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Bouchouar E, Levine MJ, Ileka-Priouzeau S, Dave S, Fu A, Salemi JL. Exploring challenges and opportunities in detecting emerging drug trends: A socio-technical analysis of the Canadian context. CANADIAN JOURNAL OF PUBLIC HEALTH = REVUE CANADIENNE DE SANTE PUBLIQUE 2024; 115:186-198. [PMID: 38158520 PMCID: PMC11006646 DOI: 10.17269/s41997-023-00842-w] [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: 07/10/2022] [Accepted: 11/15/2023] [Indexed: 01/03/2024]
Abstract
OBJECTIVES This study aimed to apply a systems thinking approach to explore factors influencing the detection of emerging drug trends in Canada's provinces and territories to better understand how the local context can influence the design and performance of a pan-Canadian (i.e., national) substance use early warning system (EWS). This study also presents a set of actionable recommendations arising from the results. METHODOLOGY AND METHODS: Semi-structured interviews were conducted with 13 purposively recruited Medical Officers of Health and epidemiologists from across Canada working in the field of substance use. Thematic and social network analysis guided by the socio-technical systems framework were subsequently employed. RESULTS Barriers and facilitators for detecting emerging drug trends in provinces and territories are a product of the collective linkages and interactions between social (objectives, people, culture), technical (tools, practices, infrastructure), and external environmental (financial, regulatory frameworks, stakeholders) factors. Shortcomings in several of these areas shaped the system's behaviour and together contributed to fragmented operations that lacked strategic focus, poorly designed cross-sector partnerships, and unactionable information outputs. Participants' experiences shaped perceptions of a national substance use EWS, with some voicing potential opportunities and others expressing doubts about its effectiveness. CONCLUSION This study highlights interconnected social, technical, and external environmental considerations for the design and implementation of a national substance use EWS in Canada. It also demonstrates the value of using the socio-technical systems framework to understand a complex public health surveillance issue and how it can be used to inform a path forward.
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Affiliation(s)
- Etran Bouchouar
- College of Public Health, University of South Florida, Tampa, FL, USA.
| | - Marissa J Levine
- College of Public Health, University of South Florida, Tampa, FL, USA
| | | | - Sailly Dave
- Public Health Agency of Canada, Ottawa, ON, Canada
| | - Allan Fu
- Business Technology, Shopify Inc, Ottawa, ON, Canada
| | - Jason L Salemi
- College of Public Health, University of South Florida, Tampa, FL, USA
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2
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Avan BI, Dubale M, Taye G, Marchant T, Persson LÅ, Schellenberg J. Data-driven decision-making for district health management: a cluster-randomised study in 24 districts of Ethiopia. BMJ Glob Health 2024; 9:e014140. [PMID: 38423549 PMCID: PMC10910485 DOI: 10.1136/bmjgh-2023-014140] [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: 10/03/2023] [Accepted: 01/14/2024] [Indexed: 03/02/2024] Open
Abstract
BACKGROUND Use of local data for health system planning and decision-making in maternal, newborn and child health services is limited in low-income and middle-income countries, despite decentralisation and advances in data gathering. An improved culture of data-sharing and collaborative planning is needed. The Data-Informed Platform for Health is a system-strengthening strategy which promotes structured decision-making by district health officials using local data. Here, we describe implementation including process evaluation at district level in Ethiopia, and evaluation through a cluster-randomised trial. METHODS We supported district health teams in 4-month cycles of data-driven decision-making by: (a) defining problems using a health system framework; (b) reviewing data; (c) considering possible solutions; (d) value-based prioritising; and (e) a consultative process to develop, commit to and follow up on action plans. 12 districts were randomly selected from 24 in the North Shewa zone of Ethiopia between October 2020 and June 2022. The remaining districts formed the trial's comparison arm. Outcomes included health information system performance and governance of data-driven decision-making. Analysis was conducted using difference-in-differences. RESULTS 58 4-month cycles were implemented, four or five in each district. Each focused on a health service delivery challenge at district level. Administrators' practice of, and competence in, data-driven decision-making showed a net increase of 77% (95% CI: 40%, 114%) in the regularity of monthly reviews of service performance, and 48% (95% CI: 9%, 87%) in data-based feedback to health facilities. Statistically significant improvement was also found in administrators' use of information to appraise services. Qualitative findings also suggested that district health staff reported enhanced data use and collaborative decision-making. CONCLUSIONS This study generated robust evidence that 20 months' implementation of the Data-Informed Platform for Health strengthened health management through better data use and appraisal practices, systemised problem analysis to follow up on action points and improved stakeholder engagement. TRIAL REGISTRATION NUMBER NCT05310682.
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Affiliation(s)
- Bilal Iqbal Avan
- Population Health, London School of Hygiene & Tropical Medicine, London, UK
| | - Mehret Dubale
- London School of Hygiene & Tropical Medicine, London, UK
| | - Girum Taye
- Health System and Reproductive Health Research Directorate, Ethiopian Public Health Institute, Addis Ababa, Ethiopia
| | - Tanya Marchant
- Disease Control, London School of Hygiene & Tropical Medicine, London, UK
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3
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Alvarado M, Adams J, Penney T, Murphy MM, Abdool Karim S, Egan N, Rogers NT, Carters-White L, White M. A systematic scoping review evaluating sugar-sweetened beverage taxation from a systems perspective. NATURE FOOD 2023; 4:986-995. [PMID: 37857862 PMCID: PMC10661741 DOI: 10.1038/s43016-023-00856-0] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/25/2022] [Accepted: 09/08/2023] [Indexed: 10/21/2023]
Abstract
Systems thinking can reveal surprising, counterintuitive or unintended reactions to population health interventions (PHIs), yet this lens has rarely been applied to sugar-sweetened beverage (SSB) taxation. Using a systematic scoping review approach, we identified 329 papers concerning SSB taxation, of which 45 considered influences and impacts of SSB taxation jointly, involving methodological approaches that may prove promising for operationalizing a systems informed approach to PHI evaluation. Influences and impacts concerning SSB taxation may be cyclically linked, and studies that consider both enable us to identify implications beyond a predicted linear effect. Only three studies explicitly used systems thinking informed methods. Finally, we developed an illustrative, feedback-oriented conceptual framework, emphasizing the processes that could result in an SSB tax being increased, maintained, eroded or repealed over time. Such a framework could be used to synthesize evidence from non-systems informed evaluations, leading to novel research questions and further policy development.
