Parent eHealth Preferences: Perceived Credibility and Personal Reactions to AbilitiCBT, BEAM, and Triple P Online

Parenting programs are consistently shown to improve child emotional and behavioral adjustment, sibling interactions, and overall family functioning (Adams, 2001; Jeong et al., 2021; Leijten et al., 2021). Psychotherapy for depressed mothers not only improves maternal mental health, but also child health, mother-child interactions, and marital satisfaction (Cuijpers et al., 2015). Some parental programs are unimodal, targeting parenting or mental health, while some are multimodal, targeting both at once. Multimodal programs may maximize efficacy through not only additive, but also transactional effects between parenting and mental health, as mental health is also associated with a parent’s capacity to implement supportive parenting strategies (Cuijpers et al., 2015; Goodman et al., 2020).

Parenting and mental health programs have long been delivered in-person (Kane et al., 2007; Long, 1997), with common contextual barriers such as difficulties with scheduling and time constraints, transportation costs and availability, and accessible childcare (Morin et al., 2022). Digital (eHealth) programs are a potential cost-efficient solution to contextual barriers associated with in-person service delivery and they also may help reach families living in areas underserved by psychosocial services. The limited access to in-person resources during the recent COVID-19 pandemic also highlighted the need for effective eHealth programs that will be available if other similar events occur (Lebow, 2021; Roos et al., 2020).

There are several eHealth programs that are currently offered to parents. Three programs that have shown promise are: AbilitiCBT (myicbt.com), Building Emotional Awareness and Mental Health (BEAM; thebeamprogram.com), and Positive Parenting Program (Triple P) Online (triplep-parenting.com). AbilitiCBT is a commercial internet-based Cognitive Behavioral Therapy (CBT) program where users go through 10 structured modules based on the principles of CBT while a therapist monitors progress. Each module teaches CBT-based techniques to help individuals understand and cope with anxiety and depression. The program is focused on mental health symptoms, with CBT being consistently found to effectively improve symptoms of depression and anxiety (Komariah et al., 2022), and some evidence showing additional positive effects on parenting-related stress (Ngai et al., 2016). BEAM is a recently developed interactive app-based group therapy and psychoeducational program targeting both mental health and parenting stress through values-based behavioural and self-compassion strategies targeting mental health symptoms combined with emotion-focused parenting strategies (Xie et al., 2022). BEAM is a 10-week program that includes weekly 1-hour group therapy sessions with other parents and clinicians and access to a mobile app that provides weekly educational videos on mental health and parenting skills, a private online forum to connect with other parents, and optional work sheets. BEAM has been found to be associated with reductions in mental health symptoms and parenting stress (MacKinnon et al., 2022; Xie et al., 2023). Finally, Triple P Online is a self-led course focused on promoting positive parenting and reducing behavioral and emotional problems in children. Parents work through eight online modules featuring video clips, interactive exercises, and a workbook on how to improve the family environment and prevent and reduce behavioral problems in children. Triple P Online has been shown to improve parent practices and well-being (Baumel & Faber, 2018). Despite the evidence for the efficacy of these different eHealth intervention models, there is a lack of studies examining whether parents find them credible and potentially useful, as well as their preferences among these programs.

While eHealth programs were found to have good efficacy for parents completing them, a review found that overall effects tend to be small, in part due to low engagement and retention (Florean et al., 2020). Limited knowledge on parental eHealth needs and preferences could partly explain this low engagement. Studies of in-person programs show that when programs are aligned with parent preferences they have higher enrollment and adherence, in turn maximizing positive effects on child development and general family functioning (Bannon & McKay, 2005; Nock & Kazdin, 2001). Better knowledge of parental impressions and preferences based on current eHealth programs could help identify programs that align with parental values, goals, and needs (Cunningham et al., 2008, 2013; Hoagwood, 2005). In turn, this could support program offerings to optimize engagement and positive effects on child, parent, and family functioning.

