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

Background: Ample evidence indicates that everyday perceptions of the social environment can affect health behaviors; these include social comparisons (i.e., self-evaluations compared to others) and positive versus negative social interactions. However, relations between social perceptions and healthy behaviors have received little attention among specific medical populations for whom an improved understanding of behavioral determinants could inform updates to tailored interventions. Research methods that capture and differentiate between stable, person-level differences and dynamic, within-person variability in these relations would be particularly useful, both for identifying their nature in daily life and informing improvements to tailored interventions. Methods: We conducted a series of three formative research studies to adapt and test the measures and instructions for an ecological momentary assessment (EMA) protocol with midlife women who had elevated risk for cardiovascular disease (CVD; e.g., current diagnosis of hypertension, type 2 diabetes). Study 1 involved a pilot test of initial EMA items, sent to participants' smartphones 5 times per day for 7 days (N=13; MAge =47, MBMI =33.7 kg/m2), as well as brief exit interviews to identify points of confusion and suggestions for improvement. Study 2 used 1-hour, individual qualitative interviews with a new sample to elicit women's perceptions of revised items and identify additional opportunities for refinement (N=10, MAge =52, MBMI =29.8 kg/m2). In Study 3, a new sample of participants completed 7 days of EMA with revised items and instructions (5 times per day; N=13, MAge =50, MBMI =33.4 kg/m2). Results: Item performance in Study 3, including the frequencies of reporting social comparisons and interactions, was compared to that in Study 1 using multilevel modeling; these tests showed meaningful improvement in reporting patterns between Studies 1 and 3 (e.g., changes of d=0.33-0.75 where appropriate). Conclusions: Together, findings from this series of studies demonstrate the utility of a multi-study approach to refining EMA methods for use with midlife women who have elevated CVD risk, which may generalize to other populations of interest.