Exploring nurse and patient perspectives on WeChat-based prenatal education in Chinese public hospitals: a qualitative inquiry

Abstract

Background

With the increasing digitization of healthcare, WeChat has emerged as a popular platform for delivering prenatal education in China. While studies have shown its potential benefits, few investigations systematically explore how nurses implement WeChat-based prenatal education and how pregnant women engage with these interventions within public hospital settings. Understanding both provider and patient perspectives is critical for developing equitable, effective digital maternal care.

Methods

A qualitative exploratory design was employed in four public hospitals in Shanxi Province, China. Seventeen obstetric nurses and eight pregnant women participated in semi-structured interviews between March and August 2024. Data were analyzed using thematic analysis to identify commonalities and divergences between nurse-driven and patient-driven experiences.

Results

Nurses perceived WeChat as extending their professional reach beyond physical clinic hours and enhancing patient education, aligning with the Technology Acceptance Model constructs of perceived usefulness and ease of use. However, organizational constraints, digital training gaps, and blurred work–life boundaries posed challenges. Pregnant women similarly recognized WeChat’s convenience for quick clarifications and access to nurse-vetted information, yet wide variations in digital health literacy led to uneven engagement. Cultural factors, such as extended family involvement and preferences for in-person consultations, further influenced both nurse and patient usage patterns. Despite these challenges, participants converged on WeChat’s value as a complementary platform that could reduce clinic visits, offer immediate reassurance, and bolster continuity of care.

Conclusion

WeChat-based prenatal education holds significant promise for improving maternal health outcomes by facilitating frequent, real-time communication between nurses and expectant mothers. Nonetheless, the findings underscore the need for hospital-level policies, structured training programs, and culturally sensitive strategies to address privacy concerns, manage workloads, and reduce digital disparities. An integrated approach that combines nurse acceptance and patient digital literacy is essential to fully harness WeChat’s potential in public hospital contexts.

Implications

The study highlights practical steps for enhancing digital prenatal interventions, including standardized protocols for WeChat-based interactions, comprehensive nurse training in eHealth communication, and tailored support for pregnant women with limited digital skills. Such interventions can inform wider policymaking on telehealth and guide technology developers in creating user-friendly, secure digital platforms that optimize maternal care and reduce health inequities.

Clinical trial number

Not applicable.

Introduction

Background

Digital interventions are increasingly reshaping prenatal education worldwide, offering pregnant women accessible information and continuous engagement with healthcare professionals. Among various digital platforms, WeChat has emerged as a prominent tool in China, boasting over one billion users [1, 2]. WeChat, launched in 2011, is a multifaceted social media application integrating messaging, group chats, multimedia sharing, and various other functions that allow for flexible communication among users [3]. This hybrid platform supports health education models that combine digital and face-to-face interactions, potentially enhancing the quality of maternal care [4]. Because WeChat can easily disseminate timely and relevant content, it is considered a promising medium for delivering prenatal education to diverse populations [5]. However, questions remain about how these digital models are integrated into clinical practice and how they align with actual patient engagement and nurse-led education.

In Chinese public hospitals, the use of WeChat is especially significant due to the unique challenges these institutions present. Public hospitals typically serve diverse populations, including patients from rural or lower socioeconomic backgrounds, many of whom have limited access to health information and face structural barriers to care [6, 7]. Moreover, these hospitals experience high patient loads, making direct communication between healthcare providers and patients more difficult, and thus necessitating innovative solutions such as WeChat for patient engagement [8, 9]. In urgent or health crisis contexts, such as the COVID-19 pandemic, WeChat has proven critical for rapidly disseminating public health information [10, 11], while also addressing individual emergencies related to maternal health [12, 13]. Understanding WeChat’s application in public hospital settings is therefore integral to evaluating its effectiveness and impact on healthcare delivery.

Nurses are crucial frontline educators in prenatal care, responsible for teaching expecting mothers about health behaviors, risk factors, and early warning signs [14]. Integrating nurse-led prenatal education with digital tools like WeChat can potentially improve accessibility, continuity of care, and patient satisfaction [15]. Through continuous, chat-based communication, nurses may extend support beyond the traditional clinical setting, offering rapid responses to patient concerns [16]. Nonetheless, adopting and maintaining digital modalities poses challenges. Ensuring the credibility of online content, addressing variable digital literacy, and balancing empathetic engagement with technological efficiency are recognized hurdles [17]. Despite these obstacles, the potential for improved maternal outcomes through evidence-based, nurse-facilitated digital education remains considerable [1].

Although nurses are central actors in such digitized prenatal care models, understanding how they navigate this changing landscape requires examining both professional and patient perspectives. Pregnant women, who rely on timely, reliable information, often face unique psychological and logistical challenges, particularly during public health emergencies or personal maternal crises [10, 12]. Their voices illuminate gaps in care that may not be apparent solely through provider-centered evaluations [18, 19]. For instance, nurses may primarily emphasize clinical accuracy, whereas patients may seek greater emotional support or personalized feedback [20, 21]. Exploring the experiences of pregnant women alongside nurses is thus critical to ensuring that WeChat-based prenatal education fulfills both clinical objectives and patient-driven needs.

Despite widespread adoption of WeChat for healthcare communication, little is known about how nurses in Chinese public hospitals implement WeChat-based prenatal education or how pregnant women feel empowered, confused, or underserved by these digital interventions. This gap in knowledge may lead to substantial implementation challenges if hospitals fail to provide adequate training and structured guidelines for digital communication [4, 22], potentially exacerbating digital health literacy disparities among older, rural, or socioeconomically disadvantaged populations [23, 24]. Consequently, maternal outcomes may become inconsistent, with some women benefiting from flexible digital access to nurse-led instruction while others remain marginalized by technology-related barriers [25, 26].

Nurses themselves can experience tensions between maintaining traditional “high-touch” care and embracing “high-tech” approaches, particularly if organizational support for digital platforms is inconsistent [27,28,29]. Inadequate digital training, concerns over data privacy, and the demands of continuous digital availability may undermine the perceived advantages of WeChat-based prenatal education [30,31,32,33,34]. Such challenges underscore the need for a holistic examination of how institutional factors, nurse competencies, and patient engagement intersect in WeChat-based care models.

The purpose of this study is to explore the experiences and perceptions of obstetric nurses (as primary participants) and pregnant women (as secondary participants) regarding WeChat-based prenatal education in a Chinese public hospital setting. Through qualitative inquiry, it aims to elucidate how nurses perceive, implement, and evaluate digital education methods and how pregnant women engage with or respond to these methods based on their digital health literacy levels.

