Are digital health interventions acceptable and effective at improving medication adherence in paediatric patients with asthma? A mixed-mode systematic review, narrative synthesis, and behavioural analysis

Background Despite being important for asthma management, medication adherence remains suboptimal among paediatric patients. Digital Health Interventions (DHIs) offer a cost-effective and convenient approach to target the behavioural determinants of adherence and have been effective for other chronic conditions. This paper provides a comprehensive review and behavioural analysis of DHIs designed to improve medication adherence in paediatric patients with asthma.Methods A mixed-mode systematic review (PROSPERO: CRD42022320097) was conducted by two independent reviewers. Seven databases were searched up to March 2025 for studies evaluating DHIs designed for paediatric patients with asthma and/or their caregivers to improve medication adherence (primary outcome). Secondary outcomes were patient quality of life (QoL), user-experiences, and DHI features or strategies and their associated theoretical constructs using the Theoretical Domains Framework (TDF). Quantitative and qualitative data were extracted and narratively synthesised.Results Fifteen studies were included. All eleven studies that statistically assessed medication adherence reported significant results, in at least one context: either compared with controls (N = 5), baseline (N = 2), or within sub-groups (N = 4), but overall confidence was low. All three studies that qualitatively assessed adherence reported improvements, and with relatively high confidence. Three studies assessed QoL, but only one reported a significant improvement. Based on the user-experiences reported by ten studies, DHIs were well-accepted, with some usability concerns, and varying satisfaction and engagement. Financial incentives and pharmacist chat were well-praised and statistically effective features for improving medication adherence, commonly mapped onto Environmental context & resources, Reinforcement, Social influences, Intentions, and Behavioural Regulation.Conclusion Due to study and review limitations, we conclude that multi-component DHIs are potentially acceptable and effective at improving medication adherence in paediatric patients with asthma. However, more high-quality theoretically informed longitudinal studies tailored to patient/caregiver unmet needs and barriers are needed to strengthen the evidence base on DHIs.