Digital literacy refers to the individual's ability to use digital platforms and resources to find, evaluate, and obtain information (1). The effects of digital literacy on varied domains of life are inevitable. In the education domain, the knowledge of digital technology can help students become lifelong learners and help to engage them in the process of acquiring academic skills (2). Digital literacy also influences social empowerment; it helps people stay connected and be informed about the things that are revolving around society.

Digital literacy is critical for children's and young people's development across a wide range of areas. These include engagement in online education, both formal and informal learning, access to critical information and support related to health and well-being, and searching for employment, career information, and entrepreneurship opportunities. This holds great importance for young girls and women's empowerment especially in settings where the women lag behind the men and lack the necessities to live (3). In addition, digital literacy fosters creativity, develops critical thinking, improves problem-solving, and facilitates overall development (4). If young girls are equipped with digital literacy it empowers them and enhances confidence and decision-making abilities (7). Digital adoption and use can also offer women, and girls, in particular, opportunities to overcome hurdles they may face in the physical world. Digital access help expand young girls' sense of self, increase civic engagement, raise awareness of their rights, and increase employment opportunities and workforce participation (5–7).

The use of digital technology also promotes accessing and utilizing sexual and reproductive health (SRH) services among young girls. Digital communication opens the gate and offers wider access to SRH information and services such as puberty, menstruation, bodily autonomy, healthy relationships, contraception etc. (8). Adolescent girls and young women like to seek sensitive SRH information through mobile apps, web browsers, and various social media platforms because it can afford privacy and/or anonymity (9). Moreover, telemedicine which is one of the attributes for digital access to services has been shown to overcome the social barriers, behavioral barriers, and geographic barriers in utilizing especially the sexual health services among adolescents while also aiding in self-utilization of these services (10). Varied digital interventions targeting SRH topics amongst various cultures have shown an acceptable mode of SRH intervention delivery and feasibility amongst the adolescent users (11–13).

Globally, ~1.2 billion people are under the age of 10–19 years, 90% of whom live in LMICs (14). Adolescence is a critical period in life, during which people experience extensive biological, psychological, and social changes (15). Creating and sharing knowledge has never been easier than ever before. But the fact remains that many people still lack the skills required to access this information and an inequity gap is growing (16). The benefits of digital literacy can only be realized if people are empowered with the knowledge and skills to access and use them (17). In many LMICs countries, young girls are 25% less likely than men to access digital technology (18). Bringing adolescent girls into the mainstream of the digital revolution can empower them with access, information, choices, and opportunities that they have never had before. Not just for themselves, but their families, communities, and nation (19). For young girls in LMICs, the internet and digital technologies are an open doorway to tangible benefits such as access to health information, education, and employment opportunities (20). Connecting more adolescent girls and helping them gain the benefits of digital literacy will also support them and their families to navigate this global pandemic, and help achieve many of the United Nation's Sustainable Development Goals (21). The purpose of this systematic review was to assess the range and nature of digital literacy interventions implemented to empower adolescent girls in LMICs and identify evidence about adolescent girls' access to and use of digital technologies in LMICs. The further objectives of this review were to identify and evaluate the effectiveness of digital literacy interventions employed to empower adolescent girls in LMICs, understand the approaches and strategies used to delivery of digital literacy interventions, and identify knowledge gaps in those contexts.

This systematic review was conducted following the Preferred Reporting Items for Systematic Reviews and Meta-analysis (PRISMA) guidelines (22), and included the following studies: experimental [randomized (individually or cluster) and non-randomized controlled trials], observational studies with an internal comparison group (cohort—prospective and retrospective and case-control studies), and qualitative studies. The studies that used case reports, case series, editorials, opinion papers, thesis papers, and review papers were excluded. The protocol for this systematic review was registered with PROSPERO—CRD42020216756.

Studies were included on adolescent girls aged 10–19 years living in LMICs defined by the World Bank (23). The studies with broader age groups were also included if they included the sub-group that included girls in the age range of 10–19 years. Studies that described the access to and interventions to increase access to digital technologies, interventions to improve SRH and rights through digital/mobile technology, and interventions to empower adolescent girls i.e., education and economic development through digital technology or digital literacy were included.

The primary outcome of the study included access to digital technologies by adolescent girls in LMICs, and improved decision-making for own health, continuing education, work, marriage, pregnancy, etc. The secondary outcome of the study included improved SRH status i.e., decrease in early marriages, teenage pregnancies, uptake of contraceptive methods, and improvements in overall health status, etc.

