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Davis BÁ, O'Dwyer C, Keating A, Sharry J, Murphy E, Doran A, Nearchou F, Carr A. The healthy habits questionnaire (HHQ): Validation of a measure designed to assess problematic influential behaviours amongst families of children living with obesity or a risk of developing obesity. Clin Child Psychol Psychiatry 2024:13591045241286223. [PMID: 39344963 DOI: 10.1177/13591045241286223] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/01/2024]
Abstract
The 48-item Healthy Habits Questionnaire (HHQ-48) was developed to (1) monitor positive changes in family lifestyles following engagement in the Parents Plus Healthy Families (PP-HF) parent training programme and (2) be utilised as a standalone measure in clinical settings to identify and track problematic influential behaviours amongst families of children in weight-management services. This study aimed to develop and validate a brief version of the HHQ-48. The scale was administered to a cross-sectional community sample (n = 480), and on two occasions to a control sample (n = 50) and an experimental sample (n = 40) from a randomised controlled trial (RCT) of the PP-HF programme to assess test-retest reliability and sensitivity to change respectively. Exploratory and confirmatory factor analysis showed that a 23-item, 4-factor version of the HHQ (i.e., the HHQ-23) best fit the data. The scale and factor subscales had good internal consistency and test-retest reliability. They also had good concurrent and construct validity shown by significant correlations with another scale that assessed lifestyle issues, and scales that assessed parenting satisfaction, family functioning, and children's strengths and difficulties. The HHQ-23 was sensitive to change following parents completing the PP-HF programme. The HHQ-23 may, therefore, be used to monitor positive changes in family lifestyles following engagement in the PP-HF parent training programme. The HHQ-23 also shows promising potential as a standalone screening measure or as part of a larger battery of screening assessments in paediatric weight-management services.
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Affiliation(s)
- Bríd Áine Davis
- UCD School of Psychology, University College Dublin, Ireland
| | - Claire O'Dwyer
- UCD School of Psychology, University College Dublin, Ireland
| | | | - John Sharry
- Parents Plus Charity, The Mater Hospital, Ireland
| | - Eddie Murphy
- Primary Care Psychology, Health Service Executive, St. Fintan's Campus, Ireland
| | - Alan Doran
- Child and Family Centre, Health Service Executive, Our Lady's Hospital Campus, Ireland
| | - Finiki Nearchou
- UCD School of Psychology, University College Dublin, Ireland
| | - Alan Carr
- UCD School of Psychology, University College Dublin, Ireland
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Wopereis TM, Dijkstra C, Wierda JJ, Rongen FC, Poelman MP. Systems thinking for local food environments: a participatory approach identifying leverage points and actions for healthy and sustainable transformations. Health Res Policy Syst 2024; 22:101. [PMID: 39135050 PMCID: PMC11318250 DOI: 10.1186/s12961-024-01199-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/02/2023] [Accepted: 07/29/2024] [Indexed: 08/16/2024] Open
Abstract
BACKGROUND Current local food environments encourage poor diets, posing a significant threat to public and planetary health. Acknowledging and addressing its inherent complexity is vital to making meaningful improvements to the food environment. Using a participatory approach with local stakeholders, this study aims to gain insight into the factors and mechanisms underlying the local food environment and to identify leverage points and system-based actions to foster healthy and sustainable local food environments. METHODS A systems-thinking approach was used in a Dutch municipality in 2022. Two group model building (GMB) workshops were held with community stakeholders (e.g. local policymakers, retailers and residents). During the first workshop (June 2022), factors and mechanisms influencing the local food environment were identified and visualized through a causal loop diagram (CLD). During the second workshop, leverage points and system-based actions to improve food environments were identified by the stakeholders. Four months after (October 2022), an action-implementation meeting was organized to stimulate the implementation of selected actions. Progress was monitored through brief telephone interviews 6 and 12 months after the second workshop. RESULTS The CLD visualises the factors and mechanisms influencing the local food environment from the point of view of the community stakeholders. The CLD consists of 46 factors shaping the local food environment, which were categorized into four identified subsystems: societal factors, individual, socio-economic factors, commercial factors and political factors. Eight leverage points were identified within the CLD, for example, 'lobby from food industry', 'governmental food policies' and 'e-commerce and platform economy'. Stakeholders formulated 20 actions targeting the identified leverage points. During the action-implementation meeting, long-term plans were created for five actions. After 1 year, only one participant (policy advisory role) remained actively engaged in three of these actions. CONCLUSIONS This study yields insight into the numerous factors and mechanisms underlying the local food environment and identified system-based actions as perceived by local stakeholders to improve this food environment locally. The CLD offers stakeholders valuable insights on employing a systems approach when enhancing food environments. More research is necessary, especially into the long-term processes and effects of implementing system-oriented actions to improve local food environments.