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Affiliation(s)
- Miriam Alvarado
- MRC Epidemiology Unit, University of Cambridge School of Clinical Medicine, Institute of Metabolic Science, Cambridge Biomedical Campus, Cambridge, UK.
| | - Jean Adams
- MRC Epidemiology Unit, University of Cambridge School of Clinical Medicine, Institute of Metabolic Science, Cambridge Biomedical Campus, Cambridge, UK
| | - Tarra Penney
- Global Food System and Policy Research, School of Global Health, Faculty of Health, York University, Toronto, Ontario, Canada
| | - Madhuvanti M Murphy
- George Alleyne Chronic Disease Research Centre, Caribbean Institute for Health Research, The University of the West Indies, Bridgetown, Barbados
| | | | - Nat Egan
- MRC Epidemiology Unit, University of Cambridge School of Clinical Medicine, Institute of Metabolic Science, Cambridge Biomedical Campus, Cambridge, UK
| | - Nina Trivedy Rogers
- MRC Epidemiology Unit, University of Cambridge School of Clinical Medicine, Institute of Metabolic Science, Cambridge Biomedical Campus, Cambridge, UK
| | - Lauren Carters-White
- SPECTRUM Consortium, Usher Institute of Population Health Sciences and Informatics, Old Medical School, University of Edinburgh, Edinburgh, UK
| | - Martin White
- MRC Epidemiology Unit, University of Cambridge School of Clinical Medicine, Institute of Metabolic Science, Cambridge Biomedical Campus, Cambridge, UK
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4
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Thelen J, Sant Fruchtman C, Bilal M, Gabaake K, Iqbal S, Keakabetse T, Kwamie A, Mokalake E, Mupara LM, Seitio-Kgokgwe O, Zafar S, Cobos Muñoz D. Development of the Systems Thinking for Health Actions framework: a literature review and a case study. BMJ Glob Health 2023; 8:bmjgh-2022-010191. [PMID: 36931663 PMCID: PMC10030275 DOI: 10.1136/bmjgh-2022-010191] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/28/2022] [Accepted: 01/19/2023] [Indexed: 03/19/2023] Open
Abstract
BACKGROUND Systems thinking is an approach that views systems with a holistic lens, focusing on how components of systems are interconnected. Specifically, the application of systems thinking has proven to be beneficial when applied to health systems. Although there is plenty of theory surrounding systems thinking, there is a gap between the theoretical use of systems thinking and its actual application to tackle health challenges. This study aimed to create a framework to expose systems thinking characteristics in the design and implementation of actions to improve health. METHODS A systematised literature review was conducted and a Taxonomy of Systems Thinking Objectives was adapted to develop the new 'Systems Thinking for Health Actions' (STHA) framework. The applicability of the framework was tested using the COVID-19 response in Pakistan as a case study. RESULTS The framework identifies six key characteristics of systems thinking: (1) recognising and understanding interconnections and system structure, (2) identifying and understanding feedback, (3) identifying leverage points, (4) understanding dynamic behaviour, (5) using mental models to suggest possible solutions to a problem and (6) creating simulation models to test policies. The STHA framework proved beneficial in identifying systems thinking characteristics in the COVID-19 national health response in Pakistan. CONCLUSION The proposed framework can provide support for those aiming to applying systems thinking while developing and implementing health actions. We also envision this framework as a retrospective tool that can help assess if systems thinking was applied in health actions.
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Affiliation(s)
- Jenna Thelen
- Epidemiology and Public Health, Swiss Tropical and Public Health Institute, Allschwil, Switzerland
- University of Basel, Basel, Switzerland
| | - Carmen Sant Fruchtman
- Epidemiology and Public Health, Swiss Tropical and Public Health Institute, Allschwil, Switzerland
- University of Basel, Basel, Switzerland
| | - Muhammad Bilal
- Public Health, Child Advocacy International, Islamabad, Pakistan
| | - Kebabonye Gabaake
- Public Health, Institute of Development Management, Gaborone, Botswana
| | - Shahid Iqbal
- Public Health, Child Advocacy International, Islamabad, Pakistan
| | | | - Aku Kwamie
- Alliance for Health Policy and Systems Research, World Health Organization, Geneve, Switzerland
| | - Ellen Mokalake
- Public Health, Institute of Development Management, Gaborone, Botswana
| | | | - Onalenna Seitio-Kgokgwe
- Monitoring Evaluation and Quality Assurance, Ministry of Health Botswana, Gaborone, Botswana
| | - Shamsa Zafar
- Department of Obstetrics and Gynecology, Fazaia Medical College, Islamabad, Pakistan
| | - Daniel Cobos Muñoz
- Epidemiology and Public Health, Swiss Tropical and Public Health Institute, Allschwil, Switzerland
- University of Basel, Basel, Switzerland
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5
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Chang HE, Manojlovich M. Clinical nurses' patient safety competency, systems thinking and missed nursing care: A cross-sectional survey. Int J Nurs Pract 2023; 29:e13130. [PMID: 36597211 DOI: 10.1111/ijn.13130] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/30/2021] [Revised: 12/12/2022] [Accepted: 12/23/2022] [Indexed: 01/05/2023]
Abstract
AIM The aim of this study was to examine the relationships among patient safety competency, systems thinking and missed nursing care. BACKGROUND Patient safety competency and systems thinking are important nurse attributes that promote patient safety. Missed nursing care is known to negatively impact patient safety. However, how nurses' patient safety competency and systems thinking relate to missed nursing care is unknown. METHODS A cross-sectional survey design was used to collect data from nurses practicing in two general hospitals in South Korea. Data were collected between 3 March and 17 April 2020. Questionnaires were distributed to nurses providing direct care in general and specialty units. Patient safety competency, systems thinking and missed nursing care were measured using reliable and valid instruments. A total of 432 complete sets of data were used in final analysis. RESULTS Higher patient safety competency of nurses was associated with lower missed nursing care. Systems thinking partially mediated the relationship between knowledge of patient safety competency and missed nursing care, and attitudes of patient safety competency and missed nursing care. CONCLUSIONS The knowledge, skills and attitudes sub-scales of patient safety competency showed somewhat different effects in the relationship between missed nursing care and systems thinking, suggesting that each attribute may tap into a separate aspect of patient safety.
