{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,7,27]],"date-time":"2026-07-27T04:01:21Z","timestamp":1785124881707,"version":"3.55.0"},"reference-count":65,"publisher":"BMJ","issue":"7","license":[{"start":{"date-parts":[[2026,7,22]],"date-time":"2026-07-22T00:00:00Z","timestamp":1784678400000},"content-version":"unspecified","delay-in-days":21,"URL":"https:\/\/creativecommons.org\/licenses\/by-nc\/4.0\/"}],"funder":[{"DOI":"10.13039\/100000025","name":"National Institute of Mental Health","doi-asserted-by":"publisher","award":["R01MH129374"],"award-info":[{"award-number":["R01MH129374"]}],"id":[{"id":"10.13039\/100000025","id-type":"DOI","asserted-by":"publisher"}]}],"content-domain":{"domain":["bmj.com"],"crossmark-restriction":true},"short-container-title":["BMJ Open"],"accepted":{"date-parts":[[2026,7,10]]},"published-print":{"date-parts":[[2026,7]]},"abstract":"<jats:sec>\n                    <jats:title>Introduction<\/jats:title>\n                    <jats:p>Anxiety disorders are the most common youth mental health problems in the USA. Most children do not receive treatment and among the few who do, many do not experience significant improvement. Thus, there is an urgent need to identify novel intervention targets to improve treatments for childhood anxiety. Past research demonstrates that parent anxiety plays a role in the development and maintenance of child anxiety, but empirical evidence for the mechanisms that drive this transmission is lacking. Interpretation bias, or the tendency to perceive threat in ambiguous situations, may lead parents to engage in anxiety-promoting parenting behaviours, which may transfer this cognitive bias to their children, resulting in youth anxiety. Given the current lack of empirical evidence supporting this theorised mechanism, the present study will test effects of parent interpretation bias on parent behaviour and child interpretation bias. Our central hypothesis is that parent interpretation bias influences child interpretation bias through its effects on anxiety-promoting parenting behaviours. The study will also evaluate potential moderators of these theorised relationships, such as parent sex, race and ethnicity, parent anxiety, child age and child sex.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods and analysis<\/jats:title>\n                    <jats:p>We will randomise 300 parents of children aged 7\u201312\u2009to a smartphone app-delivered interpretation bias manipulation condition or a self-assessment control condition. Through a series of study assessments over the course of 3 months, parents and children will complete self-report, interview, behavioural and daily diary measures to assess the primary proximal outcome (anxiety-promoting parenting behaviours), the secondary distal outcome (child interpretation bias) and moderators. To test our central hypothesis, we will first use hierarchical linear modelling to assess whether parents in the interpretation bias manipulation condition show fewer anxiety-promoting parenting behaviours compared with control, and whether children of those parents show improved interpretation bias compared with control. We will then implement mediation models to evaluate whether a reduction in anxiety-promoting parenting behaviours mediates the association between parent and child interpretation bias.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Ethics and dissemination<\/jats:title>\n                    <jats:p>\n                      Ethical approval for this study was granted by the Mass General Brigham Institutional Review Board (2022P003245). We will disseminate the results of this study to the scientific community, clinical community and the public through several channels such as peer-reviewed publications in scientific journals, national conferences, hospital lectures, press releases and\n                      <jats:italic>Psychology Today<\/jats:italic>\n                      blog posts.