Advancing equity in routine-care internet-delivered cognitive behaviour therapy: Representativeness, outcomes, engagement, and satisfaction.

Background: Internet-delivered cognitive behaviour therapy (ICBT) has potential to reduce access barriers, yet it remains unclear how well routine-care ICBT reaches underserved groups and whether symptom outcomes, engagement, and satisfaction are comparable across demographic subgroups. Methods: Routine-care ICBT clinic data ( Results: Several groups had lower representation relative to census benchmarks, including men, clients with lower education, Indigenous and some racialized groups, newcomers, rural/small-town residents, whereas women, higher education, and White clients had higher representation. Depression and anxiety symptoms declined significantly over time across all demographic groups. Engagement was high (~82% completed ≥3 of 5 lessons). Older age predicted greater lesson completion. Satisfaction was high overall and with course materials, with relatively lower satisfaction among clients who were not partnered. Conclusions: Although some groups were underrepresented, consistent with face-to-face treatment, routine-care ICBT was associated with substantial symptom improvement across all demographic subgroups, alongside high engagement and satisfaction. Areas of lower representation highlight the need for targeted outreach and engagement supports, particularly to men, people with lower educational attainment, Indigenous and some racialized communities, newcomers, and people living outside large urban centres.