Community-Based System Dynamics for Mobilizing Communities to Advance School Health

Land degradation: Addressing the vulnerability of local people through the lens of transformative change

Land degradation (LD) is driven by many factors resulting from the intricate interplay between natural and socio-economic systems, which adds dynamism and complexity to this phenomenon. The study highlights LD as a source of social vulnerability in the Baragan Plain (Romania), often called the "granary of Europe" due to its century-long history of industrial crop production. We explore the community's perceptions of vulnerability due to LD and the community-based solutions to sustainable transformations through governance using a community-based causal-effect analysis (CBCEA). CBCEA is a participatory approach that uses systems thinking, engages key informants, and generates qualitative causal-effect diagrams to illustrate the system structure. Two workshops with local key informants revealed their views on the direct and indirect causes and effects of LD, strategies they proposed to reduce the community's vulnerability, and the conditions for making the agricultural land decision-making integrative, inclusive, adaptive, and participatory (IIAP). IIAP decision-making was considered a key to transformative governance. Key informants identified "Windbreaks construction" and "(Resilient) Irrigation system" as two effective, context-specific measures to address the causes and effects of LD. We advise caution when implementing the "Irrigation system" measure, as it may risk constraining the system to an undesirable state, commonly referred to as a "trap".

Co-producing knowledge on the use of urban natural space: Participatory system dynamics modelling to understand a complex urban system

Decision-makers are increasingly asked to act differently in how they respond to complex urban challenges, recognising the value in bringing together and integrating cross-disciplinary, cross-sectoral knowledge to generate effective solutions. Participatory modelling allows to bring stakeholders together, enhance knowledge and understanding of a system, and identify the impacts of interventions to a given problem. This paper uses an interdisciplinary and systems approach to investigate a complex urban problem, using a participatory System Dynamics modelling process as an approach to facilitate learning and co-produce knowledge on the factors influencing the use of urban natural space. Stakeholders used a Systems Dynamics model and interface, as a tool to collectively identify pathways for improving the use of space and simulating their impacts. Under the lens of knowledge co-production, the paper reflects how such mechanisms can lead to the co-production of knowledge and social learning. The findings also contribute to identify ways of increasing the value of urban natural space focusing on urban areas undergoing physical and social transformation, such as the Thamesmead case study, London, UK.

Applications of Participatory System Dynamics Methods to Public Health: A Systematic Review

System dynamics, and specifically qualitative participatory applications of system dynamics, have potential to benefit public health research, scholarship, and practice. A systematic review was conducted to examine the existing applications of participatory system dynamics (PSD) to public health research. Three databases were searched using unique search terms related to PSD and methodological applications in public health research. A total of 57 unique articles met inclusion criteria and were included for review. The studies included for review were conducted globally and represent a wide breadth of public health issues. The review identified several advantages to adopting PSD methods in public health scholarship and practice. The PSD methods provide innovative frameworks for conceptualizing complex and nuanced public health problems. The participatory nature of PSD allows for increased community engagement and empowerment to address public health problems, as well as to mitigate existing power dynamics between research institutions and marginalized communities that are disproportionately impacted by social and health inequities. Finally, causal loop diagrams developed using PSD methods have unique potential to convey complex concepts to policy makers and interventionists. This systematic review reports evidence for PSD's potential to advance equity in public health research and practice.

Combining systems thinking approaches and implementation science constructs within community-based prevention: a systematic review

BACKGROUND

Systems science offers methods for designing population health interventions while implementation science provides specific guidance for successful implementation. Integrating systems and implementation science may strengthen implementation and enhance and sustain systemic change to achieve system-level outcomes. Little is known about the extent to which these two approaches have been integrated to date. This review aimed to identify and synthesise the peer-reviewed literature that has reported the combined use of systems thinking approaches and implementation science constructs (within the same study), to deliver population health interventions.

METHODS

A systematic literature search of peer-reviewed original research was conducted across six databases from 2009 to 2021. Journal manuscripts were included if they: (1) reported on a population health study conducted in a community, (2) reported the use of a systems method in the design of the intervention, and (3) used an implementation science theory, framework or model in the delivery of the intervention. Data extracted related to the specific systems methods and definitions and implementation science constructs used. The Mixed Methods Appraisal Tool (MMAT) was used to assess study quality.

RESULTS

Of the 9086 manuscripts returned, 320 manuscripts were included for full-text review. Of these, 17 manuscripts that reported on 14 studies were included in the final extraction. The most frequently reported systems methods were a 'whole of community systems approach' (n = 4/14) and 'community-based system dynamics' (n = 2/14). Nineteen different implementation science theories, frameworks and models were used for intervention delivery, with RE-AIM being the only framework used in more than one study.

CONCLUSION

There are few published peer-reviewed studies using systems thinking and implementation science for designing and delivering population health interventions. An exploration of synergies is worthwhile to operationalise alignment and improve implementation of systems thinking approaches. Review protocol registration PROSPERO CRD42021250419.

System mapping with adolescents: Using group model building to map the complexity of obesity

Public health research and practice is increasingly employing systems thinking to help grapple with complex issues, from obesity to HIV treatment. At the same time, there is growing recognition that to address a given problem it is essential collaborate with those most at risk of or affected by it. Group model building (GMB), a process grounded in system dynamics, combines systems thinking and participatory methods to structure and address complex issues. As part of the CO-CREATE project we conducted GMB sessions with young people in six countries to create causal loop diagrams showing the factors that they believe drive obesity. This paper describes the background to GMB and the process we used to construct causal loop diagrams; it discusses how GMB contributed to generating noteworthy and useful findings, and the strengths and limitations of the method. Using GMB, we identified areas of concern to adolescents in relation to obesity that have so far had little attention in obesity research and policy: mental health and online activity. In using GMB, we also helped answer calls for a more participatory approach to youth involvement in research and policy development.