\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Trial registration number<\/jats:title>\n                    <jats:p>\n                      <jats:ext-link xmlns:xlink=\"http:\/\/www.w3.org\/1999\/xlink\" ext-link-type=\"clintrialgov\" xlink:href=\"NCT05665491\">NCT05665491<\/jats:ext-link>\n                      .\n                    <\/jats:p>\n                  <\/jats:sec>","DOI":"10.1136\/bmjopen-2026-119801","type":"journal-article","created":{"date-parts":[[2026,7,27]],"date-time":"2026-07-27T03:26:05Z","timestamp":1785122765000},"page":"e119801","update-policy":"https:\/\/doi.org\/10.1136\/crossmarkpolicy","source":"Crossref","is-referenced-by-count":0,"title":["Protocol for the Parent Anxiety Transmission and Habits (PATH) study: a randomised controlled trial testing parent interpretation bias as a key mechanism of intergenerational transmission of anxiety"],"prefix":"10.1136","volume":"16","clinical-trial-number":[{"clinical-trial-number":"nct05665491","registry":"10.18810\/clinical-trials-gov"},{"clinical-trial-number":"nct05665491","registry":"10.18810\/clinical-trials-gov"}],"author":[{"ORCID":"https:\/\/orcid.org\/0009-0003-9632-2580","authenticated-orcid":false,"given":"Margaret A","family":"Chiffer","sequence":"first","affiliation":[{"name":"Division of Depression and Anxiety Disorders, McLean Hospital, Belmont, Massachusetts, USA"},{"name":"Department of Psychiatry, Mass General Brigham, Boston, Massachusetts, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-1647-5329","authenticated-orcid":false,"given":"Daniel P","family":"Dickstein","sequence":"additional","affiliation":[{"name":"Department of Psychiatry, Mass General Brigham, Boston, Massachusetts, USA"},{"name":"Simches Division of Child and Adolescent Psychiatry, McLean Hospital, Belmont, Massachusetts, USA"},{"name":"Department of Psychiatry, Harvard Medical School, Boston, Massachusetts, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0002-7011-6896","authenticated-orcid":false,"given":"Roni","family":"Itkin-Ofer","sequence":"additional","affiliation":[{"name":"Division of Depression and Anxiety Disorders, McLean Hospital, Belmont, Massachusetts, USA"},{"name":"Department of Psychiatry, Mass General Brigham, Boston, Massachusetts, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-3929-2683","authenticated-orcid":false,"given":"Jennie M","family":"Kuckertz","sequence":"additional","affiliation":[{"name":"Division of Depression and Anxiety Disorders, McLean Hospital, Belmont, Massachusetts, USA"},{"name":"Department of Psychiatry, Mass General Brigham, Boston, Massachusetts, USA"},{"name":"Department of Psychiatry, Harvard Medical School, Boston, Massachusetts, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-5300-1184","authenticated-orcid":false,"given":"Boyu","family":"Ren","sequence":"additional","affiliation":[{"name":"Division of Depression and Anxiety Disorders, McLean Hospital, Belmont, Massachusetts, USA"},{"name":"Department of Psychiatry, Mass General Brigham, Boston, Massachusetts, USA"},{"name":"Department of Psychiatry, Harvard Medical School, Boston, Massachusetts, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0004-5809-3227","authenticated-orcid":false,"given":"Doah E","family":"Shin","sequence":"additional","affiliation":[{"name":"Division of Depression and Anxiety Disorders, McLean Hospital, Belmont, Massachusetts, USA"},{"name":"Department of Psychiatry, Mass General Brigham, Boston, Massachusetts, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-8066-2308","authenticated-orcid":false,"given":"Alexandra