https://www.i-jmr.org/issue/feed 2024-01-18T09:15:04-05:00 JMIR Publications editor@jmir.org Open Journal Systems Unless stated otherwise, all articles are open-access distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by/3.0/), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work ("first published in the interactive Journal of Medical Research...") is properly cited with original URL and bibliographic citation information. The complete bibliographic information, a link to the original publication on http://www.i-jmr.org/, as well as this copyright and license information must be included. A new general medical journal for the 21st century, focusing on innovation in health and medical research. https://www.i-jmr.org/2026/1/e72866 2026-09-24T16:45:10-04:00 Heleen Riper Annet Kleiboer Adriaan Hoogendoorn Judith Bosmans Mieke Schulte Kim Mathiasen Jean Baptiste Hazo Jerome Holtzmann Karine Chevreul David Daniel Ebert Ingrid Titzler Mathias Berking Burkhardt Funk Anneke van Schaik Lise Kemmeren Roman Cieslak Ewelina Smoktunowicz Anna Maj Cristina Botella Azucena Garcia-Palacios Rosa Banos Rocío Herrero Gerhard Andersson Naira Topooco Kristofer Vernmark Thomas Berger Tobias Krieger Arlinda Cerga-Pashoja Asmae Doukani Ricardo Araya Eirini Karyotaki Spyros Kolovos Mark Hoogendoorn Ward van Breda Pepijn van de Ven Artur Rocha Gonçalo Gonçalves Pim Cuijpers

Background: Cognitive behavioral therapy (CBT) is an effective and widely used treatment for major depressive disorder (MDD). However, access is limited by long waiting lists and a shortage of trained therapists. Evidence-based guided and self-guided digital interventions can address these challenges, but their large-scale adoption in routine primary and specialized mental health care has been slow. Blended CBT (bCBT), combining face-to-face therapy with structured, guided digital treatment modules, may increase treatment capacity while maintaining the benefits of therapist support. Objective: The European Comparative Effectiveness Research on Internet-based Depression Treatment study, conducted across 9 European countries, is the first large-scale comparative bCBT study for MDD. The hypothesis was that bCBT is clinically noninferior and cost-effective when compared with treatment as usual (TAU), which mainly consisted of face-to-face CBT. Methods: A multisite randomized controlled trial was conducted with a noninferiority margin of =0.20. Main inclusion criteria were age ≥18 years, a diagnosis of MDD based on the Mini International Neuropsychiatric Interview, and a baseline Patient Health Questionnaire-9 (PHQ-9) score of ≥5. The primary outcome was the PHQ-9, with secondary outcomes including MDD remission at 12 months, therapeutic alliance, and costs. Intention-to-treat analyses were performed, and linear mixed modeling was used to assess intervention effects. Cost-effectiveness analyses were conducted from a health care perspective. Results: A total of 835 patients were included in the study. bCBT was shown to be noninferior to TAU on the primary PHQ-9 outcome during treatment (3 months after the baseline assessment, =−0.26, 95% CI −0.43 to −0.09), at 6 months (posttreatment, =−0.21, 95% CI −0.39 to−0.04), and at 12-month follow-up (=−0.01, 95% CI −0.19 to 0.17). Furthermore, the bCBT group had a significantly lower likelihood of experiencing an MDD episode at 12 months (odds ratio 0.67, 95% CI 0.45‐0.99). Subgroup analyses indicated that participants with and with no antidepressant use at baseline in both groups benefited equally from their treatment. Deterioration rates (Reliable Change Index) were below 5% in both groups. bCBT appeared acceptable for patients and therapists, with a strong working alliance in both groups. From a health care perspective, bCBT was not cost-effective at 12 months' assessment, as its total costs were not significantly lower than TAU. However, the probability that bCBT is cost-effective is high (0.95) at a willingness to pay (WTP) of €3800 per improvement in the PHQ-9 score, and 0.76 at a WTP of €10,000 per MDD case prevented (average 2017 exchange rate was €1=US $1.13). Conclusions: bCBT offers an effective and safe digitally supported alternative to face-to-face TAU for patients with MDD and their therapists in routine clinical care. From a health care perspective, its cost-effectiveness depends on policymakers’ WTP for the additional clinical benefits achieved. Trial Registration: ClinicalTrials.gov NCT02796573; https://clinicaltrials.gov/study/NCT02796573 and ClinicalTrials.gov NCT02542891; https://clinicaltrials.gov/study/NCT02542891 and German Clinical Trials Register DRKS00006866; https://drks.de/search/en/trial/DRKS00006866 and Netherlands Trials Register NTR4962; https://www.onderzoekmetmensen.nl/en/trial/25452 and ClinicalTrials.gov NCT02389660; https://clinicaltrials.gov/study/NCT02389660 and ClinicalTrials.gov NCT02361684; https://clinicaltrials.gov/study/NCT02361684 and ClinicalTrials.gov NCT02449447; https://clinicaltrials.gov/study/NCT02449447 and ClinicalTrials.gov NCT02410616; https://clinicaltrials.gov/study/NCT02410616 and ISRCTN Registry ISRCTN12388725; https://www.isrctn.com/ISRCTN12388725 International Registered Report Identifier (IRRID): RR2-10.1186/s13063-016-1511-1

