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Baugh Littlejohns L, McKee G, Rasali D, Naiman D, Mee J, Osborne T, Dang P, Winters M, Lear SA, Nelson D, McGinley S, Faulkner G. Follow the Arrows: Using a Co-Created Causal Loop Diagram to Explore Leverage Points to Strengthen Population Physical Activity Promotion in British Columbia, Canada. J Phys Act Health 2024:1-13. [PMID: 38729618 DOI: 10.1123/jpah.2023-0740] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/13/2023] [Revised: 02/21/2024] [Accepted: 03/20/2024] [Indexed: 05/12/2024]
Abstract
BACKGROUND Population physical activity promotion (PPAP) is one of the most effective noncommunicable disease prevention strategies, yet coordination is lacking around the world. Whole-of-system approaches and complex systems methods are called for to advance PPAP. This paper reports on a project which (1) used an Attributes Framework with system mapping (group model building and causal loop diagramming of feedback loops) and (2) identified potential leverage points to address the challenge of effective coordination of multisectoral PPAP in British Columbia. METHODS Key findings from stakeholder interviews and workshops described the current system for PPAP in terms of attributes and dimensions in the framework. These were translated into variables and used in group model building. Participants prioritized the importance of variables to address the coordination challenge and then created causal loop diagrams in 3 small groups. One collective causal loop diagram was created, and top priority variables and associated feedback loops were highlighted to explore potential leverage points. RESULTS Leverage points included the relationships and feedback loops among priority variables: political leadership, visible policy support and governance, connectivity for knowledge translation, collaborative multisector grants, multisector collaboration, and integrating co-benefits. Leveraging and altering "vicious" cyclical patterns to increase coordinated multisector PPAP are key. CONCLUSIONS The Attributes Framework, group model building and causal loop diagrams, and emergent feedback loops were useful to explore potential leverage points to address the challenge of multisectoral coordination of PPAP. Future research could apply the same methods in other jurisdictions and compare and contrast resultant frameworks, variables, feedback loops, and leverage points.
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Affiliation(s)
- Lori Baugh Littlejohns
- University of British Columbia, Vancouver, BC, Canada
- BC Centre for Disease Control, Vancouver, BC, Canada
| | | | - Drona Rasali
- University of British Columbia, Vancouver, BC, Canada
| | | | - Jennafer Mee
- University of Saskatchewan, Saskatoon, SK, Canada
| | | | - Phuc Dang
- BC Centre for Disease Control, Vancouver, BC, Canada
| | | | | | - Diane Nelson
- West Vancouver School District, West Vancouver, BC, Canada
| | | | - Guy Faulkner
- University of British Columbia, Vancouver, BC, Canada
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2
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Gillani B, Prince DM, Ray-Novak M, Feerasta G, Jones D, Mintz LJ, Moore SE. Mapping the Dynamic Complexity of Sexual and Gender Minority Healthcare Disparities: A Systems Thinking Approach. Healthcare (Basel) 2024; 12:424. [PMID: 38391800 PMCID: PMC10888405 DOI: 10.3390/healthcare12040424] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/14/2023] [Revised: 12/10/2023] [Accepted: 01/26/2024] [Indexed: 02/24/2024] Open
Abstract
Sexual and gender minority (SGM) populations experience extensive health disparities compared to their straight and cisgender counterparts. The importance of addressing these disparities is paramount, as SGM groups often encounter significant barriers to accessing comprehensive healthcare, including societal stigma, provider bias, and financial constraints. This study utilizes a community-based system dynamics approach to understand and visualize the barriers to and facilitators of healthcare engagement for SGM groups across their life course. It aims to identify core constructs, relationships, and dynamic feedback mechanisms related to the experiences of connection/disconnection with physical, mental, and dental healthcare of SGM individuals. Barriers to access, such as discriminatory practices and the limited availability of SGM-informed healthcare professionals, exacerbate these disparities, underscoring the urgency of developing targeted interventions. System dynamics, a complex systems science (CSS) methodology, was used for this research. Group model building sessions were conducted with diverse SGM groups, including youth, older adults, and trans and gender-expansive community members. Causal loop diagrams were developed according to an iterative process, and a meta-model of their collective experiences was created. The study revealed extensive, dynamic, and shifting structural barriers for SGM community members accessing healthcare. Societal and structural stigma, provider bias, and pathologization were identified as significant barriers throughout their life course. Community-led interventions and SGM-focused holistic healthcare were identified as critical facilitators of SGM healthcare connection. The findings highlight the need for SGM-affirming and culturally responsive healthcare settings. This paper calls for a concerted effort from SGM health researchers to use CSS in developing interventions to reduce SGM health disparities.
