UMMS Affiliation

Division of Cardiovascular Medicine, Department of Medicine

Publication Date


Document Type



Cardiology | Cardiovascular Diseases | Health Communication | Health Information Technology | Quantitative, Qualitative, Comparative, and Historical Methodologies


BACKGROUND: eCohort studies offer an efficient approach for data collection. However, eCohort studies are challenged by volunteer bias and low adherence. We designed an eCohort embedded in the Framingham Heart Study (eFHS) to address these challenges and to compare the digital data to traditional data collection.

OBJECTIVE: The aim of this study was to evaluate adherence of the eFHS app-based surveys deployed at baseline (time of enrollment in the eCohort) and every 3 months up to 1 year, and to compare baseline digital surveys with surveys collected at the research center.

METHODS: We defined adherence rates as the proportion of participants who completed at least one survey at a given 3-month period and computed adherence rates for each 3-month period. To evaluate agreement, we compared several baseline measures obtained in the eFHS app survey to those obtained at the in-person research center exam using the concordance correlation coefficient (CCC).

RESULTS: Among the 1948 eFHS participants (mean age 53, SD 9 years; 57% women), we found high adherence to baseline surveys (89%) and a decrease in adherence over time (58% at 3 months, 52% at 6 months, 41% at 9 months, and 40% at 12 months). eFHS participants who returned surveys were more likely to be women (adjusted odds ratio [aOR] 1.58, 95% CI 1.18-2.11) and less likely to be smokers (aOR 0.53, 95% CI 0.32-0.90). Compared to in-person exam data, we observed moderate agreement for baseline app-based surveys of the Physical Activity Index (mean difference 2.27, CCC=0.56), and high agreement for average drinks per week (mean difference 0.54, CCC=0.82) and depressive symptoms scores (mean difference 0.03, CCC=0.77).

CONCLUSIONS: We observed that eFHS participants had a high survey return at baseline and each 3-month survey period over the 12 months of follow up. We observed moderate to high agreement between digital and research center measures for several types of surveys, including physical activity, depressive symptoms, and alcohol use. Thus, this digital data collection mechanism is a promising tool to collect data related to cardiovascular disease and its risk factors.


Framingham Heart Study, adherence, agreement, app, cardiovascular disease, eCohort, mHealth, mobile health, smartphone, survey

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© Chathurangi H Pathiravasan, Yuankai Zhang, Ludovic Trinquart, Emelia J Benjamin, Belinda Borrelli, David D McManus, Vik Kheterpal, Honghuang Lin, Mayank Sardana, Michael M Hammond, Nicole L Spartano, Amy L Dunn, Eric Schramm, Christopher Nowak, Emily S Manders, Hongshan Liu, Jelena Kornej, Chunyu Liu, Joanne M Murabito. Originally published in the Journal of Medical Internet Research (, 20.01.2021. This is an open-access article distributed under the terms of the Creative Commons Attribution License (, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work, first published in the Journal of Medical Internet Research, is properly cited. The complete bibliographic information, a link to the original publication on, as well as this copyright and license information must be included.

DOI of Published Version



Pathiravasan CH, Zhang Y, Trinquart L, Benjamin EJ, Borrelli B, McManus DD, Kheterpal V, Lin H, Sardana M, Hammond MM, Spartano NL, Dunn AL, Schramm E, Nowak C, Manders ES, Liu H, Kornej J, Liu C, Murabito JM. Adherence of Mobile App-Based Surveys and Comparison With Traditional Surveys: eCohort Study. J Med Internet Res. 2021 Jan 20;23(1):e24773. doi: 10.2196/24773. PMID: 33470944; PMCID: PMC7857942. Link to article on publisher's site

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Journal of medical Internet research


Full author list omitted for brevity. For the full list of authors, see article.

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Creative Commons License

Creative Commons Attribution 4.0 License
This work is licensed under a Creative Commons Attribution 4.0 License.