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Abstract

Secondary prevention targeting individuals at risk of offending presents a promising strategy to combat child sexual exploitation and abuse, yet programs remain scarce and help-seeking individuals face various barriers. In response, internet-delivered programs such as Prevent It 2.0, an anonymous cognitive behavioral therapy intervention, are being developed. Effective recruitment could benefit from collaboration with the criminal police as referrers. This study examined the perceptions of German, Portuguese, and Swedish criminal police officers regarding Prevent It 2.0 and their potential role in recruitment. Using a Strengths, Weaknesses, Opportunities, and Threats (SWOT) framework to inform data generation, reflexive thematic analysis of six focus groups revealed the program’s perceived potential and limitations. Officers highlighted it as an accessible, low-threshold, and anonymous option, expressing their willingness to refer individuals and indicating a potential for integrated, interdisciplinary prevention strategies. Participants also emphasized the need for continued program refinement and sensitivity to sociocultural influences. Recommendations for implementation and recruitment are discussed.

Keywords

child sexual abuse prevention internet-based intervention offender treatment law enforcement police qualitative analysis

Combating child sexual exploitation and abuse (CSEA) effectively requires innovative, evidence-based prevention strategies and sustained interdisciplinary collaboration. One promising strategy is secondary prevention targeting individuals at risk of offending—such as those with a sexual interest in children (Seto et al., 2023)—before an offense occurs. This approach emphasizes proactively identifying and addressing risk rather than intervening post-offense (Assini-Meytin et al., 2020; Kewley et al., 2023; Knack et al., 2019). Emerging evidence suggests that such interventions show potential; however, rigorous evaluations remain limited. Reviews by Seto et al. (2024) and Stephens et al. (2022) report encouraging findings, such as a decrease in child sexual abuse material (CSAM) use and improved knowledge and recognition of harm caused by CSEA, while emphasizing a need for more robust evaluations.

Currently, most existing programs are embedded in the justice system and focus on individuals who have been convicted (Assini-Meytin et al., 2020). Those who are concerned about their thoughts or behaviors as well as those detected by the police but not convicted, remain largely underserved (Seto et al., 2024; Tenbergen et al., 2021). Germany’s Prevention Project Dunkelfeld, for instance, explicitly excludes those under active legal investigation (Beier et al., 2009). In a recent survey with individuals actively seeking help to stop using CSAM, 43.9% reported difficulty finding suitable services, and 40.4% were unable to access help at all (Insoll et al., 2024).

Bridging this gap may require closer interdisciplinary collaboration, particularly with criminal police officers who regularly interact with individuals suspected of CSEA offenses. Police officers are in a unique position to identify those who could benefit from intervention and act as potential referrers. Based on a mixed-method study with police, third sector representatives, and police data, the Police Foundation, the United Kingdom’s policing think tank, advocates for the use of diversion initiatives to prevent online CSEA and reduce police case load by directing individuals seeking behavioral change into treatment (Skidmore et al., 2022). In a statement, the National Police Chiefs’ Council (2022) welcomed and supported their recommendations. Such an approach is not unprecedented: police diversion has been used to redirect individuals, often those with mental health or substance abuse issues, into treatment (Munetz & Griffin, 2006), reducing reoffending and improving participant health (Blais et al., 2022; Wilson et al., 2018). Traditionally, those initiatives have targeted non-violent offenses, and consequently, research on police perceptions of diversion in the context of CSEA is lacking. Generally, police attitudes toward diversion seem mixed: While officers value the approach as important, skepticism persists about its impact on public safety, with concerns centering on treatment quality, accessibility, and mistrust between police and treatment providers (Anderson et al., 2022; Shefner et al., 2024). Despite these concerns and the lack of specific research, police data shows growing use of diversionary measures for under-18-year-olds suspected of CSAM offenses (Skidmore et al., 2022), indicating an emerging openness to applying such approaches in this context. Research on collaboration for CSEA victim protection further shows that police consider partnerships with treatment providers as essential to addressing CSEA, particularly when supported by training, personal contact, and mutual understanding of perspectives (Eilfgang et al., 2024).

In a recent survey examining factors that influence help-seeking among individuals who use CSAM on the darknet, 55% of respondents reported a desire to stop using CSAM, yet only 3.2% had ever accessed help (Insoll et al., 2024). Studies indicate that help-seeking individuals face substantial barriers, including stigma, shame, fear of judgment, rejection, legal consequences, and concerns about unethical treatment (Chronos et al., 2024; Grady et al., 2019; Jahnke et al., 2015; Levenson & Grady, 2019). While anonymous services could help overcome these barriers (Seto et al., 2024), 70.2% of individuals seeking help to stop their CSAM use struggle to find such resources (Insoll et al., 2024).

In this context, internet-delivered interventions have emerged as accessible, anonymous, and potentially scalable options. A growing body of research demonstrates their effectiveness across a range of psychiatric disorders, including among forensic populations (Hedman-Lagerlöf et al., 2023; Kip et al., 2018). A recent meta-analysis found that internet-delivered cognitive behavioral therapy (CBT) achieves symptom improvement comparable to in-person CBT (Hedman-Lagerlöf et al., 2023), and a systematic review of eHealth interventions in forensic settings reported similar effectiveness as in-person treatment targeting the same outcomes (Kip et al., 2018).

Reviews by Hillert et al. (2024) and Wild et al. (2019) also provide initial support for the feasibility and efficacy of internet-delivered interventions for the prevention of CSEA. In recent years, various such interventions have been developed, including self-help (e.g., Help Wanted, ReDirection, or the self-help site of Stop It Now!) and guided approaches (e.g., @myTabu, Project Bridge, or Prevent It). To date, the most rigorous evaluation is published for Prevent It: a CBT-based, counselor-guided, anonymous online program developed at the Karolinska Institute. The first English version was evaluated in a randomized placebo-controlled trial (2019-2021) with individuals using CSAM recruited online, and showed promising results (Lätth et al., 2022). Namely, the study found that Prevent It significantly reduced participants’ weekly CSAM use, was well-received and appreciated by participants, and was safe from a negative-effects perspective. In response to high attrition and based on evaluation results as well as participant and provider feedback, the program was revised into Prevent It 2.0. The revision included additional psychoeducation in the first modules to reduce early dropout, as well as new content on communication styles and social skills, explanations, examples, and instructions based on participants’ questions and difficulties. The revised Prevent It 2.0 was subsequently culturally adapted for Germany, Portugal, and Sweden (Azevedo et al., 2025): three countries that differ in population densities, legal frameworks (e.g., mandatory reporting laws in Portugal), and CSEA prevention landscapes (e.g., Prevention Project Dunkelfeld in Germany).