From a theoretical perspective, this research extends our understanding of technology acceptance in nursing practice by examining how perceived usefulness and ease of use intersect with emotional labor, organizational constraints, and cultural norms [27, 28]. It also enriches the literature on digital health literacy by spotlighting pregnant women’s engagement patterns and highlighting factors that either empower or discourage their involvement in digital prenatal education.

On a practical level, the findings offer actionable insights for hospitals, policymakers, and healthcare professionals aiming to optimize nurse-led digital prenatal programs. These insights may inform the design of structured training protocols, hospital-approved e-resources, and more equitable digital platforms that accommodate varying patient literacy levels. By centering both nurses’ and pregnant women’s voices, the study ultimately seeks to advance the effectiveness, accessibility, and person-centeredness of prenatal education in an increasingly digitized healthcare landscape.

Research questions

The present research aims to examine how obstetric nurses perceive, implement, and evaluate WeChat-based prenatal education, and to compare these perspectives with pregnant women’s experiences to identify alignment, discrepancies, and opportunities for improvement. Specifically, this research intends to answer the following four research questions:

• RQ1 (Nurse-Focused): How do nurses perceive the usefulness and ease of use of WeChat for prenatal education, and how do these perceptions shape their implementation strategies?

• RQ2 (Nurse-Focused): What organizational, technological, and cultural factors facilitate or hinder nurse-led WeChat-based prenatal education in a Chinese public hospital?

• RQ3 (Patient-Focused): How do pregnant women who receive WeChat-based prenatal education describe their experiences, and which factors influence their engagement with this digital platform?

• RQ4 (Comparative): In what ways do nurses’ perspectives on WeChat-based prenatal education align or differ from pregnant women’s experiences, and how can these insights guide program improvements?

Literature review

Digital prenatal education: Global developments

Recent years have witnessed a global shift toward digital prenatal education, driven largely by the increasing availability of mobile applications, social media platforms, and other online tools designed to support pregnant women [35, 36]. This transformation became especially visible during the COVID-19 pandemic, which accelerated the adoption of telehealth and virtual antenatal care models [37, 38]. In many regions, these digital solutions have supplemented or even replaced traditional, face-to-face prenatal classes, aiming to mitigate infection risks while maintaining consistent healthcare support and guidance [39].

Numerous studies have documented the benefits of digital prenatal interventions, particularly in terms of accessibility and convenience for both low-risk and high-risk expectant mothers [22, 40]. Mobile applications and websites enable pregnant women to access reliable, up-to-date information about fetal development, nutrition, and potential pregnancy complications from the comfort of their homes [41, 42]. Moreover, telehealth services provide real-time communication with healthcare professionals, allowing for remote consultations, personalized care plans, and ongoing monitoring of maternal health indicators [43, 44]. These services help reduce travel costs, waiting times, and exposure to infectious diseases, which is especially critical during global health crises.

Despite these advantages, digital prenatal education also presents several challenges. First, the digital divide—where disparities in internet access, digital literacy, or technological infrastructure persist—can undermine the effectiveness of online antenatal programs [40]. Such barriers risk excluding or marginalizing pregnant women who lack the devices or skills to fully benefit from telehealth services. Second, some women report feeling less engaged in virtual classes than in traditional group sessions, suggesting that reduced peer interaction and direct in-person feedback may negatively affect satisfaction and motivation [41]. Lastly, maintaining quality and consistency in online content can be difficult if there is a lack of standardized guidelines or peer-reviewed sources integrated into digital platforms [43]. Despite these concerns, the surge in telehealth adoption during the pandemic has underscored its potential to reshape prenatal education, enabling healthcare systems to develop more flexible and patient-centered models that extend beyond the constraints of physical clinics [37, 39, 45].

WeChat in Chinese healthcare

Within China’s rapidly digitizing healthcare environment, WeChat stands out as a uniquely popular and versatile platform. Estimates indicate that the application boasts hundreds of millions of daily active users, offering services ranging from messaging and social networking to mobile payments and health information dissemination [46]. Its integration into nearly every facet of daily life provides a highly receptive medium for healthcare communication and education, enabling providers to swiftly distribute tailored messages, infographics, and video tutorials to patients [47]. Given its broad user base and multimedia functionalities, WeChat is increasingly leveraged for delivering interventions that address a variety of health needs, including antenatal guidance [42].

Studies evaluating WeChat-based healthcare programs have shown promising results across multiple domains. In the context of gestational diabetes mellitus (GDM), GE, et al. [48] found that pregnant women who participated in WeChat groups for blood glucose monitoring and health education achieved better glycemic control and improved overall pregnancy outcomes compared to those receiving standard care. Similarly, an intervention combining WeChat-assisted consultations with structured prenatal visits significantly reduced the incidence of uncontrolled fasting glucose and postpartum complications [49]. Meanwhile, exclusive breastfeeding rates have also been shown to rise following WeChat-driven education campaigns. One randomized controlled trial in Huzhu County reported that regular postpartum reminders and peer support via WeChat groups led to higher breastfeeding adherence in the early postpartum period [42]. Other ongoing trials aim to extend these findings by investigating breastfeeding outcomes at later milestones, such as three and six months postpartum [50].

Beyond pregnancy-related uses, WeChat has been employed to manage chronic conditions, including hypertension, diabetes, and coronary heart disease [47, 51]. Patients engaged in digital follow-ups and interactive health monitoring through WeChat often experience improved adherence to treatment plans and better clinical indicators. These successes underscore the platform’s broad applicability in patient education and chronic disease management, largely due to its convenience, personalization options, and capacity for timely two-way communication [46]. However, as WeChat becomes more deeply embedded in China’s healthcare system, several drawbacks have emerged. First, the platform’s design fosters constant connectivity, often blurring the boundaries between work and personal life, particularly for nurses who may feel compelled to respond to messages outside of regular working hours [52, 53]. Second, the lack of institutional policies can result in inconsistent usage of WeChat, creating potential risks such as the dissemination of unverified information, privacy breaches, and variability in care quality [16, 54, 55]. Addressing these considerations will be crucial to maintaining high-quality care and patient trust as digital interventions expand across the maternal health continuum.

Nurse and patient perspectives

Scholars have increasingly recognized the need to examine digital health implementation from both the healthcare provider and patient viewpoints. In particular, the advent of technology-driven prenatal education has reshaped the roles of nurses, who must now integrate new digital competencies into their practice, and patients, who rely on these digital tools for reliable health information [56, 57].

