We used a GT approach to establish the factors and mechanisms influencing the childcare needs of parents of children aged 0–3 years. Purposive sampling and snowball sampling were used for sample selection. According to the principle of purposive sampling, the interviewees needed to fulfill the following conditions:

A small number of sample subjects were first sought through purposive sampling. Then, snowball sampling was used to finalize the 63 interviewees, including parents with children aged 0–3 years, administrators of childcare facilities, childcare teachers, education experts, and community workers. Unstructured interviews were used to obtain information for GT to establish the theory, and unstructured one-to-one telephone, WeChat, and face-to-face interviews were conducted. Every interview took 30–60 min, and each interviewee’s information was treated as confidential. After obtaining the interviewees’ consent, we recorded and collated the interview elements. Demographic statistics of the interview samples are listed in Table 1.

After identifying the research question on childcare needs and collecting and analyzing the primary data (in Chinese), the primary data were coded at three levels (40) to develop a framework and dimensions for interpreting childcare needs. To maximize the objectivity of the coding results, two researchers did the coding process independently. They used Nvivo12 software to organize and analyze the raw textual information sentence by sentence. The initial concepts were also categorized and clustered based on similarity, causality, and other relationships. Subsequently, with the help of the code comparison function in the Nvivo12 software, a code consistency test was carried out, whereby coded content with a kappa coefficient of less than 0.75 was repeatedly discussed, and concepts with a low conceptual repetition rate or a high degree of similarity were eliminated, refined, or merged by consulting with experts until the consistency ratio was 85% or more, with the specific coding steps being as follows.

We used the remaining 13 randomized data from the interviews as a saturation test sample to test the theoretical saturation of the findings. No new conceptual categories or relationships were identified during the testing. This indicates that the original GT fully accommodated the relevant categories and concepts, implying that the model passed the theory saturation test.

The coding and analysis of the interview data led to identifying five core categories: Childcare Center Management (CCM), Teacher Professionalism (TP), Environment and Facilities (EF), Health Care Services (HCS), and Educational Activities (EA). CCM refers to managing healthcare, educational teaching, and logistics safety in daycare institutions using two different models: the refined standardized model and the rough and chaotic model. TP refers to the various levels of professional knowledge, skills, and qualities of early childhood education educators and whether they have obtained relevant professional certificates. EF refers to the material facilities and cultural atmosphere of childcare centers in two different spaces, internal and external, with other qualities and utilization levels. HCS relates to the services provided by childcare institutions in various forms, such as full-day, half-day, and temporary care, to give the children different qualities of physical exercise, dietary management, disease prevention and control, health management, and injury prevention. EA refers to other attributes of life, games, and teaching activities provided by childcare institutions through child-game-based, teacher-led, and home-based cooperation.

We constructed a model with six paths based on the interview data, existing theory, and relationships among the five core categories. As shown in Table 4, the professional qualifications of teachers in these categories were directly related to EA, HCS, and EF. The management of childcare institutions is directly related to EA, EF, and HCS. EF is directly associated with HCS, whereas HCS is associated with EA. Simultaneously, the path from EF to HCS played a mediating role in teachers’ professional qualifications.

Similarly, the professional qualifications of teachers indirectly affect EA through HCS, and CCM indirectly affects HCS through EF and EA through HCS. In addition, the path from teachers’ professional qualifications to EA was also affected by the common chain-mediated effects of EF and HCS. Similarly, CCM affects HCS by influencing EF and indirectly affects EA. Finally, based on the third level of coding analysis, a model diagram of the core category “Factors Influencing the Demand for Childcare and Their Mechanism of Action” was constructed (as shown in Figure 2).

Paths one: CCM→CS. Security and routine management of teaching and learning are essential guarantees for the regular operation of education and teaching in educational institutions and the overall quality of academic activities (41). CCM directly affects the quality of EF as a critical safeguard for maintaining its daily work.

