Working mechanisms of the use and acceptability of ecological momentary interventions: A realist evaluation of a guided self-help ecological momentary intervention targeting self-esteem

Mar Rose Postma* (Lead Author), Suzanne Vranchen, Maud Daemen, Meulen Iris Hoes-van der, Nele Volbragt, Philippe Delespaul, Lieuwe de Haan, Marieke van der Pluijm, Josefien Johanna Froukje Breedvelt, Mark van der Gaag, Ramon Lindauer, David van der Berg, Claudi Bockting, Therese van Amelsvoort, Matthias Schwannauer, Lawrence Doi, Ulrich Reininghaus

*Corresponding author for this work

Research output: Contribution to journalArticlepeer-review

Abstract / Description of output

Background
Technology improves accessibility of psychological interventions for youth. An ecological momentary intervention (EMI) is a digital intervention geared toward intervening in daily life to enhance the generalizability and ecological validity, and to be able to intervene in moments most needed. Identifying working mechanisms of the use of ecological momentary interventions might generate insights to improve interventions.

Methods
The present study investigates the working mechanisms of the use and acceptability of an ecological momentary intervention, named SELFIE, targeting self-esteem in youth exposed to childhood trauma, and evaluates under what circumstances these mechanisms of use and acceptability do or do not come into play. A realist evaluation approach was used for developing initial program theories (data: expert interviews and a stakeholders focus group), and subsequently testing (data: 15 interviews with participants, a focus group with therapists, debriefing questionnaire), and refining them.

Results
The SELFIE intervention is offered through a smartphone application enabling constant availability of the intervention and thereby increasing accessibility and feasibility. When the intervention was offered on their personal smartphone, this enhanced a sense of privacy and less hesitance in engaging with the app, leading to increased disclosure and active participation. Further, the smartphone application facilitates the practice of skills in daily life, supporting the repeated practice of exercises in different situations leading to the generalizability of the effect. Buffering against technical malfunction seemed important to decrease its possible negative effects.

Conclusions
This study enhanced our understanding of possible working mechanisms in EMIs, such as the constant availability supporting increased accessibility and feasibility, for which the use of the personal smartphone was experienced as a facilitating context. Hereby, the current study contributes to relatively limited research in this field. For the field to move forward, mechanisms of use, and acceptability of EMIs need to be understood. It is strongly recommended that alongside efficacy trials of an EMI on specific target mechanisms, a process evaluation is conducted investigating the working mechanisms of use.

Trial registration
The current paper reports on a realist evaluation within the SELFIE trial (Netherlands Trial Register NL7129 (NTR7475)).
Original languageEnglish
Article number1633
Pages (from-to)1-16
Number of pages16
JournalBMC Public Health
Volume24
DOIs
Publication statusPublished - 19 Jun 2024

Keywords / Materials (for Non-textual outputs)

  • ecological momentary intervention
  • self-esteem
  • target mechanism
  • working mechanism

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