JMIR Publications

ABSTRACT

Background:

Digital parenting programs offer a promising way to disseminate evidence-based parenting knowledge and support early childhood development, particularly in low- and middle-income countries with limited resources. They help reduce costs while improving scalability and fidelity. However, their successful implementation is context-dependent, and existing research offers limited guidance on how implementation of digital parenting interventions unfolds across diverse settings.

Objective:

Guided by the RE-AIM framework, this study examines the reach, adoption, implementation, and maintenance of a digital (chatbot-led) parenting program, in both urban educational and rural healthcare settings in China. It aims to identify the common and unique facilitators and barriers affecting each aspect, as well as differentiated mechanisms for the effective implementation and institutionalization of digital parenting support, across these settings.

Methods:

A multiple-case study approach compared the implementation in the two settings, with consistent digital intervention content but different contexts and formats of local human-led support. Data were collected through program documents, field observations, semi-structured interviews, and focus group discussions with 83 stakeholders. Thematic analysis was conducted using ATLAS.ti, guided by the RE-AIM framework.

Results:

Regarding reach, strong relationships between parents and implementers and the credibility of program developers were common facilitators. However, parenting conservatism and limited understanding of the program were barriers. In rural healthcare settings, parents’ perception of village doctors as lacking parenting expertise posed an additional challenge. For adoption, trust between managers and program developers, program alignment with organizational functions, and organizational empowerment supported implementation. At the individual level, task-driven motivation helped, while time constraints hindered adoption. Teachers adopted the program due to its relevance to their roles, unlike village doctors who did not see it as part of their core duties. For implementation, supportive management and clear guidelines were facilitators, while lack of purpose and psychological pressure were barriers. Timing the program during off-seasons and providing standardized workflows helped rural delivery, whereas flexible workflows were essential in the urban educational setting. Regarding maintenance, alignment with organizational functions and internal resources facilitated sustainability, while heavy reliance on government authorization was a challenge. Urban education settings required contextual adaptation, while rural healthcare settings needed more content adaptation.

Conclusions:

Implementing digital parenting programs is a complex process, influenced by multilevel facilitators and barriers that vary across regions (rural vs. urban) and settings (educational vs. healthcare). This study highlights the importance of context-specific implementation strategies and proposes differentiated delivery models tailored to local structures and needs. Clinical Trial: The research protocols were prospectively registered on the Chinese Clinical Trial Registry (ChiCTR2400081911 and ChiCTR2400092609).