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Qin T, Li X, Qiao K, Bai X, Gu M, Wang Y. Utilizing Group Model Building to Identify Barriers and Facilitators of Hypertension Management in Primary Health Care, China. Risk Manag Healthc Policy 2024; 17:1227-1237. [PMID: 38765783 PMCID: PMC11100508 DOI: 10.2147/rmhp.s454748] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/13/2023] [Accepted: 04/12/2024] [Indexed: 05/22/2024] Open
Abstract
Purpose Group Model Building (GMB) is a qualitative method that refers to a participatory process. This project aims to identify barriers and facilitators of hypertension management in primary health care in China, through which, the leverage point for intervention may be found. Methods The GMB was used to identify the factors influencing hypertension management. Graphs over time and causal loop diagram (CLD) were main tools of GMB. To propose the influencing factors, key stakeholders were invited to participate in a workshop. During the workshop, stakeholders were encouraged to plot the graphs over time of the variables about research issues and give a descriptive explanation. And based on this, a CLD was initially developed to establish a model of the interaction of factors. After the workshop, the research group further improved the CLD through repeated mutual discussions, and gave feedback to the participants. The Vensim PLE 9.0 software package was used to build CLD. Results A total of 14 key stakeholders were invited to participate in the workshop. Finally, 26 influencing factors were identified, which were divided into three dimensions, including the institutional, the community health workers (CHWs), and the patient level. And 5 reinforcing loops and 4 balancing loops were formed in the CLD. Promoting the building of the Medical Community/Regional Medical Association, implementing the family doctor contract service (FDCS), and enhancing the motivation of CHWs may be potential leverage points for hypertension management in China. Conclusion By using GMB, we have identified key factors in the management of hypertension in primary health care and provided comprehensive suggestions to overcome the obstacles.
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Affiliation(s)
- Tingting Qin
- School of Public Health, Capital Medical University, Beijing, People’s Republic of China
| | - Xingming Li
- School of Public Health, Capital Medical University, Beijing, People’s Republic of China
| | - Kun Qiao
- School of Public Health, Capital Medical University, Beijing, People’s Republic of China
| | - Xinyuan Bai
- School of Public Health, Capital Medical University, Beijing, People’s Republic of China
| | - Mingyu Gu
- School of Public Health, Capital Medical University, Beijing, People’s Republic of China
| | - Yao Wang
- School of Public Health, Capital Medical University, Beijing, People’s Republic of China
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Neufeld LM, Nordhagen S, Leroy JL, Aberman NL, Barnett I, Djimeu Wouabe E, Webb Girard A, Gonzalez W, Levin CE, Mbuya MN, Nakasone E, Nyhus Dhillon C, Prescott D, Smith M, Tschirley D. Food Systems Interventions for Nutrition: Lessons from 6 Program Evaluations in Africa and South Asia. J Nutr 2024:S0022-3166(24)00176-7. [PMID: 38582386 DOI: 10.1016/j.tjnut.2024.04.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/11/2024] [Revised: 03/27/2024] [Accepted: 04/02/2024] [Indexed: 04/08/2024] Open
Abstract
Although there is growing global momentum behind food systems strategies to improve planetary and human health-including nutrition-there is limited evidence of what types of food systems interventions work. Evaluating these types of interventions is challenging due to their complex and dynamic nature and lack of fit with standard evaluation methods. In this article, we draw on a portfolio of 6 evaluations of food systems interventions in Africa and South Asia that were intended to improve nutrition. We identify key methodological challenges and formulate recommendations to improve the quality of such studies. We highlight 5 challenges: a lack of evidence base to justify the intervention, the dynamic and multifaceted nature of the interventions, addressing attribution, collecting or accessing accurate and timely data, and defining and measuring appropriate outcomes. In addition to more specific guidance, we identify 6 cross-cutting recommendations, including a need to use multiple and diverse methods and flexible designs. We also note that these evaluation challenges present opportunities to develop new methods and highlight several specific needs in this space.
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Affiliation(s)
- Lynnette M Neufeld
- Food and Nutrition Division, Food and Agriculture Organization of the United Nations (FAO), Rome, Italy.
| | - Stella Nordhagen
- Knowledge Leadership Team, Global Alliance for Improved Nutrition (GAIN), Geneva, Switzerland
| | - Jef L Leroy
- Nutrition, Diets and Health Unit, International Food Policy Research Institute, Washington, DC, United States
| | - Noora-Lisa Aberman
- Knowledge Leadership Team, Global Alliance for Improved Nutrition (GAIN), Geneva, Switzerland
| | - Inka Barnett
- Institute of Development Studies (IDS), University of Sussex, Brighton, United Kingdom
| | - Eric Djimeu Wouabe
- Evaluation and Adaptive Learning, Results for Development (R4D), Washington, DC, United States
| | - Amy Webb Girard
- Nutrition and Health Sciences Program, Hubert Department of Global Health, Rollins School of Public Health, Emory University, Atlanta, GA, United States
| | - Wendy Gonzalez
- Knowledge Leadership Team, Global Alliance for Improved Nutrition (GAIN), Geneva, Switzerland
| | - Carol E Levin
- Department of Global Health, University of Washington, Seattle, WA, United States
| | - Mduduzi Nn Mbuya
- Knowledge Leadership Team, Global Alliance for Improved Nutrition (GAIN), Geneva, Switzerland
| | - Eduardo Nakasone
- Department of Agricultural, Food and Resource Economics, Michigan State University, East Lansing, MI, United States
| | - Christina Nyhus Dhillon
- Knowledge Leadership Team, Global Alliance for Improved Nutrition (GAIN), Geneva, Switzerland
| | | | | | - David Tschirley
- Department of Agricultural, Food and Resource Economics, Michigan State University, East Lansing, MI, United States
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Heemskerk DM, Busch V, Piotrowski JT, Waterlander WE, Renders CM, van Stralen MM. A system dynamics approach to understand Dutch adolescents' sleep health using a causal loop diagram. Int J Behav Nutr Phys Act 2024; 21:34. [PMID: 38519989 PMCID: PMC10958857 DOI: 10.1186/s12966-024-01571-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/24/2023] [Accepted: 02/13/2024] [Indexed: 03/25/2024] Open
Abstract
BACKGROUND Healthy sleep is crucial for the physical and mental wellbeing of adolescents. However, many adolescents suffer from poor sleep health. Little is known about how to effectively improve adolescent sleep health as it is shaped by a complex adaptive system of many interacting factors. This study aims to provide insights into the system dynamics underlying adolescent sleep health and to identify impactful leverage points for sleep health promotion interventions. METHODS Three rounds of single-actor workshops, applying Group Model Building techniques, were held with adolescents (n = 23, 12-15 years), parents (n = 14) and relevant professionals (n = 26). The workshops resulted in a multi-actor Causal Loop Diagram (CLD) visualizing the system dynamics underlying adolescent sleep health. This CLD was supplemented with evidence from the literature. Subsystems, feedback loops and underlying causal mechanisms were identified to understand overarching system dynamics. Potential leverage points for action were identified applying the Action Scales Model (ASM). RESULTS The resulting CLD comprised six subsystems around the following themes: (1) School environment; (2) Mental wellbeing; (3) Digital environment; (4) Family & Home environment; (5) Health behaviors & Leisure activities; (6) Personal system. Within and between these subsystems, 16 reinforcing and 7 balancing feedback loops were identified. Approximately 60 potential leverage points on different levels of the system were identified as well. CONCLUSIONS The multi-actor CLD and identified system dynamics illustrate the complexity of adolescent sleep health and supports the need for developing a coherent package of activities targeting different leverage points at all system levels to induce system change.
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Affiliation(s)
- Danique M Heemskerk
- Department of Health Sciences, Faculty of Science and Amsterdam Public Health Research Institute, Vrije Universiteit Amsterdam, Amsterdam, The Netherlands.
- Department of Healthy Living, Public Health Service (GGD), Sarphati Amsterdam, City of Amsterdam, The Netherlands.
| | - Vincent Busch
- Department of Healthy Living, Public Health Service (GGD), Sarphati Amsterdam, City of Amsterdam, The Netherlands
| | - Jessica T Piotrowski
- Amsterdam School of Communication Research ASCoR, University of Amsterdam, Amsterdam, The Netherlands
| | - Wilma E Waterlander
- Department of Public and Occupational Health, Amsterdam Public Health Research Institute, Amsterdam UMC Location University of Amsterdam, Amsterdam, The Netherlands
| | - Carry M Renders
- Department of Health Sciences, Faculty of Science and Amsterdam Public Health Research Institute, Vrije Universiteit Amsterdam, Amsterdam, The Netherlands
| | - Maartje M van Stralen
- Department of Health Sciences, Faculty of Science and Amsterdam Public Health Research Institute, Vrije Universiteit Amsterdam, Amsterdam, The Netherlands.
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Pickard KE, Hendrix NM, Greenfield ES, Yohannes M. Using Causative Methods to Determine System-Level Factors Driving the Uptake and Use of Evidence-Based Practices in a Public Early Intervention System. ADMINISTRATION AND POLICY IN MENTAL HEALTH AND MENTAL HEALTH SERVICES RESEARCH 2024:10.1007/s10488-024-01346-6. [PMID: 38431889 DOI: 10.1007/s10488-024-01346-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/18/2024] [Indexed: 03/05/2024]
Abstract
Part C Early Intervention (EI) systems are an entry point to services for autistic toddlers and can be leveraged to facilitate access to autism evidence-based practices (EBPs). However, EI systems are complex and limited research has examined how an EI system's infrastructure (i.e. system-level factors) impacts the adoption and implementation of EBPs. To address this gap, 36 EI providers and 9 EI administrators completed a semi-structured interview or focus group about factors impacting the implementation of autism EBPs. Qualitative analysis included a combination of grounded theory and causative coding. Analyses were refined by input from providers, administrators, and family stakeholders in the form of round tables and presentations at the state's interagency coordinating council. Primary themes centered on: (1) the costs associated with independent contracting structures; (2) operational demands; (3) workforce stability; (4) communication consistency; and (5) implementation supports for EBP implementation. Causative coding helped to demonstrate the perceived relationships between these factors and underscored the important role of incentivization structures, collaboration opportunities, and championing in supporting the use of EBPs within a system that primarily uses independent contracting structures. The current study extends previous research by demonstrating how several system-level factors are perceived to play a role in the adoption and implementation of EBPs by independently contracted EI providers. These findings underscore the need for implementation strategies, such as incentivization strategies and social network building, to increase providers' implementation of autism EBPs within EI systems.
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Affiliation(s)
- Katherine E Pickard
- Department of Pediatrics, Division of Autism and Related Disabilities, Emory University School of Medicine, Atlanta, USA.