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Affiliation(s)
- Tamika M Wopereis
- Chair Group Consumption and Healthy Lifestyles, Department of Social Sciences, Wageningen University, Wageningen, 6706 KN, The Netherlands
| | - Coosje Dijkstra
- Department of Health Sciences, Amsterdam Public Health Research Institute, Vrije Universiteit Amsterdam, Amsterdam, The Netherlands
| | - Joline J Wierda
- Chair Group Consumption and Healthy Lifestyles, Department of Social Sciences, Wageningen University, Wageningen, 6706 KN, The Netherlands
| | - Frédérique C Rongen
- Chair Group Consumption and Healthy Lifestyles, Department of Social Sciences, Wageningen University, Wageningen, 6706 KN, The Netherlands
| | - Maartje P Poelman
- Chair Group Consumption and Healthy Lifestyles, Department of Social Sciences, Wageningen University, Wageningen, 6706 KN, The Netherlands.
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Sawyer ADM, van Lenthe F, Kamphuis C, Bengoechea EG, Luszczynska A, Terragni L, Volf K, Roos G, Woods C, Forberger S, Scheidmeir M, Langøien LJ, Neumann-Podczaska A, Wieczorowska-Tobis K, Stronks K. Hypothetical mechanisms driving physical activity levels in ethnic minority groups living in Europe: a systematically identified evidence-based conceptual systems model. Int J Behav Nutr Phys Act 2024; 21:87. [PMID: 39113059 PMCID: PMC11304888 DOI: 10.1186/s12966-024-01626-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/16/2024] [Accepted: 07/07/2024] [Indexed: 08/11/2024] Open
Abstract
BACKGROUND In Europe, physical activity levels tend to be lower in ethnic minority groups than the general population. Interventions and policies based on research examining isolated determinants of physical activity have had limited success in increasing physical activity levels. This study used systems dynamics theory and the capability approach theoretical framework to develop a conceptual model of how individual characteristics, institutional and physical environments and the migration context may interact to promote or hinder physical activity in ethnic minority groups living in Europe. METHODS A systematic update of Langøien et al.'s 2017 review of the determinants of physical activity in ethnic minority groups living in Europe was conducted. Our target population included individuals of all ages who reported a familial migration background from any low- and middle-income countries or belonging to minority indigenous population in Europe. Outcomes pertaining to non-work related physical activity of light, moderate or vigorous intensity performed in any setting were included. Included studies provided an evidence base from which to derive the causal loop diagrams comprising our conceptual model. Sub-system causal loop diagrams were interpreted in co-author review sessions to explicate non-linear system mechanisms, such as reinforcing and balancing feedback loops. RESULTS Forty-one studies were identified, of which the majority was qualitative. The conceptual model consisted of 4 causal loop diagrams relating to psychosocial constructs; sociocultural constructs; health and health communication and social and material resources, in interaction with environmental/migration context. Four hypothetical mechanisms were identified, e.g. hypothesizing that participation in organised activities leads to increased self-efficacy, thereby enabling further participation. CONCLUSIONS This study contributes an evidence-based conceptual systems model which elucidates how low levels of physical activity in ethnic minority groups in Europe could be supported by reinforcing and balancing mechanisms involving factors relating to physical and institutional environments, migration context and individuals. A pluralistic approach to literature review, integrating complexity methods such as CLDs into more conventional systematic literature review, supports novel insights into how factors could interact to support persistently low levels of activity, moving beyond the identification of potential relationships between isolated factors to indicating the ways in which these relationships are sustained and could be modified by intervention or policy.
