From Chatbots to Change: Acceptability and Engagement in a Digital-Human Parenting Program Embedded within the Chinese Preschool System (Preprint)

BACKGROUND Digital parenting programs offer a scalable solution to improve early childhood development outcomes, especially in low- and middle-income countries like China, but face challenges in sustaining user acceptability and engagement. The culturally specific factors that shape these processes are also not well understood. OBJECTIVE This study explored the lived experiences of caregivers and facilitators in a digital-human parenting program delivered within the preschool systems in a lower-middle-income city in China, with a particular focus on the determinants of acceptability, the facilitators and barriers to engagement, and the drivers of perceived changes. METHODS Embedded within a cluster randomized controlled trial in urban China, this qualitative study used semi-structured interviews and focus group discussions with 26 caregivers and 18 program facilitators. Data were analyzed using a thematic approach. RESULTS Findings demonstrated a virtuous cycle where acceptability (driven by content relevance and digital usability) fostered engagement, leading to perceived changes that reinforced the cycle. Engagement was shaped by intrinsic and extrinsic motivators. Cultural factors were critical: mismatched expectations from the blurred concepts of “parenting” and “education” hindered acceptance, and a "shame culture" inhibited open discussion. An anonymous “Tree-hole” feedback system emerged as a key culturally sensitive solution. CONCLUSIONS The effectiveness of digital parenting interventions in collectivist contexts requires deep cultural adaptation. Interventions must move beyond one-size-fits-all models to incorporate user-centered design and culturally resonant features, such as anonymous feedback systems. A hybrid, family-centered model leveraging trusted human figures is essential for building trust and maximizing impact. CLINICALTRIAL ChiCTR2400081911