Searching for Sustainability in Health Systems: Toward a Multidisciplinary Evaluation of Mobile Health Innovations

Round 1

Reviewer 1 Report

1. The present paper intents to reflect on how mHealth's sustainability can be assessed and challenge identified through a targeted literature review (TLR) on the relevant non-clinical aspects of mHealth, in order to establish a more sustainable health system, which in line 158 considered to analyse three real mobile health devices, including electronic thermometer, a connected pill-distributor and an interactive robot; the said mHealth sustainability were evaluated in terms of environmental and social or ethical sustainability. So is this paper about mobile health system, solution or device?
2. In line 61 and 62, please explain further how the healthcare sector itself generates significant environment burden such as GHG emissions to establish a more solid background for the study of sustainability in health systems. 
3. In line 77, why are the four dimensions of mHealth innovations selected for the study? and how those relate to the environmental and social or ethical sustainability of mHealth innovations. 
4. For subtitles of Section 4, it is suggested to specify what kind of sustainability and cost-effective, and evironmental footprint, and behaviour change and transformative social innovation for clarity.
5. In line 483, please explain how four relevant disciplines dealing with mHealth innovations have been identified as well as elements to assess sustainability.

Author Response

Please see the attachment.

Author Response File: Author Response.pdf

Reviewer 2 Report

Dear Authors,

This is a very interesting topic in the pandemic context. Below are some suggestions for improving your work:

1. The main findings of your research should be highlighted into the Abstract.
2. Highlight into the Introduction, the main aim of your current research and the research gap you are trying to address.
3. Please clarify the main practical implications of your study in terms of benefits-costs ratio. 
4. Design some limitations of your study and directions for further research.

Author Response

Please see the attachment.

Author Response File: Author Response.pdf

Reviewer 3 Report

Dear Authors.

It is an interesting and innovative study, thank you for focusing on the multi-disciplinary evaluation of mobile health innovations and sustainability. I congratulate the authors for their review work with detailed information about their work. However, I would like to offer you my point of view are as follows:

1. Major concerns have been raised over the method part of your manuscript and it must be revised rigorously (the whole literature search parts and draw a flow chart).

- In general: all the literature searches must be explained by using the flow chart of the article selection process.

Explain the reasons for searching the different databases for each discipline? it must be addressed.  

• Ex: Do the others think studies related to Information and communication technology-related sustainability are available only in Scopus than other search engines (Pubmed or Google Scholar)? 

L.162-166 - Please explain the Targeted Literature Review (TLR), is TLR suitable for this project-based literature search?  As per reference (2) systematic review nor a meta-analysis.

L.164 -165: If you want to use short or abbreviations of the terms in the whole article. Please mention “Human-Computer Interaction (HCI)” and “Information and Communication Technology (ICT)”.

L.175-178: Recommended to begin line 175:  We performed a literature search from the databases: Google Scholar, ….

L176-178: Must be sentenced as an inclusion and exclusion criteria.

• Appndix1 must be revised according to the standard search terms.

L.191-193: It must be moved to the methods part as an exclusion criterion.

L.191: 17 studies, which are not meet the eligibility criteria were excluded.

L.276-283: Recommended to recheck the sentences or intended meaning

L. 299: What is ICT literature? Explain it

L.437: Explain the intended meaning of “products per se”.

L.441-447: Please check the reference format  “Mahmood et al. 441 (2013)”, ‘Huybrechts et al. (2017)” and “Lehoux et al. (2016)’

L.493. Table 1: Add ‘s’ in Gold standard (QALY) it must be always changed into QALYs

L.595-596: Appendix: Table. 1. Acronyms must be addressed below the table (N: total hits returned by queries; n: papers included in the analysis).

"N= Total number of retrieved articles; n= number of articles included for the final analysis"

- Recommended to add strength and limitations.

Thank you

Author Response

Please see the attachment.

Author Response File: Author Response.pdf

Round 2

Reviewer 1 Report

The authors have addressed concerns brought up by reviewer and is ready to proceed for publication.

Reviewer 3 Report

Dear Authors,

Really, appreciated your great efforts to revise the manuscript well. 
However, Methodology not shown inclusion and exclusion criteria as motioned in the comments.

Congratulations for your hard work.

Thank you