From the nurse perspective, the acceptance of technology depends on multiple factors, including user proficiency, perceived benefits, and the availability of supportive training [27, 58]. While many nurses demonstrate eagerness to adapt, they also face workload pressures and limited organizational resources for professional development [58, 59]. These challenges underscore the importance of structured digital training programs that enhance nurses’ competencies and reduce apprehension about integrating eHealth platforms into routine care [60]. Furthermore, nursing roles continue to evolve with the expansion of telehealth services, as practitioners must not only master new communication methods but also guide patients with varying levels of digital literacy [56]. The COVID-19 pandemic has further accelerated this transformation, highlighting the urgency of adopting digital solutions and the necessity for organizational policies that support these evolving responsibilities [58]. However, as previously noted, the lack of well-defined guidelines for WeChat usage may place added stress on nurses, who must balance greater accessibility demands with patient privacy and institutional expectations [52, 53].

On the patient side, digital health literacy is a critical determinant of whether technology-based interventions succeed in promoting better health outcomes. Pregnant women with higher levels of digital literacy can readily harness online educational content, thereby reducing unnecessary clinic visits and improving disease self-management [57]. However, many individuals—particularly older adults or those with lower formal education—encounter barriers such as limited technological skills, lack of dependable internet access, and concerns about data privacy [57, 61]. Addressing these barriers requires that healthcare systems commit to inclusive strategies, such as offering user-friendly applications and clear tutorials, ensuring that even the least digitally proficient pregnant women can engage effectively with online information [59]. Moreover, trust and usability remain pivotal concerns. Patients often question the reliability of digital platforms and may hesitate to rely on them for critical decisions, especially if they do not receive adequate guidance or reassurance from healthcare professionals [57]. Bridging this gap calls for continuous evaluation of digital tools’ user interfaces and transparency around data security, ultimately fostering a more trusting and engaged patient population.

Taken together, these nurse and patient perspectives converge on the idea that robust support structures—spanning skill-building initiatives, resource allocation, and culturally sensitive communication—are essential for maximizing the potential of digital prenatal education. Recognizing and addressing the intricacies of both healthcare provider and patient experiences will be paramount in designing technology-enabled solutions that truly enhance maternal health services [35, 62, 63].

Theoretical underpinnings

The theoretical foundation underlying this study rests on two main constructs: the Technology Acceptance Model (TAM) and digital health literacy frameworks. This dual focus offers a systematic lens for examining how healthcare professionals adopt new technologies and how patients, such as pregnant women using WeChat, engage with digital health content.

The Technology Acceptance Model (TAM) posits that perceived usefulness and perceived ease of use are pivotal in shaping users’ attitudes toward and intention to employ specific technologies [64, 65]. In a healthcare context, these constructs help explain whether nurses are likely to embrace or resist digital interventions. For instance, if nurses view WeChat-based prenatal education as beneficial in improving patient engagement and reducing clinical load, they may be more inclined to integrate it into their daily practice [66, 67]. Conversely, if the technology is perceived as cumbersome or if privacy concerns loom large, acceptance may wane regardless of its potential value [66]. Extensions to TAM have further incorporated elements such as trust and social influence, emphasizing that broader organizational and cultural environments also play a role in healthcare technology adoption [67].

Digital health literacy frameworks, on the other hand, focus primarily on the patient’s capacity to seek, understand, evaluate, and act upon health information delivered through digital channels [64, 68]. For pregnant women receiving online guidance, digital literacy encompasses more than mere technological proficiency. It also involves critically appraising the reliability of health content, navigating interactive interfaces, and applying relevant knowledge to one’s personal circumstances [68]. Disparities in digital literacy can lead to inequitable health outcomes, where tech-savvy patients benefit significantly while others remain uncertain or left behind.

Adopting an integrative approach that combines TAM’s emphasis on provider attitudes with the principles of digital health literacy yields a holistic understanding of technology-driven prenatal education [64, 66]. Nurses’ acceptance dictates the quality and consistency of digital content they provide, whereas pregnant women’s digital literacy determines how effectively they can utilize these resources. Investigating both sides of the equation is vital for developing targeted interventions—such as enhanced nurse training programs or patient tutorials—that address specific barriers, optimize resource use, and promote better maternal outcomes overall. Figure 1 below shows the overall theoretical framework.

Fig. 1

Theoretical framework for WeChat-based prenatal education

Research gaps

Despite a growing body of research on digital prenatal care, several critical gaps remain unresolved. First, most existing studies primarily emphasize either the healthcare provider perspective or the patient perspective, rather than systematically comparing the two. Consequently, little is known about how nurses and pregnant women perceive the same digital intervention, such as a WeChat-based prenatal program, or the extent to which their experiences align or diverge [35, 58, 59, 62]. This focus on a single stakeholder group limits the capacity to develop holistic, empathetic, and user-centered interventions [63].

Second, while WeChat interventions have demonstrated success in various Chinese settings, there is a lack of context-specific insights within public hospital environments, where organizational culture, workflow patterns, and resource allocation may starkly differ from private clinics or Western healthcare institutions [27, 36, 56, 69]. The unique hierarchical structures and potential constraints on digital infrastructure in certain public hospitals can profoundly influence both nurses’ willingness to adopt new systems and patient engagement. Understanding these factors is essential for developing policies and tailored strategies that accommodate local realities [45].

Lastly, disparities in digital access may amplify existing inequalities, particularly among socioeconomically disadvantaged or rural populations [70, 71]. Although digital tools hold promise for broadening access to prenatal care [72, 73], insufficient internet connectivity, low health literacy, or minimal institutional support risk excluding the very groups most in need of additional resources. Taken together, these lacunae highlight the need for research that simultaneously engages nurse and patient narratives, situating WeChat-based prenatal education in real-world public hospital contexts. By bridging the dual perspectives of technology acceptance and digital literacy, future studies stand to offer substantive, actionable recommendations that facilitate more inclusive, effective, and empathetic prenatal care [74].

Methodology

This qualitative study was conducted from March to August 2024 in four public hospitals across Shanxi Province, China, to explore how obstetric nurses (primary participants) and pregnant women (secondary participants) perceive and engage with WeChat-based prenatal education. By adopting an exploratory qualitative design, we aimed to capture the rich, context-specific experiences and underlying meanings participants attach to digital health interventions [75, 76]. The study was grounded in a constructivist-interpretivist paradigm, recognizing that knowledge is co-constructed through the subjective experiences of nurses and pregnant women within their social and cultural contexts [75]. This perspective informed both data collection and analysis, privileging participant narratives and the meanings they ascribe to WeChat-based education.

Study design

A qualitative exploratory approach was employed to capture detailed, context-specific insights into the design, delivery, and reception of WeChat-based prenatal education. This approach was selected because it emphasizes rich descriptions of social phenomena, enabling the research team to illuminate how nurses integrated digital tools into clinical routines and how pregnant women perceived and engaged with these tools [75]. By focusing on semi-structured interviews, the study captured the subtle nuances of each participant’s experience—an essential feature given the evolving role of digital health interventions in prenatal care.

