Exploring network structure and the role of key stakeholders to understand the obesity prevention system in an Australian metropolitan health service: study protocol

A scoping review of systems approaches for increasing physical activity in populations

Introduction

The past decade has increasingly seen systems approaches as a featured theme in public health studies and policy documents. This trend is evident in the area of physical activity, which is a significant global health risk factor that is addressed in WHO’s Global Action Plan on Physical Activity. We undertook a comprehensive scoping review to characterize the application of systems approaches to physical activity, to develop a typology of the objectives, themes and methods of research papers that purported to apply systems thinking to this issue.

Methods

We searched electronic databases (PubMed, Web of Science, Scopus and PsycINFO) for studies published during the period 2010–2021 that explicitly applied systems approaches or methods to investigate and/or address population physical activity. A framework using systems-based methodological approaches was adapted to classify physical activity studies according to their predominant approach, covering basic descriptive, complex analytical and advanced forms of practice. We selected case studies from retained studies to depict the current “state of the art”.

Results

We included 155 articles in our narrative account. Literature reporting the application of systems approaches to physical activity is skewed towards basic methods and frameworks, with most attention devoted to conceptual framing and predictive modelling. There are few well-described examples of physical activity interventions which have been planned, implemented and evaluated using a systems perspective. There is some evidence of “retrofitted” complex system framing to describe programmes and interventions which were not designed as such.

Discussion

We propose a classification of systems-based approaches to physical activity promotion together with an explanation of the strategies encompassed. The classification is designed to stimulate debate amongst policy-makers, practitioners and researchers to inform the further implementation and evaluation of systems approaches to physical activity.

Conclusion

The use of systems approaches within the field of physical activity is at an early stage of development, with a preponderance of descriptive approaches and a dearth of more complex analyses. We need to see movement towards a more sophisticated research agenda spanning the development, implementation and evaluation of systems-level interventions.

Supplementary Information

The online version contains supplementary material available at 10.1186/s12961-022-00906-2.

Network Analysis for a Community-Based School- and Family-Based Obesity Prevention Program

Rising childhood obesity with its detrimental health consequences poses a challenge to the health care system. Community-based, multi-setting interventions with the participatory involvement of relevant stakeholders are emerging as promising. To gain insights into the structural and processual characteristics of stakeholder networks, conducting a network analysis (NA) is advisable. Within the program “Family+—Healthy Living Together in Families and Schools”, a network analysis was conducted in two rural model regions and one urban model region. Relevant stakeholders were identified in 2020–2021 through expert interviews and interviewed by telephone to elicit key variables such as frequency of contact and intensity of collaboration. Throughout the NA, characteristics such as density, centrality, and connectedness were analyzed and are presented graphically. Due to the differences in the number of inhabitants and the rural or urban structure of the model regions, the three networks (network#1, network#2, and network#3) included 20, 14, and 12 stakeholders, respectively. All networks had similar densities (network#1, 48%; network#2, 52%; network#3, 42%), whereas the degree centrality of network#1 (0.57) and network#3 (0.58) was one-third higher compared with network#2 (0.39). All three networks differed in the distribution of stakeholders in terms of field of expertise and structural orientation. On average, stakeholders exchanged information quarterly and were connected on an informal level. Based on the results of the NA, it appears to be useful to initialize a community health facilitator to involve relevant stakeholders from the education, sports, and health systems in projects and to strive for the goal of sustainable health promotion, regardless of the rural or urban structure of the region. Participatory involvement of relevant stakeholders can have a positive influence on the effective dissemination of information and networking with other stakeholders.

Initiatives and partnerships in an Australian metropolitan obesity prevention system: a social network analysis

BACKGROUND

Limited resources make prevention of complex population-level issues such as obesity increasingly challenging. Collaboration and partnerships between organisations operating in the same system can assist, however, there is a paucity of research into how relationships function at a local level. The aim of this study was to audit initiatives, explore networks, and identify potential opportunities for improving the obesity prevention system in a Health Service area of Western Australia (WA).

METHODS

A mixed-methods study was undertaken in a metropolitan Health Service in Perth, WA in 2019-20. Structured face-to-face interviews (n = 51) were conducted with organisations engaged in obesity prevention, to identify prevention initiatives and their characteristics using a Systems Inventory tool. The Research Team identified the 30 most active organisations during the Systems Inventory, and an online Organisational Network Survey was administered to explore: relationships across six domains; partnership duration; frequency of interaction with other organisations; barriers to implementation; and key contributions to obesity prevention. Descriptive statistics were used to summarise barriers, contributions and Systems Inventory data. Organisational Network Survey data were analysed using social network analysis through UCINET 6 for Windows and Netdraw software. Whole network and cohesion scores were calculated: average degree; density; diameter; and degree centralization. Core-periphery analysis was conducted to identify densely connected core and sparsely connected periphery organisations.

RESULTS

The Systems Inventory identified 189 unique prevention initiatives, mostly focusing on individual-level behaviour change. Fifty four percent (n = 15) of the Organisational Network Survey respondent organisations and most core organisations (67%, n = 8) were government. The information and knowledge sharing network had a density of 45% indicating a high level of information and knowledge exchange between organisations. The lowest densities were found within the receiving (3.3%), providing (5.5%) and sharing (5.6%) funding networks, suggesting that these formal relationships were the least established.

CONCLUSION

Applying a systems thinking lens to local obesity prevention revealed that initiatives conducted focused on individual-level behaviour change and that collaboration and communication between organisations focused on information sharing. Capturing the extent and nature of initiatives and the way partnerships operate to improve obesity prevention can help to identify opportunities to strengthen the networks.

Macro- and meso-level contextual influences on health care inequities among American Indian elders

BACKGROUND

American Indian elders, aged 55 years and older, represent a neglected segment of the United States (U.S.) health care system. This group is more likely to be uninsured and to suffer from greater morbidities, poorer health outcomes and quality of life, and lower life expectancies compared to all other aging populations in the country. Despite the U.S. government's federal trust responsibility to meet American Indians' health-related needs through the Indian Health Service (IHS), elders are negatively affected by provider shortages, limited availability of health care services, and gaps in insurance. This qualitative study examines the perspectives of professional stakeholders involved in planning, delivery of, and advocating for services for this population to identify and analyze macro- and meso-level factors affecting access to and use of health care and insurance among American Indian elders at the micro level.

METHODS

Between June 2016 and March 2017, we undertook in-depth qualitative interviews with 47 professional stakeholders in two states in the Southwest U.S., including health care providers, outreach workers, public-sector administrators, and tribal leaders. The interviews focused on perceptions of both policy- and practice-related factors that bear upon health care inequities impacting elders. We analyzed iteratively the interview transcripts, using both open and focused coding techniques, followed by a critical review of the findings by a Community Action Board comprising American Indian elders.

RESULTS

Findings illuminated complex and multilevel contextual influences on health care inequities for elders, centering on (1) gaps in elder-oriented services; (2) benefits and limits of the Affordable Care Act (ACA); (2) invisibility of elders in national, state, and tribal policymaking; and (4) perceived threats to the IHS system and the federal trust responsibility.

CONCLUSIONS

Findings point to recommendations to improve the prevention and treatment of illness among American Indian elders by meeting their unique health care and insurance needs. Policies and practices must target meso and macro levels of contextual influence. Although Medicaid expansion under the ACA enables providers of essential services to elders, including the IHS, to enhance care through increased reimbursements, future policy efforts must improve upon this funding situation and fulfill the federal trust responsibility.