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

Background: 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. Methods: 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. Results: -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. Conclusions: 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.