Unlike the first version of Prevent It, which aimed at adults with an ongoing criminal behavior (past week CSAM use), the revised Prevent It 2.0 targets adults concerned about their sexual urges toward children, regardless of whether they have offended. It is free, anonymous, and all contact and communication are conducted securely via the Iterapi platform (Vlaescu et al., 2016), which is accessible from both the clearnet and darknet. The program consists of nine self-paced modules featuring psychoeducational texts, short motivational videos, worksheets, and weekly feedback from counselors. Prevent It 2.0 is evaluated in two randomized controlled trials: one for an English version (11/2022-03/2024; Prevention Global; https://prevention.global) and one for the culturally adapted versions (02/2023-04/2024; PRIORITY;¹ www.uke.de/priority), with outcome results forthcoming.

While ensuring the effectiveness of such programs is essential, their success also depends on whether they are well-integrated into the preexisting context and actively used by the target population (Kip & Bouman, 2021; Varsi et al., 2019; Vis et al., 2018). Involving criminal police officers as referrers could help expand the reach of interventions like Prevent It 2.0 and promote their availability, particularly among underserved populations. However, it remains underexplored whether officers consider internet-delivered CSEA prevention programs to be viable collaboration and referral options. Therefore, this study investigates the perceptions of German, Portuguese, and Swedish criminal police officers regarding the strengths, weaknesses, opportunities, and threats of the Prevent It 2.0 program, as well as their attitudes toward supporting the recruitment of participants.

Methodology

The study is based on six semi-structured in-person focus groups with criminal police investigators (n = 13) as well as supervisors (n = 13) from Germany, Portugal, and Sweden. The same participant group as used in Tselenti et al. (2025) and Hillert et al. (2025). In the present study, previously unanalyzed parts of the focus groups were examined using reflexive thematic analysis (Braun & Clarke, 2022), with data generation informed by the Strengths, Weaknesses, Opportunities, and Threats (SWOT) framework (Benzaghta et al., 2021). The study plan received ethical approval by the local psychological ethics committee at the University Medical Center Hamburg-Eppendorf (LPEK-0513) and the ethical committee of the Faculty of Psychology and Education Sciences at the University of Porto (Ref. 2022/05-06). The Swedish Ethical Review Authority (Dnr 2022-03608-01) concluded that they have no ethical objections to the study. The study is part of the EU-funded project PRIORITY, funded through the European Union’s Internal Security Fund-Police.

Participants

Participants were recruited using a purposive sampling approach to ensure the inclusion of criminal police personnel with current experience working on CSEA cases. A total of 26 active criminal police investigators and supervisors from Germany, Portugal, and Sweden took part in the study. By including both investigators and supervisors we ensured a comprehensive picture of police perspectives: While investigators can contribute firsthand experience working in CSEA investigations, supervisors can offer their perspectives on organizational aspects. The participant group comprised 17 women and 9 men between 28 and 61 years (M = 43.57; SD = 9.06). All participants actively worked with CSEA cases, most of them focusing exclusively on offline CSEA (n = 10) or exclusively on online CSEA (n = 9), while 7 participants worked with both types of cases. A characterization of study participants is presented in Table 1.

Table 1:

Sociodemographic Characteristics of Focus Group Participants

Participant	Country	Role	Gender	Age range in years^a	Area of investigation	Experience with CSEA cases in years
DE-I1	Germany	Investigator	Male	30-39	Both	7
DE-I2	Germany	Investigator	Female	40-49	Online	16
DE-I3	Germany	Investigator	Female	30-39	Both	7
DE-I4	Germany	Investigator	Female	20-29	Both	4
DE-I5	Germany	Investigator	Male	60-69	Both	9
DE-S1	Germany	Supervisor	Female	40-49	Offline	23
DE-S2	Germany	Supervisor	Female	40-49	Both	4
DE-S3	Germany	Supervisor	Female	30-39	Online	12
DE-S4	Germany	Supervisor	Female	40-49	Online	15
PT-I1	Portugal	Investigator	Male	50-59	Offline	18
PT-I2	Portugal	Investigator	Female	40-49	Offline	20
PT-I3	Portugal	Investigator	Female	50-59	Offline	18
PT-I4	Portugal	Investigator	Male	50-59	Offline	23
PT-I5	Portugal	Investigator	Female	50-59	Offline	14
PT-S1	Portugal	Supervisor	Female	50-59	Both	1
PT-S2	Portugal	Supervisor	Male	50-59	Both	10
PT-S3	Portugal	Supervisor	Female	40-49	Offline	17
PT-S4	Portugal	Supervisor	Male	50-59	Offline	16
SE-I1	Sweden	Investigator	Female	20-29	Online	7
SE-I2	Sweden	Supervisor^b	Female	40-49	Online	10
SE-I3	Sweden	Investigator	Female	20-29	Online	6
SE-I4	Sweden	Investigator	Male	30-39	Offline	6
SE-S1	Sweden	Supervisor	Male	30-39	Offline	6
SE-S2	Sweden	Supervisor	Male	40-49	Online	15
SE-S3	Sweden	Supervisor	Female	40-49	Online	12
SE-S4	Sweden	Supervisor	Female	30-39	Online	9

Note. CSEA = Child sexual exploitation and abuse; DE = Germany; PT = Portugal; SE = Sweden.

Age ranges were used instead of specific ages to minimize risk of identification due to the small participant group. ^bThis Swedish participant, although working as a supervisor, joined the investigator focus group, a fact revealed only during the interview and therefore accepted.

Dataset Generation

Data were generated between October and November 2022—before the start of recruitment for the two Prevent It 2.0 trials—at criminal police departments in Portugal and Sweden, as well as at the University Medical Center in Hamburg-Eppendorf in Germany. The duration of the focus groups was between 1.5 and slightly over 2 hours. Each focus group was facilitated in the corresponding native language by one (MJ, Sweden) or two (JH, AD, Germany; VA, HG, Portugal) researchers from the PRIORITY consortium who had at least a Master’s degree and had completed training with a qualitative research expert. All were also involved in the Prevent It 2.0 trial in some capacity, which was known to study participants. Before each focus group, participants received information detailing the study’s aim, the voluntary nature of participation, their right to withdraw at any time, and the confidentiality of their responses. Written consent was obtained from all participants, and no compensation was provided for participation.

