Currently submitted to: JMIR Pediatrics and Parenting
Date Submitted: Oct 6, 2026
Open Peer Review Period: Oct 6, 2026 - Dec 1, 2026
(currently open for review)
Warning: This is an author submission that is not peer-reviewed or edited. Preprints - unless they show as "accepted" - should not be relied on to guide clinical practice or health-related behavior and should not be reported in news media as established information.
Therapeutic alliance in a digital mental health service for fathers: findings from a cross-sectional survey design
ABSTRACT
Background:
The demands associated with caring for a child begin prior to birth, as pregnancy itself requires substantial physical, psychological, and material resources. In previous generations, advice and support for new parents would come from trusted family members alongside health professionals. In the ‘digital age’, alternate sources of advice challenge parents to decide on a course of action. Fathers in particular are not sure who to trust for information and guidance on parenting and mental health. SMS4dads, a digital mental health service for fathers was designed to address new fathers’ use of parenting and mental health information and support. The service fosters a relational connection, and the Working Alliance Inventory Short Form (WAI-SF) was adapted to capture the unique factors of SMS4dads that are likely to contribute to alliance formation.
Objective:
(1) Examine whether SMS4dads fostered a therapeutic alliance between the service and participants. (2) Examine whether demographic factors, specifically education and location, were associated with the strength of this alliance. (3) Examine whether exposure to the service, measured by enrolment period, was associated with the strength of this alliance.
Methods:
Using a cross-sectional design, we linked data from a single-timepoint exit survey with programme enrolment records to derive demographic and exposure variables.
Results:
The SMS4dads-WAI-SR was completed by 599 fathers at the conclusion of their programme, in the period March to December 2025. Internal consistency of the total and subscales of SMS4dads-WAI-SR ranged from α.78 to .92. Mean scores ranged from Goal subscale M = 3.66 (SD 0.76) to Bond subscale M = 4.09 (SD 0.72). Fathers without tertiary education reported significantly higher Goal, Task, Bond, and Total Scale scores than fathers with tertiary education. No significant differences were observed between urban and rural fathers. Exposure was not associated with the total scale score.
Conclusions:
The results support the existence of a working alliance between the SMS4dads text-based programme and men transitioning to fatherhood. The existence of an alliance did not depend on education level, rural/urban location or exposure. The SMS4dads-WAI-SR captures unique elements of the intervention and may serve as exemplar or template for father-specific parenting or mental health initiatives or for male parents in generic parenting initiatives. Clinical Trial: n/a
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