Setting and duration

Four public hospitals in Shanxi Province were purposefully selected based on the following criteria:

• 1. Operational Obstetrics Departments: Each hospital maintained an active Gynecology and Obstetrics Department with at least one year of experience offering WeChat-based prenatal education.

• 2. Diverse Patient Volumes and Demographics: The selected hospitals served both urban and semi-urban populations, ensuring varied patient backgrounds and clinical capacities.

• 3. Geographical Distribution: Hospitals were chosen from different districts to capture a range of regional contexts within Shanxi Province.

• 4. Institutional Readiness: All four hospitals had previously expressed interest in participating in digital health pilot programs, facilitating smoother logistics and ethical approvals.

Although other hospitals in the province also operate obstetrics departments, these four were deemed representative due to their diverse patient volumes, existing WeChat implementations, and availability of dedicated nursing teams amenable to research participation. This selection approach aligns with a purposive sampling strategy aimed at capturing the breadth of experiences in public hospital settings.

Participants and recruitment

The study included two participant groups. First, obstetric nurses were recruited based on their active involvement in WeChat-based prenatal education, as evidenced by their engagement with online patient queries, content creation, or dissemination of digital materials. Nurses were included if they (a) had at least one year of professional obstetric experience, and (b) demonstrated active involvement in WeChat-based prenatal education. Active involvement was defined as responding to patient queries, creating or sharing educational materials, and maintaining frequent (daily or near-daily) communication via WeChat with pregnant women. To verify this, we consulted nurse managers who confirmed frequency of online interactions using informal usage logs and direct observation. No separate primary study established this criterion; rather, we relied on manager attestations and self-reported nurse engagement.

Pregnant Women were eligible if they (a) were ≥ 18 years of age, (b) were currently pregnant (any gestational stage), and (c) had used WeChat at least weekly to receive prenatal instructions or communicate with obstetric nurses. All pregnant women confirmed that they had received some portion of their prenatal education via WeChat—whether through text messages, infographics, video clips, or voice calls—prior to the study. Nurse referrals were used to identify women who fit these criteria and were willing to share detailed perspectives.

A purposive sampling strategy was employed to identify participants most knowledgeable about WeChat-based prenatal activities [76]. Among nurses, 17 joined the study; data saturation was reached when no new themes emerged, and this was confirmed with two additional interviews (for a total of 17). For pregnant women, eight were recruited to supplement the nurse-centered focus with patient-level insights. Although initially aiming for 6–10 participants, we stopped at eight once data saturation was achieved, as new interviews no longer produced novel codes or themes. The smaller sample reflected the study’s secondary emphasis on patient perspectives, ensuring a manageable yet informative subset.

Participant profiles

The Table 1 below summarizes the demographic characteristics of both obstetric nurses and pregnant women (The detailed profile is present in supplementary material A). All participants were de-identified, and each group’s range of experience or gestational stage was recorded to reflect the diversity of backgrounds.

Table 1 Demographic characteristics of both obstetric nurses and pregnant women

All pregnant women reported receiving at least some portion of their prenatal education via WeChat (e.g., text instructions, infographics, or brief video clips), and all nurses had prior training or orientation on using WeChat as a communication tool.

Data collection

Data were gathered using semi-structured interviews lasting approximately 30–45 min each, conducted face-to-face in private hospital rooms to ensure confidentiality and comfort. An interview guide was developed to address communication experiences, perceived barriers, digital literacy, and organizational factors (Supplementary File B). Specifically:

• Number of Questions: Each interview guide contained 12–14 main questions, plus optional follow-up probes.

• Nurse Interviews: Focused on WeChat’s perceived usefulness, ease of use, and the ways it reshapes professional roles, time management, and patient education delivery.

• Patient Interviews: Explored perceptions of WeChat-based prenatal content, barriers to usage, cultural or family influences, privacy considerations, and overall satisfaction.

While most WeChat interactions involved text messages, infographics, or video clips, some participants mentioned using voice and video calls to discuss urgent or sensitive topics. We included these synchronous methods in the interview discussions and coded participant experiences accordingly. All interviews were audio-recorded with permission and transcribed verbatim within 48 h.

Data analysis

A thematic analysis framework guided the organization and interpretation of the transcribed data [77]. First, the principal investigator closely read each transcript multiple times to gain familiarity with the content and identify preliminary impressions. Codes were then assigned to recurring ideas, phrases, or experiences. After coding all transcripts, the research team grouped codes into initial themes, distinguishing between nurse-derived themes and those emerging from pregnant women’s data. Through iterative review and discussion, the team refined these themes for clarity and conceptual alignment [78]. The detailed code book is provided in supplementary material C. Once separate themes for nurses and pregnant women were established, the team conducted a comparative analysis to determine convergences (e.g., shared views on convenience or trust in hospital-provided digital content) and divergences (e.g., differences in perceived workload versus user expectations).

To ensure credibility, dependability, confirmability, and transferability: We conducted member checks with four nurses and two pregnant women, who reviewed summary findings to confirm their accuracy. An audit trail documented all methodological steps, coding decisions, and theme revisions. Reflexive journaling was maintained by the PI to recognize potential biases and bracket personal assumptions. We provided rich contextual descriptions of the hospital settings and participant demographics, enabling readers to determine the applicability of findings to other contexts.

Ethical considerations

Ethical clearance was obtained from the Institutional Review Boards of Shanxi Provincial People’s Hospital (No. (2024)-426). Prior to each interview, participants were provided with an information sheet detailing the study’s purpose, procedures, and their rights, including the option to withdraw at any time without penalty. All participants signed an informed consent form. To preserve privacy, unique alphanumeric identifiers were used in the transcripts and any published materials. Audio recordings and transcripts were securely stored on password-protected servers, with access restricted to the research team. No monetary incentives were offered, though participants were informed of the potential benefits of contributing to the improvement of prenatal care services through their insights.

Results

To provide a clear roadmap of the core findings, Fig. 2 illustrates how WeChat-based prenatal education simultaneously shapes and is shaped by nurse perspectives (RQ1, RQ2) and pregnant women’s perspectives (RQ3). It also highlights the organizational, technological, and cultural factors influencing nurse adoption and patient engagement, as well as areas where their experiences converge or diverge (RQ4).

