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Craike M, Bartlett L, Mowle A, Riley T, Krahe M, Klepac B. Development and testing of the capacity of organisations for system practices scale. Health Promot J Austr 2024. [PMID: 39252483 DOI: 10.1002/hpja.922] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/05/2024] [Revised: 07/30/2024] [Accepted: 08/27/2024] [Indexed: 09/11/2024] Open
Abstract
BACKGROUND Systems change approaches are increasingly adopted in public health to address complex problems. It is important that measures of systems change be developed so that the effects of systems change on health outcomes can be evaluated. Organisational practices are potential levers for systems change. However, robust measures of organisational capacity to engage in these practices are lacking. Informed by the Theory of Systems Change, we developed and tested the Capacity of Organisations for System Practices (COSP) scale. The COSP scale comprises four inter-related system practices within organisations-adaptation, alignment, collaboration and evidence-driven action and learning. METHODS We applied a three-stage process: (1) Item generation; (2) Scale pre-testing; and (3) Structural analyses. Item response theory tests and semantic review, together with factor analytic techniques, were applied to refine the item set and determine the scale structure. RESULTS An initial pool of 97 items was generated and pre-tested with six content experts and four target audience representatives. Modifications resulted in 60 items. In total, 126 participants provided data for the structural analysis. A second-order hierarchical four-factor model fit the data better than the more basic correlated factor model (Δχ2 = 1.758, p = .415). The fit indices for the final 31-item model were acceptable (RMSEA = .084, TLI = .819). CONCLUSIONS The COSP scale is ready for further testing to ensure construct validity, stability and utility. SO WHAT?: Once validated, the Capacity of Organisations for System Practices (COSP) scale has the potential to advance the theory and practice of systems change approaches.
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Affiliation(s)
- Melinda Craike
- Mitchell Institute for Education and Health Policy, Victoria University, Melbourne, Victoria, Australia
- Institute for Health and Sport, Victoria University, Melbourne, Victoria, Australia
| | - Larissa Bartlett
- Menzies Institute for Medical Research, University of Tasmania, Hobart, Tasmania, Australia
| | - Amy Mowle
- Mitchell Institute for Education and Health Policy, Victoria University, Melbourne, Victoria, Australia
| | - Therese Riley
- Mitchell Institute for Education and Health Policy, Victoria University, Melbourne, Victoria, Australia
| | - Michelle Krahe
- Health Group, Griffith University, Brisbane, Queensland, Australia
- College of Medicine and Dentistry, James Cook University, Cairns, Queensland, Australia
| | - Bojana Klepac
- Mitchell Institute for Education and Health Policy, Victoria University, Melbourne, Victoria, Australia
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Domingo A, Yessis J, Zupko B, McEachern LW, Valaitis R, Skinner K, Hanning RM. Scale up of the learning circles: a participatory action approach to support local food systems in four diverse First Nations school communities within Canada. BMC Public Health 2024; 24:2222. [PMID: 39148046 PMCID: PMC11325755 DOI: 10.1186/s12889-024-19391-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/29/2023] [Accepted: 07/06/2024] [Indexed: 08/17/2024] Open
Abstract
BACKGROUND Addressing Indigenous food security and food sovereignty calls for community-driven strategies to improve access to and availability of traditional and local food. Participatory approaches that integrate Indigenous leadership have supported successful program implementation. Learning Circles: Local Healthy Food to School is a participatory program that convenes a range of stakeholders including food producers, educators and Knowledge Keepers to plan, implement and monitor local food system action. Pilot work (2014-2015) in Haida Gwaii, British Columbia (BC), showed promising results of the Learning Circles (LC) approach in enhancing local and traditional food access, knowledge and skills among youth and adolescents. The objective of the current evaluation was therefore to examine the process of scaling-up the LC vertically within the Haida Nation; and horizontally across three diverse First Nations contexts: Gitxsan Nation, Hazelton /Upper Skeena, BC; Ministikwan Lake Cree Nation, Saskatchewan; and Black River First Nation, Manitoba between 2016 and 2019. METHODS An implementation science framework, Foster-Fishman and Watson's (2012) ABLe Change Framework, was used to understand the LC as a participatory approach to facilitate community capacity building to strengthen local food systems. Interviews (n = 52), meeting summaries (n = 44) and tracking sheets (n = 39) were thematically analyzed. RESULTS The LC facilitated a collaborative process to: (1) build on strengths and explore ways to increase readiness and capacity to reclaim traditional and local food systems; (2) strengthen connections to land, traditional knowledge and ways of life; (3) foster community-level action and multi-sector partnerships; (4) drive actions towards decolonization through revitalization of traditional foods; (5) improve availability of and appreciation for local healthy and traditional foods in school communities; and (6) promote holistic wellness through steps towards food sovereignty and food security. Scale-up within Haida Gwaii supported a growing, robust local and traditional food system and enhanced Haida leadership. The approach worked well in other First Nations contexts, though baseline capacity and the presence of champions were enabling factors. CONCLUSIONS Findings highlight LC as a participatory approach to build capacity and support iterative planning-to-action in community food systems. Identified strengths and challenges support opportunities to expand, adopt and modify the LC approach in other Indigenous communities with diverse food systems.
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Affiliation(s)
- Ashleigh Domingo
- School of Public Health Sciences, University of Waterloo, Waterloo, ON, N2L 3G1, Canada.
- Department of Human Health and Nutritional Sciences, University of Guelph, Guelph, ON, N1G 2W1, Canada.
| | - Jennifer Yessis
- School of Public Health Sciences, University of Waterloo, Waterloo, ON, N2L 3G1, Canada
| | - Barbara Zupko
- School of Public Health Sciences, University of Waterloo, Waterloo, ON, N2L 3G1, Canada
| | - Louise Watson McEachern
- School of Public Health Sciences, University of Waterloo, Waterloo, ON, N2L 3G1, Canada
- Department of Geography, Western University, London, ON, N6A 3K7, Canada
| | - Renata Valaitis
- School of Public Health Sciences, University of Waterloo, Waterloo, ON, N2L 3G1, Canada
| | - Kelly Skinner
- School of Public Health Sciences, University of Waterloo, Waterloo, ON, N2L 3G1, Canada
| | - Rhona M Hanning
- School of Public Health Sciences, University of Waterloo, Waterloo, ON, N2L 3G1, Canada
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Huang A, Cooke SM, Garsden C, Behne C, Borkoles E. Transitioning to sustainable, climate-resilient healthcare: insights from a health service staff survey in Australia. BMC Health Serv Res 2024; 24:475. [PMID: 38627700 PMCID: PMC11022411 DOI: 10.1186/s12913-024-10882-8] [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: 01/26/2024] [Accepted: 03/19/2024] [Indexed: 04/19/2024] Open
Abstract
BACKGROUND More than 80 countries, including Australia, have made commitments to deliver climate-resilient and low carbon healthcare. Understanding how healthcare workers view their own and their organization's efforts to achieve sustainable and climate-resilient healthcare practice is vital to inform strategies to accelerate that transition. METHODS We conducted an online staff survey in a large state government hospital-and-health-service organisation in Queensland, Australia, to ascertain attitudes and practices towards environmentally sustainable, climate-resilient healthcare, and views about the organizational support necessary to achieve these goals in their workplace. RESULTS From 301 participants showed staff strongly support implementing sustainable and climate-resilient healthcare but require significantly more organizational support. Participants identified three categories of organizational support as necessary for the transition to environmentally sustainable and climate-resilient health services and systems: (1) practical support to make sustainability easier in the workplace (e.g. waste, energy, water, procurement, food, transport etc.); (2) training and education to equip them for 21st century planetary health challenges; and (3) embedding sustainability as 'business as usual' in healthcare culture and systems. CONCLUSIONS The research provides new insight into health workforce views on how organizations should support them to realize climate and sustainability goals. This research has implications for those planning, managing, implementing, and educating for, the transition to environmentally sustainable and climate-resilient health services and systems in Queensland, Australia, and in similar health systems internationally.
