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Concincion S, van Houtum L, Verhoeff A, Dedding C. Bored, afraid, alone: What can we learn from children with paediatric obesity about the impact of the COVID-19 pandemic for future pandemics, care practices and policies? J Pediatr Nurs 2024; 77:162-171. [PMID: 38522210 DOI: 10.1016/j.pedn.2024.03.025] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/09/2023] [Revised: 02/16/2024] [Accepted: 03/16/2024] [Indexed: 03/26/2024]
Abstract
PURPOSE The aim of this study was to gain insight into the perspectives of children with paediatric obesity themselves, during the pandemic and afterwards, regarding their wellbeing and health, and to solicit their advice on tailoring obesity care to match their daily realities. DESIGN AND METHODS We used a 'draw, write and tell' interview technique, conducted walk-alongs, participant observations and a group session with children with paediatric obesity from seldom-heard communities in Amsterdam, the Netherlands. Data was analysed using reflexive thematic analysis. RESULTS Children reported that during lockdowns they were confined to the house, causing them to feel bored and alone. This triggered them to fall into previous unhealthy patterns, such as an increase in sitting on the couch or lying in bed, gaming or watching TV, feeling hungry a lot and eating more. Some children experienced major events, such as mourning the death of a loved one or taking care of other family members, and thus felt they had to grow up fast. CONCLUSION Our study adds to our understanding of the mechanisms of the impact of the COVID-19 pandemic from the perspectives of children with paediatric obesity from seldom-heard communities and emphasizes the importance of considering how the pandemic (and related measures) affected the daily - as well as future - lives of children in vulnerable circumstances. PRACTICAL IMPLICATIONS The recommendations children gave could be explored as pathways for more child-centred, successful and tailored obesity care practices and policies in order to support their (mental) wellbeing and health.
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Affiliation(s)
- Siegnella Concincion
- Faculty of Social and Behavioural Sciences, University of Amsterdam, Youth Health Care Department (JGZ) of the Public Health Service Amsterdam (GGD), Nieuwe Achtergracht 100, 1018 WT Amsterdam, Postbus 2200, 1000 CE Amsterdam, the Netherlands.
| | - Lieke van Houtum
- Public Health Service Amsterdam (GGD), Nieuwe Achtergracht 100, 1018 WT Amsterdam, Postbus 2200, 1000 CE Amsterdam, the Netherlands.
| | - Arnoud Verhoeff
- Faculty of Social and Behavioural Sciences, University of Amsterdam, Sarphati Amsterdam, Public Health Service Amsterdam (GGD), Nieuwe Achtergracht 100, 1018 WT Amsterdam, Postbus 2200, 1000 CE Amsterdam, the Netherlands.
| | - Christine Dedding
- Department of Ethics, Law and Humanities (ERH), Amsterdam University Medical Centers, location VUmc, De Boelelaan 1089a, 1081 HV Amsterdam, the Netherlands.
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Emke H, Altenburg T, Dijkstra C, Pinzon AL, Stronks K, Waterlander W, Kremers S, Chinapaw M. Applying systems thinking in youth-centred participatory action research for health promotion in an underserved neighbourhood. Front Public Health 2024; 12:1272663. [PMID: 38887247 PMCID: PMC11180748 DOI: 10.3389/fpubh.2024.1272663] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/04/2023] [Accepted: 05/22/2024] [Indexed: 06/20/2024] Open
Abstract
Purpose Childhood overweight is considered a complex problem influenced by a range of factors, including energy balance-related behaviours (EBRBs) and interacting drivers of these behaviours. There is growing support that applying a systems approach is required to tackle complex problems resulting in actions that attempt to change the system's dynamics. Additionally, a participatory approach is advocated to include the lived experience of the population of interest both in the understanding of the system as well as the development, implementation and evaluation of relevant actions. We therefore combined Intervention Mapping, Participatory Action Research (PAR) and system dynamics in the development, implementation and evaluation of actions contributing to healthy EBRBs together with adolescents. Methods Four PAR groups comprising of 6-8 adolescent co-researchers (10-14 years) and 1-2 adult facilitators met weekly during 3-4 years. The structured Intervention Mapping protocol guided the process of the systematic development, implementation and evaluation of actions. System dynamics tools were included for the creation of Causal Loop Diagrams and development of systemic actions. Results Our approach comprised six steps that were executed by the PAR groups: (1) build Causal Loop Diagrams for each EBRB through peer research and identify overarching mechanisms, (2) determine leverage points using the Intervention Level Framework, (3) develop action ideas, (4) develop detailed actions including an implementation plan, (5) implement and, (6) evaluate the actions. PAR ensured that the actions fitted the lived experience of the adolescents, whilst system dynamics promoted actions at different levels of the system. The Intervention Mapping protocol ensured that the actions were theory-based. The main challenge involved integrating system dynamics within our practise in cooperation with adolescent co-researchers. Conclusion We experienced that combining Intervention Mapping, PAR and system dynamics worked well in developing, implementing and evaluating actions that target different levels of the system that drive adolescents' EBRBs. This study serves as an example to other studies aimed at developing, implementing and evaluating actions using a participatory and systems approach.
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Affiliation(s)
- Helga Emke
- Department of Health Sciences, Faculty of Science, Vrije Universiteit Amsterdam, Amsterdam, Netherlands
- Amsterdam Public Health Research Institute, Health Behaviour and Chronic Diseases and Methodology, Amsterdam, Netherlands
- Department of Public and Occupational Health, Amsterdam University Medical Centre, Vrije Universiteit Amsterdam, Amsterdam, Netherlands
| | - Teatske Altenburg
- Amsterdam Public Health Research Institute, Health Behaviour and Chronic Diseases and Methodology, Amsterdam, Netherlands
- Department of Public and Occupational Health, Amsterdam University Medical Centre, Vrije Universiteit Amsterdam, Amsterdam, Netherlands
| | - Coosje Dijkstra
- Department of Health Sciences, Faculty of Science, Vrije Universiteit Amsterdam, Amsterdam, Netherlands
- Amsterdam Public Health Research Institute, Health Behaviour and Chronic Diseases and Methodology, Amsterdam, Netherlands
| | - Angie Luna Pinzon
- Amsterdam Public Health Research Institute, Health Behaviour and Chronic Diseases and Methodology, Amsterdam, Netherlands
- Department of Public and Occupational Health, Amsterdam University Medical Centre, University of Amsterdam, Maastricht, Netherlands
| | - Karien Stronks
- Amsterdam Public Health Research Institute, Health Behaviour and Chronic Diseases and Methodology, Amsterdam, Netherlands
- Department of Public and Occupational Health, Amsterdam University Medical Centre, University of Amsterdam, Maastricht, Netherlands
| | - Wilma Waterlander
- Amsterdam Public Health Research Institute, Health Behaviour and Chronic Diseases and Methodology, Amsterdam, Netherlands