Paths two: TP→EA. Professionalism among early childhood teachers is a vital and central factor in implementing educational activities. This directly affects the quality and effectiveness of these activities (42). In young children’s behavior, Barandiaran et al. found that teachers’ sensitivity was positively related to young children’s exploratory behavior: the more significant the teacher’s sensitivity, the more exploratory behaviors exhibited by the children in care (43). Howes et al. pointed out that when children experience higher-quality teaching or tighter teacher-student relationships, they significantly impact academic performance (44). Aguillard et al. suggested that caregivers’ caregiving capacity is vital for implementing continuity of care. When caregivers receive more positive feedback, young children’s cognitive ability is enhanced. The communication skills of young children are reinforced (45). If TP is not high, it will hinder the improvement of the quality of educational activities in childcare institutions.

Paths three: TP→HCS→EA. Education and childcare are interpenetrating, interlinked, and interactive in early childhood. Zhong suggested that childcare is a direct pathway for teachers to become deeply involved and intervene in the routine lives of children. HCS quality affects EA quality and the degree to which the goal of young children’s whole and harmonious development is achieved (46). From the perspective of childcare teachers, Tao found that the development and science management of the childcare teacher workforce affects HCS quality (47). Similarly, Shen et al. found a lack of specialized early childhood healthcare providers constraining HCS and young children’s healthy physical and mental development (48).

Paths four: CCM→HCS→EA. Previous studies have shown that CCM influences EA through the HCS. For example, Zhao believed detailed and standardized management improved work efficiency and management levels and enhanced childcare quality and hygiene (49). Using quantitative methods, Biersteker et al. assessed the quality of childcare and child education and found that childcare centers’ managerial abilities predicted care levels (50).

Paths five: TP→EF→HCS→EA. First, teachers are the most critical factor influencing the quality of the childcare center’s environment, and they are an essential component of the structural quality of the childcare center’s environment (51). Hong et al. also point to the lack of talented teachers as an essential obstacle to guaranteeing and promoting the quality of young children’s environments (52). Second, a facility’s physical environment is one of the main elements of childcare structure quality (53). Tonge et al. found that outdoor environments, facilities, and size influence children’s physical activity. Larger outdoor play spaces provide more opportunities for children to move freely and increase their physical activity (54). Therefore, TP influences HCS through EF, which in turn impacts EA.

Paths six: CCM→EF→HCS→EA. Studies have shown that CCM influences EA through EF and HCS. For example, Adamo et al. studied unlicensed day care centers (UDC). They found that a lack of management led to green spaces lacking diversity, quality, and quantity and harmed the HCS (55). Rupprecht et al. study physical activity interventions for basic motor skills in preschoolers in childcare centers. This study showed that childcare centers that provide a stimulating and supportive environment can promote the development of young children’s motor skill potential, increasing the effectiveness of EA (56).

Through GT analysis, the factors influencing childcare demand were divided into five core categories: CCM, TP, EF, HCS, and EA. To verify the scientific validity and reasonableness of the theoretical model, we proposed research hypotheses, designed questionnaires, obtained data, and analyzed the data using SPSS 29.0 to verify the research hypotheses. Because two independent variables point to the same mediator variable in the theoretical model, we split the model into two (Models 1 and 2) to facilitate subsequent data analysis (Figure 3). Among them, Model 1 has CCM as the independent variable, and Model 2 has TP as the independent variable. Based on the theoretical model derived from the analysis of GT and combining existing theories and research, we propose the following six research hypotheses:

First, we extensively analyzed relevant literature, policy documents, and results of GT to develop quality indicators for the “Questionnaire on the Childcare Needs of Parents of Children Aged 0–3.” Second, regarding indicator and content validity, we sought the opinions of 15 experts through three interviews using the Delphi process. Experts recognized the indicators and made suggestions. Based on feedback from experts, we deleted some items. Third, parents from cities in Western China were recruited for the pilot study through convenience and purposive sampling. They were asked to complete the survey online and provide feedback on the wording of the items or other issues. Their feedback was collected and studied, and the corresponding items were refined to improve clarity and readability. The final version included 58 items categorized into five dimensions.