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Affiliation(s)
- Hyoung Eun Chang
- Research Institute of Nursing Science, College of Nursing, Jeonbuk National University, Jeonju-si, Republic of Korea
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Felmingham T, Backholer K, Hoban E, Brown AD, Nagorcka-Smith P, Allender S. Success of community-based system dynamics in prevention interventions: A systematic review of the literature. Front Public Health 2023; 11:1103834. [PMID: 37033017 PMCID: PMC10080052 DOI: 10.3389/fpubh.2023.1103834] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/21/2022] [Accepted: 03/07/2023] [Indexed: 04/11/2023] Open
Abstract
Systems thinking approaches are increasingly being used to help communities understand and develop responses to preventing complex health problems. Less is known about how success is characterized and what influences success in these approaches. We present a systematic review of how concepts of success are understood and evaluated in the peer reviewed literature of studies using systems thinking in community prevention. We searched five databases for peer-reviewed literature published between 2000 and 2022, with search terms related to systems thinking, prevention and community. Studies were included if they; reported using community-based systems thinking to prevent a public health problem; described the engagement and empowerment of community members to address a public health issue; and, were published in English. Thirty-four articles were identified from 10 countries. Twenty-one aimed to prevent a chronic disease (e.g., obesity) and 16 measured success using specific tools, 10 of which used semi-structured interviews or surveys. Measures of success included implementation processes, cultural appropriateness, the number or type of actions implemented, effectiveness of community action, and changes in individual thinking or mental models, population health outcomes, data collected, or systems level measures. Implementation factors influencing success included the capacity to engage participants, composition and experience of facilitators, strength of coordination teams, allocation of resources, adaptation to participant feedback, use of multiple systems approaches, workshop process providing time and methods to allow new insights, flexible delivery, and diversity of perspectives. Findings from each of the articles indicated that approaches increased a range of outcomes including community action, strategic thinking, future planning and evaluation, community buy-in, community voice, contribution and leadership, in addition to developing shared visions and goals and creating new, ongoing collaborations, among many others. Measures of success varied, suggesting more empirical reporting of proposed outcomes of system science in communities would be valuable. While the measurement of success in the use of systems thinking in community-based prevention efforts is limited, there are helpful examples we can look to for future measurement of success.
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Affiliation(s)
- Tiana Felmingham
- Global Centre for Preventive Health and Nutrition, Institute for Health Transformation, Deakin University, Geelong, VIC, Australia
- School of Health and Social Development, Faculty of Health, Deakin University, Geelong, VIC, Australia
- *Correspondence: Tiana Felmingham,
| | - Kathryn Backholer
- Global Centre for Preventive Health and Nutrition, Institute for Health Transformation, Deakin University, Geelong, VIC, Australia
- School of Health and Social Development, Faculty of Health, Deakin University, Geelong, VIC, Australia
| | - Elizabeth Hoban
- School of Health and Social Development, Faculty of Health, Deakin University, Geelong, VIC, Australia
| | - Andrew D. Brown
- Global Centre for Preventive Health and Nutrition, Institute for Health Transformation, Deakin University, Geelong, VIC, Australia
- School of Health and Social Development, Faculty of Health, Deakin University, Geelong, VIC, Australia
| | - Phoebe Nagorcka-Smith
- Global Centre for Preventive Health and Nutrition, Institute for Health Transformation, Deakin University, Geelong, VIC, Australia
- School of Health and Social Development, Faculty of Health, Deakin University, Geelong, VIC, Australia
| | - Steven Allender
- Global Centre for Preventive Health and Nutrition, Institute for Health Transformation, Deakin University, Geelong, VIC, Australia
- School of Health and Social Development, Faculty of Health, Deakin University, Geelong, VIC, Australia
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7
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Hong QN, Bangpan M, Stansfield C, Kneale D, O'Mara-Eves A, van Grootel L, Thomas J. Using systems perspectives in evidence synthesis: A methodological mapping review. Res Synth Methods 2022; 13:667-680. [PMID: 35932206 DOI: 10.1002/jrsm.1595] [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: 06/28/2021] [Revised: 07/15/2022] [Accepted: 08/01/2022] [Indexed: 01/07/2023]
Abstract
Reviewing complex interventions is challenging because they include many elements that can interact dynamically in a nonlinear manner. A systems perspective offers a way of thinking to help understand complex issues, but its application in evidence synthesis is not established. The aim of this project was to understand how and why systems perspectives have been applied in evidence synthesis. A methodological mapping review was conducted to identify papers using a systems perspective in evidence synthesis. A search was conducted in seven bibliographic databases and three search engines. A total of 101 papers (representing 98 reviews) met the eligibility criteria. Two categories of reviews were identified: (1) reviews using a "systems lens" to frame the topic, generate hypotheses, select studies, and guide the analysis and interpretation of findings (n = 76) and (2) reviews using systems methods to develop a systems model (n = 22). Several methods (e.g., systems dynamic modeling, soft systems approach) were identified, and they were used to identify, rank and select elements, analyze interactions, develop models, and forecast needs. The main reasons for using a systems perspective were to address complexity, view the problem as a whole, and understand the interrelationships between the elements. Several challenges for capturing the true nature and complexity of a problem were raised when performing these methods. This review is a useful starting point when designing evidence synthesis of complex interventions. It identifies different opportunities for applying a systems perspective in evidence synthesis, and highlights both commonplace and less familiar methods.