- Marcus Autism Center, Children's Healthcare of Atlanta, Atlanta, USA.
| | - Nicole M Hendrix
- Department of Pediatrics, Division of Autism and Related Disabilities, Emory University School of Medicine, Atlanta, USA
- Marcus Autism Center, Children's Healthcare of Atlanta, Atlanta, USA
| | - Elizabeth S Greenfield
- Department of Pediatrics, Division of Autism and Related Disabilities, Emory University School of Medicine, Atlanta, USA
- Marcus Autism Center, Children's Healthcare of Atlanta, Atlanta, USA
| | - Millena Yohannes
- Department of Pediatrics, Division of Autism and Related Disabilities, Emory University School of Medicine, Atlanta, USA
- Marcus Autism Center, Children's Healthcare of Atlanta, Atlanta, USA
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Luna Pinzon A, Waterlander W, de Pooter N, Altenburg T, Dijkstra C, Emke H, van den Eynde E, Overman ML, Busch V, Renders CM, Halberstadt J, Nusselder W, den Hertog K, Chinapaw M, Verhoeff A, Stronks K. Development of an action programme tackling obesity-related behaviours in adolescents: a participatory system dynamics approach. Health Res Policy Syst 2024; 22:30. [PMID: 38429775 PMCID: PMC10908105 DOI: 10.1186/s12961-024-01116-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/30/2023] [Accepted: 02/02/2024] [Indexed: 03/03/2024] Open
Abstract
System dynamics approaches are increasingly addressing the complexity of public health problems such as childhood overweight and obesity. These approaches often use system mapping methods, such as the construction of causal loop diagrams, to gain an understanding of the system of interest. However, there is limited practical guidance on how such a system understanding can inform the development of an action programme that can facilitate systems changes. The Lifestyle Innovations Based on Youth Knowledge and Experience (LIKE) programme combines system dynamics and participatory action research to improve obesity-related behaviours, including diet, physical activity, sleep and sedentary behaviour, in 10-14-year-old adolescents in Amsterdam, the Netherlands. This paper illustrates how we used a previously obtained understanding of the system of obesity-related behaviours in adolescents to develop an action programme to facilitate systems changes. A team of evaluation researchers guided interdisciplinary action-groups throughout the process of identifying mechanisms, applying the Intervention Level Framework to identify leverage points and arriving at action ideas with aligning theories of change. The LIKE action programme consisted of 8 mechanisms, 9 leverage points and 14 action ideas which targeted the system's structure and function within multiple subsystems. This illustrates the feasibility of developing actions targeting higher system levels within the confines of a research project timeframe when sufficient and dedicated effort in this process is invested. Furthermore, the system dynamics action programme presented in this study contributes towards the development and implementation of public health programmes that aim to facilitate systems changes in practice.
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Affiliation(s)
- Angie Luna Pinzon
- Department of Public and Occupational Health, Amsterdam UMC Location University of Amsterdam, Meibergdreef 9, Amsterdam, The Netherlands.
- Health Behaviors and Chronic Diseases, Amsterdam Public Health Research Institute, Amsterdam, The Netherlands.
| | - Wilma Waterlander
- Department of Public and Occupational Health, Amsterdam UMC Location University of Amsterdam, Meibergdreef 9, Amsterdam, The Netherlands
- Health Behaviors and Chronic Diseases, Amsterdam Public Health Research Institute, Amsterdam, The Netherlands
| | - Naomi de Pooter
- Department of Public and Occupational Health, Amsterdam UMC Location University of Amsterdam, Meibergdreef 9, Amsterdam, The Netherlands
- Health Behaviors and Chronic Diseases, Amsterdam Public Health Research Institute, Amsterdam, The Netherlands
| | - Teatske Altenburg
- Health Behaviors and Chronic Diseases, Amsterdam Public Health Research Institute, Amsterdam, The Netherlands
- Department of Public and Occupational Health, Amsterdam UMC Location Vrije Universiteit Amsterdam, De Boelelaan 1117, Amsterdam, The Netherlands
| | - Coosje Dijkstra
- Health Behaviors and Chronic Diseases, Amsterdam Public Health Research Institute, Amsterdam, The Netherlands
- Department of Health Sciences, Faculty of Science, Vrije Universiteit Amsterdam, 1081HV, Amsterdam, The Netherlands
| | - Helga Emke
- Health Behaviors and Chronic Diseases, Amsterdam Public Health Research Institute, Amsterdam, The Netherlands
- Department of Public and Occupational Health, Amsterdam UMC Location Vrije Universiteit Amsterdam, De Boelelaan 1117, Amsterdam, The Netherlands
- Department of Health Sciences, Faculty of Science, Vrije Universiteit Amsterdam, 1081HV, Amsterdam, The Netherlands
| | - Emma van den Eynde
- Division of Endocrinology, Department of Pediatrics, Erasmus MC-Sophia Children's Hospital, University Medical Centre Rotterdam, Rotterdam, The Netherlands
| | - Meredith L Overman
- Department of Health Promotion, NUTRIM School of Nutrition and Translational Research in Metabolism, Maastricht University, 6229ER, Maastricht, The Netherlands
| | - Vincent Busch
- Sarphati Amsterdam, Public Health Service (GGD), City of Amsterdam, Nieuwe Achtergracht 100, 1018WT, Amsterdam, The Netherlands
| | - Carry M Renders
- Health Behaviors and Chronic Diseases, Amsterdam Public Health Research Institute, Amsterdam, The Netherlands
- Department of Health Sciences, Faculty of Science, Vrije Universiteit Amsterdam, 1081HV, Amsterdam, The Netherlands
| | - Jutka Halberstadt
- Health Behaviors and Chronic Diseases, Amsterdam Public Health Research Institute, Amsterdam, The Netherlands
- Department of Health Sciences, Faculty of Science, Vrije Universiteit Amsterdam, 1081HV, Amsterdam, The Netherlands
| | - Wilma Nusselder
- Department of Public Health, Erasmus MC, University Medical Center Rotterdam, 3015CN, Rotterdam, The Netherlands
| | - Karen den Hertog
- Amsterdam Healthy Weight Approach, Public Health Service (GGD), City of Amsterdam, Nieuwe Achtergracht 100, 1018WT, Amsterdam, The Netherlands
| | - Mai Chinapaw
- Health Behaviors and Chronic Diseases, Amsterdam Public Health Research Institute, Amsterdam, The Netherlands
- Department of Public and Occupational Health, Amsterdam UMC Location Vrije Universiteit Amsterdam, De Boelelaan 1117, Amsterdam, The Netherlands
| | - Arnoud Verhoeff
- Sarphati Amsterdam, Public Health Service (GGD), City of Amsterdam, Nieuwe Achtergracht 100, 1018WT, Amsterdam, The Netherlands
- Department of Sociology, University of Amsterdam, 1018WV, Amsterdam, The Netherlands
| | - Karien Stronks
- Department of Public and Occupational Health, Amsterdam UMC Location University of Amsterdam, Meibergdreef 9, Amsterdam, The Netherlands
- Health Behaviors and Chronic Diseases, Amsterdam Public Health Research Institute, Amsterdam, The Netherlands
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Chinapaw MJM, Klaufus LH, Oyeyemi AL, Draper C, Palmeira AL, Silva MN, Van Belle S, Pawlowski CS, Schipperijn J, Altenburg TM. Youth-centred participatory action approach towards co-created implementation of socially and physically activating environmental interventions in Africa and Europe: the YoPA project study protocol. BMJ Open 2024; 14:e084657. [PMID: 38387985 PMCID: PMC10882351 DOI: 10.1136/bmjopen-2024-084657] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/24/2024] [Accepted: 02/08/2024] [Indexed: 02/24/2024] Open
Abstract
INTRODUCTION The majority of adolescents do not meet guidelines for healthy behaviours, posing major risks for developing multiple non-communicable diseases. Unhealthy lifestyles seem more prevalent in urban than rural areas, with the neighbourhood environment as a mediating pathway. How to develop and implement sustainable and effective interventions focused on adolescent health and well-being in urban vulnerable life situations is a key challenge. This paper describes the protocol of a Youth-centred Participatory Action (YoPA) project aiming to tailor, implement, and evaluate social and physical environmental interventions. METHODS AND ANALYSIS In diverse urban environments in Denmark, the Netherlands, Nigeria and South Africa, we will engage a dynamic group of 15-20 adolescents (12-19 years) growing up in vulnerable life situations and other key stakeholders (eg, policy makers, urban planners, community leaders) in local co-creation communities. Together with academic researchers and local stakeholders, adolescents will take a leading role in mapping the local system; tailoring; implementing and evaluating interventions during participatory meetings over the course of 3 years. YoPA applies a participatory mixed methods design guided by a novel Systems, User perspectives, Participatory co-creation process, Effects, Reach, Adoption, Implementation and Maintenance framework assessing: (i) the local systems, (ii) user perspectives, (iii) the participatory co-creation process, (iv) effects, (v) reach, (vi) adoption, (vii) implementation and (viii) maintenance of interventions. Through a realist evaluation, YoPA will explore why and how specific outcomes were reached (or not) in each setting (n=800-1000 adolescents in total). ETHICS AND DISSEMINATION This study received approval from the ethics committees in Denmark, the Netherlands, Nigeria and South Africa and will be disseminated via various collaborative dissemination activities targeting multiple audiences. We will obtain informed consent from all participants. We envision that our YoPA co-creation approach will serve as a guide for participation of adolescents in vulnerable life situations in implementation of health promotion and urban planning in Europe, Africa and globally. TRIAL REGISTRATION NUMBER NCT06181162.
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Affiliation(s)
- Mai J M Chinapaw
- Public and Occupational Health, Amsterdam UMC Location VUmc, Amsterdam, The Netherlands
- Health Behaviours and Chronic Diseases, Amsterdam Public Health Research Institute, Amsterdam, The Netherlands
| | - Leonie H Klaufus
- Public and Occupational Health, Amsterdam UMC Location VUmc, Amsterdam, The Netherlands
- Health Behaviours and Chronic Diseases, Amsterdam Public Health Research Institute, Amsterdam, The Netherlands
| | - Adewale L Oyeyemi
- College of Health Solutions, Arizona State University, Phoenix, Arizona, USA
- Department of Physiotherapy, Redeemer's University, Ede, Nigeria
| | - Catherine Draper
- SAMRC Developmental Pathways for Health Research Unit, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
| | - António L Palmeira
- CIDEFES, Universidade Lusófona, Lisboa, Portugal
- CIFI2D, Universidade do Porto, Porto, Lisbon
| | - Marlene Nunes Silva
- CIDEFES, Universidade Lusófona, Lisboa, Portugal
- Programa Nacional para a Promoção da Atividade Física, Direcção-Geral da Saúde, Lisboa, Portugal
| | - Sara Van Belle
- Department of Public Health, Institute of Tropical Medicine, Antwerpen, Belgium
| | - Charlotte S Pawlowski
- Department of Sports Science and Clinical Biomechanics, University of Southern Denmark, Odense, Denmark
| | - Jasper Schipperijn
- Department of Sports Science and Clinical Biomechanics, University of Southern Denmark, Odense, Denmark
| | - Teatske M Altenburg
- Public and Occupational Health, Amsterdam UMC Location VUmc, Amsterdam, The Netherlands
- Health Behaviours and Chronic Diseases, Amsterdam Public Health Research Institute, Amsterdam, The Netherlands
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Sørensen SO, Larsen KT, Høy TV, Hansen ABG, Jago R, Kristensen PL, Toftager M, Grøntved A, Gejl AK. Study protocol for the Screen-Free Time with Friends Feasibility Trial. Pilot Feasibility Stud 2024; 10:33. [PMID: 38374084 PMCID: PMC10875870 DOI: 10.1186/s40814-024-01462-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/26/2023] [Accepted: 02/06/2024] [Indexed: 02/21/2024] Open
Abstract
BACKGROUND Children are spending less leisure time with their friends in person and an increasing amount of time with digital screens. These changes may negatively affect children's physical and mental health. The Screen-Free Time with Friends Feasibility Trial will test the feasibility, including acceptability and compliance, of an intervention designed to reduce screen media usage and encourage physical interaction with friends during leisure time in 9-11-year-old children. METHODS A non-randomized single-group feasibility trial will be conducted from March to October 2023 including approximately 75 children (aged 9-11 years) and 75 parents (at least 1 per child) from 3 different schools recruited from 3 different municipalities in Denmark. The Screen-Free Time with Friends intervention is a multicomponent intervention targeting families, afterschool clubs, and local communities. It has been developed using a systematic process guided by the Medical Research Council UK's framework for developing and evaluating complex interventions. With a systems perspective in mind, the intervention and implementation approach has been designed to facilitate adaptation to the specific needs of diverse local communities while maintaining the core components of the intervention. Feasibility and acceptability of the intervention will be assessed during the intervention using process evaluation inspired by the RE-AIM framework including questionnaires and interviews with the municipality project managers, research team members, local ambassadors and stakeholders, parents and school, and afterschool club personnel. In addition, participation, recruitment, retention rate, and compliance to the outcome measurements will be investigated and presented. DISCUSSION The trial will investigate the feasibility and acceptability of the Screen-Free Time with Friends intervention, the recruitment strategy, and the planned outcome measurements. This feasibility study will investigate necessary refinements before the implementation of the intervention program in a larger cluster randomized controlled trial to evaluate its impact. TRIAL REGISTRATION CLINICALTRIALS gov, ID: NCT05480085. Registered 29 July 2022. https://clinicaltrials.gov/ct2/show/NCT05480085?cond=Screen+free+time+with+friends&draw=2&rank=1.
