Adherence to ecological momentary assessment studies in children and adolescents with psychopathology: A systematic review with meta-analysis

Abstract Ecological momentary assessment (EMA) is a tool facilitating the repeated collection of real-time data in naturalistic settings that can be applied to clinical research. Despite established methodological strengths, EMA protocols may be burdensome for participants, potentially leading to problems with adherence. Existing meta-analytic evidence is insufficient to inform the decision making of clinical researchers in using EMA in their work. In the current registered report, we address this need by conducting a systematic review with meta-analysis (1) examining adherence (enrollment, dropout, and compliance) in children and adolescents with psychological disorders and symptoms and (2) identifying aspects of study design that maximize adherence. In January 2023, we searched five databases for empirical EMA studies of youth (8–17 years) with psychological symptoms/diagnoses with data on adherence. We extracted data, assessed study quality, and conducted meta-analyses using random-effects models. We included 130 studies with 14,400 participants. On average, surveys contained 15 items, took over 3 min to complete, and incorporated surveys with multiple response scale types delivered using smartphones/cell phones provided to participants. Meta-analyses revealed that study enrollment was moderate to high (82% in youth with psychopathology, 67% in community youth) and dropout prior to starting EMA protocols was low (<1–2%). Dropout during EMA protocols was 12% for youth with psychopathology and 8% for community youth, underscoring the importance of maintaining participant engagement throughout EMA studies. Compliance approximated the 80% field benchmark for healthy youth but was lower for youth from the community and with psychopathology. Participant characteristics (e.g., younger age) and design factors (e.g., incentive-based compensation) were associated with greater compliance in certain groups. Despite limitations (missing data, methodological constraints), findings have important implications for researchers developing and conducting pediatric EMA protocols. The stage 1 protocol for this Registered Report was accepted in principle on April 19, 2024. The protocol, as accepted by the journal, can be found at: https://doi.org/10.6084/m9.figshare.25732482.v1 . This research was supported by the Intramural Research Program (IRP) of the NIMH and the NIH Library’s and Office of Research Service’s support of the NIH IRP.