IntroductionFamily Mental Health

Normatively, mental health disorders impacted >1 billion people worldwide in 2016 []. The COVID-19 pandemic brought further substantial impact on mental health, placing increased demand on mental health services []. Mental health is inherently relational [,], and family members and partners are inevitably impacted by an individual’s mental health challenges []. During the COVID-19 pandemic, markers of heightened family stress included rising rates of family violence []; increased parenting stress []; and observed rates of maladaptive parenting practices, including neglectful, harsh, and coercive parenting [-].

There is a strong evidence base for family and systemic interventions for child- and adult-focused mental health challenges. Family participation supports members of the family to safely contribute to individual recovery and improved relationships [-] and can be more beneficial than individual work [-] and family educational interventions []. In addition, parent involvement in interventions for childhood behavioral [] and adolescent anxiety disorders [] has been shown to be beneficial and contributes to positive long-term outcomes.

Digital Mental Health

The World Health Organization has emphasized the significant potential of digital mental health interventions (DMHIs) in expanding reach and access to services []. Such DMHIs have shown promise in reaching underserved populations [], leading to improved management of symptoms in individuals [], particularly youth aged <25 years [,]. There is growing meta-analytic evidence for positive mental health outcomes of digitally delivered versus in-person individual treatment, for example, in the field of cognitive behavioral interventions []. With rapid developments in technology, research interest is expanding, with most of the literature so far focused on DMHIs for individuals. For example, a review of systematic reviews of digital interventions for mental health and well-being (with no limitations placed on population) conducted in 2021 identified 246 systematic reviews published between 2016 and 2021, all of which reviewed digitally delivered mental health interventions for individuals [].

Beyond DMHIs designed for individuals, 2 first-generation reviews of dyadic (caregiver and care recipient) [] and couple-targeted DMHIs [] suggest that DMHIs can decrease barriers and improve timely access and outcomes for distressed relationships. However, research into DMHIs for families to access together is as yet undeveloped.

Despite growing evidence, and regardless of the population targeted, retention rates for DMHIs remain low, limiting their ultimate impact [-]. Among other factors, interface ease of use has been identified as a barrier to DMHI retention and engagement by individuals [,]. It is likely that similar (or possibly even greater) barriers for family engagement in the digital mental health space exist. Given the fundamental differences in the approach and focus for family and relational interventions when compared to interventions designed for individuals [,], it is likely that there are unique factors to consider when designing DMHIs for use by families. This might include considerations for individual user privacy and ways in which the platform allows multiple people to contribute to and especially cocomplete activities, such as shared goal setting. Thus, it would be ill-founded to extrapolate results from studies on DMHIs designed for use by individuals and assume similar platform interaction values for families. The need for further research specific to the design of DMHIs for family use is clear.

Design of DMHIs for Families

Therefore, the question arises about what an effective DMHI for family use might look like. Given that computers and tablets are designed for use by individuals, DMHIs intended for cocompletion by family members may use different platform and interface features to support and sustain family engagement. No review to date has examined evidence for design and build characteristics that promote cocompletion usability, including improved engagement and accessibility.

In that light, this review aimed to synthesize the available evidence regarding the build and design characteristics that enable cocompletion and discuss reported indicators of user engagement with platforms designed for such use, namely, usability, satisfaction, acceptability, and feasibility. In the digital mental health literature, these user engagement indicators measure the ability of a platform to engage and sustain users. However, there is a notable lack of agreement on both the definition and measurement of the construct of engagement, which can lead to inappropriate selection, presentation, and interpretation of user engagement indicators across studies []. As such, a scoping review was conducted, and we adopted the definition of user engagement as outlined by Perski et al []: “Engagement with [Digital Behaviour Change Interventions] is (1) the extent (e.g. amount, frequency, duration, depth) of usage and (2) a subjective experience characterised by attention, interest and affect.”

In this scoping review, we differentiate the term “platform” from the term “intervention.” We define “platform” as the tools, infrastructure, and technical foundation behind the delivery of an intervention, including interface characteristics such as the design, layout, and delivery mode. We define “intervention” as the mental health–related content that is delivered via the platform. This review sought to understand (1) the design and functionality characteristics that enable the effective engagement with and cocompletion of a family-oriented DMHI and (2) whether these elements moderate the effect of the intervention on mental health or relational outcomes. To distinguish effective platform contributors to engagement from elements pertaining to intervention content, we selected only those platforms housing interventions of established clinical efficacy (which we defined as any intervention that had at least one study reporting a significant improvement in a mental health or relational outcome). In addition, it is expected that build characteristics may vary by population, and given that there is no uniform family composition, this review scoped platforms designed for cocompletion by any family relationship type, including couples, family subsystems, and whole families.

MethodsSearch Strategy

To identify studies reviewing platforms delivering clinical interventions designed for cocompletion by families, a systematic search was conducted following the PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) guidelines []. A comprehensive electronic literature search for articles published in English was conducted in the following databases: MEDLINE, Embase, and PsycINFO via the Ovid platform; CINAHL via the EBSCOhost platform, and Web of Science. In line with developments in digital technology, studies were included if they were published in or since 2002. The search was first conducted on June 24, 2022, and additional searches were conducted on November 24, 2022; April 21, 2023; and March 15, 2024.