The questionnaire consisted of two parts: (1) Demographic characteristics of the study sample. Primary demographic information included age, guardians’ identity, educational level, career, geographical area, family structure, and number of children. (2) Scale of childcare needs of parents with children aged 0–3 years old. The scale consists of 58 questions, such as “The environment around the institution is suitable” or “The atmosphere in the institution is comfortable and warm, and the environment is created by the characteristics of children’s physical and mental development and attracts children.” The evaluation covered five dimensions: CCM, TP, EF, HCS, and EA. The scale was a 5-point Likert scale, with “1–5” corresponding to “strongly disagree, disagree, generally, agree, and strongly agree,” respectively. Ethical procedures were followed throughout this study. Parents were informed of the purpose of the survey at the beginning of the questionnaire and voluntarily agreed to participate in the test.

A total of 270 participants participated in the pretest to verify the reliability and validity of the questionnaire, and 238 valid questionnaires were returned. Subsequently, the reliability and validity of the questionnaire were tested using the SPSS 29.0. The data showed Cronbach’s alpha and KMO (Kaiser–Meyer–Olkin) for CCM, TP, EF, HCS, and EA. Dimensions. The overall Cronbach’s alpha and KMO for each pretest dimension were more than 0.9 (as shown in Table 5), indicating the questionnaire’s reliability and validity (57, 58). Therefore, the questionnaire was used as the main instrument for quantitative analysis in this study.

The questionnaire was released through the “Questionnaire Star” survey website. A stratified cluster sampling approach was adopted to recruit kindergarten teachers for the study. Previous studies have shown that highly educated young parents from core and Main families and with occupations in general management and technical staff are more likely to demand childcare services (8, 59, 60). In addition, scholars have pointed out that existing research has focused on the childcare needs of urban parents, while insufficient attention has been paid to the needs of childcare services in county towns and rural areas, where childcare services are still at a relatively late stage of development (61). Further study should be conducted on the childcare needs of parents in counties and rural areas to promote the balanced development of childcare services (62). To capture the perspectives of the main demand groups for childcare services, we sampled residents who were ready to have children and childcare and were already involved in childcare services in the Ili, Hotan, Urumqi, and Shihezi regions. We implemented purposive sampling by contacting respondents in pairs with the help of childcare center staff, maternity liaisons, early childhood education staff, and parents already involved in childcare services. A total of 530 questionnaires were collected. After excluding invalid questionnaires, 516 were retained with a validity rate of 97.4%.

Despite the relative youth in the sample, each decade of life is well-represented (63). The age of the interviewers was divided into three categories: less than 30 years (43.8%), 30–39 years old (44.4%), and more than 40 years (11.8%). According to Chen (64), the educational level of the participants was divided into six categories: junior school and lower (26.6%), senior high or vocational school (12.8%), some college (19.4%), and college degree and above (41.3%). According to Lin and Bian (65), respondents’ careers can be divided into five categories: temporary workers, unemployed, unemployable, unskilled, and agricultural workers (22.9%); manual workers (commercial service workers), self-employed, skilled workers, and workers of the same level (18.4%); general management versus general professional and technical staff (40.5%); middle management and mid-level professional and technical staff; assistant professionals (10.9%); senior professional executives (managers) and professional technicians; and professional supervisors (party and government leaders) (7.4%). According to the “Administrative Divisions of the People’s Republic of China (66),” the geographical areas of the sample covered rural areas (23.6%), townships (14.0%), countries (47.1%), and cities (15.3%). According to Zhou (67), the family structure includes the core family (parents and unmarried children) (50.6%), the main family (three generations of grandparents, parents, and their children) (21.9%), single-parent families (5.6%), intergenerational families (children living with grandparents) (9.7%), and others (12.2%). Participants’ demographic information is shown in Table 6.

Previous studies have pointed out that the Bootstrap method is helpful in reducing the adverse effects of multicollinearity and improving model robustness (73). Also, the Bootstrap method requires a sample size of at least 50 cases, and the sample size in this study met this criterion (74). Therefore, the study used Bootstrap methodology to examine the promotional effect of EF on HCS and its chain mediating role between CCM with EA and TP with EA. In reference to the majority of scholars, we embedded the PROCESS program into SPSS, selected 95% confidence intervals, and repeated the sampling 5,000 times. In addition, it was tested to provide relatively stable confidence intervals at 5,000 samples. Previous studies have shown that parental age, education level, occupation, location, family structure, and number of children significantly influence parental demand for childcare (28–33). This study included the above variables as control variables in all data analysis models. Table 9 presents the model fit indicators and regression coefficients of the mediating role model. According to the regression results, the p-values were less than 0.001, and the 95% confidence intervals did not contain 0, indicating that the model was well-fitted. Table 10 reports the results of the mediating effect sizes and percentages.

