Conference Agenda

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Session Overview
20-AM-03: ST6.1 - Implementation Issues of Systemic Disruptive Innovations
Thursday, 20/Jun/2019:
8:30am - 10:00am

Session Chair: Hans Georg Gemuenden, BI Norwegian Business School
Session Chair: Rémi Maniak, Ecole Polytechnique
Session Chair: Christophe Midler, Ecole Polytechnique
Location: Amphi Becquerel

Session Abstract

Systemic innovation (SI) generates value if accompanied by complementary innovations. It opposes autonomous innovation, which can be developed independently of other innovations. Systemic innovation changes business processes and requires companies to change their practices. The SI literature stresses the need to coordinate the actors of the value chain or business ecosystem that are external to the organisation frontiers for SI, considering the type of connection (e.g., vertical integration, contract, partnerships, and alliances), the choice of the governance structure, the degree of trust/uncertainty among the actors and the mechanisms of knowledge transfer among the firms. An issue related to the early stages in SI is the need to conceive new business models or new ecosystem architectures, because the value, in this case, is generated and distributed by complex interrelationships among the various actors. In this track, we want to invite papers that adress issues of implementation of SI. This could be contributions to exploring and co-creating new options for SI, to seizing and exploiting them together with old and new partners, and to build completely new business ecologies, or transform existing ones in a radical way. An important aspect of SI is that they often involve a sequence of projects or programs that build on each other, and that each project/programme represents a major innovation step. Research that analyzes development paths of SI by using such project lineages are in the focus of this special issue. This can be done by using complex case studies, or by delivering theoretical explanations of development paths.

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Systemic and disruptive innovation exploration dynamics toward ecosystem structuring: the case of the connected autonomous mobility

Giulia Marcocchia

Telecom ParisTech, France


The management of current innovation topics such as smart mobility, smart homes and integrated healthcare involves the consideration of the ecosystem-based dynamic of resource flows (energy, data…) among several players, resulting in an un-precedent degree of systemic-ness of the offer system and disruptiveness of the demand system.


Existing literature on strategy focuses on platforms and value creation for the involved network through articulated innovation strategy, as the industry platforms stimulate innovation (Gawer and Cusumano, 2014). Insights on roles and dynamics of innovation ecosystem have also been provided (Adner 2017, 2006, Kapoor and Lee, 2013, Wareham et al. 2014).

As far as the innovation management literature is concerned, most of the existing production is linked to development project (Lenfle and Loch, 2010; Midler, 2013; Thomke and Fujimoto, 2000). Literature on exploration projects highlights the need of flexibility degrees and adjustment in a firm context (Lenfle, 2008). As far as systemic and disruptive innovation, literature provides elements on management to be performed by one single large company, as for the case of the indication of how it should manage EV deployment, considered as systemic and disruptive innovation (Von Pechmann et al. 2015).

Literature Gap

The literatures on strategy and innovation management provide frames to consider how heterogeneous players can deliver and share value, but the dynamics of engagement toward the collaboration among such players are still under-explored and models seem not adequate to the high level of technological and market uncertainty that firms face.

Research Questions

Such inputs drive us to question which challenges actors face while exploring this typology of innovation and how actors deal with them in the ecosystem context. Our paper wants to elucidate challenges and conditions for effective collaborative exploration of unknown, when the ecosystem is the locus of such exploration.


Based on the constructivist epistemology approach and qualitative methodology, the research is based on the research-intervention method, through the active participation to the three projects for a total duration of 3,5 years.

The selected cases focus on topics at the core of the discussion for connected and autonomous mobility, such as the creation of fast charging station network, the realization of a prototype of car data marketplace and the deployment of autonomous driving related services in urban areas.Collected data were coded and presented through storytelling.

Empirical Material

Data collected were relevant to 43 semi-structured interviews of project participants and stakeholders, notes from 58 atteded meeting (consortium meetings, European commission review meetings, workshops), notes from 12 international conferences relevant to the subject of the paper, such as smart mobility, big data, intermodalities.