Eligibility Criteria

As advised by the Joanna Briggs Institute’s guidelines for conducting scoping reviews [], the population, concept, and context framework was used to define eligibility. shows the inclusion and exclusion criteria in line with the population, concept, and context framework and contains additional study elements relevant to the eligibility criteria.

Studies were not excluded when platforms contained additional components involving practitioner (sometimes referred to in the studies as a coach, professional, therapist, or staff member) engagement. Further to the inclusion and exclusion criteria outlined in , platforms offering interventions that had no evidence of clinical efficacy (ie, no identified studies that reported any significant improvements in mental health or relational outcomes) were excluded. Provided that at least 1 identified study established clinical efficacy for that platform, all studies on that intervention were then included regardless of whether they reported on clinical outcomes. Platforms that met all the other inclusion criteria but without established clinical efficacy are presented in .

Textbox 1. Inclusion and exclusion criteria detailing the population, concept, and context framework for defining eligibility criteria for scoping reviews and additional study elements.

Inclusion criteria

Population: Digital mental health interventions (DMHIs) designed for completion by at least 2 related people togetherConcept: Platform design elements of DMHIs (via a web or smartphone interface) containing some component that was intended to be completed without therapist or human intervention (ie, was self-directed by participants)Context: Open and included all care settings (eg, primary care and community) and all jurisdictions and geographic locationsStudy type and design: Empirical studiesPublication date: from January 1, 2002, to March 15, 2024Publication language: English

Exclusion criteria

Population: DMHIs designed for completion by individuals or designed for use by related people but with no activities completed together (ie, completed separately) and DMHIs where children were the focus and the parent’s role was only in assisting their child to participateConcept: DMHIs in which the target condition was physical illness, physical activity, and weight management and programs delivered through virtual reality devices, wearable devices, DVD, or other non–web-based approachesStudy type and design: Nonempirical studies and gray literature (ie, non–peer-reviewed or unpublished manuscripts)Search and Data Extraction Methodology

A total of 3 key search constructs addressed the different elements of the research question: digital intervention, mental or relational health, and population. Results were combined using Boolean operators. The search strategies for each database can be found in . The reference lists of relevant reviews were also screened for potentially relevant studies. Data extraction was completed by 2 researchers trained in systematic search methodology using a standardized template, and discrepancies were resolved through discussion between the 2 researchers. In cases in which it appeared that there could be cocompletion but it was not directly specified, the study authors were contacted, and websites were searched.

Screening and Selection Process

Search results were downloaded into EndNote (Clarivate Analytics) [] and imported into Covidence (Veritas Health Innovation) []. Duplicates were first removed in EndNote and again following import into Covidence. In total, 2 researchers screened the identified studies at the title and abstract level, with 20% being double screened. Disagreements were resolved through discussion. A total of 2 researchers screened the articles at the full-text level with 20% double screening to determine eligibility against the inclusion criteria outlined previously. Reasons for exclusion at the full-text level were recorded.

Data Synthesis

Data were synthesized using a narrative approach. Due to high variability in the reporting of outcomes and measurements across studies, a systematic or meta-analytic approach was not possible.

The included articles were grouped by the digital platform used. Information regarding the authors, the year of publication, the country where the study took place, the population, and associated user engagement indicators was extracted. Significant differences in mental health or relational outcomes following the DMHI were indicated. Details about the platforms were extracted into a separate table. Also detailed were the intervention target; the relationship between the participants; components designed to be completed in a self-paced manner, together, individually, or with a professional; tailored components; and any additional key features. Results were categorized and synthesized based on the targeted relationship for the intervention (eg, couples or families).

ResultsOverview

The combined searches yielded 17,765 results. Following removal of 46.37% (8238/17,765) of duplicates in EndNote and Covidence, 9527 papers were screened at the title and abstract level, resulting in 9184 (96.4%) exclusions. A total of 343 full-text articles were reviewed for inclusion, with 263 (76.7%) exclusions. Reasons for exclusion included the platform being designed for use by individuals (154/263, 58.6%), nonempirical studies (55/263, 20.9%), the platform not containing any self-guided components (36/263, 13.7%), or wrong indication (eg, weight loss intervention; 18/263, 6.8%). A total of 80 studies were included for data extraction. An additional 5 studies were identified through reference scanning and included in data extraction, resulting in a total of 85 studies included in this review. shows the PRISMA-ScR (Preferred Reporting Items for Systematic Reviews and Meta-Analyses extension for Scoping Reviews) diagram [].

The following sections first summarize the studies identified and then report on characteristics of and findings related to the included platforms.

‎Figure 1. PRISMA-ScR (Preferred Reporting Items for Systematic Reviews and Meta-Analyses extension for Scoping Reviews) diagram showing the inclusion and exclusion of studies at each stage of the review process. Included Studies

details the characteristics of the 85 studies, including study type, their population and sample size, usability measures and findings, and an indication of clinical efficacy based on significant improvement in mental health or relational outcomes following completion of the intervention. Among the 85 included studies, data were collected during randomized controlled trials (n=63, 74%), pilot feasibility studies (n=14, 16%), single-arm studies (n=7, 8%), and nonrandomized quasi-experimental studies (n=1, 1%).

