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.