L","family":"Silverman","sequence":"additional","affiliation":[{"name":"Division of Depression and Anxiety Disorders, McLean Hospital, Belmont, Massachusetts, USA"},{"name":"Department of Psychiatry, Mass General Brigham, Boston, Massachusetts, USA"},{"name":"Department of Psychiatry, Harvard Medical School, Boston, Massachusetts, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-8310-4539","authenticated-orcid":false,"given":"Christian A","family":"Webb","sequence":"additional","affiliation":[{"name":"Division of Depression and Anxiety Disorders, McLean Hospital, Belmont, Massachusetts, USA"},{"name":"Department of Psychiatry, Mass General Brigham, Boston, Massachusetts, USA"},{"name":"Department of Psychiatry, Harvard Medical School, Boston, Massachusetts, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-8321-8712","authenticated-orcid":false,"given":"Courtney","family":"Beard","sequence":"additional","affiliation":[{"name":"Division of Depression and Anxiety Disorders, McLean Hospital, Belmont, Massachusetts, USA"},{"name":"Department of Psychiatry, Mass General Brigham, Boston, Massachusetts, USA"},{"name":"Department of Psychiatry, Harvard Medical School, Boston, Massachusetts, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"239","published-online":{"date-parts":[[2026,7,22]]},"reference":[{"key":"2026072620255647000_16.7.e119801.1","doi-asserted-by":"publisher","DOI":"10.1016\/j.jaac.2010.05.017"},{"key":"2026072620255647000_16.7.e119801.2","doi-asserted-by":"publisher","DOI":"10.1016\/j.psc.2009.06.002"},{"key":"2026072620255647000_16.7.e119801.3","doi-asserted-by":"publisher","DOI":"10.1111\/1469-7610.00798"},{"key":"2026072620255647000_16.7.e119801.4","doi-asserted-by":"publisher","DOI":"10.1016\/S0887-6185(99)00039-0"},{"key":"2026072620255647000_16.7.e119801.5","unstructured":"Wood JJ , McLeod BD . Child anxiety disorders: a family-based treatment manual for practitioners. New York, NY, US: W. W. Norton & Company, 2008."},{"key":"2026072620255647000_16.7.e119801.6","doi-asserted-by":"crossref","first-page":"551","DOI":"10.1007\/s10802-020-00626-7","article-title":"Pediatric Anxiety Disorders: A Cost of Illness Analysis","volume":"48","author":"Pella","year":"2020","journal-title":"J Abnorm Child Psychol"},{"key":"2026072620255647000_16.7.e119801.7","doi-asserted-by":"publisher","DOI":"10.1016\/j.jaac.2010.10.006"},{"key":"2026072620255647000_16.7.e119801.8","doi-asserted-by":"publisher","DOI":"10.1037\/a0025933"},{"key":"2026072620255647000_16.7.e119801.9","doi-asserted-by":"publisher","DOI":"10.1037\/a0036365"},{"key":"2026072620255647000_16.7.e119801.10","doi-asserted-by":"crossref","unstructured":"Hudson JL , Rapee RM . Familial and social environments in the etiology and maintenance of anxiety disorders. In: Oxf. Handb. Anxiety Relat. Disord. New York, NY, US: Oxford University Press, 2009: 173\u201389.","DOI":"10.1093\/oxfordhb\/9780195307030.013.0014"},{"key":"2026072620255647000_16.7.e119801.11","doi-asserted-by":"publisher","DOI":"10.1007\/s10567-011-0108-1"},{"key":"2026072620255647000_16.7.e119801.12","doi-asserted-by":"crossref","first-page":"171","DOI":"10.1007\/s10826-010-9441-0","article-title":"Does Father Know Best? A Formal Model of the Paternal Influence on Childhood Social Anxiety","volume":"20","author":"B\u00f6gels","year":"2011","journal-title":"J Child Fam Stud"},{"key":"2026072620255647000_16.7.e119801.13","doi-asserted-by":"publisher","DOI":"10.1146\/annurev-clinpsy-021815-093436"},{"key":"2026072620255647000_16.7.e119801.14","doi-asserted-by":"crossref","first-page":"812","DOI":"10.1007\/s10608-012-9513-0","article-title":"Parental and Family Factors as Predictors of Threat Bias in Anxious Youth","volume":"37","author":"Blossom","year":"2013","journal-title":"Cogn