Acceptability, usability, and recommendations for ecological momentary assessment among patients with bipolar...

Bipolar Disorder (BD) is a severe mental disorder worldwide. Ecological Momentary Assessment (EMA) has been proposed for real-time mood assessment in BD, but its acceptability and usability among Chinese BD patients and psychiatrists remain underexplored.

To explore the acceptability, usability, and recommendations of smartphone- and wearable-device-based EMA for out-of-hospital self-monitoring among Chinese BD patients.

Qualitative interviews were conducted with BD-diagnosed patients and psychiatrists in Tianjin, China. Following the initial interviews, BD patients engaged in a 14-day self-monitoring phase, involving three daily EMAs via smartphones and wearing smart bracelets to monitor step count and sleep patterns. A second interview collected comprehensive feedback on their EMA experience. Adherence was calculated as the proportion of fully completed and submitted EMA entries relative to the total push notifications received.

A total of 19 BD patients and 17 psychiatrists participated; analysis yielded four themes: (1) Monitoring impacts (assistance and support, self-awareness, behavioral modification, adverse experiences); (2) Adherence determinants (temporal and frequency aspects, technical specifications, motivational factors, operability, demographic characteristics, assessment design flaws); (3) Areas of concern (assessment modalities, privacy and data security, application scope, limited psychiatrist input); (4) Recommendations (device feature enhancements, temporal and frequency parameters). Over the 14 days, 756 surveys were distributed, yielding 649 responses and an adherence rate of 85.8%.

Smartphone- and wearable-device-based EMA demonstrates high acceptability among Chinese BD patients. To enhance acceptability and usability, it is crucial to customize the EMA content, optimize notification timings, improve device functionalities, and strengthen privacy and data security.