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Affiliation(s)
- Braveheart Gillani
- Jack, Joseph and Morton Mandel School of Applied Social Sciences, Case Western Reserve University, Cleveland, OH 44106, USA; (B.G.); (M.R.-N.)
| | - Dana M. Prince
- Jack, Joseph and Morton Mandel School of Applied Social Sciences, Case Western Reserve University, Cleveland, OH 44106, USA; (B.G.); (M.R.-N.)
| | - Meagan Ray-Novak
- Jack, Joseph and Morton Mandel School of Applied Social Sciences, Case Western Reserve University, Cleveland, OH 44106, USA; (B.G.); (M.R.-N.)
| | - Gulnar Feerasta
- LGBT Center of Greater Cleveland, Cleveland, OH 44102, USA; (G.F.); (D.J.)
| | - Devinity Jones
- LGBT Center of Greater Cleveland, Cleveland, OH 44102, USA; (G.F.); (D.J.)
| | - Laura J. Mintz
- School of Medicine, Case Western Reserve University, Cleveland, OH 44106, USA;
| | - Scott Emory Moore
- Frances Payne Bolton School of Nursing, Case Western Reserve University, Cleveland, OH 44106, USA;
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McAlister MM, Namakula P, Annis J, Mihelcic JR, Zhang Q. Rural Sanitation Sustainability Dynamics: Gaining Insight through Participatory and Simulation Modeling. Environ Sci Technol 2024; 58:400-409. [PMID: 38113387 DOI: 10.1021/acs.est.3c09101] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/21/2023]
Abstract
Improved sanitation provides many benefits to human health and well-being and is integral to achieving Sustainable Development Goal Six. However, many nations, including most of sub-Saharan Africa, are not on track to meeting sanitation targets. Recognizing the inherent complexity of environmental health, we used systems thinking to study sanitation sustainability in Uganda. Our study participants, 37 sanitation actors in three rural districts, were engaged in interviews, group model building workshops, and a survey. The resulting model was parametrized and calibrated using publicly available data and data collected through the Uganda Sanitation for Health Activity. Our simulations revealed slippage from improved sanitation in all study districts, a behavior reflected in real interventions. This implies that systemic changes-changes to the rules and relationships in the system-may be required to improve sanitation outcomes in this context. Adding reinforcing feedback targeting households' perceived value of sanitation yielded promising simulation results. We conclude with the following general recommendations for those designing sanitation policies or interventions: (1) conceptualize sanitation systems in terms of reinforcing and balancing feedback, (2) consider using participatory and simulation modeling to build confidence in these conceptual models, and (3) design many experiments (e.g., simulation scenarios) to test and improve understanding.
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Affiliation(s)
- Martha M McAlister
- Department of Civil & Environmental Engineering, University of South Florida, 4202 E Fowler Avenue, Tampa, Florida 33620, United States
| | - Patricia Namakula
- Tetra Tech, USAID Uganda Sanitation for Health Activity, Plot 12A, Farady Road, Tetra Tech, Kampala, Uganda
| | - Jonathan Annis
- Tetra Tech, USAID Uganda Sanitation for Health Activity, Plot 12A, Farady Road, Tetra Tech, Kampala, Uganda
| | - James R Mihelcic
- Department of Civil & Environmental Engineering, University of South Florida, 4202 E Fowler Avenue, Tampa, Florida 33620, United States
| | - Qiong Zhang
- Department of Civil & Environmental Engineering, University of South Florida, 4202 E Fowler Avenue, Tampa, Florida 33620, United States
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Barsties LS, van den Berg SW, Leone SS, Nicolaou M, van Oostrom SH. A system science perspective on burn-out: development of an expert-based causal loop diagram. Front Public Health 2023; 11:1271591. [PMID: 38035310 PMCID: PMC10687398 DOI: 10.3389/fpubh.2023.1271591] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/02/2023] [Accepted: 11/02/2023] [Indexed: 12/02/2023] Open
Abstract
Introduction Burn-out leads to reduced worker well-being, long-term absenteeism, and high costs for employers and society. Determinants at different levels may affect burn-out in an interrelated and dynamic manner. The aim of the present study was to apply a broader systems perspective by exploring and visualizing the complex system of determinants at different levels (living conditions, working conditions, and societal developments) underlying the prevalence of burn-out in the Netherlands. Methods During three group model building (GMB) sessions with in total eight experts on workers' mental health, a causal loop diagram (CLD) was developed and relevant feedback loops were identified. For the selection of determinants to be included in the CLD a recently published overview of determinants on burn-out at different levels was used. Experts could also add factors that were not listed in the overview. Results The final CLD consists of 20 factors and depicts a central position of working conditions. Societal developments (e.g., access to mental health care, size of the working population, rougher social climate, etc.) were mostly located at the outside of the CLD and barely integrated in feedback loops. Several reinforcing feedback loops resulting in an increase of the prevalence of burn-out were identified in which the factors (very) high workload, imbalance between work and private life, and insufficient recovery time play an important role. Also, several balancing loops were found that visualize the crucial role of functional support from supervisors to prevent burn-out among workers. Discussion Applying a broader systems perspective, including determinants at different levels, offers new insights into dynamic feedback loops that contribute to the prevalence of burn-out. Supervisors, amongst others, have a considerable impact on the system underlying the high prevalence of burn-out and may therefore contribute to its prevention. Even though societal developments were less integrated in feedback loops, they might be considered drivers of existing feedback loops. The results from this study confirm that determinants at various levels underly the prevalence of burn-out. To be able to address the diversity of determinants underlying a high prevalence of burn-out, a complex system approach can be helpful.