- Department of Public and Occupational Health, Amsterdam University Medical Centre, University of Amsterdam, Maastricht, Netherlands
| | - Stef Kremers
- Department of Health Promotion, NUTRIM School of Nutrition and Translational Research in Metabolism, Maastricht University Medical Centre, Maastricht, Netherlands
| | - Mai Chinapaw
- Amsterdam Public Health Research Institute, Health Behaviour and Chronic Diseases and Methodology, Amsterdam, Netherlands
- Department of Public and Occupational Health, Amsterdam University Medical Centre, Vrije Universiteit Amsterdam, Amsterdam, Netherlands
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Takens FE, Indyk I, Chinapaw MJM, Ujčič-Voortman JK, van Nassau F, Busch V. Qualitative multi-stakeholder evaluation of the adoption, implementation and sustainment of the school-based dietary intervention "Jump-in". BMC Public Health 2024; 24:1337. [PMID: 38760727 PMCID: PMC11102190 DOI: 10.1186/s12889-024-18814-1] [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: 10/12/2023] [Accepted: 05/09/2024] [Indexed: 05/19/2024] Open
Abstract
BACKGROUND Comprehensive school-based programs applying the WHO Health Promoting School Model have the potential to initiate and sustain behavior change and impact health. However, since they often include intervention efforts on a school's policies, physical environment, curriculum, health care and involving parents and communities, they significantly 'intrude' on a complex system that is aimed primarily at education, not health promotion. More insights into and concrete strategies are therefore needed regarding their adoption, implementation, and sustainment processes to address the challenge to sustainable implementation of HPS initiatives in a primarily educational setting. This study consequently evaluates adoption, implementation and sustainment processes of Amsterdam's Jump-in healthy nutrition HPS intervention from a multi-stakeholder perspective. METHODS We conducted semi-structured interviews and focus groups with all involved stakeholders (n = 131), i.e., Jump-in health promotion professionals (n = 5), school principals (n = 7), at-school Jump-in coordinators (n = 7), teachers (n = 20), parents (n = 50, 9 groups) and children (n = 42, 7 groups) from 10 primary schools that enrolled in Jump-in in the school year 2016-2017. Included schools had a higher prevalence of overweight and/or obesity than the Dutch average and they were all located in Amsterdam's low-SEP neighborhoods. Data were analyzed using a directed content analysis, in which the Determinants of Innovation Model was used for obtaining theory-based predetermined codes, supplemented with new codes emerging from the data. RESULTS During intervention adoption, all stakeholders emphasized the importance of parental support, and accompanying workshops and promotional materials. Additionally, parents and teachers indicated that a shared responsibility for children's health and nuanced framing of health messages were important. During implementation, all stakeholders needed clear guidelines and support structures. Teachers and children highlighted the importance of peer influence, social norms, and uniform application of guidelines. School staff also found further tailoring of the intervention and dealing with financial constraints important. For long-term intervention sustainment, incorporating the intervention policies into the school statutes was crucial according to health promotion professionals. CONCLUSIONS This qualitative evaluation provides valuable insights into factors influencing the adoption, implementation, and sustainment processes of dietary interventions, such as the importance of transparent and consistent intervention guidelines, clear communication regarding the rationale behind intervention guidelines, and, stakeholders' involvement in decision-making.
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Affiliation(s)
- Froukje E Takens
- Department of Public and Occupational Health, Amsterdam UMC, Vrije Universiteit Amsterdam, De Boelelaan 1117, Amsterdam, The Netherlands.
- Amsterdam Public Health Research Institute, Health Behaviour and Chronic Diseases, Amsterdam, The Netherlands.
- Department Gezond Leven, Public Health Service of Amsterdam, Team Sarphati Amsterdam, Nieuwe Achtergracht 100, 1018 WT, Amsterdam, The Netherlands.
| | - Indira Indyk
- Department Gezond Leven, Public Health Service of Amsterdam, Team Sarphati Amsterdam, Nieuwe Achtergracht 100, 1018 WT, Amsterdam, The Netherlands.
| | - Mai J M Chinapaw
- Department of Public and Occupational Health, Amsterdam UMC, Vrije Universiteit Amsterdam, De Boelelaan 1117, Amsterdam, The Netherlands
- Amsterdam Public Health Research Institute, Health Behaviour and Chronic Diseases, Amsterdam, The Netherlands
| | - Joanne K Ujčič-Voortman
- Department Gezond Leven, Public Health Service of Amsterdam, Team Sarphati Amsterdam, Nieuwe Achtergracht 100, 1018 WT, Amsterdam, The Netherlands
| | - Femke van Nassau
- Department of Public and Occupational Health, Amsterdam UMC, Vrije Universiteit Amsterdam, De Boelelaan 1117, Amsterdam, The Netherlands
- Amsterdam Public Health Research Institute, Health Behaviour and Chronic Diseases, Amsterdam, The Netherlands
| | - Vincent Busch
- Department Gezond Leven, Public Health Service of Amsterdam, Team Sarphati Amsterdam, Nieuwe Achtergracht 100, 1018 WT, Amsterdam, The Netherlands
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Hagenaars LL, Schmidt LA, Groeniger JO, Bekker MPM, Ter Ellen F, de Leeuw E, van Lenthe FJ, Oude Hengel KM, Stronks K. Why we struggle to make progress in obesity prevention and how we might overcome policy inertia: Lessons from the complexity and political sciences. Obes Rev 2024; 25:e13705. [PMID: 38424004 DOI: 10.1111/obr.13705] [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: 01/11/2023] [Revised: 12/18/2023] [Accepted: 01/18/2024] [Indexed: 03/02/2024]
Abstract
Despite evidence for the effectiveness of policies that target obesogenic environments, their adoption remains deficient. Using methods and concepts from complexity and political science (Stock-and-Flow analysis and Punctuated Equilibrium Theory) and a qualitative literature review, we developed system maps to identify feedback loops that hinder policymaking on mitigating obesogenic environments and feedback loops that could trigger and sustain policy change. We found numerous self-reinforcing feedback loops that buttress the assumption that obesity is an individual problem, strengthening the biomedical and commercial weight-loss sectors' claim to "ownership" over solutions. That is, improvements in therapies for individuals with obesity reinforces policymakers' reluctance to target obesogenic environments. Random events that focus attention on obesity (e.g., celebrities dismissing soda) could disrupt this cycle, when actors from outside the medical and weight-loss sector (e.g., anti-weight stigma activists) successfully reframe obesity as a societal problem, which requires robust and politically relevant engagement with affected communities prior to such events taking place. Sustained prioritization of policies targeting obesogenic environments requires shared problem ownership of affected communities and nonhealth government sectors, by emphasizing cobenefits of policies that target obesogenic environments (e.g., ultraprocessed food taxation for raising revenue) and solutions that are meaningful for affected communities.