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Affiliation(s)
| | | | - Christine Garsden
- Sunshine Coast Hospital and Health Service, Queensland Health, Sunshine Coast, Australia
| | | | - Erika Borkoles
- Griffith Business School, Griffith University, Brisbane, Australia
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Lawlor JA, Metta KR. From parts to whole: Embracing systems science in community psychology. AMERICAN JOURNAL OF COMMUNITY PSYCHOLOGY 2023; 72:366-377. [PMID: 37786983 DOI: 10.1002/ajcp.12711] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/16/2023] [Revised: 08/19/2023] [Accepted: 08/22/2023] [Indexed: 10/04/2023]
Abstract
With our field's strong focus on context for understanding and acting on social problems, community psychologists have frequently elevated the importance of employing systems thinking and methods that help us to understand systems more effectively. As a result, community psychologists have adopted some methods from the interdisciplinary field of systems science. In this virtual special issue, we will compare how several of these approaches have been used in publications in the AJCP in the last 50 years. We identify differences in their popularity, implementation with communities, and how they create generative discussion in the field. We conclude by looking to the future to explore ways community psychology can deepen engagement with methods from systems science.
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Affiliation(s)
| | - Kyle R Metta
- Department of Integrated Science and Technology, James Madison University, Harrisonburg, Virginia, USA
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Klepac B, Mowle A, Riley T, Craike M. Government, governance, and place-based approaches: lessons from and for public policy. Health Res Policy Syst 2023; 21:126. [PMID: 38031069 PMCID: PMC10685506 DOI: 10.1186/s12961-023-01074-7] [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: 07/07/2023] [Accepted: 11/10/2023] [Indexed: 12/01/2023] Open
Abstract
BACKGROUND Place-based approaches are increasingly applied to address the determinants of health, many of which are complex problems, to ultimately improve population health outcomes. Through public policy, government actions can affect the effectiveness of place-based approaches by influencing the conceptualisation, development, implementation, governance, and/or evaluation of place-based approaches. Despite the important role of public policy, there has been limited examination of public policy related to place-based approaches. We add to the limited knowledge base by analysing Australian national public policy, to explore: (1) the definitions, conceptualisations, and characteristics of place-based approaches in public policy; (2) the government's perception and communication of its role in place-based approaches; and (3) the extent to which government policy reflects the necessary conditions for successful place-based governance developed by Marsh and colleagues, namely localised context, embedded learning, and reciprocal accountability. METHODS This research was underpinned by the Theory of Systems Change and methodologically informed by the READ approach to document analysis. Ritchie and Spencer's framework method was utilised to analyse the data. RESULTS We identified and reviewed 67 policy documents. In terms of conceptualisation, common characteristics of place-based approaches related to collaboration, including community in decision-making, responsiveness to community needs, and suitability of place-based approaches to address complex problems and socio-economic determinants of health. Three roles of government were identified: funder, partner, and creator of a supportive policy environment. From the three criteria for successful place-based governance, localised context was the most dominant across the documents and reciprocal accountability the least. CONCLUSIONS Based on our findings, we drew key implications for public policy and research. There was a disproportionate emphasis on the bottom-up approach across the documents, which presents the risk of diminishing government interest in place-based approaches, potentially burdening communities experiencing disadvantage beyond their capacities. Governments engaged in place-based approaches should work towards a more balanced hybrid approach to place-based approaches that maintain the central functions of government while allowing for successful place-based governance. This could be achieved by promoting consistency in conceptualisations of 'place-based', employing an active role in trust building, advancing the creation of a supportive policy environment, and embedding 'learning' across place-based approaches.
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Affiliation(s)
- Bojana Klepac
- Mitchell Institute for Education and Health Policy, Victoria University, Footscray Park Campus, Pathways in Place, Melbourne, VIC, Australia.
| | - Amy Mowle
- Mitchell Institute for Education and Health Policy, Victoria University, Footscray Park Campus, Pathways in Place, Melbourne, VIC, Australia
| | - Therese Riley
- Mitchell Institute for Education and Health Policy, Victoria University, Footscray Park Campus, Pathways in Place, Melbourne, VIC, Australia
| | - Melinda Craike
- Mitchell Institute for Education and Health Policy, Victoria University, Footscray Park Campus, Pathways in Place, Melbourne, VIC, Australia
- Institute for Health and Sport, Victoria University, Melbourne, VIC, Australia
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Mowle A, Klepac B, Riley T, Craike M. The C-CAP Process: A Comprehensive Approach to Community Resource Mapping. Health Promot Pract 2023:15248399231193696. [PMID: 37650392 DOI: 10.1177/15248399231193696] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 09/01/2023]
Abstract
INTRODUCTION Place-based systems change approaches are gaining popularity to address the complex problems associated with locational disadvantage. An important stage of place-based systems change involves understanding the context that surrounds (re)produces a target problem. Community resource mapping can be used to establish the context and identify the strengths of a community that might be leveraged through systems change efforts. Approaches to community resource mapping draw on a range of philosophical assumptions and methodological frameworks. However, comprehensive, practical guidance for researchers and practitioners to conduct community resource mapping is scarce. METHOD Drawing on the learnings from a literature review, scoping workshops, and reflective practice sessions, we developed a flexible, methodologically robust process called the Contextualize, Collect, Analyze, and Present (C-CAP) process: a four-phase approach to preparing for, conducting, and reporting on community resource mapping. The C-CAP process was co-developed by researchers and practitioners and was tested and refined in two different communities. RESULTS The C-CAP process provides robust guidance for conducting and reporting on a community resource mapping project. The C-CAP process can be applied by public health practitioners and researchers and adapted for use across different communities, problems, and target groups. We encourage others guided by differing theoretical perspectives to apply C-CAP and share the learnings. CONCLUSION Application of the C-CAP process has the potential to improve the comparability and comprehensiveness of findings from community resource mapping projects and avoids duplication of effort by reducing the need to design new processes for each new community resource mapping activity.
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Affiliation(s)
- Amy Mowle
- Mitchell Institute for Education and Health Policy, Victoria University, Victoria, Australia
| | - Bojana Klepac
- Mitchell Institute for Education and Health Policy, Victoria University, Victoria, Australia
| | - Therese Riley
- Mitchell Institute for Education and Health Policy, Victoria University, Victoria, Australia
| | - Melinda Craike
- Mitchell Institute for Education and Health Policy, Victoria University, Victoria, Australia
- Institute for Health & Sport, Victoria University, Victoria, Australia
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Domingo A, Yessis J, Charles KA, Skinner K, Hanning RM. Integrating knowledge and action: learnings from an implementation program for food security and food sovereignty with First Nations communities within Canada. Implement Sci 2023; 18:34. [PMID: 37573323 PMCID: PMC10422772 DOI: 10.1186/s13012-023-01291-2] [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: 04/12/2023] [Accepted: 07/31/2023] [Indexed: 08/14/2023] Open
Abstract
BACKGROUND Collaborative approaches to knowledge translation (KT) are important for advancing community-engaged research. However, there is a need for examples of participatory approaches that have effectively supported public health research, program development, and implementation with First Nations communities. To strengthen KT with communities, we proposed a set of guiding principles for participatory planning and action for local food system change. Principles emerged from a cross-community analysis of Learning Circles: Local Healthy Food to School (LC:LHF2S) a participatory program (2015-2019) for Indigenous food system action. The objective was to identify guiding principles for participatory planning and action from key learnings and successes on scaling-up of the Learning Circles (LC) model vertically in Haida Nation, British Columbia (BC), and horizontally in three distinct community contexts: Gitxsan Nation, Hazelton /Upper Skeena, BC; Ministikwan Lake. The application of these principles is discussed in the context of our ongoing partnership with Williams Treaties First Nations to support community planning to enhance food security and sovereignty. METHODS A cross-community thematic analysis was conducted and guided by an implementation science framework, Foster-Fishman and Watson's (2012) ABLe Change Framework, to identify key learnings and successes from adapting the LC approach. Information gathered from interviews (n = 55) and meeting reports (n = 37) was thematically analyzed to inform the development of guiding principles. Community sense-making of findings informed applicability in a new community context embarking on food systems work. RESULTS Emergent guiding principles for participatory food system planning and action are described within four main areas: (1) create safe and ethical spaces for dialog by establishing trust and commitment from the ground up, (2) understand the context for change through community engagement, (3) foster relationships to strengthen and sustain impact, and (4) reflect and embrace program flexibility to integrate learnings. CONCLUSIONS Emergent principles offer guidance to supporting Indigenous community-led research and mobilization of knowledge into action. Principles are intended to support researchers and health system administrators with taking a collaborative approach that fosters relationships and integration of community leadership, knowledge, and action for food system change. Application of principles with implementation frameworks can strengthen KT in Indigenous contexts by incorporating community protocols and perspectives in support of Indigenous self-determined priorities.
