Ripple Effect Mapping Outcomes of a Childhood Obesity Prevention Program From Youth and Adult Dyads Using a Qualitative Approach: iCook 4-H

Engaging diverse midlife and older adults in a multilevel participatory physical activity intervention: evaluating impacts using Ripple Effects Mapping

Multilevel interventions are increasingly recommended to increase physical activity (PA) but can present evaluation challenges. Participatory qualitative evaluation methods can complement standard quantitative methods by identifying participant-centered outcomes and potential mechanisms of individual and community-level change. We assessed the feasibility and utility of Ripple Effects Mapping (REM), a novel qualitative method, within the context of a multi-level cluster randomized trial, Steps for Change. Housing sites with ethnically diverse, low-income aging adults were randomized to a PA behavioral intervention alone or in combination with a citizen science-based intervention (Our Voice) for promoting PA-supportive neighborhoods. Four REM sessions were conducted after 12 months of intervention and involved six housing sites (n = 35 participants) stratified by intervention arm. Interviews (n = 5) were also conducted with housing site staff. Sessions leaders engaged participants in visually mapping intended and unintended outcomes of intervention participation and participant-driven solutions to reported challenges. Maps were analyzed using Excel and Xmind 8 Pro and data were classified according to the socio-ecological model. Eight themes were identified for outcomes, challenges, and solutions. Most themes (6/8) were similar across intervention arms, including increasing PA and PA tracking, improving health outcomes, and increasing social connectedness. Groups (n = 2) engaged in Our Voice additionally identified increased community knowledge and activities directly impacting local environmental change (e.g., pedestrian infrastructure changes). Housing staff interviews revealed additional information to enhance future intervention recruitment, sustainability, and implementation. Such qualitative methodologies can aid in evaluating multi-level, multi-component interventions and inform future intervention optimization, implementation, and dissemination.

Use of Ripple Effects Mapping to assess student-perceived benefits of undergraduate research and learning objective attainment with Irish nutrition students

Ripple Effects Mapping (REM) is a qualitative data analysis approach that combines mind mapping with inductive analysis to condense data obtained from group interviews. One benefit of REM is the ability to identify unintended outcomes, or "ripples," of the intervention of interest. Ripples are visually represented by a mind map created during the REM session. Mind maps connect related concepts, typically with the main concept in the center of the map and supporting ideas radiating from a central node. This project applied REM to undergraduate course evaluation. The purpose of this study was threefold: to use REM to identify undergraduate student-perceived benefits of research projects, to assess whether REM could be used to confirm achievement of course learning objectives, and to compare the themes identified from the mind mapping component of REM to those identified by inductive analysis. Mind maps were generated with Xmind (Xmind Ltd., Hong Kong) during online sessions by two groups of students, those who completed a "mandatory" research project (n = 11) and those who chose to participate in an additional "optional" research project (n = 9). There was considerable overlap in identified themes between mind mapping and inductive analysis, with skills, relationships, career direction, and unexpected benefits identified by both techniques. Mind mapping identified several additional themes. Findings from both approaches were compared to course learning objectives, and both confirmed that all objectives were met. In situations where time is a limiting factor, mind mapping could be superior to the complete REM approach for course learning objective assessments.NEW & NOTEWORTHY This study used Ripple Effects Mapping (REM) to identify undergraduate student-perceived benefits of research projects, to assess whether REM could confirm achievement of course learning objectives for a research project-based course, and to compare themes identified from the mind mapping component of REM to those identified by inductive analysis. Mind mapping confirmed achievement of course objectives and may be a better choice compared to inductive reasoning when time is limited.

Ripple effects mapping: capturing the wider impacts of systems change efforts in public health

BACKGROUND

Systems approaches are currently being advocated and implemented to address complex challenges in Public Health. These approaches work by bringing multi-sectoral stakeholders together to develop a collective understanding of the system, and then to identify places where they can leverage change across the system. Systems approaches are unpredictable, where cause-and-effect cannot always be disentangled, and unintended consequences - positive and negative - frequently arise. Evaluating such approaches is difficult and new methods are warranted.

METHODS

Ripple Effects Mapping (REM) is a qualitative method which can capture the wider impacts, and adaptive nature, of a systems approach. Using a case study example from the evaluation of a physical activity-orientated systems approach in Gloucestershire, we: a) introduce the adapted REM method; b) describe how REM was applied in the example; c) explain how REM outputs were analysed; d) provide examples of how REM outputs were used; and e) describe the strengths, limitations, and future uses of REM based on our reflections.

