{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,8,19]],"date-time":"2026-08-19T17:36:50Z","timestamp":1787161010834,"version":"build-2736575974"},"reference-count":29,"publisher":"JMIR Publications Inc.","content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["JMIR Form Res"],"abstract":"Abstract<\/jats:title>\n \n Background<\/jats:title>\n Parent management training (PMT) is an evidence-based intervention for addressing child behavioral difficulties; however, caregivers often need additional guidance when implementing skills in daily life. Pat is an AI conversational agent designed to augment a therapist-led PMT program by providing caregivers with real-time guidance, reinforcement, and answers to parenting questions between sessions.<\/jats:p>\n <\/jats:sec>\n \n Objective<\/jats:title>\n This study explored caregivers\u2019 engagement with Pat, satisfaction, and the therapeutic alliance formed between caregivers and Pat during online group PMT.<\/jats:p>\n <\/jats:sec>\n \n Methods<\/jats:title>\n Data from 88 caregivers of children aged 3 to 14 years participating in an online PMT program were analyzed at 3 time points (wk 4, 8, and 12). Engagement with Pat was measured through the number of messages exchanged with Pat, modules completed, in-the-moment support chats, and days the platform was used. Satisfaction with the intervention was measured using the Net Promoter Score and the Therapy Attitude Inventory. The therapeutic alliance between caregivers and Pat was assessed using the Working Alliance Inventory\u2013Short Form Revised.<\/jats:p>\n <\/jats:sec>\n \n Results<\/jats:title>\n \n Caregivers exchanged a high number of messages with Pat (mean 383.09, SD 185.64 by wk 4 and mean 726.47, SD 405.41 by wk 8) and completed multiple required and optional modules (mean 5.41, SD 1.93 at wk 4; mean 10.49, SD 9.18 at wk 8).\n \n Net Promoter Scores remained high and stable across the study (wk 4=77.8, wk 8=76.7, and wk 12=75.0), with no significant change over time (\n F<\/jats:italic>\n 2,114<\/jats:sub>\n =0.10;\n P<\/jats:italic>\n =.91).\n \n Therapy attitudes increased significantly from week 4 (mean 4.22, SD 0.47) to week 8 (mean 4.49, SD 0.37) and remained stable through week 12 (mean 4.49, SD 0.48,\n F<\/jats:italic>\n 2, 114<\/jats:sub>\n =5.69;\n P<\/jats:italic>\n =.004). Therapeutic alliance ratings with Pat were consistently high across time points (mean 4.10, SD 0.63 at wk 4; mean 4.10, SD 0.55 at wk 8; and mean 4.04, SD 0.63 at wk 12), with no significant differences across weeks (\n F<\/jats:italic>\n 2, 114<\/jats:sub>\n =0.182;\n P<\/jats:italic>\n =.83).\n <\/jats:p>\n <\/jats:sec>\n \n Conclusions<\/jats:title>\n These findings show that caregivers meaningfully engaged with Pat, remained highly satisfied across time, established a strong therapeutic alliance, and held positive therapy attitudes. Overall, the hybrid group model integrating human therapists with Pat may represent a promising and efficient strategy for enhancing engagement and providing scalable and real-time support to parents.<\/jats:p>\n <\/jats:sec>","DOI":"10.2196\/100302","type":"journal-article","created":{"date-parts":[[2026,7,3]],"date-time":"2026-07-03T16:05:16Z","timestamp":1783094716000},"page":"e100302-e100302","source":"Crossref","is-referenced-by-count":0,"title":["Engagement, Satisfaction, and Therapeutic Alliance With an AI Conversational Agent for Parents: Quantitative Descriptive Study"],"prefix":"10.2196","volume":"10","author":[{"ORCID":"https:\/\/orcid.org\/0000-0001-8011-5278","authenticated-orcid":false,"given":"Karin","family":"Mostovoy","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-6719-9355","authenticated-orcid":false,"given":"Blanca S","family":"Pineda","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0002-3692-7070","authenticated-orcid":false,"given":"Arjun","family":"Bharat","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0002-2129-707X","authenticated-orcid":false,"given":"Tyrique","family":"Patterson","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0003-0234-0439","authenticated-orcid":false,"given":"Jing","family":"Mao","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0001-8154-7555","authenticated-orcid":false,"given":"Carlos Felipe","family":"Rivera-Cepeda","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-9918-9311","authenticated-orcid":false,"given":"Daniel M","family":"Bagner","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-9860-8625","authenticated-orcid":false,"given":"Antonio Y","family":"Hardan","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-1487-7618","authenticated-orcid":false,"given":"Eduardo L","family":"Bunge","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1010","published-online":{"date-parts":[[2026,8,19]]},"reference":[{"issue":"1","key":"R1","doi-asserted-by":"publisher","first-page":"1","DOI":"10.4073\/csr.2012.12","article-title":"Behavioural and cognitive\u2010behavioural group\u2010based parenting programmes for early\u2010onset conduct problems in children aged 3 to 12 years","volume":"8","author":"Furlong","journal-title":"Campbell Syst Rev"},{"key":"R2","doi-asserted-by":"publisher","DOI":"10.1016\/j.childyouth.2018.12.004","article-title":"Group-based parenting program to improve parenting and children\u2019s behavioral problems in families using special services: a randomized controlled trial in a real-life setting","volume":"96","author":"Karjalainen","journal-title":"Child Youth Serv Rev"},{"issue":"1","key":"R3","doi-asserted-by":"publisher","first-page":"164","DOI":"10.1007\/s10578-022-01367-y","article-title":"The efficacy of parent management training with or without involving the child in the treatment among children with clinical levels of disruptive behavior: a meta-analysis","volume":"55","author":"Helander","journal-title":"Child Psychiatry Hum Dev"},{"issue":"3","key":"R4","doi-asserted-by":"publisher","first-page":"692","DOI":"10.1007\/s10578-021-01276-6","article-title":"Evaluating the effect of parent-child interactive groups in a school-based parent training program: parenting behavior, parenting stress and sense of competence","volume":"54","author":"Buchanan-Pascall","journal-title":"Child Psychiatry Hum Dev"},{"issue":"3","key":"R5","doi-asserted-by":"publisher","first-page":"113","DOI":"10.1016\/j.brat.2012.11.006","article-title":"A randomized trial of group parent training: reducing child conduct problems in real-world settings","volume":"51","author":"Kj\u00f8bli","journal-title":"Behav Res Ther"},{"issue":"20","key":"R6","doi-asserted-by":"publisher","DOI":"10.3390\/ijerph192013655","article-title":"Parenting programme structure, potential barriers, and facilitators: a scoping review","volume":"19","author":"Ramos","journal-title":"Int J Environ Res Public Health"},{"issue":"6","key":"R7","doi-asserted-by":"publisher","first-page":"623","DOI":"10.1007\/s00787-016-0930-6","article-title":"What do parents perceive are the barriers and facilitators to accessing psychological treatment for mental health problems in children and adolescents? 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