It is important to also consider that demographic and psychosocial factors may be associated with different preferences. For example, programs that encourage peer support were found to have positive perceptions from parents (Álvarez et al., 2021). A systematic review found that mothers were unique in flagging their poor mental health, being single, being a young parent, and having several children as barriers to accessing in-person programs (Jukes et al., 2022). Yet, few studies examined fathers, and even fewer examined differences between mothers and fathers, limiting the ability to make inferences on group differences.

Studies examining treatment modalities provide some more specific insights on eHealth. In one study, parents with mental health issues and fathers in general were more likely to prefer eHealth interventions, while mothers preferred in-person interventions, although effect sizes were small (Gonzalez et al., 2021). A prior study found the opposite, as fathers were more likely to prefer in-person interventions, citing that web-based interventions were unappealing as they reminded them of work and were not motivating (Frank et al., 2015). One study of eHealth preferences found that lower-income and less educated parents preferred briefer modules, with less educated parents also preferring a predefined module order (Broomfield et al., 2022). Overall, these studies suggest that some demographic and psychosocial factors are associated with parental preferences for treatment modalities and specific treatment components. It is important to have this evidence on specific program features to tailor new or existing programs. However, it is also important to examine preferences between existing programs, as this could inform how parents are guided in obtaining support while navigating current program offerings.

The present study’s main objective was to examine parental perceptions between AbilitiCBT, BEAM, and Triple P Online, as well as how demographic and psychosocial factors (including mental health symptoms, stress, and social support) were associated with their preferences. A secondary and complementary objective was to assess general parent preferences in treatment modalities (in-person vs. eHealth; mental health vs. parenting support).

Participants were recruited through Amazon Mechanical Turk (MTurk), which prior research has found to be an effective and efficient online parent recruitment strategy (Dworkin et al., 2016). The Human Intelligence Task (HIT) was restricted to MTurk workers with a Parenthood Status premium qualification in the United States (US) or Canada (but only parents from the US participated). Parents were eligible if they were comfortable understanding, reading, and speaking English and had at least one child between 0-5 years of age. Eligible participants filled out a one-time Qualtrics survey in March 2022. Ethics approval was obtained from the Psychology/Sociology Research Ethics Board at the University of Manitoba (HE2021-0090). All study procedures were conducted with the electronic informed consent of participants.

Best-practice MTurk recommendations (Aguinis et al., 2021) were employed, including a captcha verification. Unreliable data (from inattention, careless responding, and web robots) was identified through attention checks, mismatches between country and province/state (e.g., selects US and a Canadian province for their current residence), and completion times under 10 minutes, which were considered impossible based on survey testing. Our HIT for 300 responses yielded 335 completed surveys from eligible participants, of which 47.2% were deemed unreliable based on the criteria listed above. Thus, the final sample consists of 177 parents.

The sample consists of 177 parents of 0-5–year-old children in the US. Parents were from 37 different states (see Figure S1). Sample characteristics are presented in Table 1.

All measures were obtained through self-reported online questionnaires. When questionnaires pertained to a child or the relation of parents with their child, participants were asked to think about their oldest child between 0-5 years of age.

Participants first answered four questions about treatment modality preferences. The first question asked if they were seeking professional support, would they prefer receiving mental health support only, parenting support only, or both. The second question asked the type of help they would most prefer receiving if they were seeking mental health support (prescription medication, in-person individual counseling, in-person support group, or app-based/internet-based program). The third question asked the type of help they would most prefer receiving if they were seeking parenting support (in-person individual counseling, in-person support group, or app-based/internet-based program). Finally, participants were asked what length of a virtual mental health and parenting support program would best fit their life on a visual analog scale from 6 to 20 weeks.

Descriptions of the three programs (provided in online supplemental materials) were drafted and reviewed by three clinical psychologists with expertise in mental health and parenting interventions. Consistent with previous research (e.g., Cameron et al., 2017; Goodman et al., 2013), each description included six pieces of information: What is the approach? How does the approach conceptualize mental health/depression or parenting stress/problems? How does the approach work? What will I do in this approach? How much time is involved? What are the risks? For each description, participants completed the credibility and personal reactions to rationales scales discussed below, which were adapted from the original developed for depression research (Addis & Carpenter, 1999), where parenting stress, depression, and/or anxiety was used in place of depression. Following completion of all three descriptions, participants were asked which program they would be most likely to prefer taking part in.

