Virtual care is an umbrella term for technology-based support in healthcare. Diverse terms to describe virtual care or telehealth have been used such as synchronous monitoring (1–3), telerehabilitation (4), eHealth (1, 5), mHealth (6), and web-based education (7). Pediatric virtual care has been applied in a range of clinical populations such as children and youth with autism (2), chronic illness (5), cancer (8), and acquired brain injury (9). At present, there is a growing body of reviews assessing the role of virtual care, however, these reviews have specific focus on (i) populations with specific conditions such as children with special health care needs (1), autism (2), asthma (3), chronic pulmonary disease (5), diabetes (10) and chronic illness (11), (ii) delivery within specific pediatric specialties such as rehabilitation (4) or surgery (6), (iii) certain online platforms such as mobile, eHealth or mHealth (6–9), (iv) geographical regions such as rural settings (12) and (v) research designs such as interventions that have been evaluated using random controlled trials (13).

Reviews have examined benefits and limitations of virtual care. Overall, general acceptance of virtual care in clinical practice and research has been reported by patients and family caregivers (3, 5–9, 12–16), physicians (17), and a range of health care professionals (18–23). Reviews conclude that virtual care can reduce costs related to travel (20, 24) for family caregivers and lower staff labor costs for organizations (18). However, patients and/or their caregivers have cited challenges with virtual care including limited personal interaction (24), technological challenges (24), and concerns with security of health information (6, 16) and privacy risks (14).

During the COVID-19 pandemic, there was widespread implementation of virtual care. While the literature has variably addressed the access, use, and impact of virtual care, there has been limited attention given to patient and family experiences of virtual care, thus raising questions about children/youth and caregiver preferences in using virtual care. To address this gap, a scoping review of the last decade of literature was undertaken to assess how virtual care intervention have been delivered and evaluated, and have impacted children and their families. An additional aim was to review how interventions incorporated equity considerations, particularly the social determinants of health (SDOH). We defined SDOH as “the conditions in the environments where people are born, live, learn, work, play, worship, and age that affect a wide range of health, functioning, and quality-of-life outcomes and risks” (25). SDOH also consider the broader forces and systems that shape daily life including economic and social policies, norms, political structures and systemic factors (e.g., racism, ableism, sexism) (25). To this end, this study addressed the following questions: (1) What virtual care approaches have been used in pediatric care relative to child and family experiences and benefits, (2) What are the aims and how are virtual care approaches implemented in clinical practice?, (3) What are families’ experiences and perceptions of virtual care?, (4) What study approaches have been used to evaluate children/youth and family experiences of virtual care?, and (5) How are SDOH considered in the design and/or implementation plans of virtual care?

The scoping review was informed by guidelines outlined by the Joanna Briggs Institute (JBI) (26, 27). A search of the literature published between January 1, 2013, and December 31, 2023, was led by a research colleague with expertise in scoping reviews using APA PsycInfo, CINAHL, EBSCO, Embase, and MEDLINE electronic databases. Search terms were as follows: virtual (e.g., telemedicine, telehealth, telecare, teleconference, Zoom), pediatrics (e.g., infants, child, toddler, adolescent, youth), hospital (e.g., secondary care, tertiary care, inpatient, outpatient) and experience (e.g., perspectives, satisfaction, preferences) (search strategy in Table 1). Study inclusion criteria were: (1) peer-reviewed, (2) published in English, (3) focused on pediatric synchronous virtual care (e.g., online and/or phone) based on the following definition, “.real-time, virtual, direct-to-patient appointments. Synchronous telehealth happens in live, real-time settings, in which the patient interacts with a provider(s), usually via phone or video. Providers and patients communicate directly, often resulting in a diagnosis, treatment plan, and/or prescription” (28), (5) inclusive of pediatric patients (including birth to 18 years) and/or their family, (6) inclusive of primary data (e.g., surveys, interviews), and (7) inclusive of outcomes of family satisfaction, preferences and/or perspectives about the virtual care approaches. Exclusion criteria consisted of: (1) conference/meeting, proceedings, congress, guidelines, dissertation, or a review (e.g., literature review, systematic review, scoping review, meta-analysis), (2) sole focus on healthcare provider perspectives, (3) only administrative data provided, (4) development of a test or model of virtual care, and/or (5) focus on obstetrical care. At the last stage, when we extracted information from a full text review of each article, we examined how SDOH were addressed, including equity considerations (29, 30). Addressing these considerations emerged as critical in bringing an equity, diversity, inclusion, and accessibility (EDIA) lens to this work, in terms of interrogating study inclusion of diverse groups relative to the utility, impact and experience of virtual care. For reviews such as this current one, an EDIA lens can highlight how marginalized groups may experience unique challenges in accessing care.