Ther Res"},{"key":"2026072620255647000_16.7.e119801.15","doi-asserted-by":"publisher","DOI":"10.1016\/j.brat.2004.10.009"},{"key":"2026072620255647000_16.7.e119801.16","doi-asserted-by":"crossref","first-page":"3413","DOI":"10.1007\/s10826-015-0143-5","article-title":"Shared Cognition in Childhood Anxiety: Interpretation Bias in Preschool Children and Their Parents","volume":"24","author":"Ooi","year":"2015","journal-title":"J Child Fam Stud"},{"key":"2026072620255647000_16.7.e119801.17","doi-asserted-by":"crossref","first-page":"642","DOI":"10.1080\/15374416.2014.987378","article-title":"Transmission of Cognitive Bias and Fear From Parents to Children: An Experimental Study","volume":"45","author":"Remmerswaal","year":"2016","journal-title":"J Clin Child Adolesc Psychol"},{"key":"2026072620255647000_16.7.e119801.18","doi-asserted-by":"crossref","first-page":"353","DOI":"10.1002\/da.22745","article-title":"Influence of maternal negative emotion reactivity and cognitive reappraisal on child anxiety disorder","volume":"35","author":"Wald","year":"2018","journal-title":"Depress Anxiety"},{"key":"2026072620255647000_16.7.e119801.19","doi-asserted-by":"crossref","first-page":"15","DOI":"10.1016\/j.janxdis.2018.11.002","article-title":"A systematic review of the role of parents in the development of anxious cognitions in children","volume":"62","author":"Emerson","year":"2019","journal-title":"J Anxiety Disord"},{"key":"2026072620255647000_16.7.e119801.20","doi-asserted-by":"crossref","first-page":"851","DOI":"10.1016\/j.janxdis.2014.09.011","article-title":"Interpretation bias modification for youth and their parents: a novel treatment for early adolescent social anxiety","volume":"28","author":"Reuland","year":"2014","journal-title":"J Anxiety Disord"},{"key":"2026072620255647000_16.7.e119801.21","doi-asserted-by":"publisher","DOI":"10.1007\/s10826-013-9767-5"},{"key":"2026072620255647000_16.7.e119801.22","doi-asserted-by":"publisher","DOI":"10.1016\/j.brat.2010.02.006"},{"key":"2026072620255647000_16.7.e119801.23","doi-asserted-by":"crossref","first-page":"171","DOI":"10.1016\/j.janxdis.2012.12.004","article-title":"Parenting practices, interpretive biases, and anxiety in Latino children","volume":"27","author":"Varela","year":"2013","journal-title":"J Anxiety Disord"},{"key":"2026072620255647000_16.7.e119801.24","doi-asserted-by":"crossref","first-page":"135","DOI":"10.1007\/s10608-006-9021-1","article-title":"A Longitudinal Investigation of Maternal and Child \u2018Anxious Cognitions\u2019","volume":"30","author":"Creswell","year":"2006","journal-title":"Cogn Ther Res"},{"key":"2026072620255647000_16.7.e119801.25","doi-asserted-by":"publisher","DOI":"10.1007\/s10578-016-0655-2"},{"key":"2026072620255647000_16.7.e119801.26","doi-asserted-by":"crossref","first-page":"379","DOI":"10.1177\/1948550617715068","article-title":"Determining Power and Sample Size for Simple and Complex Mediation Models","volume":"8","author":"Schoemann","year":"2017","journal-title":"Soc Psychol Personal Sci"},{"key":"2026072620255647000_16.7.e119801.27","doi-asserted-by":"publisher","DOI":"10.18637\/jss.v059.i09"},{"key":"2026072620255647000_16.7.e119801.28","doi-asserted-by":"publisher","DOI":"10.1001\/archinte.166.10.1092"},{"key":"2026072620255647000_16.7.e119801.29","doi-asserted-by":"crossref","first-page":"406","DOI":"10.1007\/s10608-009-9235-0","article-title":"Interpretation in Social Anxiety: When Meaning Precedes Ambiguity","volume":"33","author":"Beard","year":"2009","journal-title":"Cogn Ther Res"},{"key":"2026072620255647000_16.7.e119801.30","doi-asserted-by":"crossref","unstructured":"Wechsler D . Wechsler abbreviated scale of intelligence--second edition (WASI-II). APA PsycTests, 2011. Available: https:\/\/doi.org\/10.1037\/t15171-000","DOI":"10.1037\/t15171-000"},{"key":"2026072620255647000_16.7.e119801.31","doi-asserted-by":"crossref","first-page":"331","DOI":"10.1007\/s10826-011-9483-y","article-title":"Unique Roles of Mothering and Fathering in Child Anxiety; Moderation by Child\u2019s Age and Gender","volume":"21","author":"Verhoeven","year":"2012","journal-title":"J Child Fam Stud"},{"key":"2026072620255647000_16.7.e119801.32","doi-asserted-by":"crossref","first-page":"365","DOI":"10.1016\/j.beth.2020.04.013","article-title":"HabitWorks: Development of a CBM-I Smartphone App to Augment and Extend Acute Treatment","volume":"52","author":"Beard","year":"2021","journal-title":"Behav Ther"},{"key":"2026072620255647000_16.7.e119801.33","doi-asserted-by":"crossref","first-page":"125","DOI":"10.1037\/ccp0000996","article-title":"Randomized controlled trial of smartphone-based interpretation bias intervention for anxiety and depression","volume":"94","author":"Silverman","year":"2026","journal-title":"J Consult Clin Psychol"},{"key":"2026072620255647000_16.7.e119801.34","doi-asserted-by":"publisher","DOI":"10.1016\/j.jbi.2008.08.010"},{"key":"2026072620255647000_16.7.e119801.35","doi-asserted-by":"publisher","DOI":"10.3928\/0048-5713-20020901-06"},{"key":"2026072620255647000_16.7.e119801.36","doi-asserted-by":"publisher","DOI":"10.1037\/a0029516"},{"key":"2026072620255647000_16.7.e119801.37","doi-asserted-by":"crossref","first-page":"168","DOI":"10.1080\/15295192.2019.1694838","article-title":"Introducing a Novel Online Observation of Parenting Behavior: Reliability and Validation","volume":"21","author":"Oliver","year":"2021","journal-title":"Parenting"},{"key":"2026072620255647000_16.7.e119801.38","doi-asserted-by":"publisher","DOI":"10.1002\/da.21998"},{"key":"2026072620255647000_16.7.e119801.39","doi-asserted-by":"publisher","DOI":"10.1023\/A:1025894928131"},{"key":"2026072620255647000_16.7.e119801.40","doi-asserted-by":"crossref","first-page":"761","DOI":"10.1348\/026151005X70418","article-title":"Anxious cognitions in children: An exploration of associations and mediators","volume":"24","author":"Creswell","year":"2006","journal-title":"British J of Dev Psycho"},{"key":"2026072620255647000_16.7.e119801.41","doi-asserted-by":"publisher","DOI":"10.1007\/BF01441484"},{"key":"2026072620255647000_16.7.e119801.42","doi-asserted-by":"crossref","first-page":"289","DOI":"10.1111\/j.2517-6161.1995.tb02031.x","article-title":"Controlling the False Discovery Rate: A Practical and Powerful Approach to Multiple Testing","volume":"57","author":"Benjamini","year":"1995","journal-title":"J Royal Stat Soc Series B"},{"key":"2026072620255647000_16.7.e119801.43","doi-asserted-by":"crossref","first-page":"1","DOI":"10.18637\/jss.v033.i01","article-title":"Regularization Paths for Generalized Linear Models via Coordinate Descent","volume":"33","author":"Friedman","year":"2010","journal-title":"J Stat Soft"},{"key":"2026072620255647000_16.7.e119801.44","doi-asserted-by":"publisher","DOI":"10.18637\/jss.v028.i05"},{"key":"2026072620255647000_16.7.e119801.45","doi-asserted-by":"publisher","DOI":"10.1016\/j.jeconom.2007.02.002"},{"key":"2026072620255647000_16.7.e119801.46","unstructured":"Beard C . From lab to real world. Psychol Today; 2026. Available: https:\/\/www.psychologytoday.com\/us\/blog\/from-lab-to-real-world [Accessed 17 Mar 2026]."