As shown in Table 9, the positive direct effect of TP on EA was significant (β = 0.371, p < 0.001), and the positive direct impact of CCM on EA was also significant (β = 0.142, p < 0.001). The stability of the results was further validated by the fact that both sets of results showed 95% confidence intervals that did not contain 0. The empirical results verified H1 and H2. Similarly, CCM significantly affected HCS (β = 0.870, p < 0.001), and HCS significantly affected EA (β = 0.656, p < 0.001). The confidence intervals for the two datasets do not include 0, which suggests that HCS acts as a mediating variable between CCM and EA. The empirical results support H3. TP significantly affected HCS (β = 0.666, p < 0.001), and HCS significantly affected EA (β = 0.461, p < 0.001). The confidence intervals for the two datasets do not include 0, suggesting that HCS is a mediating variable between TP and EA. The empirical results support H4.

Table 10 shows that the chain-mediated effect size of EF and HCS between CCM and EA is 0.236, with a confidence interval of [0.120, 0.387], excluding 0. The chain-mediated effects were also significant. Thus, H5 was validated using the data results. EF and HCS had a chain-mediated effect size of 0.128 between TP and EA, with a confidence interval of [0.060, 0.221], excluding 0. The chain-mediated effects were also significant. The empirical results verified that H6.

The hypothesized theoretical model focuses on whether the effects between variables hold, namely, whether TP and CCM affect EA, whether the mediating impact of HCS is significant, and whether the chain-mediating effect of EH in promoting HCS is significant between TP with EA and CCM with EA. As shown in Figure 4, the path coefficients between all Model 1 and Model 2 variables are significant. Based on the results of the mediation effects analysis, it can be seen that both the theoretical model and the research hypotheses are valid.

This study had two findings regarding direct effects: CCM positively and directly affects EA. The CCM is an operating fundamental of childcare centers, which is essential for the quality of the center’s education. This means the higher the CCM quality, the better the EA quality. The results of this study are similar to those of a previous study. As stated in Weick’s occupational socialization theory (75), leaders and workers of childcare centers form many childcare practices and standards through consultation and communication, providing support for the teaching activity, facilitating communication, and co-constructing consensus among teachers, which boosts the quality of EA. Bayly et al. also noted that one factor affecting the quality of childcare programs may be the management of childcare facilities (76). Specifically, childcare centers are managed using a business model that meets the needs of employers and seeks to maximize shareholder profits rather than focusing on the needs of parents and children and the quality of early education (76, 77). In addition, Yang and Lim pointed out that if the instructional management system in childcare institutions is not reasonable, it will cause tremendous organizational and instructional pressure to achieve the vision of realizing distributed instructional leadership and improving the quality of education in childcare institutions (78).

Management should be used to enhance the quality of education in childcare centers and improve the quality of the process. Specifically, in the management philosophy, childcare centers should establish the concept of self-management and continuous improvement as an unchanging pursuit. For example, the National Association for the Education of Young Children (NAEYC) quality accreditation process begins with the self-reflection of all staff members (79). Regarding management content, childcare centers should focus on managing the quality of the process, such as strengthening the curricular leadership of directors and teachers and creating a good learning environment for children (80). Regarding administration, childcare centers should break the top-down single leadership paradigm and lead the change of leadership paradigm to form an atmosphere of goal sharing, mutual respect, wisdom integration, power and responsibility sharing, and democratic management in the childcare centers (81).

Second, TP positively and directly affects EA. TP is the basis of EA and plays a decisive role in the quality of education in childcare centers. This means the higher the TP quality, the better the EA quality. The study by Hunter et al. supports the results of this study. Hunter et al. found that teachers’ teaching skills and receptivity to intervention counseling can predict the quality of the childcare centers’ teaching methods (82). Other research has suggested that childcare teachers’ professional competence positively correlates with infants’ development, future academic achievement, and individual growth (83). Teachers are in close contact with young children, and with the support of professional concepts, knowledge, and skills, they carry out educational activities based on their understanding of the children, which improves the quality of education.

