“Is the use of
electronic diaries (EDs), for assessing clients in their natural
environment, conducive to better management of the cases?” The
studies reviewed in this paper show that electronic diaries provide a
strategic advantage by capturing near real-time reports of events,
which have been shown to be notably more accurate and useful compared
with traditional recall-based reporting of the same events. Use of
electronic diaries has the potential to improve the quality of
clinical assessments by providing a near real-time approach to data
capture and to improve understanding and better management of the
cases by clinicians. However, the caveat is that EDs are just as good
as the questions they ask, and the clients have to take on the
responsibility of entering data regularly.
Assessing
clients in their natural environments with electronic diaries:
rationale, benefits, limitations, and barriers
Piasecki TM, Hufford
MR, Solhan M, Trull TJ. Psychol Assess. 2007 Mar;19(1):25-43
Reviewed by: Muzna
Mirza
This study focuses on
the general approach of electronically reporting clinical assessment
data on a near real-time basis – and not on any methodology in
particular.
Research design/methodology
This paper reports a
review of studies focusing mainly on a number of clinical
psychological problems. The number of articles reviewed and assessed
for inclusion in this review was not described.
Eligibility criteria
Articles describing
studies that compared the ED approach to traditional assessment
approaches or examined different aspects of the electronic diary
approach were included in the review. The reviewed studies examined a
variety of clinical problems and were not focused on any particular
clinical domain or technology. Detailed information about the study
types and participants was not provided. A variety of comparisons and
outcome measures were discussed; the most common being the comparison
between ED and traditional recall-based approaches for assessment, in
terms of compliance with data recording schedule and the reliability
of the records as compared to actual events.
Search methodology
The authors do not
describe the methodology used to find the articles reviewed in this
study.
Analysis
Qualitative analysis
was conducted in this study by briefly describing the methods and
results of various articles.
Assessment
of methodological quality
Neither the inclusion
nor the exclusion criteria for the studies reviewed were explicitly
stated. However, the title and introductory section of this report
implied some of the eligibility criteria mentioned above. The absence
of clear criteria makes it difficult for other researchers to
replicate the review, and there are chances that others may come to
different conclusions from those implied in this report. The authors
refer to the studies as clinical, but it is not clear whether they
were only clinical psychological studies or also included clinical
medical studies.
Research question
“Is the use of
electronic diaries (EDs), for assessing clients in their natural
environment, conducive to better management of the cases?”
Intervention
The intervention in
the reviewed studies was the ED approach for data reporting by
clients. The use of various platforms for EDs is discussed in the
review.
Technologies
No particular
hardware or software was the focus of this study. The authors
reviewed a number of diverse studies comparing the use of the
electronic diary methodology with traditional recall-based data
reporting. Various platforms for ED were mentioned in the review
including pagers, programmable wristwatches, personal digital
assistants, interactive
voice response systems, World Wide Web, pill
bottles that record times and dates of opening, portable transducers
for measuring smoking topography and wearable devices to track blood
alcohol content via skin.
Outcome
HIGHLIGHTS:
Electronic diaries have the potential to improve the quality of
clinical assessments by providing a near real-time approach to data
capture and improving understanding and better management of the
cases by clinicians.
IMPLICATIONS:
Traditional methods of assessment include “retrospective
questionnaires” that are simple to use but yield largely
inaccurate reports because of the limitations of recall, an important
factor in this approach. On the other hand, electronic diaries have
the potential to improve the quality of the assessment by providing a
near real-time approach to data capture and reducing the incidence of
retro-filling of the diary. This may reduce biased recording of past
observations based on events in the future. Improved assessment may
lead to better understanding and management of patient cases by
clinicians.
GENERALIZABILITY: The
issue of the “limitations of recall” and the benefits of
the ED approach seem to be generalizable to a variety of clinical
practice domains, as shown by the reviewed studies which focus on a
number of clinical problems. However, intentional bias is likely in
all diary approaches and is of greater concern in clinical
assessment, as compared to basic research, because of personal
relationships between clients and clinicians. Therefore, the results
of this review are more applicable to clinical research and
assessment. However, in situations where diary assessment is likely
to influence an action such as a major surgery, direct in-hospital
observation, per se or in addition to the ED approach, is advisable.
CONSISTENCY: Most of
the studies reviewed in this report described the benefits of the ED
approach for yielding rich data. Additionally, the studies caution
that the overall benefits may depend on factors like the objectives
of the assessment, the diary design and the ability of the clients to
use the devices.
Further areas for research
Using EDs may add
considerable burden for clients, and may not be useful for certain
populations, such as those with visual impairment or other physical
limitations. The effect of such factors should be assessed before a
generalized recommendation for the use of the ED approach can be
made. Additionally, trials which compare the data reported through
traditional methods to that by the ED approach should also attempt to
carry out direct observation in order to validate both data reporting
approaches.