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Affiliation(s)
- Sarah Overgaard Sørensen
- Research Unit for Exercise Epidemiology, Department of Sports Science and Clinical Biomechanics, University of Southern Denmark, Odense, Denmark.
| | - Kristian Traberg Larsen
- Research Unit for Exercise Epidemiology, Department of Sports Science and Clinical Biomechanics, University of Southern Denmark, Odense, Denmark
| | - Teresa Victoria Høy
- National Institute of Public Health, University of Southern Denmark, Copenhagen, Denmark
| | | | - Russell Jago
- Population Health Sciences, Bristol Medical School, University of Bristol, Bristol, UK
- NIHR Bristol Biomedical Research Centre, University Hospitals Bristol and Weston NHS Foundation Trust and University of Bristol, Bristol, UK
| | - Peter Lund Kristensen
- Research Unit for Exercise Epidemiology, Department of Sports Science and Clinical Biomechanics, University of Southern Denmark, Odense, Denmark
| | - Mette Toftager
- Research Unit for Active Living, Department of Sports Science and Clinical Biomechanics, University of Southern Denmark, Odense, Denmark
| | - Anders Grøntved
- Research Unit for Exercise Epidemiology, Department of Sports Science and Clinical Biomechanics, University of Southern Denmark, Odense, Denmark
| | - Anne Kær Gejl
- Research Unit for Exercise Epidemiology, Department of Sports Science and Clinical Biomechanics, University of Southern Denmark, Odense, Denmark
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Nicholson CF, Monterrosa E. Analysing the potential impacts of three interventions on fruit and vegetable consumption in urban Kenya using participatory systems modelling. Public Health Nutr 2023; 26:3076-3087. [PMID: 37721018 PMCID: PMC10755454 DOI: 10.1017/s1368980023002033] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/28/2023] [Revised: 08/03/2023] [Accepted: 09/11/2023] [Indexed: 09/19/2023]
Abstract
OBJECTIVE This study uses participatory modelling with stakeholders to assess the potential impacts of three interventions intended to increase fruit and vegetable (F&V) consumption in urban Kenya. DESIGN A participatory process using Group Model Building (GMB) developed a conceptual model of the determinants of vegetable consumption. A subsequent quantitative System Dynamics model using data from primary and secondary sources simulated vegetable consumption from 2020 to 2024 under three proposed interventions suggested by stakeholders: increasing consumer awareness, reducing post-harvest losses and increasing farm yields. Model analyses assumed mean parameter values and assessed uncertainty using 200 simulations with randomised parameter values. SETTING The research was implemented in Nairobi, Kenya with simulation analyses of mean per capita consumption in this location. PARTICIPANTS Workshops convened diverse F&V value chain stakeholders (farmers, government officials, NGO staff and technical experts) to develop the conceptual model, data inputs and intervention scenarios. RESULTS Increasing consumer awareness was simulated to increase vegetable consumption by relatively modest amounts by 2024 (5 g/person/d from a base of 131 g/person/d) under mean assumed value of value chain response parameters. Reducing perishability was simulated to reduce consumption due to the higher costs required to reduce losses. Increasing farm yields was simulated to have the largest impact on consumption at assumed parameter values (about 40 g/person/d) but would have a negative impact on farm profits, which could undermine efforts to implement this intervention. CONCLUSIONS The combination of GMB and simulation modelling informed intervention priorities for an important public health nutrition issue.
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Affiliation(s)
- Charles F Nicholson
- Department of Agricultural and Applied Economics, University of Wisconsin—Madison, 442 Animal Science Building, 1675 Observatory Drive, Madison, WI53706, USA
| | - Eva Monterrosa
- Global Alliance for Improved Nutrition, Geneva, Switzerland
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Decker H, Wendel M. Applications of Participatory System Dynamics Methods to Public Health: A Systematic Review. FAMILY & COMMUNITY HEALTH 2023; 46:S6-S21. [PMID: 37696012 DOI: 10.1097/fch.0000000000000369] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 09/13/2023]
Abstract
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.
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Affiliation(s)
- Hallie Decker
- Health Equity Innovation Hub, University of Louisville, Louisville, Kentucky (Ms Decker); and Health Promotion & Behavioral Sciences, School of Public Health and Information Sciences, and Health Equity Innovation Hub, University of Louisville, Louisville, Kentucky (Dr Wendel)
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10
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Li B, He Z, Peters R, Allender S, Zou Y, Zhou W, Lao J, Poh BK, Swinburn B. Cultural adaptations and methodological innovations to group model building for the systems actions to reduce malnutrition in all its forms in Southeast Asian countries and China (SYSTAM CHINA-SEACS International Consortium) project. Int J Behav Nutr Phys Act 2023; 20:111. [PMID: 37723534 PMCID: PMC10506199 DOI: 10.1186/s12966-023-01510-5] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2023] [Accepted: 09/02/2023] [Indexed: 09/20/2023] Open
Abstract
BACKGROUND Group Model Building (GMB) is a participatory system dynamics method increasingly used to address complex public health issues like obesity. GMB represents a set of well-defined steps to engage key stakeholders to identify shared drivers and solutions of a given problem. However, GMB has not yet been applied specifically to develop multi-duty interventions that address multiple inter-related issues such as malnutrition in all its forms (MIAIF). Moreover, a recent systematic review of empirical applications of a systems approach to developing obesity interventions found no published work from non-western, low- and middle-income countries (LMICs). In this paper we describe adaptations and innovations to a common GMB process to co-develop systemic MIAIF interventions with Chinese decision-makers. METHODS We developed, piloted and implemented multiple cultural adaptations and two methodological innovations to the commonly used GMB process in Fang Cheng Gang city, China. We included formal, ceremonial and policy maker engagement events before and between GMB workshops, and incorporated culturally tailored arrangements during participant recruitment (officials of the same seniority level joined the same workshop) and workshop activities (e.g., use of individual scoring activities and hand boards). We made changes to the commonly used GMB activities which enabled mapping of shared drivers of multiple health issues (in our case MIAIF) in a single causal loop diagram. We developed and used a 'hybrid' GMB format combining online and in person facilitation to reduce travel and associated climate impact. RESULTS Our innovative GMB process led to high engagement and support from decision-makers representing diverse governmental departments across the whole food systems. We co-identified and prioritised systemic drivers and intervention themes of MIAIF. The city government established an official Local Action Group for long-term, inter-departmental implementation, monitoring and evaluation of the co-developed interventions. The 'hybrid' GMB format enabled great interactions while reducing international travel and mitigating limitations of fully online GMB process. CONCLUSIONS Cultural and methodological adaptations to the common GMB process for an Asian LMIC setting were successful. The 'hybrid' GMB format is feasible, cost-effective, and more environmentally friendly. These cultural adaptations could be considered for other Asian settings and beyond to address inter-related, complex issues such as MIAIF.
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Affiliation(s)
- Bai Li
- Centre for Exercise, Nutrition and Health Sciences, School for Policy Studies, University of Bristol, Bristol, UK.
- School of Public Health, Guangxi Medical University, Nanning, Guangxi, China.
| | - Zouyan He
- School of Public Health, Guangxi Medical University, Nanning, Guangxi, China
| | - Remco Peters
- Centre for Exercise, Nutrition and Health Sciences, School for Policy Studies, University of Bristol, Bristol, UK
| | - Steven Allender
- Global Centre for Preventive Health and Nutrition (GLOBE), Institute for Health Transformation, Faculty of Health, Deakin University, Geelong, VIC, Australia
| | - Yunfeng Zou
- School of Public Health, Guangxi Medical University, Nanning, Guangxi, China.
| | - Weiwen Zhou
- Institute of Nutrition and School Health, Guangxi Zhuang Autonomous Region Center for Disease Control and Prevention, Nanning, Guangxi, China
| | - Jianfeng Lao
- Fang Cheng Gang Health Commission, Fangchenggang, Guangxi, China
| | - Bee Koon Poh
- Centre for Community Health Studies (ReaCH), Faculty of Health Sciences, Universiti Kebangsaan Malaysia, Kuala Lumpur, Malaysia
| | - Boyd Swinburn
- School of Population Health, University of Auckland, Auckland, New Zealand
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Needham C, Wheaton N, Wong Shee A, McNamara K, Malakellis M, Murray M, Alston L, Peeters A, Ugalde A, Huggins C, Yoong S, Allender S. Enhancing healthcare at home for older people in rural and regional Australia: A protocol for co-creation to design and implement system change. PLoS One 2023; 18:e0290386. [PMID: 37682945 PMCID: PMC10490867 DOI: 10.1371/journal.pone.0290386] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/20/2023] [Accepted: 08/07/2023] [Indexed: 09/10/2023] Open
Abstract
BACKGROUND World-wide, health service providers are moving towards innovative models of clinical home-based care services as a key strategy to improve equity of access and quality of care. To optimise existing and new clinical home-based care programs, evidence informed approaches are needed that consider the complexity of the health care system across different contexts. METHODS We present a protocol for working with health services and their partners to perform rapid identification, prioritisation, and co-design of content-appropriate strategies to optimise the delivery of healthcare at home for older people in rural and regional areas. The protocol combines Systems Thinking and Implementation Science using a Consensus Mapping and Co-design (CMC) process delivered over five workshops. DISCUSSION The protocol will be implemented with rural and regional healthcare providers to identify digital and non-digital solutions that have the potential to inform models of service delivery, improve patient experience, and optimise health outcomes. The combination of system and implementation science is a unique approach for optimising healthcare at home for older populations, especially in the rural context where need is high. This is the first protocol to integrate the use of systems and implementation science into one process and articulating these methods will help with replicating this in future practice. Results of the design phase will translate into practice through standard health service planning methods to enhance implementation and sustainability. The delivery of the protocol will include building capacity of health service workers to embed the design, implementation, and evaluation approach into normal practice. This protocol forms part of the DELIVER (Delivering Enhanced heaLthcare at home through optImising Virtual tools for oldEr people in Rural and regional Australia) Project. Funded by Australia's Medical Research Future Fund, DELIVER involves a collaboration with public health services of Western Victoria, Australia.