The Credibility Scale (Addis & Carpenter, 1999) assessed the extent to which participants perceived each program to be logical, complete, scientific, and helpful in other areas of life, and how likely they would be to recommend the approach. The Credibility Scale consists of seven items rated on a Likert scale from 1 (not at all) to 7 (extremely). Mean scores were computed, with higher scores indicating greater credibility. Reliability was good in this sample (Cronbach’s α AbilitiCBT = .88; BEAM = .89; Triple P = .92).

The Personal Reactions to Rationales Scale (Addis & Carpenter, 1999) assessed participants’ perceptions of each program in terms of (1) how helpful they expect the program would be for them, (2) the extent to which the approach would help them to understand the causes of parenting stress, anxiety and/or depression, (3) the extent to which the approach would help them learn to cope with parenting stress, anxiety and/or depression, (4) how likely they would be to choose the approach, and (5) how effective they think the approach would be in treating parenting stress, anxiety and/or depression. Items were answered on a Likert scale from 1 (not at all) to 7 (extremely). Mean scores were computed, with higher scores indicating more positive personal reactions. Reliability was good in this sample (Cronbach’s α AbilitiCBT = .86; BEAM = .90; Triple P = .89).

Depression symptoms were measured using the Patient Health Questionnaire-9 item (PHQ-9; Kroenke et al., 2001). The PHQ-9 assesses depression symptoms over the last two weeks, rated on a Likert scale from 0 (not at all) to 3 (nearly every day). Sum scores were computed. Reliability was good in this sample (Cronbach’s α = .88). Dichotomous scores were computed based on the scale’s established cut-off scores (Kroenke et al., 2001) for mild depression symptoms (0-9) and moderate-high depression symptoms (10+).

General anxiety symptoms were measured using the Generalized Anxiety Disorder 7-Item Scale (GAD-7; Spitzer et al., 2006). The GAD-7 assesses general anxiety symptoms over the last two weeks, rated on a Likert scale from 0 (not at all) to 3 (nearly every day). Sum scores were computed. Reliability was good in this sample (Cronbach’s α = .90). Dichotomous scores were then computed based on the scale’s established cut-off scores (Spitzer et al., 2006) for mild anxiety symptoms (0-9) and moderate-high anxiety symptoms (10+). Because the continuous scores of depression and anxiety were highly correlated (r = .88, p < .001), their scores were combined into one dummy variable, with 0 = mild mental health symptoms, and 1 = clinically concerning mental health symptoms (depression and/or anxiety is moderate-high).

Parenting stress was measured using the Parenting Stress Index-Short Form (PSI-SF; Abidin, 2012). The PSI-SF consists of 36 items rated on a Likert scale from 1 (Strongly disagree) to 5 (Strongly agree) assessing parent stress and interactional style in three domains: how parents feel in their role, how satisfied they are in the relationship with their child, and how difficult they perceive their child to be. Sum scores were computed. Reliability was good in this sample (Cronbach’s α = .97). Dichotomous scores were then computed based on the scale’s established cut-off scores (Abidin, 2012) for mild parenting stress (36-89) and clinically concerning parenting stress (90+).

The established clinical cut-off scores were used for depression, anxiety, and parenting stress as they are clinically informative and are sometimes used for targeted intervention program implementations where eligibility for the program may be based on having symptoms above the clinical cut-off (e.g., Joyce et al., 2022; Rayce et al., 2020; Tsivos et al., 2015; Xie et al., 2022). Supplementary analyses were conducted to examine the effect of symptom severity wherein all models that included these variables were rerun using the continuous scores. To make the mental health symptom continuous score, depression (PHQ-9) and anxiety symptoms (GAD-7) were combined by standardizing them (since they are on different scales) and then averaging them. The continuous PSI-SF score was used as is. Effects with symptom severity are mentioned in the manuscript and all models with these continuous scores can be found in Online Supplemental Materials (Tables S7-S12).