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Affiliation(s)
- Lisa S. Barsties
- National Institute for Public Health and the Environment (RIVM), Bilthoven, Netherlands
| | | | - Stephanie S. Leone
- Department of Mental Health & Prevention, Trimbos Institute, Netherlands Institute of Mental Health and Addiction, Utrecht, Netherlands
| | - Mary Nicolaou
- Department of Public and Occupational Health, Amsterdam University Medical Centers, University of Amsterdam, Amsterdam, Netherlands
- Centre for Urban Mental Health, University of Amsterdam, Amsterdam, Netherlands
| | - Sandra H. van Oostrom
- National Institute for Public Health and the Environment (RIVM), Bilthoven, Netherlands
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Li B, Alharbi M, Allender S, Swinburn B, Peters R, Foster C. Comprehensive application of a systems approach to obesity prevention: a scoping review of empirical evidence. Front Public Health 2023; 11:1015492. [PMID: 37614454 PMCID: PMC10442543 DOI: 10.3389/fpubh.2023.1015492] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/09/2022] [Accepted: 06/12/2023] [Indexed: 08/25/2023] Open
Abstract
A systems approach to obesity prevention is increasingly urged. However, confusion exists on what a systems approach entails in practice, and the empirical evidence on this new approach is unclear. This scoping review aimed to identify and synthesise studies/programmes that have comprehensively applied a systems approach to obesity prevention in intervention development, delivery/implementation, and evaluation. By searching international databases and grey literature, only three studies (10 publications) met inclusion criteria, which might be explained partially by suboptimal reporting. No conclusion on the effectiveness of this approach can be drawn yet due to the limited evidence base. We identified common features shared by the included studies, such as measuring ongoing changes, in addition to endpoint outcomes, and supporting capacity building. Some facilitators and barriers to applying a comprehensive systems approach in practice were identified. More well-designed and reported studies are needed, especially from low- and middle-income countries.
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Affiliation(s)
- Bai Li
- Centre for Exercise, Nutrition and Health Sciences, School for Policy Studies, University of Bristol, Bristol, United Kingdom
| | - Mohammed Alharbi
- Centre for Exercise, Nutrition and Health Sciences, School for Policy Studies, University of Bristol, Bristol, United Kingdom
| | - Steve Allender
- Global Centre for Preventive Health and Nutrition (GLOBE), Institute for Health Transformation, Faculty of Health, Deakin University, Geelong, VIC, Australia
| | - Boyd Swinburn
- School of Population Health, University of Auckland, Auckland, New Zealand
| | - Remco Peters
- Centre for Exercise, Nutrition and Health Sciences, School for Policy Studies, University of Bristol, Bristol, United Kingdom
| | - Charlie Foster
- Centre for Exercise, Nutrition and Health Sciences, School for Policy Studies, University of Bristol, Bristol, United Kingdom
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Ansah JP, Chia AWY, Koh VJW, Lai WX, Koh JSB, Goh KS, Yeo W, Howe TS, Seow DCC, Mamun K, Balasubramanian D, Varman SD, Yeo AKS, Elamin A, Chan AWM, Matchar DB. Systems modelling as an approach for eliciting the mechanisms for hip fracture recovery among older adults in a participatory stakeholder engagement setting. Front Rehabil Sci 2023; 4:1184484. [PMID: 37424878 PMCID: PMC10327561 DOI: 10.3389/fresc.2023.1184484] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 03/11/2023] [Accepted: 06/08/2023] [Indexed: 07/11/2023]
Abstract
Introduction Due to an aging population, the rising prevalence and incidence of hip fractures and the associated health and economic burden present a challenge to healthcare systems worldwide. Studies have shown that a complex interplay of physiological, psychological, and social factors often affects the recovery trajectories of older adults with hip fractures, often complicating the recovery process. Methods This research aims to actively engage stakeholders (including doctors, physiotherapists, hip fracture patients, and caregivers) using the systems modeling methodology of Group Model Building (GMB) to elicit the factors that promote or inhibit hip fracture recovery, incorporating a feedback perspective to inform system-wide interventions. Hip fracture stakeholder engagement was facilitated through the Group Model Building approach in a two-half-day workshop of 25 stakeholders. This approach combined different techniques to develop a comprehensive qualitative whole-system view model of the factors that promote or inhibit hip fracture recovery. Results A conceptual, qualitative model of the dynamics of hip fracture recovery was developed that draws on stakeholders' personal experiences through a moderated interaction. Stakeholders identified four domains (i.e., expectation formation, rehabilitation, affordability/availability, and resilience building) that play a significant role in the hip fracture recovery journey.. Discussion The insight that recovery of loss of function due to hip fracture is attributed to (a) the recognition of a gap between pre-fracture physical function and current physical function; and (b) the marshaling of psychological resilience to respond promptly to a physical functional loss via uptake of rehabilitation services is supported by findings and has several policy implications.
