Success of community-based system dynamics in prevention interventions: A systematic review of the literature

The common drivers of children and young people's health and wellbeing across 13 local government areas: a systems view

BACKGROUND

System dynamics approaches, including group model building (GMB) and causal loop diagrams (CLDs), can be used to document complex public health problems from a community perspective. This paper aims to apply Social Network Analysis (SNA) methods to combine multiple CLDs created by local communities into a summary CLD, to identify common drivers of the health and wellbeing of children and young people.

METHODS

Thirteen community CLDs regarding children and young people health and wellbeing were merged into one diagram involving three steps: (1) combining variable names; (2) CLD merging, where multiple CLDs were combined into one CLD with a set of unique variables and connections; (3) paring, where the Decision-Making Trial and Evaluation Laboratory (DEMATEL) method was used to generate a cut-point to reduce the number of variables and connections and to rank the overall importance of each variable in the merged CLD.

RESULTS

Combining variable names resulted in 290 variables across the 13 CLDS. A total of 1,042 causal links were identified in the merged CLD. The DEMATEL analysis of the merged CLD identified 23 common variables with a net importance between 1.0 and 4.5 R + C values and 57 causal links. The variables with the highest net importance were 'mental health' and 'social connection & support' classified as high net receivers of influence within the system.

CONCLUSIONS

Combining large CLDs into a simple diagram represents a generalisable model of the drivers of complex health problems.

Methods and measures to evaluate the impact of participatory model building on public policymakers: a scoping review protocol

INTRODUCTION

Public policymakers are increasingly engaged in participatory model building processes, such as group model building. Understanding the impacts of policymaker participation in these processes on policymakers is important given that their decisions often have significant influence on the dynamics of complex systems that affect health. Little is known about the extent to which the impacts of participatory model building on public policymakers have been evaluated or the methods and measures used to evaluate these impacts.

METHODS AND ANALYSIS

A scoping review protocol was developed with the objectives of: (1) scoping studies that have evaluated the impacts of facilitated participatory model building processes on public policymakers who participated in these processes; and (2) describing methods and measures used to evaluate impacts and the main findings of these evaluations. The Joanna Briggs Institute's Population, Concept, Context framework was used to formulate the article identification process. Seven electronic databases-MEDLINE (Ovid), ProQuest Health and Medical, Scopus, Web of Science, Embase (Ovid), CINAHL Complete and PsycInfo-will be searched. Identified articles will be screened according to inclusion and exclusion criteria and the Preferred Reporting Items for Systematic Reviews and Meta-Analyses extension for Scoping Reviews checklist for scoping reviews will be used and reported. A data extraction tool will collect information across three domains: study characteristics, methods and measures, and findings. The review will be conducted using Covidence, a systematic review data management platform.

ETHICS AND DISSEMINATION

The scoping review produced will generate an overview of how public policymaker engagement in participatory model building processes has been evaluated. Findings will be disseminated through peer-reviewed publications and to communities of practice that convene policymakers in participatory model building processes. This review will not require ethics approval because it is not human subject research.

Strengthening the System Supporting Perinatal People with Substance Use Disorder in the Midwest Using Group Model Building

INTRODUCTION

Providing comprehensive, evidence-based care to perinatal people with substance use disorders (SUD) requires multi-stakeholder collaboration and alignment. The National Maternal and Child Health Workforce Development Center facilitated a system-strengthening process with the Midwest substance use in pregnancy (SUPper) club, a regional collaborative of health care providers, state public health agencies, and community-rooted organizations.

METHODS

Facilitators led a 2 day group model building (GMB) workshop with 20 participants and two semi-structured interviews. Workshop participants were invited to complete an evaluation.