A semi-structured interview guide with open-ended initial questions was used to facilitate the discussion and an interactive dialogue between participants while allowing flexibility for narrative-generating follow-up questions to explore emerging topics. The interview guide consisted of three sections: (a) experiences and challenges associated with working with CSEA cases (Tselenti et al., 2025), (b) perceptions of individuals with a sexual interest in children (Hillert et al., 2025), and (c) perceptions of CSEA prevention, including a specific focus on the Prevent It 2.0 intervention (this study). Participants were introduced to the Prevent It 2.0 program via a single-page leaflet outlining its aim, target group, format, and content, and were then invited to perform a SWOT analysis (Benzaghta et al., 2021) of the program. To stimulate a meaningful discussion, they were given time to read and ask questions before identifying and writing down encouraging (internal strengths and external opportunities) and discouraging (internal weaknesses and external threats) aspects of Prevent It 2.0 that could impact whether it would achieve its objective to prevent CSEA. Once participants finished writing their reflections, facilitators invited them to share and discuss the aspects they identified with each other. The written notes served as prompts to support reflection and facilitate discussion and were not collected or analyzed. The analysis instead focused on the co-constructed interaction between participants, as our interest was the collective meaning-making process rather than individual pre-discussion views.

The focus group discussions were recorded, and all potentially identifying information in the audio was anonymized before the recordings were transcribed by a professional transcription service. After checking the transcriptions in the original language, they were translated into English by independent translation companies. The final transcripts contained no identifying information, and participants were indicated by a system of letters and numbers.

Data Analysis

The focus group transcripts were managed using the NVivo R1 software and analyzed following Braun and Clarke’s (2022) reflexive thematic analysis to identify shared meaning within the dataset. While data generation was informed by the SWOT framework, the analytic process was primarily inductive and reflexive. Together, this approach can be described as a framework-informed reflexive thematic analysis, indicating that while data generation was initially structured, coding and theme creation remained data-driven and prioritized data-based meaning. This involved active engagement and reflexive interpretation of the data to develop the themes and subthemes based on conceptual significance rather than the SWOT framework.

The data analysis began with becoming familiar with the data, followed by systematic coding of relevant parts. Initial coding was conducted by VA, followed by independent interpretative engagement by the first author, LH. The codes were then grouped into potential themes, representing overarching patterns, and subthemes, capturing distinct aspects within each theme. In line with Braun and Clarke (2022), no numeric threshold was applied to determine themes. Instead, themes were generated to convey patterns of shared meaning relevant to the study aim, with attention to how meaning was constructed in the interaction and recognizing that a concept expressed by a single participant can offer valuable insights. Themes and subthemes were refined through regular discussions between LH and senior author AD to enhance the quality of the analysis and ensure a rich and nuanced interpretation of the data. Finally, each theme was clearly labeled and defined to develop the narrative presented in this paper.

Although focus groups were conducted separately with investigators and supervisors, the data were analyzed collectively. This approach reflects the aim of identifying shared meaning across the data rather than comparing role-specific perspectives, while ensuring that both frontline and organizational perspectives were represented in the data.

Reflexivity

All researchers involved in this study were engaged in Prevent It 2.0 in various roles, which inevitably influenced both dataset generation and analysis. While this involvement brought valuable contextual knowledge, it also called for continuous critical awareness of how researchers’ roles and assumptions might shape participant responses and data interpretation. Participants may have been inclined to provide responses aligning with what they assumed facilitators valued. To mitigate this, we actively encouraged constructive feedback, inviting participants to identify and discuss weaknesses and threats of the program. To further maintain analytical rigor, the team used regular reflexive discussions throughout the research process to ensure transparency, self-examination, and thoughtful interpretation.

In addition, the integration of the SWOT framework in the interview guide shaped the focus group discussions and directed participants toward identifying strengths, weaknesses, opportunities, and threats of Prevent It 2.0, aligning with the study’s aim to explore perceptions of these aspects. This enabled a focus on these perspectives while allowing attention to be paid to the way participants interpreted these categories. Nonetheless, integrating the framework in the interview guide may have limited exploration of interrelated or cross-category factors. The group format, together with facilitator follow-up questions, helped mitigate this by encouraging participants to build on and challenge each other’s contributions and elaborate on underlying relationships between factors. In addition, reflexive attention during the analysis ensured that themes were developed from the data rather than being limited by the SWOT structure, allowing for nuanced insights.

Results

The framework-informed reflexive thematic analysis produced four themes and eleven subthemes across the three study sites among both criminal police investigators and supervisors (see Table 2). The following sections present each theme and its subthemes, with codes in italics, and supporting quotes to illustrate the findings.

Table 2:

Brief Descriptions of Main Themes and Subthemes

Themes and subthemes	Brief descriptions
The format reduces barriers but imposes demands on participants
The format lowers the threshold to participate	The program is easily, immediately, flexibly, and anonymously usable for a wide range of participants.
Requirements for participants	Participation requirements, including cognitive, online and tech skills, and minimum age, limit program reach.
The platform’s dependability could be compromised	Officers cautioned against hackers, data leaks, platform issues, and privacy concerns of the target group.
Vulnerabilities inherent to the format	The anonymous online format can hinder intervention and lack personal connection.
The framework can foster credibility, but may cause disruptions
Credibility through international research implementation	The international implementation in an EU project increases acceptance, legitimizes, and creates confidence.
Collaboration and research outcomes are under pressure	Involving different countries could lead to disagreements, and, in an ongoing evaluation, research results could later show that the program is ineffective.
Expected increase in awareness and support amid concerns about participants’ motives
The program fills gaps in the CSEA prevention landscape by addressing needs and raising awareness	The program could provide support for an underserved group, reduce the occurrence of CSEA, and improve awareness and knowledge of this target group.
Threat of participants exploiting the program for unintended purposes	Individuals may participate to look favorable in court rather than for genuine motivation.
Officers are willing to collaborate, but success depends on public reception
Open to police referrals and provide constructive recommendations	Officers are willing to refer those they encounter when investigating CSEA cases to the program.
Public discourse can both facilitate and challenge recruitment efforts	Public discourse about CSEA could bring attention to the program, but common defensive attitudes may hinder implementation.
Using diverse recruitment channels	Officers recommended various additional recruitment strategies.