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Affiliation(s)
- John Pastor Ansah
- Center for Community Health Integration, School of Medicine, Case Western Reserve University, Cleveland, United States
- Programme in Health Services and Systems Research, Duke-NUS Medical School, National University of Singapore, Singapore, Singapore
| | - Aloysius Wei-Yan Chia
- Programme in Health Services and Systems Research, Duke-NUS Medical School, National University of Singapore, Singapore, Singapore
| | - Vanessa Jean Wen Koh
- Programme in Health Services and Systems Research, Duke-NUS Medical School, National University of Singapore, Singapore, Singapore
- Centre for Ageing Research and Education (CARE), Duke-NUS Medical School, Singapore, Singapore
| | - Wei Xuan Lai
- Programme in Health Services and Systems Research, Duke-NUS Medical School, National University of Singapore, Singapore, Singapore
| | - Joyce Suang Bee Koh
- Department of Orthopaedic Surgery, Singapore General Hospital, Singapore, Singapore
| | - Kiat Sern Goh
- Department of Geriatric Medicine, Changi General Hospital, Singapore, Singapore
| | - William Yeo
- Orthopaedic Diagnostics Centre, Singapore General Hospital, Singapore, Singapore
| | - Tet Sen Howe
- Department of Orthopaedic Surgery, Singapore General Hospital, Singapore, Singapore
| | | | - Kaysar Mamun
- Department of Geriatric Medicine, Singapore General Hospital, Singapore, Singapore
| | | | | | - Andy Kuei Siong Yeo
- Department of Orthopaedic Surgery, Changi General Hospital, Singapore, Singapore
| | - Amal Elamin
- School of Human Sciences, Faculty of Education, Health and Human Sciences, University of Greenwich, London, United Kingdom
| | - Angelique Wei-Ming Chan
- Programme in Health Services and Systems Research, Duke-NUS Medical School, National University of Singapore, Singapore, Singapore
- Centre for Ageing Research and Education (CARE), Duke-NUS Medical School, Singapore, Singapore
| | - David Bruce Matchar
- Programme in Health Services and Systems Research, Duke-NUS Medical School, National University of Singapore, Singapore, Singapore
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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] [What about the content of this article? (0)] [Affiliation(s)] [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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Matson PA, Stankov I, Hassmiller Lich K, Flessa S, Lowy J, Thornton RLJ. A systems framework depicting how complex neighborhood dynamics and contextual factors could impact the effectiveness of an alcohol outlet zoning policy. Am J Community Psychol 2022; 70:18-32. [PMID: 34784432 DOI: 10.1002/ajcp.12566] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/19/2021] [Revised: 09/18/2021] [Accepted: 10/06/2021] [Indexed: 06/13/2023]
Abstract
An updated zoning policy eliminating all alcohol outlets (liquor stores) in residential districts was implemented to reduce high rates of violent crime in Baltimore City. Diverse stakeholders were engaged in group model building (GMB) activities to develop causal loop diagrams (CLDs) that elucidate the impact of the new zoning policy on crime, and more broadly, the potentially unintended social and environmental consequences of the policy. Three distinct groups, community advocates, city officials/academics, and community residents, participated in three separate GMB sessions. Three CLDs, one from each stakeholder group, were created to depict the possible outcomes of the zoning policy. Our findings offer insight into potential unintended consequences of removing liquor stores from residential areas that may undermine the policy. Community members described the need for additional supports related to mental health and substance use, opportunities for investment in the community, access to other goods and services, and community-police relations to ensure the policy achieved its intended goal of reducing violent crime. Our findings highlight the importance of timely engagement of local stakeholders to understand how complex neighborhood dynamics and contextual factors could impact the effectiveness of a zoning policy change.