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Affiliation(s)
- Alexia D M Sawyer
- Medical Research Council Epidemiology Unit, University of Cambridge, Cambridge, UK
| | - Frank van Lenthe
- Department of Public Health, Erasmus Medical Center, Erasmus University Rotterdam, Rotterdam, The Netherlands
| | - Carlijn Kamphuis
- Department of Interdisciplinary Social Science, Utrecht University, Utrecht, The Netherlands
| | - Enrique Garcia Bengoechea
- Department of Physical Education and Sport Sciences, Physical Activity for Health Research Centre, Health Research Institute, University of Limerick, Limerick, Ireland
| | - Aleksandra Luszczynska
- Center for Applied Research On Health Behavior and Health, SWPS University, Wroclaw, Poland
| | - Laura Terragni
- Department of Nursing and Health Promotion, Oslo Metropolitan University, Oslo, Norway
| | - Kevin Volf
- Department of Physical Education and Sport Sciences, Physical Activity for Health Research Centre, Health Research Institute, University of Limerick, Limerick, Ireland
| | - Gun Roos
- Centre for Welfare and Labour Research, Oslo Metropolitan University, Oslo, Norway
| | - Catherine Woods
- Department of Physical Education and Sport Sciences, Physical Activity for Health Research Centre, Health Research Institute, University of Limerick, Limerick, Ireland
| | - Sarah Forberger
- Department of Prevention and Evaluation, The Leibniz Institute for Prevention Research and Epidemiology - BIPS, Bremen, Germany
- Department of Health Science, University of York, York, UK
| | - Marie Scheidmeir
- Department of Health Psychology, Johannes Gutenberg University Mainz, Mainz, Germany
| | - Lars Jørun Langøien
- Department of Reviews and Health Technology Assessments, Norwegian Institute of Public Health, Oslo, Norway
| | | | | | - Karien Stronks
- Department of Public and Occupational Health, Amsterdam UMC, University of Amsterdam, Amsterdam, The Netherlands.
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Emke H, Altenburg T, Dijkstra C, Pinzon AL, Stronks K, Waterlander W, Kremers S, Chinapaw M. Applying systems thinking in youth-centred participatory action research for health promotion in an underserved neighbourhood. Front Public Health 2024; 12:1272663. [PMID: 38887247 PMCID: PMC11180748 DOI: 10.3389/fpubh.2024.1272663] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/04/2023] [Accepted: 05/22/2024] [Indexed: 06/20/2024] Open
Abstract
Purpose Childhood overweight is considered a complex problem influenced by a range of factors, including energy balance-related behaviours (EBRBs) and interacting drivers of these behaviours. There is growing support that applying a systems approach is required to tackle complex problems resulting in actions that attempt to change the system's dynamics. Additionally, a participatory approach is advocated to include the lived experience of the population of interest both in the understanding of the system as well as the development, implementation and evaluation of relevant actions. We therefore combined Intervention Mapping, Participatory Action Research (PAR) and system dynamics in the development, implementation and evaluation of actions contributing to healthy EBRBs together with adolescents. Methods Four PAR groups comprising of 6-8 adolescent co-researchers (10-14 years) and 1-2 adult facilitators met weekly during 3-4 years. The structured Intervention Mapping protocol guided the process of the systematic development, implementation and evaluation of actions. System dynamics tools were included for the creation of Causal Loop Diagrams and development of systemic actions. Results Our approach comprised six steps that were executed by the PAR groups: (1) build Causal Loop Diagrams for each EBRB through peer research and identify overarching mechanisms, (2) determine leverage points using the Intervention Level Framework, (3) develop action ideas, (4) develop detailed actions including an implementation plan, (5) implement and, (6) evaluate the actions. PAR ensured that the actions fitted the lived experience of the adolescents, whilst system dynamics promoted actions at different levels of the system. The Intervention Mapping protocol ensured that the actions were theory-based. The main challenge involved integrating system dynamics within our practise in cooperation with adolescent co-researchers. Conclusion We experienced that combining Intervention Mapping, PAR and system dynamics worked well in developing, implementing and evaluating actions that target different levels of the system that drive adolescents' EBRBs. This study serves as an example to other studies aimed at developing, implementing and evaluating actions using a participatory and systems approach.
