Ecological momentary assessment of daily drug use and harm reduction service utilization among people who inject drugs in non-urban areas: A concurrent mixed-method feasibility study.

Background: Ecological momentary assessments (EMA) can improve data accuracy and be useful for understanding the real-time co-occurrence of drug use and harm reduction service utilization among people who inject drugs (PWID); however, feasibility and acceptability of EMA in this population is unknown.

Methods: We conducted qualitative interviews (n = 45) and EMA surveys (n = 38) with PWID in cities and towns outside of Massachusetts' and Rhode Island's capital cities to 1) assess EMA feasibility and acceptability and 2) examine day-level correlations between drug use and harm reduction service utilization.

Results: Qualitative and quantitative data demonstrated that a 14-day EMA study was both feasible and acceptable. Interviews identified housing instability and related disruptions in cellphone access as challenges to consistent EMA participation. In the 14-day EMA study, EMA completion was high (mean = 10.1 days,SD = 5.3). High completion was associated with higher education (p = 0.005), receiving EMA via SMS text (vs. email, p = 0.017), and not having injected crack in the past month (p = 0.026). Of those who responded (n = 29), 100 % reported willingness to participate in a similar future study. Past 24 -h use of harm reduction services was positively associated with past 24 -h injection drug use (p = 0.013), but not past 24 -h syringe sharing (p = 0.197).

Conclusion: Findings support the acceptability, feasibility, and potential utility of EMA for understanding daily experiences of PWID. Future studies should explore strategies to overcome structural barriers to maximize EMA participation, and assess how injection practices, syringe sharing, and use of harm reduction services interact to impact health risks in larger and diverse samples of PWID.