Ecological momentary assessment plus designs: A case study of implementation on fly-in, fly-out workers and their partners

This case study will take you through the development and implementation processes of a study utilizing an innovative design strategy: ecological momentary assessment plus (EMA+). EMA+ studies involve repeated quantitative sampling of participants’ current psychosocial and behavioral experiences with qualitative supplemental components. As an example of how EMA+ can reveal insight into dynamic behavioral and psychosocial experiences, we describe our study on a unique work roster style, fly-in, fly-out, in which workers are temporarily relocated for on-shift times and return to their residency for off-shift times. We take you through our decision-making and implementation processes from idea generation to dissemination of scientific publications. The topics we cover include managing an EMA+ study with a modest budget, coordinating project management, and how to capture rich qualitative and quantitative data across time to reveal comprehensive perspectives on the participants’ experiences. What started as interest in the dynamics of partners managing physical and mental health amid arduous work rosters of fly-in, fly-out workers resulted in the very first study to investigate the day-to-day mental and physical health of both fly-in, fly-out workers and their partners, enriched with qualitative data. Our EMA+ design allowed us to investigate dyads (worker and their partner) across time (daily assessments for 14 days) and between contexts (on-shift at work [partners living apart] and off-shift at home [partners living together]). Relations between behavior and psychosocial experiences can be complex and change rapidly over time; such dynamic processes can be studied and analyzed cost-effectively through EMA+ designs

Mental health and well-being concerns of fly-in fly-out workers and their partners in Australia: A qualitative study

OBJECTIVES: Fly-in fly-out (FIFO) work involves commuting long distances to the worksite and living in provided accommodation for 1-4 weeks while on shift. While the potentially detrimental impact of FIFO work on the health and well-being of workers has been documented, little attention has been paid to how workers, or their partners, cope with this impact. This study sought to investigate how workers and their partners negotiate the impact of FIFO on their mental health and well-being. DESIGN: The study design was qualitative. FIFO workers and partners responded to open-ended questions on concerns about the FIFO lifestyle and the support they use. SETTING: Australian FIFO workers and partners responded to the questions via email. PARTICIPANTS: Participants were 34 FIFO workers (25 men,Mage=41 years) and 26 partners of FIFO workers (26 women,Mage=40 years). RESULTS: Participant-validated thematic analysis generated three main themes: managing multiple roles, impact on mental health and well-being, and social support needs. Results revealed difficulties in adjusting between the responsibilities of perceptually distinct on-shift and off-shift lives, and managing potential psychological distance that develops while workers are on site. Participants emphasised the importance of maintaining quality communication and support from family members. Workers and partners attempted to maintain mental health and well-being by regularly engaging with support networks, although many felt organisational support was tokenistic, stigmatised or lacking. CONCLUSIONS: Recommendations for enhancing support provided by FIFO organisations are offered. In particular, organisations should emphasise the importance of good mental health and well-being, maintain transparency regarding potential challenges of FIFO lifestyles, and offer professional support for managing multiple social roles and effective communication

Health behaviours of Australian fly-in, fly-out workers and partners during on-shift and off-shift days: An ecological momentary assessment study

Objectives Fly-in, fly-out (FIFO) work involves long commutes, living on-site for consecutive days and returning home between shifts. This unique type of work requires constant transitioning between the roles and routines of on-shift versus off-shift days. This study aims to examine health behaviour patterns of FIFO workers and FIFO partners during on-shift and off-shift time frames. Design This study used ecological momentary assessment and multilevel modelling to examine daily health behaviours. Setting FIFO workers and FIFO partners from across Australia responded to daily online surveys for up to 7 days of on-shift and up to 7 days of off-shift time frames. Participants Participants included 64 FIFO workers and 42 FIFO worker partners. Results Workers and partners reported poorer sleep and nutrition quality for on-shift compared with off-shift days. Both workers and partners exercised less, smoked more cigarettes, took more physical health medication and drank less alcohol during on-shift compared with off-shift days. Conclusions FIFO organisations should consider infrastructure changes and support services to enhance opportunities for quality sleep and nutrition, sufficient exercise, moderate alcohol consumption and cigarette cessation for workers on-site and their partners at home. © Author(s) (or their employer(s)) 2018

