Piezoelectric wafer active sensors (PWAS) are lightweight and inexpensive enablers for a large class of damage detection and structural health monitoring (SHM) applications. This paper starts with a brief review of PWAS physical principles and basic modelling and continues by considering the various ways in which PWAS can be used for damage detection: (a) embedded guided-wave ultrasonics, i.e., pitch-catch, pulse-echo, phased arrays, thickness mode; (b) high-frequency modal sensing, i.e., the electro-mechanical (E/M) impedance method; (c) passive detection, i.e., acoustic emission and impact detection. An example of crack-like damage detection and localization with PWAS phased arrays on a small metallic plate is given. The modelling of PWAS detection of disbond damage in adhesive joints is achieved with the analytical transfer matrix method (TMM). The analytical methods offer the advantage of fast computation which enables parameter studies and carpet plots. A parametric study of the effect of crack size and PWAS location on disbond detection is presented. The power and energy transduction between PWAS and structure is studied analytically with a wave propagation method. Special attention is given to the mechatronics modeling of the complete transduction cycle from electrical excitation into ultrasonic acoustic waves by the piezoelectric effect, the transfer through the structure, and finally reverse piezoelectric transduction to generate the received electric signal. It is found that the combination of PWAS size and wave frequency/wavelength play an important role in identifying transduction maxima and minima that could be exploited to achieve an optimum power-efficient design. The multi-physics finite element method (MP-FEM), which permits fine discretization of damaged regions and complicated structural geometries, is used to study the generation of guided waves in a plate from an electrically excited transmitter PWAS and the capture of these waves as electric signals at a receiver PWAS. Wave diffraction from a hole damage is illustrated through time-frame snapshots. The paper ends with conclusions and suggestions for further work.