Fig. 2

Conceptual overview of nurse (RQ1, RQ2) and pregnant women (RQ3) perspectives in WeChat-based prenatal education, culminating in convergences and divergences (RQ4)

RQ1: Nurses’ perceptions of WeChat’s usefulness and ease of use

Evolving nurse roles and professional identity

Nurses consistently described WeChat as a powerful tool that extended their educational reach beyond the physical confines of antenatal clinics. Many noted that digital communication introduced “micro-interactions” with patients, who were no longer limited to in-person appointments. One participant (N2) explained, “Before WeChat, I might only see a patient twice before her due date. Now, I can check on her every week, answer her questions within minutes, and even send her reassuring messages late in the evening.” This sentiment exemplified WeChat’s perceived usefulness, aligning with the Technology Acceptance Model (TAM) construct of perceived usefulness.

However, this expanded role also bred a sense of role ambiguity. Several nurses found it challenging to maintain professional–personal boundaries when patients expected them to be accessible around the clock. A senior nurse (N5) remarked, “Patients have my WeChat ID and see me as always on-call. It’s great for their comfort, but sometimes I feel I’m a nurse 24/7, even at home.” These heightened expectations elevated the nurses’ sense of importance—knowing their expertise was valued around the clock—yet created new pressures to respond promptly. Rather than seeing themselves solely as hospital-based caregivers, nurses felt they had become “digital educators,” reimagining their professional identities in a technology-driven era.

Despite these demands, few nurses wished to stop using WeChat, implying that the platform’s perceived usefulness outweighed its inconveniences. Some interpreted frequent messages as tangible evidence of their educational impact. One participant (N6) commented, “It’s definitely more work, but at least I know patients are paying attention and trusting my guidance. If I see them less worried or more prepared at their next visit, it’s worth it.” This mixture of empowerment, responsibility, and boundary confusion underscored WeChat’s essential yet complex role in modern prenatal nursing.

Balancing “high-touch” with “high-tech”

Enthusiasm for WeChat’s efficiency coexisted with concerns that digital communication might erode the empathetic, face-to-face rapport traditionally valued in prenatal nursing. Nurses worried that emotional support—critical to patient trust—could be diluted in brief chat messages. One participant (N4) noted, “When I’m with a patient in person, I can read her expression, sense her anxiety, and comfort her right away. On WeChat, it’s different. Words alone sometimes don’t convey the warmth or reassurance she needs.” Although WeChat was perceived as straightforward to navigate technologically (perceived ease of use), nurses found that conveying empathy via text or emoticons presented relational challenges.

Some participants pointed out that WeChat, which mostly involves asynchronous text or infographics, can also support synchronous communications like voice or video calls. However, these were less common. One nurse (N9) recalled, “A few times, I used video calls when a mother was really upset at night, but it’s not our usual practice. Most interactions are still text-based.” While synchronous calls had the potential to foster deeper emotional connections, they also demanded more time and immediate availability, adding stress to busy nurses’ workloads.

Nonetheless, many nurses felt that certain topics—like medication schedules or appointment reminders—worked well through text, whereas emotionally charged issues still benefited from in-person discussions or occasional synchronous calls. A junior nurse (N3) explained, “The mothers love how convenient WeChat is for quick updates and scheduling issues, but some things—like dealing with labor fears—still work better face-to-face. It’s about mixing both approaches.”

Striking the right balance proved difficult in practice. Several participants admitted giving matter-of-fact replies that might have seemed detached to anxious mothers. N9 said, “In person, I’d notice her tense body language. On WeChat, if I’m busy, I might just say ‘Don’t worry, it’s normal,’ which isn’t the same as talking it through for ten minutes.” Most nurses were optimistic that improved hospital guidelines, communication training, and a thoughtful approach could preserve core elements of compassionate care in the digital environment. While initial worries about losing emotional warmth persisted, the possibility of a hybrid model—combining face-to-face empathy with digital efficiency—remained appealing.

Summary: Answering RQ1

Nurses perceived WeChat as a valuable extension of their educational and supportive capacities, aligning with TAM’s perceived usefulness. Yet, the platform’s ease of use introduced unintended consequences: heightened expectations for constant availability and the risk of diluting empathic connections. Although most nurses did not view these challenges as insurmountable, they emphasized the importance of thoughtful implementation. WeChat reshaped their roles, expanding their professional identities while also requiring new time management strategies and interpersonal skills. From the nurses’ perspective, the key lies in effectively balancing “high-tech” digital interactions with the “high-touch” emotional support central to prenatal care.

RQ2: Organizational, technological, and cultural factors influencing nurse-led WeChat education

Organizational influence: training, incentives, and integration

Nurses repeatedly cited organizational structures and resources as pivotal in determining whether WeChat-based prenatal education thrived. Some described the absence of formal digital communication policies, forcing them to adapt through trial and error. One participant (N7) said, “No one really told us how to do this. We just started using WeChat because patients wanted it, but then we realized we didn’t have any official guidelines on what content to share or how often we should respond.”

A lack of systematic training led some to rely on peers or online tutorials, although a few hospitals did offer informal workshops. N11 recalled, “My head nurse set up a ‘tips and tricks’ session on WeChat communication, which was incredibly helpful. I wish it happened regularly.” Uneven digital skills remained an issue, with junior staff feeling particularly unprepared to handle large volumes of patient queries.

Some hospitals attempted to incentivize WeChat usage, albeit modestly. Monthly acknowledgments like “Most Responsive Nurse on WeChat” recognized effort, but others offered no tangible support. N2 stated, “They emphasize WeChat in staff meetings, but there’s no extra pay or reduced workload. It’s just more work on top of everything else.” Many participants agreed that if WeChat practices were formalized—through administrative guidelines or scheduling changes—it would become more sustainable. A participant (N10) whose department had designated “digital consultation hours” each week praised the approach, noting that it “reduces stress because it’s official. Everyone understands it’s part of my job, not just a personal favor.”

Perceptions of content quality, safety, and credibility

Beyond organizational backing, nurses underscored the importance of sharing accurate, evidence-based information through WeChat. One participant (N8) cautioned, “It’s so easy for misinformation to spread on social media. We have to double-check every tip we give on WeChat. If we slip up, it undermines the whole system.” Although some nurses lacked user-friendly resources or hospital-approved templates, others took on a “gatekeeping” role by verifying and translating medical material into accessible formats. N3 admitted, “Sometimes I’m Googling resources at midnight, trying to confirm that the advice I gave wasn’t outdated.”

Data privacy and ethical concerns were also prevalent. N1 recounted, “I had a mother send me sensitive lab results over WeChat. I worried about confidentiality—what if her phone gets lost or hacked? But I also didn’t want to ignore her request.” Although hospital leadership reminded staff to protect patient data, the specifics were murky. Still, nurses felt patients trusted them more than random online sources. N12 summarized, “Patients say things like ‘I only trust the nurse’s messages, because everything else online might be rumors.’ That trust is powerful, but it also makes us even more responsible for getting it right.”