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Affiliation(s)
- Cindy Needham
- Institute for Health Transformation, Global Centre for Preventative Health and Nutrition, School of Health and Social Development Faculty of Health, Deakin University, Geelong, Australia
| | - Nikita Wheaton
- Institute for Health Transformation, Global Centre for Preventative Health and Nutrition, School of Health and Social Development Faculty of Health, Deakin University, Geelong, Australia
| | - Anna Wong Shee
- Deakin Rural Health, School of Medicine, Faculty of Health, Deakin University, Geelong, Australia
- Community and Aged Care, Grampians Health, Ballarat, Victoria, Australia
| | - Kevin McNamara
- Deakin Rural Health, School of Medicine, Faculty of Health, Deakin University, Geelong, Australia
| | - Mary Malakellis
- Deakin Rural Health, School of Medicine, Faculty of Health, Deakin University, Geelong, Australia
| | - Margaret Murray
- Deakin Rural Health, School of Medicine, Faculty of Health, Deakin University, Geelong, Australia
| | - Laura Alston
- Deakin Rural Health, School of Medicine, Faculty of Health, Deakin University, Geelong, Australia
- Research Unit, Colac Area Health, Colac, Victoria, Australia
| | - Anna Peeters
- Institute for Health Transformation, Faculty of Health, Deakin University, Geelong, Australia
| | - Anna Ugalde
- Institute for Health Transformation, Faculty of Health, Deakin University, Geelong, Australia
| | - Catherine Huggins
- Institute for Health Transformation, Global Centre for Preventative Health and Nutrition, School of Health and Social Development Faculty of Health, Deakin University, Geelong, Australia
| | - Serene Yoong
- Institute for Health Transformation, Global Centre for Preventative Health and Nutrition, School of Health and Social Development Faculty of Health, Deakin University, Geelong, Australia
| | - Steven Allender
- Institute for Health Transformation, Global Centre for Preventative Health and Nutrition, School of Health and Social Development Faculty of Health, Deakin University, Geelong, Australia
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Felmingham T, O'Halloran S, Poorter J, Rhook E, Needham C, Hayward J, Fraser P, Kilpatrick S, Leahy D, Allender S. Systems thinking in local government: intervention design and adaptation in a community-based study. Health Res Policy Syst 2023; 21:90. [PMID: 37667377 PMCID: PMC10478182 DOI: 10.1186/s12961-023-01034-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/05/2023] [Accepted: 08/11/2023] [Indexed: 09/06/2023] Open
Abstract
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.
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Affiliation(s)
- Tiana Felmingham
- Global Centre for Preventive Health and Nutrition (GLOBE), Institute for Health Transformation, Deakin University, 1 Geringhap Street, Geelong, VIC, 3220, Australia.
| | - Siobhan O'Halloran
- Global Centre for Preventive Health and Nutrition (GLOBE), Institute for Health Transformation, Deakin University, 1 Geringhap Street, Geelong, VIC, 3220, Australia
| | - Jaimie Poorter
- Global Centre for Preventive Health and Nutrition (GLOBE), Institute for Health Transformation, Deakin University, 1 Geringhap Street, Geelong, VIC, 3220, Australia
| | - Ebony Rhook
- Global Centre for Preventive Health and Nutrition (GLOBE), Institute for Health Transformation, Deakin University, 1 Geringhap Street, Geelong, VIC, 3220, Australia
- Barwon South West Public Health Unit, Geelong, Australia
| | - Cindy Needham
- Global Centre for Preventive Health and Nutrition (GLOBE), Institute for Health Transformation, Deakin University, 1 Geringhap Street, Geelong, VIC, 3220, Australia
| | - Joshua Hayward
- Global Centre for Preventive Health and Nutrition (GLOBE), Institute for Health Transformation, Deakin University, 1 Geringhap Street, Geelong, VIC, 3220, Australia
| | - Penny Fraser
- Global Centre for Preventive Health and Nutrition (GLOBE), Institute for Health Transformation, Deakin University, 1 Geringhap Street, Geelong, VIC, 3220, Australia
| | | | | | - Steven Allender
- Global Centre for Preventive Health and Nutrition (GLOBE), Institute for Health Transformation, Deakin University, 1 Geringhap Street, Geelong, VIC, 3220, Australia
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Whelan J, Fraser P, Bolton KA, Love P, Strugnell C, Boelsen-Robinson T, Blake MR, Martin E, Allender S, Bell C. Combining systems thinking approaches and implementation science constructs within community-based prevention: a systematic review. Health Res Policy Syst 2023; 21:85. [PMID: 37641151 PMCID: PMC10463953 DOI: 10.1186/s12961-023-01023-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/27/2022] [Accepted: 06/22/2023] [Indexed: 08/31/2023] Open
Abstract
BACKGROUND Systems science offers methods for designing population health interventions while implementation science provides specific guidance for successful implementation. Integrating systems and implementation science may strengthen implementation and enhance and sustain systemic change to achieve system-level outcomes. Little is known about the extent to which these two approaches have been integrated to date. This review aimed to identify and synthesise the peer-reviewed literature that has reported the combined use of systems thinking approaches and implementation science constructs (within the same study), to deliver population health interventions. METHODS A systematic literature search of peer-reviewed original research was conducted across six databases from 2009 to 2021. Journal manuscripts were included if they: (1) reported on a population health study conducted in a community, (2) reported the use of a systems method in the design of the intervention, and (3) used an implementation science theory, framework or model in the delivery of the intervention. Data extracted related to the specific systems methods and definitions and implementation science constructs used. The Mixed Methods Appraisal Tool (MMAT) was used to assess study quality. RESULTS Of the 9086 manuscripts returned, 320 manuscripts were included for full-text review. Of these, 17 manuscripts that reported on 14 studies were included in the final extraction. The most frequently reported systems methods were a 'whole of community systems approach' (n = 4/14) and 'community-based system dynamics' (n = 2/14). Nineteen different implementation science theories, frameworks and models were used for intervention delivery, with RE-AIM being the only framework used in more than one study. CONCLUSION There are few published peer-reviewed studies using systems thinking and implementation science for designing and delivering population health interventions. An exploration of synergies is worthwhile to operationalise alignment and improve implementation of systems thinking approaches. Review protocol registration PROSPERO CRD42021250419.
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Affiliation(s)
- Jillian Whelan
- School of Medicine, Deakin University, Geelong, Australia.
- Institute for Health Transformation, Geelong, Australia.
- Global Centre for Preventive Health and Nutrition, Geelong, Australia.
| | - Penny Fraser
- School of Health and Social Development, Deakin University, Geelong, Australia
- Institute for Health Transformation, Geelong, Australia
- Global Centre for Preventive Health and Nutrition, Geelong, Australia
| | - Kristy A Bolton
- School of Exercise and Nutrition Sciences, Deakin University, Geelong, Australia
- Institute for Health Transformation, Geelong, Australia
- Institute for Physical Activity and Nutrition, Geelong, Australia
| | - Penelope Love
- School of Exercise and Nutrition Sciences, Deakin University, Geelong, Australia
- Institute for Physical Activity and Nutrition, Geelong, Australia
| | - Claudia Strugnell
- School of Health and Social Development, Deakin University, Geelong, Australia
- Global Centre for Preventive Health and Nutrition, Geelong, Australia
- Institute for Physical Activity and Nutrition, Geelong, Australia
| | - Tara Boelsen-Robinson
- School of Health and Social Development, Deakin University, Geelong, Australia
- Institute for Health Transformation, Geelong, Australia
- Global Centre for Preventive Health and Nutrition, Geelong, Australia
| | - Miranda R Blake
- School of Health and Social Development, Deakin University, Geelong, Australia
- Institute for Health Transformation, Geelong, Australia
- Global Centre for Preventive Health and Nutrition, Geelong, Australia
| | - Erik Martin
- School of Medicine, Deakin University, Geelong, Australia
| | - Steven Allender
- School of Health and Social Development, Deakin University, Geelong, Australia
- Institute for Health Transformation, Geelong, Australia
- Global Centre for Preventive Health and Nutrition, Geelong, Australia
| | - Colin Bell
- School of Medicine, Deakin University, Geelong, Australia
- Institute for Health Transformation, Geelong, Australia
- Global Centre for Preventive Health and Nutrition, Geelong, Australia
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Estrada-Magbanua WM, Huang TTK, Lounsbury DW, Zito P, Iftikhar P, El-Bassel N, Gilbert L, Wu E, Lee BY, Mateu-Gelabert P, S. Sabounchi N. Application of group model building in implementation research: A systematic review of the public health and healthcare literature. PLoS One 2023; 18:e0284765. [PMID: 37590193 PMCID: PMC10434911 DOI: 10.1371/journal.pone.0284765] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/15/2021] [Accepted: 04/09/2023] [Indexed: 08/19/2023] Open
Abstract
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.
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Affiliation(s)
- Weanne Myrrh Estrada-Magbanua
- Center for Systems and Community Design and NYU-CUNY Prevention Research Center, CUNY Graduate School of Public Health and Health Policy, New York, NY, United States of America
| | - Terry T.-K. Huang
- Center for Systems and Community Design and NYU-CUNY Prevention Research Center, CUNY Graduate School of Public Health and Health Policy, New York, NY, United States of America
| | - David W. Lounsbury
- Division of Health Behavior Research and Implementation Science, Albert Einstein College of Medicine, New York, NY, United States of America
| | - Priscila Zito
- Center for Systems and Community Design and NYU-CUNY Prevention Research Center, CUNY Graduate School of Public Health and Health Policy, New York, NY, United States of America
| | - Pulwasha Iftikhar
- Center for Systems and Community Design and NYU-CUNY Prevention Research Center, CUNY Graduate School of Public Health and Health Policy, New York, NY, United States of America
| | - Nabila El-Bassel
- Social Intervention Group, School of Social Work, Columbia University, New York, NY, United States of America
| | - Louisa Gilbert
- Social Intervention Group, School of Social Work, Columbia University, New York, NY, United States of America
| | - Elwin Wu
- Social Intervention Group, School of Social Work, Columbia University, New York, NY, United States of America
| | - Bruce Y. Lee
- Center for Systems and Community Design and NYU-CUNY Prevention Research Center, CUNY Graduate School of Public Health and Health Policy, New York, NY, United States of America
| | - Pedro Mateu-Gelabert
- Center for Systems and Community Design and NYU-CUNY Prevention Research Center, CUNY Graduate School of Public Health and Health Policy, New York, NY, United States of America
| | - Nasim S. Sabounchi
- Center for Systems and Community Design and NYU-CUNY Prevention Research Center, CUNY Graduate School of Public Health and Health Policy, New York, NY, United States of America
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Koh VJW, Matchar DB, Chan AWM, Lee JML, Lai WX, Rosario D, George A, Ho V, Ismail NHB, Lien CTC, Merchant RA, Tan SM, Wong CH, Xu T. Reducing Falls Among Community-Dwelling Older Adults From Clinicians' Perspectives: A Systems Modeling Approach. Innov Aging 2023; 7:igad077. [PMID: 37694132 PMCID: PMC10484166 DOI: 10.1093/geroni/igad077] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/22/2023] [Indexed: 09/12/2023] Open
Abstract
Background and Objectives Falls among older adults are a significant health problem globally. Studies of multicomponent fall prevention programs in randomized controlled trials demonstrate effectiveness in reducing falls; however, the translation of research into the community remains challenging. Although there is an increasing interest to understand the factors contributing to implementation barriers, the dynamic relationships between factors are less well examined. Furthermore, evidence on implementation barriers from Asia is lacking as most of these studies originate from the West. As such, this study aims to engage stakeholders in uncovering the factors that facilitate or inhibit implementing community-based fall prevention programs in Singapore, with a focus on the interrelationship between those factors. Research Design and Methods Health care professionals familiar with fall prevention programs were invited to discuss the enablers and challenges to the implementation. This effort was facilitated using a systems modeling methodology of Group Model Building (GMB) to share ideas and create a common conceptual model of the challenges. The GMB employs various engagement techniques to draw on the experiences and perceptions of all stakeholders involved. Results This process led to the development of a Causal Loop Diagram (CLD), a qualitative conceptual model of the dynamic relationships between the barriers and facilitators of implementing fall prevention programs. Results from the CLD show that implementation is influenced by two main drivers: health care provider factors that influenced referrals, and patient factors that influenced referral acceptance and long-term adherence. Key leverage points for potential interventions were identified as well. Discussion and Implications The overall recommendation emphasized closer coordination and collaboration across providers to ensure sustainable and effective community-based fall prevention programs. This has to be supported by a national effort, involving a multidisciplinary stakeholder advisory group. These findings generated would be promising to guide future approaches to fall prevention.