2026-09-24T16:45:10-04:00 https://www.i-jmr.org/2026/1/e93231 2026-09-21T16:30:12-04:00 Josh Hamilton Emilie Pain Jesper Riise Zhiheng Zhang

Background: Insomnia is a common and persistent symptom in major depressive disorder (MDD), associated with poorer outcomes and reduced quality of life (QoL). Despite its prevalence, recent patient-reported data on the burden of insomnia symptoms in MDD remains limited. Objective: This study aimed to assess the burden of insomnia among individuals with MDD experiencing insomnia symptoms (MDDIS) and its impact on patient-perceived disease burden and QoL. Methods: A noninterventional, cross-sectional online study was conducted from October 2022 to February 2023 in adults with self-reported MDD and insomnia symptoms, residing in the United States or 1 of 5 European countries (EU5: France, Germany, Italy, Spain, and the United Kingdom). Participants completed validated questionnaires (Patient Health Questionnaire-9 [PHQ-9] for depression severity and Insomnia Severity Index [ISI] for insomnia severity) and provided data on demographics, clinical history, treatment experience, and perceptions. Descriptive statistics were used to summarize results, and subgroup analyses were conducted based on depression status and severity. Results: Among 1250 participants (United States: 500; EU5: 750), most were cisgender women (United States: 363/500, 72%; EU5: 637/750, 85%), aged ~48 years, and on average 13.4 years in the United States and 11.2 years in EU5 had passed since being diagnosed with MDD. Around 60% (United States: 312/500; EU5: 439/750) reported having moderate to severe insomnia symptoms. Most had used antidepressants (United States: 460/500, 92%; EU5: 646/750, 86%) at least 40% (United States: 198/500; EU5: 343/750) in both regions reported using sleep-related medications (over-the-counter sleep aids, dual-purpose medication, or sleep-specific medication). However, insomnia symptoms persisted, with around half of participants reporting 8 to 15 insomnia nights over 2 weeks. Insomnia symptom severity differed significantly according to depression severity and current depressive episode status. Nearly all participants reported negative consequences for daily functioning, including irritability, cognitive impairment, and reduced productivity, and approximately two-thirds identified sleep disturbances as having a major impact on their daily lives. Satisfaction with current treatments, particularly their effectiveness on sleep, was low, and 65%‐71% (488/750-354/500) of participants expressed a desire for alternative therapies. Conclusions: Insomnia symptoms are highly prevalent and burdensome among patients with MDD, severely affecting daily life and perceived treatment success. Insomnia remains inadequately controlled despite high medication use. These findings emphasize the need for integrated treatment strategies targeting both mood and sleep symptoms. Given its role in depression relapse, suicidality, and treatment resistance, addressing insomnia symptoms in MDD should be a clinical priority.

2026-09-21T16:30:12-04:00 https://www.i-jmr.org/2026/1/e93769 2026-09-17T16:00:17-04:00 Amirah Azzeri Wan Mastura Wan Musaludin Hafiz Jaafar Nurnabihah MD Hafidz Azimatun Noor Aizuddin