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Affiliation(s)
- Pamela A Matson
- Department of Pediatrics, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
| | - Ivana Stankov
- Urban Health Collaborative, Dornsife School of Public Health, Drexel University, Philadelphia, Pennsylvania, USA
- UniSA Allied Health and Human Performance, University of South Australia, Adelaide, South Australia, Australia
| | - Kristen Hassmiller Lich
- Department of Health Policy and Management, Gillings School of Global Public Health, University of North Carolina Chapel Hill, Chapel Hill, North Carolina, USA
| | - Sarah Flessa
- Department of Pediatrics, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
| | - Jacob Lowy
- Department of Pediatrics, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
| | - Rachel L J Thornton
- Department of Pediatrics, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
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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. Int J Environ Res 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] [What about the content of this article? (0)] [Affiliation(s)] [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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Hendricks G, Savona N, Aguiar A, Alaba O, Booley S, Malczyk S, Nwosu E, Knai C, Rutter H, Klepp KI, Harbron J. Adolescents' Perspectives on the Drivers of Obesity Using a Group Model Building Approach: A South African Perspective. Int J Environ Res Public Health 2022; 19:ijerph19042160. [PMID: 35206348 PMCID: PMC8871984 DOI: 10.3390/ijerph19042160] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 12/15/2021] [Revised: 01/31/2022] [Accepted: 02/03/2022] [Indexed: 11/16/2022]
Abstract
Overweight and obesity increase the risk of a range of poor physiological and psychosocial health outcomes. Previous work with well-defined cohorts has explored the determinants of obesity and employed various methods and measures; however, less is known on the broader societal drivers, beyond individual-level influences, using a systems framework with adolescents. The aim of this study was to explore the drivers of obesity from adolescents' perspectives using a systems approach through group model building in four South African schools. Group model building was used to generate 4 causal loop diagrams with 62 adolescents aged 16-18 years. These maps were merged into one final map, and the main themes were identified: (i) physical activity and social media use; (ii) physical activity, health-related morbidity, and socio-economic status; (iii) accessibility of unhealthy food and energy intake/body weight; (iv) psychological distress, body weight, and weight-related bullying; and (v) parental involvement and unhealthy food intake. Our study identified meaningful policy-relevant insights into the drivers of adolescent obesity, as described by the young people themselves in a South African context. This approach, both the process of construction and the final visualization, provides a basis for taking a novel approach to prevention and intervention recommendations for adolescent obesity.
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Affiliation(s)
- Gaironeesa Hendricks
- Research Centre for Health through Physical Activity, Lifestyle & Sport, Division of Physio-Logical Sciences, Department of Human Biology, Faculty of Health Sciences, University of Cape Town, Cape Town 7925, South Africa; (S.B.); (S.M.); (E.N.); (J.H.)
- Correspondence:
| | - Natalie Savona
- Faculty of Public Health and Policy, London School of Hygiene & Tropical Medicine, London WC1E 7HT, UK; (N.S.); (C.K.)
| | - Anaely Aguiar
- System Dynamics Group, Department of Geography, University of Bergen, N-5020 Bergen, Norway;
| | - Olufunke Alaba
- Health Economics Division, School of Public Health and Family Medicine, University of Cape Town, Cape Town 7925, South Africa;
| | - Sharmilah Booley
- Research Centre for Health through Physical Activity, Lifestyle & Sport, Division of Physio-Logical Sciences, Department of Human Biology, Faculty of Health Sciences, University of Cape Town, Cape Town 7925, South Africa; (S.B.); (S.M.); (E.N.); (J.H.)
| | - Sonia Malczyk
- Research Centre for Health through Physical Activity, Lifestyle & Sport, Division of Physio-Logical Sciences, Department of Human Biology, Faculty of Health Sciences, University of Cape Town, Cape Town 7925, South Africa; (S.B.); (S.M.); (E.N.); (J.H.)
| | - Emmanuel Nwosu
- Research Centre for Health through Physical Activity, Lifestyle & Sport, Division of Physio-Logical Sciences, Department of Human Biology, Faculty of Health Sciences, University of Cape Town, Cape Town 7925, South Africa; (S.B.); (S.M.); (E.N.); (J.H.)
| | - Cecile Knai
- Faculty of Public Health and Policy, London School of Hygiene & Tropical Medicine, London WC1E 7HT, UK; (N.S.); (C.K.)
| | - Harry Rutter
- Department of Social and Policy Sciences, University of Bath, Bath BA2 7PJ, UK;
| | - Knut-Inge Klepp
- Division of Mental and Physical Health, Norwegian Institute of Public Health, N-0316 Oslo, Norway;
| | - Janetta Harbron
- Research Centre for Health through Physical Activity, Lifestyle & Sport, Division of Physio-Logical Sciences, Department of Human Biology, Faculty of Health Sciences, University of Cape Town, Cape Town 7925, South Africa; (S.B.); (S.M.); (E.N.); (J.H.)
