Treatment adherence is an important component of successful pediatric care. For children with acute and chronic illnesses, outcomes may depend on taking medications as prescribed, attending scheduled appointments, completing investigations, following dietary or behavioral recommendations, and recognizing symptoms that require medical attention. Unlike adults, children frequently depend on parents or other caregivers to organize and deliver treatment. Consequently, pediatric adherence is influenced not only by the child’s illness and behavior but also by caregiver knowledge, competing responsibilities, financial circumstances, transportation, communication with health professionals, and access to medicines and health services.

For this review, the term low-resource settings refers to environments in which limitations at the health-system level, the household level, or both constrain timely access to pediatric treatment and follow-up. Health-system constraints may include limited staffing, medication stock-outs, restricted service availability, or weak communication infrastructure. Household-level constraints may include transportation costs, loss of income, limited access to mobile data, food or accommodation costs, and competing caregiving responsibilities. The term therefore describes resource constraints relevant to care delivery rather than serving simply as a synonym for low- or middle-income country status.

These challenges can be amplified when families travel long distances to reach pediatric services, incur substantial transportation costs, encounter medication stock-outs, or experience interruptions in care because of work and household responsibilities. Limited health literacy and language barriers may further complicate communication between families and healthcare providers. Pediatric conditions requiring prolonged treatment can therefore create a substantial burden for families and health systems.

Mobile health, commonly referred to as mHealth, describes the use of mobile and wireless technologies to support health and healthcare delivery. These technologies include short message service (SMS), telephone calls, smartphone applications, messaging platforms, and mobile-based telehealth. The World Health Organization (WHO) has identified targeted client communication, telemedicine, and other digital interventions as potential tools for strengthening health services, while emphasizing that digital technologies should complement rather than substitute for functioning health systems [1].

The potential value of mHealth in resource-constrained environments is particularly relevant because mobile phones can reach populations where more complex digital infrastructure may not be feasible. Pediatric digital health research in developing countries has described applications including SMS, mobile applications, websites, telephone calls, and teleconsultation for activities such as vaccination, breastfeeding, child growth, and healthcare delivery [2]. At the same time, the evidence base remains heterogeneous, and successful implementation depends strongly on context.

Recent evidence also highlights the importance of involving parents and caregivers. A 2025 systematic review of parent-oriented mHealth interventions identified 49 unique studies and reported improvements in selected parent and child outcomes, while noting substantial heterogeneity and a high risk of bias in more than half of the included studies [3]. These findings suggest that the relevant question is not simply whether mobile technology can be used in pediatric care, but which outcomes are improved, for whom, under what conditions, and through which mechanisms.

This narrative review focuses on caregiver-centered mHealth strategies for pediatric treatment adherence in low-resource settings. The aims are to describe common adherence barriers, summarize practical applications of mHealth, synthesize direct caregiver-facing evidence and the outcomes measured, discuss implementation challenges, and propose an author-developed framework for designing equitable and sustainable interventions.

Pediatric treatment adherence is multidimensional. A child may have access to an effective treatment but still experience poor outcomes if medication is not administered consistently, follow-up appointments are missed, or caregivers do not receive timely guidance when symptoms change. Adherence should therefore be understood as a process involving the child, caregiver, healthcare team, and health system.

Pediatric mHealth interventions should recognize caregivers as active participants in care. The caregiver is often the person who administers medication, transports the child, observes symptoms, communicates with clinicians, and decides whether and when to seek additional care. Designing technology around caregiver responsibilities can therefore improve the likelihood that a digital intervention is usable in real-world settings.

Co-design is particularly important. Rather than selecting a technology based solely on what is technically available, healthcare teams should first understand how families currently communicate, what type of mobile device they use, which languages they prefer, and what barriers make treatment difficult. The 2025 review of parent-oriented mHealth interventions identified co-design and theory-informed development among features used in intervention design [2].

The caregiver-centered approach also changes the tone of digital communication. Messages should support problem-solving rather than blame. For example, instead of sending repeated reminders after a missed dose, a system could ask whether the caregiver experienced difficulty obtaining the medicine, administering it, or understanding the instructions. This transforms mHealth from a passive reminder tool into a mechanism for identifying barriers to care.

Evidence from low-resource settings demonstrates that mobile technologies can support different aspects of pediatric care, although the interventions, populations, and outcomes vary considerably. A 2025 systematic review identified 16 eligible studies of digital health interventions in pediatric care in developing countries, including mobile applications, SMS, websites, and telephone calls, with common areas including breastfeeding, vaccination, and child growth [3]. This literature provides important implementation context but should not be interpreted as direct evidence that caregiver-centered mHealth improves pediatric treatment adherence.

Based on the reviewed evidence and WHO digital-health guidance, this review proposes seven domains for designing caregiver-centered pediatric mHealth interventions: accessible, caregiver-centered, bidirectional, context-adapted, clinically connected, equitable, and sustainable [1][3]. These domains are an author-proposed conceptual framework rather than a validated implementation framework. Each domain is linked to recurring barriers and implementation considerations identified in the literature.

Children’s health information requires particular attention to privacy. Mobile phones may be shared among family members, and messages may be visible to people other than the intended recipient. Sensitive diagnoses should therefore not be disclosed unnecessarily in text messages. Communication systems should use appropriate consent procedures, data-protection safeguards, and clear policies regarding who can access information.