Background: Accurate clinical coding is critical in the casemix system to ensure proper resource allocation, health care policy planning, and data reliability. Inaccurate coding can result in significant financial losses to the hospital. To date, the implications of inaccurate coding in casemix implementations in Malaysia have rarely been explored. Objective: This study aimed to evaluate the accuracy of clinical coding and identify factors associated with accurate coding practices in a major teaching hospital in Malaysia. Methods: A cross-sectional study was conducted using 445 inpatient discharge records from Hospital Canselor Tuanku Muhriz from January 2023 to December 2023. Stratified random sampling was applied across 4 departments. Coding accuracy was determined by comparing electronic medical record entries to a gold-standard set by trained coders and specialists. Descriptive and bivariate analyses were performed accordingly. Results: This study found that the overall clinical coding accuracy was 76.4% (340/445). Documentation completeness (<.001) and coding turnaround time (=.02) were significantly associated with coding accuracy. Other variables such as patients’ sex, patient age, department, and coder experience were not significantly associated. Clinical coding accuracy in this setting was suboptimal. Conclusions: Continuous training and regular audits are recommended to improve coding quality and ensure reliable casemix data for policy and funding decisions.

2026-09-17T16:00:17-04:00 https://www.i-jmr.org/2026/1/e84466 2026-09-10T15:30:03-04:00 Lebogang Faith Thaga Gudani Goodman Mukoma Terry Jeremy Ellapen Takalani Clearance Muluvhu

<strong>Background:</strong> Hypertension is a significant modifiable risk factor for cardiometabolic syndrome, leading to increased morbidity and premature mortality. Understanding the differences in cardiometabolic risk profiles between hypertensive and normotensive adults is essential for effective prevention strategies. <strong>Objective:</strong> This study examined cardiometabolic risk profiles among adults in Johannesburg South, Gauteng Province, South Africa. <strong>Methods:</strong> A cross-sectional study was conducted with 209 adults aged 25 to 65 years who were recruited from 3 Johannesburg townships in Region G. Anthropometric measures (BMI and waist circumference), blood pressure, and biochemical indexes (random glucose, total cholesterol, high-density lipoprotein cholesterol, low-density lipoprotein cholesterol, and triglycerides) were assessed. Statistical analyses were performed using Stata (version 19), with statistical significance set at <i>P</i>&lt;.05. <strong>Results:</strong> Hypertension prevalence increased significantly with BMI (<i>P</i>&lt;.001) and waist circumference (<i>P</i>=.003). In multivariable analysis, age and elevated glucose levels were independently associated with hypertension, whereas obesity and central adiposity were not significantly associated after adjustment. <strong>Conclusions:</strong> Hypertension was independently associated with advancing age and elevated glucose levels in this population. Although obesity and central adiposity showed significant associations in unadjusted analyses, they were not independently associated with hypertension after adjustment. These findings highlight the importance of early screening and targeted interventions to address cardiometabolic risk in underserved South African communities.

2026-09-10T15:30:03-04:00 https://www.i-jmr.org/2026/1/e94085 2026-09-08T16:15:13-04:00 Angela Yee Man Leung Karen Siu Lan Cheung Kai-ling Ou Ivy Yan Zhao Min Qiu Ka Ming Wan Jed Montayre Yaqi Huang

Background: Over the past 2 decades, concerns have arisen about the distinction between health span and lifespan, highlighting that longevity does not necessarily equate to good health, a concept often referred to as “healthy longevity.” While various strategies have been explored to promote healthy aging and achieve healthy longevity, it remains uncertain which practices are most effective. Objective: This scoping review identifies the existing and emerging practices and interventions that promote healthy longevity, identifies the key components of these practices and interventions, and considers how stakeholders contribute to these practices and interventions. Methods: A scoping review of the literature was conducted using Arksey and O’Malley’s 6-stage framework. The Joanna Briggs Institute Population-Concept-Context framework was used to define the eligibility criteria and select studies reporting practices or interventions aimed at achieving a long health span or promoting healthy longevity carried out in the community. Data were manually extracted by 2 independent reviewers to detail the characteristics of these practices and interventions and guide the data charting process and narrative synthesis. Six databases (PubMed, Web of Science, Embase, Scopus, CINAHL, and Google Scholar) were searched for academic papers published between January 2010 and February 2025. Results: A total of 21 studies met the inclusion criteria. Most studies (n=15, 71%) were published after 2020 and were predominantly conducted in high-income settings (n=17, 81%) across North America, Europe, and Asia. Four study types were identified: interventional (n=7, 33%), intervention development (n=4, 19%), association (n=5, 24%), and descriptive (n=5, 24%). Interventional and intervention development studies primarily described multicomponent programs targeting individual and social determinants of health and generally reported beneficial effects on physical, cognitive, and psychosocial outcomes. Association studies linked micro-, meso-, and macro-level factors (eg, nutrition, household expenditure, housing quality, health insurance, and public financing policy) to healthy longevity indicators. Descriptive studies highlighted themes across the micro and meso levels, including finance, physical activity, mental and spiritual health, digital literacy, independent living, safety, social support, and health care support. Conclusions: The identified community-based strategies, practices, and policies that extend health span represent the joint efforts of multiple stakeholders and disciplines. The implementation of these practices and policies is worthy of being supported. More studies in diverse socioeconomic contexts are needed.

