Simulating system dynamics of the HIV care continuum to achieve treatment as prevention

Participatory Modeling for High Complexity, Multi-System Issues: Challenges and Recommendations for Balancing Qualitative Understanding and Quantitative Questions

Community stakeholder participation can be incredibly valuable for the qualitative model development process. However, modelers often encounter challenges for participatory modeling projects focusing on high-complexity, synergistic interactions between multiple issues, systems, and granularity. The diverse stakeholder perspectives and volumes of information necessary for developing such models can yield qualitative models that are difficult to translate into quantitative simulation or clear insight for informed decision-making. There are few reccomended best practices for developing high-complexity, participatory models. We use an ongoing project as a case study to highlight three practical challenges for tackling high-complexity, multi-system issues with system dynamics tools. These challenges include balanced and respectful stakeholder engagement, defining boundaries and levels of variable aggregation, and timing and processes for qualitative/quantitative model integration. Our five recommendations to address these challenges serve as a foundation for further research on methods for developing translatable qualitative multi-system models for informing actions for systemic change.

Applications of Participatory System Dynamics Methods to Public Health: A Systematic Review

System dynamics, and specifically qualitative participatory applications of system dynamics, have potential to benefit public health research, scholarship, and practice. A systematic review was conducted to examine the existing applications of participatory system dynamics (PSD) to public health research. Three databases were searched using unique search terms related to PSD and methodological applications in public health research. A total of 57 unique articles met inclusion criteria and were included for review. The studies included for review were conducted globally and represent a wide breadth of public health issues. The review identified several advantages to adopting PSD methods in public health scholarship and practice. The PSD methods provide innovative frameworks for conceptualizing complex and nuanced public health problems. The participatory nature of PSD allows for increased community engagement and empowerment to address public health problems, as well as to mitigate existing power dynamics between research institutions and marginalized communities that are disproportionately impacted by social and health inequities. Finally, causal loop diagrams developed using PSD methods have unique potential to convey complex concepts to policy makers and interventionists. This systematic review reports evidence for PSD's potential to advance equity in public health research and practice.

Sabounchi N. Application of group model building in implementation research: A systematic review of the public health and healthcare literature

BACKGROUND

Group model building is a process of engaging stakeholders in a participatory modeling process to elicit their perceptions of a problem and explore concepts regarding the origin, contributing factors, and potential solutions or interventions to a complex issue. Recently, it has emerged as a novel method for tackling complex, long-standing public health issues that traditional intervention models and frameworks cannot fully address. However, the extent to which group model building has resulted in the adoption of evidence-based practices, interventions, and policies for public health remains largely unstudied. The goal of this systematic review was to examine the public health and healthcare applications of GMB in the literature and outline how it has been used to foster implementation and dissemination of evidence-based interventions.

METHODS

We searched PubMed, Web of Science, and other databases through August 2022 for studies related to public health or health care where GMB was cited as a main methodology. We did not eliminate studies based on language, location, or date of publication. Three reviewers independently extracted data on GMB session characteristics, model attributes, and dissemination formats and content.

RESULTS

Seventy-two studies were included in the final review. Majority of GMB activities were in the fields of nutrition (n = 19, 26.4%), health care administration (n = 15, 20.8%), and environmental health (n = 12, 16.7%), and were conducted in the United States (n = 29, 40.3%) and Australia (n = 7, 9.7%). Twenty-three (31.9%) studies reported that GMB influenced implementation through policy change, intervention development, and community action plans; less than a third reported dissemination of the model outside journal publication. GMB was reported to have increased insight, facilitated consensus, and fostered communication among stakeholders.

CONCLUSIONS

GMB is associated with tangible benefits to participants, including increased community engagement and development of systems solutions. Transdisciplinary stakeholder involvement and more rigorous evaluation and dissemination of GMB activities are recommended.

The Application of Systems Thinking to the Prevention and Control of Sexually Transmissible Infections among Adolescents and Adults: A Scoping Review

Systems thinking is a mechanism for making sense of complex systems that challenge linear explanations of cause-and-effect. While the prevention and control of sexually transmissible infections (STIs) has been identified as an area that may benefit from systems-level analyses, no review on the subject currently exists. The aim of this study is to conduct a scoping review to identify literature in which systems thinking has been applied to the prevention and control of STIs among adolescent and adult populations. Joanna Briggs Institute guidelines for the conduct of scoping reviews were followed. Five databases were searched for English-language studies published after 2011. A total of n = 6102 studies were screened against inclusion criteria and n = 70 were included in the review. The majority of studies (n = 34) were conducted in African nations. Few studies focused on priority sub-populations, and 93% were focused on HIV (n = 65). The most commonly applied systems thinking method was system dynamics modelling (n = 28). The review highlights areas for future research, including the need for more STI systems thinking studies focused on: (1) migrant and Indigenous populations; (2) conditions such as syphilis; and (3) innovations such as pre-exposure prophylaxis and at-home testing for HIV. The need for conceptual clarity around 'systems thinking' is also highlighted.

Using participatory system dynamics learning to support Ryan White Planning Council priority setting and resource allocations

The Ryan White CARE Act provides federal dollars supporting low income people living with HIV/AIDS (PLWH). Regional Ryan White Planning Councils (RWPC) are responsible for setting priorities and deciding CARE Act fund allocations, using local data to identify greatest need. However, RWPC are challenged with interpreting complex epidemiological, service utilization, and community needs data to inform priority setting and resource allocations. We piloted system dynamics (SD) learning, using a validated HIV care continuum SD simulation model calibrated to one northeastern U.S. Ryan White funding area. The pilot applied systems thinking to understand the complex HIV care continuum and to simulate and compare outcomes of various resource allocation decisions. Three scripted workshops provided opportunities to learn the SD modeling process and simulation tool, simulate various resource allocations, and compare population health outcomes. Mixed methods evaluation documented the SD modeling process, member responses to the modeling sessions, and attitudes regarding benefits and limitations of SD modeling for RWPC decision-making. Despite high member turnover and complexity of the SD model, members could understand the simulation model and propose strategies to seek greatest improvements in HIV care retention, viral suppression, and reduced infections. Findings suggests the value of SD modeling to assist RWPC decisions.

Meanings and significance attributed by people with HIV/aids to their lives with this virus/disease

OBJECTIVES

to understand the meanings and significance attributed by people with HIV/aids to the process of living with this virus/disease.

METHODS

qualitative and exploratory study, carried out in Rio de Janeiro, Brazil. The Grounded Theory and the Symbolic Interactionism were used. Data were collected in a semistructured interview and through non-participant observation, from August 2017 to May 2018. 29 patients participated.

RESULTS

living with HIV/AIDS is a social phenomenon in which it is not possible to disconnect the process of adapting to the disease from the social relations one (re)constructs during life. It also involves stigmatization, rejection, and isolation.

FINAL CONSIDERATIONS

understanding the meanings of this process is a positive influence for proactive behavior and resilience, not only in regard to the care concerning the presence of the virus and the uninterrupted need to adhere to medication, but also in the way to deal with the social values that reproduce previous models, which, in turn, can help improve self-knowledge.