A total of 74% (63/85) of the studies were conducted in the United States; 12% (10/85) were conducted in Canada; 5% (4/85) were conducted in Australia; 2% (2/85) were conducted in the United Kingdom; 2% (2/85) were conducted in China; and 1% (1/85) were conducted each in the Netherlands, Sweden, Japan, and Korea. In total, 52% (44/85) of the included studies were published between January 2019 and March 2024, whereas 5% (4/85) of the studies were published in the first 5 years of the search period (2002-2006 inclusive) and the remainder (37/85, 43%) were published in between these periods.

Table 1. Characteristics of the studies meeting the eligibility criteria, including name of the platform examined; study and country; type of study and comparator (where applicable); population, sample size, and attrition rate; relational and individual constructs or outcomes; reported user engagement indicators; and corresponding findings.Platform, study, and countryStudy characteristicsMeasures or outcomes
Design; comparatorPopulation; sample size; attritionRelational and individualUser engagement indicatorsReported findings4Cs:CRCa []; ChinaPilot feasibility trialHeterosexual couples where one member was experiencing colorectal cancer; 24 couples; 16.7%Dyadic coping; cancer-related communication; self-efficacy; physical and mental health; positive and negative emotions(1) Postintervention evaluation; (2) feasibility and acceptability(1) Highly rated usefulness, ease of use, and satisfaction; all mean acceptability ratings >5.2/7; (2) 83.8% retention; 609 session views; mean 29 views per page; mean 3-7 page views per session per dyad4Cs:CRC []; ChinaRCTb; web-based, face-to-face, blended, or controlHeterosexual couples where one member had colorectal cancer; 212 couples; 16%Dyadic copingc; cancer-related communicationc; marital satisfaction; self-efficacyc; physical and mentalc health; positivec and negativec emotionsNot reportedNot reportedCA-CIFFTAd []; United KingdomRCT; no treatmentHispanic (80%) and Black (20%) adolescents and their families; 80 parent-child dyads; 27% (intervention)Family cohesionc; family conflict; parenting practices; adolescent behavioral problemscNot reportedNot reportedC-MBIe for YBCSsf []; United StatesRCT; MBIg completed by YBCSs only (I-MBIh)Female breast cancer survivors and their male partners; 117 couples; 26% (I-MBI) and 38% (C-MBI)Couple functioningc (I-MBI only); individual-level functioningc(1) Feasibility and acceptability of YBCSs (self-report); (2) feasibility and acceptability of partners (self-report)(1) 39% requested more contact with peers; 63% would recommend it; 77% watched all videos; 90% used the supplemental material; 91% completed some or all of the assignments; rated most useful: mindfulness sessions (80%), yoga (14%), and partner interaction (7%); time constraints were the most cited reason for not recommending the intervention; (2) 93% had no desire to interact with peers; 69% would recommend it; 69% watched all videos; 89% used the supplemental materials; 92% completed some or all of the assignments; time constraints were the most cited reason for not recommending the interventionCool Kids Online []; AustraliaRCT; waitlistChildren (aged 7-12 years) with anxiety and their parents or caregivers; 95 dyads; 12% at posttreatment time point and 27% at 6-month follow-upAnxiety diagnosisc; anxiety scale; life interferencec (parent only); mood and feelingsc; strengths and difficultiesc(1) Satisfaction; (2) completion(1) 73% of parents were satisfied or very satisfied, 92% reported it as helpful, and 97% were moderately or very confident recommending the intervention; 64% of children were “happy” with the intervention, 89% reported it as helpful or very helpful, and 70% were moderately or very confident that it would help a friend; (2) 83% accessed all lessons (mean 7.52, SD 1.23; range 3-8); received a mean of 8.8/10 (SD 1.61; range 3-10) callsCouple HOPESi []; CanadaPilot feasibility trial; pretest-posttestCouples where one member was a military member, veteran, or first responder with PTSDj symptoms; 10 couples; 30%Relationship satisfactionc (partners only); conflict; PTSD symptomsc; partner’s accommodations to PTSD symptomsc; anxiety, distress, and QoLc,k; AODl useSatisfaction (CSQm)PTSD: mean 3.4/4 (SD 0.7); partner: mean 3.7/4 (SD 0.4)Couple HOPES []; CanadaSingle armCouples where one member was a military member, veteran, or first responder with PTSD symptoms; 17 couples; 35%Relationship satisfactionc (ineffective arguing); PTSD self-report; partner report of PTSD symptoms; mental health; well-beingc (perceived health); partner accommodationsSatisfaction (CSQ)PTSD: mean 3.5/4 (SD 0.6); partner: mean 3.7/4 (SD 0.3)Couple HOPES []; CanadaSingle armCouples where one member was a military member, veteran, or first responder with PTSD symptoms; 27 couples; 33%Relationship functioningc (ineffective arguing); mental health; well-beingc (perceived health and QoL)Satisfaction (CSQ)Partner: mean 3.7/4 (SD 0.4)Couple HOPES []; United StatesPilot feasibility trial; pretest-posttestCouples where one member was a military veteran with PTSD; 15 couples; 27%Relationship satisfactionc; relationship qualityc (negative relationship quality); PTSD symptomsc; depression; QoL; significant other’s response to trauma(1) Completion; (2) feedback(1) Mean duration 7.20 (SD 5.56) weeks; n=11 completed; 4 noncompleters ( n=2 completed 4/7 modules, n=1 completed 2/7, and n=1 completed 1/7); n=3 “treatment responders” completed it faster; (2) coach was helpful for processing information, thoughts, and feelings; feedback videos were unrealistic or “cheesy,” others found them helpful for digesting and relating to the materialCouplelinks []; CanadaPilot feasibility trialHeterosexual couples where a member had a breast cancer diagnosis; 16 couples; 38%Not reported(1) Treatment satisfaction (TSQn); (2) usability(1) Mean 4/5 (SD 0.56); (2) mean 4/5 (SD 0.83)Couplelinks []; CanadaPilot feasibility trialHeterosexual couples where a member had a breast cancer diagnosis; 6 couples; not reportedNot reportedEngagement promotion by therapistRational model of engagement promotion: friendly and positive yet firm approach, humanizing technology, and inclusive and empathic attitude; empirical model of engagement promotion: fostering couple-facilitator bond, fostering intervention adherence, and fostering within-couple bondCouplelinks []; CanadaPilot feasibility trialHeterosexual couples where a member had a breast cancer diagnosis; 12 couples; not reportedNot reportedTypes of engagementCouple “types”—keen: completed with minimal engagement; compliant: met facilitator deadlines; apologetic: enjoyed it and were committed but had trouble staying on track; straggling: least engagedCouplelinks []; CanadaPilot feasibility trialHeterosexual couples where a member had a breast cancer diagnosis; 13 couples; not reportedNot reportedPerceived benefits and limitations58% agreed or strongly agreed that it was beneficial; 35% said that it was somewhat beneficialCouplelinks []; CanadaRCT; waitlistHeterosexual couples where a member had a breast cancer diagnosis; 67 couples; 20.5% in the intervention group and 0% in the control groupDyadic copingc; dyadic consensus, cohesion, and satisfaction; marital satisfaction; collective copingc; anxietyc and depressionNot reportedNot reportedCouplelinks []; CanadaRCT; waitlistHeterosexual couples where a member had a breast cancer diagnosis; 57 participants; not reportedNot reportedTreatment satisfaction (TSQ)Mean 4.3/5 (SD 0.54); female participants’ satisfaction ratings were significantly higher (P=.01); medium effect size (0.57)eMBo []; United StatesRCT; controlCouples where one member was pregnant; 30 couples; 0%Anxietyc (pregnant person’s anxiety) and depression symptoms(1) Satisfaction (CSQ-8p); (2) completion rates and adherence(1) Excellent satisfaction: mean 3.42 (SD 0.55); pregnant: mean 3.42 (SD 0.59); and partner: mean 3.43 (SD 0.49); factors perceived to promote engagement included flexibility (independent and joint options and own pace) and focus on the self before talking to their partner; helpful elements included videos, web-based exercises, and activities; factors impacting engagement included video relatability, poor quality, outdated images, simplistic and low-technology visualizations, videos perceived as old or silly, extreme vignettes and illustrations, and videos being overly dramatized and unrelatable; (2) 50% used it alone, 9% used it together with their partner, and 27% were a combination of both; 14% did not engage; 0% completed 1 lesson per week as advised; 83 discrete log-ins; pregnant people visited more (mean 4.17 vs mean [partners] 3.44 visits to the intervention)Embers the Dragon []; United KingdomPilot feasibility trial; no treatmentChildren aged 2-7 years and a parent; 129 families; 7.7% in the intervention group and 20.4% in the control groupParental responses to childhood behaviorscNot reportedNot reportedePREPq (studies on ePREP and OurRelationship reported separately) []; United StatesRCT; IRCrHeterosexual couples in long-term relationships; 77 couples; 0%Commitment attitudesc; communicationc; relationship satisfactionc; psychological aggression and assaultc; depression, dysphoria, and well-beingc; anxietycLevel of engagement as a moderator of clinical outcomesHigher engagement (measured via results on quizzes): greater intervention effect for alternative monitoring (β=–.33; P=.04), constructive communication (β=.29; P=.07), self-reported physical assault (β=–.58; P=.11), male relationship satisfaction (β=.48; P=.02), and female depression (β=–.37; P=.10). Greater time spent completing homework assignments: greater intervention effect for reported couple physical assault (β=–.69; P=.06), severe psychological aggression for male (β=–.90; P=.02) and female (β=–.09; P=.01) individuals, and male-perpetrated physical assault (partner report; β=–1.10; P=.02) but an attenuation of the positive effect of ePREP on self-reported minor psychological aggression (male individuals: β=.40 and P=.11; female individuals: β=.43 and P=.12). Male individuals with higher engagement experienced attenuation of positive impact on anxiety (β=.35; P=.01), and female individuals who completed more homework assignments experienced attenuation of positive impact on depression symptoms (β=.45; P=.03).ePREP []; United StatesRCT; IRCMarried couples; 52 couples; 4% after the intervention and 92% at the 1-year follow-up (8% in the intervention group and 7.6% in the control group)Conflict resolution methodsc; psychological aggression and assaultcNot reportedNot reportedFOCUSs []; United StatesSingle arm; repeated measuresPatient-caregiver dyads; 38 dyads; 14%Communication; social support; emotional distressc; QoLc; appraisalc; coping resources; self-efficacy(1) Satisfaction; (2) comfort and skill using computers and the internet; (3) feasibility(1) Ease of use: mean 6.0/7 (SD 1.1); usefulness: mean 4.4/7 (SD 1.4); general satisfaction: mean 4.8 (SD 1.7); no adverse effects of completing the intervention together; (2) moderate skill level; (3) lower enrollment rate than previous in-person RCTs (51% compared with 68%-80%); retention rate was higher than in-person RCTs (86% compared with 62%-83%)iCBTt []; SwedenRCT; waitlistFamilies where the child (aged 8-12 years) had a mental health diagnosis; 93 families (93 children and 182 parents); 2% in the intervention group and 4% in the control groupAnxietyc (parent reported); development and well-being; child depression; primary carer mental health(1) Satisfaction; (2) compliance(1) Child satisfaction: mean 3.67; parent satisfaction: mean 3.78; 86% of parents agreed or very much agreed that they would recommend it; 82% of children agreed or very much agreed that the treatment was effective; (2) completed modules: mean 9.7 (SD 1.8; range 4-11); 83% completed the first 9 modules; 4 families did not complete the modules intended for both children and parentsMilitary Family Foundations []; United StatesRCT; no treatmentHeterosexual couples expecting their first child where one member was in the military; 56 couples; 34.5% for mothers and 48.3% for fathers in the intervention group and 7.4% for mothers and 22.2% for fathers in the control groupInterparental relationshipc (mothers only); parental adjustmentc; parent report of child outcomesc (sadness)CompletionMean 3.93/8 completed modulesMindGuide Couple []; South KoreaSingle armKorean heterosexual couples; 17 couples; 11%Couple relationship satisfaction; family relationshipc; mental health; positive and negative emotions; satisfaction with lifec(1) Satisfaction and acceptability; (2) recruitment, retention, and completion(1) 100% reported that the content and tasks were helpful; 90% reported that the content was applicable to everyday activities; coaching was most helpful (90%), followed by video lectures (43%) and practical tasks (43%); reported benefits included flexible access (90%), being less burdensome than face-to-face interventions (86.3%), and no geographic limitations (76.7%); reported drawbacks included being too long (33.3%) and time burden (76.7%); 93.4% were satisfied; 100% were satisfied with the level of coaching; (2) 94.1% completedMRu []; United StatesRCT; MR plus PREPv, PREP alone or waitlistVeteran-partner dyads; 320 individuals (160 couples); 1.2% for MR, 2.5% for MRc plus PREP, 1.2% for PREP alone, and 0% for waitlistPerceived social support; dyadic adjustment; stressc; depressionc; PTSD symptomsc; self-compassionc; response to stressful experiencesc; sleep quality; physical pain(1) Intervention use; (2) satisfaction(1) Mean 2.5 hours of use per week; at 16-week follow-up: mean 90 minutes per week; (2) likely to recommend: mean (veterans) 8.7/10 and mean (partners) 9.1/10Mother-daughter program []; United StatesRCT; waitlistGirls aged 10-13 years and their mothers; 202 dyads; 0% between pre- and posttest, and 2% in the intervention group and 1% in the control group lost between postintervention time point and follow-upMother communicationc; conflict managementc; daughter communicationc; perceived rulesc; parental monitoring; normative beliefsc; self-efficacyc; alcohol usec; drinking intentionc; refusal skills; parental rulesc; parental monitoringcAnonymous program ratingImproved mother-daughter relationship: mean (girls) 4.14/5 (SD 0.35) and mean (mothers) 4.25/5 (SD 0.29); learned useful information: mean (girls) 4.16/5 (SD 0.38) and mean (mothers) 4.13/5 (SD 0.34); enjoyed the intervention: mean (girls) 4.07/5 (SD 0.39); mean (mothers) 4.20/5 (SD 0.34); found time to complete it together: mean (girls) 3.04/5 (SD 0.37); mean (mothers) 3.24/5 (SD 0.33)Mother-daughter program []; United StatesRCT; no treatmentGirls aged 11-13 years and their mothers; 591 dyads; 3.2% in the intervention groupMother-daughter communicationc; substance usec; family rulesc; parental monitoringc; normative beliefsc; depression; problem-solving skills; body esteem; drug refusal self-efficacyc; intentionscNot reportedNot reportedMother-daughter program []; United StatesRCT; no treatmentGirls aged 11-13 years and their mothers; 916 dyads; 5.7% from baseline to 1-year follow-up and 4.2% between 1- and 2-year follow-upCommunicationc; mother-daughter closenessc; family rulesc; parental monitoringc; body esteem; depression; coping abilityc; normative beliefsc; refusal self-efficacyc; substance usec; intentionsc; family ritualscNot reportedNot reportedMother-daughter program []; United StatesRCT; no treatmentAsian American girls aged 11-14 years and their mothers; 108 dyads; 3.5% in the intervention group and 3.8% in the control groupMother-daughter closenessc; mother-daughter communicationc; substance usec; intentions; depressionc; self-efficacyc; refusal skillsc; parental monitoringc; family rulescNot reportedNot reportedMother-daughter program []; United StatesRCT; no treatmentAsian American girls aged 11-14 years and their mothers; 108 dyads; 89.2% completed the 2-year measureMother-daughter closenessc (girls only); mother-daughter communicationc; parental monitoringc (girls only); family rulesc (girls only); depressive symptoms; body esteem; self-efficacyc; refusal skillsc; normative beliefs; substance usec; intentionscCompletion96.4% completed the entire intervention; 94.6% completed the booster session; participants completed initial 9 sessions (mean 175, SD 68.9 days)Mother-daughter program []; United