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Affiliation(s)
- Quan Nha Hong
- EPPI-Centre, UCL Social Research Institute, University College London, London, UK
| | - Mukdarut Bangpan
- EPPI-Centre, UCL Social Research Institute, University College London, London, UK
| | - Claire Stansfield
- EPPI-Centre, UCL Social Research Institute, University College London, London, UK
| | - Dylan Kneale
- EPPI-Centre, UCL Social Research Institute, University College London, London, UK
| | - Alison O'Mara-Eves
- EPPI-Centre, UCL Social Research Institute, University College London, London, UK
| | | | - James Thomas
- EPPI-Centre, UCL Social Research Institute, University College London, London, UK
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Tobin R, Crawford G, Hallett J, Maycock B, Lobo R. Utilizing Causal Loop Diagramming to Explore a Research and Evaluation Capacity Building Partnership. Front Public Health 2022; 10:857918. [PMID: 35712267 PMCID: PMC9194391 DOI: 10.3389/fpubh.2022.857918] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/19/2022] [Accepted: 04/12/2022] [Indexed: 11/13/2022] Open
Abstract
The capacity to engage in research, evaluation and evidence-informed decision-making supports effective public health policy and practice. Little is known about partnership-based approaches that aim to build capacity across a system or how to evaluate them. This study examines the impacts of a research and evaluation capacity building partnership called the Western Australian Sexual Health and Blood-borne Virus Applied Research and Evaluation Network (hereafter, SiREN). SiREN aims to strengthen capacity across a system of clinical and medical services and government and non-government organizations. These organizations are connected through their shared aim of preventing and managing sexually transmissible infections and blood-borne viruses. To examine SiREN, systems concepts and methods were used. Data were collected from SiREN organizational documents (n = 42), a survey tool (n = 104), in-depth interviews (n = 17), a workshop and three meetings with SiREN stakeholders and used to develop two causal loop diagrams. Findings show engagement with SiREN was influenced by a complex interplay of contextual (e.g., organizational capacity) and process (e.g., presence of trusting relationships) factors. SiREN contributed to system level changes, including increased resources for research and evaluation, the development of networks and partnerships that led to more efficient responses to emerging health issues, evidence sharing, and sustainable research and evaluation practice. The use of causal loop diagrams enabled the identification of key leverage points that SiREN can use for continuous improvement or evaluation. The focus on how contextual factors influenced SiREN's ability to create change provides valuable information for researchers, policymakers or practitioners seeking to develop a similar partnership.
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Affiliation(s)
- Rochelle Tobin
- Collaboration for Evidence, Research and Impact in Public Health, School of Population Health, Curtin University, Perth, WA, Australia
| | - Gemma Crawford
- Collaboration for Evidence, Research and Impact in Public Health, School of Population Health, Curtin University, Perth, WA, Australia
| | - Jonathan Hallett
- Collaboration for Evidence, Research and Impact in Public Health, School of Population Health, Curtin University, Perth, WA, Australia
| | - Bruce Maycock
- European Centre for Environment and Human Health, College of Medicine and Health, University of Exeter, Exeter, United Kingdom
| | - Roanna Lobo
- Collaboration for Evidence, Research and Impact in Public Health, School of Population Health, Curtin University, Perth, WA, Australia
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9
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Linnéusson G, Andersson T, Kjellsdotter A, Holmén M. Using systems thinking to increase understanding of the innovation system of healthcare organisations. J Health Organ Manag 2022; 36:179-195. [PMID: 35788441 PMCID: PMC9897203 DOI: 10.1108/jhom-01-2022-0004] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
PURPOSE This paper applies systems thinking modelling to enhance the dynamic understanding of how to nurture an innovative culture in healthcare organisations to develop the innovation system in practice and speed up the innovative work. The model aims to provide a holistic view of a studied healthcare organisation's innovation processes, ranging from managerial values to its manifestation in improved results. DESIGN/METHODOLOGY/APPROACH The study is based on empirical material from a healthcare unit that, within a few years, changed from having no innovations to repeatedly generating innovations. The study uses the modelling language of causal loop diagrams (CLDs) in the system dynamics methodology to identify the key important aspects found in the empirical material. FINDINGS The proposed model, based on the stories of the interviewees, explores the dynamics of inertia when nurturing an innovative culture, identifying delays attributed to the internal change processes and system relationships. These findings underscored the need for perseverance when developing an innovative culture in the entrepreneurial phases. PRACTICAL IMPLICATIONS The approach of using systems thinking to make empirical healthcare research results more tangible through the visual notations of CLDs and mental simulations is believed to support exploring complex phenomena to induce and nurture both individual and organisational learning. ORIGINALITY/VALUE The results from this approach provide deepened analysis and provoke the systems view to explain how the nurturing of the culture can accelerate the innovation processes, which helps practitioners and researchers to further expand their understanding of their healthcare contexts.
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Affiliation(s)
- Gary Linnéusson
- School of Engineering,
Jönköping University
, Jönköping,
Sweden
| | | | - Anna Kjellsdotter
- Research and Development Centre
,
Skaraborg Hospital Skövde
, Skövde,
Sweden
| | - Maria Holmén
- Innovation Platform
,
Region Västra Götaland
, Gothenburg,
Sweden
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10
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Karim A, de Savigny D, Ngaima JS, Mäusezahl D, Cobos Muñoz D, Tshefu A. Assessing Determinants of Programmatic Performance of Community Management of Malaria, Pneumonia, and Diarrhea in Children in Africa: Protocol and Data Collection for a Mixed Methods Evaluation of Integrated Community Case Management. JMIR Res Protoc 2022; 11:e33076. [PMID: 35285813 PMCID: PMC8961344 DOI: 10.2196/33076] [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: 08/25/2021] [Revised: 11/11/2021] [Accepted: 11/16/2021] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND Integrated community case management (iCCM) is a child health program designed to provide integrated community-based care for children with pneumonia, malaria, or diarrhea in hard-to-reach areas of low- and middle-income countries. The foundation of the intervention is service delivery by community health workers (CHWs) who depend on reliable provision of drugs and supplies, consistent supervision, comprehensive training, and community acceptance and participation to perform optimally. The effectiveness of the program may also depend on a number of other elements, including an enabling policy environment, financing mechanisms from the national to the local level, data transmission systems, and appropriate monitoring and evaluation. The extent to which these factors act upon each other to influence the effectiveness and viability of iCCM is both variable and challenging to assess, especially across different implementation contexts. OBJECTIVE In this paper, we describe a mixed methods systems-based study protocol to assess the programmatic components of iCCM that are associated with intervention effectiveness and report preliminary results of data collection. METHODS This protocol uses a mixed qualitative and quantitative study design based on a systems thinking approach within four iCCM programs in Malawi, Democratic Republic of the Congo, and Niger State and Abia State in Nigeria. Routine monitoring data are collected to determine intervention effectiveness, namely testing, treatment, and referral outcomes. Surveys with CHWs, supervisors, and caregivers are performed to collect quantitative data on their demographics, activities, and experiences within the program and how these relate to the areas of intervention effectiveness. Focus group discussions are conducted with these stakeholders as well as local traditional leaders to contextualize these data. Key informant interviews are undertaken with national- and district-level program stakeholders and officers knowledgeable in critical program processes. RESULTS We performed 3836 surveys and 45 focus group discussions of 379 participants with CHWs, supervisors, caregivers, and traditional leaders, as well as 120 key informant interviews with district- and national-level program managers, health officers, and ministry officials. Policy and program documents were additionally collected for review. CONCLUSIONS We expect that evidence from this study will inform child health programs and practice in low- and middle-income settings as well as future policy development within the iCCM intervention. INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID) DERR1-10.2196/33076.
