TITLE:
Caregiver-Centered Mobile Health Strategies for Improving Pediatric Treatment Adherence in Low-Resource Settings
AUTHORS:
Chandana Reddy Balaka, Bayowa Onabajo, Shubhdeep Singh Sandhu, Vikramjit Singh Gill, Harnoor Singh Aujla, Faridkhan H. Kulakarni
KEYWORDS:
Mobile Health, mHealth, Pediatric Treatment Adherence, Caregivers, Digital Health, Low-Resource Settings, Health Equity, Pediatric Care
JOURNAL NAME:
Open Journal of Pediatrics,
Vol.16 No.5,
September
24,
2026
ABSTRACT: Background: Pediatric treatment adherence remains a significant challenge in low-resource settings, where families may face transportation barriers, limited healthcare access, medication shortages, financial constraints, and gaps in health literacy. For this review, low-resource settings refers to settings in which health-system constraints, household-level resource limitations, or both restrict timely access to pediatric treatment and follow-up. Mobile health (mHealth) technologies, including text messaging, telephone calls, mobile applications, and messaging platforms, offer potentially accessible approaches to support children and their caregivers between healthcare visits. Objective: This narrative review examines caregiver-centered mHealth strategies that may support pediatric treatment adherence in low-resource settings, distinguishes the outcomes evaluated in existing studies, and identifies practical considerations for developing equitable and sustainable digital health strategies. Discussion: Evidence directly evaluating caregiver-facing mHealth interventions in low-resource pediatric populations remains limited and heterogeneous. Available studies have assessed different outcomes, including medication adherence, vaccination or appointment completion, caregiver response to follow-up, caregiver knowledge, and engagement with digital systems. In Kampala, Uganda, a randomized trial of caregiver-selected SMS or automated telephone reminders increased timely receipt of needed HPV vaccination, demonstrating an effect on service completion rather than medication adherence or clinical outcomes. Other Ugandan studies have demonstrated the feasibility and challenges of mobile adherence monitoring among caregivers of children with HIV and the acceptability of adherence-monitoring systems among adolescents and caregivers, but these studies do not establish that caregiver-centered mHealth improves long-term clinical outcomes. Broader pediatric mHealth literature also shows substantial heterogeneity and methodological limitations. These findings suggest that engagement, knowledge, appointment attendance, medication adherence, and clinical outcomes should not be treated as interchangeable measures of effectiveness. Conclusion: mHealth may strengthen pediatric treatment continuity when it addresses a specific caregiver barrier and is connected to an appropriate clinical or service pathway. The most useful interventions are likely to be accessible, caregiver-centered, bidirectional, context-adapted, clinically connected, equitable, and sustainable. These seven domains constitute an author-proposed framework informed by the reviewed literature and WHO digital-health guidance. Future studies should prioritize direct measures of pediatric adherence and clinical outcomes in low-resource settings while reporting implementation outcomes and equity.