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11
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Cordova-Pozo KL, Korzilius HPLM, Rouwette EAJA, Píriz G, Herrera-Gutierrez R, Cordova-Pozo G, Orozco M. Using Systems Dynamics for Capturing the Multicausality of Factors Affecting Health System Capacity in Latin America while Responding to the COVID-19 Pandemic. Int J Environ Res Public Health 2021; 18:10002. [PMID: 34639304 DOI: 10.3390/ijerph181910002] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [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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Strauss C, Bildstein G, Efe J, Flacher T, Hofmann K, Huggler M, Stämpfli A, Schmid M, Schmid E, Gehring C, Häske D, Prückner S, Stock JP, Trentzsch H. Optimizing Emergency Medical Service Structures Using a Rule-Based Discrete Event Simulation-A Practitioner's Point of View. Int J Environ Res Public Health 2021; 18:2649. [PMID: 33808033 DOI: 10.3390/ijerph18052649] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 12/30/2020] [Revised: 02/05/2021] [Accepted: 02/24/2021] [Indexed: 11/21/2022]
Abstract
Many studies in research deal with optimizing emergency medical services (EMS) on both the operational and the strategic level. It is the purpose of this method-oriented article to explain the major features of “rule-based discrete event simulation” (rule-based DES), which we developed independently in Germany and Switzerland. Our rule-based DES addresses questions concerning the location and relocation of ambulances, dispatching and routing policies, and EMS interplay with other players in prehospital care. We highlight three typical use cases from a practitioner’s perspective and go into different countries’ peculiarities. We show how research results are applied to EMS and healthcare organizations to simulate and optimize specific regions in Germany and Switzerland with their strong federal structures. The rule-based DES serves as basis for decision support to improve regional emergency services’ efficiency without increasing cost. Finally, all simulation-based methods suggest normative solutions and optimize EMS’ performance within given healthcare system structures. We argue that interactions between EMS, emergency departments, and public healthcare agencies are crucial to further improving effectiveness, efficiency, and quality.
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Gerritsen S, Harré S, Rees D, Renker-Darby A, Bartos AE, Waterlander WE, Swinburn B. Community Group Model Building as a Method for Engaging Participants and Mobilising Action in Public Health. Int J Environ Res Public Health 2020; 17:E3457. [PMID: 32429183 DOI: 10.3390/ijerph17103457] [Citation(s) in RCA: 19] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 04/25/2020] [Revised: 05/13/2020] [Accepted: 05/13/2020] [Indexed: 11/17/2022]
Abstract
Group model building (GMB) is a qualitative method aimed at engaging stakeholders to collectively consider the causes of complex problems. Tackling inequities in community nutrition is one such complex problem, as the causes are driven by a variety of interactions between individual factors, social structures, local environments and the global food system. This methods paper describes a GMB process that utilises three system mapping tools in a study with members of a multicultural, low-income community to explore declining fruit and vegetable intake in children. The tools were: 1) graphs over time, which captures the community's understanding of an issue; 2) cognitive mapping, which enables participants to think systemically about the causes and consequences of the issue; 3) causal loop diagrams, which describe feedback loops that reinforce the issue and identify potential actions. Cognitive mapping, a tool not usually associated with GMB, was added to the research process to support the gradual development of participants' thinking and develops the skills needed to tackle an issue from a systems perspective. We evaluate the benefits and impact of these three tools, particularly in engaging participants and increasing understanding of systems thinking in order to develop and mobilise action. The tools could be adapted for use in other community-based research projects. Key learnings were the value of genuine partnership with a local organisation for longevity of the project, recruitment of key decisionmakers from the community early in the process, and allowing time to create sustainable change.
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Bolt T, Bayer S, Kapsali M, Brailsford S. An analytical framework for group simulation model building. Health Syst (Basingstoke) 2020; 10:198-211. [PMID: 34377443 DOI: 10.1080/20476965.2020.1740613] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022] Open
Abstract
This paper presents a framework for understanding and improving the process of simulation model building involving a group of domain experts, classifying the different roles the model may play at various stages of its development. The framework consists of four different "object roles", defined along two dimensions: a functional dimension (boundary object vs. representational object) and a knowledge dimension (epistemic object vs. technical object). A model can take different roles during the development process, e.g. for facilitating communication, for gaining insight into the real-world system, or for experimentation and policy evaluation. The use of the framework is illustrated by two case studies in healthcare. Its relevance and applicability are examined through a survey on model use. The survey was conducted among a group of modelling consultants with experience of using both discrete-event simulation and system dynamics within the NHS, and indicated the potential usefulness of the framework.
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Affiliation(s)
- Timothy Bolt
- Faculty of Economics, Saitama University, Saitama City, Japan
| | - Steffen Bayer
- Southampton Business School, University of Southampton, Southampton, UK
| | - Maria Kapsali
- Manchester Metropolitan Business School, Manchester Metropolitan University, Manchester, UK
| | - Sally Brailsford
- Southampton Business School, University of Southampton, Southampton, UK
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Abstract
Background. Whole-of-community interventions have been recommended and show promise for preventing obesity; however, research to understand the mechanisms underlying their success or failure is lacking. Complex systems approaches may be useful to address this gap. Purpose. To describe the evolution and utilization of qualitative and quantitative complex systems methods to understand and model whole-of-community obesity prevention interventions. Approach. We illustrate the retrospective qualitative development of a systems map representing community change dynamic within the Shape Up Somerville (SUS) intervention. We then describe how this systems map, and complementary work of other successful obesity prevention interventions (Romp & Chomp intervention), informed the COMPACT (childhood obesity modeling for prevention and community transformation) study. COMPACT's design aligns complex systems science principles and community-engaged research to better understand stakeholders' leadership roles in whole-of-community interventions. We provide an overview of the complex systems tools used in COMPACT: agent-based modeling, group model building, and social network analysis and describe how whole-of-community intervention stakeholders ("agents") use their social networks to diffuse knowledge about and engagement with childhood obesity prevention efforts, laying the groundwork for community readiness for sustainable change. Conclusion. Complex systems approaches appear feasible and useful to study whole-of-community obesity prevention interventions and provide novel insights that expand on those gained from traditional approaches. Use of multiple methods, both qualitative and quantitative, from the complex systems toolkit working together can be important to success.