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Affiliation(s)
- Ashleigh Domingo
- Faculty of Health, School of Public Health Sciences, University of Waterloo, 200 University Avenue West, Waterloo, ON, N2L 3G1, Canada.
| | - Jennifer Yessis
- Faculty of Health, School of Public Health Sciences, University of Waterloo, 200 University Avenue West, Waterloo, ON, N2L 3G1, Canada
| | | | - Kelly Skinner
- Faculty of Health, School of Public Health Sciences, University of Waterloo, 200 University Avenue West, Waterloo, ON, N2L 3G1, Canada
| | - Rhona M Hanning
- Faculty of Health, School of Public Health Sciences, University of Waterloo, 200 University Avenue West, Waterloo, ON, N2L 3G1, Canada
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Riley T, Hopkins L, Gomez M, Davidson S, Jacob J. System Action Learning: Reorientating Practice for System Change in Preventive Health. SYSTEMIC PRACTICE AND ACTION RESEARCH 2023:1-16. [PMID: 37359404 PMCID: PMC10060912 DOI: 10.1007/s11213-023-09638-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/07/2023] [Indexed: 03/31/2023]
Abstract
It is now widely accepted that many of the problems we face in public health are complex, from chronic disease to COVID-19. To grapple with such complexity, researchers have turned to both complexity science and systems thinking to better understand the problems and their context. Less work, however, has focused on the nature of complex solutions, or intervention design, when tackling complex problems. This paper explores the nature of system intervention design through case illustrations of system action learning from a large systems level chronic disease prevention study in Australia. The research team worked with community partners in the design and implementation of a process of system action learning designed to reflect on existing initiatives and to reorient practice towards responses informed by system level insights and action. We were able to observe and document changes in the mental models and actions of practitioners and in doing so shine a light on what may be possible once we turn our attention to the nature and practice of system interventions.
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Affiliation(s)
- Therese Riley
- The Australian Prevention Partnership Centre, The Sax Institute, Sydney, Australia
| | - Liza Hopkins
- The Australian Prevention Partnership Centre, The Sax Institute, Sydney, Australia
| | - Maria Gomez
- The Australian Prevention Partnership Centre, The Sax Institute, Sydney, Australia
| | - Seanna Davidson
- The Australian Prevention Partnership Centre, The Sax Institute, Sydney, Australia
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Pescud M, Rychetnik L, Allender S, Irving MJ, Howse E, Rutter H, Ison R, Riley T, Friel S, Finegood DT. Leadership for systems change: Researcher practices for enhancing research impact in the prevention of chronic disease. Front Public Health 2022; 10:1045001. [PMID: 36561852 PMCID: PMC9767460 DOI: 10.3389/fpubh.2022.1045001] [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: 09/15/2022] [Accepted: 11/16/2022] [Indexed: 12/12/2022] Open
Abstract
Introduction Strengthening systems for chronic disease prevention is essential. Leadership for systems change is an important key to strengthening systems. Leadership in prevention research for supporting systems change remains a relatively abstract concept and there is limited empirical information about the leadership practices of prevention research teams when viewed through a complexity lens. In this paper we examine and describe some systems leadership practices for creating change through prevention research, as identified in a series of six case studies. Methods A qualitative approach incorporating semi-structured interviews, participant observation, and document review was used to facilitate an in-depth investigation of the research topic. Results Several researcher practices for enhancing research impact in the prevention of chronic disease were distilled from the data pertaining to how they sought to create change. These included persuasive communication, compassion and deep listening, reflective practice, and embedding themselves within the systems they sought to change. Discussion The findings provide insights that may assist prevention researchers and other practitioners dedicated to creating change in chronic disease prevention.
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Affiliation(s)
- Melanie Pescud
- Menzies Centre for Health Governance, School of Regulation and Global Governance (RegNet), Australian National University, Canberra, ACT, Australia
- The Australian Prevention Partnership Centre, The Sax Institute, Glebe, NSW, Australia
| | - Lucie Rychetnik
- The Australian Prevention Partnership Centre, The Sax Institute, Glebe, NSW, Australia
- School of Public Health, Faculty of Medicine and Health, University of Sydney, Camperdown, NSW, Australia
| | - Steven Allender
- School of Health and Social Development, Faculty of Health, Deakin University, Geelong, VIC, Australia
| | - Michelle J. Irving
- The Australian Prevention Partnership Centre, The Sax Institute, Glebe, NSW, Australia
- School of Public Health, Faculty of Medicine and Health, University of Sydney, Camperdown, NSW, Australia
- Centre for Evidence and Implementation, Carlton, VIC, Australia
| | - Eloise Howse
- The Australian Prevention Partnership Centre, The Sax Institute, Glebe, NSW, Australia
| | - Harry Rutter
- Department of Social and Policy Sciences, University of Bath, Bath, United Kingdom
| | - Ray Ison
- School of Engineering and Innovation, Faculty of Science, Technology, Engineering and Mathematics, The Open University, Milton Keynes, United Kingdom
| | - Therese Riley
- Therese Riley Consulting, Melbourne, VIC, Australia
- Mitchell Institute, Victoria University, Melbourne, VIC, Australia
| | - Sharon Friel
- Menzies Centre for Health Governance, School of Regulation and Global Governance (RegNet), Australian National University, Canberra, ACT, Australia
| | - Diane T. Finegood
- Morris J. Wosk Centre for Dialogue, Simon Fraser University, Vancouver, BC, Canada
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Paterson S, McInerney EEW, Evans SD. Using social network analysis as a tool in action research. JOURNAL OF COMMUNITY PSYCHOLOGY 2022; 50:3421-3437. [PMID: 35322891 DOI: 10.1002/jcop.22844] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/03/2020] [Revised: 03/02/2022] [Accepted: 03/03/2022] [Indexed: 06/14/2023]
Abstract
The following paper presents case examples of one research team's use of social network analysis (SNA) with three different collaboratives in South Florida: (a) a Collective Impact initiative seeking to end youth homelessness, (b) a university collaborative of campus organizations working towards Black students' concerns, and (c) a movement network of local social justice organizations. The research team used SNA to assess the level of connectivity of three different community coalitions. While research questions were slightly different for each collaborative, each project asked about the frequency of communication between organizations to determine connectivity. Results vary between case examples. Both the Youth Homeless Collaboration and the Black Student Association used Gephi to analyze results, while The Community Partnership used R to measure network centrality. The paper concludes with a general discussion of challenges related to using SNA as an action research tool, as well as the role of power in organizational networks.