The search strategy was made with the research librarian from the University of Alberta (SC). Databases were searched from inception to December 2020. The databases that were used for running the search strategy included. PubMed, Ovid MEDLINE, the Cochrane Central Register of Controlled Trials (CENTRAL), EPOC systematic review database, Cochrane Database of Systematic Reviews, Database of Abstracts of Reviews of Effects, Health Technology Assessment Database, HealthStar, EMBASE (Excerpta Medica), CINAHL (Cumulative Index to Nursing and Allied Health Literature), PsycINFO (Psychological Abstracts), WHO library and other relevant websites (that publish girls empowerment material) and Sociological Abstracts (Supplementary Material). To minimize the chances of missing any relevant papers, the bibliographical list of the included studies and the systematic reviews were hand-searched. The search results were firstly transferred in an Endnote file and were then uploaded on web-based COVIDENCE software following the removal of the duplicates.

COVIDENCE software was used for streamlining the screening process of systematic review from the stage of title and abstract screening and full-text screening (24). Two independent reviewers (KAR and SM) screened all the potential articles. In case of any discrepancy/conflict between the two reviewers, a third reviewer (ZSL) from the team decided for possible inclusion or exclusion of the study at both stages. The papers that passed eligibility by the reviewers were finally included.

Data were extracted from the included studies such as the name of the author, year of publication, study design, the objective of the paper, target population, sample size, intervention type, intervention mode of delivery, outcomes, and key findings (Tables 1, 2; Supplementary Material). One reviewer (KAR) extracted the data from the included studies. A second reviewer (SM/ZSL) verified all the data extracted from the studies and checked for their accuracy and completeness. Any conflicts were resolved through discussion and consensus.

The methodological quality of all the included studies was assessed by using the Mixed Methods Appraisal Tool (MMAT tool). The tool provided ground to assess the methodological quality of five types of study designs including qualitative studies, randomized-controlled trials, non-randomized cohort studies, quantitative descriptive studies, and mixed-method studies (25).

A tailored approach to synthesize the data was employed by utilizing an evidence table (Tables 1, 2). A narrative synthesis of the included studies was carried out. Given the sparse and heterogeneous data such as age group, study setting, intervention, mode of delivery, and outcomes, the findings of this study cannot be meta-analyzed.

The initial search retrieved a total of 1,283 articles. After removing duplicates and articles in other languages and reviewing abstracts with respect to the inclusion criteria, a total of 987 studies were considered relevant. Following a full-text review and consultation among the authors, 35 articles were included in the final review and analysis using the PRISMA diagram (Figure 1) (22). Findings from each article were summarized in a table format and systematic analysis was performed to extract major themes. A descriptive synthesis table was formulated containing the textual descriptions of all the findings. A detailed analysis was performed to evaluate the effectiveness of the digital literacy interventions and their impact on adolescent girls' empowerment in LMICs.

A summary of all 35 selected papers, including author, and place of the study, study design, sample size, intervention delivery strategy, and outcomes, are provided in Tables 1, 2. The majority of studies were RCTs (n = 6) (26–31), followed by quasi-experimental studies (n = 2) (32, 33), before and after studies (n = 3) (34–36); while 11 were cross-sectional/descriptive survey design (37–47), seven studies used a mixed-method approach (48–54), and six were qualitative studies (55–60). Sample sizes ranged from 120 to 25,929 subjects in quantitative studies, 12 to 726 participants in qualitative studies, and 68–800 participants in mixed methods studies. Most of the studies have been conducted in the African countries (n = 20) (30–33, 37, 39–43, 45, 49, 53–58, 60), 12 studies conducted in Asia (26, 27, 29, 35, 36, 38, 39, 46, 51, 52, 59), three studies conducted in South American countries (34, 38, 54), and one study in North America: Mexico (34). The methodological qualities of included studies are provided in Tables 1, 2. We assessed the methodological quality of the quantitative and qualitative papers using the Mixed-Method Appraisal Tool (M-MAT) (25). The majority of the studies scored moderate to high for interventional studies and poor to high for observational studies. Studies were not excluded based on assessment scores as the purpose was to examine and gain insight into the existing research in this field.

Various digital strategies and interventions were used to empower adolescent girls such as text messages, mHealth, mass media, website development, and mobile-based games. We thematically analyzed and put up the major findings under the thematic areas of digital literacy to empower adolescent girls in LMICs. The studies included were categorized under three headings: digital literacy for sexual and reproductive health and rights empowerment, digital literacy to promote health information and decision making, digital literacy for social and educational empowerment.

This review has identified 35 studies that have assessed the digital literacy interventions and reported outcomes broadly as SRH empowerment, overall health information and decision-making empowerment, and social and educational empowerment.

