Feasibility and acceptability of smartphone-based ecological momentary assessment for monitoring suicidal ideation among gay, bisexual, and other men who have sex with men in Nepal.

BACKGROUND: Ecological momentary assessment (EMA) measures suicidal thoughts and behaviors in real-time. This study evaluated the feasibility and acceptability of smartphone-based EMA for suicide prevention among gay, bisexual, and other men who have sex with men (GBMSM) in Nepal. METHODS: Participants with prior suicidal ideation or moderate-to-severe depression completed three daily smartphone EMAs for 30 days. Feasibility was measured through recruitment, retention, and compliance, and acceptability through exit surveys and interviews. RESULTS: Of 55 individuals screened, 50 were enrolled and completed the baseline survey. Forty-eight participants (96%) completed at least one EMA and responded to 2,943 of 4,500 prompts (65.4%). Compliance remained stable across time points and did not differ by suicidal ideation (median 76.7% in both groups). Prior suicide planning (β:-19.9, 95% CI:-36.2 to -3.7), chemsex engagement (β:-30.1, 95% CI:-50.4 to -9.7), and identity disclosure (β:-23.0, 95% CI:-45.8 to -1.3) were associated with lower compliance. Acceptability ratings were high (means 4.0-4.4, range 1-5). Qualitative feedback noted ease of use, self-reflection, and perceived support, alongside concerns about repetitive suicide-related questions and privacy. CONCLUSIONS: EMA is feasible and acceptable for monitoring suicidal ideation among GBMSM in Nepal and may inform scalable digital suicide prevention interventions in similar low -and middle-income countries.