Using Covidence Systematic Review software, the search yielded 1,079 articles after removal of duplicates. Two rounds of screening were conducted, as follows. Two independent reviewers examined all titles and abstracts, and a third reviewer resolved disagreements as needed. Based on inclusion and exclusion criteria, the number of included articles was reduced to 157, which were subsequently advanced for full article review. This second review resulted in 117 articles (Figure 1). Article review was conducted by team leads (RTZ, SS), with supervision by team members who bring extensive experience in secondary review. As this was a scoping review, institutional ethics board approval was not required.

We addressed key questions to interrogate virtual care in reviewed articles, as follows: (1) how has virtual care been implemented?; (2) what are study objectives and aims of the virtual care application?, (3) by whom, when, where and how has virtual care been evaluated?, (4) how does virtual care address SDOH?, and (5) how do children, youth and families experience virtual care (e.g., benefits, satisfaction, challenges, and advice offered in improving care)? These questions are addressed below. Within the Supplementary Section, Supplementary Table 1 provides the full list of the 117 articles including details of each study aim and design, the virtual care intervention addressed and outcomes. Supplementary Table 2 summarizes findings reported in individual studies.

Virtual care approaches were conveyed as often implemented on a video-based platform, located largely within urban settings. Despite some variation of perceived impacts including reported barriers for marginalized communities, studies generally indicated benefits of implementing virtual care in pediatrics, as identified by families. Accordingly, virtual care generally was determined by children and their parents/caregivers as favorable. Findings also demonstrated that platforms and ways to implement virtual care approaches can vary relative to the needs of the child/youth and/or the parent/caregiver. These findings are complementary to results in other secondary reviews in this area which convey virtual care as acceptable, with emerging evidence of beneficial outcomes in care delivery. As an example, Shah & Badawy's (13) review of randomized controlled trials addressing telemedicine approaches demonstrated improved or comparable impacts of telemedicine compared to controls, based on outcomes of symptom management, satisfaction, quality of life, medication use adherence, visit completion, and disease progression.

This review adds to the overall literature by synthesizing primary studies specifically from the perspective of children and their families. In inclusively focusing on this literature across clinical areas and populations, this review importantly incorporates virtual care in a wide range of practice areas and methodological approaches. Other secondary reviews tend to address specific clinical areas or study designs. As an example, Mitra et al. (15) conducted a systematic review of telemedicine in pediatric emergency care, and Faical et al. (5) reviewed telehealth articles addressing youth with chronic pulmonary disease. Both reviews found overall benefits of virtual care including enhanced care, therapeutic decision-making, diagnostic accuracy in the pre-clinical setting, reduced costs, length of stay and patient satisfaction in emergency care (15), and improved treatment adherence, quality of life and physiological variables (5).

Cumulatively, articles invite greater precision in differentiating virtual care design relative to patient and family needs, and targeted benefits or preferences. This supports the careful consideration of virtual care design for specific purposes and populations. For instance, Siani et al. (7) note potential parental preference for “one type of communication technology over the other, for instance, videoconferencing vs. telephone discussion, due to accommodation of visual content, ability to record or repeat messages, and opportunities to ask questions, particularly when parents are not present for direct discussion following physician's daily evaluations” (7) (p.338).

