Digital health interventions for medication adherence and adherence-related outcomes in pediatric oncology: a systematic review and meta-analysis

Background Medication non-adherence can compromise treatment outcomes in pediatric oncology. Digital health interventions (DHIs) may support medication-taking behavior and related skills. This review evaluated DHIs for medication adherence and adherence-related outcomes in pediatric oncology. Methods PubMed, Scopus, and Web of Science were searched through December 2025. Study characteristics and outcomes were extracted into a shared spreadsheet. Direct adherence outcomes were distinguished from self-efficacy, knowledge, treatment intention, feasibility, and acceptability. Random-effects models were used for the quantitative syntheses, which were interpreted according to their underlying designs and measures. Results After removal of 2,214 duplicates, 827 records were screened and nine reports were included. The pooled post-intervention objective adherence proportion was 76% (95% CI: 59%–87%; I2 = 76.0%); this descriptive proportion does not establish an intervention effect. Three studies contributed to the exploratory within-intervention standardized mean-change synthesis (0.46, 95% CI: 0.14–0.78; I2 = 84.0%). Because the underlying measures differed, this estimate was not interpreted as a single adherence effect. Randomized between-group findings and uncontrolled observations were reported separately. Conclusion DHIs may support medication adherence and related outcomes in pediatric oncology; however, the pooled post-intervention adherence proportion should not be interpreted as evidence of effectiveness. Heterogeneity in interventions, outcomes, and measurement methods warrants cautious interpretation. Systematic Review Registration PROSPERO: CRD420261510631.