Ethical issues in researching daily life
By Timothy J. Trull, PhD
Researchers who conduct ambulatory assessment should be aware of the pitfalls that may come
with new technology that captures participant data.
Advances in technology have profoundly influenced the possibilities for clinical assessment. Perhaps the
biggest development is a method of assessment that targets
people’s moods, cognitions, behaviors, physiological states and
experiences as they live their daily lives. Ambulatory assessment,
which is also referred to as ecological momentary assessment
(Stone & Shiffman, 1994), differs from traditional forms of
assessment such as questionnaires or clinical and diagnostic
interviews in at least two important ways (Trull & Ebner-Priemer, 2013).
First, because ambulatory assessment involves multiple
assessments over time, it is uniquely suited to focus on within-individual processes. For example, mood is a dynamic process
that ebbs and flows over time, often as a result of contextual
or environmental factors. Yet traditional, cross-sectional
assessment requires individuals to somehow characterize
mood by aggregating across time in some unspecified way.
Ambulatory assessment captures slices of this process in real-or near-real time, allowing an evaluation not only of changing
mood but also of internal and external influences on mood.
Second, the ecological validity and external validity of
ambulatory assessment exceeds that of more traditional
measures that are often completed in the artificial environment
of the clinic, office or hospital.
Ambulatory assessment: data-collection methods
Before discussing the ethical issues associated with ambulatory
assessment, it is important to briefly present some of the
data-collection methods that are used. Early research on daily
life used paper-and-pencil diaries for participants to record
thoughts, feelings and experiences (typically referred to as the
experience sampling method). Often, participants were given
packets of paper diaries and instructed on when to complete the
individual surveys, or they were prompted by pages or timers to
complete the surveys. These surveys were then turned in to the
researchers at designated intervals or at the end of the study.
The introduction of electronic diaries for recording
experiences represented a major advancement for several
reasons. First, all entries are time-stamped. Second, there is
no need to transcribe or score responses by hand. And third,
electronic diaries are more convenient to carry and can store
large amounts of data.
Also, and perhaps less familiar, there are “passive” data
collection methods for ambulatory assessment research.
Behaviors or states can be “observed” by electronic devices.
For example, devices can record opening of medication bottles
(including digital time stamps), smartphones can record
audio or video as well as geographical location, and there are
a number of products on the market that can record physical
activity levels, cardiac activity, respiration and electro-dermal
The widespread availability and use of smartphones is a
game-changer for ambulatory assessment. Almost 60 percent of
American adults own smartphones, and there are approximately
2 billion smartphone users worldwide. The smartphone can
serve as an electronic diary and can collect data using many
of its own built-in sensors and functions. Furthermore, using
Bluetooth connections, the smartphone can serve as a wireless
hub that collects and transmits data from both internal and
Ethical issues and challenges
With this increased utility comes a parallel increase in both
ethical issues and assessment challenges. They include:
• Informed consent. As with all forms of assessment, it is
necessary to ensure that ambulatory assessment participants
are informed about the procedures or protocol of the study,
the exact nature of the data to be collected, and potential risks
and burdens related to the study. Several unique features of
ambulatory assessment should be considered. First, especially
because ambulatory assessment may involve passive data
collection, it is vital to make the participant aware of all of the
data that are being collected, as well as how these data might
be used. It is also important to recognize that ambulatory
assessment may unintentionally capture data on nonconsenting
people who interact with the participant via audio recordings,
videos or photos. Investigators must decide ahead of time how
this should be handled. Should people be encouraged to discuss