Clinical safety is equally important. Automated messages should not be interpreted as a substitute for clinical assessment. Families should receive clear instructions about which symptoms require urgent in-person evaluation. Similarly, digital systems should avoid creating false reassurance when a caregiver has reported a concerning symptom but has not received a clinical response.

The success of mHealth depends on more than technical functionality. Barriers may include unreliable network coverage, electricity access, changing telephone numbers, limited digital literacy, language differences, privacy concerns, staff workload, and insufficient integration with existing medical records or communication systems.

Health-worker engagement is particularly important. If a digital system generates messages or caregiver requests without assigning responsibility for responding, it can increase rather than decrease workload. Implementation should therefore define who monitors responses, how urgent concerns are escalated, and how non-urgent questions are handled.

Technology fatigue is another potential problem. Frequent messages can become background noise, particularly when they are repetitive or poorly timed. Messages should be purposeful, concise, and appropriately spaced. Families should have the ability to modify communication preferences when feasible.

Evaluation should include both effectiveness and implementation outcomes. Useful measures include medication adherence, appointment or service completion, treatment interruptions, caregiver knowledge, patient retention, emergency visits, caregiver satisfaction, feasibility, acceptability, cost, and sustainability. Digital engagement metrics alone, such as the number of messages sent or opened, should not be interpreted as evidence of improved health.

Importantly, studies should prespecify the primary outcome and distinguish proximal from distal effects. For example, message response is a proximal engagement measure; caregiver knowledge is an intermediate outcome; medication adherence and appointment completion are behavioral or service outcomes; and viral suppression, symptom control, hospitalization, or mortality are clinical outcomes. This hierarchy can reduce overinterpretation of findings across heterogeneous studies.

This review has several limitations. First, it is a narrative review rather than a systematic review and therefore does not provide a comprehensive or quantitatively pooled assessment of the literature. Second, the included evidence is heterogeneous with respect to pediatric age groups, clinical conditions, intervention types, delivery platforms, comparator groups, follow-up periods, and outcome definitions. Third, many studies evaluate feasibility, acceptability, engagement, caregiver knowledge, or service utilization rather than direct measures of medication adherence or clinical health outcomes. Fourth, direct evidence specifically evaluating caregiver-centered pediatric treatment adherence interventions in low-resource settings remains limited. The framework proposed here is therefore conceptual and author-developed rather than empirically validated. These limitations support cautious interpretation and highlight the need for prospective studies using standardized adherence and clinical outcome measures.

The experience of implementing health interventions in resource-constrained settings offers broader lessons for pediatric practice. First, technology should be viewed as a tool rather than the intervention itself. The intervention is the care process that the technology supports. Second, families should be involved in designing the intervention because they understand barriers that may not be visible to clinicians or developers. Third, simple technologies can be highly valuable when they are reliable, accessible, and integrated into clinical workflows.

These principles are relevant beyond low-resource countries. Rural and underserved communities in high-income countries may also experience transportation difficulties, limited pediatric subspecialty access, fragmented care, caregiver work constraints, and digital inequities. The specific barriers differ by setting, and solutions should not be transferred uncritically. Nevertheless, the underlying implementation principle is similar: pediatric digital health should be designed around the child and family rather than around the technology.

Future research should move beyond measuring whether a message was delivered and determine whether digital interventions produce meaningful changes in pediatric adherence and health outcomes. Studies should use standardized adherence measures where possible and examine longer-term outcomes. Research should also include families with limited digital access so that interventions do not selectively benefit those who are already well connected to healthcare.

More implementation research is needed to determine which models can be integrated into routine pediatric services at sustainable cost. Co-design with caregivers and healthcare workers should be incorporated early in intervention development. Research should also examine how digital tools can be linked with appointment systems, electronic medical records, pharmacy services, community health workers, and established referral pathways.

Importantly, future interventions should distinguish between different reasons for non-adherence. Forgetfulness may respond to reminders, whereas transportation, medication availability, adverse effects, or financial barriers require different solutions. A useful mHealth system should therefore help identify the reason for a missed treatment or appointment rather than simply labeling the event as non-adherence.

mHealth may provide a practical opportunity to strengthen pediatric treatment continuity in low-resource settings, particularly when it supports caregivers between clinical encounters. However, the direct evidence base remains limited and heterogeneous. Existing studies demonstrate improvements in selected outcomes such as service completion, engagement, caregiver experience, and feasibility, while evidence for sustained medication adherence and downstream clinical outcomes is less consistent.

The most useful pediatric mHealth interventions are unlikely to be the most technologically complex. Instead, they should 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 guidance [1][3]. Moving from simple reminders toward communication and problem-solving may allow mHealth to address the real-world barriers that contribute to pediatric treatment interruptions. Future research should prioritize direct measures of adherence and clinical outcomes, while also reporting implementation, equity, cost, and sustainability.

Not applicable. This manuscript is a narrative review and does not involve human participants, patient-level data, or identifiable clinical records.

Not applicable.

No specific funding was received for this work.

No original datasets were generated or analyzed for this manuscript.

All authors conceived the topic, conducted the literature review, interpreted the literature, and prepared the manuscript. All authors read and approved the final manuscript.