image:
Trevor van Mierlo, DBA.
Credit: Image provided by the author
(Toronto, June 24, 2026) JMIR Publications released a feature News and Perspectives story on the foundational role of trust in digital behavioral health. Authored by researcher, digital behavioral health platform founder, Trevor van Mierlo, DBA, “You Can’t Launch This: Trust as Infrastructure in Digital Behavioral Health” caps off a four-part exclusive series exploring the current and future landscape of digital behavioral health interventions.
Engagement Is Not Trust
Speaking with a wide range of researchers and practitioners who work in informatics, behavioral health, cybersecurity, and public digital infrastructure, Van Mierlo notes how, since users may engage with a digital health system out of necessity, engagement may not indicate trust in the system. Drawing on insights from Tonia San Nicolas-Rocca, PhD, he explains that distrustful users might minimize symptoms, avoid sensitive disclosures, or provide “safe” rather than accurate information. Because of this, engagement metrics alone do not guarantee that the underlying behavioral data remains authentic or clinically meaningful.
Dynamic Consent and Enforceable Governance
Because behavioral systems continually collect data from user interactions, static privacy policies and consent buttons are no longer sufficient. Benjamin Schooley, PhD, argues for “computable governance,” suggesting that if AI systems continue to evolve, their disclosures and governance must be dynamic as well. Cybersecurity architect Kavya Pearlman, meanwhile, notes that governance must be transparent and verifiable, advocating for cryptographically verifiable audit trails that can reconstruct exactly what data, models, and autonomy levels informed an AI’s decisions.
Trust is Social First
Trust problems often begin long before users even encounter technology, particularly in environments shaped by institutional distrust, low digital literacy, or misinformation. Van Mierlo argues that trust is no longer a secondary feature, but the foundational layer upon which digital behavioral systems must be built, engineered, and audited, hearing from Joe Grzywacz, PhD that because individuals must be vulnerable and cede interpretive authority to algorithms they may not fully understand, the asymmetry between users and infrastructure is a core source of mistrust. “As AI becomes increasingly integrated into behavioral health, the question is no longer simply whether systems work,” writes van Mierlo. “Trust may be equally important.”
Please cite as:
van Mierlo T. You Can’t Launch This: Trust as Infrastructure in Digital Behavioral Health.
J Med Internet Res 2026;28:e104731
URL: https://www.jmir.org/2026/1/e104731/
doi: 10.2196/104731
About JMIR Publications News and Perspectives
JMIR Publications is a leading open access publisher of digital health research. The News and Perspectives section is the newest addition to its portfolio, established to bring the rigor and integrity of academic publishing to scientific journalism. The section features well-researched, expert-driven content from the Scientific News Editor, Kayleigh-Ann Clegg, PhD, and a network of specialist JMIR Publications Correspondents to keep the digital health community informed, inspired, and ahead of the curve.
About JMIR Publications
JMIR Publications is a leading open access publisher of digital health research and a champion of open science. With a focus on author advocacy and research amplification, JMIR Publications partners with researchers to advance their careers and maximize the impact of their work. As a technology organization with publishing at its core, we provide innovative tools and resources that go beyond traditional publishing, supporting researchers at every step of the dissemination process. Our portfolio features a range of peer-reviewed journals, including the renowned Journal of Medical Internet Research.
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Journal
Journal of Medical Internet Research
Method of Research
Commentary/editorial
Subject of Research
People
Article Title
You Can’t Launch This: Trust as Infrastructure in Digital Behavioral Health
Article Publication Date
23-Jun-2026
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