2026-09-08T16:15:13-04:00 https://www.i-jmr.org/2026/1/e64150 2026-09-03T15:15:12-04:00 Kiyomi Tsuyuki Marguerite B Lucea Andrea N Cimino Michael Killian Christina J Catabay Engle Abrams Emmanuel Baffour-Siaw Jacquelyn C Campbell Douglas A Granger Jamila K Stockman

Background: Emerging evidence supports that women with histories of abuse have heightened stress and immune dysregulation. Few studies have examined the biological plausibility of this association in US Black women—a population disproportionately affected by gender-based violence (GBV), health disparities, and generally underrepresented in research. Biomarkers of stress and immune health remain challenging to study due to barriers in recruitment, retention, and protocol adherence. Objective: This study developed and examined the feasibility of an at-home, self-collected, and minimally invasive salivary cortisol awakening response (CAR) collection protocol among Black women with histories of abuse in Baltimore City, Maryland. Methods: Black women were recruited from November 2015 to May 2018 from Baltimore City sexually transmitted disease clinics. Participants received in-person instruction and demonstration on saliva self-collection using the passive drool method, and were provided study-issued cell phones for reminders and adherence tracking. Participants self-collected saliva samples upon waking and 30 minutes post waking on 3 consecutive days to assess CAR. Outcomes included protocol completion, self-reported adherence, and experiences (via saliva collection logs), a weighted protocol adherence score, and cortisol measures (waking, post waking, and CAR). Differences in sociodemographic characteristics and outcome measures were assessed by adult forced sex exposure status using chi-square tests and ANOVA. The Pearson correlation coefficient assessed the day-to-day reproducibility of cortisol measures among women with 2 full days of valid samples. Results: Of the 305 women completing the study survey, 228 completed the saliva specimen collection protocol, with no significant differences in completion between women with and without forced sex histories. Protocol feasibility was high, with 84% (191/228) completing at least 1 full day of adherent saliva collection and more than half (132/228) completing 2 full days. While feasibility did not differ by exposure status, women with adult forced sex exposure demonstrated lower protocol adherence scores compared to their unexposed counterparts. Between-day cortisol measures demonstrated variable reproducibility across waking, post waking, and CAR measures. Conclusions: This at-home salivary cortisol collection protocol was feasible in our robust sample of Black women with histories of abuse. The process of at-home collection of salivary biomarkers, including cortisol measures, was well-documented, and participants were able to adhere to it. The protocol yielded usable data that will facilitate the examination of the physiological and health repercussions of GBV.

2026-09-03T15:15:12-04:00 https://www.i-jmr.org/2026/1/e96541 2026-08-31T14:30:14-04:00 Samuel Thomas Harrold

Health care organizations face a “triple threat” of low analytics maturity, high workforce instability, and semantic technical barriers that together produce a crisis of “institutional amnesia.” Leadership turnover, workforce shortages, and widespread intent to leave among informatics specialists systematically erase the tacit knowledge required to navigate complex clinical data schemas, trapping organizations in a cycle where knowledge loss outpaces knowledge capture. Viewed through the socialization, externalization, combination, and internalization model of knowledge creation by Nonaka, the root cause is a “socialization failure”: high turnover fractures the social networks required for mentorship, rendering the traditional apprenticeship model of informatics unsustainable. To address this failure, we used a design science research approach synthesizing evidence from health care informatics, knowledge management, and natural language processing to develop a sociotechnical framework: human-in-the-loop knowledge governance (HITL-KG). HITL-KG is designed to shift the locus of organizational knowledge from volatile human memory to durable semantic artifacts called “validated query triples,” each comprising a natural language intent, executable SQL, and rationale metadata. By embedding knowledge capture into the daily query workflow, the framework aims to convert ephemeral analytics into permanent institutional assets. The accompanying 3-pillar assessment rubric enables organizations to identify compounding vulnerabilities across analytics maturity, workforce agility, and technical enablement. The “validator paradox” (who validates the AI when experts leave?) is addressed by reframing validation through lean “standard work”: each validated query establishes the current known standard rather than eternal truth, functioning as a “knowledge ratchet” that prevents regression. Decoupling analytical capability from individual tenure lets analytics maturity advance even as the workforce evolves. This paper proposes and theoretically motivates the framework; empirical validation is deferred to a companion study.