This review, like others, raises questions about the design of virtual care, and the need for greater precision in complementing virtual or hybrid care relative to the specific care needs and ‘fit’ for a given child and family (121, 133). To facilitate this, shared decision-making between children/youth, their families and healthcare providers is necessary to address initial and emergent challenges throughout the design and implementation of virtual care. Study learnings demonstrate that a third of articles addressed design/implementation aspects that affected the accessibility of virtual care (e.g., need for digital equipment, need to speak in a specific language). Consulting with patients and their families (133), and managing families’ expectations of virtual care are highlighted as important in seeking optimal means of offering virtual care (126). This focus on the “fit” of virtual care approaches complements earlier reviews that amplify the need for greater applicability of research to the target population, clinical area and level of acuity (14, 15, 29). In addition, considerations related to “fit” are imperative as virtual care approaches may incorporate additional tasks (e.g., gathering and uploading children's information) that require guidance from the care team/technological staff and time for families to master.

Despite what generally emerged as benefits and preferences for the inclusion of virtual care in contemporary healthcare, caution and substantial research gaps remain. This review as well as other secondary reviews have found insufficient evidence of virtual care utility and outcomes for specific populations; hence, further evidence is needed in addressing outcomes and processes for targeted populations (2, 13, 14, 16)^,. Like in other reviews (2, 5, 7), heterogeneity and varying rigor were noted in articles. In moving forward, co-design of approaches may contribute to elements of salience for families.

Multiple articles, as reviewed, indicate concerns about SDOH-related inequities in virtual care. As an example, concern was raised about the need to better understand and accommodate logistical issues and reduce costs for patients and families (125, 128, 130) when designing and implementing virtual care, particularly for families in lower income strata (128). Several previous reviews also have identified inequities in virtual care access (14); however, it appears that advances have been made in this area. For instance, Obregon et al. (16) reviewed articles addressing telehealth among families with limited English proficiency. Their review demonstrates the acceptability and feasibility of telehealth in that population; however, health outcomes have not yet been extensively determined. Accordingly, targeted focus is needed with equity, inclusion, and accessibility lenses particularly for children and families from equity-deserving communities as emphasized by Birnie and colleagues (137). Priorities include widespread access to the internet, data plans, and wireless secure Internet hotspots for patients and their families (120, 121), equitable technology access (76), and reimbursement of costs related to virtual care (e.g., insurance payment to healthcare providers and families) (111).

Reviewed articles offer recommendations to improve access, experiences, and benefits of virtual care. In moving forward, robust organizational infrastructure and more support and training for both users and providers of virtual care are invited. This includes staff training, dedicated information technology (IT) support, improved IT applications, facilitators, and increased role clarity (120, 127, 128, 131, 133, 138). In alignment with EDIA, external staff resources such as interpreters and/or culture brokers are critical to help patients, families and/or healthcare providers overcome linguistic and/or cultural barriers that emerge in virtual care. Tailored approaches are required to meet the needs of all children and families (110, 119, 135, 139). Design considerations must accommodate children/families’ levels of comfort with the virtual care approach used, as well as ensuring its accessibility. Facilitating factors identified in this scoping review can be useful in tailoring virtual care approaches relative to needs. Doing so requires the development of a relationship with patients and their families as well as offering support and guidance to families as they transition from in-person to remote care.

Overall, articles included in this review convey over-arching benefits of virtual care, thereby supporting the use of virtual care. But similar to findings of Siani et al. (7), we suggest caution such that virtual care not be viewed as a replacement to face-to-face interaction. Other key takeaways include the urgent need to address SDOH barriers and offer virtual care applications tailored to patient and family needs as well as clinical context. To this end, we emphasize the incorporation of equity frameworks that can better support the design and implementation of virtual care for all.

While current guidelines of the JBI protocol do not incorporate scoping review consultation, scholars such as Arksey and O'Malley (140) and Oravec et al. (141) emphasize that seeking feedback from patients and caregivers for scoping reviews, increases the potential uptake of findings, increased satisfaction and the generalizability of results. We shared our learnings with a broad group of stakeholders, including caregivers, who expressed resonance with the review findings.

Included articles generally convey positive family perceptions about the use of virtual care in pediatrics. However, further research is needed to determine benefits of virtual care for particular populations and under what circumstances those benefits are incurred. Such work is anticipated to offer greater virtual care precision relative to patient and family need. Further refinement of approaches will inform care design; this invites engaging and empowering patients and families to co-design virtual care options. It appears that virtual care indeed is here to stay; thus, it is important to carefully determine care approaches for positive patient and family experience, equitable access and optimal outcomes.