Project participants include automotive OEMs, service providers, utility providers, cloud operators, Tier 1 software developers, public authorities etc. Attended conferences were held as follows: 1 in Seoul (South Korea), 1 in HongKong (China), 1 in Berlin (Germany), 1 in Venice (Italy), 6 in Paris, 1 in Vancouver (Canada) 1 in London.

Data collection instruments, such as new questions, and new data sources have been added along the way, as workshops with public authorities, because they were relevant to the phenomena observed (i.e. of hybridization of business model).


Results emerged in term of similar mechanisms across the three projects.

Heterogeneous partners in observed projects face similar challenges, such as concept alignment, information sharing, alignment of in-house efforts with the project efforts, completion with initially set project timeline, awareness of strategic relevance of the projects, target of the projects and identification of ignition factors to action. Partners go through a four-step process of challenges management, characterized by specific objects to be collectively redesigned. The identified sequence involves the redesign of concepts, of the performance of exploration project, of the value proposition and of the actor network. In such a sequence, the collective action of convergence is characterized by the management of qui pro quo related to concept definition, expectation and understanding of interests. Artefacts resulted to be effective tools of expansive interaction. Specific artefacts to each phase of challenge management contributed to partners’ alignment and convergence. Systemic and disruptive innovation exploration might generate the structuring of an ecosystem if heterogeneous partners are involved in a lineage of exploration projects.

Contribution to Scholarship

We elucidate the specific characteristics of systemic and disruptive innovation management and we highlighted that the exploration of a lineage of projects might be relevant to ecosystem structuring. The 4-step process through which heterogeneous actors deal with specific challenges complements literature in innovation management as it introduces elements to move forward when the exploration is performed by heterogeneous actors. It also contributes to strategy literature as we highlight that systemic and disruptive innovation project are contributing to ecosystem structuring, as they allow knowledge generation, positioning definition and network expansion. Results point out the role of artefact design in the performance of such process, contributing to cognitive convergence and knowledge generation.

Contribution to Practice

We provide specific tools for the management of the process of systemic and disruptive innovation exploration in eco-systemic context, as well as performance assessment guidance for a lineage of ecosystem projects. Firms should take such elements into consideration to improve the effectiveness of innovation management through the management of a lineage of projects related to ecosystem.


The chosen focus for this paper is at the intersection of private and public concerns. By elucidating the process of collaboration and alignment of several actors for a temporary goal, as a part of a longer term strategy built on a lineage of projects, our paper bridges research, industry and society.


Adner, R., 2017. Ecosystem as Structure An Actionable Construct for Strategy. Journal of Management, 43(1), 39-58.

Adner, R., 2006. Match your innovation strategy to your innovation ecosystem. Harvard business review, 84(4), 98.

Gawer, A., Cusumano, M.A., 2014. Industry platforms and ecosystem innovation. Journal of Product Innovation Management, 31(3), p.417-433.

Jacobides, M.G., Cennamo, C., Gawer, A., 2018. Towards a theory of ecosystems. Strategic Management Journal

Lenfle, S., Söderlund, J., 2018. Large-Scale Innovative Projects as Temporary Trading

Lenfle, S., 2008. Exploration and project management. International Journal of Project Management, 26(5), 469-478.Zones: Toward an Interlanguage Theory. Organization Studies, 0170840618789201.

Midler, C., 2013. Implementing low-end disruption strategy through multi-project lineage management: The logan case. Project Management Journal 44(5), p.24-35.

Thomke, S., Fujimoto, T., 2000. The effect of “front-loading” problem-solving on product development performance. Journal of. Product Innovation Management, 17(2), 128-142.

von Pechmann, F., Midler, C., Maniak, R., Charue-Duboc, F., 2015. Managing systemic and disruptive innovation: lessons from the Renault Zero Emission Initiative. Industrial and corporate change, 24(3), 677-695.

