Abstract
Introduction: Digital health education offers scalable opportunities to improve health literacy among school-aged children, yet culturally diverse communities in low- and middle-income countries (LMICs) face unique implementation challenges.This systematic review synthesizes evidence on implementation strategies, barriers, and ethical considerations for culturally tailored digital health education interventions targeting school-aged children in LMICs.
Methods: A systematic search of Embase, Web of Science, Scopus, and PubMed was conducted for peer-reviewed studies published between January 2018 and March 2026. Studies were included if they evaluated digital health education interventions for school-aged children (ages 3–18) in LMICs, reported on implementation strategies, barriers, or ethical considerations, and were published in English. Data were synthesized thematically following PRISMA guidelines. Methodological quality was assessed using the Mixed Methods Appraisal Tool.
Results: Seventeen primary studies met inclusion criteria, originating from Africa, South Asia, the Middle East, Southeast Asia, and South America. Effective implementation strategies included multimodal delivery (65%), mobile-first design (53%), and stakeholder engagement (59%). Key barriers were infrastructural limitations (65%), digital exclusion (59%), socio-cultural sensitivities (53%), and student engagement challenges (29%). Cultural adaptations—including language translation (65%), culturally resonant narratives (53%), and community engagement (59%)—enhanced acceptability and effectiveness. Significant knowledge gains were documented. Ethical considerations centered on cultural appropriateness (76%), data privacy (59%), consent (53%), and digital equity (35%). Methodological quality was rated high in 6%, good in 71%, and moderate in 24% of studies.
Conclusion: Culturally tailored digital health education shows promise for improving health literacy in LMICs. Success requires systemic integration, stakeholder participation, and ethical safeguards. Future research should prioritize long-term evaluation and equity-focused implementation frameworks.