Embedding social determinants in mHealth for pediatric oncology: co-designing a patient-centred tool for febrile neutropenia in resource-limited settings

Febrile neutropenia (FN) is a potentially life-threatening complication of chemotherapy in pediatric oncology. In resource-limited settings, timely care is often hampered by structural and social barriers. Broader social determinants of health (SDoH)—including food insecurity, housing instability, limited transport, digital exclusion, and caregiver mental health conditions—undermine caregivers’ capacity to respond to FN episodes effectively. This study aimed to identify and operationalize key SDoH influencing FN management and integrate them into the co-design of the SaludConecta system, a patient-centered (mHealth) tool tailored to pediatric oncology in underserved settings. From May to July 2021, a sequential qualitative study was conducted at the Hospital Infantil de México, Federico Gómez (HIMFG), a national referral center serving uninsured children with cancer. Using non-participant observation and semi-structured interviews with caregivers and healthcare personnel, we mapped the FN care pathway across household, care-seeking, and hospital levels. Thematic analysis, guided by Levesque’s patient-centred framework on healthcare access, informed the identification of actionable SDoH indicators. We translated contextual barriers into measurable SDoH indicators, cross-referenced with national surveys, and integrated them into an mHealth application to support early warning, triage, and referral. Barriers such as unstable housing, caregiver fatigue, poor connectivity, and limited access to transportation were found to delay the provision of FN care. These were translated into measurable indicators, such as food insecurity, internet access, caregiver literacy, mental health conditions, and shelter availability, that informed the platform’s design. The SaludConecta system enables offline use, simplifies navigation for users with low literacy, and provides AI-supported triage alerts. It was co-designed with families, clinicians, and hospital administrators to align with clinical workflows and the constraints of the pandemic era. Integrating SDoH into mHealth design enhances equity and responsiveness in pediatric cancer care. By addressing caregiver relations and structural barriers, the SaludConecta system provides a replicable, equity-driven model for enhancing FN management in resource-constrained settings.