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Affiliation(s)
- Aliya Karim
- University of Basel, Basel, Switzerland.,Swiss Tropical and Public Health Institute, University of Basel, Basel, Switzerland
| | - Don de Savigny
- University of Basel, Basel, Switzerland.,Swiss Tropical and Public Health Institute, University of Basel, Basel, Switzerland
| | - Jean Serge Ngaima
- Université de Kinshasa, Kinshasa, the Democratic Republic of the Congo
| | - Daniel Mäusezahl
- University of Basel, Basel, Switzerland.,Swiss Tropical and Public Health Institute, University of Basel, Basel, Switzerland
| | - Daniel Cobos Muñoz
- University of Basel, Basel, Switzerland.,Swiss Tropical and Public Health Institute, University of Basel, Basel, Switzerland
| | - Antoinette Tshefu
- Université de Kinshasa, Kinshasa, the Democratic Republic of the Congo
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11
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Critical factors that affect the functioning of a research and evaluation capacity building partnership: A causal loop diagram. PLoS One 2022; 17:e0262125. [PMID: 35025924 PMCID: PMC8757999 DOI: 10.1371/journal.pone.0262125] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/29/2021] [Accepted: 12/18/2021] [Indexed: 01/13/2023] Open
Abstract
Introduction Public health policy and practice is strengthened by the application of quality evidence to decision making. However, there is limited understanding of how initiatives that support the generation and use of evidence in public health are operationalised. This study examines factors that support the internal functioning of a partnership, the Western Australian Sexual Health and Blood-borne Virus Applied Research and Evaluation Network (SiREN). SiREN aims to build research and evaluation capacity and increase evidence-informed decision making in a public health context. Methods This study was informed by systems concepts. It developed a causal loop diagram, a type of qualitative system model that illustrated the factors that influence the internal operation of SiREN. The causal loop diagram was developed through an iterative and participatory process with SiREN staff and management (n = 9) via in-depth semi-structured interviews (n = 4), workshops (n = 2), and meetings (n = 6). Results Findings identified critical factors that affected the functioning of SiREN. Central to SiREN’s ability to meet its aims was its capacity to adapt within a dynamic system. Adaptation was facilitated by the flow of knowledge between SiREN and system stakeholders and the expertise of the team. SiREN demonstrated credibility and capability, supporting development of new, and strengthening existing, partnerships. This improved SiREN’s ability to be awarded new funding and enhanced its sustainability and growth. SiREN actively balanced divergent stakeholder interests to increase sustainability. Conclusion The collaborative development of the diagram facilitated a shared understanding of SiREN. Adaptability was central to SiREN achieving its aims. Monitoring the ability of public health programs to adapt to the needs of the systems in which they work is important to evaluate effectiveness. The detailed analysis of the structure of SiREN and how this affects its operation provide practical insights for those interested in establishing a similar project.
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Heine M, Badenhorst M, van Zyl C, de Melo Ghisi GL, Babu AS, Buckley J, Serón P, Turk-Adawi K, Derman W. Developing a Complex Understanding of Physical Activity in Cardiometabolic Disease from Low-to-Middle-Income Countries-A Qualitative Systematic Review with Meta-Synthesis. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 18:11977. [PMID: 34831732 PMCID: PMC8619369 DOI: 10.3390/ijerph182211977] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 09/01/2021] [Revised: 11/05/2021] [Accepted: 11/06/2021] [Indexed: 11/17/2022]
Abstract
Physical activity behaviour is complex, particularly in low-resource settings, while existing behavioural models of physical activity behaviour are often linear and deterministic. The objective of this review was to (i) synthesise the wide scope of factors that affect physical activity and thereby (ii) underpin the complexity of physical activity in low-resource settings through a qualitative meta-synthesis of studies conducted among patients with cardiometabolic disease living in low-to-middle income countries (LMIC). A total of 41 studies were included from 1200 unique citations (up to 15 March 2021). Using a hybrid form of content analysis, unique factors (n = 208) that inform physical activity were identified, and, through qualitative meta-synthesis, these codes were aggregated into categories (n = 61) and synthesised findings (n = 26). An additional five findings were added through deliberation within the review team. Collectively, the 31 synthesised findings highlight the complexity of physical activity behaviour, and the connectedness between person, social context, healthcare system, and built and natural environment. Existing behavioural and ecological models are inadequate in fully understanding physical activity participation in patients with cardiometabolic disease living in LMIC. Future research, building on complexity science and systems thinking, is needed to identify key mechanisms of action applicable to the local context.
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Affiliation(s)
- Martin Heine
- Institute of Sport and Exercise Medicine, Division of Orthopaedics, Department of Surgical Sciences, Faculty of Health and Medicine, Stellenbosch University, Cape Town 8000, South Africa; (C.v.Z.); (W.D.)
| | - Marelise Badenhorst
- Sports Performance Research Institute New Zealand (SPRINZ), School of Sport and Recreation, Auckland University of Technology, Auckland 1010, New Zealand;
| | - Chanel van Zyl
- Institute of Sport and Exercise Medicine, Division of Orthopaedics, Department of Surgical Sciences, Faculty of Health and Medicine, Stellenbosch University, Cape Town 8000, South Africa; (C.v.Z.); (W.D.)
| | - Gabriela Lima de Melo Ghisi
- Cardiovascular Prevention and Rehabilitation Program, KITE-Toronto Rehabilitation Institute, University Health Network, 347 Rumsey Road, Toronto, ON M4G 2R6, Canada;
| | - Abraham Samuel Babu
- Department of Physiotherapy, Manipal College of Health Professions, Manipal Academy of Higher Education, Manipal 576104, Karnataka, India;
| | - John Buckley
- The School of Allied Health Professions, Keele University, Staffordshire ST5 5AZ, UK;
| | - Pamela Serón
- Department of Internal Medicine and Center of Excellence CIGES, Facultad de Medicina, Universidad de La Frontera, Temuco 4781176, Chile;
| | - Karam Turk-Adawi
- Department of Public Health, College of Health Sciences, QU-Health, Qatar University, Doha P.O. Box 2713, Qatar;
| | - Wayne Derman
- Institute of Sport and Exercise Medicine, Division of Orthopaedics, Department of Surgical Sciences, Faculty of Health and Medicine, Stellenbosch University, Cape Town 8000, South Africa; (C.v.Z.); (W.D.)