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Affiliation(s)
- Luc L Hagenaars
- Department of Public Health, Amsterdam UMC Location University of Amsterdam, Amsterdam, The Netherlands
- Philip R. Lee Institute for Health Policy Studies, School of Medicine, University of California, San Francisco, USA
| | - Laura A Schmidt
- Philip R. Lee Institute for Health Policy Studies, School of Medicine, University of California, San Francisco, USA
| | - Joost Oude Groeniger
- Department of Public Health, Erasmus MC, University Medical Center, Rotterdam, The Netherlands
- Erasmus School of Social and Behavioural Sciences, Erasmus MC, Rotterdam, The Netherlands
| | - Marleen P M Bekker
- Health and Society Group, Wageningen University & Research, Wageningen, The Netherlands
| | - Fleur Ter Ellen
- Department of Public Health, Erasmus MC, University Medical Center, Rotterdam, The Netherlands
| | - Evelyne de Leeuw
- Urban Health and Policy, University of New South Wales, Sydney, Australia
- École de Santé Publique, Université de Montréal, Montréal, Canada
| | - Frank J van Lenthe
- Department of Public Health, Erasmus MC, University Medical Center, Rotterdam, The Netherlands
- Department of Human Geography and Spatial Planning, Faculty of Geosciences, Utrecht University, Utrecht, The Netherlands
| | - Karen M Oude Hengel
- Department of Public Health, Erasmus MC, University Medical Center, Rotterdam, The Netherlands
- Department of Work Health Technology, Netherlands Organisation for Applied Scientific Research TNO, The Hague, The Netherlands
| | - Karien Stronks
- Department of Public Health, Amsterdam UMC Location University of Amsterdam, Amsterdam, The Netherlands
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O'Halloran SA, Hayward J, Valdivia Cabrera M, Felmingham T, Fraser P, Needham C, Poorter J, Creighton D, Johnstone M, Nichols M, Allender S. The common drivers of children and young people's health and wellbeing across 13 local government areas: a systems view. BMC Public Health 2024; 24:847. [PMID: 38504205 PMCID: PMC10949822 DOI: 10.1186/s12889-024-18354-8] [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: 11/30/2023] [Accepted: 03/13/2024] [Indexed: 03/21/2024] Open
Abstract
BACKGROUND System dynamics approaches, including group model building (GMB) and causal loop diagrams (CLDs), can be used to document complex public health problems from a community perspective. This paper aims to apply Social Network Analysis (SNA) methods to combine multiple CLDs created by local communities into a summary CLD, to identify common drivers of the health and wellbeing of children and young people. METHODS Thirteen community CLDs regarding children and young people health and wellbeing were merged into one diagram involving three steps: (1) combining variable names; (2) CLD merging, where multiple CLDs were combined into one CLD with a set of unique variables and connections; (3) paring, where the Decision-Making Trial and Evaluation Laboratory (DEMATEL) method was used to generate a cut-point to reduce the number of variables and connections and to rank the overall importance of each variable in the merged CLD. RESULTS Combining variable names resulted in 290 variables across the 13 CLDS. A total of 1,042 causal links were identified in the merged CLD. The DEMATEL analysis of the merged CLD identified 23 common variables with a net importance between 1.0 and 4.5 R + C values and 57 causal links. The variables with the highest net importance were 'mental health' and 'social connection & support' classified as high net receivers of influence within the system. CONCLUSIONS Combining large CLDs into a simple diagram represents a generalisable model of the drivers of complex health problems.
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Affiliation(s)
- Siobhan A O'Halloran
- Global Centre for Preventive Health and Nutrition, Institute for Health Transformation, School of Health and Social Development, Faculty of Health, Deakin University, Geelong, VIC, 3220, Australia.
| | - Joshua Hayward
- Global Centre for Preventive Health and Nutrition, Institute for Health Transformation, School of Health and Social Development, Faculty of Health, Deakin University, Geelong, VIC, 3220, Australia
| | - Melissa Valdivia Cabrera
- Institute for Intelligent Systems Research and Innovation, Deakin University, 75 Pigdons Rd, Waurn Ponds, VIC, 3216, Australia
| | - Tiana Felmingham
- Global Centre for Preventive Health and Nutrition, Institute for Health Transformation, School of Health and Social Development, Faculty of Health, Deakin University, Geelong, VIC, 3220, Australia
| | - Penny Fraser
- Global Centre for Preventive Health and Nutrition, Institute for Health Transformation, School of Health and Social Development, Faculty of Health, Deakin University, Geelong, VIC, 3220, Australia
| | - Cindy Needham
- Global Centre for Preventive Health and Nutrition, Institute for Health Transformation, School of Health and Social Development, Faculty of Health, Deakin University, Geelong, VIC, 3220, Australia
| | - Jaimie Poorter
- Global Centre for Preventive Health and Nutrition, Institute for Health Transformation, School of Health and Social Development, Faculty of Health, Deakin University, Geelong, VIC, 3220, Australia
| | - Doug Creighton
- Institute for Intelligent Systems Research and Innovation, Deakin University, 75 Pigdons Rd, Waurn Ponds, VIC, 3216, Australia
| | - Michael Johnstone
- Institute for Intelligent Systems Research and Innovation, Deakin University, 75 Pigdons Rd, Waurn Ponds, VIC, 3216, Australia
| | - Melanie Nichols
- Global Centre for Preventive Health and Nutrition, Institute for Health Transformation, School of Health and Social Development, Faculty of Health, Deakin University, Geelong, VIC, 3220, Australia
| | - Steven Allender
- Global Centre for Preventive Health and Nutrition, Institute for Health Transformation, School of Health and Social Development, Faculty of Health, Deakin University, Geelong, VIC, 3220, Australia
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Breslin G, Fakoya O, Wills W, Lloyd N, Bontoft C, Wellings A, Harding S, Jackson J, Barrett K, Wagner AP, Miners L, Greco HA, Brown KE. Whole systems approaches to diet and healthy weight: A scoping review of reviews. PLoS One 2024; 19:e0292945. [PMID: 38478570 PMCID: PMC10936799 DOI: 10.1371/journal.pone.0292945] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/09/2023] [Accepted: 10/03/2023] [Indexed: 07/23/2024] Open
Abstract
BACKGROUND Obesity is a global epidemic affecting all age groups, populations, and income levels across continents, though is known to disproportionately affect socioeconomically disadvantaged populations. The causes of obesity are complex, informed by diet and weight practices, but shaped by social, commercial, and environmental factors and government policy. Consequently, a Whole System Approach (WSA)-which considers the many causes of obesity and shifts the focus away from individuals as points of intervention and puts an emphasis on understanding and improving the system in which people live-is required. This scoping review of reviews aims to: determine how WSAs to diet and healthy weight have been implemented and evaluated nationally and internationally; to determine what models or theories have been used to implement WSAs; describe how WSAs have been evaluated; determine if WSAs are effective; and to identify the contribution of the public and/or service users in the development of WSAs. METHOD Systematic searches were carried out using CINAHL, Scopus, PsycINFO (ProQuest), the Cochrane Library, and MEDLINE. Included review papers were those that focused on the application of a whole system approach to diet and/or healthy weight, and/or reported the theory/model used to implement or simulate this approach. Databases were searched from 1995 to March 2022 using a combination of text and Medical Subject Headings (MeSH terms). In addition, reference sections of identified articles were examined for additional relevant articles. Covidence software was used to screen titles and abstracts from the electronic databases and resolve conflicts. RESULTS A total of 20,308 articles were initially retrieved; after duplicate removal 7,690 unique title and abstracts were reviewed, and 110 articles were selected for full text review. On completion of full text review, 8 review articles were included for data extraction. These included: one umbrella review, four systematic reviews, a rapid review, and two literature reviews (one of which was on strategic reports written for government and public health policy). Evaluations of WSA were mainly process evaluations although health outcomes were assessed in some studies. Several conceptual frameworks or mathematical modelling approaches have been applied to WSAs for diet, healthy weight, and obesity to inform their planning or delivery, and to understand/map the associated systems. Common mathematical approaches include agent based or System Dynamic Modelling. Underlying both conceptual and mathematical models is an understanding how the elements of the complex systems impact each other to affect diet, healthy weight, and obesity. WSA implementations have reported some success in positively impacting health outcomes including reducing Body Mass Index, reducing sugary food intake, and increasing physical activity. Public and user involvement in WSA was not widely reported. CONCLUSION The application of WSA to diet and healthy weight shows promise, yet the research is lagging behind their implementation. Further robust evidence for using WSA to address diet and healthy weight are required, including incorporating process and outcome evaluations (perhaps using established approaches such as Systems Dynamic Modelling). Furthermore, the analysis of epidemiological data alongside longitudinal process and outcome evaluation regarding the implementation of a WSA is required.