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Affiliation(s)
- Vanessa Jean Wen Koh
- Programme in Health Services and Systems Research (HSSR), Duke-NUS Medical School, Singapore, Singapore
- Centre for Ageing Research and Education (CARE), Duke-NUS Medical School, Singapore, Singapore
| | - David B Matchar
- Programme in Health Services and Systems Research (HSSR), Duke-NUS Medical School, Singapore, Singapore
- Department of Medicine (General Internal Medicine), Duke University Medical Center, Durham, North Carolina, USA
| | - Angelique Wei-Ming Chan
- Programme in Health Services and Systems Research (HSSR), Duke-NUS Medical School, Singapore, Singapore
- Centre for Ageing Research and Education (CARE), Duke-NUS Medical School, Singapore, Singapore
| | - June May-Ling Lee
- Centre for Ageing Research and Education (CARE), Duke-NUS Medical School, Singapore, Singapore
| | - Wei Xuan Lai
- Programme in Health Services and Systems Research (HSSR), Duke-NUS Medical School, Singapore, Singapore
| | - Dulcie Rosario
- Centre for Ageing Research and Education (CARE), Duke-NUS Medical School, Singapore, Singapore
| | - Anne George
- Rehabilitation Services, Changi General Hospital, Singapore, Singapore
| | - Vanda Ho
- Department of Geriatric Medicine, National University Hospital, Singapore, Singapore
| | | | | | - Reshma A Merchant
- Division of Geriatric Medicine, Department of Medicine, National University Hospital, Singapore, Singapore
| | | | - Chek Hooi Wong
- Programme in Health Services and Systems Research (HSSR), Duke-NUS Medical School, Singapore, Singapore
| | - Tianma Xu
- Health and Social Sciences Cluster, Singapore Institute of Technology, Singapore, Singapore
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van den Akker A, Fabbri A, Alardah DI, Gilmore AB, Rutter H. The use of participatory systems mapping as a research method in the context of non-communicable diseases and risk factors: a scoping review. Health Res Policy Syst 2023; 21:69. [PMID: 37415182 DOI: 10.1186/s12961-023-01020-7] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/13/2022] [Accepted: 06/15/2023] [Indexed: 07/08/2023] Open
Abstract
CONTEXT Participatory systems mapping is increasingly used to gain insight into the complex systems surrounding non-communicable diseases (NCDs) and their risk factors. OBJECTIVES To identify and synthesize studies that used participatory systems mapping in the context of non-communicable diseases. DESIGN Scoping review. ELIGIBILITY CRITERIA Peer-reviewed studies published between 2000 and 2022. STUDY SELECTION Studies that focused on NCDs and/or related risk factors, and included participants at any stage of their system's mapping process, were included. CATEGORIES FOR ANALYSIS The main categories for analysis were: (1) problem definition and goal-setting, (2) participant involvement, (3) structure of the mapping process, (4) validation of the systems map, and (5) evaluation of the mapping process. RESULTS We identified 57 studies that used participatory systems mapping for a variety of purposes, including to inform or evaluate policies or interventions and to identify potential leverage points within a system. The number of participants ranged from 6 to 590. While policymakers and professionals were the stakeholder groups most often included, some studies described significant added value from including marginalized communities. There was a general lack of formal evaluation in most studies. However, reported benefits related mostly to individual and group learning, whereas limitations described included a lack of concrete actions following from systems mapping exercises. CONCLUSIONS Based on the findings of this review, we argue that research using participatory systems mapping would benefit from considering three different but intertwined actions: explicitly considering how different participants and the power imbalances between them may influence the participatory process, considering how the results from a systems mapping exercise may effectively inform policy or translate into action, and including and reporting on evaluation and outcomes of the process, wherever possible.
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Felmingham T, Backholer K, Hoban E, Brown AD, Nagorcka-Smith P, Allender S. Success of community-based system dynamics in prevention interventions: A systematic review of the literature. Front Public Health 2023; 11:1103834. [PMID: 37033017 PMCID: PMC10080052 DOI: 10.3389/fpubh.2023.1103834] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/21/2022] [Accepted: 03/07/2023] [Indexed: 04/11/2023] Open
Abstract
Systems thinking approaches are increasingly being used to help communities understand and develop responses to preventing complex health problems. Less is known about how success is characterized and what influences success in these approaches. We present a systematic review of how concepts of success are understood and evaluated in the peer reviewed literature of studies using systems thinking in community prevention. We searched five databases for peer-reviewed literature published between 2000 and 2022, with search terms related to systems thinking, prevention and community. Studies were included if they; reported using community-based systems thinking to prevent a public health problem; described the engagement and empowerment of community members to address a public health issue; and, were published in English. Thirty-four articles were identified from 10 countries. Twenty-one aimed to prevent a chronic disease (e.g., obesity) and 16 measured success using specific tools, 10 of which used semi-structured interviews or surveys. Measures of success included implementation processes, cultural appropriateness, the number or type of actions implemented, effectiveness of community action, and changes in individual thinking or mental models, population health outcomes, data collected, or systems level measures. Implementation factors influencing success included the capacity to engage participants, composition and experience of facilitators, strength of coordination teams, allocation of resources, adaptation to participant feedback, use of multiple systems approaches, workshop process providing time and methods to allow new insights, flexible delivery, and diversity of perspectives. Findings from each of the articles indicated that approaches increased a range of outcomes including community action, strategic thinking, future planning and evaluation, community buy-in, community voice, contribution and leadership, in addition to developing shared visions and goals and creating new, ongoing collaborations, among many others. Measures of success varied, suggesting more empirical reporting of proposed outcomes of system science in communities would be valuable. While the measurement of success in the use of systems thinking in community-based prevention efforts is limited, there are helpful examples we can look to for future measurement of success.
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Affiliation(s)
- Tiana Felmingham
- Global Centre for Preventive Health and Nutrition, Institute for Health Transformation, Deakin University, Geelong, VIC, Australia
- School of Health and Social Development, Faculty of Health, Deakin University, Geelong, VIC, Australia
- *Correspondence: Tiana Felmingham,
| | - Kathryn Backholer
- Global Centre for Preventive Health and Nutrition, Institute for Health Transformation, Deakin University, Geelong, VIC, Australia
- School of Health and Social Development, Faculty of Health, Deakin University, Geelong, VIC, Australia
| | - Elizabeth Hoban
- School of Health and Social Development, Faculty of Health, Deakin University, Geelong, VIC, Australia
| | - Andrew D. Brown
- Global Centre for Preventive Health and Nutrition, Institute for Health Transformation, Deakin University, Geelong, VIC, Australia
- School of Health and Social Development, Faculty of Health, Deakin University, Geelong, VIC, Australia
| | - Phoebe Nagorcka-Smith
- Global Centre for Preventive Health and Nutrition, Institute for Health Transformation, Deakin University, Geelong, VIC, Australia
- School of Health and Social Development, Faculty of Health, Deakin University, Geelong, VIC, Australia
| | - Steven Allender
- Global Centre for Preventive Health and Nutrition, Institute for Health Transformation, Deakin University, Geelong, VIC, Australia
- School of Health and Social Development, Faculty of Health, Deakin University, Geelong, VIC, Australia
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Calancie L, Fair ML, Wills S, Werner K, Appel JM, Moore TR, Hennessy E, Economos CD. Implementing a stakeholder-driven community diffusion-informed intervention to create healthier, more equitable systems: a community case study in Greenville County, South Carolina. Front Public Health 2023; 11:1034611. [PMID: 37213614 PMCID: PMC10196143 DOI: 10.3389/fpubh.2023.1034611] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/01/2022] [Accepted: 04/11/2023] [Indexed: 05/23/2023] Open
Abstract
This case study describes the application of a theory-informed, stakeholder-driven intervention with a group of 19 multi-sector stakeholders from an existing coalition to promote whole-of-community change that supports childhood obesity prevention. The intervention applied community-based system dynamics to design and implement activities that promoted insights into the systems driving childhood obesity prevalence and helped participants prioritize actions to influence those systems. This led to three new priority areas for the coalition: addressing food insecurity; building power among historically marginalized voices within the community; and supporting advocacy efforts to promote community-wide change beyond the coalition's previous focus on organizational-level policy, systems and environment change. The intervention spurred the application of community-based system dynamics to other health issues and in partner organizations, which demonstrates paradigm shifts about how to address complex public health issues in the community.
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Affiliation(s)
- Larissa Calancie
- ChildObesity180, Friedman School of Nutrition Science and Policy, Tuft’s University, Boston, MA, United States
- *Correspondence: Larissa Calancie,
| | - Melissa L. Fair
- Institute for the Advancement of Community Health, Furman University, Greenville, SC, United States
| | - Sally Wills
- LiveWell Greenville, Greenville, SC, United States
| | - Kelsey Werner
- Social System Design Lab, Washington University, St. Louis, MO, United States
- School of Social Work, Boston College, Chestnut Hill, MA, United States
| | - Julia M. Appel
- Institute for the Advancement of Community Health, Furman University, Greenville, SC, United States
| | - Travis R. Moore
- ChildObesity180, Friedman School of Nutrition Science and Policy, Tuft’s University, Boston, MA, United States
- Department of Community Health, School of Arts and Sciences, Tuft’s University, Medford, MA, United States
| | - Erin Hennessy
- ChildObesity180, Friedman School of Nutrition Science and Policy, Tuft’s University, Boston, MA, United States
| | - Christina D. Economos
- ChildObesity180, Friedman School of Nutrition Science and Policy, Tuft’s University, Boston, MA, United States
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Savila F, Harding T, Swinburn B, Bagg W, Letele D, Laban F, Goodyear-Smith F. Building culturally-centred, system dynamics logic models for the Brown Buttabean Motivation organization: a study protocol (Preprint). JMIR Res Protoc 2022. [DOI: 10.2196/44229] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/17/2023] Open
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D’Hooghe S, Inaç Y, De Clercq E, Deforche B, Dury S, Vandevijvere S, Van de Weghe N, Van Dyck D, De Ridder K. The CIVISANO protocol: a mixed-method study about the role of objective and perceived environmental factors on physical activity and eating behavior among socioeconomically disadvantaged adults. Arch Public Health 2022; 80:219. [PMID: 36199109 PMCID: PMC9533259 DOI: 10.1186/s13690-022-00956-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/14/2021] [Accepted: 08/19/2022] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Overweight and obesity have a strong socioeconomic profile. Unhealthy behaviors like insufficient physical activity and an unbalanced diet, which are causal factors of overweight and obesity, tend to be more pronounced in socioeconomically disadvantaged groups in high income countries. The CIVISANO project aims to identify objective and perceived environmental factors among different socioeconomic population groups that impede or facilitate physical activity and healthy eating behavior in the local context of two peri-urban Flemish municipalities in Belgium. We also aim to identify and discuss possible local interventions and evaluate the participatory processes of the project. METHODS This study (2020-2023) will use community-based participatory tools, involving collaborative partnerships with civic and stakeholder members of the community and regular exchanges among all partners to bridge knowledge development and health promotion for socioeconomically disadvantaged citizens. Furthermore, a mixed-methods approach will be used. A population survey and geographic analysis will explore potential associations between the physical activity and eating behaviors of socioeconomically disadvantaged adults (25-65 years old) and both their perceived and objective physical, food and social environments. Profound perceptive context information will be gathered from socioeconomically disadvantaged adults by using participatory methods like photovoice, walk-along, individual map creation and group model building. An evaluation of the participatory process will be conducted simultaneously. DISCUSSION The CIVISANO project will identify factors in the local environment that might provoke inequities in adopting a healthy lifestyle. The combination of perceived and objective measures using validated strategies will provide a robust assessment of the municipality environment. Through this analysis, the project will investigate to what extent community engagement can be a useful strategy to reduce health inequities. The strong knowledge exchange and capacity-building in a local setting is expected to contribute to our understanding of how to maximize research impact in this field and generate evidence about potential linkages between a health enhancing lifestyle among socioeconomically disadvantaged groups and their physical, food and social environments.