Wareham, J., Fox, P.B., Cano Giner, J.L., 2014. Technology ecosystem governance. Organization Science, 25(4), 1195-1215.

A systemic innovation in science-based industry: how to manage suppliers by a manufacturer outsourcing all components

Noriko Taji1, Tatsuo Enami2, Kenji Takahisa2

1Hosei University, Japan; 2Gigaphoton,Inc


Exposure tools used for manufacturing semiconductor chips, are large-scale industry equipment with extremely complex architectures comprised of many high technology components. The Dutch company, ASML entered the market behind others and managed to overturn Nikon’s dominance by integrating all outsourced components. ASML excelled in system design and fine-tuning among components.


Systemic innovation was advocated by Chesbrough and Teece(1996) as redesigning a whole product or changing an architecture. It was difficult to complete systemic innovation in science-based industries like Semiconductor (Henderson and Clak,1990). In general, manufacturers making an end product pursue innovation by taking an initiative (Brusoni,2001; Heide,2003;etc). Brusoni (2001) and Brusoni and Principe (2011) explained that aircraft engine manufacturers attained systemic innovation by building a loosely coupled organization and taking a role of system-integrator in 1980’ s and 1990’s. As an example in Semiconductor industry, the exposure tool maker, ASML succeeded in building a new architecture and beat a competitor in the late 1990s and early 2000s. Chuma (2006) pointed that ASML managed external suppliers and collaborated with a consortium and universities, resulting in fine-tuning when integrating a product. Our study introduces the next architecture of ASML in the middle of 2000s.

Literature Gap

Previous studies exhibited a role of system-integrator, however, did not clarify internal organization structure, the content of acquired knowledge and knowhow of supplier management. We obtained an organization chart and specification sheets of components and unveiled the details.

Research Questions

How could ASML integrate all outsourced components into the systemized complex product? What kind of internal organization structure enable ASML to design a whole product, direct detailed specification and fine-tune among components in integrating a product? Furthermore, how did ASML strengthen supplier management?

We investigate the architecture after Chuma’s study.


Our study is qualitative. We did a case study by comparing a Dutch company, ASML and Japanese company, Nikon. They aggressively competed in the oligopoly market. We collected public and informal data; academic papers, articles, and internal documents etc. And we interviewed manufacturers, suppliers and an external partner.

Empirical Material

The market share transition aggregated by a light source supplier shows performance.

The number of academic papers categorized into solo or collaborative shows the level of collaboration with suppliers and external partners.

The chart of organization shows how to organize an effective team.

Interviews were conducted between 2014 and 2017. There are six of ASML, three of Nikon, five of suppliers and two of consortium. For examples, ASML: Executive vice president, Manager of supplier management, Director of system engineering, Nikon: Technical fellow, Engineer of quality assurance, Supplier: manager of marketing and development, Consortium: CEO of IMEC, fellow of IMEC Japan


In general, as manufacturers take part in producing components, they build not only component knowledge but also architectural knowledge, which is equal to the linkage among components (Brusoni,2011,etc). On the other hand, ASML didn’t produce any component, nevertheless, secured both knowledge. It is because the cooperation of system engineer and product manager enabled ASML to update suppliers’ component knowledge and accumulate architectural knowledge.

ASML’s organization for developing a new product is project team, in which product manager, system engineer and marketing manager have responsibility for launching a product. Under them, unit leaders are assigned. That is to say, internal organization of the manufacturer represents mirror structure so that can match the product architecture. Our finding supports mirroring theory (Colfer and Baldwin, 2010).

Unit leaders are in charge of managing suppliers and furthermore second-tier suppliers. Suppliers have to make enormous specification documents including second-tier suppliers’ lead time and cost. The emphasized point is an appropriate balance between quality and cost. In case of finding a hard conflict, ASML gives up high quality. It is an important judgment because ASML must support user’s efficient recovery of an amount of the investment.