Comparing the effects of FIFO/DIDO workers being home versus away on sleep and loneliness for partners of Australian mining workers

Fly in Fly out/Drive in Drive out (FIFO/DIDO) is a prevalent work arrangement in the Australian mining industry and has been associated with adverse outcomes such as psychological stress, sleep disturbances, fatigue, and work/life interference. FIFO/DIDO work arrangements have the potential to not only impact the FIFO/DIDO worker, but also the partner of the FIFO/DIDO worker. However, there is sparse empirical evidence on the impact of FIFO/DIDO work arrangements on partners’ sleep and subsequent performance. Therefore, the primary aim of this study was to describe and compare partners’ sleep quality, sleep duration, sleepiness, and loneliness when the FIFO/DIDO workers were at home (off-shift) and away (on-shift). A secondary aim of this study was to examine whether differences in partners’ sleep quality and sleep duration as a result of FIFO/DIDO worker’s absence could be partially explained through the presence of dependents in the home, relationship duration, chronotype, duration in a FIFO/DIDO role, and loneliness. Self-reported questionnaires were completed by 195 female and 4 male participants, mostly aged between 18 and 44 years and who had been in a relationship with a FIFO/DIDO mining worker for more than five years. Of note, most participants subjectively reported poor sleep quality, insufficient sleep duration, excessive sleepiness, and moderate to extreme loneliness compared to the general population regardless of whether the FIFO/DIDO workers were at home or away. Compared to when the FIFO/DIDO workers were at home, partners experienced reduced sleep quality and increased loneliness when the FIFO/DIDO workers were away. Secondary analyses revealed that loneliness may partially underpin the negative effect that FIFO/DIDO workers’ absence has on sleep quality. Further research is needed to understand the factors that contribute to poor sleep quality, insufficient sleep duration, excessive sleepiness, and loneliness of FIFO/DIDO partners to inform appropriate strategies to support FIFO/DIDO partners’ health and wellbeing not only in the mining population, but other industries that incorporate similar FIFO/DIDO work arrangements (e.g., emergency services, offshore drilling, and transport)

Using ecological momentary assessment to understand differences in associations of exercise time and psychological stress

Psychological stress puts people at risk for acute health problems (e.g., headaches, influenza), chronic illnesses (e.g., heart disease), and all-cause mortality. Evidence suggests daily exercise may help reduce stress; however, some people may benefit more from exercise than others. For example, Fly-in, Fly-out (FIFO) workers, who commute long distances to work and stay on-site for consecutive days/weeks experience different daily stressors (e.g., long-work hours, fatigue) from their partners at home (e.g., loneliness, additional childcare and domestic responsibilities), and from university students (e.g., studying, financial strains). The aim of our study was to determine if the daily exercise-stress association differs between these groups

A mixed-methods exploration of attitudes towards pregnant Facebook fitness influencers

Background: Exercise during pregnancy is associated with various health benefits for both mother and child. Despite these benefits, most pregnant women do not meet physical activity recommendations. A known barrier to engaging in exercise during pregnancy is a lack of knowledge about appropriate and safe exercise. In our current era of social media, many pregnant women are turning to online information sources for guidance, including social media influencers. Little is known about attitudes towards pregnancy exercise information provided by influencers on social media platforms. This study aimed to explore attitudes towards exercise during pregnancy depicted by social media influencers on Facebook, and user engagement with posted content. Methods: A mixed-methods approach was used to analyse data from 10 Facebook video posts of social media influencers exercising during pregnancy. Quantitative descriptive analyses were used to report the number of views, shares, comments and emotive reactions. Qualitative analysis of user comments was achieved using an inductive thematic approach. Results: The 10 video posts analysed were viewed a total of 12,117,200 times, shared on 11,181 occasions, included 13,455 user comments and 128,804 emotive icon reactions, with the most frequently used icon being ‘like’ (81.48%). The thematic analysis identified three themes associated with attitudes including [1] exercise during pregnancy [2] influencers and [3] type of exercise. A fourth theme of community was also identified. Most user comments were associated with positive attitudes towards exercise during pregnancy and the influencer. However, attitudes towards the types of exercise the influencer performed were mixed (aerobic and body weight exercises were positive; resistance-based exercise with weights were negative). Finally, the online community perceived by users was mostly positive and recognised for offering social support and guidance. Conclusions: User comments imply resistance-based exercise with weights as unsafe and unnecessary when pregnant, a perception that does not align with current best practice guidelines. Collectively, the findings from this study highlight the need for continued education regarding exercise during pregnancy and the potential for social media influencers to disseminate evidence-based material to pregnant women who are highly receptive to, and in need of reliable health information