Cumulative exposure to recent stressful experiences was measured using the Recent Stressful Experiences checklist (Roos et al., 2021). Using 10 questions answered with “Yes” or “No”, this questionnaire assesses the presence or absence of stressors in the last twelve months. These items were summed to obtain a cumulative recent stressful experiences score ranging from 0 to 10. Reliability was acceptable in this sample (Cronbach’s α = .71).

Perceived adequacy of social support from family, friends, and significant others was measured using the Multidimensional Scale of Perceived Social Support (Zimet et al., 1988, 1990). This scale consists of 12 items answered on a Likert scale from 1 (Very strongly disagree) to 7 (Very strongly agree). Mean scores were computed with higher scores representing higher perceived levels of social support. Reliability was excellent in this sample (Cronbach’s α = .92).

Sociodemographic variables considered as covariates included parent age, income, gender, and number of children. There was not enough variability in education, marital status, ethnicity, and characteristics of the children in this sample (see Table 1) to examine these variables as covariates. As 97.1% of participants were cisgender, there were also not enough gender-diverse participants to include that category in statistical analyses. Thus, in analyses gender included only mothers and fathers identifying as cisgender women and men.

All analyses were conducted using IBM SPSS Statistics 27 on MacOS. Chi-square tests were conducted to assess preferences. Within-subject Analyses of Variance (ANOVAs) were used to analyse participant credibility and personal reactions to the three programs. These analyses included the full sample (177 participants). Multinomial logistic regressions and multiple linear regressions were used to examine predictors of preferences and credibility and personal reaction scores. Every regression model included all covariates outlined above: age, income, number of children, recent stressful events, social support, gender, clinically concerning mental health symptoms, and clinically concerning parenting stress. These analyses included only cisgender participants (n = 172; see Sociodemographic covariates).

Frequencies indicated that mental health and parenting stress symptoms were high in this sample; 70.1% of participants had clinically concerning mental health symptoms and 74.6% had clinically concerning parenting stress symptoms. More specifically, anxiety symptoms were distributed with 26.0% minimal, 14.7% mild, 22.6% moderate, and 36.7% severe. Depression symptoms were distributed with 17.5% minimal, 13.0% mild, 28.8% moderate, 32.2% moderately severe, and 8.5% severe. Parenting stress symptoms do not have additional levels (i.e., established levels are only for mild and clinically concerning, see Methods section). Correlations between all continuous study variables are provided in Table S1.

For type of support, 36.2% of participants preferred mental health support only, 21.5% preferred parenting support only, and 42.3% preferred both types of support together. A chi-square test indicated that these preference differences were significant (χ²(2) = 11.24, p = .004). Chi-square analyses on pairs of selections indicated that mental health support only (χ²(1) = 6.128, p = .013) was selected significantly more frequently than parenting support only. Additionally, mental health support and parenting support (χ²(1) = 11.12, p < .001) was also selected significantly more frequently than parenting support only. There was no significant difference in the frequency at which mental health support only and mental health support and parenting support were selected (χ²(1) = 0.781, p = .377). Multinomial logistic regressions (see Table S2) showed that mothers had 2.55 times higher odds than fathers of selecting mental health support and parenting support over mental health support only (B = .93, SE = .41, OR[95%CI] = 2.55[1.14-5.69]) and 2.75 times higher odds than fathers of selecting mental health support and parenting support over parenting support only (B = 1.01, SE = .47, OR[95%CI] = 2.75[1.10-6.87]). Furthermore, parents with clinically concerning mental health symptoms had 75% lower odds of selecting mental health support and parenting support over mental health support only than those with mild symptoms (B = -1.38, SE = .62, OR[95%CI] = .25[.08-.84]); symptom severity was not predictive (see Table S8). Finally, for each additional child in the family, parents had 61% lower odds of selecting parenting support only over mental health support only (B = -0.95, SE = .48, OR[95%CI] = .39[.15-.99]).