The findings from this systematic review highlighted that the use of internet and mHealth interventions were found to be effective in improving the knowledge, attitude, and practice toward SRH topics including HIV/STI prevention, and improved uptake of contraception amongst adolescents. Social media especially Facebook, Google, WhatsApp, and YouTube are key online resources for adolescent girls and a great source of information on SRH related topics. Similarly, SMS is a medium for imparting knowledge as well. The odds for accessing the information on SRH topics were significantly higher among girls who owned a mobile phone.

These findings are in concordance with the other reviews, which suggest, that mobile phone approaches; including text messages, in particular, provide feasible and potential effective medium to increase SRH education and ensure safe sexual behaviors among adolescents (61, 62). A Cochrane review on mobile phone-based interventions for improving contraceptive use also suggests that a series of voice messages and daily educational text messages can improve contraceptive use among adolescents (63). Another study also reported that mHealth and digital interventions are not only an effective tool in increasing SRH knowledge, but the digital medium also engages key target populations who are at greater risk of poor SRH outcomes, including adolescents with low parental education, adolescents with low SRH knowledge, adolescents with an early sexual debut, and adolescents with low parental support (30). The internet browsing of sensitive personal information related to SRH or using mobile phones can be very confidential; however, it does vary upon the context (64). There are instances especially in LMICs where mobile phones are being shared within the families and hold the potential to breach the privacy and confidentiality of the SRH accessed information (65). This can also serve as a hindering factor in digital access especially for girls in LMICs lining in resource constraint households (8).

Another important aspect gained from this systematic review is that the use of digital media by adolescent girls not only promotes SRH related outcomes but also improves general well-being and healthcare decision-making. Young girls also access information about the dangers of self-medication, use of disposable syringes for injection, information about causes of hepatitis B and C, and regarding garbage disposal through the digital medium. Similar behavior was seen in school-going adolescent children that they use the internet and other broadband applications for accessing healthcare information. They also used emails to ask for health-related information from the physicians if they had any concerns and also initiate conversations with their teachers pertinent to health-related information (66).

The review also highlighted the effect of digital literacy on social and educational empowerment amongst adolescent girls. These educational attributes were in general but only limited to academic performances, improved self-esteem, and better relationships with significant others. These findings resembled with one of the studies conducted to evaluate the role of digital literacy on performance tests and showed a positive relationship between digital literacy and academic scores. However, after adjusting the confounders, the results were not the same (67). These confounders can be related to classroom-related factors. There is an increased likelihood that the regression analysis of the included study in this systematic review leads to a reverse relationship (non-significant association). Similarly, a study by Girl Effect reports that in contexts where girls have more freedom and agency, they are more likely to have access to digital technology and more opportunities for learning and skill development (68).

While on one hand, digital literacy contributes toward the empowerment of the adolescent population, it also directs them in a negative direction where the youth engage themselves in acts including online harassment, sexual exploitation (69), cyberbullying (70), and pornography (71). Women and girls are at greater risk of digital harm. These digital risks and harms reduce or restrict adolescent girls' digital media use by parents, spouses, and gatekeepers. However, these kinds of issues are less encountered in the nations like LMICs where access to technology is the major hindrance. The absence of mobile, lack of internet connectivity, and the censorship by the parents and government all serve as hindering factors (72). To promote digital/online safety parents and gatekeepers must be informed and educated to help their children on how to stay safe online and what prevention services might be available to them to prevent digital harm and protect users (73).

In the modern era where everything is more digitalized and technology-related, the inequalities based on gender in accessing these are a real concern, especially for girls from disadvantaged settings such as LMICs. The role of digital literacy in empowering adolescent girls living in LMICs is an emerging idea. It not only plays a role in improving the SRH outcomes but also contributes to improving health-related and educational outcomes and decision-making. The findings from this review can be used as a ground for developing new evidence-informed interventions, policies, and practices for girls in LMICs.

The original contributions presented in the study are included in the article/Supplementary Material, further inquiries can be directed to the corresponding author.

SM and ZL participated in the study conception and design. SC searched the articles. SM, ZL, and KR participated in analyses. SM and KR performed the quality assessment and wrote a first draft of the manuscript. ZL commented on this draft and performed critical revisions. All authors have read and approved the manuscript.

This project was supported by University of Alberta, Faculty of Nursing VPR SIG Funding 2020.

The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest.

The reviewer AK declared a shared affiliation with one of the authors, ZL, to the handling editor at the time of review.

All claims expressed in this article are solely those of the authors and do not necessarily represent those of their affiliated organizations, or those of the publisher, the editors and the reviewers. Any product that may be evaluated in this article, or claim that may be made by its manufacturer, is not guaranteed or endorsed by the publisher.