Outpatient assessment

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Outpatient assessment means collecting data in the everyday life of the person examined. The data is collected on an outpatient basis ("mobile") in contrast to inpatient measurements that are linked to locations such as clinics or laboratories. The current experience and behavior are recorded promptly in the respective concrete situation. In addition, the recorders used in psychophysiology can also register movement activity ( accelerometry ) and various physiological measured values. This shows how psychological and physical changes are related. In medicine, outpatient 24-hour monitoring (surveillance) has proven itself, for example to examine patients with high blood pressure under everyday living conditions.

definition

Outpatient assessment means collecting data in the everyday life of those examined, today mostly with computer-aided methodology to record information about the current state of health and behavior (self-reports), behavioral measures, exercise behavior and physiological measured values. In addition, mostly objective framework conditions (English. Setting) such as whereabouts, activity, presence of other people and the subjective evaluations of the situation are recorded. The Experience Sampling Method ESM, developed in the 1970s by Mihály Csíkszentmihályi and colleagues in Chicago, was, in contrast to the first German research work by Kurt Pawlik and Lothar Buse, originally not a computer-aided method, but used a programmed clock and questionnaires in attached form (booklet).

Outpatient assessment is the meanwhile widespread and comprehensive term in the German-speaking area for data collection in everyday life. In contrast, similar terms such as Ecological Momentary Assessment EMA, Experience Sampling Method ESM, Time Sampling Diary TSD or electronic diary (electronic diary) usually only refer to the diary-like recording of current self-reports and not to behavioral data and physiological measurements.

The systematic recording, observation and monitoring of a process with the intention of intervening in a controlling manner if the desired course does not occur is called monitoring (see biomonitoring , patient monitoring ). In contrast, the outpatient assessment is not limited to monitoring functions, but has a wide range of possible uses and, as a " field investigation ", stands in contrast to the psychological experiment in a laboratory (as an "artificial" situation) or subsequent data collection when the situation is no longer present (e.g. B. evening answers to questions about experiencing stress in certain situations of the day).

Methods and general assessment strategies

At set times, a small portable computer, a personal digital assistant (hand-held PC), prompts you to enter the agreed report, for example about your whereabouts and activities, your well-being, physical complaints and symptoms. Another version is that the person determines the input time themselves as soon as they find themselves in a certain situation.

Today, computer-aided methods are so developed that they are suitable for various data:

  • Self-reports about whereabouts, activity, presence of other people (so-called setting);
  • Information about the state of health, symptoms, comments on everyday events and the current examination;
  • psychological test results under field conditions;
  • Behavioral observations and external perception data;
  • Behavior measurements, speech activity, physical activity and movement patterns;
  • Environmental conditions, noise, brightness, temperature, etc .;
  • physiological measured values ​​in continuous and automatic registration;
  • medical parameters based on self-measurements. (see Fahrenberg, Leonhart and Foerster, 2002).

Compared to the conventional “paper-and-pencil” methods ( questionnaire , personality questionnaire ), an “electronic diary” has the important advantage of being close to the situation to be assessed, whereby memory effects and evaluations will have less of an impact than with one time interval. Such computer-aided self-reports are current and situation-related statements that are anchored with an exact time. In general, because they are more closely related to behavior, they will be more valid and convincing than the answers to a questionnaire completed later. The technical reliability of the computer-aided data collection surpasses that of the questionnaire method, and the exact chronological logging of the entries also controls the reliability - instead of just hoping that all those examined will keep to the agreed schedule for their self-reports in everyday life. Further practical advantages of the computer-aided self-reports are the flexible programming of questions and answer options as well as the simple data transfer. In addition, there are the newer communication technologies: unidirectional or bidirectional communication with investigators or therapists via mobile phone (cell phone) as well as web applications with the possibility of data transfer and data analysis in real time , possibly with feedback to the examined.

With modern recording and evaluation systems, important physiological functions can also be recorded under everyday conditions. a. the electrocardiogram (heart rate), blood pressure , breathing , skin temperature and motor functions ( accelerometry ). There are now a large number of portable data acquisition systems with versatile software (Ebner-Priemer and Kubiak, 2007; Myrtek, Foerster and Brügner, 2001). A promising methodology is to record speech activity and ambient noise when the participants are ready. In this way, after a familiarization, everyday data, u. a. about the social environment, social interactions, habits, hints e.g. B. on depressive mood changes can be obtained (Mehl & Holleran, 2007).

The psychological assessment of the data collected on an outpatient basis is fundamentally dependent on information about the respective context (setting). Self-reports are mostly used for this, and less often behavioral observations. In addition, important environmental conditions can be measured.

Applications

While outpatient monitoring in medicine is primarily used to diagnose and monitor high-risk patients, etc. a. for cardiovascular diseases, the tasks of outpatient assessment in psychology are more varied. Even in industrial psychology and clinical psychology , there are monitoring tasks such. B. in risky workplaces or as self-monitoring for certain chronic health disorders or behavioral problems.

For many other questions, behavioral and experience data from everyday life are essential. In future, outpatient assessment will be the method of choice here instead of the questionnaires that are currently predominant. Work and health are important fields of research and practice that require everyday data collection. Examples are the thorough recording of workloads, the pain diary for chronic pain disorders and the diagnosis and therapy control in patients with panic disorder (applications in the field of clinical psychology and psychiatry, see Wilhelm and Perrez, 2008).

