JMIR Publications

ABSTRACT

Background:

Health information technology (HIT) interventions are complex, context-dependent, and often insufficiently theorized, which can hinder their design, implementation, and evaluation. Programme theory approaches such as logic models and Theory of Change (ToC) are well established in public health and implementation science for articulating causal assumptions and guiding evaluation. Their use in medical informatics, however, appears inconsistent and insufficiently understood. A systematic overview of how logic models and ToC have been applied to HIT interventions is therefore needed to support theory-informed development and cumulative learning in the field.

Objective:

This scoping review aimed to map how logic models, ToC, and related programme theory approaches have been conceptualized, constructed, and applied in HIT-related interventions across disciplines. A secondary objective was to identify implications for medical informatics research and practice.

Methods:

Following PRISMA-ScR, a protocol was preregistered. Searches were conducted in PubMed, Web of Science, Academic Search Elite, APA PsycArticles and CINAHL. Eligible publications explicitly used a logic model, ToC, or related construct within an HIT intervention in any healthcare or social-care setting. Two reviewers independently screened records and extracted data on study characteristics, type and purpose of HIT, model structure, theoretical foundations, and reported benefits and challenges. Findings were synthesized descriptively and thematically.

Results:

Sixty-nine publications (2012–2025) met the criteria. Use of programme theory increased markedly after 2020 and spanned medical informatics, public health, health services research, and implementation science. Logic models were most frequently applied to patient-facing and self-management technologies, particularly mobile health, telehealth, and home-based remote monitoring. Most models were used to support HIT development or evaluation. Eighty-seven percent of studies provided a visualization, although structures varied considerably. Seventy-two percent cited guidelines for model development, most commonly MRC guidance, realist evaluation, or the Kellogg Logic Model. Forty-one percent used behavioural or implementation frameworks such as COM-B, CFIR, ERIC, FITT, or NASSS to populate model content. Only three studies reused an existing model. Reported benefits concerned improved theorization, structured evaluation, and stakeholder engagement; challenges included limited empirical evidence, high resource demands, and tensions between context specificity and generalizability.

Conclusions:

Programme theory approaches are increasingly used to conceptualize and evaluate HIT interventions, yet their application in medical informatics remains fragmented and inconsistently reported. More systematic and theory-informed use of logic models could enhance conceptual clarity, methodological rigour, and cumulative learning. Future work should promote model reuse, establish repositories, strengthen reporting standards, and integrate programme theory in HIT education and research to support coherent development, evaluation, and scaling of digital health interventions. Clinical Trial: Ammenwerth E, Bindel M, Hörhammer I. Logic Models on Interventions Including Health Information Technology: A Scoping Review Across Disciplines (Protocol) [Internet]. Open Science Framework (OSF). 2025. Available from: https://osf.io/zru3n/overview