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Lookup NU author(s): Dr Sophia BradyORCiD
This work is licensed under a Creative Commons Attribution 4.0 International License (CC BY 4.0).
©Richard Lane, Louise A C Millard, Ruth Salway, Chris J Stone, Andy L Skinner, Sophia M Brady, Jeevitha Mariapun, Sutha Rajakumar, Amutha Ramadas, Hussein Rizal, Laura Johnson, Tin Tin Su, Miranda Elaine Glynis Armstrong.Background: Mobile phone ecological momentary assessment (EMA) methods are a well-established measure of eating and drinking behaviors, but compliance can be poor. Micro-EMA (μEMA), which collects information with a single tap response to brief questions on smartwatches, offers a novel application that may improve response rates. To our knowledge, there is no data evaluating μEMA to measure eating habits in children or in low-to-middle-income countries. Objective: In this study, we investigated the feasibility of micro-EMA to measure eating patterns in Malaysian children and adolescents. Methods: We invited 100 children and adolescents aged 7-18 years in Segamat, Malaysia, to participate in 2021-2022. Smartwatches were distributed to 83 children and adolescents who agreed to participate. Participants were asked to wear the smartwatch for 8 days and respond to 12 prompts per day, hourly, from 9AM to 8PM, asking for information on their meals, snacks, and drinks consumed. A questionnaire captured their experiences using the smartwatch and μEMA interface. Response rate (proportion of prompts responded to) assessed participants’ adherence. We explored associations between response rate with time of day, across days, age, and sex using multilevel binomial logistic regression modeling. Results: Eighty-two participants provided usable smartwatch data. The median number (IQR) of meals, drinks, and snacks per day was 2 (2-4), 3 (1-5), and 1 (0-2), respectively, on the first day of the study. The median response rate across the study was 68% (IQR 50-83). The response rate decreased across study days from 74% (68-78) on Day 1 to 40% (30-50) on Day 7 (odds ratio [OR] per study day 0.73, 95% CI 0.64-0.83). Response rate was lowest at the start of the day and highest between the hours of 12 PM and 2 PM. Female participants responded to more prompts than male participants (OR 1.72, 95% CI 1.03-2.86). There was no evidence of differential response by age (OR 0.73, 95% CI 0.41-1.28). Most participants (65%) rated their experience using the smartwatch positively, with 33% saying they were happy to participate in future studies using the smartwatch. For children that did not wear the smartwatch for the full study duration (n=22), discomfort was the most common complaint (41%). Conclusions: In this study of the feasibility of μEMA on smartwatches to measure eating in Malaysian children, we found the method was acceptable. However, response rates declined across study days, resulting in substantial missingness. Future studies (eg, through focus groups) should explore approaches to improving response to event prompts, trial alternative devices to increase children’s comfort, and evaluate revised protocols for reporting of intake events.
Author(s): Lane R, Millard LAC, Salway R, Stone CJ, Skinner AL, Brady SM, Mariapun J, Rajakumar S, Ramadas A, Rizal H, Johnson L, Su TT, Armstrong MEG
Publication type: Article
Publication status: Published
Journal: Journal of Medical Internet Research
Year: 2026
Volume: 28
Online publication date: 06/02/2026
Acceptance date: 30/12/2025
Date deposited: 17/02/2026
ISSN (print): 1439-4456
ISSN (electronic): 1438-8871
Publisher: JMIR Publications Inc.
URL: https://doi.org/10.2196/73435
DOI: 10.2196/73435
Data Access Statement: Data cannot be shared publicly for confidentiality and ethical reasons. Deidentified data are available and can be freely requested from the South East Asia Community Observatory, Monash University Malaysia Institutional Data Access at “mum.seaco@monash.edu” for researchers who meet the criteria for access to confidential data. For more information, please refer to [38]
PubMed id: 41649858
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