Note. Main themes are presented in bold with additional spacing; subthemes are listed below each theme. EU = European Union; CSEA = Child sexual exploitation and abuse.

Theme 1: The Format Reduces Barriers but Imposes Demands on Participants

Criminal police officers perceived not only strengths but also weaknesses and threats in Prevent It 2.0’s anonymous internet-delivered format. On the one hand, they recognized its potential to lower barriers for accessing and engaging with prevention offers; on the other hand, they identified format-specific challenges and demands on participants.

Subtheme 1.1: The Format Lowers the Threshold to Participate

Officers framed the anonymous and internet-delivered format as a strength because it reduces the threshold to participate. They emphasized that the program is easily and immediately usable and, by being available without the need for appointments, enables participants to seek help effortlessly. Officers further highlighted that participants’ ability to schedule their time freely could support balancing the program with life schedules. Finally, they identified that anonymity allows participation without the risk of recognition:

The anonymity I believe in very much, actually, because it’s like, you don’t want it to come out. Because then you might burn the bridges. Many may not have such a large network of contacts either, and if this emerges, then suddenly they may be completely alone. (SE-I4)

Officers further observed that the program is available for a broad target group, including those under investigation, which sets the program apart from other treatment services where participation is not possible during legal investigation.

Subtheme 1.2: Requirements for Participants

Officers also identified aspects they found more limiting, describing requirements for participants as weaknesses. They criticized that individuals need to be at least 18 years old to participate in Prevent It 2.0, which excludes “a good target group for us to get our foot in the door” (DE-I3). In addition, they stressed that participants need cognitive skills to successfully engage in the program: “I could imagine that the program requires a certain mental maturity [. . .] [and that] a certain amount of intelligence is necessary so that you can a) understand the program and b) consciously deal with yourself” (DE-I1). They also noted that individuals with lower language proficiency might struggle to understand and process the content. Finally, officers discussed that participation requires online and tech skills, as well as devices, which could prevent certain individuals—such as the elderly and those who have had their devices confiscated—from engaging:

As a weakness, I have the person who is not reached, [. . .] older people who are not IT-savvy, so especially in respect of hands-on offenders, you also have the older grandpa who perhaps can’t cope with a computer, you wouldn’t reach him either. (DE-S4)

Subtheme 1.3: The Platform’s Dependability Could be Compromised

Officers worried that the platform’s dependability could be compromised, raising concerns about its reliability facing potential threats. For one, officers feared that hackers or data leaks could threaten participant anonymity:

And then, as for threats, if there should be some kind of leak here. So if you somehow either hack or someone leaks out that these people [. . .] have been in this program, it would be, well, it would be absolutely devastating, of course. (SE-S2)

Officers also foresaw that the platform could be overwhelmed if too many individuals attempted to access it. They expressed concern about server failure or that it could become impossible to distinguish between genuine help-seekers and trolls. In addition, they cautioned that the target group is very concerned about privacy and might not trust the anonymity and therefore, may not use the program, emphasizing that program providers should clarify how privacy and anonymity are assured.

Subtheme 1.4: Vulnerabilities Inherent to the Format

Officers also pointed to vulnerabilities inherent to the format that could present both internal weaknesses and enable external threats. They noted that the anonymity weakens engagement and hinders follow-up contact, presuming that it might make disengagement from the program easier and restrict providers’ ability to reach participants after the end of treatment or when they drop out. Another perceived weakness of the format was that it cannot replace direct interaction with a therapist, as officers felt it lacked a sense of personal connection. They also noted that the program duration is limited, expressing concern that participants might need additional support afterwards. In addition, they voiced concerns about managing revelations of offending behavior. Officers considered how disclosures of past or intended CSEA offenses could place a burden on counselors, potentially undermining their well-being, especially as the anonymity limits options for both reporting offenses and protecting potential children at risk:

[. . .] the staff members who are available in this chat function may feel a certain pressure to act when offences are revealed to them [. . .], and it is somehow a blunt sword if they can’t get the personal details of the person. [. . .] I think the burden on the staff is definitely a big risk. (DE-I1)

Portuguese officers added that, in Portugal, “these are mandatory reporting crimes, crimes of sexual abuse of minors, therefore, whoever knows is obliged to report” (PT-I2)² which can lead to “reluctance [. . .] to resort to the program, given the nature of the offense and the possibility of being exposed and denounced” (PT-I1), thus potentially threatening program engagement.

Theme 2: The Framework Can Foster Credibility, but May Cause Disruptions

Criminal police officers revealed a conflicted understanding of the organizational framework in which the intervention is embedded, framing it as both a strength and a source for a potential threat.

Subtheme 2.1: Credibility Through International Research Implementation

Officers viewed the program’s international research basis as a strength that enhances its perceived trustworthiness, resulting in credibility through international research implementation. They discussed that the simultaneous international implementation increases acceptance because it conveys a sense of being widely recognized and added that the association with the European Union (EU) legitimizes and lends authority, because as “an EU project, [that] makes it feel a little more credible in some way” (SE-S2). Finally, they emphasized that a foundation in research evidence fosters confidence.

Subtheme 2.2: Collaboration and Research Outcomes are Under Pressure

However, officers also offered a contrasting perspective, expressing that the involvement of multiple countries might pose a threat and create tensions, and that collaboration and research outcomes are under pressure. They reasoned that the involvement of different countries could lead to disagreements, which could threaten the program because external CSEA prevention rationales may differ between countries. In addition, they voiced concern about the possibility that study results may ultimately show that the program is ineffective in addressing its intended goals.³

Theme 3: Expected Increase in Awareness and Support Amid Concerns About Participants’ Motives

Criminal police officers expressed diverse expectations about the impact of Prevent It 2.0. On the one hand, they expressed optimism that it would support prevention efforts, pointing to expected future benefits rather than only describing a current internal strength or external opportunity. On the other hand, they identified potential external threats related to concerns that participants might “misuse” the program.