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Affiliation(s)
- Suzannah D’Hooghe
- grid.508031.fSciensano, Department of Epidemiology and Public Health, Brussels, Belgium ,grid.5342.00000 0001 2069 7798Ghent University, Faculty of Medicine and Health Sciences, Department of Public Health and Primary Care, Ghent, Belgium ,grid.8767.e0000 0001 2290 8069Vrije Universiteit Brussel (VUB), Faculty of Psychology and Educational Sciences, Adult Educational Sciences, Brussels, Belgium
| | - Yasemin Inaç
- grid.508031.fSciensano, Department of Epidemiology and Public Health, Brussels, Belgium ,grid.8767.e0000 0001 2290 8069Vrije Universiteit Brussel (VUB), Faculty of Psychology and Educational Sciences, Adult Educational Sciences, Brussels, Belgium ,grid.5342.00000 0001 2069 7798Ghent University, Faculty of Sciences, Department of Geography, Ghent, Belgium
| | - Eva De Clercq
- grid.508031.fSciensano, Department of Chemical and Physical Health Risks, Brussels, Belgium
| | - Benedicte Deforche
- grid.5342.00000 0001 2069 7798Ghent University, Faculty of Medicine and Health Sciences, Department of Public Health and Primary Care, Ghent, Belgium ,grid.8767.e0000 0001 2290 8069Vrije Universiteit Brussel (VUB), Faculty of Physical Education and Physiotherapy, Department of Movement and Sport Sciences, Brussels, Belgium
| | - Sarah Dury
- grid.8767.e0000 0001 2290 8069Vrije Universiteit Brussel (VUB), Faculty of Psychology and Educational Sciences, Adult Educational Sciences, Brussels, Belgium
| | - Stefanie Vandevijvere
- grid.508031.fSciensano, Department of Epidemiology and Public Health, Brussels, Belgium
| | - Nico Van de Weghe
- grid.5342.00000 0001 2069 7798Ghent University, Faculty of Sciences, Department of Geography, Ghent, Belgium
| | - Delfien Van Dyck
- grid.5342.00000 0001 2069 7798Ghent University, Faculty of Medicine and Health Sciences, Department of Movement and Sports Sciences, Brussels, Belgium
| | - Karin De Ridder
- grid.508031.fSciensano, Department of Epidemiology and Public Health, Brussels, Belgium
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Salloum RG, Wagner TH, Midboe AM, Daniels SI, Quanbeck A, Chambers DA. The economics of adaptations to evidence-based practices. Implement Sci Commun 2022; 3:100. [PMID: 36153575 PMCID: PMC9509646 DOI: 10.1186/s43058-022-00345-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/07/2022] [Accepted: 09/15/2022] [Indexed: 11/10/2022] Open
Abstract
Background Evidence-based practices (EBPs) are frequently adapted in response to the dynamic contexts in which they are implemented. Adaptation is defined as the degree to which an EBP is altered to fit the setting or to improve fit to local context and can be planned or unplanned. Although adaptations are common and necessary to maximizing the marginal impact of EBPs, little attention has been given to the economic consequences and how adaptations affect marginal costs. Discussion In assessing the economic consequences of adaptation, one should consider its impact on core components, the planned adaptive periphery, and the unplanned adaptive periphery. Guided by implementation science frameworks, we examine how various economic evaluation approaches accommodate the influence of adaptations and discuss the pros and cons of these approaches. Using the Framework for Reporting Adaptations and Modifications to Evidence-based interventions (FRAME), mixed methods can elucidate the economic reasons driving the adaptations. Micro-costing approaches are applied in research that integrates the adaptation of EBPs at the planning stage using innovative, adaptive study designs. In contrast, evaluation of unplanned adaptation is subject to confounding and requires sensitivity analysis to address unobservable measures and other uncertainties. A case study is presented using the RE-AIM framework to illustrate the costing of adaptations. In addition to empirical approaches to evaluating adaptation, simulation modeling approaches can be used to overcome limited follow-up in implementation studies. Conclusions As implementation science evolves to improve our understanding of the mechanisms and implications of adaptations, it is increasingly important to understand the economic implications of such adaptations, in addition to their impact on clinical effectiveness. Therefore, explicit consideration is warranted of how costs can be evaluated as outcomes of adaptations to the delivery of EBPs.
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Using Systems Science for Strategic Planning of Obesity Prevention and Treatment: The Roundtable on Obesity Solutions Experience. Curr Probl Cardiol 2022:101240. [PMID: 35513185 DOI: 10.1016/j.cpcardiol.2022.101240] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/25/2022] [Accepted: 04/29/2022] [Indexed: 11/20/2022]
Abstract
The sustained multi-decade increase in the prevalence of obesity calls for a new approach on addressing this public health concern. The Roundtable on Obesity Solutions (ROOS) (of the National Academies of Sciences, Engineering, and Medicine [NASEM]), a multisector group comprised of members from a variety of organizations and institutions, initiated a year-long effort to build a strategic plan and roadmap for action that would drive a paradigm shift for the ROOS in pursuing obesity solutions. Following a review of obesity prevention and treatment recommendations with sufficient actionable-evidence by authoritative organizations, the ROOS deployed systems science methods. Members engaged in group model building (GMB) exercises to develop an obesity systems map based on determinants and drivers from a multi-sector perspective and overlaid with aligned solutions. To expand the understanding of systems science approaches and methods, three public workshops were held in tandem with the development of the map. The causal map was refined, and solutions were ranked using a leverage-point framework to inform a strategic plan and narrative roadmap for action. For the ROOS, structural racism and social justice, biased mental models and social norms, and effective health communications were prioritized as the leverage points most likely to have a significant impact in addressing obesity. Complementary to the mission, vision, and guiding principles of the ROOS, the obesity systems map, and narrative roadmap will drive the ROOS activities over the next 3-6 years and serve as a resource for researchers, organizations, and institutions involved with policy, prevention, and treatment of obesity.
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McKelvie-Sebileau P, Rees D, Tipene-Leach D, D’Souza E, Swinburn B, Gerritsen S. Community Co-Design of Regional Actions for Children's Nutritional Health Combining Indigenous Knowledge and Systems Thinking. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:4936. [PMID: 35564331 PMCID: PMC9106006 DOI: 10.3390/ijerph19094936] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 03/10/2022] [Revised: 04/01/2022] [Accepted: 04/15/2022] [Indexed: 02/01/2023]
Abstract
Children's nutrition is highly influenced by community-level deprivation and socioeconomic inequalities and the health outcomes associated, such as childhood obesity, continue to widen. Systems Thinking using community-based system dynamics (CBSD) approaches can build community capacity, develop new knowledge and increase commitments to health improvement at the community level. We applied the formal structure and resources of a Group Model Building (GMB) approach, embedded within an Indigenous worldview to engage a high deprivation, high Indigenous population regional community in New Zealand to improve children's nutrition. Three GMB workshops were held and the youth and adult participants created two systems map of the drivers and feedback loops of poor nutrition in the community. Māori Indigenous knowledge (mātauranga) and approaches (tikanga) were prioritized to ensure cultural safety of participants and to encourage identification of interventions that take into account social and cultural environmental factors. While the adult-constructed map focused more on the influence of societal factors such as cost of housing, financial literacy in communities, and social security, the youth-constructed map placed more emphasis on individual-environment factors such as the influence of marketing by the fast-food industry and mental wellbeing. Ten prioritized community-proposed interventions such as increasing cultural connections in schools, are presented with the feasibility and likely impact for change of each intervention rated by community leaders. The combination of community-based system dynamics methods of group model building and a mātauranga Māori worldview is a novel Indigenous systems approach that engages participants and highlights cultural and family issues in the systems maps, acknowledging the ongoing impact of historical colonization in our communities.
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Affiliation(s)
- Pippa McKelvie-Sebileau
- School of Population Health, University of Auckland, Auckland 1023, New Zealand; (B.S.); (S.G.)
- Research and Innovation Centre, Eastern Institute of Technology, Napier 4112, New Zealand;
| | - David Rees
- Synergia Consulting Ltd., Auckland 1011, New Zealand;
| | - David Tipene-Leach
- Research and Innovation Centre, Eastern Institute of Technology, Napier 4112, New Zealand;
| | - Erica D’Souza
- School of Future Environments, AUT University, Auckland 1141, New Zealand;
| | - Boyd Swinburn
- School of Population Health, University of Auckland, Auckland 1023, New Zealand; (B.S.); (S.G.)
| | - Sarah Gerritsen
- School of Population Health, University of Auckland, Auckland 1023, New Zealand; (B.S.); (S.G.)
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Critical factors that affect the functioning of a research and evaluation capacity building partnership: A causal loop diagram. PLoS One 2022; 17:e0262125. [PMID: 35025924 PMCID: PMC8757999 DOI: 10.1371/journal.pone.0262125] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/29/2021] [Accepted: 12/18/2021] [Indexed: 01/13/2023] Open
Abstract
Introduction Public health policy and practice is strengthened by the application of quality evidence to decision making. However, there is limited understanding of how initiatives that support the generation and use of evidence in public health are operationalised. This study examines factors that support the internal functioning of a partnership, the Western Australian Sexual Health and Blood-borne Virus Applied Research and Evaluation Network (SiREN). SiREN aims to build research and evaluation capacity and increase evidence-informed decision making in a public health context. Methods This study was informed by systems concepts. It developed a causal loop diagram, a type of qualitative system model that illustrated the factors that influence the internal operation of SiREN. The causal loop diagram was developed through an iterative and participatory process with SiREN staff and management (n = 9) via in-depth semi-structured interviews (n = 4), workshops (n = 2), and meetings (n = 6). Results Findings identified critical factors that affected the functioning of SiREN. Central to SiREN’s ability to meet its aims was its capacity to adapt within a dynamic system. Adaptation was facilitated by the flow of knowledge between SiREN and system stakeholders and the expertise of the team. SiREN demonstrated credibility and capability, supporting development of new, and strengthening existing, partnerships. This improved SiREN’s ability to be awarded new funding and enhanced its sustainability and growth. SiREN actively balanced divergent stakeholder interests to increase sustainability. Conclusion The collaborative development of the diagram facilitated a shared understanding of SiREN. Adaptability was central to SiREN achieving its aims. Monitoring the ability of public health programs to adapt to the needs of the systems in which they work is important to evaluate effectiveness. The detailed analysis of the structure of SiREN and how this affects its operation provide practical insights for those interested in establishing a similar project.
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25
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Baugh Littlejohns L, Hill C, Neudorf C. Diverse Approaches to Creating and Using Causal Loop Diagrams in Public Health Research: Recommendations From a Scoping Review. Public Health Rev 2022; 42:1604352. [PMID: 35140995 PMCID: PMC8712315 DOI: 10.3389/phrs.2021.1604352] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/16/2021] [Accepted: 11/25/2021] [Indexed: 11/13/2022] Open
Abstract
Objectives: Complex systems thinking methods are increasingly called for and used as analytical lenses in public health research. The use of qualitative system mapping and in particular, causal loop diagrams (CLDs) is described as one promising method or tool. To our knowledge there are no published literature reviews that synthesize public health research regarding how CLDs are created and used. Methods: We conducted a scoping review to address this gap in the public health literature. Inclusion criteria included: 1) focused on public health research, 2) peer reviewed journal article, 3) described and/or created a CLD, and 4) published in English from January 2018 to March 2021. Twenty-three articles were selected from the search strategy. Results: CLDs were described as a new tool and were based upon primary and secondary data, researcher driven and group processes, and numerous data analysis methods and frameworks. Intended uses of CLDs ranged from illustrating complexity to informing policy and practice. Conclusion: From our learnings we propose nine recommendations for building knowledge and skill in creating and using CLDs for future public health research.