2026-08-31T14:30:14-04:00 https://www.i-jmr.org/2026/1/e89803 2026-08-28T16:45:11-04:00 Srinjaya Saha Yvonne Latham Carol Holland

Background: Digital medication adherence interventions for individuals diagnosed with chronic conditions have been developed, but their long-term efficacy in improving medication adherence has been limited. Exploring mechanisms and contexts related to outcomes of digital medication adherence interventions is important for these to be effectively tailored for different populations and contexts. A realist review was conducted to assess which intervention components might work for whom, and under what circumstances. Methods: A realist review of literature published between 2002‐2024 was conducted. Studies reporting digital medication adherence interventions for people diagnosed with chronic diseases and experiencing unintentional medication nonadherence issues were included. MEDLINE, CINAHL, PsycInfo, Web of Science, Scopus, Embase, and gray literature databases, Overton, and Policy Commons were searched. Data regarding contexts, mechanisms, and outcomes were extracted and synthesized into program theories. Program theories from the realist review were triangulated with findings from two rounds of workshops (three workshops in each round), in which context-mechanism-outcome (CMO) configurations were cocreated with various stakeholders of a project aimed at implementing a digital medication adherence intervention to reduce unintentional nonadherence among people with chronic diseases. There were 12 participants in each round. Results: The analysis of 83 papers and content of the cocreation workshops led to 35 CMOs theories in seven theory areas, which were (1) building and maintaining medication intake habits; (2) solving medication-related barriers to adherence; (3) enabling collection of prescription medications on time; (4) supporting people with unpredictable health conditions and sensory or motor impairments; (5) supporting individuals with high anxiety, low medication self-efficacy, and low social support; (6) supporting individuals who are uncomfortable with technology; and (7) economic, policy, and organizational factors affecting implementation of smart medication devices. Fourteen CMOs came from both the literature and workshops, 7 CMOs from the literature alone, and 14 CMOs from the workshops alone. Conclusions: Analysis of the program theories suggested a range of intervention components considering contextual factors that may improve medication adherence of individuals. These were used to form recommendations for intervention developers and implementers. Further studies are required on policy and economic factors affecting large-scale implementation of digital medication adherence interventions in different settings. Future interventions should report intervention content and delivery in detail and codevelop effective implementation strategies with professionals who can support the implementation of the intervention. Trial Registration: PROSPERO CRD42025641383; https://www.crd.york.ac.uk/PROSPERO/view/CRD42025641383

2026-08-28T16:45:11-04:00 https://www.i-jmr.org/2026/1/e91603 2026-08-28T16:30:14-04:00 Pauline Kaboth Lorenz Harst Jochen Schmitt Madlen Scheibe

