There are now few hundred thousand healthcare apps, yet there is a gap in our understanding of the theoretical mechanisms for which, and how, technological features translate into improved healthcare outcomes. In particular the technological convergence, within mobile health (mHealth) apps, of the processes of mass and interpersonal communication, and humancomputer interaction requires greater parsing in the literature. This paper analyzed 85 empirical studies on mHealth apps using the Input-Mechanism-Output model. We found in the literature that, firstly, there is a greater emphasis on technological inputs (87%) of accessibility, usability, usage, and data quality, than health outputs (52%) such as system process efficiencies and individual level behavioral or health outcomes. Secondly, there is little evidence of explanatory mechanisms (19%) of how the effects of mHealth apps are achieved. While we believe that successful apps would require research that incorporates technological inputs, theoretical mechanisms and health outputs, such studies are a rarity (n=3). There is a minor increase in rigor with randomized control trials (n = 5), and a preponderance of discussion around social influence (n = 8) and gamification (n = 7), albeit in a scattered manner. We discuss the implications of the trend towards socialization and gamification findings in terms of future research, particularly in terms of study design guided by theoretical mechanisms.

Systems theory has influenced and spawned theory and research development in organizational studies since the 1960s. Seeing a parallel between biological and human social systems, systems theory places dual emphases on organizations' relationships and interdependence among the components of the system as well as the organization–environment relationships. The structure and patterns and relationships of a system emerge from interactions among components, thus each system is unique. Systems have common defining properties, such as hierarchical ordering, coupling, permeability, holism, emergence, equifinality, and homeostasis. Representing the broader systems perspective are several specific theories and perspectives, such as Weick's theory of organizing, communication network perspectives, ecological and evolutionary perspectives, and self‐organizing systems theory. Systems theory has been extensively applied in research areas ranging from communication design and adoption of technology use in organizational operations to professional communication, health campaigns, and public relations.

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This review evaluated transdisciplinary empirical research on wearable health technologies using the input-mechanism-output model and addressed a major concern relating to the invasiveness of wearables. The dataset consisted of 250 published papers that investigated wearables for health-related purposes. Papers focused on technological inputs and health output factors, de-emphasizing theoretical mechanisms that could effectively translate the former into the latter. The lack of transdisciplinary research in the field is limiting both identification of effectiveness and evidence of beneficial health outcomes, with a considerable divide between technologists and public health researchers. Privacy concerns relate to increasing trends in collecting data for mental health and physical health, with the latter escalating exponentially. Invasiveness of wearables has increased over time in terms of collected signals and the derived health information, monitoring both users and their social and physical environments. We conclude with reflections for conceptual development, commercial application and policy regulation.

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