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Affiliation(s)
| | - Carly Hill
- Community Health and Epidemiology, University of Saskatchewan, Saskatoon, SK, Canada
| | - Cory Neudorf
- Community Health and Epidemiology, University of Saskatchewan, Saskatoon, SK, Canada
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26
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Calancie L, Nappi D, Appel J, Hennessy E, Korn AR, Mitchell J, Patrick A, Werner K, Economos CD. Implementing and Evaluating a Stakeholder-Driven Community Diffusion-Informed Early Childhood Intervention to Prevent Obesity, Cuyahoga County, Ohio, 2018-2020. Prev Chronic Dis 2022; 19:E03. [PMID: 35050848 PMCID: PMC8794263 DOI: 10.5888/pcd19.210181] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
Abstract
PURPOSE AND OBJECTIVES The purpose of this article is to demonstrate and evaluate aspects of a Stakeholder-Driven Community Diffusion (SDCD)-informed intervention with a group of stakeholders drawn from a large coalition seeking a novel approach for promoting policy, systems, and environmental-level change. The objectives were to implement an SDCD intervention, assess changes in participants' perspectives, and evaluate where the group's actions fit within the context of a systems map that the group created during the intervention. INTERVENTION APPROACH An SDCD-informed intervention convened 12 multisector stakeholders from the Early Ages Healthy Stages coalition in Cuyahoga County, Ohio. They participated in group model building activities to promote systems thinking related to childhood obesity prevention, reviewed evidence about topics of interest to the group, and were provided with technical assistance and seed funding to guide the selection and implementation of actions prioritized by the group. EVALUATION METHODS Data were collected via meeting notes and group model building outputs to demonstrate implementation and action prioritization; online surveys and qualitative interviews to measure perspective change among stakeholders; and a follow-up survey to the broader coalition assessing actions coalition members were taking. RESULTS An SDCD-informed intervention guided the development of a systems map and the selection of 4 actions: 1) develop a better understanding of the local early childcare environment; 2) assess the effectiveness and impact of Ohio Healthy Programs (OHP); 3) advocate for OHP and improved early childhood education quality; and 4) hold OHP designees accountable to high-quality programming. Data collected from surveys and interviews showed increased awareness of programs, resources, and collaboration opportunities among stakeholders. Follow-up survey results showed ongoing coalition action throughout the systems map. IMPLICATIONS FOR PUBLIC HEALTH Using an SDCD-informed intervention among a coalition of community stakeholders provided a unique approach for implementing, assessing, and analyzing collaborative efforts to prevent childhood obesity in Cuyahoga County. Our approach can be applied to help researchers and stakeholders improve efforts to address childhood obesity in their communities.
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Affiliation(s)
- Larissa Calancie
- Gerald J. and Dorothy R. Friedman School of Nutrition Science and Policy, Tufts University, Boston, Massachusetts
| | - Deanna Nappi
- Gerald J. and Dorothy R. Friedman School of Nutrition Science and Policy, Tufts University, Boston, Massachusetts
| | - Julia Appel
- Gerald J. and Dorothy R. Friedman School of Nutrition Science and Policy, Tufts University, Boston, Massachusetts
| | - Erin Hennessy
- Gerald J. and Dorothy R. Friedman School of Nutrition Science and Policy, Tufts University, Boston, Massachusetts
| | - Ariella R Korn
- Gerald J. and Dorothy R. Friedman School of Nutrition Science and Policy, Tufts University, Boston, Massachusetts
| | | | | | - Kelsey Werner
- Boston College School of Social Work, Chestnut Hill, Massachusetts
| | - Christina D Economos
- Gerald J. and Dorothy R. Friedman School of Nutrition Science and Policy, Tufts University, 150 Harrison Ave, Boston, MA 02111.
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Brown KK, Lemke MK, Fallah‐Fini S, Hall A, Obasanya M. Planning, implementing, and evaluating an online group-model-building workshop during the COVID-19 pandemic: celebrating successes and learning from shortcomings. SYSTEM DYNAMICS REVIEW 2022; 38:93-112. [PMID: 35599641 PMCID: PMC9111080 DOI: 10.1002/sdr.1704] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/05/2021] [Revised: 12/08/2021] [Accepted: 02/08/2022] [Indexed: 06/06/2023]
Affiliation(s)
- Kyrah K. Brown
- Department of KinesiologyThe University of Texas at Arlington500 W. Nedderman Drive, Box 19259ArlingtonTexas76019USA
| | - Michael Kenneth Lemke
- Department of Social SciencesUniversity of Houston‐DowntownOne Main Street, Suite N1025HoustonTexas77002USA
| | - Saeideh Fallah‐Fini
- Industrial and Manufacturing Engineering DepartmentCalifornia State Polytechnic University‐Pomona3801 W. Temple Avenue, Building 17PomonaCalifornia91768USA
| | - Ariel Hall
- Department of KinesiologyThe University of Texas at Arlington500 W. Nedderman Drive, Box 19259ArlingtonTexas76019USA
| | - Mercy Obasanya
- Department of KinesiologyThe University of Texas at Arlington500 W. Nedderman Drive, Box 19259ArlingtonTexas76019USA
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Adams S, Rhodes T, Lancaster K. New directions for participatory modelling in health: Redistributing expertise in relation to localised matters of concern. Glob Public Health 2021; 17:1827-1841. [PMID: 34775919 DOI: 10.1080/17441692.2021.1998575] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
Abstract
Participatory modelling seeks to foster stakeholder engagement to better attune models to their decision-making and policy contexts. Such approaches are increasingly advocated for use in the field of health. We review the instrumental and epistemological claims made in support of participatory modelling approaches. These accentuate participatory models as offering a better evidence-base for health policy decisions. By drawing attention to recent modelling experiments in a sector outside of health, that of water management, we outline a different way of thinking about participation and modelling. Here, the participatory model is configured in relation to matters of 'knowledge controversy', with modelling constituted as an 'evidence-making intervention' in relation to the making of science and expertise. Rather than presenting participatory models as an improved technical solution to addressing given policy problems within an evidence-based intervention approach, models are alternatively potentiated as sites for the redistribution of expertise among actor networks as they seek to engage politically in a matter of concern. This leads us to consider possible new directions for participatory modelling in the field of health.
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Affiliation(s)
- Sophie Adams
- School of Humanities and Languages, University of New South Wales, Kensington, Sydney, NSW, Australia
| | - Tim Rhodes
- School of Humanities and Languages, University of New South Wales, Kensington, Sydney, NSW, Australia.,London School of Hygiene and Tropical Medicine, London, UK
| | - Kari Lancaster
- School of Humanities and Languages, University of New South Wales, Kensington, Sydney, NSW, Australia
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Using Systems Dynamics for Capturing the Multicausality of Factors Affecting Health System Capacity in Latin America while Responding to the COVID-19 Pandemic. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 18:ijerph181910002. [PMID: 34639304 PMCID: PMC8507654 DOI: 10.3390/ijerph181910002] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 08/10/2021] [Revised: 09/05/2021] [Accepted: 09/16/2021] [Indexed: 11/24/2022]
Abstract
Similar interventions to stop the spread of COVID-19 led to different outcomes in Latin American countries. This study aimed to capture the multicausality of factors affecting HS-capacity that could help plan a more effective response, considering health as well as social aspects. A facilitated GMB was constructed by experts and validated with a survey from a wider population. Statistical analyses estimated the impact of the main factors to the HS-capacity and revealed the differences in its mechanisms. The results show a similar four-factor structure in all countries that includes public administration, preparedness, information, and collective self-efficacy. The factors are correlated and have mediating effects with HS-capacity; this is the base for differences among countries. HS-capacity has a strong relation with public administration in Bolivia, while in Nicaragua and Uruguay it is related through preparedness. Nicaragua lacks information as a mediation effect with HS-capacity whereas Bolivia and Uruguay have, respectively, small and large mediation effects with it. These outcomes increase the understanding of the pandemic based on country-specific context and can aid policymaking in low-and middle-income countries by including these factors in future pandemic response models.
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Waterlander WE, Singh A, Altenburg T, Dijkstra C, Luna Pinzon A, Anselma M, Busch V, van Houtum L, Emke H, Overman ML, Chinapaw MJM, Stronks K. Understanding obesity-related behaviors in youth from a systems dynamics perspective: The use of causal loop diagrams. Obes Rev 2021; 22:e13185. [PMID: 33369045 PMCID: PMC8243923 DOI: 10.1111/obr.13185] [Citation(s) in RCA: 22] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/28/2020] [Revised: 11/30/2020] [Accepted: 12/01/2020] [Indexed: 12/21/2022]
Abstract
This paper reports how we applied systems dynamics methods to gain insight into the complexity of obesity-related behaviors in youth, including diet, physical activity, sedentary behavior, and sleep, by integrating a literature review into causal loop diagrams (CLDs). Results showed that the CLDs consisted of multiple subsystems and three types of dynamics appeared, including (1) feedback loops, (2) connections between feedback loops and subsystems, and (3) mechanisms. We observed clear similarities in the dynamics for the four behaviors in that they relate to "traditional" subsystems, such as home and school environments, as well as to newly added subsystems, including macroeconomics, social welfare, and urban systems. The CLDs provided insights that can support the development of intervention strategies, including (1) the confirmation that a range of mechanisms cover and connect multiple levels and settings, meaning that there is no silver bullet to address obesity; (2) understanding of how interventions in one particular setting, such as school, might be influenced by the interactions with other settings, such as urban systems; and (3) a comprehensive view of (un)intended consequences. This way of framing the problem will assist moving towards public health interventions that respond to and operate in the complexity of the real world.
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Affiliation(s)
- Wilma E Waterlander
- Department of Public and Occupational Health, Amsterdam Public Health Research Institute, Amsterdam UMC, University of Amsterdam, Amsterdam, The Netherlands
| | - Amika Singh
- Department of Public and Occupational Health, Amsterdam Public Health Research Institute, Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam, The Netherlands.,Mulier Institute, Utrecht, The Netherlands
| | - Teatske Altenburg
- Department of Public and Occupational Health, Amsterdam Public Health Research Institute, Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam, The Netherlands
| | - Coosje Dijkstra
- Department of Health Sciences, Amsterdam Public Health Research Institute, Vrije Universiteit Amsterdam, Amsterdam, The Netherlands
| | - Angie Luna Pinzon
- Department of Public and Occupational Health, Amsterdam Public Health Research Institute, Amsterdam UMC, University of Amsterdam, Amsterdam, The Netherlands
| | - Manou Anselma
- Department of Public and Occupational Health, Amsterdam Public Health Research Institute, Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam, The Netherlands
| | - Vincent Busch
- Public Health Service Amsterdam, Sarphati Amsterdam, Amsterdam, The Netherlands
| | - Lieke van Houtum
- Public Health Service Amsterdam, Sarphati Amsterdam, Amsterdam, The Netherlands
| | - Helga Emke
- Department of Public and Occupational Health, Amsterdam Public Health Research Institute, Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam, The Netherlands
| | - Meredith L Overman
- Department of Health Promotion, NUTRIM School of Nutrition and Translational Research in Metabolism, Maastricht University, Maastricht, The Netherlands
| | - Mai J M Chinapaw
- Department of Public and Occupational Health, Amsterdam Public Health Research Institute, Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam, The Netherlands
| | - Karien Stronks
- Department of Public and Occupational Health, Amsterdam Public Health Research Institute, Amsterdam UMC, University of Amsterdam, Amsterdam, The Netherlands
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Sustainable Agri-Food Systems: Environment, Economy, Society, and Policy. SUSTAINABILITY 2021. [DOI: 10.3390/su13116260] [Citation(s) in RCA: 15] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Agri-food systems (AFS) have been central in the debate on sustainable development. Despite this growing interest in AFS, comprehensive analyses of the scholarly literature are hard to find. Therefore, the present systematic review delineated the contours of this growing research strand and analyzed how it relates to sustainability. A search performed on the Web of Science in January 2020 yielded 1389 documents, and 1289 were selected and underwent bibliometric and topical analyses. The topical analysis was informed by the SAFA (Sustainability Assessment of Food and Agriculture systems) approach of FAO and structured along four dimensions viz. environment, economy, society and culture, and policy and governance. The review shows an increasing interest in AFS with an exponential increase in publications number. However, the study field is north-biased and dominated by researchers and organizations from developed countries. Moreover, the analysis suggests that while environmental aspects are sufficiently addressed, social, economic, and political ones are generally overlooked. The paper ends by providing directions for future research and listing some topics to be integrated into a comprehensive, multidisciplinary agenda addressing the multifaceted (un)sustainability of AFS. It makes the case for adopting a holistic, 4-P (planet, people, profit, policy) approach in agri-food system studies.
