Assessing Minority Stress and Physiological Response Through Ecological Momentary Assessment and Sensors: Protocol for a Feasibility and Acceptability of the Stress and Heart Pilot Study.

backgroundLGBTQ+ (lesbian, gay, bisexual, transgender, queer, and other diverse sexual and gender identities) young adults may experience discrimination based on their sexual and gender minority status, which results in LGBTQ+ population health disparities. Although the health effects of minority stress have been studied for more than 30 years, most research relies on retrospective and cross-sectional designs. These methods limit the ability to establish causal links and to capture the fluctuating and time-sensitive nature of stress responses. In contrast, ecological momentary assessment (EMA) and wearable sensors allow for real-time tracking of stress exposures and their resulting physiological effects, enhancing data accuracy and ecological validity.

objectiveThe EMA and sensor protocol of the Stress and Heart Study was developed to capture real-time physiological responses to minority stress experiences among LGBTQ+ young adults. This pilot study aims to evaluate the acceptability and feasibility of the Stress and Heart Study protocol.

methodsParticipants who identified as LGBTQ+ between the ages of 18 and 30 years who reported experiencing LGBTQ+ discrimination in the past 30 days in a screening survey were invited to participate in a 2-week EMA and sensor study. Participants received 4 daily EMA surveys and one end-of-day (EOD) survey on their smartphones, assessing general and minority stress experiences, positive and negative emotional states, and substance use. Heart rate variability was continuously recorded using a wearable sensor. Upon completion, participants completed a short exit survey to evaluate their study experience and satisfaction.

resultsTwenty participants aged 18 to 27 (mean 21.7, SD 2.6) years were enrolled, representing diverse sexual orientations (8 lesbian/gay, 2 bisexual, 4 pansexual, and 6 queer), gender identities (10 cisgender, 3 transgender, and 7 non-binary), and racial/ethnic backgrounds (9 non-Hispanic [NH] White, 5 Latinx, 2 NH Black, and 4 NH Asian). Participants completed 89.4% (1001/1120) of EMA daily surveys and 92.1% (258/280) of EOD surveys. On average, participants wore the sensor for 74.6% (SD 24%) of the expected time (179/240 hours). The overall EMA daily and EOD surveys completion rate was 89.9% (1259/1400), with individual participation ranging from 70% (49/70) to 98.6% (69/70). A total of 85% (n=17) of participants reported wearing the sensor daily. In the exit survey, all participants indicated that the study's time commitment met their expectations. Additionally, 90% (n=18) of participants reported that the sensor was comfortable and that the EMA app was user-friendly, with appropriately timed questions.

conclusionsThis study supports the feasibility and acceptability of the Stress and Heart Study protocol using smartphones and wearable sensors to collect real-time data on minority stress experiences and physiological response. Further research is needed to validate the use of this protocol in larger observational and intervention studies aimed at addressing the adverse health impacts of minority stress among LGBTQ+ populations.