Subtheme 3.1: Program Fills Gaps in the CSEA Prevention Landscape by Addressing Needs and Raising Awareness

Officers described that the program fills gaps in the CSEA prevention landscape by addressing needs and raising awareness. They emphasized that Prevent It 2.0 provides critical support for an underserved group, creating space for self-reflection and meeting an unfulfilled need. Officers further highlighted the program’s potential to reduce CSEA offending by preventing both recidivism and initial sexual offenses against children:

I think that an opportunity⁴ will be the obvious one of the decrease in relapse, the decrease in the occurrence of sexual crimes, and the improvement of resources in the fight against sexual crime. (PT-I1)

Another anticipated impact was that the program could improve awareness for individuals with a sexual interest in children. Officers discussed this both in relation to a reduction of stigma, “as a chance that perhaps a kind of de-tabooing would take place, [. . .] to make this topic somewhat more visible in society” (DE-S1), and increased availability of information that could facilitate access for help-seeking individuals:

[. . .] if people have an awareness of their own problems and at the same time know where to turn, and at the same time the environment is educated on how to both detect these individuals and motivate them to seek help, [. . .] then perhaps more people can be reached before abuse is actually committed. (SE-I3)

Finally, officers deliberated that study findings will improve the knowledge of this target group, expanding the understanding of the demographics of this population.

Subtheme 3.2: Threat of Participants Exploiting the Program for Unintended Purposes

However, a specific concern mentioned by officers was the threat of participants exploiting the program for unintended purposes. They expressed unease that participants may exploit the program to use as a mitigating circumstance in court, seeking penal benefits rather than showing genuine motivation. Officers feared this could undermine the program’s integrity and aim:

[. . .] some people might take advantage of it when they have an ongoing trial to present themselves in a better light, saying things like, look, I have done something about it, I have done this program, I have been purified, please don’t judge me so harshly or best not at all, and that the program will then become more of a fake show. (DE-I4)

Theme 4: Officers are Willing to Collaborate, but Success Depends on Public Reception

Criminal police officers expressed a strong willingness to collaborate with program providers—indicating potential for referrals—but also emphasized that the program’s success is closely tied to how it is received by the public, representing both opportunity and threat.

Subtheme 4.1: Open to Police Referrals and Provide Constructive Recommendations

Officers seemed open to police referrals and provided constructive recommendations, highlighting a valuable opportunity for collaboration. They expressed a willingness toward sharing a flyer, link, or QR code with individuals they encounter when investigating CSEA cases, indicating a referral pathway. They also suggested that referral flyers should strike a balance between raising interest and discretion, so that they are “not recognizable for others, what it is exactly, if [interested individuals] leave it somewhere” (DE-S1). In addition, officers advised that information be actively disseminated across the criminal police to ensure widespread awareness. Program providers should proactively engage criminal police departments through presentations, workshops, and other outreach efforts to inform as many officers as possible. However, officers also cautioned that an association with the police could be discouraging and deter potential participants from taking part, thus possibly threatening participant engagement.

Subtheme 4.2: Public Discourse Can Both Facilitate or Challenge Recruitment Efforts

Officers also emphasized that the public discourse can both facilitate or challenge recruitment efforts, stressing its importance in shaping recruitment processes as both a potential opportunity and threat. On the one hand, they discussed how an active public discourse about CSEA could bring attention and awareness to the program. On the other hand, officers also named a threat that common defensive attitudes about “offender” support programs could hinder implementation because of the stigma associated with the topic, reasoning that program objectives could be misunderstood by the public as prioritizing “offender” rights over victim protection: “The society might not be prepared for the existence of this program, due to the repulsion that exists toward this type of crime and the fact that the aggressor is taken into consideration, which I think is fundamental” (PT-I1).

Subtheme 4.3: Using Diverse Recruitment Channels

Finally, officers proposed diverse recruitment channels as opportunities. They mentioned the possibility of sharing information on the darknet and related fora, which they assumed could reach many help-seeking individuals. Another possibility discussed was recruiting via social media platforms, such as implementing a “stop button [concerned individuals] could press” (SE-S3) directly on social media sites to access information about Prevent It 2.0 or other support options. Moreover, the program could be linked to on porn platforms, displaying a short message referencing the program whenever a person searches for concerning material. Officers also recommended that lawyers reach participants for tertiary prevention whenever they represent individuals suspected of CSEA offenses. Along the same lines, they referenced correctional institutions and proposed that they share information before releasing individuals convicted for CSEA offenses. Other opportunities discussed were collaborations with other CSEA prevention organizations with big outreach and awareness campaigns in health care and the public.

Discussion

Framework-informed reflexive thematic analysis of six focus group interviews with criminal police officers from Germany, Portugal, and Sweden identified four interrelated themes that reflect the nuanced nature of the program, with officers perceiving both potential and limitations: i) the format reduces barriers but imposes demands on participants, ii) the framework can foster credibility, but may cause disruptions, iii) an expected increase in awareness and support amid concerns about participants’ motives, and iv) officers are willing to collaborate, but success depends on public reception.

Across all focus groups and regardless of country context, officers viewed Prevent It 2.0 as a promising initiative that can contribute meaningfully to the prevention of CSEA, suggesting a shared sense of its anticipated value. They highlighted its potential to improve treatment access, provide timely support, and raise awareness. This positive perspective was accompanied by the recognition that there is a need for ongoing program refinement and sensitivity to broader sociocultural influences, including legal frameworks, particularly given the complexity of CSEA prevention. Notably, officers’ perspectives appear to broadly resonate with the rationale and aims of the Prevent It 2.0 project, suggesting a meaningful foundation for more integrated, interdisciplinary responses to CSEA.

Strengths: Flexibility, Anonymity, and EU Association Foster Engagement

Officers identified that the flexible, low-threshold, and anonymous design of Prevent It 2.0 is particularly valuable in engaging this hard-to-reach population and overcoming help-seeking barriers. Anonymity was regarded as a crucial strength in engaging individuals at risk of CSEA offending, who are often deterred from seeking help due to concerns about legal consequences or stigma (Insoll et al., 2024; Jahnke, 2018). Consistent with prior research (Borghouts et al., 2021; Woolderink et al., 2015), this study also reinforces the value of privacy guarantees in this context. To effectively reach this security- and privacy-cautious target group, it is valuable to concretely communicate the measures taken to ensure anonymity and data privacy. In addition, the ability to access the program anytime, from any location, was deemed beneficial for engaging participants, which is especially important in rural areas where in-person mental health care is limited or entirely unavailable (Gaebel et al., 2009; Saurman et al., 2015). This reflects previous research highlighting the flexibility of digital mental health interventions (Borghouts et al., 2021; Hillert et al., 2024) and aligns with police diversion research indicating the importance of timely program access to engage those referred by the police (Blais et al., 2022).

