Integrating complex systems science into road safety research and practice, Part 2: applying systems tools to the problem of increasing pedestrian death rates

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

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

Pedestrian Safety Among High School Runners: A Case Series

BACKGROUND

Participation in high school cross-country and track has increased over the last few decades. At the same time, the rate of pedestrian-involved motor vehicle crashes (MVCs) has also increased. In the context of organized sport, pedestrian safety among runners is often not highlighted, despite the risk of catastrophic injury.

PURPOSE

To describe incidents of pedestrian-involved MVCs involving student athletes captured by the National Center for Catastrophic Sport Injury Research (NCCSIR) at the University of North Carolina at Chapel Hill.

STUDY DESIGN

Case series.

LEVEL OF EVIDENCE

Level 5.

METHODS

This study utilized surveillance data from the NCCSIR from 2011 to 2020. It presents descriptive statistics, including frequencies and percentages, detailed summaries, and a Haddon Matrix.

RESULTS

There were 8 incidents involving 11 student athletes, resulting in 9 fatalities. Of these, 5 cases occurred in the afternoon or early evening, 4 occurred in the Fall, and 6 occurred in a rural area. Haddon Matrix analyses of case descriptions indicate schools should implement a runner safety program for all new runners and ensure that runner safety measures are included in emergency action plans.

CONCLUSION

Runner-related MVCs are relatively rare, but tragic, incidents. Pedestrian safety measures should be incorporated into school-sponsored practices and training runs.

CLINICAL RELEVANCE

Pedestrian safety should be incorporated into runner safety and injury prevention efforts.

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

BACKGROUND

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

METHODS

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

RESULTS

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

CONCLUSIONS

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

Mixed-methods approach to describing Vision Zero initiatives in United States' municipalities

Vision Zero (VZ) aims to reduce fatalities and serious injuries from road traffic crashes to zero through a Safe Systems approach. Little is known about the extent of uptake of VZ in the United States (US), or the attributes and functioning of the initiatives. Using a mixed-methods design, our objectives were to describe the status of VZ implementation and characteristics of those initiatives among US municipalities. Websites of all US municipalities with a population of at least 50,000 (n = 788) were searched to identify involvement in VZ. When initiatives were identified, we abstracted information from their website and other published documents, using a comprehensive framework of best practice VZ components. From the VZ initiatives identified, we interviewed representatives from 12 municipalities with diversity by region of the country, population size, and VZ implementation. Interviews were recorded, transcribed, and coded for themes. Through systematic web-based searching, we identified 86 of 788 (10.9%) municipalities with a VZ initiative. Among 314 larger municipalities (population >=100,000), 68 (21.7%) were identified. Among 476 medium-size municipalities (population of 50,000-99,999), 18 (3.8%) were identified. VZ initiatives began as early as 2014, starting with larger municipalities, and followed in 2015 with medium-size municipalities. Among the VZ initiatives, 58 (67.4%) recorded a vision statement, with 51 (59.3%) setting a target year to reach zero deaths. Thirty-nine (45.3%) had published VZ plans, with another 22 (25.6%) working towards a plan. Twenty-five initiatives (29.1%) shared resources across stakeholder groups, such as funding or staff. Forty-six initiatives (53.5%) had an established coalition, and 18 (20.9%) proposed or were developing a coalition. Twenty-six initiatives (30.2%) provided regular updates or evaluation on progress towards performance metrics, but only 4 (4.7%) had implemented a performance management system to regularly track progress on VZ-related actions. The interviews provided further context and a more detailed understanding of results. Documenting the characteristics of VZ initiatives among US municipalities can contribute to an understanding of current practice, potential opportunities to support ongoing initiatives, and information to assist new initiatives. Ultimately, the impact of municipal-level VZ efforts should be evaluated with regards to traffic-related serious injuries and fatalities.

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

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.

Simulating congestion pricing policy impacts on pedestrian safety using a system dynamics approach

Research on congestion pricing policy (CPP) impacts has generally focused on the economic and congestion-related benefits of CPPs. Few studies have examined safety effects and the interrelated factors that produce safety outcomes for vulnerable road users. We built a novel system dynamics simulation model to explore the potential mechanisms producing pedestrian injuries over time and the impacts of a CPP (and related interventions) on this trend. We found that pedestrian injury trends varied based on important decisions related to how the CPP is designed, including investments in potential safety-related supports for pedestrians. Infrastructure improvements and speed management interventions could help cities achieve both congestion-relieving goals while also improving safety. Additionally, certain CPP configurations (e.g., additional charges on for-hire vehicles) could further reduce daily vehicle trips and congestion but might lead to unintended negative safety consequences of greater pedestrian injuries. This is the first model to provide a holistic and endogenous look at how interconnected processes affecting congestion and CPP impacts also affect vulnerable road user safety. The use of system dynamics models can facilitate a holistic inspection of potential intended and unintended effects across a range of outcomes, prior to policy implementation.