Organizational mechanisms in digital public health transformation: change communication, collective sensemaking, and cross-functional collaboration

Introduction Digital public health transformation extends beyond technology deployment and requires organizational processes that align interpretation, coordination, governance, and population-health goals. Existing research examines change communication, collective sensemaking, and cross-functional collaboration separately, with limited integration of their boundaries, recursive interactions, cross-level transmission, and multilevel outcomes. This review develops an organizational explanation of how these mechanisms may support transformation. Methods A narrative integrative review synthesized theoretical, empirical, policy, and technical literature from organizational science, implementation science, digital public health, data governance, and artificial intelligence governance. Searches covered PubMed/MEDLINE, Embase, Scopus, Web of Science Core Collection, APA PsycINFO, CINAHL, IEEE Xplore, ProQuest Public Health Database, Business Source Complete, and traceable institutional sources from inception to October 1, 2026. Sources were purposively selected for relevance, contribution, public health applicability, analytical level, and traceability. Synthesis used construct coding, within-theme comparison, framework comparison, cross-level mechanism mapping, and analysis of competing explanations and evidence boundaries. Results Change communication establishes credible and contestable direction; collective sensemaking develops shared problem representations; cross-functional collaboration translates shared understanding into coordinated action. They operate recursively rather than sequentially. A seven-layer framework links structural contextual conditions, organizational mechanisms, potential mediating capabilities, implementation outcomes, organizational or system outcomes, population-level service and equity outcomes, and population health outcomes. Team psychological safety moderates the relationship between proximal support conditions and risk-detection behaviors, which feed back into the mechanisms. Organizational readiness for change, knowledge absorption and translation, interoperability governance, organizational learning, and resilience are proposed as mediating capabilities. Power and equity governance, community decision rights, representativeness, vendor accountability, auditing, appeals, portability, and exit management cut across the framework. The model complements CFIR, NASSS, i-PARIHS, EPIS, and sociotechnical approaches by specifying observable interactive mechanisms and feedback pathways. Discussion The framework provides a testable explanatory structure and governance-diagnostic tool for surveillance, data infrastructures, laboratory networks, artificial intelligence, and community co-production. Evidence more strongly supports organizational and system processes than causal effects on population health. Longitudinal, multilevel, and mechanism-oriented studies should test mediation, moderation, feedback, equity, and cross-level transmission.