When intentions are translated into actions: A thematic qualitative investigation of the factors associated with caregivers’ engagement with a non-AI chatbot-led parenting intervention in South Africa

<title>Abstract</title> <p>Introduction While previous research has demonstrated the feasibility of chatbots in delivering low-cost digital health interventions, further research is needed to understand the factors that enhance user engagement and intervention effectiveness. Objective This study examines the facilitators and barriers to engagement in a chatbot-led parenting intervention delivered to caregivers of adolescent girls in low-income South African communities. Methods This qualitative study was nested within a 2 x 2 factorial cluster randomised trial testing external human-delivered components designed to support engagement in the ParentText chatbot. Ninety-seven participants were purposively recruited from the larger sample for focus group discussions. Thematic analysis was used to identify facilitators and barriers to engagement, informed by the Digital Health Engagement Model and the Health Action Process Approach. Results Caregivers reported that engagement with the chatbot contributed to reductions in physical punishment and parent–adolescent conflict while promoting greater openness to discussions of sensitive reproductive health topics. Caregiver perceptions of both content quality (perceptions of how useful the chatbot was in supporting adolescents’ wellbeing) and delivery quality (safe and empathetic delivery by the chatbot) motivated initial and ongoing chatbot use. Social influence emerged as an important facilitator of ongoing use and application of positive parenting skills, while lack of internet and smartphone access were major drivers of disengagement. Access to human support for troubleshooting chatbot errors helped re-engage users when they felt less motivated due to challenges with troubleshooting chatbot errors. Gender-related barriers also emerged, such as women’s disproportionate caregiving and household responsibilities limiting their completion of chatbot parenting modules, underscoring the need for gender-intentional design in digital parenting interventions. A major barrier to adopting more positive parenting practices was the entrenched beliefs that non-violent forms of discipline are ineffective. Conclusion This is the first known African study investigating qualitatively user engagement with a chatbot-delivered parenting intervention. Our findings underscore the importance of adopting a participatory approach while distinguishing strategies that enhance the technology itself from those that support caregivers’ behaviour change. Our results also provide unique insights into the key role of integrating person-centred design and community partnerships alongside strategies to address structural barriers to engagement. Trial Registration: Registry: Pan African Clinical Trial Registry</p>