Contribution to Scholarship

In the previous studies, manufacturers produced in-house components by loosely coupled organization in order to complete systemic innovation, whereas ASML managed to take an initiative and achieve systemic innovation without in-house components. ASML accomplished the innovation by controlling cost and lead-time covering down to second-tier suppliers and rearranging mirror organization in accordance with product architecture. Outsourcing all components without making in-house one could be effective in order to rearrange organization structure flexibly. Then, SE is crucial position because SE accounts for software to control all components.

Contribution to Practice

In the consumer goods industry like smartphone, PC and TV, assigning plural suppliers is thought to be the standard tactics in preparation to the unexpected contingency. In that case, manufacturers can’t request suppliers to disclose the cost. In the industrial goods like exposure tools, it is rational for manufacturers to assign a single supplier for each component and request strong commitment. What is more, even in global economy era, ASML has a basic policy of dealing with suppliers located closely. It would suggest that intimate relationship all the time is necessary to accomplish systemic innovation.


We investigated a case of science based industry, semiconductor.

ASML, a leading company making a platform of semiconductor production process has showed cultivated supplier management for the past 25 years,

The topic can give insight into the notion of systemic innovation and derive managerial suggestions for practitioners.


Brusoni, Stefano, Andrea Prencipe, and Keith Pavitt. 2001. “Knowledge Specialization, Organizational Coupling and the Boundaries of the Firm: Why Do Firms Know More Than They Make?” Administrative Science Quarterly 46(4): 597–621.

Brusoni, Stefano, Andrea Prencipe. 2011. “Patterns of modularization the dynamics of product architecture in complex systems,” European Management Review , 8 :67–80.

Chesbrough, Henry W., and David Teece. 1996. “Organization for Innovation: When Is Virtual Virtuous?” Harvard Business Review,74(1):65-73.

Chuma, Hiroyuki. 2006. “Increasing Complexity and Limits of Organization in the Microlithography Industry: Implications for Science-based Industries.” Research Policy 35(3): 394-411.

Colfer, Lyra, and Carliss Y. Baldwin.2010. “The Mirroring Hypothesis: Theory, Evidence and Exceptions.” Harvard Business School Finance Working Paper WP#10-058.

Heide,Jan B. 2003. “Plural Governance in Industrial Purchasing.” Journal of Marketing 67(4): 18-29.

Henderson, Rebecca M., and Kim B. Clark. 1990. “Architectural Innovation: The Reconfiguration of Existing Product Technologies and the Failure of Established Firms.” Administrative Science Quarterly 35(1): 9–30.

How does stakeholder attitude influence innovativeness? The case of urban innovation projects

Julia Kroh, Carsten Schultz

Kiel University, Germany


The development and implementation of system innovations in a city’s complex (eco)system like offering innovative car sharing services to create a new mobility infrastructure afford the cooperation between various locally established stakeholders from public and private. The success of such urban innovations thus heavily depends on the stakeholder management structures.


Urban innovations are instruments to transform existing urban structures into sustainable and innovative cities (e.g., Dente and Colletti, 2011; Mieg, 2012), thereby combining product, process, and service innovations for implementation in a city’s complex (eco)system (e.g., Katz, 2006). Recent research shows that stakeholder integration is necessary to achieve high performance in such complex innovation processes (e.g., Pinkse et al., 2014; Juntunen et al., 2018), because the integration of heterogeneous stakeholders helps to cope with and profit from complexity (Dougherty and Dunne, 2011). However, integrating heterogeneous stakeholders in urban innovations may require compromises as the individual objectives of each stakeholder may contradict each other (Whitmarsh and Nykvist, 2008). The presence of skeptical, highly influential stakeholders may lead to downsides for efficiency, efficacy, and the degree of innovativeness of the suggested innovation alternatives, which is the fundament for addressing the current ecological needs of cities (Bengtsson et al., 2015).