Regarding mental health support modality, 34.1% of participants preferred prescription medication, 25.1% in-person individual counseling, 17.7% in-person support groups, and 22.6% and app-based or internet-based program. A chi-square test indicated that these preference differences were significant (χ²(3) = 9.42, p = .024). Chi-square analyses on pairs of selections indicated that prescription medication was selected more frequently than in-person support groups (χ²(1) = 8.58, p = .003) and eHealth (χ²(1) = 3.88, p = .049). There was no significant difference in the frequency at which participants selected prescription medication and in-person individual counseling (χ²(1) = 1.00, p = .157), in-person individual counseling and support groups (χ²(1) = 2.38, p = .123), individual counseling and eHealth (χ²(1) = .32, p = .574), or support groups and eHealth (χ²(1) = .97, p = .325). Multinomial logistic regressions (see Table S3) showed that, compared to parents with mild mental health symptoms, parents with clinically concerning symptoms had 4.8 times higher odds of selecting an app- or internet-based program over in-person counseling (B = 1.57, SE = .79, OR[95%CI] = 4.79 [1.01-22.68]). No other factors significantly predicted mental health support modality preferences.

Regarding parenting support modality, 47.3% of participants preferred in-person individual counseling, 23.7% in-person support groups, and 29.0% and app-based or internet-based program. A chi-square test indicated that these preference differences were significant (χ²(2) = 15.63, p < .001). Chi-square analyses on pairs of selections indicated that in-person individual counseling was selected more frequently than in-person support groups (χ²(1) = 13.33, p < .001) and eHealth (χ²(1) = 7.45, p = .006). There was no significant difference in the frequency at which in-person support groups and eHealth were selected (χ²(1) = 0.781, p = .377). Multinomial logistic regressions (see Table S4) showed that for each additional child in the family, parents had 63% lower odds of selecting eHealth over in-person counseling (B = -0.98, SE = .42, OR[95%CI] = .37[.17-.85]). None of the covariates examined predicted these preferences.

Average program length preference was 13.06 weeks (SD = 2.56). Multivariate linear regression results (see Table S5) indicated that having experienced more recent stressful life events and having more social support were associated with preference for a longer program.

Within-subject ANOVAs were used to examine whether credibility and personal reactions ratings differed among the three program choices. Because there were three conditions, the assumption of sphericity was examined. Mauchly’s tests of sphericity for the credibility scale was non-significant (χ²(2) = 0.85, p = .655). No significant differences in credibility ratings were found among the three programs (see Table 2).

Mauchly’s tests of sphericity for the personal reactions scale was significant (χ²(2) = 7.04, p = .030), thus degrees of freedom were corrected using Huynh-Feldt estimates of sphericity (ε = .97). Significant differences in personal reactions ratings were found among the three programs (see Table 2). Pairwise comparisons with the Bonferroni correction showed that mean personal reactions ratings for AbilitiCBT were significantly higher than credibility ratings for BEAM and Triple P. Personal reactions ratings for BEAM and Triple P did not significantly differ.

Multivariate linear regressions were used to examine whether covariates predicted credibility and personal reactions ratings (see Table 3). Higher social support was associated with higher credibility and personal reactions ratings overall. More recent stressful experiences were associated with higher credibility and personal reactions ratings for BEAM. Clinically concerning mental health symptoms were associated with higher credibility and personal reactions ratings for Triple P. Clinically concerning parenting stress symptoms were associated with lower credibility ratings for AbilitiCBT. Analyses for symptom severity (see Table S7) showed that higher levels of parenting stress were also associated with lower credibility and personal reactions ratings for AbilitiCBT. Furthermore, higher levels of mental health symptoms were associated with higher credibility and personal reactions ratings for AbilitiCBT.

