JMIR Publications

ABSTRACT

Background:

Virtual self-management programs for pediatric autoimmune diseases combine digital content, participant activity, and human support. Understanding whether their intended components are delivered, received, and enacted requires fidelity evidence that is distinguishable from platform use and clinical outcomes.

Objective:

To map how intervention and implementation-strategy fidelity are defined, assessed, and reported in virtual self-management programs for pediatric autoimmune diseases, and distinguish fidelity evidence from related process and outcome measures.

Methods:

Guided by the Joanna Briggs Institute and Preferred Reporting Items for Systematic Reviews and Meta-Analyses Extension for Scoping Reviews (PRISMA-ScR), we searched six databases (2002–2026) for peer-reviewed articles involving pediatric autoimmune populations and relevant fidelity measures, assessment procedures, implementation strategies, or quality-assurance processes. Synthesis was informed by the Dunst framework, the Consolidated Framework for Implementation Research (CFIR), and the Expert Recommendations for Implementing Change (ERIC) taxonomy. Direct fidelity assessments were distinguished from participation indicators, acceptability and usability measures, and health outcomes.

Results:

Of 284 identified records, 39 articles were included: 25 addressing type 1 diabetes, 7 inflammatory bowel disease, 5 juvenile idiopathic arthritis, 1 systemic lupus erythematosus, and 1 mixed rheumatic-disease population. Direct fidelity evidence included interventionist checklists, recorded-session review, automated treatment-integrity controls, competency assessment, and structured delivery-standardization procedures. Other articles contributed intended-dose, attendance, module or app use, engagement, acceptability, and usability indicators. Two trial design/baseline articles contributed fidelity procedures without final effectiveness findings. Fidelity to implementation strategies was not consistently distinguished from fidelity to intervention delivery, and the heterogeneous evidence did not establish that higher fidelity caused better outcomes.

Conclusions:

This review adds a cross-modality account of what reported fidelity procedures and indicators establish in virtual pediatric autoimmune self-management. Separating intended standards, assessment procedures, observed delivery, receipt and enactment, implementation support, and patient outcomes can support interpretation, replication, and service planning. The synthesis does not establish that higher fidelity causes better outcomes. Clinical Trial: N/A