System approaches to childhood obesity prevention: ground up experience of adaptation and real-world context

OBJECTIVE

Childhood obesity prevention is critical to reducing the health and economic burden currently experienced by the Australian economy. System science has emerged as an approach to manage the complexity of childhood obesity and the ever-changing risk factors, resources and priorities of government and funders. Anecdotally, our experience suggests that inflexibility of traditional research methods and dense academic terminology created issues with those working in prevention practice. Therefore, this paper provides a refined description of research-specific terminology of scale-up, fidelity, adaptation and context, drawing from community-based system dynamics and our experience in designing, implementing and evaluating non-linear, community-led system approaches to childhood obesity prevention.

DESIGN

We acknowledge the importance of using a practice lens, rather than purely a research design lens, and provide a narrative on our experience and perspectives on scale-up, fidelity, context and adaptation through a practice lens.

SETTING

Communities.

PARTICIPANTS

Practice-based researcher experience and perspectives.

RESULTS

Practice-based researchers highlighted the key finding that community should be placed at the centre of the intervention logic. This allowed communities to self-organise with regard to stakeholder involvement, capacity, boundary identification, and co-creation of actions implemented to address childhood obesity will ensure scale-up, fidelity, context and adaptation are embedded.

CONCLUSIONS

We need to measure beyond primary anthropometric outcomes and focus on evaluating more about implementation, process and sustainability. We need to learn more from practitioners on the ground and use an implementation science lens to further understand how actions work. This is where solutions to sustained childhood obesity prevention will be found.

Reflexive Evidence and Systems interventions to Prevention Obesity and Non-communicable Disease (RESPOND): protocol and baseline outcomes for a stepped-wedge cluster-randomised prevention trial

INTRODUCTION

Systems science methodologies have been used in attempts to address the complex and dynamic causes of childhood obesity with varied results. This paper presents a protocol for the Reflexive Evidence and Systems interventions to Prevention Obesity and Non-communicable Disease (RESPOND) trial. RESPOND represents a significant advance on previous approaches by identifying and operationalising a clear systems methodology and building skills and knowledge in the design and implementation of this approach among community stakeholders.

METHODS AND ANALYSIS

RESPOND is a 4-year cluster-randomised stepped-wedge trial in 10 local government areas in Victoria, Australia. The intervention comprises four stages: catalyse and set up, monitoring, community engagement and implementation. The trial will be evaluated for individuals, community settings and context, cost-effectiveness, and systems and implementation processes. Individual-level data including weight status, diet and activity behaviours will be collected every 2 years from school children in grades 2, 4 and 6 using an opt-out consent process. Community-level data will include knowledge and engagement, collaboration networks, economic costs and shifts in mental models aligned with systems training. Baseline prevalence data were collected between March and June 2019 among >3700 children from 91 primary schools.

ETHICS AND DISSEMINATION

Ethics approval: Deakin University Human Research Ethics Committee (HREC 2018-381) or Deakin University's Faculty of Health Ethics Advisory Committee (HEAG-H_2019-1; HEAG-H 37_2019; HEAG-H 173_2018; HEAG-H 12_2019); Victorian Government Department of Education and Training (2019_003943); Catholic Archdiocese of Melbourne (Catholic Education Melbourne, 2019-0872) and Diocese of Sandhurst (24 May 2019). The results of RESPOND, including primary and secondary outcomes, and emerging studies developed throughout the intervention, will be published in the academic literature, presented at national and international conferences, community newsletters, newspapers, infographics and relevant social media.

TRIAL REGISTRATION NUMBER

ACTRN12618001986268p.

What Can Cognitive Science Do for People?

The critical question for cognitive scientists is what does cognitive science do, if anything, for people? Cognitive science is primarily concerned with human cognition but has fallen short in continuously and critically assessing the who in human cognition. This complacency in a world where white supremacist and patriarchal structures leave cognitive science in the unfortunate position of potentially supporting those structures. We take it that many cognitive scientists operate on the assumption that the study of human cognition is both interesting and important. We want to invoke that importance to note that cognitive scientists must continue to work to show how the field is useful to all of humanity and reflects a humanity that is not white by default. We wonder how much the field has done, and can do, to show that it is useful not only in the sense that we might make connections with researchers in other fields, win grants and write papers, even of the highest quality, but useful in some material way to the billions of non-cognitive scientists across the globe.

Research to Translation: The Healthy Schools Toolkit and New Approaches to the Whole School, Whole Community, Whole Child Model

BACKGROUND

The Whole School, Whole Community, Whole Child (WSCC) model is an evidence-based comprehensive framework to address health in schools. WSCC model use improves health and educational outcomes, but implementation remains a challenge.

METHODS

Working with 6 schools in 2 districts in the Midwest, we used a mixed-methods approach to determine the people, systems, and messages needed to activate WSCC implementation. We report on social network analysis and message testing findings and research translation to develop the Healthy Schools Toolkit.

RESULTS

Social networks for both districts included more than 150 individuals. Both demonstrated network densities less than half of the desirable threshold, with evidence of clustering by role and minimal cross-school relationships, posing challenges for WSCC implementation. Across stakeholder groups, messages that emphasize empathy, teamwork, and action were well-received, especially when shared by trusted individuals through communication channels that align with stakeholder needs.

CONCLUSIONS

The Healthy Schools Toolkit provides an example of a translational product that helps to bridge research with practice. With features that highlight 6 design principles, the toolkit provides complementary activities that schools and districts can use as they plan for integration of the WSCC model.