StatesRCT; no treatmentBlack and Hispanic girls aged 10-13 years and their mothers; 564 dyads; 6.6% in the intervention group and 3.3% in the control groupMother-daughter closeness; mother-daughter communicationc; substance usec; normative beliefsc; intentionsc; depressionc; self-efficacyc; refusal skills; parental monitoringc; family rulesc; body esteemNot reportedNot reportedMother-daughter program []; United StatesRCT; no treatmentMother-daughter dyads in public housing; 36 dyads; 3%Mother-daughter closenessc; mother-daughter communicationc; parental monitoringc; substance use; fruit and vegetable intakec; physical activityc; perceived stressc; drug refusal skillscFidelity97% completed all 3 sessionsOFPSw []; United StatesPilot feasibility trial; pretest-posttestChildren (aged 5-16 years) with moderate to severe TBIx and families (all family members could participate; outcomes reported for one parent and child); 19 participants in 6 families; 0%Child-parent relationshipc; sibling relationshipc; therapeutic alliancec(1) Feasibility; (2) ease of use; (3) helpfulness and satisfaction (WEQy)(1) All web sessions completed without therapist assistance; families completed a mean of 10.3 web sessions; (2) ease of use: mean 3.59/5; (3) website helpfulness: mean 4.12/5; videoconferencing helpfulness: mean 4.35/5; 94.7% would recommend the intervention to othersOFPS []; United StatesPilot feasibility trial; pretest-posttestChildren (aged 5-16 years) with moderate to severe TBI and families (all family members could participate; outcomes reported for one parent and child); 19 participants in 6 families; 0%Injury-related family stress and burdenc; therapeutic alliancec; parental distress, depression, and anxietyc; child adjustmentcNot reportedNot reportedOFPS []; United StatesRCT; usual care plus IRCChildren (aged 5-16 years) with moderate to severe TBI and families (all family members could participate; outcomes reported for one parent and child); 46 families; 12% in the intervention group and 0% in the IRC groupFamily problem-solving, communication, and behavior management; parental problem-solving; parental distress, depression, and anxietycWebsite use and caregiver satisfaction (WEQ)100% of parents indicated that they would recommend it to others; 33% indicated that they would prefer to meet in person; 94.4% reported that the website was moderately to extremely easy to useOFPS []; United StatesRCT; usual care plus IRCChildren (aged 5-16 years) with moderate to severe TBI and families (all family members could participate; outcomes reported for one parent and child); 46 families; 12% in the intervention group and 0% in the IRC groupChild adjustmentc (self-control and compliance only)(1) Child’s self-reported website use; (2) satisfaction (WEQ)(1) Strong negative correlations between number of sessions completed and child behavioral problems (–0.59) and parental distress (–0.60) at baseline, suggesting families with more problems at baseline completed fewer sessions; (2) 88% rated the website as at least moderately easy to use; 26% rated it as hardly or not easy to use relative to other sites; all children rated the website content as at least moderately helpful; 94% reported feeling at least moderate support and understanding when using the website; 31% reported feeling angry when using the website; 25% reported feeling moderately to extremely worried when using the websiteOFPS []; United StatesRCT; usual care plus IRCChildren (aged 5-16 years) with moderate to severe TBI and families (all family members could participate; outcomes reported for one parent and child); 46 families; 12% in the intervention group and 0% in the IRC groupTherapeutic alliance (no moderation by previous technology use); parental depression (moderated by previous technology use) and anxiety(1) Parents’ self-reported website use; (2) satisfaction (WEQ); (3) previous computer use; (4) computer equipment comfort rating(1) Both groups reported spending equivalent amounts of time on the website; (2) satisfaction did not differ by previous technology use; (3) significant effect of technology at home for improvements in depression (t22=2.24; P=.04); trend in the same direction for anxiety; non–technology users more likely to miss sessions (mean 16.33 missed sessions, SD 11.29; t18=2.43; P=.03); (4) technology users became more comfortable with the technology over timeOFPS []; United StatesPilot feasibility study; pretest-posttestTeenagers (aged 11-18 years) with moderate to severe TBI and families (all family members could participate; outcomes reported for one parent and child only); 9 families; 0%Family functioningc; adolescent adjustment; parental distress and depressioncFeasibilityAll families completed the 10 core sessions; 6 families completed one or more supplemental sessionsOFPS []; United StatesPilot feasibility study; pretest-posttestTeenagers (aged 11-18 years) with moderate to severe TBI and families (all family members could participate; outcomes reported for one parent and child only); 9 families; 0%Not reported(1) Self-reported website use; (2) satisfaction (WEQ and OSSz)(1) In addition to parents and teenagers, 9 siblings participated in at least some of the sessions; (2) father satisfaction was generally high; 4/9 teenagers and 2/7 mothers reported a preference for face-to-face meetings; feedback provided support for acceptability and helpfulness of the interventionOFPS []; United StatesRCT; usual care plus IRCTeenagers (aged 