Teacher quality is the core and key to the quality of childcare, and improving the quality of the childcare process requires a higher level of childcare teachers (84). Based on this, the study concluded that the quality of childcare teachers can be improved in three ways: first, strengthening the training of talents in childcare services and enhancing their capacity to supply them. Support universities and colleges with conditions to develop relevant disciplines and specialties, such as infant and child development, health management, and infant and childcare (85). Second, the training of childcare professionals should be strengthened, and paths should be explored to upgrade “childcare workers” to “childcare masters” to improve caregivers’ comprehensive quality and professional skills (86). Third, access and evaluation systems for childcare teachers should be improved. International experience has shown that professional emotions, love, knowledge, and competence are emphasized in the qualifications for access to childcare teachers. Knowledge and competence criteria are also translated into the basis for assessment, certification, and auditing access to qualifications (87).

It was found that the HCS is an intermediary variable between CCM and EA. Improving the CCM level contributes to the HCS’s quality and enhances the EA’s quality. This result confirms the conclusions of existing studies that effective CCM is an essential factor in the quality of health care in childcare centers (81) and that health care is a powerful means of ensuring young children’s right to survival and development and an essential support for effective EA (88). Refined management often establishes a scientific safety and health system and a system of childcare services to ensure the safety of children’s lives and physical health (49) and to provide fundamental safeguards for educational activities. In contrast, the absence of a scientific management philosophy and standardized management system will lead to lower childcare center efficiency and HCS quality. Eventually, the operation of educational activities is affected.

The present study also found that HCS mediated the relationship between TP and EA. This means that the level of TP affects the quality of the HCS, which in turn affects EA. This mirrors the findings of Werner et al. (89), who noted that improving teacher professionalism is often effective in improving childcare quality, caregiver interaction skills, and child development. Therefore, as a crucial subject in infant and toddler education, teachers in childcare centers are essential guides and companions for infant and toddler development. The professionalism and competence of teachers play a crucial role in the healthy physical and mental growth of infants and toddlers, as well as in the development of their personalities (90).

This shows that HCS are an essential basis for improving the quality of education in childcare centers. We make the following recommendations to improve the quality of the following recommendations. First, we established the scientific concept of healthcare to provide ideological guidance for childcare centers. Teachers’ lack of knowledge about children’s healthcare can make it difficult for childcare centers to practice proper healthcare, leading to a disconnect between teaching and learning (91). Second, having a written policy can provide the organization with a framework for decision-making and allow employees to understand their roles and responsibilities (92). Therefore, relevant departments should introduce a system of professional healthcare workers as soon as possible, formulate professional qualification standards, and clarify job responsibilities (93). Dietary education planning, daylife dietary guidance for young children, and healthcare management can be taken as the responsibility of the healthcare teacher to build a specialized healthcare teacher team. Third, training on “healthcare knowledge and skills” has been organized for teachers and healthcare workers to enrich their knowledge and skills to provide scientific guidance for childcare centers (94).

Two pathways have been identified that play a role in chain mediation. (1) EF and HCS are chain mediators between CCM and EA. (2) EF and HCS mediated TP and EA. Among them, EF and HCS are chain mediators between CCM and EA, which means that CCM influences EA through the combined effects of EF and HCS. The conclusions of this study support those of the previous studies. Previous studies (95, 96) have shown that managing childcare institutions affects the quality of the spatial environment. By contrast, the quality of the spatial environment affects children’s physical health, which in turn affects the quality of education in early childhood institutions. The management of childcare centers includes choice of location, spatial environment design, and facilities provision. The outdoor and indoor environments of childcare centers are essential for children’s physical and mental development. When the health and safety of children is compromised, it is difficult for educational activities to take place.

