Acceptability of Intensive Ambulatory Assessment Combining Four Wearable Sensors and Ecological Momentary Assessment to Assess Physical and Eating Behaviors in Adults: The WEALTH Project

Background: This study explored the acceptability of an intensive ambulatory protocol combining four wearable devices and ecological momentary assessment (EMA) to assess physical and eating behaviors. Methods: EMA and wearable data were collected over 7 days in a convenience sample of 622 participants (56.1% women, M_age = 38.2 years) in Ireland, Germany, France, and the Czech Republic. Short EMA questionnaires (eight to 17 items) assessing current activity, context, and mood were triggered randomly (seven per day) and in response to behavioral patterns detected by Fitbit, such as prolonged sitting (max four per day), walking, or running (each max three per day). EMA compliance was assessed by the proportion of completed questionnaires. Among four wearables worn (Fitbit/ActivPAL/Actigraph/LifeQ), compliance was measured using Fitbit heart rate recordings. Acceptability for EMA and wearables was assessed using 5-point Likert-scale questionnaires on daily burden, ease of use, interference, and ethical satisfaction. Associations with sociodemographic and health factors were analyzed. Results: Participants received on average 11.5 (±SD 1.9) EMA questionnaires per day. EMA acceptability scores ranged from 3.8 (burden) to 4.6 (ethical satisfaction), while wearable acceptability scores ranged from 4.1 (burden/reactivity) to 4.6 (ease of use/ ethical satisfaction). Low perceived daily burden was associated with higher compliance for EMA wearables (odds ratio: 1.88, 95% CI [1.30, 2.72] and 1.74, 95% CI [1.08, 2.80], respectively), while smartphone interference increased with age (odds ratio: 0.62, 95% CI [0.50, 0.78]). No association was found with sex and educational level. Conclusions: Acceptability of EMA and wearables was generally satisfactory. As EMA compliance may be affected by daily burden, well-designed protocols are key to leveraging ambulatory assessment of real-time behavioral and contextual data.