Comparing the feasibility and acceptability of global versus momentary sampling strategies to assess patterns of participation among individuals with

Individuals with disabilities and their caregivers report decreased participation in desired activities. They generally participate in fewer activities outside the home, with less intensity than able-bodied peers. Limited frequency and intensity of participation in desired or meaningful activities is significant because participation, defined as involvement in an activity or life situation, contributes to skill development, gives meaning to life, and generates social networks, which are important for health and development. Previous research has identified barriers and facilitators to participation, including body structures and functions, physical and social environments, and access to resources. However, participation measures often focus on context – including body, environments, and resources – as static constructs, while they are often experienced more dynamically in the real world. To this end, measures of participation in context are necessary for research and clinical care. Time use measures focus on how individuals occupy their time and can capture information about context at the time of participation in specific activities. Studies of time use can also reveal periods of inactivity, when there is little or no participation. This information can be used to more effectively identify and address barriers or facilitators to participation. Ecological momentary assessment (EMA) is a validated framework for capturing how people spend time, as well as influences on- and of participation. However, EMA encompasses a range of methods, with strengths and limitations relating to memory (bias) and response burden. To date, there is no consensus for methods of EMA, which can be applied to studies of participation among individuals with disabilities. Therefore, the purpose of this research is to compare the feasibility and acceptability of two EMA methods (global and momentary) for studies of participation with a cohort of individuals with spinal cord injuries (SCIs) and their caregivers. This study will follow a mixed-method cross-over design, wherein participants will be randomized to complete global or momentary EMA methods, before participating in a focus group to discuss burden and acceptability of each approach. Data analysis will focus primarily on examination of feasibility and construct validity. Estimated time for completion of recruitment, data collection, and analysis is approximately six months. This innovative study builds on traditions in occupational therapy to consider participation in context, and it will draw on expertise of participants to inform future work. Findings will be reported in a manuscript for publication and used to prepare a grant application for a larger study of participation among individuals with SCI and their caregivers.