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Guariguata L, Rouwette EAJA, Murphy MM, Saint Ville A, Dunn LL, Hickey GM, Jones W, Samuels TA, Unwin N. Using Group Model Building to Describe the System Driving Unhealthy Eating and Identify Intervention Points: A Participatory, Stakeholder Engagement Approach in the Caribbean. Nutrients 2020; 12:E384. [PMID: 32024025 PMCID: PMC7071222 DOI: 10.3390/nu12020384] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/10/2019] [Revised: 01/10/2020] [Accepted: 01/15/2020] [Indexed: 12/16/2022] Open
Abstract
Many Small Island Developing States of the Caribbean experience a triple burden of malnutrition with high rates of obesity, undernutrition in children, and iron deficiency anemia in women of reproductive age, driven by an inadequate, unhealthy diet. This study aimed to map the complex dynamic systems driving unhealthy eating and to identify potential points for intervention in three dissimilar countries. Stakeholders from across the food system in Jamaica (n = 16), St. Kitts and Nevis (n = 19), and St. Vincent and the Grenadines (n = 6) engaged with researchers in two group model building (GMB) workshops in 2018. Participants described and mapped the system driving unhealthy eating, identified points of intervention, and created a prioritized list of intervention strategies. Stakeholders were also interviewed before and after the workshops to provide their perspectives on the utility of this approach. Stakeholders described similar underlying systems driving unhealthy eating across the three countries, with a series of dominant feedback loops identified at multiple levels. Participants emphasized the importance of the relative availability and price of unhealthy foods, shifting cultural norms on eating, and aggressive advertising from the food industry as dominant drivers. They saw opportunities for governments to better regulate advertising, disincentivize unhealthy food options, and bolster the local agricultural sector to promote food sovereignty. They also identified the need for better coordinated policy making across multiple sectors at national and regional levels to deliver more integrated approaches to improving nutrition. GMB proved to be an effective tool for engaging a highly diverse group of stakeholders in better collective understanding of a complex problem and potential interventions.
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Affiliation(s)
- Leonor Guariguata
- George Alleyne Chronic Disease Research Centre, University of the West Indies, “Avalon”, Jemmott’s Lane, Bridgetown BB11115, Barbados; (M.M.M.); (W.J.); (T.A.S.); (N.U.)
| | - Etiënne AJA Rouwette
- Nijmegen School of Management, Radboud University, Heyendaalseweg 141, 6525 AJ Nijmegen, The Netherlands;
| | - Madhuvanti M Murphy
- George Alleyne Chronic Disease Research Centre, University of the West Indies, “Avalon”, Jemmott’s Lane, Bridgetown BB11115, Barbados; (M.M.M.); (W.J.); (T.A.S.); (N.U.)
| | - Arlette Saint Ville
- Department of Natural Resource Sciences, McGill University, Macdonald-Steward Building, 21111 Lakeshore Road, Sainte-Anne-de-Bellevue, QC H9X 3V9, Canada; (A.S.V.); (G.M.H.)
| | - Leith L Dunn
- Institute of Gender and Development Studies, University of the West Indies, Mona Campus, Kingston 7, Jamaica;
| | - Gordon M Hickey
- Department of Natural Resource Sciences, McGill University, Macdonald-Steward Building, 21111 Lakeshore Road, Sainte-Anne-de-Bellevue, QC H9X 3V9, Canada; (A.S.V.); (G.M.H.)
| | - Waneisha Jones
- George Alleyne Chronic Disease Research Centre, University of the West Indies, “Avalon”, Jemmott’s Lane, Bridgetown BB11115, Barbados; (M.M.M.); (W.J.); (T.A.S.); (N.U.)
| | - T Alafia Samuels
- George Alleyne Chronic Disease Research Centre, University of the West Indies, “Avalon”, Jemmott’s Lane, Bridgetown BB11115, Barbados; (M.M.M.); (W.J.); (T.A.S.); (N.U.)
- Caribbean Institute for Health Research, University of the West Indies, Mona Campus, Kingston 7, Jamaica
| | - Nigel Unwin
- George Alleyne Chronic Disease Research Centre, University of the West Indies, “Avalon”, Jemmott’s Lane, Bridgetown BB11115, Barbados; (M.M.M.); (W.J.); (T.A.S.); (N.U.)
