Automated Daily Phone Surveys in Older Adults: Feasibility Study in the Multi-Ethnic Study of Atherosclerosis

Background: An ecological momentary assessment (EMA) is a methodological framework designed to capture real-time data in a participant's natural environment, yet its feasibility in older adults, particularly in a large, multisite study, remains underexplored. Objective: This study aims to assess the feasibility of implementing automated daily phone surveys in a large, geographically diverse cohort of older adults. Methods: A total of 1283 participants from the Multi-Ethnic Study of Atherosclerosis (MESA) were enrolled across 6 US field sites. Participants were scheduled to receive 1 automated phone survey per day for 7 consecutive days following a clinic visit. Feasibility was assessed through a dual lens of participant engagement (survey adherence, phone survey duration, and cancellations) and administrative implementation (scheduling errors). Results: Of the 1272 participants who received at least 1 of the 7 phone surveys, high adherence was observed, with 81.84% (1041/1272) completing 5 to 7 surveys. Age was the only demographic characteristic significantly associated with completion (P=.002), as younger participants demonstrated higher adherence. While the median survey duration was 3 (IQR 2-4) minutes, 26.84% (2371/8835) of surveys lasted 5 minutes or longer. However, adherence remained remarkably robust even among participants experiencing these extended durations. Participant-initiated cancellations during the 7-day monitoring period were rare, occurring among 21 of 1272 (1.65%) participants who began monitoring. Administrative scheduling errors were also uncommon, accounting for 37 of the 8835 (0.42%) total scheduled surveys not being delivered. Conclusions: Findings support the feasibility of automated daily phone surveys for collecting repeated real-world data in large, multisite studies of older adults. Future studies should incorporate standardized participant feedback to identify barriers to engagement and support more inclusive, participant-centered adaptations of automated phone-based EMA protocols.