Descriptive statistics indicated that given the choice between the three programs, 41.2% of participants would have preferred AbilitiCBT, 37.9% would have preferred BEAM, and 20.9% would have preferred Triple P. A chi-square test indicated that these preference differences were significant (χ²(2) = 12.61, p = .002). Chi-square analyses on pairs of selections indicated that Triple P was selected less frequently than AbilitiCBT (χ²(1) = 11.78, p < .001) and BEAM (χ²(1) = 0.26, p = .612). There was no significant difference in the frequency at which AbilitiCBT and BEAM were selected (χ²(1) = 0.26, p = .612). Multinomial logistic regressions (see Table S6) showed that income was positively associated with choosing BEAM over AbilitiCBT. The odds of choosing BEAM over AbilitiCBT were 1.44 times higher for each increase on the household income scale (B = .36, SE = .16, OR[95%CI] = 1.44[1.06-1.95]; see Table 1 for scale). No other factors significantly predicted program choice (see Table S7).

The present study examined parent preferences for treatment modalities as well as their perceptions and preferences when comparing textual descriptions of AbilitiCBT (mental-health focused), BEAM (mental health and parenting-focused), and Triple P Online (parenting-focused). The sample had high levels of clinically concerning depression/anxiety (70.1%) and parenting stress (74.6%). Two characteristics of the sample may explain this high distress. First, the data was collected in March 2022, two years into the COVID-19 pandemic, during which levels of psychological distress have been shown to be elevated in parents (Cameron et al., 2020; Racine et al., 2022). Second, the sample consists of MTurk workers, who were found to have higher levels of distress than the general population (Ophir et al., 2020), with a recent study finding that parents on MTurk may be considered an at-risk or clinical sample (Jensen-Doss et al., 2022).

On average, parents preferred eHealth programs to be 13 weeks in duration. In this sample with high psychological and parenting-related distress, both mental health support and combined mental health and parenting support were preferred over parenting support only. This is in line with the sample’s need for psychological support. Despite these significant differences in preferences, all three options were preferred by a portion of parents, with 36.2% preferring mental health support only, 21.5% preferring parenting support only, and 42.3% preferring both together. This suggests that to match parent preferences, programs may consider offering both types of support, with the option for parents to choose which parts of the programs they opt in to. In line with those ratings, when given the choice between the three programs based on their descriptions, Triple P Online was chosen less frequently than both AbilitiCBT and BEAM. Credibility ratings did not differ between the programs, while personal reactions ratings were higher for AbilitiCBT than for BEAM and Triple P Online. The higher personal ratings for AbilitiCBT compared to Triple P are in line with participants’ preferences for programs that integrate mental health. More positive reactions to AbilitiCBT compared to BEAM may be due to a variety of factors that differentiate the programs. For example, CBT is ubiquitous and is present in the program’s name, and BEAM had more activities (weekly group therapy, videos, forum, and worksheets) compared to AbilitiCBT (10 modules with two check-ins). While the present survey focused on program comparisons, future surveys and experiments (such as discrete choice experiments; McGrady et al., 2021; van den Broek-Altenburg & Atherly, 2020) disaggregating specific eHealth program features would help better understand parents’ preferences and support program development.

While for mental health support prescription medication was preferred over in-person support groups and eHealth, there was no significant difference in parents’ preference between prescription medication and in-person individual counselling, or between eHealth and in-person services. For parenting support, in-person individual counselling was preferred over in-person support groups and eHealth. Preferences for in-person services are in line with research in medicine finding that about half of participants prefer in-person services over telemedicine (Allison et al., 2022; Predmore et al., 2021). The proportion of participants preferring in-person support was slightly higher in our study. This may have been partly due to the timing of the survey (March 2022), when reports of Zoom fatigue (Nesher Shoshan & Wehrt, 2022) and of frequent virtual social contact being associated with higher feelings of loneliness (Rumas et al., 2021) could have made people more eager to distance themselves from screens. This may be further compounded by the MTurkers working on their computer as a previous study found that working fathers preferred in-person interventions partly because eHealth reminded them of work (Frank et al., 2015). A study also indicated that while 85% of people found mental eHealth services to be very effective, over three-quarters found that it was better than expected (Steidtmann et al., 2022), suggesting that there may be some preconceived notions about psychological eHealth that lead people to prefer in-person services when they haven’t tried eHealth yet. Qualitative studies could help identify these preconceived notions to better explain program modalities and their advantages/disadvantages to parents in need. Furthermore, like for treatment focus (parenting and/or mental health), all treatment modalities were preferred by >15% of the sample, further supporting the importance of a varied service offering for parents.