In addition, the program’s multinational scope and EU association were considered advantageous as officers felt that these enhanced the credibility, legitimacy, and trust in the intervention. In line with Hensell (2022), EU-funded projects may benefit from being associated with the European Commission’s established authority and strategic engagement, which could increase participant confidence and further reduce participation barriers. While the specific impact of cross-country implementation has not yet been tested for CSEA prevention programs, it likely enables larger sample sizes and can offer insights into program efficacy across different cultural and legal contexts. The evaluation of Prevent It 2.0 across three EU member states will provide valuable insights in this context.

Weaknesses: Inclusivity, Usability, Provider Well-Being, and Ethical Considerations

Despite these strengths, officers identified several weaknesses that could limit the program’s impact. One perceived limitation was the exclusion of those under 18. Officers viewed this as a barrier for early intervention, especially in light of evidence that a considerable proportion of CSEA offenses is committed by minors (Letourneau et al., 2017; Mathews et al., 2024). This highlights the need for future research into the feasibility and efficacy of adopting internet-delivered prevention programs for adolescents at risk of CSEA, including potential adaptations to ensure appropriateness.

Consistent with prior studies on mobile and eHealth interventions in forensic contexts (Aarts et al., 2025; Kip & Bouman, 2021), officers also flagged usability as a concern, particularly regarding individuals with lower literacy or cognitive capacities. Research has linked lower education levels to higher dropout rates and poorer outcomes in online and self-help interventions (Martinez et al., 2008; Rozental et al., 2017; Salomonsson et al., 2020). However, findings on cognitive abilities among individuals at risk of committing CSEA remain mixed: Some studies report lower IQ scores among pedophilic individuals who offended (Franke et al., 2019), while others suggest that these differences may be less pronounced in non-forensic samples (Jahnke et al., 2022). This raises the question of whether certain subgroups of at-risk individuals are actually able to navigate and benefit from a written, internet-delivered program. Future studies should investigate how educational and cognitive factors influence engagement and outcomes in internet-delivered CSEA prevention programs, and explore different strategies—such as simplified language, interactive attention-engaging elements, and platform use tutorials (Friedman & Bryen, 2007; Kip & Bouman, 2021; Wild et al., 2019)—to improve usability.

While anonymity was generally considered a strength, officers noted that it restricts providers’ ability to assess or intervene when participants disengage. This reiterates concerns that online settings hinder intervention in cases of disengagement and uncertainty as to whether this stems from technical issues, the treatment, or crises (e.g., suicidality; Rummell & Joyce, 2010). The dual perception of anonymity highlights the complexity of designing interventions for CSEA prevention: The very feature that can help facilitate access (strength) can also create challenges for monitoring and following up with participants (weakness). Officers also highlighted the emotional toll on providers. Working with this population has been associated with compassion fatigue, vicarious trauma, secondary traumatic stress, burnout, and a heightened sense of responsibility felt toward potential victims and society (Baum & Moyal, 2020; Hardeberg Bach & Demuth, 2018; Raymond et al., 2023). The anonymous online format may aggravate this burden by increasing the perceived expectation of constant availability (Feijt et al., 2018), while limiting the ability to intervene or report offenses. It can also complicate legal responsibilities, leaving providers uncertain how to respond when risk is unclear (Harris & Birnbaum, 2015). To address these challenges, clear guidelines and training are essential to help providers assess risk situations and navigate mandatory reporting laws. In addition, providers should receive adequate support, including supervision, access to mental health resources, and guidance for navigating difficult situations (Evans & Ward, 2019). In the case of Prevent It 2.0, all counselors participated in weekly joint supervision with a licensed specialist in forensic psychology.

Finally, officers also questioned the absence of personal interaction between participants and counselors. Although some studies suggest that online formats can increase therapist-client contact frequency, communication, and even perceived relationship quality (Aarts et al., 2025; Feijt et al., 2018; Mishna et al., 2017), others underscore the risk of miscommunication due to the absence of verbal and nonverbal cues (Harris & Birnbaum, 2015; Stoll et al., 2020). Specific training should be provided to actively prepare providers to facilitate meaningful relationships and teach them how to communicate emotions, empathy, genuineness, and openness in online settings. In addition, future studies could explore blended care models, which integrate online and in-person elements, as an approach to balance the benefits and limitations of both modalities (Kip & Bouman, 2021; Kip et al., 2018).

Opportunities: Interdisciplinary Collaboration and Targeted Outreach

Officers identified several external opportunities the Prevent It 2.0 program can leverage to expand CSEA prevention and address gaps. Most notably, they expressed a willingness to support recruitment efforts for the program. This signals an important shift from a shared understanding toward a more active, collaborative role in prevention where law enforcement works alongside researchers and practitioners. Even when treatment becomes available after conviction, CSEA cases typically take several months to be processed (Quas et al., 2024), leaving a critical gap during which those under investigation may experience substantial psychological distress, as well as shame, uncertainty, and isolation, but may also be especially motivated to seek help. Interdisciplinary collaboration could present a key opportunity to reach this population earlier. Research highlights that insufficient training and lack of leadership support can leave officers uncertain how to fit referrals into their daily schedules (Blais et al., 2022; Dickson-Gomez et al., 2022; Hoke et al., 2020), while clear protocols and supervisor endorsement foster collaboration (Eilfgang et al., 2024; Hoke et al., 2020; Shefner et al., 2024). Building on this, our study suggests that sharing flyers, links, or QR codes with individuals suspected of CSEA could be integrated into police workflow when these resources are readily available and distributed in accessible formats. Consistent with prior research, engaging supervisors may further facilitate collaboration and ensure consistent implementation. Program providers should therefore use proactive outreach—such as training workshops or presentations—to distribute information within police departments, clarify referral processes, and secure leadership support.

Consistent with a recent review (Roche et al., 2026), officers also suggested using various strategies to recruit for CSEA prevention. Recruitment opportunities were identified in targeting spaces frequented by at-risk individuals, such as specific darknet fora or pornography sites, which could help reach the secondary prevention potential of the program. Previous research supports that individuals seeking to stop their CSAM use can be reached through the darknet (Nurmi et al., 2024), a strategy successfully employed in the first Prevent It trial (Lätth et al., 2022). In addition, a report by Protect Children Finland (2024) found that 77% of individuals who searched for CSAM on the darknet had previously encountered it on clearnet sites, primarily on pornography platforms and social media. In this context, officers recommended warning banners and help-seeking messages. Recent studies support this approach, showing that warning and referral messages on pornography sites can not only deter individuals from using barely legal pornography but also promote engagement with linked prevention resources (Prichard et al., 2024; Scanlan et al., 2024). Finally, officers suggested outreach campaigns in health care and public, which have successfully been employed in in-person prevention initiatives such as Prevention Project Dunkelfeld (Beier, 2016; Beier et al., 2009), and collaboration with other CSEA prevention stakeholders.