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Affiliation(s)
- Helga Emke
- Department of Health Sciences, Faculty of Science, Vrije Universiteit Amsterdam, Amsterdam, Netherlands
- Amsterdam Public Health Research Institute, Health Behaviour and Chronic Diseases and Methodology, Amsterdam, Netherlands
- Department of Public and Occupational Health, Amsterdam University Medical Centre, Vrije Universiteit Amsterdam, Amsterdam, Netherlands
| | - Teatske Altenburg
- Amsterdam Public Health Research Institute, Health Behaviour and Chronic Diseases and Methodology, Amsterdam, Netherlands
- Department of Public and Occupational Health, Amsterdam University Medical Centre, Vrije Universiteit Amsterdam, Amsterdam, Netherlands
| | - Coosje Dijkstra
- Department of Health Sciences, Faculty of Science, Vrije Universiteit Amsterdam, Amsterdam, Netherlands
- Amsterdam Public Health Research Institute, Health Behaviour and Chronic Diseases and Methodology, Amsterdam, Netherlands
| | - Angie Luna Pinzon
- Amsterdam Public Health Research Institute, Health Behaviour and Chronic Diseases and Methodology, Amsterdam, Netherlands
- Department of Public and Occupational Health, Amsterdam University Medical Centre, University of Amsterdam, Maastricht, Netherlands
| | - Karien Stronks
- Amsterdam Public Health Research Institute, Health Behaviour and Chronic Diseases and Methodology, Amsterdam, Netherlands
- Department of Public and Occupational Health, Amsterdam University Medical Centre, University of Amsterdam, Maastricht, Netherlands
| | - Wilma Waterlander
- Amsterdam Public Health Research Institute, Health Behaviour and Chronic Diseases and Methodology, Amsterdam, Netherlands
- Department of Public and Occupational Health, Amsterdam University Medical Centre, University of Amsterdam, Maastricht, Netherlands
| | - Stef Kremers
- Department of Health Promotion, NUTRIM School of Nutrition and Translational Research in Metabolism, Maastricht University Medical Centre, Maastricht, Netherlands
| | - Mai Chinapaw
- Amsterdam Public Health Research Institute, Health Behaviour and Chronic Diseases and Methodology, Amsterdam, Netherlands
- Department of Public and Occupational Health, Amsterdam University Medical Centre, Vrije Universiteit Amsterdam, Amsterdam, Netherlands
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Hagenaars LL, Schmidt LA, Groeniger JO, Bekker MPM, Ter Ellen F, de Leeuw E, van Lenthe FJ, Oude Hengel KM, Stronks K. Why we struggle to make progress in obesity prevention and how we might overcome policy inertia: Lessons from the complexity and political sciences. Obes Rev 2024; 25:e13705. [PMID: 38424004 DOI: 10.1111/obr.13705] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/11/2023] [Revised: 12/18/2023] [Accepted: 01/18/2024] [Indexed: 03/02/2024]
Abstract
Despite evidence for the effectiveness of policies that target obesogenic environments, their adoption remains deficient. Using methods and concepts from complexity and political science (Stock-and-Flow analysis and Punctuated Equilibrium Theory) and a qualitative literature review, we developed system maps to identify feedback loops that hinder policymaking on mitigating obesogenic environments and feedback loops that could trigger and sustain policy change. We found numerous self-reinforcing feedback loops that buttress the assumption that obesity is an individual problem, strengthening the biomedical and commercial weight-loss sectors' claim to "ownership" over solutions. That is, improvements in therapies for individuals with obesity reinforces policymakers' reluctance to target obesogenic environments. Random events that focus attention on obesity (e.g., celebrities dismissing soda) could disrupt this cycle, when actors from outside the medical and weight-loss sector (e.g., anti-weight stigma activists) successfully reframe obesity as a societal problem, which requires robust and politically relevant engagement with affected communities prior to such events taking place. Sustained prioritization of policies targeting obesogenic environments requires shared problem ownership of affected communities and nonhealth government sectors, by emphasizing cobenefits of policies that target obesogenic environments (e.g., ultraprocessed food taxation for raising revenue) and solutions that are meaningful for affected communities.