Compared to fathers, mothers had higher odds of preferring combined mental health and parenting support over mental health or parenting support only, but no other cisgender differences were found in these treatment modality preferences, nor were they reflected in ratings of the descriptions of AbilitiCBT, BEAM, and Triple P Online. This suggests fathers may be more likely to initially view mental health and parenting skills as separate entities while being more open to combined treatment when programs are outlined to them. A common theme in emerging literature is that fathers want more information about parenting and child development as early as pregnancy (Deave & Johnson, 2008). Fathers often feel excluded from the transition to parenthood and unprepared for parenting (Cameron et al., 2023; Shorey et al., 2017), which can lead to increases in mental health concerns (Wee et al., 2011). Thus, there is a growing body of evidence that suggests fathers want father-specific and/or inclusive parenting support programs and could, in some cases, benefit from programs targeting both mental health and parenting. Our results suggest that this need may be met best by clearly outlining programs to fathers, although these results should be replicated and examined in a clinical context.

Clinically concerning parenting stress symptoms were associated with lower credibility of the AbilitiCBT program, which is consistent with those parents’ need for parenting support. Similarly, parents with clinically concerning mental health symptoms had lower odds of preferring combined mental health and parenting support over mental health support only, which is consistent with those parents needing mental health support that is not found in this program. Clinically concerning mental health symptoms were also associated with higher odds of selecting an eHealth program over in-person counseling. A previous study of college students similarly found that depression was associated with preference for eHealth over in-person services (Benjet et al., 2020). As people experiencing a mood disorder were found to delay treatment an average of four years in the US (Goldberg et al., 2019; Wang et al., 2007), it was suggested that eHealth may be a more attractive first stage of treatment when a lack of energy and motivation stemming from depressive symptoms are a barrier to attending in-person therapy (Benjet et al., 2020).

Parents with more children were less likely to prefer parenting support only over mental health support only. Few other studies have examined how the number of children in a household predicts the preferences of parents, but there is some preliminary evidence that parents with more children seek less parenting information (Butler et al., 2020). Some studies also found that parenting self-efficacy is higher when a parent has more children (Fang et al., 2021), which could explain them being less likely to seek parenting support. Parents with more children were also less likely to select eHealth over in-person individual counseling for parenting support. Several factors could explain this and could be clarified in future studies. For example, it is possible that parents with more children feel a higher need to be outside their home to attend to their own needs, as they may feel it would be difficult to successfully engage in remote parenting support if their children are at home with them. They may also be worried about discussing their parenting difficulties and their children hearing them in a more crowded household.

Higher social support was associated with preference for a longer program and with higher credibility and personal reactions ratings across all three programs (AbilitiCBT, BEAM, and Triple P Online). The self-labeling theory posits that, although perceiving more support generally reduces the likelihood of accessing mental health treatment, when mental health symptoms are more severe (as is the case in the current sample), high levels of support increase the likelihood that individuals will access mental health services because support systems will encourage treatment seeking (Thoits, 1985, 2011). Accordingly, it is possible that among these parents with high levels of distress, higher social support contributes to receiving more encouragement to seek out programs, in turn leading to preferences for longer programs and higher ratings of credibility and personal reactions of the programs. In addition to encouraging access to mental health treatments, greater access to social support may allow parents more time to participate in programming since lack of support has been found to be a common barrier to engaging in parenting programs (Butler et al., 2020).

More recent stressful experiences were also associated with preference for a longer program and were associated with higher credibility and personal reactions ratings for BEAM only. Similarly, while income was not associated with modality preferences generally, after being presented with program descriptions a higher income was associated with higher odds of choosing BEAM over AbilitiCBT. This seems to suggest that parents with a higher income and those experiencing stressful events are more drawn to a combined treatment approach and a program with aspects of self-compassion and emotion awareness, a main distinguishing factor of BEAM compared to AbilitiCBT and Triple P Online. It is also possible that for parents experiencing more stressful events, that are perhaps putting more demands on their time, BEAM was perceived as more manageable given its guided structure and clear timeline for completion.