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Affiliation(s)
- Susan Paterson
- Department of Educational and Psychological Studies, University of Miami, Coral Gables, Florida, USA
| | - Elizabeth E W McInerney
- Department of Educational and Psychological Studies, University of Miami, Coral Gables, Florida, USA
| | - Scotney D Evans
- Department of Educational and Psychological Studies, University of Miami, Coral Gables, Florida, USA
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Charlot-Swilley D, Condon MC, Rahman T. At the feet of storytellers: Implications for practicing early relational health conversations. Infant Ment Health J 2022; 43:373-389. [PMID: 35579376 DOI: 10.1002/imhj.21981] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/09/2021] [Accepted: 03/02/2022] [Indexed: 11/08/2022]
Abstract
A family- and culturally-centered approach to conversations about early relational health (ERH) can open up opportunities for universal family engagement. The appraisal of family-baby relational health is more trustworthy and useful when there is attunement to family voice and facilitator bias. Early Relational Health Conversations (ERH-C) is a model for ERH promotion and intervention. This model has eight components: preparing and entering the ERH-C space, accessing strength and knowledge in a healing-centered space, pausing and co-creating, storytelling, witnessing, mutual reflection, affirming, and claiming their relationship narrative, and mutual insight. It is a paradigm shift in working with African American families and possibly other historically marginalized families who are also impacted by structural racism. The eight components are explained, and examples are given from the perspective of an Africentric worldview. The importance of cultural humility, attuning to and honoring family culture is emphasized. Insights for implementation in primary care and other settings are provided. Healing-centered engagement practices embedded in ERH-C have the potential to move ERH work into the social justice arena. The ERH-C is a family reflection model. Ideas for future directions for ERH-C are discussed.
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Affiliation(s)
- Dominique Charlot-Swilley
- Early Childhood Innovation Network, Washington, D.C., USA.,Children's National Primary Care, Children's Health Center - Anacostia, Washington, D.C., USA
| | | | - Tininka Rahman
- Early Childhood Innovation Network, Washington, D.C., USA.,Children's National Primary Care, Children's Health Center - Anacostia, Washington, D.C., USA
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Condon MC, Charlot-Swilley D, Rahman T. At the feet of storytellers: Equity in early relational health conversations. Infant Ment Health J 2022; 43:390-409. [PMID: 35579361 DOI: 10.1002/imhj.21979] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/09/2021] [Accepted: 12/16/2021] [Indexed: 11/08/2022]
Abstract
Early Relational Health (ERH) focuses attention on family-baby relationships during the first 1000 days of life. Positive ERH enhances child health and development and family wellbeing. Universal, early identification of RH and vulnerability could add value to care. How to screen, when, where, and with whom is the question. Tools and models for screening are practitioner-centered. Bias can affect family engagement and outcomes. This may be problematic for African American families. Authors present findings of a discourse analysis and phenomenological study of experiences of African American families' and HealthySteps Specialists' (HSS) of color with screening ERH in Washington, D.C., USA (N = 13). Findings indicate relevance, acceptance and utility may be influenced by positionality, cultural context, issues of equity, and engagement in mutual reflection. A family-centered approach that opened space for non-dominant knowledge about ERH made positive differences in engagement and utility for families and practioners alike. Health and vulnerability were detected reliably using this approach. Outcomes include new theories about ERH-focused visits with African American families and infants, and a new model for centering ERH in pediatric practice, entitled Early Relational Health Conversations. ERH-C is a family reflection model, not necessarily dyadic. It may have value for other populations. Future directions in ERH-C research are suggested.
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Affiliation(s)
| | - Dominique Charlot-Swilley
- Early Childhood Innovation Network, Washington, D.C. (ECIN), USA.,Children's National Primary Care, Children's Health Center - Anacostia, Washington, D.C., USA
| | - Tininka Rahman
- Early Childhood Innovation Network, Washington, D.C. (ECIN), USA.,Children's National Primary Care, Children's Health Center - Anacostia, Washington, D.C., USA
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Guerrero M, Anderson AJ, Catlett BS, Sánchez B, Liao CL. Emerging Adults' Social Justice Engagement: Motivations, Barriers, and Social Identity. AMERICAN JOURNAL OF COMMUNITY PSYCHOLOGY 2021; 68:73-87. [PMID: 33410543 DOI: 10.1002/ajcp.12495] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/12/2023]
Abstract
This study examines emerging adults' perceived motivations and barriers to social justice engagement, and how their social identities shape involvement. We conducted in-depth interviews with service-learning students (n = 30). Thematic analysis of interview data revealed that participants perceived several motivations and barriers to engagement, including the following: (a) the current political climate, (b) self-efficacy to make small-scale changes, (c) social support in action, (d) proximity to the social issue, (e) knowledge of resources, and (f) limited personal resources. Participants also described how their identities shaped engagement such that participants reflected upon their multiple privileged and marginalized identities and how their identities influenced their approach to engaging with a particular social issue. Findings have implications for recruiting and sustaining emerging adults' involvement in activities aimed at changing social issues.
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From Understanding to Impactful Action: Systems Thinking for Systems Change in Chronic Disease Prevention Research. SYSTEMS 2021. [DOI: 10.3390/systems9030061] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
Abstract
Within the field of chronic disease prevention, research efforts have moved to better understand, describe, and address the complex drivers of various health conditions. Change-making is prominent in this paper, and systems thinking and systems change are prioritised as core elements of prevention research. We report how the process of developing a theory of systems change can assist prevention research to progress from understanding systems, towards impactful action within those systems. Based on Foster-Fishman and Watson’s ABLe change framework, a Prevention Systems Change Framework (PSCF) was adapted and applied to an Australian case study of the drivers of healthy and equitable eating as a structured reflective practice. The PSCF comprises four components: building a systemic lens on prevention, holding a continual implementation focus, integrating the systemic lens and implementation focus, and developing a theory of change. Application of the framework as part of a systemic evaluation process enabled a detailed and critical assessment of the healthy and equitable eating project goals and culminated in the development of a theory of prevention systems change specific to that project, to guide future research and action. Arguably, if prevention research is to support improved health outcomes, it must be more explicitly linked to creating systems change.
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Sarmiento I, Zuluaga G, Paredes-Solís S, Chomat AM, Loutfi D, Cockcroft A, Andersson N. Bridging Western and Indigenous knowledge through intercultural dialogue: lessons from participatory research in Mexico. BMJ Glob Health 2021; 5:bmjgh-2020-002488. [PMID: 32994227 PMCID: PMC7526303 DOI: 10.1136/bmjgh-2020-002488] [Citation(s) in RCA: 16] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/12/2020] [Revised: 06/05/2020] [Accepted: 06/08/2020] [Indexed: 12/12/2022] Open
Abstract
Indigenous communities in Latin America and elsewhere have complex bodies of knowledge, but Western health services generally approach them as vulnerable people in need of external solutions. Intercultural dialogue recognises the validity and value of Indigenous standpoints, and participatory research promotes reciprocal respect for stakeholder input in knowledge creation.As part of their decades-long community-based work in Mexico's Guerrero State, researchers at the Centro de Investigación de Enfermedades Tropicales responded to the request from Indigenous communities to help them address poor maternal health. We present the experience from this participatory research in which both parties contributed to finding solutions for a shared concern. The aim was to open an intercultural dialogue by respecting Indigenous skills and customs, recognising the needs of health service stakeholders for scientific evidence.Three steps summarise the opening of intercultural dialogue. Trust building and partnership based on mutual respect and principles of cultural safety. This focused on understanding traditional midwifery and the cultural conflicts in healthcare for Indigenous women. A pilot randomised controlled trial was an opportunity to listen and to adjust the lexicon identifying and testing culturally coherent responses for maternal health led by traditional midwives. Codesign, evaluation and discussion happened during a full cluster randomised trial to identify benefits of supporting traditional midwifery on maternal outcomes. A narrative mid-term evaluation and cognitive mapping of traditional knowledge offered additional evidence to discuss with other stakeholders the benefits of intercultural dialogue. These steps are not mechanistic or invariable. Other contexts might require additional steps. In Guerrero, intercultural dialogue included recovering traditional midwifery and producing high-level epidemiological evidence of the value of traditional midwives, allowing service providers to draw on the strengths of different cultures.