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Affiliation(s)
- Gavin Breslin
- School of Psychology, Queen’s University Belfast, Belfast, United Kingdom
| | - Olujoke Fakoya
- Department of Psychology, Sport and Geography, School of Life and Medical Sciences, College Lane, University of Hertfordshire, Hatfield, United Kingdom
| | - Wendy Wills
- Centre for Research in Public Health and Community Care (CRIPACC), School of Health and Social Work, College Lane, University of Hertfordshire, Hatfield, United Kingdom
| | - Nigel Lloyd
- Department of Psychology, Sport and Geography, School of Life and Medical Sciences, College Lane, University of Hertfordshire, Hatfield, United Kingdom
| | - Charis Bontoft
- Department of Psychology, Sport and Geography, School of Life and Medical Sciences, College Lane, University of Hertfordshire, Hatfield, United Kingdom
| | - Amander Wellings
- Member of the PHIRST Public Involvement in Research Group, School of Life and Medical Sciences & School of Health & Social Work, University of Hertfordshire, Hatfield, United Kingdom
| | - Sian Harding
- Member of the PHIRST Public Involvement in Research Group, School of Life and Medical Sciences & School of Health & Social Work, University of Hertfordshire, Hatfield, United Kingdom
| | - John Jackson
- Member of the PHIRST Public Involvement in Research Group, School of Life and Medical Sciences & School of Health & Social Work, University of Hertfordshire, Hatfield, United Kingdom
| | - Katherine Barrett
- Member of the PHIRST Public Involvement in Research Group, School of Life and Medical Sciences & School of Health & Social Work, University of Hertfordshire, Hatfield, United Kingdom
| | - Adam P. Wagner
- Norwich Medical School, University of East Anglia, Norwich Research Park, Norwich, United Kingdom
- National Institute for Health Research (NIHR) Applied Research Collaboration (ARC) East of England (EoE), Cambridge, United Kingdom
| | - Lisa Miners
- Norwich Medical School, University of East Anglia, Norwich Research Park, Norwich, United Kingdom
- National Institute for Health Research (NIHR) Applied Research Collaboration (ARC) East of England (EoE), Cambridge, United Kingdom
| | - Honey-Anne Greco
- Department of Psychology, Sport and Geography, School of Life and Medical Sciences, College Lane, University of Hertfordshire, Hatfield, United Kingdom
| | - Katherine E. Brown
- Department of Psychology, Sport and Geography, School of Life and Medical Sciences, College Lane, University of Hertfordshire, Hatfield, United Kingdom
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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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Griffiths C, Radley D, Gately P, South J, Sanders G, Morris MA, Clare K, Martin A, Heppenstall A, McCann M, Rodgers J, Nobles J, Coggins A, Cooper N, Cooke C, Gilthorpe MS, Ells L. A complex systems approach to obesity: a transdisciplinary framework for action. Perspect Public Health 2023; 143:305-309. [PMID: 37395317 PMCID: PMC10683338 DOI: 10.1177/17579139231180761] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 07/04/2023]
Affiliation(s)
- C Griffiths
- Obesity Institute, School of Sport, Leeds Beckett University, Headingly Campus, Leeds LS6 3QS, Yorkshire, UK
| | - D Radley
- Obesity Institute, School of Sport, Leeds Beckett University, Leeds, UK
| | - P Gately
- Obesity Institute, School of Sport, Leeds Beckett University, Leeds, UK
| | - J South
- Centre for Health Promotion Research, School of health, Leeds Beckett University, UK
| | - G Sanders
- Obesity Institute, School of Sport, Leeds Beckett University, Leeds, UK
| | - MA Morris
- Leeds Institute for Data Analytics and Leeds Institute for Medical Research, University of Leeds, Leeds, UK
| | - K Clare
- Obesity Institute, School of Health, Leeds Beckett University, Leeds, UK
| | - A Martin
- Leeds Institute of Health Sciences, School of Medicine, University of Leeds, Leeds, UK
| | - A Heppenstall
- School of Political and Social Sciences, MRC/CSO Social and Public Health Sciences Unit, University of Glasgow, Glasgow, UK
| | - M McCann
- MRC/CSO Social and Public Health Sciences Unit, University of Glasgow, Glasgow, UK
| | - J Rodgers
- International Business School, Teesside University, Middlesbrough, UK
| | - J Nobles
- Obesity Institute, School of Health, Leeds Beckett University, Leeds, UK
| | - A Coggins
- Essex County Council, Chelmsford, UK
| | - N Cooper
- Suffolk County Council, Ipswich, UK
| | - C Cooke
- Obesity Institute, School of Sport, Leeds Beckett University, UK
| | - MS Gilthorpe
- Obesity Institute, School of Sport, Leeds Beckett University, Leeds, UK
| | - L Ells
- Obesity Institute, School of Health, Leeds Beckett University, Leeds, UK
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9
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Breslin G, Wills W, Bontoft C, Fakoya O, Greco HA, Lloyd N, Wagner AP, Wellings A, Harding S, Brown KE. Whole systems approach to diet and healthy weight: a longitudinal process evaluation in East Scotland. Perspect Public Health 2023; 143:347-357. [PMID: 37902308 PMCID: PMC10683340 DOI: 10.1177/17579139231203858] [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] [Indexed: 10/31/2023]
Abstract
AIMS Obesity contributes to morbidity and early mortality, affecting people of all ages and sociodemographic backgrounds. Despite attempts to address obesity, efforts to date have only had limited success. Adopting a whole systems approach (WSA) may potentially address obesity and emphasise complex inter-relating factors beyond individual choice. This study aimed to assess implementation of WSA to diet and healthy weight in two council areas of Scotland, longitudinally exploring enablers and barriers. One area followed a Leeds Beckett WSA model (LBM) of implementation, while the other used a hybrid model incorporating existing working systems. METHODS To assess the process of implementing a WSA, interviews and focus groups were conducted after initiation and 1 year later. RESULTS Main enablers included: belief in WSA effectiveness; positive relationships between key personnel; buy-in at community and national levels; funding availability; the working group responsible for coordinating the system development comprising individuals with diverse expertise; good communication; and existing governance structures. Barriers included: insufficient funding; high staff turnover; inadequate training in WSA methodology; engaging all relevant stakeholders and reverting to 'old ways' of non-WSA working. The LBM provided a framework for system setup and generating an action plan. CONCLUSION This study provides the first independent longitudinal process evaluation of WSAs that have incorporated Leeds Beckett methodology, and offers insights into how a WSA can be implemented to address diet and healthy weight.