Threats: Legal, Technological, and Sociocultural Challenges

Finally, officers identified potential external threats that could undermine the program’s impact, reputation, and ability to recruit and maintain participants. While the multinational scope was seen as a strength, officers also cautioned that it introduces complexity. Implementing across different legal frameworks and cultural contexts demands careful cultural adaptation and provider training to ensure the intervention’s acceptability across diverse settings (Evlat et al., 2021; Patel et al., 2011). Consistent with this approach, Prevent It 2.0 was culturally adapted (Azevedo et al., 2025), and all counselors completed four days of joint preparatory training.

Although our analysis was conducted across the full dataset and did not aim to assess national differences, one noteworthy nuance emerged: Legal frameworks were identified as a possible threat only in Portugal, suggesting that this may be a context-specific challenge, shaped by the specific legal framework. Portuguese officers pointed out that mandatory reporting laws—such as in Portugal—can create a barrier to participant engagement. This concern is supported by prior research (Kewley et al., 2023; Seto et al., 2024; Stephens et al., 2021) and reflected in the experience from the Portuguese Prevent It 2.0 trial, where recruitment had to be suspended for several months to assess how to navigate the reporting obligations. To facilitate recruitment, questions regarding CSEA behavior had to be dropped from all assessments in the Portuguese arm before resuming the trial (see Maimone et al., 2025, for a full study protocol). In addition, a protocol for handling offense disclosures was put into place together with the University’s legal department and the external study monitor, and a reminder was added at the beginning of each module in the Portuguese arm to remind participants of the obligation to report in case they disclosed any CSEA behavior (i.e., in worksheets or in messages to the counselors). This underscores how legal constraints can complicate implementing and delivering preventive efforts and highlights the importance of tailoring prevention strategies to national legal frameworks.

Another concern centered on “unintended” use of the program by those under legal investigation. Officers noted that although offering treatment during investigation might provide support for a vulnerable population, it could result in some individuals participating primarily to appear favorable in court, rather than from genuine motivation. Indeed, experience from the Prevent It 2.0 trial—particularly in Germany—showed several participants asking for participation certificates to present in court. And while initial evidence suggests only minor differences in treatment progress between mandated and voluntary treatment for men who committed CSEA (von Franqué & Briken, 2021), further research is needed to explore how such motivations influence treatment engagement and outcomes for those currently under investigation. Building on research suggesting the value of tailoring eHealth interventions (Kip & Bouman, 2021), individually adapting programs to first target motivation, for example, using motivational interviewing techniques, may be a promising strategy.

Platform unreliability was identified as another potential threat that could disrupt treatment and cause frustration, echoing prior research on the negative impact of technical issues on program engagement and therapeutic alliance (Borghouts et al., 2021; Lopez et al., 2019). Officers also worried that hackers or data breaches could compromise participant anonymity and weaken trust in the program. This concern is widely recognized in digital mental health literature (Inkster et al., 2023; Lustgarten et al., 2020; Stoll et al., 2020) and seems prevalent with forensic populations (Kip et al., 2018). Although security was a key interest during the development of the Iterapi platform (Vlaescu et al., 2016), where Prevent It 2.0 is hosted, and several efforts were taken to enhance platform security, these concerns emphasize that constant testing and updating of platforms is essential to maintain trust and program integrity. In addition, accessible resources, such as Frequently Asked Questions (FAQs) and responsive technical support, could help participants resolve issues quickly and remain engaged with the program.

The public discourse surrounding individuals who commit CSEA was mentioned as another threat. Consistent with prior research (Grady et al., 2019; Insoll et al., 2024; Jahnke et al., 2015; Levenson & Grady, 2019), officers acknowledged that stigma can be a meaningful factor for recruitment. They noted that negative public attitudes—such as skepticism about the potential of change (Guastaferro et al., 2023; Höing et al., 2016) and a preference for punitive measures (Rosselli & Jeglic, 2017)—may discourage individuals from seeking help. Media coverage, while potentially helpful to bring attention to the program, often uses emotionally negative language that reinforces punitive attitudes (Harper & Hogue, 2015; Stelzmann et al., 2020) and might hinder help-seeking (Levenson & Grady, 2019). It is therefore vital to raise public awareness about the importance of secondary CSEA prevention to promote support. In general, the relationship between stigma and help-seeking is not yet fully understood and internalized stigma may even encourage help-seeking. A recent study found that individuals who experience higher levels of internalized stigma have more positive attitudes toward seeking treatment (Jahnke et al., 2024). Future research is needed to better understand the relationship between stigma and help-seeking behavior.

Finally, officers echoed concerns identified in prior research that an association with the police may deter potential participants out of police distrust or fear of legal consequences (Barberi & Taxman, 2019; Costigan et al., 2022). Future research should examine how this dynamic affects help-seeking behavior and identify strategies for maintaining trust, such as clearly defining the limits of police involvement and structuring collaborations to avoid misunderstandings and mitigate negative impacts on recruitment.

Limitations

The study should be interpreted in light of its limitations. As noted in the Reflexivity section, the involvement of focus group facilitators in Prevent It 2.0 may have limited officers’ willingness to critique the program. To address this, participants were explicitly asked to offer critical perspectives and reflect on weaknesses and threats of the program. Notably, participants followed through, discussing multiple weaknesses and threats, and not just strengths and opportunities. In addition, participants only received a flyer about Prevent It 2.0 and did not see the actual program website, which was still being finalized, and it might be questioned whether this provided them with sufficient understanding to give meaningful feedback. To mitigate this, participants were given time to read and ask questions to the facilitators, as experts on the program, to provide an adequate base for discussion. Finally, the study did not aim to systematically compare national differences, and additional research would be needed to examine national specificities in depth. The observed nuance with the legal framework in Portugal may therefore not be taken as a definitive cross-country comparison but instead as a context-specific insight that warrants further examination.

Conclusion

This study highlights that criminal police officers from Germany, Portugal, and Sweden see potential in the internet-delivered prevention program Prevent It 2.0 to contribute to the broader CSEA prevention landscape by addressing prevention barriers and providing an accessible, low-threshold, anonymous option for at-risk individuals. Officers express willingness to refer individuals to the program, however recognizing the need for ongoing program refinement and sensitivity to the broader sociocultural context. As such, the study contributes to the understanding of internet-delivered CSEA perpetration prevention, not only adding a law enforcement perspective to the existing literature but indicating a foundation for integrated strategies based on interdisciplinary collaboration.

