A Factorial Randomized Controlled Trial to Optimize User Engagement With a Chatbot-Led Parenting Intervention: Protocol for the ParentText Optimisation Trial (Preprint)

Abstract

BACKGROUND Violence against children (VAC) is a serious public health concern with long-lasting adverse effects. Evidence-based parenting programmes are one effective means to prevent VAC; however, these interventions are not scalable in their typical in-person group format, especially in low- and middle-income countries where the need is greatest. While digital delivery, including via chatbots, offers a scalable and cost-effective means to scale up parenting programmes within these settings, it is crucial to understand the key pillars of user engagement to ensure their effective implementation. OBJECTIVE This study aims to investigate the most effective and cost-effective combination of external components to optimise user engagement in ParentText, an open-source chatbot-led parenting intervention to prevent VAC, in Mpumalanga, South Africa. METHODS This study will use a mixed-method design, incorporating a 2x2 factorial cluster randomised controlled trial and qualitative interviews. Parents of adolescent girls (N = 32 clusters; N = 120 (60 parents and 60 girls aged 10 to 17 years) per cluster, N = 3,840 total participants) will be recruited from the Ehlanzeni and Nkangala Districts of Mpumalanga. Clusters will be randomly assigned to receive one of the four engagement packages that include ParentText alone or combined with in-person sessions and a facilitated WhatsApp support group. Quantitative data collected will include pre-post parent- and adolescent-report surveys, facilitator-report implementation data, and digitally tracked engagement data. Qualitative data will be collected from parents and facilitators through in-person or over-the-phone individual semi-structured interviews and utilised to expand the interpretation and understanding of quantitative findings. RESULTS N/A CONCLUSIONS The ParentText Optimisation Trial is the first study to rigorously test engagement in a chatbot-led parenting intervention in a low- and middle-income country. The results from this study will inform the final selection of external delivery components to support engagement with ParentText in preparation for further evaluation in a randomised controlled trial in 2024. CLINICALTRIAL Open Science Framework, (https://doi.org/10.17605/OSF.IO/WFXNE). Registered on 20 August 2023.