COPE-EMBRACE: Coping with stress after encephalitis using real-time assessment

Encephalitis can cause acquired brain injury due to inflammation, leading to cognitive issues and fatigue, exacerbating daily stress. Knowledge of real-time stress coping mechanisms among people post-encephalitis and how this relates to depression is limited. Ecological momentary assessment (EMA) may address limitations in standardized cross-sectional self-report assessments. This study evaluates the feasibility and acceptability of collecting EMA data on mood and coping. Twenty adults post-encephalitis (12 women, age range 26:67) completed daily and self-initiated EMA for mood and coping over 4 months, and post-study interviews explored acceptability using framework analysis. Average daily compliance rate was 79.3% (range 37.3-97.5%), showing EMA's feasibility, though low self-initiated EMA usage indicated challenges. Linear mixed-effects model revealed significant relationships between coping style and depression levels within individuals and over time. Framework analysis categorized two themes: "Encephalitis experience and its relationship to stress response" and "Experience of EMA: barriers and facilitators'. Qualitative analysis indicated acceptability for the m-Path app and measuring daily mood. Results suggest long-term daily EMA is feasible for collecting mood and coping in adults with encephalitis. However, patient and public involvement should be utilized to establish suitability. Following adaptations, EMA may serve as a psychological intervention targeting stress coping in daily life.