Literature Gap

Although the awareness of stakeholders’ influence on complex innovation projects like urban innovation increases, empirical studies that investigate the effects of stakeholder integration on project success measures like the degree of innovativeness are still missing. Especially the influence of stakeholders’ attitude is still under-researched.

Research Questions

Against the backdrop of urban innovations’ heterogeneous stakeholder groups, this article investigates the influence of stakeholder integration on the degree of innovativeness, in dependence on stakeholders’ attitude towards the urban innovation project. Thereby, further influencing factors like the project team’s work quality and the resource availability will be analyzed.


The research questions are examined based on text mining and survey data from a German urban innovation initiative, in which concepts are developed that describe selected system innovation alternatives for innovative urban restructuring like new heat and mobility infrastructures. A project team, consisting of, e.g., public administration, energy providers, and housing companies, suggests such innovation alternatives for implementation in a specific urban environment. The overall objective of the initiative is the same for all project teams, so the list of potential innovation alternatives is constant. Therefore, it is possible to compare the nature of individual innovation projects within the sample.

Empirical Material

To overcome single source bias, the urban innovations’ performance measure, their innovativeness, was measured based on text mining (e.g., Meyer et al., 2008). Therefore, the concepts of 100 urban innovation projects were evaluated following the principle of sentiment analysis in opinion mining (e.g., Pang and Lee, 2008). The more often words like “innovation”, “research”, and “exploration” are used in a concept, the higher its degree of innovativeness. The text mining data was combined with survey data on stakeholder integration from the 100 above-mentioned urban innovation projects based on established indicators from prior research. To overcome the likelihood of common method bias, all of the project team’s organizations were invited to participate. In total, 129 organizations answered the questionnaire (1.29 participating organizations per urban innovation project). The variables that were assessed by several project team organizations were aggregated to an urban-innovation-project score by calculating the means across their individual responses. The project team stated first, which stakeholder groups were relevant, second, which attitude the relevant stakeholders had towards the urban innovation project, and third, how intensively they integrated them during the development of urban innovation alternatives. The integration intensities, dependent on the stakeholder attitude, are used as the studies predicting variables.


A high degree of innovativeness is desirable in urban innovation projects to account for cities’ future needs and achieve a sustainable transition of established urban structures. However, a high degree of innovativeness of developed innovation alternatives is hard to achieve, because of urban innovations’ systemic character, their complexity, and their fuzziness caused by their heterogeneous stakeholder network. The results of the regression analysis show that intensive skeptical stakeholder integration does not reduce the degree of innovativeness of the suggested innovation alternatives, but facilitates higher degrees of innovativeness. Such skeptical stakeholder groups are foremost groups that need to invest in suggested innovation alternatives like residents, real estate and housing companies, and energy providers. The intensive integration of such groups may challenge a project team’s innovation alternatives, thereby resulting in more innovative outcomes. Skeptical stakeholder groups may therefore be more willing to support innovation alternatives with higher degrees of innovativeness. Intensive integration of supportive and neutral stakeholders does not influence urban innovations’ innovativeness. Focusing on skeptical stakeholder integration may thus reduce urban innovation projects’ complexity. Furthermore, a high team work quality that means intensive communication and organization within the project team supports skeptical stakeholder integration and increases the degree of innovativeness.

Contribution to Scholarship

This study contributes to literature on stakeholder theory, complex and systemic innovation, and innovation management in general by examining the stakeholder integration intensity in dependence on stakeholders’ attitude on urban innovation projects’ degree of innovativeness. While stakeholders’ legitimacy is one of the main criteria for stakeholder analysis in stakeholder theory (e.g., Mitchell et al., 1997), to the best of our knowledge, the influence of the attitude of legitimated stakeholders has not been empirically tested yet. This research therefore delivers valuable insights for stakeholder management in complex and systemic innovations like urban innovations. Against the backdrop of the increasing theoretical relevance of sustainable and innovative urban restructuring in innovation management literature, this study extends current knowledge on the underlying mechanisms in managing stakeholders for innovation. Additionally, this study contributes to a deeper understanding of urban innovation as a stand-alone innovation type besides well-known innovation types like product and service innovations.