RESULTS

Ripple Effects Mapping is a participatory method that requires the active input of programme stakeholders in data gathering workshops. It produces visual outputs (i.e., maps) of the programme activities and impacts, which are mapped along a timeline to understand the temporal dimension of systems change efforts. The REM outputs from our example were created over several iterations, with data collected every 3-4 months, to build a picture of activities and impacts that have continued or ceased. Workshops took place both in person and online. An inductive content analysis was undertaken to describe and quantify the patterns within the REM outputs. Detailed guidance related to the preparation, delivery, and analysis of REM are included in this paper.

CONCLUSION

REM may help to advance our understanding and evaluation of complex systems approaches, especially within the field of Public Health. We therefore invite other researchers, practitioners and policymakers to use REM and continuously evolve the method to enhance its application and practical utility.

Evaluating the Benefits of a SNAP-Ed-Funded Community Garden Intervention Using Ripple Effect Mapping

In North Carolina, rural communities experience high rates of chronic illness due to health inequities exacerbated by the decline of major industries. Community gardens increase access to fresh produce and opportunities for physical activity and may offer additional benefits. These benefits can be difficult to measure as they are often unplanned or unintended. This article describes how we utilized Ripple Effect Mapping (REM), a participatory approach for evaluating complex interventions, to understand the impact of a SNAP-Ed-funded program. We purposively selected six community gardens to participate in 2-hour, facilitated REM sessions. On average, 15 people participated in each session. Participants developed a map of benefits using Appreciative Inquiry, mind mapping, and consensus-building methods. The map organized benefits across three levels: first ripple (individual), second ripple (interpersonal), and third ripple (community). In addition, participants coded benefits using the Community Capitals Framework. After the sessions, the research team extracted identified impacts into a matrix, aligned them with the SNAP-Ed Evaluation Framework, and developed digitized maps. These data corroborated findings from previous evaluations and offered insight into community-identified benefits not previously documented, including other types of capital generated by community gardens in rural communities. In addition, REM was an effective approach to measure and report several SNAP-Ed evaluation indicators, including LT11: Unexpected Benefits. Ultimately, the research team found REM to be an effective community-engaged method for understanding a complex intervention's benefits while centering participant community voices and transferring ownership of the data to community partners, a key principle in equitable evaluation.

Development of the iCook 4-H Curriculum for Youth and Adults: Cooking, Eating, and Playing Together for Childhood Obesity Prevention

The objective was to describe the development process of a curriculum (iCook 4-H) targeted to low-income, rural, and/or diverse youths and their adult primary meal preparer to promote cooking, eating, and playing together. Lessons learned highlighted the importance of grounding the curriculum in Social Cognitive Theory and applying the experiential 4-H learning model using a multiphased, community-based participatory approach with cyclical development and evaluation, and key modifications made for dissemination and distribution. Findings across 4 testing phases over 6 years and 5 states demonstrated the time-intensive, cyclical process that required flexibility with fidelity to form a hands-on, interactive curriculum.

eB4CAST: An Evidence-Based Tool to Promote Dissemination and Implementation in Community-Based, Public Health Research

eB4CAST, evidence-Based forecast C-capture, A-assemble, S-sustain, T-timelessness (eB4CAST), framework was developed from existing dissemination and implementation (D & I) constructs as a dissemination tool to promote community-based program usability and future application in targeted populations. eB4CAST captures and transforms research findings into a dissemination report that shows program need and impact to endorse program continuation and expansion. This is achieved through direct and indirect data collection of community factors and program impact that can showcase the need for program sustainability and potential for future dissemination sites. Testimonials, individual feedback, and program process and outcomes contribute to the direct data while data collected from census, county, and state databases and reports allow for indirect information to be captured and analyzed. Capturing data in the two levels allow eB4CAST to forecast program need and highlight program impact through a footprint. eB4CAST framework for dissemination tool creation is organized into four sections: Capture, Assemble, Sustainability, and Timelessness. Capture encompasses the collection of indirect and direct data related to intervention goals. Assemble is the compilation of the data into a visually appealing and easily understood media. Sustainability encourages the use of dissemination tools to provide forecast of program need and footprint of program impact back to community participants, program leaders, and key stakeholders to endorse program sustainability. Lastly, timelessness encourages cyclic movement through these constructs to continue program monitoring and data sharing to ensure timeless program evaluation and conformation to change in needs. The eB4CAST framework provides a systematic method to capture justification of program need and impact of community-based research that can be modified to fit diverse public health interventions providing a necessary D & I tool.