Clinical and psychosocial outcomes of digital health interventions in pediatric chronic care: An integrative review advancing the theory of digital autonomy and hybrid care.

AIM: This integrative review aimed to evaluate the clinical and psychosocial outcomes of digital health interventions in pediatric chronic illness care and to propose the "Pediatric Digital Autonomy and Hybrid Care Theory" as a conceptual framework. METHOD: This review was conducted using the integrative review methodology of Whittemore and Knafl and reported in accordance with the PRISMA 2020 guidelines. Quantitative, qualitative, and mixed-methods studies examining digital health interventions for children and adolescents with chronic conditions were systematically identified and synthesized. Methodological quality was assessed using the Mixed Methods Appraisal Tool (MMAT, 2018). Narrative and thematic synthesis approaches were applied, considering developmental appropriateness, patient and family engagement, and care model characteristics. RESULTS: Digital health interventions improved clinical monitoring, self-management, treatment adherence, and psychosocial adjustment by promoting active participation in disease management. However, digital interventions alone produced limited long-term benefits, whereas hybrid care models integrating nursing support, family involvement, and face-to-face follow-up demonstrated more sustainable outcomes. Interventions lacking developmental appropriateness and motivational design were associated with increased care burden and reduced engagement. CONCLUSION: This review proposes the Pediatric Digital Autonomy and Hybrid Care Theory, which conceptualizes effective digital pediatric care through three interconnected dimensions: clinical safety and decision support, self-efficacy and motivational internalization, and family clinical integration. The proposed framework offers theoretical guidance for pediatric nursing practice and the development of developmentally appropriate digital care models.