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Affiliation(s)
- Iván Sarmiento
- CIET-PRAM, Department of Family Medicine, McGill University, Montreal, Quebec, Canada .,Grupo de Estudios en Sistemas Tradicionales de Salud (GESTS), Universidad del Rosario, Bogotá, Cundinamarca, Colombia
| | - Germán Zuluaga
- Grupo de Estudios en Sistemas Tradicionales de Salud (GESTS), Universidad del Rosario, Bogotá, Cundinamarca, Colombia
| | - Sergio Paredes-Solís
- Centro de Investigación de Enfermedades Tropicales (CIET), Universidad Autónoma de Guerrero, Acapulco, Guerrero, México
| | - Anne Marie Chomat
- CIET-PRAM, Department of Family Medicine, McGill University, Montreal, Quebec, Canada
| | - David Loutfi
- CIET-PRAM, Department of Family Medicine, McGill University, Montreal, Quebec, Canada
| | - Anne Cockcroft
- CIET-PRAM, Department of Family Medicine, McGill University, Montreal, Quebec, Canada
| | - Neil Andersson
- CIET-PRAM, Department of Family Medicine, McGill University, Montreal, Quebec, Canada.,Centro de Investigación de Enfermedades Tropicales (CIET), Universidad Autónoma de Guerrero, Acapulco, Guerrero, México
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Lawlor JA, Metta KR, Neal Z. What is a coalition? A systematic review of coalitions in community psychology. JOURNAL OF COMMUNITY & APPLIED SOCIAL PSYCHOLOGY 2021. [DOI: 10.1002/casp.2554] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Affiliation(s)
- Jennifer A. Lawlor
- Department of Psychology Michigan State University East Lansing Michigan USA
- School of Information University of Michigan, 105S. State St Ann Arbor MI USA
| | - Kyle R. Metta
- Department of Community Sustainability Michigan State University Ann Arbor Michigan USA
- Lifespan Institute University of Kansas 1000 Sunnyside Avenue, 4082 Dole Center Lawrence KS USA
| | - Zachary Neal
- Department of Psychology Michigan State University East Lansing Michigan USA
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Indigenous Community Perspectives of Food Security, Sustainable Food Systems and Strategies to Enhance Access to Local and Traditional Healthy Food for Partnering Williams Treaties First Nations (Ontario, Canada). INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 18:ijerph18094404. [PMID: 33919110 PMCID: PMC8122547 DOI: 10.3390/ijerph18094404] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 03/19/2021] [Revised: 04/15/2021] [Accepted: 04/18/2021] [Indexed: 11/30/2022]
Abstract
In partnership with communities of the Williams Treaties First Nations in southern Ontario (Canada), we describe an approach to work with communities, and highlight perspectives of food security and sustainability, including priorities and opportunities to revitalize local food systems as a pathway to food security and food sovereignty. The objectives of our project were: (1) to build a shared understanding of food security and sustainability; and (2) to document community priorities, challenges and opportunities to enhance local food access. Utilizing an Indigenous methodology, the conversational method, within the framework of community-based participatory research, formative work undertaken helped to conceptualize food security and sustainability from a community perspective and solidify interests within the four participating communities to inform community-led action planning. Knowledge generated from our project will inform development of initiatives, programs or projects that promote sustainable food systems. The community-based actions identified support a path towards holistic wellbeing and, ultimately, Indigenous peoples' right to food security and food sovereignty.
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Petras H, Israelashvili M, Miller B. Introduction to the Special Issue on "Promoting a Culture of Prevention: an International Perspective". PREVENTION SCIENCE : THE OFFICIAL JOURNAL OF THE SOCIETY FOR PREVENTION RESEARCH 2020; 22:1-6. [PMID: 33188498 PMCID: PMC7665086 DOI: 10.1007/s11121-020-01190-8] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/06/2020] [Indexed: 11/29/2022]
Abstract
The primary goal of this special issue is to showcase novel, theory-driven, creative, and rigorous contributions to our understanding of the existence and development of a culture of prevention and readiness to prevent. The term “culture of prevention” is neither a set of practical guidelines nor a leading theory. Instead, it is a multidimensional term representing the general orientation and readiness of a group of people (be it a family, community, school, organization, nation, etc.) to deal with problems using a preventive, rather than a reactive, approach. The COVID-19 pandemic creates an opportunity for taking stock of the worldwide progress in creating a “culture of prevention.” This special issue aims to stimulate this discourse by presenting six studies and three commentaries from international scholars focused on themes and approaches for creating a culture of prevention.
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Affiliation(s)
- Hanno Petras
- American Institutes for Research, Washington, DC, USA.
| | | | - Brenda Miller
- Pacific Institute for Research and Evaluation at the Prevention Research Center (PRC), Berkeley, CA, USA
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A Systems Thinking Methodology for Studying Prevention Efforts in Communities. SYSTEMIC PRACTICE AND ACTION RESEARCH 2020. [DOI: 10.1007/s11213-020-09544-7] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
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20
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Wright J, Hayward A, West J, Pickett K, McEachan RM, Mon-Williams M, Christie N, Vaughan L, Sheringham J, Haklay M, Sheard L, Dickerson J, Barber S, Small N, Cookson R, Garnett P, Bywater T, Pleace N, Brunner EJ, Cameron C, Ucci M, Cummins S, Fancourt D, Kandt J, Longley P, Morris S, Ploubidis G, Savage R, Aldridge R, Hopewell D, Yang T, Mason D, Santorelli G, Romano R, Bryant M, Crosby L, Sheldon T. ActEarly: a City Collaboratory approach to early promotion of good health and wellbeing. Wellcome Open Res 2019; 4:156. [PMID: 31840089 PMCID: PMC6904987 DOI: 10.12688/wellcomeopenres.15443.1] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/02/2019] [Indexed: 11/20/2022] Open
Abstract
Economic, physical, built, cultural, learning, social and service environments have a profound effect on lifelong health. However, policy thinking about health research is dominated by the ‘biomedical model’ which promotes medicalisation and an emphasis on diagnosis and treatment at the expense of prevention. Prevention research has tended to focus on ‘downstream’ interventions that rely on individual behaviour change, frequently increasing inequalities. Preventive strategies often focus on isolated leverage points and are scattered across different settings. This paper describes a major new prevention research programme that aims to create City Collaboratory testbeds to support the identification, implementation and evaluation of upstream interventions within a whole system city setting. Prevention of physical and mental ill-health will come from the cumulative effect of multiple system-wide interventions. Rather than scatter these interventions across many settings and evaluate single outcomes, we will test their collective impact across multiple outcomes with the goal of achieving a tipping point for better health. Our focus is on early life (ActEarly) in recognition of childhood and adolescence being such critical periods for influencing lifelong health and wellbeing.
