Exploring and validating themes of the eHealth Therapeutic Alliance Inventory in digital health interventions: A qualitative analysis

Objective: Studies indicate that users can establish a therapeutic alliance (TA) with digital health interventions. However, research examining how TA unfolds in digital settings and its unique facets compared to conventional TA remains limited. This qualitative study aimed to explore and validate preliminary quantitative findings suggesting three distinct themes unique to eHealth TA. Methods: Qualitative data were collected from users of a digital parent training program aiming to explore participants' general experiences with the program. Semi-structured double-blind interviews were conducted (n = 16), and responses to open-ended questions from a larger sample of users were collected (n = 64). Data were thematically analyzed using the six-step framework outlined by Braun and Clarke. Results: In the deductive thematic analysis all three eHealth TA themes were identified – Sense of Relatedness (SR), Application-Induced Accountability (AIA), and Perceived Emotional Investment (PEI), along with the three sub-themes of conventional TA (Goal, Task and Bond). Two eHealth TA themes (SR, AIA) were fully represented in participant's responses, while one (PEI) was only marginally validated. Regarding conventional TA, Goal and Task were fully represented, while Bond was only marginally validated. Validation of eHealth TA themes was further supported by the analysis of the open-ended questions. Conclusions: Findings reinforce prior research, indicating that TA in digital health settings unfolds in distinct ways, and underscoring the need for further exploration of eHealth TA's unique characteristics. Additionally, the study emphasizes potential advantages of employing double-blind methodology in qualitative studies.