Footnotes

Authors’ Note:

The study was part of the PRIORITY project, funded by the European Union’s Internal Security Fund-Police under Grant Agreement number 101038787. The content of this publication represents the views of the authors only and is their sole responsibility. The European Commission does not accept any responsibility for use that may be made of the information it contains.

ORCID iDs

Lina S. Haubrock

Vanessa Azevedo

Hugo S. Gomes

Joana Carvalho

Notes

Lina S. Haubrock is a PhD Candidate at the Institute for Sex Research, Sexual Medicine, and Forensic Psychiatry at the University Medical Center Hamburg-Eppendorf, focusing on barriers to child sexual exploitation and abuse prevention in the EU. She is currently completing a scholarship-funded research visit at the Karolinska Institutet.

Vanessa Azevedo is a licensed psychologist and a researcher at the Sexuality and Gender Research Group from the Center for Psychology at University of Porto. Her research interests focus on sexual violence and the prevention of sexual offending against children.

Jana Hillert is a PhD Candidate at the Institute for Sex Research, Sexual Medicine, and Forensic Psychiatry at the University Medical Center Hamburg-Eppendorf, focusing on stigmatization of individuals with a sexual interest in children.

Peer Briken is Professor and Chair of the Institute for Sex Research, Sexual Medicine, and Forensic Psychiatry at the University Medical Center Hamburg-Eppendorf. His main clinical and research activities are psychotherapeutic and pharmacological treatment of patients with Compulsive sexual behavior disorder, paraphilic disorders, and people who committed sexual offenses.

Elizabeth Letourneau is the Moore Family Professor, Department of Mental Health at Johns Hopkins Bloomberg School of Public Health, where she is also the director of MOORE—Preventing Child Sexual Abuse. She has led child sexual abuse prevention, policy, and practice efforts for 37 years.

Christoffer Rahm, MD, PhD, is a board-certified psychiatrist and Associate Professor at Karolinska Institutet, Stockholm, Sweden. His work focuses on clinical trials aimed at preventing sexual abuse and exploitation perpetration, and he has developed and evaluated multiple innovative interventions, including both pharmacological and psychotherapeutic approaches, both delivered online and in person.

Michael C. Seto is a registered clinical and forensic psychologist and research director with The Royal and Professor in Psychiatry at the University of Ottawa. He is also cross-appointed to the University of Toronto, Carleton University, and Ontario Tech University. Dr Seto has published extensively on pedophilia, sexual offending against children and online sexual offending.

Rebecca L. Fix is an Assistant Professor in the Department of Mental Health at the Johns Hopkins Bloomberg School of Public Health and a licensed clinical child and adolescent psychologist. Dr Fix’s research focuses on the prevention of youth-perpetrated violence and on promoting equity in the juvenile legal system with an emphasis on policing and carceral institutions.

Hugo S. Gomes is a Fulbright Scholar, Invited Professor at the School of Criminology, University of Porto, and Junior Researcher at the Institute of Public Health (ISPUP), Portugal. His research examines the development of criminal and violent behavior across the life-course, drawing on multiple longitudinal and cohort studies conducted in several countries.

Malin Joleby is a leader in the Perpetration Prevention research group at Karolinska Institutet in Stockholm, Sweden. Her work focuses on sexual abuse research, with a particular emphasis on victimology, psychotherapy, and strategies for prevention.

Sacha Maimone is a postdoctoral fellow at the University of Ottawa’s Institute of Mental Health Research at the Royal. Her research focuses on establishing the construct validity of variables related to violent and sexual offending—most notably the psychometric assessment and development of measures assessing offense-related cognitions. Most recently, her research has focused on the prevention of child sexual exploitation and abuse.

Joana Carvalho is the director of the Sexual Behavior and Health Lab (SexBeHealth) at the University of Aveiro, Portugal. Carvalho is currently researching in the field of chronotype and sexual health, sexual violence, and sexual objectification tendencies, with a special focus on how sexual behavior emerges in the digital tech culture. Carvalho has been credited in clinical psychology, forensic psychology, and sexology by the Portuguese Board of Psychologists.

Arne Dekker is Deputy Director and Research Coordinator of the Institute for Sex Research, Sexual Medicine, and Forensic Psychiatry at the University Medical Center Hamburg-Eppendorf. His fields of work include interdisciplinary sex research, social science survey research, and digital sexual health.

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Criminal Police Perceptions of the Internet-Delivered Child Sexual Exploitation and Abuse Prevention Program Prevent It 2.0 in Germany,Portugal,and Sweden

Abstract

Keywords

Methodology

Participants

Dataset Generation

Data Analysis

Reflexivity

Results

Theme 1: The Format Reduces Barriers but Imposes Demands on Participants

Subtheme 1.1: The Format Lowers the Threshold to Participate

Subtheme 1.2: Requirements for Participants

Subtheme 1.3: The Platform’s Dependability Could be Compromised

Subtheme 1.4: Vulnerabilities Inherent to the Format

Theme 2: The Framework Can Foster Credibility, but May Cause Disruptions

Subtheme 2.1: Credibility Through International Research Implementation

Subtheme 2.2: Collaboration and Research Outcomes are Under Pressure

Theme 3: Expected Increase in Awareness and Support Amid Concerns About Participants’ Motives

Subtheme 3.1: Program Fills Gaps in the CSEA Prevention Landscape by Addressing Needs and Raising Awareness

Subtheme 3.2: Threat of Participants Exploiting the Program for Unintended Purposes

Theme 4: Officers are Willing to Collaborate, but Success Depends on Public Reception

Subtheme 4.1: Open to Police Referrals and Provide Constructive Recommendations

Subtheme 4.2: Public Discourse Can Both Facilitate or Challenge Recruitment Efforts

Subtheme 4.3: Using Diverse Recruitment Channels

Discussion

Strengths: Flexibility, Anonymity, and EU Association Foster Engagement

Weaknesses: Inclusivity, Usability, Provider Well-Being, and Ethical Considerations

Opportunities: Interdisciplinary Collaboration and Targeted Outreach

Threats: Legal, Technological, and Sociocultural Challenges

Limitations

Conclusion

Footnotes

Authors’ Note:

ORCID iDs

Notes

References