Contribution to Practice

This research supports managers in complex innovation projects like urban innovation projects in choosing the relevant stakeholder groups for achieving a high degree of innovativeness. Urban innovation project managers should focus on integrating those stakeholders that have a high influence on the urban innovation implementation and differentiate those groups based on their attitude towards the project. As suggested by this study’s results, skeptical stakeholders may facilitate a high degree of innovativeness. Stakeholder integration is additionally supported by a high quality of communication and organization within the project team.


Urban innovations have the claim to transform cities’ complex (eco)systems to account for future ecological and technological needs. This transition can only be successful if all relevant stakeholders from public and private work together to implement sustainable and innovative solutions, thereby bridging research, industry, and society.


Bengtsson, L., Lakemond, N., Lazzarotti, V., Manzini, R., Pellegrini, L., Tell, F. (2015). Open to a select few? Matching partners and knowledge content for open innovation performance. Creativity and Innovation Management, 24(1), 72-86.

Dente, B., Coletti, P. (2011). Measuring governance in urban innovation. Local Government Studies. 37(1), 43-56.

Dougherty, D., Dunne, D. D. (2011). Organizing ecologies of complex innovation. Organization Science, 22(5), 1214-1223.

Juntunen, J. K., Halme, M., Korsunova, A., Rajala, R. (2018). Strategies for integrating stakeholders into sustainability innovation: A configurational perspective. Journal of Product Innovation Management, doi: 10.1111/jpim.12481 (in press).

Katz, J. S. (2006). Indicators for complex innovation systems. Research Policy, 35(7), 893-909.

Meyer, D., Hornik, K., Feinerer, I. (2008). Text mining infrastructure in R. Journal of Statistical Software, 25(5), 1-54.

Mieg, H. A. (2012). Sustainability and innovation in urban development: concept and case. Sustainable Development. 20(4), 251-263.

Mitchell, R. K., Agle, B. R., Wood, D. J. (1997). Toward a theory of stakeholder identification and salience: Defining the principle of who and what really counts. Academy of Management Review, 22(4), 853-886.

Pang, B., Lee, L. (2008). Opinion mining and sentiment analysis. Foundations and Trends® in Information Retrieval, 2(1-2), 1-135.

Pinkse, J., Bohnsack, R., Kolk, A. (2014). The role of public and private protection in disruptive innovation: The automotive industry and the emergence of low‐emission vehicles. Journal of Product Innovation Management, 31(1), 43-60.

Whitmarsh, L., Nykvist, B. (2008). Integrated sustainability assessment of mobility transitions: simulating stakeholders' visions of and pathways to sustainable land-based mobility. International Journal of Innovation and Sustainable Development, 3(1-2), 115-127.

Next frontier for health systems: Learning from patient’s behavior and fuzzy factors identification

Shengjing Sun1, Xiaochen Zheng1, Joaquín Ordieres-Meré1, irène Georgescu2, Étienne Minvielle3

1PMQ research group; ETSII; Universidad Politécnica de Madrid, Madrid, Spain; 2Université de Montpellier, France; 3I3-CRG; École Polytechnique; Paris; France


This paper aims to explore opportunities and challenges that technology brings when applied to better understanding effects that patient’s behavior has in relationship with evolution of their disease. The selected approach, will overview existing contributions helping to describe such behavior and consider other aspects like feeling and attitudes as significant.


Regarding the extant literature, it becomes clear that the patient’s behavior can be managed, or at least influenced, by proper messages from physicians [1]. This is also evidenced for chronic diseases [2], but also when feelings are involved [3]. Such influence also recognizes its intrinsic relevance and some studies have extended the effects to psychosocial interventions [4]. Based on such evidence, the idea of using available technology to collect relevant information is not new [5]. Indeed, there are research activities addressing home environment and feeling of patients by using IoT [6-8].