Mobile APPlications targeting exercise in pregnancy: Quality and APPropriateness of behaviour change techniques

Purpose: Pregnancy presents a unique opportunity to positively influence exercise behaviours. Access to information, education and monitoring through m-health, including mobile applications (apps), may facilitate behaviour change. However, app quality and the presence and appropriateness of Behaviour Change Techniques (BCTs) used in apps is unknown. This study reviewed pregnancy apps to assess their quality and the prevalence and appropriateness of BCTs

Quality, features, and presence of behavior change techniques in mobile Apps designed to improve physical activity in pregnant women: Systematic search and content analysis

BACKGROUND: Physical activity during pregnancy is associated with several health benefits for the mother and child. However, very few women participate in regular physical activity during pregnancy. eHealth platforms (internet and mobile apps) have become an important information source for pregnant women. Although the use of pregnancy-related apps has significantly increased among pregnant women, very little is known about their theoretical underpinnings, including their utilization of behavior change techniques (BCTs). This is despite research suggesting that inclusion of BCTs in eHealth interventions are important for promoting healthy behaviors, including physical activity. OBJECTIVE: The aim of this study was to conduct a systematic search and content analysis of app quality, features, and the presence of BCTs in apps designed to promote physical activity among pregnant women. METHODS: A systematic search in the Australian App Store and Google Play store using search terms relating to exercise and pregnancy was performed. App quality and features were assessed using the 19-item Mobile App Rating Scale (MARS), and a taxonomy of BCTs was used to determine the presence of BCTs (26 items). BCTs previously demonstrating efficacy in behavior changes during pregnancy were also identified from a literature review. Spearman correlations were used to investigate the relationships between app quality, app features, and number of BCTs identified. RESULTS: Nineteen exercise apps were deemed eligible for this review and they were accessed via Google Play (n=13) or App Store (n=6). The MARS overall quality scores indicated moderate app quality (mean 3.5 [SD 0.52]). Functionality was the highest scoring MARS domain (mean 4.2 [SD 0.5]), followed by aesthetics (mean 3.7 [SD 0.6]) and information quality (mean 3.16 [SD 0.42]). Subjective app quality (mean 2.54 [SD 0.64]) and likelihood for behavioral impact (mean 2.5 [SD 0.6]) were the lowest scoring MARS domains. All 19 apps were found to incorporate at least two BCTs (mean 4.74, SD 2.51; range 2-10). However, only 11 apps included BCTs that previously demonstrated efficacy for behavior change during pregnancy, the most common being provide opportunities for social comparison (n=8) and prompt self-monitoring of behavior (n=7). There was a significant positive correlation between the number of BCTs with engagement and aesthetics scores, but the number of BCTs was not significantly correlated with functionality, information quality, total MARS quality, or subjective quality. CONCLUSIONS: Our findings showed that apps designed to promote physical activity among pregnant women were functional and aesthetically pleasing, with overall moderate quality. However, the incorporation of BCTs was low, with limited prevalence of BCTs previously demonstrating efficacy in behavior change during pregnancy. Future app development should identify and adopt factors that enhance and encourage user engagement, including the use of BCTs, especially those that have demonstrated efficacy for promoting physical activity behavior change among pregnant women