11-18 years) with moderate to severe TBI and families (all family members could participate; outcomes reported for one parent and child only); 41 families; 20% in the intervention group and 5% in the IRC groupExecutive functioningc (teenagers with severe TBI)Not reportedNot reportedOFPS []; United StatesRCT; usual care plus IRCTeenagers (aged 11-18 years) with moderate to severe TBI and families (all family members could participate; outcomes reported for one parent and child only); 41 families; 20% in the intervention group and 5% in the IRC groupFamily conflictc; adolescent adjustmentSelf-reported website use and satisfactionFamilies completed an average of 10 sessions; 95% completed all 10 sessions; 87% of parents reported meeting their goals, learning ways to improve their child’s behavior, and understanding their child better (P<.05 relative to IRC)OFPS []; United StatesRCT; usual care plus IRCTeenagers (aged 11-18 years) with moderate to severe TBI and families (all family members could participate; outcomes reported for one parent and child only); 41 families; 20% in the intervention group and 5% in the IRC groupParental distress and depressionc (lower SESaa only); social problem-solvingc (lower SES only)Website use, ease of use, and satisfaction (WEQ and OSS)93% rated it as moderately or extremely helpful compared to other sites; parents’ suggestions for change included fewer questionnaires; 20% of parents agreed that the intervention was too shortOFPS []; United StatesRCT; usual care plus IRCChildren (aged 12-17 years) with moderate to severe TBI and families (all family members could participate; outcomes reported for one parent and child only); 132 children and their families; 12.3% in the intervention group and 5.9% in the control groupTeenager executive functionc (older adolescents)Not reportedNot reportedOFPS []; United StatesRCT; usual care plus IRCChildren (aged 12-17 years) with moderate to severe TBI and families (all family members could participate; outcomes reported for one parent and child only); 132 children and their families; 12.3% in the intervention group and 5.9% in the control groupCaregiver depression and distressc (intention-to-treat analysis); caregiver efficacy(1) Previous technology use; (2) completion(1) Previous computer use did not moderate reductions in depression and distress; nonfrequent computer users in the intervention group reported significantly higher levels of caregiver efficacy (F41=7.15; P=.01); (2) 43% of parents reported spending <30 minutes per week on CAPSab; 50% reported spending 30 minutes-2 hours per week; 88% completed ≥4 sessionsOFPS []; United StatesRCT; usual care plus IRCChildren (aged 12-17 years) with moderate to severe TBI and families (all family members could participate; outcomes reported for one parent and child only); 132 children and their families; 12.3% in the intervention group and 5.9% in the control groupChild behavioral outcomesc (older adolescents)Completion43% of parents reported spending <30 minutes per week on CAPS; 50% reported spending 30 minutes-2 hours per week; 88% completed ≥4 sessions; 93% rated the website as moderately to extremely helpfulOFPS []; United StatesRCT; usual care plus IRCChildren (aged 12-17 years) with moderate to severe TBI and families (all family members could participate; outcomes reported for one parent and child only); 132 children and their families; 12.3% in the intervention group and 5.9% in the control groupParent-teenager conflict; parent-teenager interactions; structural, organizational, and transactional characteristics of familiesCompletion43% of parents reported spending <30 minutes per week on CAPS; 50% reported spending 30 minutes-2 hours per week; 88% completed ≥4 sessionsOFPS []; United StatesRCT; usual care plus IRCChildren (aged 12-17 years) with moderate to severe TBI and families (all family members could participate; outcomes reported for one parent and child only); 132 children and their families; 12.3% in the intervention group and 5.9% in the control group (final assessment: 13.4% in the intervention group and 11.4% in the control group)Long-term caregiver depression and distressc (distress only); long-term perceived parenting efficacyNot reportedNot reportedOFPS []; United StatesRCT; usual care plus IRCChildren (aged 12-17 years) with moderate to severe TBI and families (all family members could participate; outcomes reported for one parent and child only); 132 children and their families; 12.3% in the intervention group and 5.9% in the control group (final assessment: 30.8% in the intervention group and 19.4% in the control group)Long-term child behavioral outcomesc (internalizing behaviors of older adolescents)CompletionNumber of sessions completed unrelated to improvements in internalizing symptoms over time; those who completed more sessions reported less improvement in externalizing symptoms over time (P=.007)OFPS []; United StatesRCT; usual care plus IRCChildren (aged 12-17 years) with moderate to severe TBI and families (all family members could participate; outcomes reported for one parent and child only); 132 children and their families; 25% in the intervention group and 21% in the control groupAdolescent emotional and behavioral functioning; adolescent mood and behavior (as a function of parent marital status)Not reportedNot reportedOFPS []; United StatesRCT; face-to-face F-PSTac, therapist-guided F-PST, or self-guided web-based F-PSTAdolescents (aged 14-18 years) with