Nurse-patient power dynamics and cultural expectations

Cultural norms, including familial involvement and a deep respect for healthcare professionals, significantly shaped WeChat usage. Nurses sometimes managed multi-generational group chats where grandparents and other relatives advocated particular interventions. N4 described a scenario: “The grandmother insisted on adding me to a family group chat. Every morning she sent herbal recipes, asking if they were safe. It was difficult to address her concerns without overshadowing the mother-to-be.”

Additionally, a longstanding preference for in-person consultations affected digital adoption. N5 observed, “Some families still think an in-person consultation is more ‘real.’ If it’s a serious concern, they insist on seeing a nurse or doctor face-to-face.” While WeChat remained a convenient tool for routine interactions, traditional beliefs occasionally limited its broader acceptance. Younger women generally embraced WeChat more readily, although they, too, had to navigate family expectations that conflicted with digital practices. N16 remarked, “Most younger mothers love the efficiency, but their mothers or mothers-in-law want them to visit the hospital more often. We use WeChat to mediate that tension, which can be challenging but also helps us understand family dynamics better.”

Summary: Answering RQ2

Participants identified organizational, technological, and cultural factors that either enabled or hindered WeChat-based prenatal education. Without formal guidelines, nurses improvised digital communication strategies and faced uneven workload distribution. Privacy concerns, misinformation risks, and extended family involvement further complicated the landscape. Nonetheless, many nurses successfully built trust by curating credible content and respecting cultural norms. These findings highlight the need for hospitals to implement standardized policies, designate digital consultation hours, and provide robust eHealth training. By doing so, WeChat could evolve from an ad hoc tool into a seamlessly integrated, culturally sensitive medium for prenatal care.

RQ3: Pregnant women’s experiences and engagement with WeChat

Digital health literacy gaps and customized strategies

Pregnant women’s engagement with WeChat-based prenatal education varied widely, largely reflecting their comfort with smartphones. Some, especially those with higher education or frequent app usage, described WeChat as indispensable for daily health management. PW5 commented, “It’s so easy to message my nurse if I have a weird symptom. I just show her a photo, and she’ll guide me on whether to come in or not. I feel more secure knowing she’s only a text away.” Others struggled with features like opening hyperlinks or downloading attachments. PW3 admitted, “I had no idea how to open the PDF file my nurse sent. My husband had to help me, and even then, it took us a while to find it again in the chat history.”

Nurses who devised step-by-step tutorials or visually engaging materials were especially appreciated. PW7 recalled, “My nurse made these mini-infographics showing each trimester’s do’s and don’ts, and even color-coded them. I could instantly see what to watch out for. That really helped me because I’m more of a visual learner.” Brief video clips and voice messages also facilitated clearer communication for some participants. However, not all nurses had the time or digital savvy to customize content. Consequently, some pregnant women received comprehensive digital guidance, while others felt their concerns were dismissed or addressed too briefly.

Expanded access vs. unintended inequities

Many pregnant women praised WeChat for bridging geographic or logistical barriers, particularly those living far from the hospital or with limited financial means. PW2 emphasized, “Without WeChat, I’d have to take a day off work each time I had a small question. This app saved me travel time, plus I didn’t lose wages.” Younger, tech-savvy mothers appeared to embrace the platform wholeheartedly, viewing it as a convenient, real-time channel for advice and reassurance.

Yet some participants highlighted potential inequities. Women who were older or less educated reported difficulty interpreting digital instructions. PW4, age 35, confessed, “I sometimes feel too embarrassed to ask all my questions via text. I worry the nurse will think I’m old-fashioned. So I end up calling my mother or just waiting until my next appointment.” This digital divide could marginalize those less comfortable with technology, leaving them reliant on in-person visits or informal family advice. Although in-person consultations remained available, these participants felt “left behind” when the hospital increasingly assumed patients would navigate WeChat with ease. Participants expressed hope that the hospital would offer more structured tutorials or support sessions for those less digitally fluent.

Some pregnant women also voiced mild data privacy or cultural concerns, though fewer than nurses. PW6 commented, “I don’t mind sharing my test results, but my husband worries about hacking. He asks me not to store them on my phone.” Others described tensions with older family members who viewed digital communication as impersonal. PW3 explained, “My mother-in-law said, ‘Doctors should talk to you in person, not on a phone.’ So I have to reassure her that this is normal now, and the nurse is still trustworthy.”

Summary: Answering RQ3

Pregnant women reported a spectrum of digital experiences, ranging from highly interactive and reassuring to confusing and underutilized. High digital literacy correlated with more seamless WeChat integration, enabling women to share photos, ask quick questions, and receive timely feedback. Those with lower confidence in their smartphone skills or those influenced by older relatives felt more hesitant. Though many participants praised nurses who offered clear tutorials or voice notes, these supportive strategies were inconsistently applied. Overall, WeChat showed promise for broadening access and offering immediate guidance, yet risked amplifying existing inequities if hospitals did not systematically address literacy gaps, cultural sensitivities, and privacy worries.

RQ4: Comparing nurse and pregnant woman perspectives and guiding program improvements

Areas of convergence: Mutual appreciation of convenience and trust

Both nurses and pregnant women recognized WeChat’s potential to streamline prenatal education, offering near-instant clarifications, timely appointment reminders, and easier sharing of test results. PW2 remarked, “If I have a pressing concern late at night, I can send a message right away and often get a response by the next morning. Before, I would worry until my next appointment.” Nurses, in turn, valued the heightened engagement. N8 explained, “When a patient messages me questions about her lab results, it shows she’s taking her health seriously. That trust in my digital advice makes me feel more connected to her journey.”

Both groups also valued receiving or providing hospital-vetted content. PW6 said, “There’s a lot of scary stuff online, but if my nurse sends me a WeChat article, I trust it’s legit.” N14 corroborated, “Patients often say, ‘I only believe what you post, because it’s from the hospital.’ That credibility is powerful.” This reliance on verified information underscored WeChat’s role in reinforcing trust and reducing exposure to misinformation.

Points of divergence: Response expectations and personalization

Despite these shared positive views, nurses and pregnant women often diverged in their expectations around response times. Pregnant women tended to want quick replies, sometimes interpreting delays as disinterest. PW1 noted, “If I don’t get a response the same day, I start wondering if my question wasn’t important.” Nurses, meanwhile, reported feeling overwhelmed and unable to check WeChat regularly amid ward duties or emergencies. N2 stressed, “I can’t check my phone every hour during a busy shift. Then the patient thinks I’m ignoring her, which isn’t true, but it’s the reality.”