With blood pressure monitoring it has been shown that the measurements in the medical practice and in the research laboratory often do not match the measurements in everyday life ( blood pressure measurement , white coat hypertension ). There could also be systematic errors in other areas due to a lack of everyday data.

criticism

Most of the investigators reported that the acceptance of computer-assisted methods, i.e. H. of equipment and requirements, as a rule, is good. The sense of pain diaries with regard to testing and setting the optimal medication is just as evident as the practical use of blood pressure measurement under everyday conditions. An undesirable, method- related reactivity can - depending on the examination plan - express itself in different effects. Only some of those examined believed that objective self-awareness had increased through regular self-reports. Being paged several times a day by an electronic diary can become annoying after a while, at least in certain situations. Therefore, the programming should provide that the self-report can be postponed if necessary. In contrast, the glued-on electrodes for a long-term ECG or the sensors for accelerometric movement measurement are so unobtrusive that they can simply be forgotten for a long time. The limits of outpatient monitoring and assessment become clear when individual persons show strong method-related reactivity or when various disruptive effects overlap in everyday life. In the meantime, control strategies have been developed to differentiate the interesting from the disruptive effects.

Everyday recordings could invade privacy more than other investigation methods . H. a participant could get into unpredictable situations whose registration is undesirable. Therefore, this option should be addressed when the participant's informed consent is obtained. In addition, it could happen, especially with audio recordings, that other people are unintentionally involved. Such problematic aspects have to be clarified retrospectively - up to the complete deletion of data.

The outpatient assessment can help avoid false conclusions and remains the most important methodology when it comes to the psychological situation, the behavioral differences or the behavioral disorders in everyday life.

See also

Individual evidence

  1. ↑ see: Fahrenberg, Myrtek, Pawlik and Perrez, 2007.
  2. ↑ Kurt Pawlik, Lothar Buse: Computer-aided behavioral registration in the field: description and first psychometric review of a new survey method. In: Journal for Differential and Diagnostic Psychology , 1982, Volume 3, 101-118.
  3. ↑ Joel M. Hektner, Jennifer A. Schmidt, Mihály Csíkszentmihályi: Experience sampling method. Measuring the quality of everyday life. Sage Publications, Thousand Oaks 2007. ISBN 1-4129-2557-6 .
  4. ^ Hermann Brandstätter: The Time Sampling Diary (TSD) of emotional experience in everyday life situations. In JA Coan, JJB Allen (Eds.). Handbook of Emotion Elicitation and Assessment . Oxford University Press, New York 2007, ISBN 0-19-516915-8 , pp. 318-331.
  5. ↑ Fahrenberg u. a., 2002

literature

  • Hans BJBussmann, Ulrich Ebner-Priemer, Jochen Fahrenberg: Ambulatory behavior monitoring: Progress in measurement of activity, posture, and specific motion patterns in daily life . In: European Psychologist , 2009, Volume 14, 142–152.
  • Ulrich Ebner-Priemer, Thomas Kubiak: Psychological and psychophysiological ambulatory monitoring - a review on hardware and software solutions . In: European Journal of Psychological Assessment , 2007, Volume 23, 214–226.
  • Jochen Fahrenberg, Rainer Leonhart, Friedrich Foerster: Everyday psychology with hand-held PC and physiological measuring system. Huber-Verlag, Bern 2002, ISBN 3-456-83818-2 . [1]
  • Jochen Fahrenberg, Michael Myrtek, Kurt Pawlik, Meinrad Perrez : Outpatient assessment - recording behavior in everyday life. A behavioral science challenge to psychology. In: Psychologische Rundschau, 2007, Volume 58, pp. 12-23.
  • Matthias R. Mehl, Tamlin S. Conner (Eds.): Handbook of research methods for studying daily life. Guilford Press, New York 2012, ISBN 978-1-60918-747-7 .
  • Matthias R. Mehl, Shannon E. Holleran: An unobtrusive observation sampling approach to psychological ambulatory assessment: The Electronically Activated Recorder (EAR). In: European Journal of Psychological Assessment , 2007, Volume 23, 248–257.
  • Michael Myrtek: Heart and emotion. Ambulatory monitoring studies in everyday life. Hogrefe & Huber, Cambridge, MA. 2004, ISBN 0-88937-286-1 .
  • Michael Myrtek, Friedrich Foerster, Georg Brügner: Freiburg Monitoring System (FMS). A data recording and evaluation system for examinations in everyday life: emotional stress, body position, movement, EKG, subjective well-being, behavior. Peter Lang Verlag, Frankfurt am Main 2001, ISSN  1430-8169 .
  • Kurt Pawlik, Lothar Buse: Environmental psychological methods of observation and data collection. In: Ernst-Dieter Lantermann , Volker Linneweber (Hrsg.): Encyclopedia of Psychology. Environmental psychology. Volume 1. Foundations, paradigms and methods of environmental psychology (pp. 751–783). Hogrefe, Göttingen 2008, ISBN 978-3-8017-0595-4 , pp. 751–783.
  • Meinrad Perrez : Ambulatory Assessment - computer-aided self-observation in the field. In: Franz Petermann., Michael Eid (Ed.). Manual of Psychological Diagnostics. Hogrefe, Göttingen 2006, ISBN 3-8017-1911-1 , pp. 187-195.
  • Arthur A. Stone, Saul Shiffman, Audie A. Atienza, Linda Nebeling: The science of real-time data capture: self-reports in health research . Oxford University Press, New York 2007, ISBN 978-0-19-517871-5 .
  • Peter Wilhelm, Meinrad Perrez : Outpatient Assessment in Clinical Psychology and Psychiatry (PDF; 139 kB). In: Journal of Psychiatry, Psychology and Psychotherapy , 2008, Volume 56, 169–179.

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