- IOC Research Centre, Cape Town 8000, South Africa
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13
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Gravitt PE, Silver MI, Hussey HM, Arrossi S, Huchko M, Jeronimo J, Kapambwe S, Kumar S, Meza G, Nervi L, Paz-Soldan VA, Woo YL. Achieving equity in cervical cancer screening in low- and middle-income countries (LMICs): Strengthening health systems using a systems thinking approach. Prev Med 2021; 144:106322. [PMID: 33678230 DOI: 10.1016/j.ypmed.2020.106322] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/11/2020] [Revised: 11/04/2020] [Accepted: 11/05/2020] [Indexed: 01/01/2023]
Abstract
The World Health Organization (WHO) is leading a call to action to eliminate cervical cancer by the end of the century through global implementation of two effective evidence-based preventive interventions: HPV vaccination and cervical screening and management (CSM). Models estimate that without intervention, over the next 50 years 12.2 million new cases of cervical cancer will occur, nearly 60% of which are preventable only through CSM. Given that more than 80% of the cervical cancer occurs in low- and middle-income countries (LMICs), scaling up sustainable CSM programs in these countries is a top priority for achieving the global elimination goals. Multiple technologies have been developed and validated to meet this need. Now it is critical to identify strategies to implement these technologies into complex, adaptive health care delivery systems. As part of the coordinated cervical cancer elimination effort, we applied a systems thinking lens to reflect on our experiences with implementation of HPV-based CSM programs using the WHO health systems framework. While many common health system barriers were identified, the effectiveness of implementation strategies to address them was context dependent; often reflecting differences in stakeholder's belief in the quality of the evidence supporting a CSM algorithm, the appropriateness of the evidence and algorithm to context, and the 'implementability' of the algorithm under realistic assessments of resource availability and constraints. A structured planning process, with early and broad stakeholder engagement, will ensure that shared-decisions in CSM implementation are appropriately aligned with the culture, values, and resource realities of the setting.
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Affiliation(s)
- Patti E Gravitt
- Department of Epidemiology and Public Health, University of Maryland School of Medicine, Baltimore, MD, USA.
| | | | - Heather M Hussey
- Department of Epidemiology and Public Health, University of Maryland School of Medicine, Baltimore, MD, USA
| | | | - Megan Huchko
- Duke Global Health Institute, Duke University, Durham, NC, USA
| | | | | | | | - Graciela Meza
- Universidad Nacional de la Amazonia Peruana, Iquitos, Peru
| | - Laura Nervi
- College of Population Health, University of New Mexico, Albuquerque, NM, USA
| | - Valerie A Paz-Soldan
- Department of Global Community Health and Behavioral Sciences, Tulane University School of Public Health and Tropical Medicine, New Orleans, LA, USA
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14
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Perceptions of co-designing health promotion interventions with Indigenous communities in New Zealand. Health Promot Int 2020; 36:964-975. [DOI: 10.1093/heapro/daaa128] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022] Open
Abstract
Summary
Health inequities among Indigenous and non-Indigenous communities are well documented and the research literature includes robust discussions about innovative ways to reduce inequities including co-design. Co-designing health promotion interventions with Indigenous communities presents many benefits and challenges for researchers, health professionals and communities involved in the process. The purpose of this study was to identify the facilitators and barriers of co-designing a health promotion intervention with Māori communities. Additionally, this study considers a specific Māori co-design framework, He Pikinga Waiora (HPW). HPW is a participatory approach to creating interventions emphasizing community engagement, systems thinking and centred on Kaupapa Māori (an approach grounded in Māori worldviews). The research design for this study was Kaupapa Māori. Participants (n = 19) in this study were stakeholders in the New Zealand health sector. Participants were interviewed using an in-depth, semi-structured protocol. Thematic analysis was employed to analyse the data. Facilitators for co-designing health promotion interventions with Māori communities were collaboration and community voice. Barriers identified were mismanaged expectations and research constraints. Finally, facilitators for the HPW framework included providing clear guidelines and being grounded in Māori perspectives, while barriers included limited concrete case studies, jargon and questions about sustainability. Collaboration and inclusion of community voice supports the development of more effective co-design health promotion interventions within Māori communities which may address health inequities. The HPW framework offers clear guidelines and Māori perspectives which may assist in the development of effective co-design health promotion interventions, although areas for improvement were suggested.
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15
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Shrier LA, Burke PJ, Jonestrask C, Katz-Wise SL. Applying systems thinking and human-centered design to development of intervention implementation strategies: An example from adolescent health research. J Public Health Res 2020; 9:1746. [PMID: 33117757 PMCID: PMC7582103 DOI: 10.4081/jphr.2020.1746] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/07/2020] [Accepted: 08/26/2020] [Indexed: 12/02/2022] Open
Abstract
Introducing innovative health interventions into clinic settings requires a comprehensive and creative approach to multiple implementation challenges. To optimize implementation of a sexual and reproductive health intervention for young women with depression, we applied systems thinking and human-centered design thinking methods to develop tools and strategies to address issues influencing intervention implementation in diverse clinics. We recruited staff from three clinics that provide sexual and reproductive health and behavioral health care to young women. Across five sessions (four video conference calls, one in-person workshop), we used systems mapping to identify key stakeholders and their relationships, processes, and challenges to care; formed clinic staff-investigator design teams; brainstormed about challenges that would influence intervention implementation and considered potential solutions; prioritized implementation challenges; and designed prototypes of solutions. Participants responded positively to the systems thinking perspective and collaborative design thinking process. Findings included generalizable considerations about solving implementation challenges for clinic-based interventions, such as forming a team of champions representing the diverse disciplines involved in and impacted by intervention implementation, and creating multiple tools and strategies for implementation that can be tailored to a given clinic’s culture. Significance for public health Implementing innovative health interventions in clinic systems requires consideration of multiple human, environmental, and process factors. To develop implementation tools and strategies for a sexual and reproductive health intervention for young women with depression, we applied systems thinking to consider clinic system elements and their connections, and human-centered design to tackle challenges with intervention implementation by centering on the clinic staff who would be experiencing these challenges. Using this approach, the investigators and clinic staff efficiently and effectively identified implementation challenges in diverse clinic settings and designed tools and strategies to overcome these challenges. This form of investigator-clinic staff collaboration, attention to system factors, and focus on creative solutions can inform research and care around implementing novel interventions in established clinical systems.