Another divergence lay in the desire for personalization. While both sides favored efficient digital communications, pregnant women wanted tailored content, such as trimester-specific videos or personalized voice messages. PW7 explained, “I’d love more videos that directly address my stage of pregnancy. Sometimes it’s just generic text.” By contrast, nurses lacked the time and tools to individualize guidance extensively. N11 admitted, “I know women want more than a generic reply, but I don’t have time to craft a unique message for everyone.”

Guiding program improvements: Toward an integrated, inclusive model

Participants offered practical strategies for refining WeChat-based prenatal education. Several pregnant women proposed co-created digital materials, whereby nurses and mothers collaborate on short videos or Q&A segments based on real questions that arise during pregnancy. PW3 said, “I’d love to help shape the content. After all, we know what we worry about most.” Nurses suggested setting “digital office hours” or rotating schedules so that no single provider felt perpetually on call, thereby reducing burnout and clarifying when patients could expect replies. Many also envisioned a hospital-approved library of infographics and frequently asked questions to expedite responses. N5 remarked, “If we had a well-organized set of resources, we’d spend less time reinventing the wheel. Patients would still feel personal care if we add a short note at the beginning or end.”

Both groups acknowledged that bridging the digital divide would require more robust patient tutorials and culturally sensitive approaches. For instance, in-person workshops could demonstrate basic app functions for older patients, and family-inclusive sessions might address older relatives’ skepticism. While nurses championed policies that standardize content and set clear online boundaries, pregnant women called for user-friendly, interactive, and personally relevant materials. These recommendations pointed toward a multifaceted approach: institutional support, structured nurse training, and increased patient involvement could help WeChat reach its full potential while reducing disparities.

Summary: Answering RQ4

Nurses and pregnant women aligned in their appreciation of WeChat’s convenience, immediacy, and reliable content. Yet gaps persisted regarding response-time expectations and the level of personalization. Overall, a collaborative, multi-pronged strategy—equipping nurses with adequate resources, engaging pregnant women in content creation, and instituting clear hospital guidelines—emerged as the most promising avenue. By balancing high-tech efficiency with the relational depth of prenatal care, WeChat can evolve into a truly integrative platform that benefits both providers and expectant mothers. To further illustrate these convergences and divergences, we have included an optional conceptual diagram in Supplementary File D, highlighting how nurse and patient perspectives overlap or diverge under WeChat-based prenatal education.

Discussion

Overview of key findings

This study explored how obstetric nurses and pregnant women in four public hospitals in Shanxi Province, China, perceive and experience WeChat-based prenatal education. The aims were to investigate: (a) nurses’ views on WeChat’s usefulness, ease of use, and professional role changes; (b) organizational, technological, and cultural factors shaping implementation; (c) pregnant women’s digital literacy and engagement levels; and (d) how nurse and patient perspectives converge or diverge. By gathering insights from both providers and recipients of prenatal care, the investigation captured a multifaceted view of digital prenatal education in a healthcare environment that is rapidly evolving yet still grounded in traditional values.

In RQ1, nurses emphasized WeChat’s “anytime, anywhere” flexibility and capacity to increase micro-interactions with pregnant women, resonating with the Technology Acceptance Model (TAM) construct of “perceived usefulness.” At the same time, they experienced new stresses regarding boundary management and constant availability, reflecting an interplay between “perceived ease of use” and emotional or workload burdens. These results suggest that technology acceptance in healthcare extends beyond interface simplicity to encompass organizational support and emotional well-being—a nuance that corroborates findings in other nursing contexts [27, 28].

Turning to RQ2, participants identified organizational constraints, such as the absence of standardized guidelines or training, which forced improvisational approaches. Concerns over data privacy and extended family involvement further highlighted the cultural intricacies of WeChat adoption. As in prior research emphasizing the need for institutional policies when integrating digital platforms [3, 9], the nurses in this study called for more structured resources and eHealth training—particularly in public hospitals that serve diverse, often under-resourced populations [6].

In RQ3, pregnant women reported varying degrees of digital literacy. While tech-savvy mothers leveraged WeChat for real-time clarifications and reassurance, those less adept with smartphones felt apprehensive or left out, underscoring an ongoing digital divide that could exacerbate maternal health inequities [70]. Many praised nurse-led interventions—such as infographics, mini-tutorials, or voice messages—but these supportive efforts were inconsistently applied. The results underline that effective digital health requires not just technical access but also culturally sensitive and literacy-aware strategies, paralleling global calls for inclusive telehealth practices [35, 73].

Finally, RQ4 revealed both convergence—nurses and women alike valued immediacy and trust in nurse-provided content—and divergence, particularly around response-time expectations and personalized guidance. Pregnant women sought empathetic, individualized advice, while nurses struggled with limited time and mounting digital workloads, a dynamic that aligns with prior observations in maternal telehealth services [36, 63]. Overall, the study presents a nuanced portrait of how WeChat reshapes prenatal care by extending its reach and convenience while also introducing new complexities in professional roles, cultural expectations, and equitable access.

Integration with literature and theoretical frameworks

Technology acceptance model in nurse adoption

Nurses’ experiences validated two primary TAM constructs: perceived usefulness and perceived ease of use [65]. Many described WeChat as enabling frequent, rapid communication—contributing to improved patient rapport and satisfaction [27]. Yet, ease of use was not limited to technical proficiency; emotional labor and boundary-setting emerged as major factors affecting sustained adoption. These findings corroborate research suggesting that in clinical practice, a purely “functionality-centric” view of ease of use is insufficient [28]. As others have noted, “usefulness” does not equate to unconditional acceptance when nurses feel overextended or lack institutional support [29]. The present study thus illustrates how the “classical” TAM might be expanded to account for nurses’ psychological well-being, workload balance, and the cultural norms embedded in public hospital systems [8].

Digital health literacy and patient engagement

In line with digital health literacy frameworks [57, 68], pregnant women’s adoption of WeChat hinged on their ability to navigate app features and critically assess health content [12]. High-literacy women were proactive, using multimedia resources and seeking immediate clarifications. Conversely, older or less digitally adept participants expressed hesitation or confusion, consistent with “digital divide” themes reported in maternal eHealth contexts [70]. The success of WeChat-based interventions thereby hinges on integrating culturally tailored tutorials, voice messages, or simplified infographics. This study’s findings reinforce prior calls for targeted eHealth literacy programs [45, 73] that simultaneously respect local family dynamics and address trust, privacy, and usability concerns.

