Institutionalizing Digital Parenting Programs in Low Resource Settings in China: Comparative Case Study of Health Care and Education Sectors Using the RE-AIM Framework.

Background: Digital parenting programs offer a promising way to disseminate evidence-based parenting knowledge and support early childhood development. They help reduce costs while improving scalability and fidelity. However, their successful implementation is context-dependent, and existing research offers limited guidance on how the implementation of digital parenting interventions unfolds across diverse settings. Objective: This study aims to identify the shared and unique facilitators and barriers affecting each dimension of implementation, as well as differentiated mechanisms that support the effective implementation and institutionalization of such interventions across diverse settings. Methods: Using a multiple-case study design, this research compared the implementation of a digital (chatbot-led) parenting program across 2 distinct settings in China: urban educational and rural health care contexts. The intervention content remained consistent, while the contexts and formats of local human-led support differed. Guided by the RE-AIM framework, this study examines the program's reach, adoption, implementation, and maintenance in both settings. Data sources included program documents, field observations, semistructured interviews, and focus group discussions with 83 stakeholders. Thematic analysis was conducted using ATLAS.ti until thematic saturation was reached. Results: Data were collected from 83 stakeholders, and findings are based on an analysis of 18 interviews and 4 focus groups with caregivers, village doctors, and health officials from the rural health care setting, and 29 interviews and 4 focus groups with caregivers, teachers, social workers, and managers from the urban educational setting. Regarding reach, strong relationships between parents and implementers and the credibility of program developers were shared facilitators in both settings. Parenting conservatism and limited understanding of the program were shared barriers. In rural health care 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 are shared facilitators in both settings. At the individual level, task-driven motivation helped, while time constraints hindered adoption in the health care setting. Teachers adopted the program due to its relevance to their roles in the educational setting, unlike village doctors, who did not see it as part of their core duties. For implementation, supportive management and clear guidelines were shared facilitators in both settings, while a lack of purpose and psychological pressure acted as barriers. Rural implementation was aided by scheduling during off-seasons and standardized workflows, whereas flexible workflows were essential in the educational setting. Regarding maintenance, alignment with organizational functions and internal resources facilitated sustainability in both settings, while overreliance on government authorization posed challenges. Educational settings required contextual adaptation, while health care 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 health care). This study highlights the importance of context-specific implementation strategies and proposes differentiated delivery models tailored to local structures and needs.