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Affiliation(s)
- G Breslin
- School of Psychology, Queen’s University Belfast, Belfast, UK
| | - W Wills
- School of Health and Social Work, University of Hertfordshire, Hatfield, UK; Applied Research Collaboration (ARC) East of England, National Institute for Health and Care Research (NIHR), London, UK
| | - C Bontoft
- Department of Psychology, Sport and Geography, School of Life and Medical Sciences, University of Hertfordshire, College Lane Campus, College Lane, Hatfield AL10 9AB, UK
| | - O Fakoya
- Department of Psychology, Sport and Geography, School of Life and Medical Sciences, University of Hertfordshire, Hatfield, UK
| | - H-A Greco
- Department of Psychology, Sport and Geography, School of Life and Medical Sciences, University of Hertfordshire, Hatfield, UK
| | - N Lloyd
- Department of Psychology, Sport and Geography, School of Life and Medical Sciences, University of Hertfordshire, Hatfield, UK
| | - AP Wagner
- Applied Research Collaboration (ARC) East of England, National Institute for Health and Care Research (NIHR), London, UK; Norwich Medical School, University of East Anglia, Norwich, UK
| | - A Wellings
- Department of Psychology, Sport and Geography, School of Life and Medical Sciences, University of Hertfordshire, Hatfield, UK
| | - S Harding
- Department of Psychology, Sport and Geography, School of Life and Medical Sciences, University of Hertfordshire, Hatfield, UK
| | - KE Brown
- Department of Psychology, Sport and Geography, School of Life and Medical Sciences, University of Hertfordshire, Hatfield, UK
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10
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Bogt MJJT, Bevelander KE, Tholen L, Molleman GRM, van den Muijsenbergh M, Fransen GAJ. Leverage point themes within Dutch municipalities' healthy weight approaches: A qualitative study from a systems perspective. PLoS One 2023; 18:e0287050. [PMID: 37310977 DOI: 10.1371/journal.pone.0287050] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/17/2023] [Accepted: 05/30/2023] [Indexed: 06/15/2023] Open
Abstract
INTRODUCTION Despite all efforts of national and local approaches, obesity rates continue to rise worldwide. It is increasingly recognized that the complexity of obesity should be further addressed by incorporating a systems perspective when implementing approaches. Such an approach has four interconnected system levels: events, structures, goals, and beliefs, in which small changes ('leverage points') can lead to substantial changes in the functioning of the entire system. The current research examined the functioning of five Dutch municipalities' healthy weight approaches (HWAs) and the leverage point themes that can be identified in their system. METHODS Thirty-four semi-structured interviews were conducted with various stakeholders about the HWA, including policy advisors, care professionals, practice professionals, and citizens. An inductive thematic analysis was performed. RESULTS Three main themes were identified: 1) HWA organization structure, 2) collaboration between professionals, and 3) citizen participation. Across all system levels, we identified leverage point themes. The upper-levels events and structures occurred the most and were explained by underlying goals and beliefs. Leverage point themes regarding "HWA organization structure" were municipal processes, such as perceived impact; diversity of themes, activities, and tasks; network; and communication strategies, such as messages about the HWA. Leverage point themes regarding "collaboration between professionals" were linking pins, indicating central players within the network; motivation and commitment including support base; and stimulating one another to work on the HWA by spurring other professionals into action. Lastly, leverage point themes under "citizen participation" included reaching the target group, e.g., look for entry points; and citizens' motivation, including customization. DISCUSSION This paper provides unique insights into HWAs' leverage point themes that can lead to substantial changes in how the entire system functions and makes suggestions about underlying leverage points to help stakeholders improve their HWA. Future research could focus on studying leverage points within leverage point themes.
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Affiliation(s)
- Maud J J Ter Bogt
- Primary and Community Care, Radboud University Medical Centre, Nijmegen, The Netherlands
- AMPHI Academic Collaborative Centre, Nijmegen, The Netherlands
| | - Kirsten E Bevelander
- Primary and Community Care, Radboud University Medical Centre, Nijmegen, The Netherlands
- AMPHI Academic Collaborative Centre, Nijmegen, The Netherlands
| | - Lisa Tholen
- Primary and Community Care, Radboud University Medical Centre, Nijmegen, The Netherlands
| | - Gerard R M Molleman
- Primary and Community Care, Radboud University Medical Centre, Nijmegen, The Netherlands
- AMPHI Academic Collaborative Centre, Nijmegen, The Netherlands
| | - Maria van den Muijsenbergh
- Primary and Community Care, Radboud University Medical Centre, Nijmegen, The Netherlands
- Pharos, The Dutch Centre of Expertise on Health Disparities, Utrecht, The Netherlands
| | - Gerdine A J Fransen
- Primary and Community Care, Radboud University Medical Centre, Nijmegen, The Netherlands
- AMPHI Academic Collaborative Centre, Nijmegen, The Netherlands
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11
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Luna Pinzon A, Stronks K, Emke H, van den Eynde E, Altenburg T, Dijkstra SC, Renders CM, Hermans R, Busch V, Chinapaw MJM, Kremers SPJ, Waterlander W. Understanding the system dynamics of obesity-related behaviours in 10- to 14-year-old adolescents in Amsterdam from a multi-actor perspective. Front Public Health 2023; 11:1128316. [PMID: 37304107 PMCID: PMC10248031 DOI: 10.3389/fpubh.2023.1128316] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/17/2023] [Accepted: 04/28/2023] [Indexed: 06/13/2023] Open
Abstract
Introduction and Methods To develop an understanding of the dynamics driving obesity-related behaviours in adolescents, we conducted systems-based analysis on a causal loop diagram (CLD) created from a multi-actor perspective, including academic researchers, adolescents and local stakeholders. Results The CLD contained 121 factors and 31 feedback loops. We identified six subsystems with their goals: (1) interaction between adolescents and the food environment, with profit maximisation as goal, (2) interaction between adolescents and the physical activity environment, with utility maximisation of outdoor spaces as goal, (3) interaction between adolescents and the online environment, with profit maximisation from technology use as goal, (4) interaction between adolescents, parenting and the wider socioeconomic environment, with a goal focused on individual parental responsibility, (5) interaction between healthcare professionals and families, with the goal resulting in treating obesity as an isolated problem, and (6) transition from childhood to adolescence, with the goal centring around adolescents' susceptibility to an environment that stimulates obesity-related behaviours. Discussion Analysis showed that inclusion of the researchers' and stakeholders' perspectives contributed to an understanding of how the system structure of an environment works. Integration of the adolescents' perspective enriched insights on how adolescents interact with that environment. The analysis further showed that the dynamics driving obesity-related behaviours are geared towards further reinforcing such behaviours.
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Affiliation(s)
- Angie Luna Pinzon
- Amsterdam UMC location University of Amsterdam, Department of Public and Occupational Health, Amsterdam, Netherlands
- Amsterdam Public Health Research Institute, Health Behaviors and Chronic Diseases, Amsterdam, Netherlands
| | - Karien Stronks
- Amsterdam UMC location University of Amsterdam, Department of Public and Occupational Health, Amsterdam, Netherlands
- Amsterdam Public Health Research Institute, Health Behaviors and Chronic Diseases, Amsterdam, Netherlands
| | - Helga Emke
- Amsterdam Public Health Research Institute, Health Behaviors and Chronic Diseases, Amsterdam, Netherlands
- Amsterdam UMC location Vrije Universiteit Amsterdam, Department of Public and Occupational Health, Amsterdam, Netherlands
- Department of Health Sciences, Faculty of Science, Vrije Universiteit Amsterdam, Amsterdam, Netherlands
| | - Emma van den Eynde
- Obesity Center CGG, Erasmus MC, University Medical Center Rotterdam, Rotterdam, Netherlands
| | - Teatske Altenburg
- Amsterdam Public Health Research Institute, Health Behaviors and Chronic Diseases, Amsterdam, Netherlands
- Amsterdam UMC location Vrije Universiteit Amsterdam, Department of Public and Occupational Health, Amsterdam, Netherlands
| | - S. Coosje Dijkstra
- Amsterdam Public Health Research Institute, Health Behaviors and Chronic Diseases, Amsterdam, Netherlands
- Department of Health Sciences, Faculty of Science, Vrije Universiteit Amsterdam, Amsterdam, Netherlands
| | - Carry M. Renders
- Amsterdam Public Health Research Institute, Health Behaviors and Chronic Diseases, Amsterdam, Netherlands
- Department of Health Sciences, Faculty of Science, Vrije Universiteit Amsterdam, Amsterdam, Netherlands