Organizational and cultural context

Although not explicitly framed by Implementation Science models, this research highlights the organizational and cultural influences on WeChat integration. In resource-limited public hospitals lacking standardized policies, nurses improvised digital protocols, mirroring the challenges seen in other settings where top-down guidance is scarce [28]. Cultural norms—such as deference to elder relatives and a preference for in-person consultations—either hindered or reshaped digital engagement. These insights echo studies on how collectivist cultural dynamics can shape technology acceptance [9]. Overall, weaving together TAM, digital health literacy, and organizational readiness perspectives yields a holistic understanding of WeChat-based prenatal education. Only by addressing provider acceptance, patient competencies, and institutional or cultural factors can policymakers and practitioners optimize digital maternal care.

Practical implications

Implications for clinical practice

By connecting the present findings to clinical initiatives, several recommendations emerge. Hospitals could institute formal digital support hours to reduce nurse burnout, echoing the successful “digital consultation hours” reported by some participants. As existing literature shows, offering explicit time blocks for telehealth activities can foster better workforce satisfaction and more consistent patient communication [31, 32]. Furthermore, nurses require structured eHealth training that covers not just technical proficiency but also how to convey empathy in text or synchronous video calls [28]. The development of hospital-approved content libraries—ranging from curated infographics to short videos—can help nurses quickly share reliable information, aligning with calls in the literature to reduce informational discrepancies across digital platforms [16].

Implications for health policy

On a policy level, more robust frameworks surrounding patient data security and privacy are urgently needed, particularly in public hospitals that serve heterogeneous populations. Government entities or health bureaus could establish guidelines on what types of patient data may be shared on WeChat, how to encrypt sensitive health records, and how to handle out-of-hours consultations. Such policies would alleviate uncertainties about liability and confidentiality [53, 55]. Addressing the digital divide observed in this study requires subsidized smartphone plans or free data packages for low-income women, as well as accessible eHealth tutorials—efforts that have been proposed in other telehealth contexts to improve uptake and equity [70, 74]. By systematically equipping pregnant women from varied backgrounds with technological tools, healthcare systems can reduce disparities and align digital prenatal education with broader public health goals.

Implications for technology design

In terms of technology design, WeChat or dedicated hospital apps could incorporate AI-driven FAQs, symptom checkers, or interactive reminders that address common prenatal concerns. Research suggests that such automated features can help nurses manage routine queries more efficiently, freeing them to focus on complex cases [45, 69]. Design improvements might also involve multimedia modules for each trimester, user-friendly dashboards that track fetal development, or push notifications for scheduled appointments [12]. These elements could empower patients to self-serve basic health questions, aligning with calls for self-management features in maternal digital health [35]. Combined with localized, culturally adapted designs, such innovations stand to enhance engagement and trust in WeChat-based prenatal care.

Collectively, these recommendations for clinical practice, policy, and technology design underscore the multi-dimensional nature of WeChat-based interventions. The core lesson is that effective digital maternal care goes beyond merely digitizing traditional services; it necessitates comprehensive strategies that account for nurse well-being, patient literacy, and broader cultural or organizational realities [63, 73].

Limitations of the study

This research focused on four public hospitals in a single province, possibly limiting the transferability of findings to other regions or private health systems. Although we included both nurses and pregnant women, older or less digitally literate patients remained somewhat underrepresented, raising questions about whether the full spectrum of digital engagement was captured. Additionally, recruitment through nurse referrals may have introduced an authority bias, whereby patients felt obliged to participate after being approached by a trusted healthcare figure. Future studies could mitigate this by employing community-based recruitment or third-party invitations [70].

The cross-sectional nature of the study also means it cannot capture longitudinal shifts in WeChat usage or how nurse–patient relationships evolve over multiple trimesters and postpartum periods. As technology adoption is often dynamic, subsequent studies employing mixed methods or extended timelines could identify how digital literacy and organizational policies evolve. Finally, while TAM and digital health literacy frameworks were central to interpreting the data, other theories—such as UTAUT or culturally focused models—might reveal additional nuances, especially in collectivist contexts where elder family members exert strong influence [9].

Directions for future research

Building on these findings, longitudinal and multi-site research could examine how WeChat-based prenatal interventions unfold across entire pregnancies or postpartum intervals, capturing shifts in digital engagement and evolving nurse–patient dynamics. Investigating how digital tools address different stages—from early prenatal screening to postpartum recovery—would offer a comprehensive lifecycle perspective [35].

Further, intervention-based studies that pilot standardized eHealth protocols, structured nurse training sessions, and patient literacy workshops would clarify whether such measures genuinely enhance satisfaction and reduce workload. Randomized controlled trials exploring the efficacy of chatbot-assisted learning or gamified modules in bridging literacy gaps could shed light on scalable solutions, extending current telehealth innovations [45, 69]. Collaboration with WeChat or other app developers to integrate AI features (e.g., voice-enabled triage tools) may alleviate nurse burdens while delivering responsive, context-appropriate guidance.

Ultimately, exploring cross-cultural applications of WeChat or similar platforms in varied healthcare systems can deepen our understanding of how local norms, familial decision-making, and institutional structures interact with digital health technology. By continuing to compare nurse and patient perspectives in diverse cultural and organizational contexts, researchers can hone best practices for inclusive, empathetic, and technologically adept prenatal care on a global scale.

Conclusion

This study reinforces that WeChat-based prenatal education has significantly reconfigured both nurse roles and patient engagement in the examined Chinese public hospitals, demonstrating clear advantages in accessibility and real-time support while simultaneously introducing new complexities. The capacity to deliver timely advice, build rapport through frequent micro-interactions, and address routine health questions remotely underscores the technology’s potential for elevating maternal care. Yet the research also highlights emergent dilemmas around workload, empathy, and the digital divide, suggesting that without thoughtful organizational strategies and explicit digital literacy initiatives, these gains may be unevenly distributed across different patient groups.

By incorporating both nurse and pregnant woman viewpoints, the study delivers a more holistic understanding of digital prenatal education’s strengths and shortcomings. Nurses’ acceptance of the platform is closely tied to perceived usefulness and institutional backing, whereas pregnant women’s participation varies with their digital competence and cultural context. This dual perspective underscores the need for integrated approaches that respect both professional and patient experiences—where nurse training, patient tutorials, and inclusive policy frameworks converge to foster seamless, empathetic digital care.

Addressing these challenges is crucial for advancing maternal health in China’s rapidly digitizing healthcare landscape and may also hold relevance for other regions navigating similar technology transitions. Emphasizing clear guidelines, robust infrastructure support, and tailored eHealth literacy efforts will be indispensable in shaping digital prenatal care into a more inclusive, sustainable, and person-centered model. As digital interventions continue to evolve, concerted efforts that build upon these findings can refine best practices and ultimately enhance maternal and neonatal outcomes on a broader scale.