RESULTS

Two primary trends were identified as priorities for change: (1) Birthing people's perception/experience of stigma and (2) The Midwest SUPper Club's reach and influence. Three causal loop diagrams (CLDs) were created to capture the interconnected dynamics of the Midwest perinatal SUD system: (1) the influence of stigma on maternal and infant health outcomes, (2) the role of clinic, organizational, and state policies, and (3) the impact of workforce education and evidence-based practices on care. From the CLDs, four priorities for action emerged: (1) align and promote shared mental models across stakeholders, (2) expand education and training opportunities for the perinatal SUD workforce, (3) strengthen systems infrastructure to support care navigation for patients and providers, and (4) collaboratively identify evidence-based practices that meet regional needs. All evaluation respondents reported that the workshop supported the development of a shared mental model.

DISCUSSION

The GMB process strengthened collaboration and advanced strategic planning for the SUPper Club. GMB can be further utilized among diverse stakeholders across MCH systems to create shared mental models and accelerate collaborative planning efforts.

Diet-Related Disease Prevention in a Rural Australian Setting: Understanding Barriers, Enablers, and the Role of Rural Health Services in Supporting Changes in Local Rural Food Environments

Bold and comprehensive action is needed to prevent diet-related diseases in rural areas, which includes improving food environments to enable healthier dietary practices. Rural health services are integral to the health of rural populations, yet their role in community disease prevention is not swell understood. This study sought to understand health service, local government, and food outlet stakeholders' perspectives on (1) the drivers of unhealthy retail environments in a rural setting; (2) the role of rural health services in supporting changes in local food environments; and to (3) identify characteristics of potential interventions. Two Group Model Building workshops were held with health service and local government leaders (n = 9), and interviews were conducted with local food outlet participants (n = 13). Key themes included 'enablers to healthier food environments', 'barriers to healthier food environments', 'Rural health services are a leading broker of knowledge for healthy food environments', and 'characteristics of desirable healthy food environment interventions.'. Rural health services can play a key role in addressing the current barriers to healthy food environments in rural areas. Effective promotion of healthier diets in rural populations will require consideration of key stakeholder perspectives and the development of further evidence on the role that rural health services can play in improving the healthiness of food environments.

Mapping communities as complex adaptive systems: A study of the response to violence against women by communities in Samoa

This paper explores the concept of communities as complex adaptive systems in the context of violence against women (VAW) prevention. Using thematic network analysis on data from 80 semi-structured interviews with community members in Samoa, we found that communities exhibit many properties of complex adaptive systems. Within nested systems, diverse and dynamic agents interact based on their knowledge and attitudes, which changes over time, leading to emergent and unpredictable outcomes. The functioning of communities and their response to VAW is a product of non-linear and emerging relationships and interactions between systems components at the community level. The approach we propose for conceptualising communities as complex adaptive systems provides a structured method for designing and evaluating community-based interventions that are grounded in the local context and existing resources. With in-depth knowledge of how a community works, interventions can be better equipped to address wicked problems such as VAW.

Systems thinking in local government: intervention design and adaptation in a community-based study

BACKGROUND

Systems thinking approaches are increasingly being used by communities to address complex chronic disease. This paper reports on the VicHealth Local Government Partnership (VLGP) which sought to co-create improvements in the health and well-being of children and young people by working with local government in Victoria, Australia.

METHODS

The VLGP included a series of health promotion modules, aimed at creating policy, programme and practice changes across local government. One of these modules, Connecting the Dots - creating solutions for lasting change, aimed to build capacity for systems thinking in municipal public health and well-being planning across 13 councils. The approach was adapted and data were collected on the stimuli for, and results of, adaptation.

RESULTS

The council adapted the systems thinking approach to meet geographic characteristics, priority health issue/s and participant target group needs. Adaptions applied to workshop materials, training delivery, existing and new resources, and to align with other community-based approaches. Stimuli for adaptation included the COVID-19 pandemic, needs of children and young people, capacity of council to deliver the workshop series, and time available within the project or for the participant group.

CONCLUSIONS

Systems thinking was used and adapted by councils to improve the health and well-being of children and young people and increase the voices of children and young people in decision-making. Flexible delivery is critical to ensure communities can adapt the approach to meet local needs.