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Affiliation(s)
- Lydia A Shrier
- Division of Adolescent/Young Adult Medicine, Boston Children's Hospital Boston, MA.,Department of Pediatrics, Harvard Medical School in Boston, Boston, MA
| | - Pamela J Burke
- Division of Adolescent/Young Adult Medicine, Boston Children's Hospital Boston, MA.,Department of Pediatrics, Harvard Medical School in Boston, Boston, MA.,Department of Nursing, Northeastern University, Boston, MA
| | | | - Sabra L Katz-Wise
- Division of Adolescent/Young Adult Medicine, Boston Children's Hospital Boston, MA.,Department of Pediatrics, Harvard Medical School in Boston, Boston, MA.,Social and Behavioral Sciences, Harvard T. H. Chan School of Public Health, Boston, MA, USA
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16
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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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17
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Conte KP, Ryder TJ, Hopkins L, Gomez M, Riley T. Committed, ambivalent, concealed, or distanced: community organisations’ perceptions of their role in local prevention systems. CRITICAL PUBLIC HEALTH 2020. [DOI: 10.1080/09581596.2020.1795083] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Affiliation(s)
- Kathleen P. Conte
- The Australian Prevention Partnership Centre, Ultimo, Australia
- School of Public Health, DePaul University, Chicago, Illinois, USA; Menzies Centre for Health Policy and University Centre for Rural Health, School of Public Health, Faculty of Medicine and Health, University of Sydney, Camperdown, Australia
| | - Tayhla J. Ryder
- The Australian Prevention Partnership Centre, Ultimo, Australia
- Australian Institute of Health Innovation, Macquarie University, Sydney, Australia
| | - Liza Hopkins
- The Australian Prevention Partnership Centre, Ultimo, Australia
- Alfred Health, Melbourne, Australia
| | - Maria Gomez
- The Australian Prevention Partnership Centre, Ultimo, Australia
| | - Therese Riley
- The Australian Prevention Partnership Centre, Ultimo, Australia
- Therese Riley Consulting, Melbourne, Australia
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18
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Conte KP, Davidson S. Using a 'rich picture' to facilitate systems thinking in research coproduction. Health Res Policy Syst 2020; 18:14. [PMID: 32005252 PMCID: PMC6995183 DOI: 10.1186/s12961-019-0514-2] [Citation(s) in RCA: 21] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/01/2019] [Accepted: 12/03/2019] [Indexed: 12/03/2022] Open
Abstract
Background In coproduction research, traditional ‘end-users’ are involved in the entire research process. The aim is to facilitate research translation by improving the timeliness and relevance of research. Because end-users often come from multiple sectors and hold diverse perspectives and priorities, involving them in coproduction can be challenging. Tools and approaches are needed to support coproduction teams to successfully navigate divergent viewpoints while producing rigorous but meaningful research outcomes. Rich pictures are a systems thinking tool to help make sense of complexity. In this paper, we describe how we developed and applied a ‘rich picture’ in a coproduction project with policy-level partners. Methods Guided by systems thinking principles, we conducted a systemic analysis of ethnographic fieldnotes collected as part of a broader study that examined the dynamics between an IT system and the implementation of the state-wide childhood obesity prevention programmes it was designed to monitor. Translating qualitative themes into metaphor and imagery, we created a visual depiction of the system to reflect the experience of the system’s users (health promotion practitioners) and facilitated a workshop with policy-level programme administrators (i.e. participants, n = 7). Our aim was to increase the transparency of the system for our research partners and to spark new insights to improve the quality of programme implementation. Results Guided by provocative questions, participants discussed and challenged each other’s thinking on the current functioning of the system. They identified future lines of inquiry to explore for quality improvement. Participants strongly agreed that the picture was a constructive way to engage with the ethnographic data but were challenged by the information and its implications. The opportunity for participants to co-learn from each other as well as from the picture was an added value. Conclusion In the context of the facilitated workshop, the rich picture enabled research partners to engage with complex research findings and gain new insights. Its value was harnessed via the guided participatory process. This demonstrates the importance that, in the future, such tools should be accompanied by practices that enable participants to think with and apply systems thinking concepts and principles.
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Affiliation(s)
- Kathleen P Conte
- The Australian Prevention Partnership Centre, Sydney, Australia. .,Menzies Centre for Health Policy and University Centre for Rural Health, School of Public Health, Faculty of Medicine, University of Sydney, Sydney, Australia.
| | - Seanna Davidson
- The Australian Prevention Partnership Centre, Sydney, Australia.,The Systems School, Melbourne, Australia
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19
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Whole of Systems Approaches to Physical Activity Policy and Practice in Australia: The ASAPa Project Overview and Initial Systems Map. J Phys Act Health 2020; 17:68-73. [PMID: 31756721 DOI: 10.1123/jpah.2019-0121] [Citation(s) in RCA: 22] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/05/2019] [Revised: 07/22/2019] [Accepted: 09/10/2019] [Indexed: 11/18/2022]
Abstract
BACKGROUND The literature on whole of system approaches (WSAs) has been largely theoretical in focus. The Australian Systems Approaches to Physical Activity is a national project designed to contribute a practical implementation focus to such approaches at the population level. METHODS National meetings were convened with federal and state government sector stakeholders to identify physical activity (PA) related policies and programs. Policies and programs were audited to develop an understanding of the existing PA system. A WSA conceptual map for PA was developed using feedback from system stakeholders, existing WSAs, and related work in obesity. RESULTS Completion of the policy audit has revealed key areas of need regarding policy governance, coordination, financing, and evaluation. An initial WSA conceptual map for Australia has been developed incorporating governance, translation, and advocacy. Stakeholder co-production of an integrated framework for PA and design plans for a community of practice knowledge hub has commenced. CONCLUSIONS In Australia, Australian Systems Approaches to Physical Activity project partners have developed a conceptual whole of systems map that is guiding progress beyond the theoretical to application in the real world: a national PA policy audit, co-production of an integrated PA policy framework, and planning for a PA community of practice knowledge hub.