While the present study identified some factors associated with parent preferences in eHealth and the literature helps hypothesize processes underlying these preferences, further studies, including interview-based qualitative studies, could clarify the rationales and contextualize the reasons for different parent preferences. This would be helpful in better informing parents of their options and in explaining programs to them in a manner that highlights the factors that are important to them in making decisions. A study of college students also found that preference for eHealth was related to being embarrassed, being worried about in-person counseling harming one’s career, wanting to handle problems on one’s own, and beliefs about treatment efficacy (Benjet et al., 2020) and evidence from in-person parenting programs shows that stigma related to being judged for being a bad parent is a barrier to enrollment for both mothers and fathers, and that fathers additionally report concerns about help-seeking being seen as a sign of weakness or being ridiculed (Jukes et al., 2022). Thus, future studies with parents could also further clarify preferences for eHealth by measuring attitudinal barriers, which may be important to address when offering treatment and support options. The present study also examined parent preferences for programs based on textual descriptions, which can help better support parent enrollment in programs, but does not generalize to retention or preferences once participating in programs.

Furthermore, this survey has some limitations in terms of the population it generalizes to. Results are limited to predominately White American/European participants, leaving gaps in the preferences of BIPOC (Black, Indigenous, and people of color) communities. Some previous research shows the importance of considering cultural preferences. For example, a study examining First Nations peoples found that they would prefer interventions that are conducted by another First Nations individual, and that would incorporate their traditions and culture (Toombs et al., 2018). The sample of the present study was also highly educated, and previous research shows the importance of assessing preferences across education levels. For example, Broomfield et al. (2022) found that parents who had less formal education preferred briefer parenting intervention modules with concise information that was clear to understand. Lower computer literacy was also found to be associated with preference for in-person services (Cunningham et al., 2013), which is an important factor that could not be properly examined in our online study using a crowdsourcing service. Beyond these specific characteristics of the sample, MTurk worker parents should be considered an at-risk or clinical sample (Jensen-Doss et al., 2022). Thus, while this study provides an essential first look into parent preferences for mental health and/or parenting eHealth programs, results should be used to inform studies with community samples.

The present study showed small parental preferences for programs that integrate mental health support. Despite this, there was considerable variability in preferences and all treatment targets, modalities, and programs were preferred by at least 17% of parents. Accordingly, the present study clearly supports the importance of offering diverse psychosocial service options to meet the needs of more parents. Taking parental preferences and expectancies into consideration is a key factor in enrollment and retention (Bannon & McKay, 2005; Morrissey-Kane & Prinz, 1999; Nock & Kazdin, 2001). Accordingly, further research is needed to identify specific program characteristics that parents prefer, which would help better tailor interventions to their preferences. Furthermore, research is needed regarding parents’ rationale for their choices, understanding of program features, and preconceived notions about treatment modalities, which could better inform how certain programs fit for their needs and preferences.

Contributed to conception and design: CR, AK, LT-M, ALM, EEC, DW, LER;

Contributed to acquisition of data: CR, AK

Contributed to analysis and interpretation of data: CR, LT-M, ALM, EEC, DW, LER

Drafted and/or revised the manuscript: All authors

Approved the submitted version for publication: All authors .

This study was funded by a grant from Research Manitoba to LT-M and LER. CR was partly supported by a postdoctoral fellowship from Research Manitoba, the Children’s Hospital Research Institute of Manitoba, and the Children’s Hospital Foundation of Manitoba. EC was supported by a postdoctoral fellowship from the Social Sciences and Humanities Research Council of Canada.

The authors have no competing interests to declare that are relevant to the content of this article

All the materials, participant data, and analysis scripts can be found on this paper’s project page on the Open Science Framework, which can be retrieved from https://doi.org/10.17605/OSF.IO/J7D2Q