| | - Roel Hermans
- Department of Health Promotion, NUTRIM School of Nutrition and Translational Research in Metabolism, Maastricht University, Maastricht, Netherlands
| | - Vincent Busch
- Sarphati Amsterdam, Public Health Service (GGD), Amsterdam, Netherlands
| | - Mai J. M. Chinapaw
- Amsterdam Public Health Research Institute, Health Behaviors and Chronic Diseases, Amsterdam, Netherlands
- Amsterdam UMC location Vrije Universiteit Amsterdam, Department of Public and Occupational Health, Amsterdam, Netherlands
| | - Stef P. J. Kremers
- Department of Health Promotion, NUTRIM School of Nutrition and Translational Research in Metabolism, Maastricht University, Maastricht, Netherlands
| | - Wilma Waterlander
- Amsterdam UMC location University of Amsterdam, Department of Public and Occupational Health, Amsterdam, Netherlands
- Amsterdam Public Health Research Institute, Health Behaviors and Chronic Diseases, Amsterdam, Netherlands
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12
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Carroll Á, Collins C, McKenzie J, Stokes D, Darley A. Application of complexity theory in health and social care research: a scoping review. BMJ Open 2023; 13:e069180. [PMID: 36921939 PMCID: PMC10030763 DOI: 10.1136/bmjopen-2022-069180] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 03/17/2023] Open
Abstract
BACKGROUND Complexity theory has been chosen by many authors as a suitable lens through which to examine health and social care. Despite its potential value, many empirical investigations apply the theory in a tokenistic manner without engaging with its underlying concepts and underpinnings. OBJECTIVES The aim of this scoping review is to synthesise the literature on empirical studies that have centred on the application of complexity theory to understand health and social care provision. METHODS This scoping review considered primary research using complexity theory-informed approaches, published in English between 2012 and 2021. Cochrane Database of Systematic Reviews, MEDLINE, CINAHL, EMBASE, Web of Science, PSYCHINFO, the NHS Economic Evaluation Database, and the Health Economic Evaluations Database were searched. In addition, a manual search of the reference lists of relevant articles was conducted. Data extraction was conducted using Covidence software and a data extraction form was created to produce a descriptive summary of the results, addressing the objectives and research question. The review used the revised Arksey and O'Malley framework and adhered to the Preferred Reporting Items for Systematic Reviews and Meta-analysis Extension for Scoping Reviews (PRISMA-ScR). RESULTS 2021 studies were initially identified with a total of 61 articles included for extraction. Complexity theory in health and social care research is poorly defined and described and was most commonly applied as a theoretical and analytical framework. The full breadth of the health and social care continuum was not represented in the identified articles, with the majority being healthcare focused. DISCUSSION Complexity theory is being increasingly embraced in health and care research. The heterogeneity of the literature regarding the application of complexity theory made synthesis challenging. However, this scoping review has synthesised the most recent evidence and contributes to translational systems research by providing guidance for future studies. CONCLUSION The study of complex health and care systems necessitates methods of interpreting dynamic prcesses which requires qualitative and longitudinal studies with abductive reasoning. The authors provide guidance on conducting complexity-informed primary research that seeks to promote rigor and transparency in the area. REGISTRATION The scoping review protocol was registered at Open Science Framework, and the review protocol was published at BMJ Open (https://bit.ly/3Ex1Inu).
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Affiliation(s)
- Áine Carroll
- School of Medicine, University College Dublin, Dublin, Ireland
- Academic Department, National Rehabilitation University Hospital, Dublin, Ireland
| | - Claire Collins
- Henley Business School, University of Reading, Reading, UK
| | - Jane McKenzie
- Henley Business School, University of Reading, Reading, UK
| | - Diarmuid Stokes
- College of Health Sciences, University College Dublin, Dublin, Ireland
| | - Andrew Darley
- School of Medicine, University College Dublin, Dublin, Ireland
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13
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Rod MH, Rod NH, Russo F, Klinker CD, Reis R, Stronks K. Promoting the health of vulnerable populations: Three steps towards a systems-based re-orientation of public health intervention research. Health Place 2023; 80:102984. [PMID: 36773380 DOI: 10.1016/j.healthplace.2023.102984] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/10/2022] [Revised: 12/20/2022] [Accepted: 02/02/2023] [Indexed: 02/11/2023]
Abstract
This paper proposes a novel framework for the development of interventions in vulnerable populations. The framework combines a complex systems lens with syndemic theory. Whereas funding bodies, research organizations and reporting guidelines tend to encourage intervention research that (i) focuses on singular and predefined health outcomes, (ii) searches for generalizable cause-effect relationships, and (iii) aims to identify universally effective interventions, the paper suggests that a different direction is needed for addressing health inequities: We need to (i) start with exploratory analysis of population-level data, and (ii) invest in contextualized in-depth knowledge of the complex dynamics that produce health inequities in specific populations and settings, while we (iii) work with stakeholders at multiple levels to create change within systems.
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Affiliation(s)
- Morten Hulvej Rod
- Health Promotion Research, Copenhagen University Hospital - Steno Diabetes Center Copenhagen, Herlev, Denmark; National Institute of Public Health, University of Southern Denmark, Copenhagen, Denmark; Institute for Advanced Study, University of Amsterdam, Amsterdam, the Netherlands.
| | - Naja Hulvej Rod
- Institute for Advanced Study, University of Amsterdam, Amsterdam, the Netherlands; Section of Epidemiology, Department of Public Health, University of Copenhagen, Copenhagen K, Denmark
| | - Federica Russo
- Institute for Advanced Study, University of Amsterdam, Amsterdam, the Netherlands; Department of Philosophy & ILLC, Amsterdam University, Amsterdam, the Netherlands
| | - Charlotte Demant Klinker
- Health Promotion Research, Copenhagen University Hospital - Steno Diabetes Center Copenhagen, Herlev, Denmark
| | - Ria Reis
- Department of Public Health & Primary Care, Leiden University Medical Center, Leiden, the Netherlands; Amsterdam Institute for Global Health and Development, Amsterdam, Netherlands
| | - Karien Stronks
- Institute for Advanced Study, University of Amsterdam, Amsterdam, the Netherlands; Amsterdam University Medical Centers, Locatie AMC, Amsterdam, the Netherlands
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14
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Frazer M, Seims A, Tatterton MJ, Lockyer B, Bingham D, Barber S, Daly-Smith A, Hall J. Child and family experiences of a whole-systems approach to physical activity in a multiethnic UK city: a citizen science evaluation protocol. BMJ Open 2023; 13:e069334. [PMID: 36810182 PMCID: PMC9945040 DOI: 10.1136/bmjopen-2022-069334] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/20/2022] [Accepted: 02/03/2023] [Indexed: 02/23/2023] Open
Abstract
INTRODUCTION Whole-systems approaches are being adopted to tackle physical inactivity. The mechanisms contributing to changes resulting from whole-systems approaches are not fully understood. The voices of children and families that these approaches are designed for need to be heard to understand what is working, for whom, where and in what context. This paper describes the protocol for the children and families' citizen science evaluation of the Join Us: Move, Play (JU:MP) programme, a whole-systems approach to increasing physical activity in children and young people aged 5-14 years in Bradford, UK. METHODS AND ANALYSIS The evaluation aims to understand the lived experiences of children and families' relationship with physical activity and participation in the JU:MP programme. The study takes a collaborative and contributory citizen science approach, including focus groups, parent-child dyad interviews and participatory research. Feedback and data will guide changes within this study and the JU:MP programme. We also aim to examine participant experience of citizen science and the suitability of a citizen science approach to evaluate a whole-systems approach. Data will be analysed using framework approach alongside iterative analysis with and by citizen scientists in the collaborative citizen science study. ETHICS AND DISSEMINATION Ethical approval has been granted by the University of Bradford: study one (E891-focus groups as part of the control trial, E982-parent-child dyad interviews) and study two (E992). Results will be published in peer-reviewed journals and summaries will be provided to the participants, through schools or directly. The citizen scientists will provide input to create further dissemination opportunities.