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Affiliation(s)
- John Wright
- Bradford Institute for Health Research, Bradford, BD9 6RJ, UK
| | - Andrew Hayward
- Institute of Epidemiology and Health Care, UCL, London, WC1E 6BT, UK
| | - Jane West
- Bradford Institute for Health Research, Bradford, BD9 6RJ, UK
| | - Kate Pickett
- Department of Health Sciences, University of York, UK, York, YO10 5DD, UK
| | | | | | - Nicola Christie
- Centre for Transport Studies, Department of Civil, Environmental and Geomatic Engineering, UCL, London, WC1E 6BT, UK
| | - Laura Vaughan
- Space Syntax Laboratory, Bartlett School of Architecture, UCL, London, WC1E 6BT, UK
| | - Jess Sheringham
- Institute of Epidemiology and Health Care, UCL, London, WC1E 6BT, UK
| | - Muki Haklay
- Extreme Citizen Science Group, Department of Geography, UCL, London, WC1E 6BT, UK
| | - Laura Sheard
- Bradford Institute for Health Research, Bradford, BD9 6RJ, UK
| | - Josie Dickerson
- Bradford Institute for Health Research, Bradford, BD9 6RJ, UK
| | - Sally Barber
- Bradford Institute for Health Research, Bradford, BD9 6RJ, UK
| | - Neil Small
- University of Bradford, Bradford, BD7 1DP, UK
| | - Richard Cookson
- Centre for Health Economics, University of York, York, YO10 5DD, UK
| | - Philip Garnett
- York Cross-disciplinary Centre for Systems Analysis and School of Management, University of York, York, YO10 5GD, UK
| | - Tracey Bywater
- Department of Health Sciences, University of York, UK, York, YO10 5DD, UK
| | - Nicholas Pleace
- Centre for Housing Policy, University of York, UK, York, YO10 5DD, UK
| | - Eric J Brunner
- Institute of Epidemiology and Health Care, UCL, London, WC1E 6BT, UK
| | - Claire Cameron
- Department of Social Science, UCL Institute of Education, UCL, London, WC1H 0AA, UK
| | - Marcella Ucci
- UCL Institute for Environmental Design and Engineering, The Bartlett Faculty of the Built Environment, UCL, London, WC1H 0NN, UK
| | - Steve Cummins
- Population Health Innovation Lab, Department of Public Health, Environments & Society, London School of Hygiene & Tropical Medicine, London, WC1H 9SH, UK
| | - Daisy Fancourt
- Institute of Epidemiology and Health Care, UCL, London, WC1E 6BT, UK
| | - Jens Kandt
- Space Syntax Laboratory, Bartlett School of Architecture, UCL, London, WC1E 6BT, UK
| | - Paul Longley
- Consumer Data Research Centre Department of Geography, UCL, London, WC1E 6BT, UK
| | - Steve Morris
- Primary Care Unit, Department of Public Health and Primary Care, University of Cambridge, Cambridge, CB1 8RN, UK
| | | | | | | | | | - Tiffany Yang
- Bradford Institute for Health Research, Bradford, BD9 6RJ, UK
| | - Dan Mason
- Bradford Institute for Health Research, Bradford, BD9 6RJ, UK
| | | | - Richard Romano
- Institute for Transport Studies, University of Leeds, Leeds, LS2 9JT, UK
| | - Maria Bryant
- Leeds Institute of Clinical Trials Research, University of Leeds, Leeds, LS2 9JT, UK
| | - Liam Crosby
- Institute of Epidemiology and Health Care, UCL, London, WC1E 6BT, UK
| | - Trevor Sheldon
- Department of Health Sciences, University of York, UK, York, YO10 5DD, UK
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Kennedy H, DeChants J, Bender K, Anyon Y. More than Data Collectors: A Systematic Review of the Environmental Outcomes of Youth Inquiry Approaches in the United States. AMERICAN JOURNAL OF COMMUNITY PSYCHOLOGY 2019; 63:208-226. [PMID: 30843254 DOI: 10.1002/ajcp.12321] [Citation(s) in RCA: 17] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/09/2023]
Abstract
Over the last twenty years, research on the impact of engaging children and adolescents in the generation of new knowledge about their lives, schools, and communities, has grown tremendously. This systematic review summarizes the findings from empirical studies of youth inquiry approaches in the United States, with a focus on their environmental outcomes. Searches of four interdisciplinary databases retrieved a total of 3,724 relevant articles published between 1995 and 2015. Sixty-three distinct studies met the systematic review inclusion criteria, of which, 36 (57.1%) reported that the youth inquiry approach contributed to positive changes among adults, peers, organizations, and/or institutions. These environmental outcomes were qualitatively recorded, inductively categorized, and then organized into Bronfenbrenner's ecological framework. Youth inquiry approaches led to practitioner growth and changes in peer group norms at the micro-system level, program development or improvement and research benefits at the meso-system level, and school, city, and state level policy adoption at the exo-system level. Qualitative methods, especially case studies, were most commonly used to evaluate the impact of youth inquiry approaches on environmental outcomes. Studies of approaches that utilized advocacy to create change, targeted decision-makers as the audience for the youth's work and convened for a longer duration were more likely to report improved environmental outcomes. This systematic review suggests that youth inquiry approaches are a promising strategy for ecological systems change.
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Affiliation(s)
- Heather Kennedy
- Graduate School of Social Work, University of Denver, Denver, CO, USA
| | - Jonah DeChants
- Graduate School of Social Work, University of Denver, Denver, CO, USA
| | - Kimberly Bender
- Graduate School of Social Work, University of Denver, Denver, CO, USA
| | - Yolanda Anyon
- Graduate School of Social Work, University of Denver, Denver, CO, USA
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Nelson G, Worton SK, Macnaughton E, Tsemberis S, MacLeod T, Hasford J, Goering P, Stergiopoulos V, Aubry T, Distasio J. Systems change in the context of an initiative to scale up Housing First in Canada. JOURNAL OF COMMUNITY PSYCHOLOGY 2019; 47:7-20. [PMID: 30506925 DOI: 10.1002/jcop.22095] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/07/2018] [Revised: 04/26/2018] [Accepted: 05/04/2018] [Indexed: 06/09/2023]
Abstract
In this study, we examine changes in the homeless-serving system in the context of a training and technical assistance initiative to scale up Housing First (HF) in 6 Canadian communities. Based on qualitative data from focus groups and individual interviews with key stakeholders (k = 7, n = 35) and field notes gathered over a 3-year period (n = 146), we found 2 main system changes: (a) changes in the capacity of the service delivery system at multiple levels of analysis (from individual to policy) to implement HF, and (b) changes in the coordination of parts of the service delivery system and collaboration among local stakeholders to enhance HF implementation. These changes were facilitated or constrained by the larger context of evidence, climate, policy, and funding. The findings were discussed in terms of systems change theory and implications for transformative systems change in the mental health and homelessness sectors.
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Affiliation(s)
| | | | | | | | | | | | - Paula Goering
- Centre for Addiction and Mental Health
- University of Toronto
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Dickson-Gomez J, Glasman LA, Bodnar G, Murphy M. A social systems analysis of implementation of El Salvador's national HIV combination prevention: a research agenda for evaluating Global Health Initiatives. BMC Health Serv Res 2018; 18:848. [PMID: 30419904 PMCID: PMC6233270 DOI: 10.1186/s12913-018-3667-8] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/17/2018] [Accepted: 10/31/2018] [Indexed: 11/23/2022] Open
Abstract
Background Global Health Initiatives (GHIs) have been instrumental in the rapid acceleration of HIV prevention, treatment access, and availability of care and support services for people living with HIV (PLH) in low and middle income countries (LMIC). These efforts have increasingly used combination prevention approaches that include biomedical, behavioral, social and structural interventions to reduce HIV incidence. However, little research has evaluated their implementation. We report results of qualitative research to examine the implementation of a national HIV combination prevention strategy in El Salvador funded by the Global Fund to Fight AIDS, Tuberculosis and Malaria. Methods We conducted in-depth interviews with principal recipients of the funding, members of the Country Coordinating Mechanism (CCM) and front line peer outreach workers and their clients. We analyzed the data using a dynamic systems framework. Results El Salvador’s national HIV combination prevention strategy had three main goals: 1) to decrease the sexual risk behaviors of men who have sex with men (MSM), commercial sex workers (CSW) and transgender women (TW); 2) to increase HIV testing rates among members of these populations and the proportion of PLH who know their status; and 3) to improve linkage to HIV treatment and adherence to antiretroviral therapy (ART). Intervention components to achieve these goals included peer outreach, community prevention centers and specialized STI/HIV clinics, and new adherence and retention protocols for PLH. In each intervention component, we identified several factors which reinforced or diminished intervention efforts. Factors that negatively affected all intervention activities were an increase in violence in El Salvador during implementation of the strategy, resistance to decentralization, and budget constraints. Factors that affected peer outreach and sexual risk reduction were the human resource capacity of grassroots organizations and conflicts of the national HIV strategy with other organizational missions. Conclusions Overall, the national strategy improved access to HIV prevention and care through efforts to improve capacity building of grass roots organizations, reduced stigma, and improved coordination among organizations. However, failure to respond to environmental and organizational factors limited the intervention’s potential impact. Electronic supplementary material The online version of this article (10.1186/s12913-018-3667-8) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Julia Dickson-Gomez
- Center for AIDS Intervention Research, Medical College of Wisconsin, Milwaukee, WI, USA.