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Bensberg M, Joyce A, Wilson E. Building a Prevention System: Infrastructure to Strengthen Health Promotion Outcomes. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 18:1618. [PMID: 33567719 PMCID: PMC7914461 DOI: 10.3390/ijerph18041618] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 12/22/2020] [Revised: 02/01/2021] [Accepted: 02/04/2021] [Indexed: 12/27/2022]
Abstract
Prevention systems improve the performance of health promotion interventions. This research describes the establishment of the Australian state government initiative, Healthy Together Victoria's (HTV) macro infrastructure for the delivery of large-scale prevention interventions. METHODS This paper reports on findings of 31 semi-structured interviews about participants' understanding of systems thinking and their reflections of the strengths and weaknesses of the HTV prevention system. A chronic disease prevention framework informed the coding that was used to create a causal loop diagram and a core feedback loop to illustrate the results. RESULTS Findings highlighted that HTV created a highly connected prevention system that included a sizeable workforce, significant funding and supportive leadership. Operating guidelines, additional professional development and real-time evaluation were significant gaps, which hindered systems practice. For inexperienced systems thinkers, these limitations encouraged them to implement programs, rather than interact with the seemingly ambiguous systems methods. CONCLUSIONS HTV was an innovative attempt to strengthen health promotion infrastructure, creating a common language and shared understanding of prevention system requirements. However, the model was inadequate for HTV to achieve population-level reductions in chronic disease as system oversight was missing, as was an intervention delivery focus. Clarity was needed to define the systems practice that HTV was seeking to achieve. Importantly, the HTV prevention system needed to be understood as complex and adaptive, and not prioritized as individual parts.
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Affiliation(s)
- Monica Bensberg
- Centre for Social Impact, Faculty of Business and Law, Swinburne University of Technology, P.O. Box 218, Mail H25, Hawthorn, VIC 3122, Australia; (A.J.); (E.W.)
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Mehta KM, Ward VC, Darmstadt GL. Best practices in global health evaluation: Reflections on learning from an independent program analysis in Bihar, India. J Glob Health 2021; 10:020395. [PMID: 33403103 PMCID: PMC7750022 DOI: 10.7189/jogh.10.020395] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022] Open
Affiliation(s)
- Kala M Mehta
- Department of Pediatrics, Stanford University School of Medicine, Stanford, California, USA.,Department of Epidemiology and Biostatistics, University of California San Francisco, San Francisco, California, USA
| | - Victoria C Ward
- Department of Pediatrics, Stanford University School of Medicine, Stanford, California, USA
| | - Gary L Darmstadt
- Department of Pediatrics, Stanford University School of Medicine, Stanford, California, USA
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Waterlander WE, Luna Pinzon A, Verhoeff A, den Hertog K, Altenburg T, Dijkstra C, Halberstadt J, Hermans R, Renders C, Seidell J, Singh A, Anselma M, Busch V, Emke H, van den Eynde E, van Houtum L, Nusselder WJ, Overman M, van de Vlasakker S, Vrijkotte T, van den Akker E, Kremers SPJ, Chinapaw M, Stronks K. A System Dynamics and Participatory Action Research Approach to Promote Healthy Living and a Healthy Weight among 10-14-Year-Old Adolescents in Amsterdam: The LIKE Programme. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2020; 17:ijerph17144928. [PMID: 32650571 PMCID: PMC7400640 DOI: 10.3390/ijerph17144928] [Citation(s) in RCA: 24] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 06/09/2020] [Revised: 07/02/2020] [Accepted: 07/04/2020] [Indexed: 11/25/2022]
Abstract
This paper describes the design of the LIKE programme, which aims to tackle the complex problem of childhood overweight and obesity in 10–14-year-old adolescents using a systems dynamics and participatory approach. The LIKE programme focuses on the transition period from 10-years-old to teenager and was implemented in collaboration with the Amsterdam Healthy Weight Programme (AHWP) in Amsterdam-East, the Netherlands. The aim is to develop, implement and evaluate an integrated action programme at the levels of family, school, neighbourhood, health care and city. Following the principles of Participatory Action Research (PAR), we worked with our population and societal stakeholders as co-creators. Applying a system lens, we first obtained a dynamic picture of the pre-existing systems that shape adolescents’ behaviour relating to diet, physical activity, sleep and screen use. The subsequent action programme development was dynamic and adaptive, including quick actions focusing on system elements (quick evaluating, adapting and possibly catalysing further action) and more long-term actions focusing on system goals and/or paradigm change. The programme is supported by a developmental systems evaluation and the Intervention Level Framework, supplemented with routinely collected data on weight status and health behaviour change over a period of five years. In the coming years, we will report how this approach has worked to provide a robust understanding of the programme’s effectiveness within a complex dynamic system. In the meantime, we hope our study design serves as a source of inspiration for other public health intervention studies in complex systems.
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Affiliation(s)
- Wilma E. Waterlander
- Department of Public and Occupational Health, Amsterdam Public Health Research Institute, Amsterdam UMC, University of Amsterdam, Meibergdreef 9, 1105 AZ Amsterdam, The Netherlands; (A.L.P.); (T.V.); (K.S.)
- Correspondence:
| | - Angie Luna Pinzon
- Department of Public and Occupational Health, Amsterdam Public Health Research Institute, Amsterdam UMC, University of Amsterdam, Meibergdreef 9, 1105 AZ Amsterdam, The Netherlands; (A.L.P.); (T.V.); (K.S.)
| | - Arnoud Verhoeff
- Public Health Service Amsterdam, Sarphati Amsterdam, 1018 WT Amsterdam, The Netherlands; (A.V.); (V.B.); (L.v.H.); (S.v.d.V.)
- Department of Sociology, University of Amsterdam, 1018 WV Amsterdam, The Netherlands
| | - Karen den Hertog
- Amsterdam Healthy Weight Programme, Public Health Service Amsterdam, 1018 WT Amsterdam, The Netherlands;
| | - Teatske Altenburg
- Department of Public and Occupational Health, Amsterdam Public Health Research Institute, Amsterdam UMC, Vrije Universiteit Amsterdam, Van der Boechorststraat 7, NL-1081 BT Amsterdam, The Netherlands; (T.A.); (A.S.); (M.A.); (H.E.); (M.C.)
| | - Coosje Dijkstra
- Department of Health Sciences, Amsterdam Public Health Research Institute, Vrije Universiteit Amsterdam, 1081 HV Amsterdam, The Netherlands; (C.D.); (J.H.); (C.R.); (J.S.)
| | - Jutka Halberstadt
- Department of Health Sciences, Amsterdam Public Health Research Institute, Vrije Universiteit Amsterdam, 1081 HV Amsterdam, The Netherlands; (C.D.); (J.H.); (C.R.); (J.S.)
| | - Roel Hermans
- Department of Health Promotion, NUTRIM School of Nutrition and Translational Research in Metabolism, Maastricht University, 6229 ER Maastricht, The Netherlands; (R.H.); (M.O.); (S.P.J.K.)
| | - Carry Renders
- Department of Health Sciences, Amsterdam Public Health Research Institute, Vrije Universiteit Amsterdam, 1081 HV Amsterdam, The Netherlands; (C.D.); (J.H.); (C.R.); (J.S.)
| | - Jacob Seidell
- Department of Health Sciences, Amsterdam Public Health Research Institute, Vrije Universiteit Amsterdam, 1081 HV Amsterdam, The Netherlands; (C.D.); (J.H.); (C.R.); (J.S.)
| | - Amika Singh
- Department of Public and Occupational Health, Amsterdam Public Health Research Institute, Amsterdam UMC, Vrije Universiteit Amsterdam, Van der Boechorststraat 7, NL-1081 BT Amsterdam, The Netherlands; (T.A.); (A.S.); (M.A.); (H.E.); (M.C.)
| | - Manou Anselma
- Department of Public and Occupational Health, Amsterdam Public Health Research Institute, Amsterdam UMC, Vrije Universiteit Amsterdam, Van der Boechorststraat 7, NL-1081 BT Amsterdam, The Netherlands; (T.A.); (A.S.); (M.A.); (H.E.); (M.C.)
| | - Vincent Busch
- Public Health Service Amsterdam, Sarphati Amsterdam, 1018 WT Amsterdam, The Netherlands; (A.V.); (V.B.); (L.v.H.); (S.v.d.V.)
| | - Helga Emke
- Department of Public and Occupational Health, Amsterdam Public Health Research Institute, Amsterdam UMC, Vrije Universiteit Amsterdam, Van der Boechorststraat 7, NL-1081 BT Amsterdam, The Netherlands; (T.A.); (A.S.); (M.A.); (H.E.); (M.C.)
| | - Emma van den Eynde
- Department of Pediatric Endocrinology, Erasmus MC, University Medical Center, 3025 GD Rotterdam, The Netherlands; (E.v.d.E.); (E.v.d.A.)
| | - Lieke van Houtum
- Public Health Service Amsterdam, Sarphati Amsterdam, 1018 WT Amsterdam, The Netherlands; (A.V.); (V.B.); (L.v.H.); (S.v.d.V.)
| | - Wilma J. Nusselder
- Department of Public Health, Erasmus MC, University Medical Center Rotterdam, 3015 CN Rotterdam, The Netherlands;
| | - Meredith Overman
- Department of Health Promotion, NUTRIM School of Nutrition and Translational Research in Metabolism, Maastricht University, 6229 ER Maastricht, The Netherlands; (R.H.); (M.O.); (S.P.J.K.)
| | - Susan van de Vlasakker
- Public Health Service Amsterdam, Sarphati Amsterdam, 1018 WT Amsterdam, The Netherlands; (A.V.); (V.B.); (L.v.H.); (S.v.d.V.)
| | - Tanja Vrijkotte
- Department of Public and Occupational Health, Amsterdam Public Health Research Institute, Amsterdam UMC, University of Amsterdam, Meibergdreef 9, 1105 AZ Amsterdam, The Netherlands; (A.L.P.); (T.V.); (K.S.)
| | - Erica van den Akker
- Department of Pediatric Endocrinology, Erasmus MC, University Medical Center, 3025 GD Rotterdam, The Netherlands; (E.v.d.E.); (E.v.d.A.)
| | - Stef P. J. Kremers
- Department of Health Promotion, NUTRIM School of Nutrition and Translational Research in Metabolism, Maastricht University, 6229 ER Maastricht, The Netherlands; (R.H.); (M.O.); (S.P.J.K.)
| | - Mai Chinapaw
- Department of Public and Occupational Health, Amsterdam Public Health Research Institute, Amsterdam UMC, Vrije Universiteit Amsterdam, Van der Boechorststraat 7, NL-1081 BT Amsterdam, The Netherlands; (T.A.); (A.S.); (M.A.); (H.E.); (M.C.)
| | - Karien Stronks
- Department of Public and Occupational Health, Amsterdam Public Health Research Institute, Amsterdam UMC, University of Amsterdam, Meibergdreef 9, 1105 AZ Amsterdam, The Netherlands; (A.L.P.); (T.V.); (K.S.)
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