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Affiliation(s)
- Marie Frazer
- Born in Bradford, Bradford Institute for Health Research, Bradford, UK
- Faculty of Health Studies, University of Bradford, Bradford, UK
- Centre for Applied Education Research, Wolfson Centre for Applied Health Research, Bradford, UK
| | - Amanda Seims
- Born in Bradford, Bradford Institute for Health Research, Bradford, UK
- Faculty of Health Studies, University of Bradford, Bradford, UK
| | - Michael J Tatterton
- Faculty of Health Studies, University of Bradford, Bradford, UK
- Centre for Applied Education Research, Wolfson Centre for Applied Health Research, Bradford, UK
| | - Bridget Lockyer
- Born in Bradford, Bradford Institute for Health Research, Bradford, UK
| | - Daniel Bingham
- Born in Bradford, Bradford Institute for Health Research, Bradford, UK
- Faculty of Health Studies, University of Bradford, Bradford, UK
- Centre for Applied Education Research, Wolfson Centre for Applied Health Research, Bradford, UK
| | - Sally Barber
- Born in Bradford, Bradford Institute for Health Research, Bradford, UK
| | - Andy Daly-Smith
- Born in Bradford, Bradford Institute for Health Research, Bradford, UK
- Faculty of Health Studies, University of Bradford, Bradford, UK
- Centre for Applied Education Research, Wolfson Centre for Applied Health Research, Bradford, UK
| | - Jennifer Hall
- Born in Bradford, Bradford Institute for Health Research, Bradford, UK
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15
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O'Halloran S, Hayward J, Strugnell C, Felmingham T, Poorter J, Kilpatrick S, Fraser P, Needham C, Rhook E, DeMaio A, Allender S. Building capacity for the use of systems science to support local government public health planning: a case study of the VicHealth Local Government Partnership in Victoria, Australia. BMJ Open 2022; 12:e068190. [PMID: 36572496 PMCID: PMC9806011 DOI: 10.1136/bmjopen-2022-068190] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/27/2022] Open
Abstract
OBJECTIVE To present an approach to build capacity for the use of systems science to support local communities in municipal public health and well-being planning. DESIGN Case study. SETTING Local government authorities participating in the VicHealth Local Government Partnership in Victoria, Australia. PARTICIPANTS Local government staff members were trained in community-based system dynamics (CBSD), and group model building (GMB) techniques to mobilise local community efforts. The trained local government facilitation teams then delivered GMB workshops to community stakeholder groups from 13 local government areas (LGA)s. MAIN OUTCOMES Training in CBSD was conducted with council facilitation teams in 13 LGAs, followed by the local delivery of GMB workshops 1-3 to community stakeholders. Causal loop diagrams (CLD) representing localised drivers of mental well-being, healthy eating, active living or general health and well-being of children and young people were developed by community stakeholders. Locally tailored action ideas were generated such as well-being classes in school, faster active transport and access to free and low-cost sporting programmes RESULTS: Overall, 111 local government staff participated in CBSD training. Thirteen CLDs were developed, with the stakeholders that included children, young people and community members, who had participated in the GMB workshops across all 13 council sites. Workshop 3 had the highest total number of participants (n=301), followed by workshop 1 (n=287) and workshop 2 (n=171). CONCLUSIONS Local facilitation of the CBSD process has developed community informed and locally relevant CLDs that will be used to lead local action to improve the well-being of children and young people. Training employees in CBSD is one approach to increase systems thinking capacity within local government.
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Affiliation(s)
- Siobhan O'Halloran
- Global Centre for Preventative Health and Nutrition, Institute for Health Transformation, Deakin University, Geelong, Victoria, Australia
| | - Joshua Hayward
- Global Centre for Preventative Health and Nutrition, Institute for Health Transformation, Deakin University, Geelong, Victoria, Australia
| | - Claudia Strugnell
- Global Centre for Preventative Health and Nutrition, Institute for Health Transformation, Deakin University, Geelong, Victoria, Australia
| | - Tiana Felmingham
- Global Centre for Preventative Health and Nutrition, Institute for Health Transformation, Deakin University, Geelong, Victoria, Australia
| | - Jaimie Poorter
- Global Centre for Preventative Health and Nutrition, Institute for Health Transformation, Deakin University, Geelong, Victoria, Australia
| | - Stephanie Kilpatrick
- Victorian Health Promotion Foundation (VicHealth), West Melbourne, Victoria, Australia
| | - Penny Fraser
- Global Centre for Preventative Health and Nutrition, Institute for Health Transformation, Deakin University, Geelong, Victoria, Australia
| | - Cindy Needham
- Global Centre for Preventative Health and Nutrition, Institute for Health Transformation, Deakin University, Geelong, Victoria, Australia
| | - Ebony Rhook
- Southern Grampians Glenelg, Barwon Southwest Public Health Unit, Hamilton, Victoria, Australia
| | - Alessandro DeMaio
- Victorian Health Promotion Foundation (VicHealth), West Melbourne, Victoria, Australia
| | - Steven Allender
- Global Centre for Preventative Health and Nutrition, Institute for Health Transformation, Deakin University, Geelong, Victoria, Australia
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16
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Belmon LS, Van Stralen MM, Harmsen IA, Den Hertog KE, Ruiter RAC, Chinapaw MJM, Busch V. Promoting children's sleep health: Intervention Mapping meets Health in All Policies. Front Public Health 2022; 10:882384. [PMID: 36466483 PMCID: PMC9709501 DOI: 10.3389/fpubh.2022.882384] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/23/2022] [Accepted: 10/24/2022] [Indexed: 11/17/2022] Open
Abstract
Background To design a comprehensive approach to promote children's sleep health in Amsterdam, the Netherlands, we combined Intervention Mapping (IM) with the Health in All Policies (HiAP) perspective. We aimed to create an approach that fits local infrastructures and policy domains across sectors. Methods First, a needs assessment was conducted, including a systematic review, two concept mapping studies, and one cross-sectional sleep diary study (IM step 1). Subsequently, semi-structured interviews with stakeholders from policy, practice and science provided information on potential assets from all relevant social policy sectors to take into account in the program design (HiAP and IM step 1). Next, program outcomes and objectives were specified (IM step 2), with specific objectives for policy stakeholders (HiAP). This was followed by the program design (IM step 3), where potential program actions were adapted to local policy sectors and stakeholders (HiAP). Lastly, program production (IM step 4) focused on creating a multi-sector program (HiAP). An advisory panel guided the research team by providing tailored advice during all steps throughout the project. Results A blueprint was created for program development to promote children's sleep health, including a logic model of the problem, a logic model of change, an overview of the existing organizational structure of local policy and practice assets, and an overview of policy sectors, and related objectives and opportunities for promoting children's sleep health across these policy sectors. Furthermore, the program production resulted in a policy brief for the local government. Conclusions Combining IM and HiAP proved valuable for designing a blueprint for the development of an integrated multi-sector program to promote children's sleep health. Health promotion professionals focusing on other (health) behaviors can use the blueprint to develop health promotion programs that fit the local public service infrastructures, culture, and incorporate relevant policy sectors outside the public health domain.