| | - Laura A Glasman
- Center for AIDS Intervention Research, Medical College of Wisconsin, Milwaukee, WI, USA
| | - Gloria Bodnar
- Fundación Antidrogas de El Salvador, Santa Tecla, El Salvador
| | - Molly Murphy
- Center for AIDS Intervention Research, Medical College of Wisconsin, Milwaukee, WI, USA
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Jain S, Cohen AK, Jagannathan P, Leung Y, Bassey H, Bedford S. Evaluating the Implementation of a Collaborative Juvenile Reentry System in Oakland, California. INTERNATIONAL JOURNAL OF OFFENDER THERAPY AND COMPARATIVE CRIMINOLOGY 2018; 62:3662-3680. [PMID: 29426252 DOI: 10.1177/0306624x18755480] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/08/2023]
Abstract
Traditional juvenile reentry systems often inadequately meet offenders' complex needs. Policymakers and researchers increasingly recognize the importance of a collaborative community- and development-based reentry system to improve recidivism, youth developmental outcomes, and public safety. Yet, system-level process evaluations of integrated reentry systems are scarce. California's Alameda County juvenile reentry system implemented evidence-based strategies and practices to better serve reentry youth. We report findings from a process evaluation, using data from 15 key stakeholder interviews, focus groups with community-based providers, a reentry system-wide stakeholder survey, site visit observations, and document reviews. We identified strengths, challenges, and lessons learned. System-level strengths included increased multidisciplinary assessments, interagency collaboration, and specialty courts. Challenges included differing agency agendas, limited family and youth engagement, and data sharing. We recommend future researchers and practitioners to further examine and implement integrated system-level processes and organizational change, informed by the ecological-developmental perspective, to help promote positive outcomes for reentry youth.
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Affiliation(s)
| | - Alison K Cohen
- 1 DNA Global, LLC, Oakland, CA, USA
- 2 University of California, Berkeley, School of Public Health & Graduate School of Education, USA
| | | | - Yvette Leung
- 4 Y's Change, Oakland, CA, USA
- 5 Alameda County Health Care Services Agency, San Leandro, CA, USA
| | | | - Sara Bedford
- 3 Department of Human Services, Oakland, CA, USA
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Addressing Complex Societal Problems: Enabling Multiple Dimensions of Proximity to Sustain Partnerships for Collective Impact in Quebec. SUSTAINABILITY 2018. [DOI: 10.3390/su10040980] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
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Worton SK, Hasford J, Macnaughton E, Nelson G, MacLeod T, Tsemberis S, Stergiopoulos V, Goering P, Aubry T, Distasio J, Richter T. Understanding Systems Change in Early Implementation of Housing First in Canadian Communities: An Examination of Facilitators/Barriers, Training/Technical Assistance, and Points of Leverage. AMERICAN JOURNAL OF COMMUNITY PSYCHOLOGY 2018; 61:118-130. [PMID: 29251344 DOI: 10.1002/ajcp.12219] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/07/2023]
Abstract
We present interim findings of a cross-site case study of an initiative to expand Housing First (HF) in Canada through training and technical assistance (TTA). HF is an evidence-based practice designed to end chronic homelessness for consumers of mental health services. We draw upon concepts from implementation science and systems change theory to examine how early implementation occurs within a system. Case studies examining HF early implementation were conducted in six Canadian communities receiving HF TTA. The primary data are field notes gathered over 1.5 years and evaluations from site-specific training events (k = 5, n = 302) and regional network training events (k = 4, n = 276). We report findings related to: (a) the facilitators of and barriers to early implementation, (b) the influence of TTA on early implementation, and (c) the "levers" used to facilitate broader systems change. Systems change theory enabled us to understand how various "levers" created opportunities for change within the communities, including establishing system boundaries, understanding how systems components can function as causes of or solutions to a problem, and assessing and changing systems interactions. We conclude by arguing that systems theory adds value to existing implementation science frameworks and can be helpful in future research on the implementation of evidence-based practices such as HF which is a complex community intervention. Implications for community psychology are discussed.
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Affiliation(s)
| | | | | | | | | | | | - Vicky Stergiopoulos
- Centre for Addiction and Mental Health, University of Toronto, Toronto, ON, Canada
| | - Paula Goering
- Centre for Addiction and Mental Health, University of Toronto, Toronto, ON, Canada
| | - Tim Aubry
- University of Ottawa, Ottawa, ON, Canada
| | | | - Tim Richter
- Canadian Alliance to End Homelessness, Calgary, AB, Canada
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Willis CD, Riley BL, Stockton L, Abramowicz A, Zummach D, Wong G, Robinson KL, Best A. Scaling up complex interventions: insights from a realist synthesis. Health Res Policy Syst 2016; 14:88. [PMID: 27993138 PMCID: PMC5168709 DOI: 10.1186/s12961-016-0158-4] [Citation(s) in RCA: 36] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/19/2016] [Accepted: 11/22/2016] [Indexed: 11/28/2022] Open
Abstract
Preventing chronic diseases, such as cancer, cardiovascular disease and diabetes, requires complex interventions, involving multi-component and multi-level efforts that are tailored to the contexts in which they are delivered. Despite an increasing number of complex interventions in public health, many fail to be ‘scaled up’. This study aimed to increase understanding of how and under what conditions complex public health interventions may be scaled up to benefit more people and populations. A realist synthesis was conducted and discussed at an in-person workshop involving practitioners responsible for scaling up activities. Realist approaches view causality through the linkages between changes in contexts (C) that activate mechanisms (M), leading to specific outcomes (O) (CMO configurations). To focus this review, three cases of complex interventions that had been successfully scaled up were included: Vibrant Communities, Youth Build USA and Pathways to Education. A search strategy of published and grey literature related to each case was developed, involving searches of relevant databases and nominations from experts. Data extracted from included documents were classified according to CMO configurations within strategic themes. Findings were compared and contrasted with guidance from diffusion theory, and interpreted with knowledge users to identify practical implications and potential directions for future research. Four core mechanisms were identified, namely awareness, commitment, confidence and trust. These mechanisms were activated within two broad scaling up strategies, those of renewing and regenerating, and documenting success. Within each strategy, specific actions to change contexts included building partnerships, conducting evaluations, engaging political support and adapting funding models. These modified contexts triggered the identified mechanisms, leading to a range of scaling up outcomes, such as commitment of new communities, changes in relevant legislation, or agreements with new funding partners. This synthesis applies and advances theory, realist methods and the practice of scaling up complex interventions. Practitioners may benefit from a number of coordinated efforts, including conducting or commissioning evaluations at strategic moments, mobilising local and political support through relevant partnerships, and promoting ongoing knowledge exchange in peer learning networks. Action research studies guided by these findings, and studies on knowledge translation for realist syntheses are promising future directions.