EF and HCS are chain mediators between TP and EA, indicating that TP influences EA through the interaction between EF and HCS. This finding is similar to the philosophy of Luo and Liu (97), who believe that teachers are central to improving and ensuring the quality of childcare organizations. When teachers use appropriate facilities and materials to engage infants and toddlers in activities and provide them with learning opportunities, they can develop, and educational activities can be meaningful. Guided by professional philosophy and knowledge, teachers provide children with appropriate learning environments, facilities, and materials. The learning environment affects how a child thinks, feels, and behaves. This is critical for developing a child’s self-concept and identity (98). Specifically, teachers consider the value and function of different environmental systems when constructing the curriculum and emphasize the organic linkages between the diverse elements of the environment to enhance the foundational and sustainable nature of young children’s development (99).

Therefore, improving the quality of EF is essential to improve the quality of HCS. The study concludes that the quality of EF can be enhanced in several ways. First, childcare providers should focus on increasing awareness and knowledge of environmental health issues (100). Second, increasing the natural elements of childcare centers promotes physical activity and other positive health effects on children (101). For example, adding appropriate natural features such as trees, flowers, small animals, sandboxes, and pools provides opportunities for young children to get close to nature. Finally, some scholars suggest that the environmental design of childcare institutions should be based on a two-way perspective for young children (102), considering not only their physiological structures but also their psychological functions. Environmental design should stimulate young children’s motivation and curiosity and gradually cultivate lifelong learning habits.

As the mixed research method realizes the complementary roles of qualitative and quantitative methods, it allows for a more in-depth and comprehensive exploration of the research problem (103). Therefore, this study adopts a mixed-method approach to understand the factors influencing the demand for parental childcare for children aged 0–3 years in China and its operating mechanism.

Relative to previous studies, this study makes several contributions: (1) The study mainly focuses on the parents of 0–3-year-old children as the research object, from the micro level of parents to understand their demand for childcare service influencing factors and their role in the mechanism, which is conducive to supplementing the theoretical content of 0–3-year-old infants and toddlers in childcare services, and provides a reference for future theoretical research. (2) Exploring the factors influencing parents’ demand for childcare and the relationship between those factors is conducive to understanding the current situation of parental childcare to accurately provide childcare services, balance the contradictions between women’s families and their work, and revitalize the willingness of the appropriate age group to have children. (3) This study used a mixed research method to explore the factors influencing parents’ childcare needs for children aged 0–3 years and their mechanisms of action, thus providing a new research paradigm for studying childcare centers and parents’ childcare needs in other countries and regions.

Despite the many contributions of this study, it still has some shortcomings: (1) Whether there are reverse paths between the factors in the theoretical model has to be verified and can be explored in a more profound step in the future. (2) This study was cross-sectional and did not track parental childcare needs; however, parental needs for childcare may change over time and as children grow. Therefore, a tracking study of parental childcare needs should be conducted at different points to provide more valuable references for childcare providers to meet parental needs. (3) Since we only sampled some districts, the sampling method and sample size may have introduced a slight bias in the data results, which potentially limits the generalizability of the findings. We acknowledge that these results may be more applicable to the specific region or country studied, given the influence of local cultural attitudes, practices, politics, and organizational structures. Future studies will refine the sampling strategy to ensure a representative and randomized sample, thereby mitigating issues related to uneven sample sizes and enhancing the potential for broader applicability.

In summary, a mixed-methods approach was used to explore the factors influencing childcare demand by parents of children aged 0–3 years and their operating mechanisms. First, through semi-structured interviews and GT, the study summarized the factors influencing the childcare needs of parents of 0–3-year-old children, including CCM, TP, EF, HCS, and EA. Second, the theoretical model combines the relevant theories and proposes six hypotheses. Third, questionnaires were used to obtain quantitative data and to test the research hypotheses in conjunction with regression and mediation analyses. Finally, three main conclusions are drawn. (1) Correlation analysis showed significant positive correlations among CCM, TP, EF, HCS, and EA. (2) Regression analysis revealed that CCM and TP had positive and direct effects on EA, respectively. (3) Mediating role analysis showed that HCS mediated between CCM with EA and TP with EA, EF, and HCS acting as chain mediators between CCM with EA and TP with EA. This study provides theoretical references and a practical basis for solving the imbalance between the supply and demand for childcare, promoting the effective development of infant and childcare services, and improving the quality of childcare services.