moderate to severe TBI and families (all family members could participate; outcomes reported for one parent and child only); 149 parents and caregivers; 18%Parent depressionc (therapist-guided group only); parent psychological distressc (therapist-guided group only)Computer use before and duringParents with less comfort with technology improved more with therapist-guided treatment when compared to self-guided treatment (F1,107=3.80; P=.05)OFPS []; United StatesRCT; face-to-face F-PST, therapist-guided F-PST, or self-guided web-based F-PSTAdolescents (aged 14-18 years) with moderate to severe TBI and families (all family members could participate; outcomes reported for one parent and child only); 149 parents and caregivers; at the 9-month assessment: 35.3% in the face-to-face group, 21.5% in the therapist-guided group, and 20% in the self-guided groupBehavioral outcomes(1) Patient-perceived preference for treatment (before the intervention); (2) adherence; (3) satisfaction; (4) computer use(1) 71% of parents agreed or strongly agreed that self-guided F-PST was most convenient; 54% of parents agreed or strongly agreed that self-guided and therapist-guided web-based F-PST would be most beneficial; 55% of teenagers agreed or strongly agreed that self-guided F-PST was most convenient; (2) median 5 hours per week; parents assigned to their preferred group completed a mean of 5.29 sessions, and those assigned to their nonpreferred group completed a mean of 6.37 sessions; adolescents in their preferred group completed a mean of 6.12 sessions, and those in their nonpreferred group completed a mean of 5.17 sessions; adolescent treatment preference was significantly related to attrition (χ2=4.2, 95% CI 1.03–5.44; P=.04); (3) parents in the face-to-face group rated the intervention more favorably than those in the therapist-guided (Cohen d=0.67, 95% CI 0.10-1.15; t=–2.49; P<.04) or self-guided (Cohen d=1.18, 95% CI 0.56-1.62; t=–4.36; P<.001) group; parents in the face-to-face group reported higher satisfaction than parents in the self-guided group (Cohen d=0.63, 95% CI 0.09-1.11; t=–2.51; P=.04); (4) no significant association with treatment preferenceOFPS []; United StatesRCT; face-to-face F-PST, therapist-guided F-PST, or self-guided web-based F-PSTAdolescents (aged 14-18 years) with moderate to severe TBI and families (all family members could participate; outcomes reported for one parent and child only); 149 parents and caregivers; at the 9-month assessment: 35.3% in the face-to-face group, 21.5% in the therapist-guided group, and 20% in the self-guided groupAdolescent QoLc; brain injury symptomsNot reportedNot reportedOFPS []; United StatesRCT; TOPSad with family, TOPS with teenagers only, or IRCTeenagers (aged 11-18 years) with moderate to severe TBI and families (all family members could participate; outcomes reported for one parent and child only); 152 teenagers and their families; 31% in the TOPS with family group, 24% in the TOPS with teenagers only group, and 23% in the IRC groupChild behavioral outcomesc (TOPS with family)CompletionCompletion: mean sessions completed (TOPS with family) 8.00 (SD 2.90) and mean sessions completed (TOPS with teenagers only) 8.40 (SD 2.80); completed supplemental sessions: 14.29% for TOPS with family and 13.46% for TOPS with teenagers onlyOFPS []; United StatesRCT; TOPS with family, TOPS with teenagers only, or IRCTeenagers (aged 11-18 years) with moderate to severe TBI and families (all family members could participate; outcomes reported for one parent and child only); 152 teenagers and their families; 31% in the TOPS with family group, 24% in the TOPS with teenagers only group, and 23% in the IRC groupFamily functioning; family cohesionc (TOPS with family and 2-parent households); parent-adolescent conflict; parental psychological distress and depressionc (TOPS with family and 2-parent households)Not reportedNot reportedOurRelationship []; United StatesRCT; waitlistHeterosexual couples; 300 couples; 8%Relationship satisfactionc; positive and negative relationship qualityc (reducing negative relationship quality); relationship confidencec; depressionc; anxietyc; perceived healthc; work functioningc; QoLc(1) Evaluation (Client Evaluation of Services Questionnaire); (2) completion rates; (3) coach engagement(1) Mean 26.81 (SD 4.44), nearly equivalent to in-person individual therapy (Cohen d=–0.07) and high-quality couple therapy (Cohen d=–0.18); 94% were mostly or very satisfied with the services received; 97% would recommend it to a friend; (2) 86% completed the entire intervention; an additional 5% completed up to the “Understand” phase; (3) coaches spent a mean of 51.32 (SD 17.11) minutes with the couples; individuals received a mean of 5.11 (SD 1.7) scripted chat reminders and no tailored chat messagesOurRelationship []; United StatesRCT; waitlistHeterosexual couples; 300 couples; 8%Relationship satisfactionc (no moderation by LI-IPVae)Not reportedNot reportedOurRelationship []; United StatesRCT; waitlistHeterosexual couples; 300 couples; 8%Relationship satisfaction; relationship confidence; positive and negative relationship qualityc (moderated by rurality); depression; anxiety; perceived healthc (moderated by race); work functioning; QoL(1) Evaluation (Client Evaluation of Services Questionnaire); (2) participant predictors of completion(1) Couples were generally satisfied with the intervention (mean 26.81, SD 4.44); service evaluation was not moderated by race, ethnicity,