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Affiliation(s)
- Cameron D Willis
- Propel Centre for Population Health Impact, Faculty of Applied Health Sciences, University of Waterloo, Waterloo, ON, Canada. .,Menzies Centre for Health Policy and the Australian Prevention Partnership Centre, University of Sydney, Sydney, NSW, Australia.
| | - Barbara L Riley
- Propel Centre for Population Health Impact, Faculty of Applied Health Sciences, University of Waterloo, Waterloo, ON, Canada
| | - Lisa Stockton
- Propel Centre for Population Health Impact, Faculty of Applied Health Sciences, University of Waterloo, Waterloo, ON, Canada
| | - Aneta Abramowicz
- Propel Centre for Population Health Impact, Faculty of Applied Health Sciences, University of Waterloo, Waterloo, ON, Canada
| | - Dana Zummach
- Propel Centre for Population Health Impact, Faculty of Applied Health Sciences, University of Waterloo, Waterloo, ON, Canada
| | - Geoff Wong
- Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, United Kingdom
| | - Kerry L Robinson
- Centre for Chronic Disease Prevention, Public Health Agency of Canada, Ottawa, ON, Canada
| | - Allan Best
- InSource Research Group, West Vancouver, BC, Canada
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Gates EF. Making sense of the emerging conversation in evaluation about systems thinking and complexity science. EVALUATION AND PROGRAM PLANNING 2016; 59:62-73. [PMID: 27591941 DOI: 10.1016/j.evalprogplan.2016.08.004] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/24/2015] [Revised: 08/02/2016] [Accepted: 08/13/2016] [Indexed: 06/06/2023]
Abstract
In the last twenty years, a conversation has emerged in the evaluation field about the potential of systems thinking and complexity science (STCS) to transform the practice of evaluating social interventions. Documenting and interpreting this conversation are necessary to advance our understanding of the significance of using STCS in planning, implementing, and evaluating social interventions. Guided by a generic framework for evaluation practice, this paper reports on an inter-disciplinary literature review and argues that STCS raises some new ways of thinking about and carrying out the following six activities: 1) supporting social problem solving; 2) framing interventions and contexts; 3) selecting and using methods; 4) engaging in valuing; 5) producing and justifying knowledge; and 6) facilitating use. Following a discussion of these issues, future directions for research and practice are suggested.
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Affiliation(s)
- Emily F Gates
- University of Illinois at Urbana-Champaign, College of Education, 1310 South Sixth Street, Champaign, IL 61820, USA.
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29
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Lawlor JA, Neal ZP. Networked Community Change: Understanding Community Systems Change through the Lens of Social Network Analysis. AMERICAN JOURNAL OF COMMUNITY PSYCHOLOGY 2016; 57:426-436. [PMID: 27221668 DOI: 10.1002/ajcp.12052] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/05/2023]
Abstract
Addressing complex problems in communities has become a key area of focus in recent years (Kania & Kramer, 2013, Stanford Social Innovation Review). Building on existing approaches to understanding and addressing problems, such as action research, several new approaches have emerged that shift the way communities solve problems (e.g., Burns, 2007, Systemic Action Research; Foth, 2006, Action Research, 4, 205; Kania & Kramer, 2011, Stanford Social Innovation Review, 1, 36). Seeking to bring clarity to the emerging literature on community change strategies, this article identifies the common features of the most widespread community change strategies and explores the conditions under which such strategies have the potential to be effective. We identify and describe five common features among the approaches to change. Then, using an agent-based model, we simulate network-building behavior among stakeholders participating in community change efforts using these approaches. We find that the emergent stakeholder networks are efficient when the processes are implemented under ideal conditions.
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30
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Van Dyke MK, Naoom SF. The Critical Role of State Agencies in the Age of Evidence-Based Approaches: The Challenge of New Expectations. JOURNAL OF EVIDENCE-INFORMED SOCIAL WORK 2015; 13:45-58. [PMID: 26072941 DOI: 10.1080/15433714.2014.942021] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/04/2023]
Abstract
Evidence-based approaches only benefit individuals when fully and effectively implemented. Since funding and monitoring alone will not ensure the full and effective implementation of effective strategies, state agencies have the opportunity to assess and modify current roles, functions, and policies to align with the requirements of evidence-based strategies. Based on a growing body of knowledge to guide effective implementation processes, state agencies, or designated partner organizations, can develop the capacity, mechanisms, and infrastructure to effectively implement evidence-based strategies. This article describes a framework that can guide this process. Informed by the literature and shaped by "real-world experience," the Active Implementation Frameworks provide a stage-matched approach to purposeful, active, and effective implementation.
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Affiliation(s)
- Melissa K Van Dyke
- a National Implementation Research Network, Frank Porter Graham Child Development Institute, The University of North Carolina at Chapel Hill , Carrboro , North Carolina , USA
| | - Sandra F Naoom
- a National Implementation Research Network, Frank Porter Graham Child Development Institute, The University of North Carolina at Chapel Hill , Carrboro , North Carolina , USA
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31
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Miller BD, Blau GM, Christopher OT, Jordan PE. Sustaining and expanding systems of care to provide mental health services for children, youth and families across America. AMERICAN JOURNAL OF COMMUNITY PSYCHOLOGY 2012; 49:566-579. [PMID: 22543719 DOI: 10.1007/s10464-012-9517-7] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/31/2023]
Abstract
The Substance Abuse and Mental Health Services Administration has been instrumental in supporting the development and implementation of systems of care to provide services to children and youth with serious mental health conditions and their families. Since 1993, 173 grants have been awarded to communities in all 50 states, Puerto Rico, Guam, the District of Columbia, and 21 American Indian/Alaska Native communities. The system of care principles of creating comprehensive, individualized services, family-driven and youth-guided care and cultural and linguistic competence, supported by a well-trained and competent workforce, have been successful in transforming the field of children's mental health and facilitating the integration of child-serving systems. This approach has achieved positive outcomes at the child and family, practice and system levels, and numerous articles have been published using data collected from system of care communities, demonstrating the effectiveness of this framework. This article will describe lessons learned from implementing the system of care approach, and will discuss the importance of expanding and sustaining systems of care across the country.
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Affiliation(s)
- Bethany D Miller
- Substance Abuse and Mental Health Services Administration, Rockville, MD 20857, USA.
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32
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Cook JR, Kilmer RP. Systems of care: new partnerships for community psychology. AMERICAN JOURNAL OF COMMUNITY PSYCHOLOGY 2012; 49:393-403. [PMID: 22538407 DOI: 10.1007/s10464-012-9516-8] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/31/2023]
Abstract
For almost two decades, the federal government has supported the development of integrated models of mental health service delivery for children and families, known as systems of care (SOCs), that strive to be child-centered, family-focused, community-based, and culturally competent. These efforts align well with the values and principles (e.g., empowerment, collaboration, strengths emphasis, focus on macro-level social/system change) central to community psychology (CP; Kloos et al. in Community psychology, Cengage Learning, Belmont, 2012). Despite the convergence of many core values, CPs have historically been underrepresented in key roles in SOC initiatives. However, this has changed in recent years, with increasing examples of community psychology skills and principles applied to the development, implementation, and evaluation of SOCs. Because successful and sustainable implementation of SOCs requires community and system-level change, and SOCs are increasingly being urged to adopt a stronger "public health" orientation (Miles et al. in A public health approach to children's mental health: a conceptual framework, Georgetown University Center for Child and Human Development, National Technical Assistance Center for Children's Mental Health, Washington, DC, 2010), there is great potential for CPs to play important roles in SOCs. This paper discusses opportunities and roles for CPs in SOCs in applied research and evaluation, community practice, and training.
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Affiliation(s)
- James R Cook
- Department of Psychology, The University of North Carolina at Charlotte, 28223-0001, USA.
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