},{"key":"2026072620255647000_16.7.e119801.47","doi-asserted-by":"publisher","DOI":"10.1001\/archpsyc.1987.01800180050009"},{"key":"2026072620255647000_16.7.e119801.48","doi-asserted-by":"crossref","unstructured":"Narrow WE , Clarke DE , Kuramoto SJ , et al . DSM-5 dimensional cross-cutting symptom assessment for adult patients. APA PsycTests, 2013. Available: https:\/\/doi.org\/10.1037\/t73890-000","DOI":"10.1037\/t73890-000"},{"key":"2026072620255647000_16.7.e119801.49","doi-asserted-by":"crossref","unstructured":"Chorpita BF , Yim L , Moffitt C , et al . Revised child anxiety and depression scale. APA PsycTests, 2000. Available: https:\/\/doi.org\/10.1037\/t03547-000","DOI":"10.1037\/t03547-000"},{"key":"2026072620255647000_16.7.e119801.50","unstructured":"First MB , Williams JBW . Quick structured clinical interview for DSM-5 disorders (QuickSCID-5). 2021."},{"key":"2026072620255647000_16.7.e119801.51","doi-asserted-by":"publisher","DOI":"10.1176\/appi.ajp.2011.10111704"},{"key":"2026072620255647000_16.7.e119801.52","doi-asserted-by":"publisher","DOI":"10.1192\/bjp.180.5.461"},{"key":"2026072620255647000_16.7.e119801.53","doi-asserted-by":"crossref","first-page":"171","DOI":"10.1111\/j.1752-0606.1983.tb01497.x","article-title":"The McMaster family assessment device*","volume":"9","author":"Epstein","year":"1983","journal-title":"J Marital Family Therapy"},{"key":"2026072620255647000_16.7.e119801.54","unstructured":"Harrell SP . The racism and life experience scales. 1994."},{"key":"2026072620255647000_16.7.e119801.55","doi-asserted-by":"publisher","DOI":"10.1136\/adc.44.235.291"},{"key":"2026072620255647000_16.7.e119801.56","doi-asserted-by":"publisher","DOI":"10.1136\/adc.45.239.13"},{"key":"2026072620255647000_16.7.e119801.57","doi-asserted-by":"publisher","DOI":"10.1097\/00004583-199704000-00018"},{"key":"2026072620255647000_16.7.e119801.58","doi-asserted-by":"publisher","DOI":"10.1037\/0022-3514.54.6.1063"},{"key":"2026072620255647000_16.7.e119801.59","doi-asserted-by":"publisher","DOI":"10.1016\/0005-7967(94)00075-U"},{"key":"2026072620255647000_16.7.e119801.60","doi-asserted-by":"crossref","first-page":"48","DOI":"10.1080\/15283488.2014.989442","article-title":"A Brief Form of the Ethnic Identity Scale: Development and Empirical Validation","volume":"15","author":"Douglass","year":"2015","journal-title":"Identity"},{"key":"2026072620255647000_16.7.e119801.61","doi-asserted-by":"crossref","unstructured":"Utsey SO , Belvet B , Hubbard RR , et al . Prolonged activation and anticipatory race-related stress scale. APA PsycTests, 2013. Available: https:\/\/doi.org\/10.1037\/t27626-000","DOI":"10.1037\/t27626-000"},{"key":"2026072620255647000_16.7.e119801.62","doi-asserted-by":"publisher","DOI":"10.2471\/BLT.09.067231"},{"key":"2026072620255647000_16.7.e119801.63","unstructured":"Weathers FW , Blake DD , Schnurr PP , et al . The life events checklist for DSM-5 (LEC-5) \u2013 standard. 2013."},{"key":"2026072620255647000_16.7.e119801.64","doi-asserted-by":"publisher","DOI":"10.1097\/00004583-199707000-00021"},{"key":"2026072620255647000_16.7.e119801.65","unstructured":"Williams CD , Lozada FT , Winter MA . Children\u2019s discrimination experiences measure: an assessment for early and middle childhood in prep."}],"container-title":["BMJ Open"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/syndication.highwire.org\/content\/doi\/10.1136\/bmjopen-2026-119801","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,7,27]],"date-time":"2026-07-27T03:26:16Z","timestamp":1785122776000},"score":1,"resource":{"primary":{"URL":"https:\/\/bmjopen.bmj.com\/lookup\/doi\/10.1136\/bmjopen-2026-119801"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2026,7]]},"references-count":65,"journal-issue":{"issue":"7","published-online":{"date-parts":[[2026,7,22]]},"published-print":{"date-parts":[[2026,7]]}},"alternative-id":["10.1136\/bmjopen-2026-119801"],"URL":"https:\/\/doi.org\/10.1136\/bmjopen-2026-119801","relation":{},"ISSN":["2044-6055","2044-6055"],"issn-type":[{"value":"2044-6055","type":"print"},{"value":"2044-6055","type":"electronic"}],"subject":[],"published":{"date-parts":[[2026,7]]}}}