Literature Gap

The paper will review the contributions from the Internet of Things (IoT) paradigm, but also it will consider alternate sources to collect feelings and interests which are related to the big-data dimension, like social media exploration, etc. Based on the current status of the technology some managerial considerations are discussed.

Research Questions

To what end the IoT and other technologies can help to consistently clarify the patient's behaviour ?

What are the main limitations in having such information?


The adopted methodology relays on the literature review from the different involved areas (health, care services, environment, technology, information processing, and management), as well as on the market observation. These elements will bring on the table opportunities to be explored. On the contrary, some specific challenges like atomization of data, silos, etc., that can jeopardize the value of such solutions, will be identified and analyzed. By this way the research can help both researchers and practitioners to pay specific attention.

Empirical Material

The paper reviewes the contributions from the Internet of Things (IoT) paradigm, but also it will consider alternate sources to collect feelings and interests which are related to the big-data dimension, like social media exploration, etc. Based on the current status of the technology some managerial considerations are discussed trying to estimate the shortage involved in not handling a wider perspective from the patient’s available information.


Therefore, main result will be an overview of potential contribution of extending the vision for current health systems, and maybe other related systems, to enable individuals to handle their ‘self-quantified’ data as context rich information helping to understand influence of indirect factors. Such influence cannot be derived from individual data, and it can neither be consistently assessed with current big-data techniques, as they need to consider the context of the individual and because of many factors are interrelated, with different influence ratio depending on both, people and context.

Contribution to Scholarship

The paper looks to contribute to the convenient path to enlarge and efficiently share collected data in the proper context. Obviously, it will require complementary research to evaluate the economic dimension involved, where all the cost structures need to be reviewed.

Contribution to Practice

In addition, this paper can be seen as relevant from the practical perspective, because it argues that the role of the health system needs to evolve from the current role of reactive service provider to a more active one in terms of information exchange with patients.


The relationship between the paper content and the conference theme is addressed as the paper claims for the need of specific innovation bringing together the cross industry research (IoT, BigData and social sciences related to human behavior) to unveil additional effects regarding health.



[1] Kreuter, M. W., Chheda, S. G., & Bull, F. C. (2000). How does physician advice influence patient behavior?: Evidence for a priming effect. Archives of family medicine, 9(5), 426.

[2] Kaplan, S. H., Greenfield, S., & Ware Jr, J. E. (1989). Assessing the effects of physician-patient interactions on the outcomes of chronic disease. Medical care, S110-S127.

[3] Blumenthal, J. A., Babyak, M. A., Moore, K. A., Craighead, W. E., Herman, S., Khatri, P., ... & Doraiswamy, P. M. (1999). Effects of exercise training on older patients with major depression. Archives of internal medicine, 159(19), 2349-2356.

[4] Meyer, T. J., & Mark, M. M. (1995). Effects of psychosocial interventions with adult cancer patients: a meta-analysis of randomized experiments. Health psychology, 14(2), 101.

[5] Heron, K. E., & Smyth, J. M. (2010). Ecological momentary interventions: incorporating mobile technology into psychosocial and health behaviour treatments. British journal of health psychology, 15(1), 1-39.

[6] Mano, L. Y., Faiçal, B. S., Nakamura, L. H., Gomes, P. H., Libralon, G. L., Meneguete, R. I., ... & Ueyama, J. (2016). Exploiting IoT technologies for enhancing Health Smart Homes through patient identification and emotion recognition. Computer Communications, 89, 178-190.

[7] Verma, P., & Sood, S. K. (2018). Fog assisted-IoT enabled patient health monitoring in smart homes. IEEE Internet of Things Journal, 5(3), 1789-1796.

[8] Naqishbandi, T., Imthyaz Sheriff, C., & Qazi, S. (2015). Big data, CEP and IoT: redefining holistic healthcare information systems and analytics. Int J Eng Res and Technol, 4(1), 1-6.

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