Background: With the ongoing digitalization of health care, digital health literacy (DHL) is becoming increasingly important, requiring appropriate measurement instruments (DHLMIs). However, the wide range of available DHLMIs makes selection difficult and raises questions about their suitability and comparability. Objective: This review aimed to provide an overview of available DHLMIs for adult populations and to compare their dimensions, identifying overlaps and differences to determine which (key) dimensions are most commonly studied and thus define DHL. Methods: A narrative overview of reviews was conducted. The database search was conducted in November 2024, with an updated search in March 2026, in PubMed and Google Scholar using specific search terms and predefined inclusion and exclusion criteria. This was complemented by a forward citation search in Web of Science. All identified records were screened in a multistage process. At the review level, systematic and scoping reviews published since January 1, 2020, were included that analyzed DHLMIs in adult populations. At the primary study level, studies were included in which DHLMIs were used for self-assessment, performance-based evaluation, or a combination of both. Data extraction was performed by one reviewer and verified by a second reviewer. Data on underlying theories, methods of data collection (performance-based or self-reported), and target groups were extracted. DHL dimensions, their definitions, and the associated items were categorized by 2 researchers using qualitative content analysis according to Kuckartz. Results: A total of 12 reviews were included. Of the 170 measurement instruments examined in these reviews, 33 (19%) were selected for detailed analysis after applying the inclusion and exclusion criteria. The majority of the included measurement instruments (n=20, 61%) were not based on a theory, 20 (61%) measured DHL exclusively via self-report, and 21 (64%) addressed specific target groups. The measurement instruments encompassed a total of 209 original dimensions of DHL. The number of dimensions measured per instrument varied between 2 and 22. The qualitative content analysis identified a total of 30 assigned dimensions. Key dimensions captured in almost all instruments, although under different names, include evaluating health information, using health information, researching health information, and the ability to use technology. Conclusions: The large number of measurement instruments and original dimensions makes it difficult to select suitable instruments for measuring DHL and to compare and synthesize study results. Nevertheless, we were able to identify key dimensions as relevant regardless of target groups and types of digital applications, which could be used to develop a core outcome set for DHL. Our findings offer a foundation for refining existing instruments and developing new ones. They provide practical guidance for researchers and health care professionals in selecting suitable DHLMIs. Additionally, our review underlines the importance of theory to ensure content validity and comparability of DHLMIs.

2026-08-28T16:30:14-04:00 https://www.i-jmr.org/2026/1/e95238 2026-08-26T16:30:14-04:00 Weijie Wang Erika Penney Jaime Garcia

Background: Perinatal mental health issues are widely recognized as a significant public health concern; however, fathers remain underrecognized and underserved within perinatal care systems. Existing reviews have largely focused on mothers, infants, couples, or general paternal mental health interventions, leaving limited synthesis of technology-based and digitally delivered support relevant to paternal perinatal depression. Digital interventions, including SMS programs, online groups, web-based platforms, mobile health apps, and hybrid digital follow-up, may offer flexible ways of engaging fathers; however, their evidence base remains unclear. Objective: This scoping review aimed to map the available evidence on technology-based, digitally delivered, and hybrid interventions relevant to paternal postnatal depression and paternal perinatal mental health. Specifically, it examined the types of evidence available; how interventions varied by delivery mode, methodology, and population; how interventions were characterized in terms of format and duration; and what outcomes had been measured across studies. Methods: This review was conducted in accordance with the PRISMA-ScR (Preferred Reporting Items for Systematic Reviews and Meta-Analyses Extension for Scoping Reviews) framework. A comprehensive search was conducted between February and April 2025 and updated in June 2026 across multidisciplinary electronic databases. Search terms covered 4 concepts: fathers or nonbirthing parents, perinatal mental health, digital or technology-based modalities, and intervention or evaluation purpose. Eligible studies were peer-reviewed English-language articles in which fathers, expectant fathers, new fathers, male partners, or nonbirthing parents were active participants, target users, or reported subgroups, and in which a digital, technology-based, or hybrid support strategy was described or evaluated. Data were charted and synthesized descriptively and comparatively. Results: Six studies met the inclusion criteria. The evidence included a feasibility study of an SMS-based, father-specific program, randomized controlled trials of hybrid psychoeducational or paternal support interventions, a pilot randomized feasibility trial of an online cognitive behavioral therapy–based intervention for pregnant people and partners, a mixed methods online group intervention for new fathers, and a feasibility, acceptability, and usability study of a father-specific mobile health app. Delivery modes included SMS messaging, WhatsApp follow-up, online video, telephone follow-up, online groups, web-based intervention content, and mobile app features. Outcomes included depression, anxiety, stress, parenting stress, dyadic adjustment, marital quality, resilience, usability, acceptability, engagement, adherence, and qualitative user experience. Findings were most consistent for feasibility, acceptability, and engagement, while evidence for effectiveness in reducing paternal postnatal depression remained limited and mixed. Conclusions: The current evidence base is small, heterogeneous, and preliminary. Digital interventions may offer acceptable ways to engage some fathers and partners during the perinatal period. However, there is insufficient evidence to draw firm conclusions about effectiveness, scalability, or suitability for fathers experiencing perinatal depression. Future research should prioritize father-specific, theory-informed, co-designed digital interventions using validated paternal outcomes, longer follow-up, transparent engagement reporting, and more diverse samples.

2026-08-26T16:30:14-04:00