Effectiveness of Digital and Remote Health Interventions in Pediatric Populations From Underserved or Rural Areas: A Systematic Review of Randomized Controlled Trials

TL;DR

This paper reviews how digital health tools like telehealth and mobile apps help children in rural or underserved areas improve their health outcomes.

Contribution

The study provides a systematic review of RCTs evaluating digital health interventions specifically in underserved pediatric populations.

Findings

Telehealth interventions improved behavioral and biometric outcomes in children in the United States.

mHealth interventions in low- and middle-income countries increased referral rates and caregiver engagement.

Abstract

Children living in underserved and rural areas experience significant barriers to healthcare access due to geographic isolation, health workforce shortages, and systemic inequities. Digital and remote health interventions such as telehealth, telemental health (TMH), and mobile health (mHealth) offer promising strategies to improve pediatric health outcomes in these contexts. However, the extent of their effectiveness remains insufficiently examined through high‐quality evidence.

A systematic review was conducted in accordance with PRISMA 2020 guidelines and structured using the PROPS framework. Five databases (PubMed, Scopus, Web of Science, Embase, and Cochrane Library) were searched for randomized controlled trials (RCTs) published until May 2025. Eligible studies targeted children (0–17 years) in underserved or rural settings and evaluated digital or remote interventions versus standard care. Data were extracted on study design, population, intervention modality, outcomes, and implementation characteristics. Risk of bias was assessed using the Cochrane RoB 2.0 tool.

Eleven RCTs were included, covering interventions for obesity, asthma, ADHD, diabetes, oral health, and neonatal care. Telehealth interventions improved behavioral and biometric outcomes (e.g., BMI z‐score, and adherence), particularly in the United States. TMH showed high fidelity and effectiveness for ADHD management. mHealth interventions in low‐ and middle‐income countries enhanced referral rates, service coverage, and caregiver engagement. Most studies were rated low risk of bias, though few incorporated economic or equity analyses.

Digital health interventions are effective and feasible for improving pediatric outcomes in underserved settings. Future research should emphasize long‐term impact, cost‐effectiveness, and equitable access to ensure sustainable and inclusive digital healthcare delivery.

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