Electronic Diaries
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LEADING ARTICLE
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Electronic Diaries Appraisal and Current Status Joan E. Broderick Department of Psychiatry & Behavioral Science, Stony Brook University, Stony Brook, New York, USA
Abstract
The recent explosion of technology has moved the field of patient reported outcomes into a new era. The use of paper-and-pencil questionnaires administered before and after treatment has been eclipsed by highly sophisticated random prompts for symptom ratings at multiple points throughout the day; a method known as ecological momentary assessment (EMA). During the last 25 years, research has demonstrated that retrospective ratings are subject to a variety of cognitive heuristics that can distort the report. Initially, this was addressed by adopting paper diary protocols involving multiple ratings in a day or across a week. However, advances in technology subsequently led to the use of electronic platforms for EMA assessment. A good deal of research has since been conducted to compare paper and electronic formats. Issues of compliance have been particularly problematic for paper diaries. Electronic technologies can be expensive and require expertise in programming and data management. Not all research questions will require intensive momentary assessment, and end-of-day ratings may be adequate for many applications. What is required of the investigator is familiarity with the strengths and weaknesses of the methods and platforms available, as well as a reasoned decision to select a particular methodology for the study question at hand.
1. Historical Roots of Diaries The historical roots of diaries as a form of data collection go back to at least the early part of the 20th century. In order to better understand the aetiology and course of symptoms of an illness, patients were asked to keep an on-going symptom record that could be reviewed by the physician.[1] However, it was not until later in the century that the method gained scientific attention. Mihaly Csikszentmihalyi, while at the University of Chicago, developed the ‘experience sampling method’ during his seminal work on the ‘flow’ of personal experience.[2] Rather than limiting the characterization of experience to a single rating or set of ratings provided retrospectively, Csikszentmihalyi asserted that the unfolding of experience on a moment-to-moment basis contained unique information not available from traditional self-report methods. At the same time, the blossoming of the Skinnerian behavioural movement in psychology in the 1970s viewed human behaviour as the result of learned experiences happening at that moment in the person’s environment. Consequently, behavioural observation of momentary events and reactions by an individual were viewed as theoretically and methodologically superior to traditional ques-
tionnaire assessment.[3] Shortly afterwards, psychologists in Europe and the US began to apply this new approach in a variety of studies, such as those investigating schizophrenia,[4] the relationship betw
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