and ecological momentary assessment research.
By installing the RealLife Exp mobile app (Android & iOS), participants can quickly join experience studies, receive push notifications and complete questionnaires with different field types. Additionally, LifeData makes consent and remote onboarding easier by allowing researchers to present participants with images or videos within a form.
Joining a study in LifeData is very easy; participants can scan a QR code and that onboards them directly to a specific study.
Participants can also search within the app among different public studies that have been created by LifeData researchers and easily join them.
LifeData stands out, among other experience sampling solutions for its advanced sampling capabilities, such as triggering delayed follow-up questions, limiting the time a participant has to complete a form and linking two participants together to trigger a survey when another one has completed a questionnaire (also known as "yoked control design").
Cost: Contact LifeData for pricing.
Availability: iOS, Android and Web
Smartphones have changed how we communicate and do science on human behaviour. While decades ago, the only way to study a subject was in a lab, clinic, or in person. We can now engage with them remotely, capture data on their daily experiences in real-time, and use GPS and mobility sensors to understand where they are or what they are doing.
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The possibilities for understanding the daily life of their participants have never been more exciting for researchers. Across different disciplines, such as healthcare, environmental research or product innovation, researchers can without any programming knowledge required design experience-based studies, remotely invite participants and collect rich and high quality "in the moment" data.
With a near-infinite number of survey and mobile data collection solutions out there, searching for data capture technologies that support elaborate form design, recurrent reminders, data security, can save organizations time and money.
References:
Dear Digital Diary,
I realized that there is an unquestionable comfort in being misunderstood. For to be understood, one must peel off all the emotional layers and be exposed.
This requires both vulnerability and strength. I guess by using a physical diary (a paper and a pen), I never felt like what I was saying was analyzed or judged. But I also never thought I was understood.
Paper does not talk back.Using a daily digital diary has required emotional strength. It has required the need to trust and the need to provide information to be helped and understood.
Using a daily diary has needed less time and effort than a physical diary as I am prompted to interact through mobile notifications. I also no longer relay information from memory, but rather the medical or personal insights I enter are real-time behaviours and experiences.
The interaction is more organic. I also must confess this technology has allowed me to see patterns in my behaviour that I would have otherwise never noticed. I trust that the data I enter is safe as it is password protected. I also trust that I am safe because my doctor and nutritionist can view my records in real-time.
Also, with the data entered being more objective and diverse through pictures and voice recordings, my treatment plan has been better suited to my needs.
Sincerely,
No more elephants in this room
Diego is the founder and CEO of Teamscope. He started Teamscope from a scribble on a table. It instantly became his passion project and a vehicle into the unknown. Diego is originally from Chile and lives in Nijmegen, the Netherlands.
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