- MRC Epidemiology Unit, University of Cambridge, Level 3 Institute of Metabolic Science, Addenbrooke’s Treatment Centre, Cambridge CB2 0SL, UK
- European Centre for Environment and Human Health, University of Exeter Medical School, Knowledge Spa, Royal Cornwall Hospital, Truro, Cornwall TR1 3HD, UK
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Sie YT, Château PA, Chang YC, Lu SY. Stakeholders Opinions on Multi-Use Deep Water Offshore Platform in Hsiao-Liu-Chiu, Taiwan. Int J Environ Res Public Health 2018; 15:ijerph15020281. [PMID: 29415521 PMCID: PMC5858350 DOI: 10.3390/ijerph15020281] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 11/30/2017] [Revised: 01/11/2018] [Accepted: 01/23/2018] [Indexed: 11/16/2022]
Abstract
This paper describes a group model building activity designed to elicit the potential effects a projected multi-use deep water offshore platform may have on its local environment, including ecological and socio-economic issues. As such a platform is proposed for construction around the island of Hsiao-Liu-Chiu, Taiwan, we organized several meetings with the local stakeholders and structured the debates using group modeling methods to promote consensus. During the process, the participants iteratively built and revised a causal-loop diagram that summarizes their opinions. Overall, local stakeholders concluded that a multi-use deep water offshore marine platform might have beneficial effects for Hsiao-Liu-Chiu because more tourists and fish could be attracted by the structure, but they also raised some potential problems regarding the law in Taiwan and the design of the offshore platform, especially its resistance to extreme weather. We report the method used and the main results and insights gained during the process.
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Affiliation(s)
- Ya-Tsune Sie
- Department of Marine Environment and Engineering, National Sun Yat-sen University, Kaohsiung 80424, Taiwan.
| | - Pierre-Alexandre Château
- Department of Bioenvironmental Systems Engineering, National Taiwan University, Taipei 10617, Taiwan.
| | - Yang-Chi Chang
- Department of Marine Environment and Engineering, National Sun Yat-sen University, Kaohsiung 80424, Taiwan.
| | - Shiau-Yun Lu
- Department of Marine Environment and Engineering, National Sun Yat-sen University, Kaohsiung 80424, Taiwan.
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Wijenberg E, Wagemakers A, Herens M, Hartog FD, Koelen M. The value of the participatory network mapping tool to facilitate and evaluate coordinated action in health promotion networks: two Dutch case studies. Glob Health Promot 2017; 26:32-40. [PMID: 28832266 PMCID: PMC6755660 DOI: 10.1177/1757975917716923] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/03/2022]
Abstract
Introduction: Facilitating processes for coordinated action in the field of health promotion is a challenge. Poorthuis and Bijl’s (2006) Participatory Network Mapping Tool (PNMT) uses visualization and discussion to map the positions and roles of network actors, stimulate learning processes, and elicit actionable knowledge. This article describes the results from the application of the PNMT in networks of two Dutch health promotion programmes (Health Race and BeweegKuur) with the aim of determining the value of the PNMT to partners in health promotions networks. Methods: A qualitative secondary analysis (QSA) was conducted to clarify positions and roles, learning processes, and actionable knowledge of network actors in existing data sets including five group interviews of the Health Race programme and 16 individual interviews and 15 group interviews of the BeweegKuur programme. Results: The PNMT maps both positions and roles of (missing) actors and makes successes (e.g. knowing each other) and challenges (e.g. implementing new activities) visible. Thus, the PNMT provides a starting point for discussion and reflection and eliciting actionable knowledge such as involving new actors and target populations in the programme. Conclusion: The PNMT contributes to the facilitation of coordinated action in health promotion networks by making positions and roles of network partners visible. In combination with dialogue and reflection the PNMT helps to elucidate factors influencing coordinated action and outcomes. The PNMT is valuable in grasping intangible aspects between actors by stimulating collective learning. These insights can be used by researchers and network actors to achieve more successful coordinated action for health promotion.
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Affiliation(s)
- Evianne Wijenberg
- Health and Society, Department of Social Sciences, Wageningen University, Wageningen, The Netherlands.,Management of Health Care, Faculty of Health Care, HU University of Applied Sciences Utrecht, Amersfoort, The Netherlands
| | - Annemarie Wagemakers
- Health and Society, Department of Social Sciences, Wageningen University, Wageningen, The Netherlands
| | - Marion Herens
- Health and Society, Department of Social Sciences, Wageningen University, Wageningen, The Netherlands
| | - Franciska den Hartog
- Health and Society, Department of Social Sciences, Wageningen University, Wageningen, The Netherlands
| | - Maria Koelen
- Health and Society, Department of Social Sciences, Wageningen University, Wageningen, The Netherlands
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