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20
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Harding T, Oetzel J. Implementation effectiveness of health interventions for indigenous communities: a systematic review. Implement Sci 2019; 14:76. [PMID: 31382994 PMCID: PMC6683565 DOI: 10.1186/s13012-019-0920-4] [Citation(s) in RCA: 38] [Impact Index Per Article: 7.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/08/2018] [Accepted: 07/01/2019] [Indexed: 01/08/2023] Open
Abstract
BACKGROUND Translating research into practice is an important issue for implementing health interventions effectively for Indigenous communities. He Pikinga Waiora (HPW) is a recent implementation framework that provides a strong foundation for designing and implementing health interventions in Indigenous communities for non-communicable diseases around community engagement, culture-centred approach, systems thinking and integrated knowledge translation. This study addresses the following research question: How are the elements of the HPW Implementation Framework reflected in studies involving the implementation of a non-communicable disease health intervention in an Indigenous community? METHODS A systematic review was conducted using multiple databases. Studies were included if they involved the implementation or evaluation of a health intervention targeting non-communicable diseases for Indigenous communities in Australia, Canada, New Zealand or the United States of America. Published quantitative and qualitative literature from 2008 to 2018 were included. Methodological appraisal of the included articles was completed using the Joanna Briggs Institute System for the Unified Management, Assessment and Review of Information. Data on the population, topic, methods, and outcomes were detailed for each individual study. Key data extracted included the HPW elements along with study characteristics, who delivered the intervention and health outcomes. Data analysis involved a qualitative synthesis of findings as guided by a coding scheme of the HPW elements. RESULTS Twenty-one studies were included. Health topics included diabetes, nutrition, weight loss, cancer and general health. The key themes were as follows: (a) two thirds of studies demonstrated high levels of community engagement; (b) from the culture-centred approach, two-thirds of studies reflected moderate to high levels of community voice/agency although only a third of the studies included structural changes and researcher reflexivity; (c) about a quarter of studies included multi-level outcomes and activities consistent with systems thinking, 40% had individual-level outcomes with some systems thinking, and 33% included individual-level outcomes and limited systems thinking; and (d) almost 40% of studies included high levels of end user (e.g., policy makers and tribal leaders) engagement reflective of integrated knowledge translation, but nearly half had limited end-user engagement. CONCLUSIONS The HPW Implementation Framework is a comprehensive model for potentially understanding implementation effectiveness in Indigenous communities. The review suggests that the studies are reflective of high levels of community engagement and culture-centredness. The long-term sustainability and translation of evidence to practice may be inhibited because of lower levels of systems thinking and integrated knowledge translation. REGISTRATION Not registered.
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Affiliation(s)
- Truely Harding
- Waikato Management School, University of Waikato, Private Bag 3105, Hamilton, 3240 New Zealand
| | - John Oetzel
- Waikato Management School, University of Waikato, Private Bag 3105, Hamilton, 3240 New Zealand
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21
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Moresky RT, Razzak J, Reynolds T, Wallis LA, Wachira BW, Nyirenda M, Carlo WA, Lin J, Patel S, Bhoi S, Risko N, Wendle LA, Calvello Hynes EJ. Advancing research on emergency care systems in low-income and middle-income countries: ensuring high-quality care delivery systems. BMJ Glob Health 2019; 4:e001265. [PMID: 31406599 PMCID: PMC6666806 DOI: 10.1136/bmjgh-2018-001265] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/29/2018] [Revised: 02/07/2019] [Accepted: 02/08/2019] [Indexed: 02/07/2023] Open
Abstract
Emergency care systems (ECS) address a wide range of acute conditions, including emergent conditions from communicable diseases, non-communicable diseases, pregnancy and injury. Together, ECS represent an area of great potential for reducing morbidity and mortality in low-income and middle-income countries (LMICs). It is estimated that up to 54% of annual deaths in LMICs could be addressed by improved prehospital and facility-based emergency care. Research is needed to identify strategies for enhancing ECS to optimise prevention and treatment of conditions presenting in this context, yet significant gaps persist in defining critical research questions for ECS studies in LMICs. The Collaborative on Enhancing Emergency Care Research in LMICs seeks to promote research that improves immediate and long-term outcomes for clients and populations with emergent conditions. The objective of this paper is to describe systems approaches and research strategies for ECS in LMICs, elucidate priority research questions and methodology, and present a selection of studies addressing the operational, implementation, policy and health systems domains of health systems research as an approach to studying ECS. Finally, we briefly discuss limitations and the next steps in developing ECS-oriented interventions and research.
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Affiliation(s)
- Rachel T Moresky
- sidHARTe-Strengthening Emergency Systems Program, Columbia University Heilbrunn Department of Population and Family Health, New York, New York, USA.,Department of Emergency Medicine, Columbia University College of Physicians and Surgeons, New York, New York, USA
| | - Junaid Razzak
- Department of Emergency Medicine, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
| | - Teri Reynolds
- Department for Management of Noncommunicable Diseases, Disability, Violence and Injury Prevention, World Health Organization, Geneva, Switzerland
| | - Lee A Wallis
- Division of Emergency Medicine, University of Cape Town, Cape Town, South Africa
| | | | - Mulinda Nyirenda
- Adult Emergency and Trauma Centre, Queen Elizabeth Central Hospital, Ministry of Health, Blantyre, Malawi.,Emergency Medicine Section, Internal Medicine Department, College of Medicine, University of Malawi, Blantyre, Malawi
| | - Waldemar A Carlo
- Department of Pediatrics, Division of Neonatology, University of Alabama at Birmingham, Birmingham, Alabama, USA
| | - Janet Lin
- Department of Emergency Medicine and Center for Global Health, University of Illinois at Chicago, College of Medicine, Chicago, Illinois, USA
| | - Shama Patel
- Department of Emergency Medicine, Columbia University College of Physicians and Surgeons, New York, New York, USA
| | - Sanjeev Bhoi
- Department of Emergency Medicine, All India Institute of Medical Sciences, New Delhi, India
| | - Nicholas Risko
- Department of Emergency Medicine, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
| | - Lily A Wendle
- sidHARTe-Strengthening Emergency Systems Program, Columbia University Heilbrunn Department of Population and Family Health, New York, New York, USA
| | - Emilie J Calvello Hynes
- Department of Emergency Medicine, University of Colorado School of Medicine, Aurora, Colorado, USA
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22
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Sturmberg JP. Embracing complexity in health and health care-Translating a way of thinking into a way of acting. J Eval Clin Pract 2018; 24:598-599. [PMID: 29878609 DOI: 10.1111/jep.12935] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/26/2018] [Accepted: 03/26/2018] [Indexed: 11/29/2022]
Affiliation(s)
- Joachim P Sturmberg
- School of Medicine and Public Health, Faculty of Health and Medicine, University of Newcastle, Newcastle, Australia
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