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Affiliation(s)
- Laura S. Belmon
- Department of Public and Occupational Health, Amsterdam University Medical Centers (UMC), Vrije Universiteit Amsterdam, Amsterdam Public Health Research Institute, Amsterdam, Netherlands,Sarphati Amsterdam, Public Health Service (GGD), Amsterdam, Netherlands,Department of Healthy Living, Public Health Service (GGD), Amsterdam, Netherlands,*Correspondence: Laura S. Belmon
| | - Maartje M. Van Stralen
- Department of Health Sciences, Faculty of Science and Amsterdam Public Health Research Institute, Vrije Universiteit Amsterdam, Amsterdam, Netherlands
| | - Irene A. Harmsen
- Sarphati Amsterdam, Public Health Service (GGD), Amsterdam, Netherlands
| | - Karen E. Den Hertog
- Department of Healthy Living, Public Health Service (GGD), Amsterdam, Netherlands
| | - Robert A. C. Ruiter
- Department of Work and Social Psychology, Maastricht University, Maastricht, Netherlands
| | - Mai J. M. Chinapaw
- Department of Public and Occupational Health, Amsterdam University Medical Centers (UMC), Vrije Universiteit Amsterdam, Amsterdam Public Health Research Institute, Amsterdam, Netherlands
| | - Vincent Busch
- Sarphati Amsterdam, Public Health Service (GGD), Amsterdam, Netherlands,Vincent Busch
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17
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Nau T, Bauman A, Smith BJ, Bellew W. A scoping review of systems approaches for increasing physical activity in populations. Health Res Policy Syst 2022; 20:104. [PMID: 36175916 PMCID: PMC9524093 DOI: 10.1186/s12961-022-00906-2] [Citation(s) in RCA: 11] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/12/2022] [Accepted: 09/02/2022] [Indexed: 11/27/2022] Open
Abstract
Introduction The past decade has increasingly seen systems approaches as a featured theme in public health studies and policy documents. This trend is evident in the area of physical activity, which is a significant global health risk factor that is addressed in WHO’s Global Action Plan on Physical Activity. We undertook a comprehensive scoping review to characterize the application of systems approaches to physical activity, to develop a typology of the objectives, themes and methods of research papers that purported to apply systems thinking to this issue. Methods We searched electronic databases (PubMed, Web of Science, Scopus and PsycINFO) for studies published during the period 2010–2021 that explicitly applied systems approaches or methods to investigate and/or address population physical activity. A framework using systems-based methodological approaches was adapted to classify physical activity studies according to their predominant approach, covering basic descriptive, complex analytical and advanced forms of practice. We selected case studies from retained studies to depict the current “state of the art”. Results We included 155 articles in our narrative account. Literature reporting the application of systems approaches to physical activity is skewed towards basic methods and frameworks, with most attention devoted to conceptual framing and predictive modelling. There are few well-described examples of physical activity interventions which have been planned, implemented and evaluated using a systems perspective. There is some evidence of “retrofitted” complex system framing to describe programmes and interventions which were not designed as such. Discussion We propose a classification of systems-based approaches to physical activity promotion together with an explanation of the strategies encompassed. The classification is designed to stimulate debate amongst policy-makers, practitioners and researchers to inform the further implementation and evaluation of systems approaches to physical activity. Conclusion The use of systems approaches within the field of physical activity is at an early stage of development, with a preponderance of descriptive approaches and a dearth of more complex analyses. We need to see movement towards a more sophisticated research agenda spanning the development, implementation and evaluation of systems-level interventions. Supplementary Information The online version contains supplementary material available at 10.1186/s12961-022-00906-2.
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Affiliation(s)
- Tracy Nau
- Prevention Research Collaboration, Charles Perkins Centre, School of Public Health, Faculty of Medicine and Health, The University of Sydney, Sydney, NSW, Australia. .,The Australian Prevention Partnership Centre, Sydney, NSW, Australia.
| | - Adrian Bauman
- Prevention Research Collaboration, Charles Perkins Centre, School of Public Health, Faculty of Medicine and Health, The University of Sydney, Sydney, NSW, Australia.,The Australian Prevention Partnership Centre, Sydney, NSW, Australia
| | - Ben J Smith
- Prevention Research Collaboration, Charles Perkins Centre, School of Public Health, Faculty of Medicine and Health, The University of Sydney, Sydney, NSW, Australia.,The Australian Prevention Partnership Centre, Sydney, NSW, Australia
| | - William Bellew
- Prevention Research Collaboration, Charles Perkins Centre, School of Public Health, Faculty of Medicine and Health, The University of Sydney, Sydney, NSW, Australia.,The Australian Prevention Partnership Centre, Sydney, NSW, Australia
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Luna Pinzon A, Stronks K, Dijkstra C, Renders C, Altenburg T, den Hertog K, Kremers SPJ, Chinapaw MJM, Verhoeff AP, Waterlander W. The ENCOMPASS framework: a practical guide for the evaluation of public health programmes in complex adaptive systems. Int J Behav Nutr Phys Act 2022; 19:33. [PMID: 35346233 PMCID: PMC8962023 DOI: 10.1186/s12966-022-01267-3] [Citation(s) in RCA: 17] [Impact Index Per Article: 8.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/04/2021] [Accepted: 02/17/2022] [Indexed: 11/10/2022] Open
Abstract
Background Systems thinking embraces the complexity of public health problems, including childhood overweight and obesity. It aids in understanding how factors are interrelated, and it can be targeted to produce favourable changes in a system. There is a growing call for systems approaches in public health research, yet limited practical guidance is available on how to evaluate public health programmes within complex adaptive systems. The aim of this paper is to present an evaluation framework that supports researchers in designing systems evaluations in a comprehensive and practical way. Methods We searched the literature for existing public health systems evaluation studies. Key characteristics on how to conduct a systems evaluation were extracted and compared across studies. Next, we overlaid the identified characteristics to the context of the Lifestyle Innovations Based on Youth Knowledge and Experience (LIKE) programme evaluation and analyzed which characteristics were essential to carry out the LIKE evaluation. This resulted in the Evaluation of Programmes in Complex Adaptive Systems (ENCOMPASS) framework. Results The ENCOMPASS framework includes five iterative stages: (1) adopting a system dynamics perspective on the overall evaluation design; (2) defining the system boundaries; (3) understanding the pre-existing system to inform system changes; (4) monitoring dynamic programme output at different system levels; and (5) measuring programme outcome and impact in terms of system changes. Conclusions The value of ENCOMPASS lies in the integration of key characteristics from existing systems evaluation studies, as well as in its practical, applied focus. It can be employed in evaluating public health programmes in complex adaptive systems. Furthermore, ENCOMPASS provides guidance for the entire evaluation process, all the way from understanding the system to developing actions to change it and to measuring system changes. By the nature of systems thinking, the ENCOMPASS framework will likely evolve further over time, as the field expands with more completed studies.
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A Proposed Research Agenda for Promoting Healthy Retail Food Environments in the East Asia-Pacific Region. Curr Nutr Rep 2021; 10:267-281. [PMID: 34894342 DOI: 10.1007/s13668-021-00381-1] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/20/2021] [Indexed: 10/19/2022]
Abstract
PURPOSE OF REVIEW This paper aimed to summarise existing literature on strategies to improve the healthiness of retail food environments in the East Asia and Pacific (EAP) region, and propose a prioritised research agenda on this topic. RECENT FINDINGS Little research on retail food environments has been conducted in the EAP region. Several approaches for measuring retail food environments were identified, although none have been tailored to the EAP context. A small number of policies and initiatives to promote healthy retail food environments have been implemented in EAP. Lessons learnt from successful implementation of initiatives in other regions could be applied in EAP. Retail food environments have a strong influence on food choices and health outcomes. Research can contribute to efforts to improve the healthiness of retail food environments in EAP by (1) describing the current state of retail food environments to highlight areas of good practice and concern and (2) identifying policies and initiatives that are likely to be effective, and mechanisms for their successful implementation.
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