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Affiliation(s)
- Luc L Hagenaars
- Department of Public Health, Amsterdam UMC Location University of Amsterdam, Amsterdam, The Netherlands
- Philip R. Lee Institute for Health Policy Studies, School of Medicine, University of California, San Francisco, USA
| | - Laura A Schmidt
- Philip R. Lee Institute for Health Policy Studies, School of Medicine, University of California, San Francisco, USA
| | - Joost Oude Groeniger
- Department of Public Health, Erasmus MC, University Medical Center, Rotterdam, The Netherlands
- Erasmus School of Social and Behavioural Sciences, Erasmus MC, Rotterdam, The Netherlands
| | - Marleen P M Bekker
- Health and Society Group, Wageningen University & Research, Wageningen, The Netherlands
| | - Fleur Ter Ellen
- Department of Public Health, Erasmus MC, University Medical Center, Rotterdam, The Netherlands
| | - Evelyne de Leeuw
- Urban Health and Policy, University of New South Wales, Sydney, Australia
- École de Santé Publique, Université de Montréal, Montréal, Canada
| | - Frank J van Lenthe
- Department of Public Health, Erasmus MC, University Medical Center, Rotterdam, The Netherlands
- Department of Human Geography and Spatial Planning, Faculty of Geosciences, Utrecht University, Utrecht, The Netherlands
| | - Karen M Oude Hengel
- Department of Public Health, Erasmus MC, University Medical Center, Rotterdam, The Netherlands
- Department of Work Health Technology, Netherlands Organisation for Applied Scientific Research TNO, The Hague, The Netherlands
| | - Karien Stronks
- Department of Public Health, Amsterdam UMC Location University of Amsterdam, Amsterdam, The Netherlands
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Heemskerk DM, Busch V, Piotrowski JT, Waterlander WE, Renders CM, van Stralen MM. A system dynamics approach to understand Dutch adolescents' sleep health using a causal loop diagram. Int J Behav Nutr Phys Act 2024; 21:34. [PMID: 38519989 PMCID: PMC10958857 DOI: 10.1186/s12966-024-01571-0] [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: 08/24/2023] [Accepted: 02/13/2024] [Indexed: 03/25/2024] Open
Abstract
BACKGROUND Healthy sleep is crucial for the physical and mental wellbeing of adolescents. However, many adolescents suffer from poor sleep health. Little is known about how to effectively improve adolescent sleep health as it is shaped by a complex adaptive system of many interacting factors. This study aims to provide insights into the system dynamics underlying adolescent sleep health and to identify impactful leverage points for sleep health promotion interventions. METHODS Three rounds of single-actor workshops, applying Group Model Building techniques, were held with adolescents (n = 23, 12-15 years), parents (n = 14) and relevant professionals (n = 26). The workshops resulted in a multi-actor Causal Loop Diagram (CLD) visualizing the system dynamics underlying adolescent sleep health. This CLD was supplemented with evidence from the literature. Subsystems, feedback loops and underlying causal mechanisms were identified to understand overarching system dynamics. Potential leverage points for action were identified applying the Action Scales Model (ASM). RESULTS The resulting CLD comprised six subsystems around the following themes: (1) School environment; (2) Mental wellbeing; (3) Digital environment; (4) Family & Home environment; (5) Health behaviors & Leisure activities; (6) Personal system. Within and between these subsystems, 16 reinforcing and 7 balancing feedback loops were identified. Approximately 60 potential leverage points on different levels of the system were identified as well. CONCLUSIONS The multi-actor CLD and identified system dynamics illustrate the complexity of adolescent sleep health and supports the need for developing a coherent package of activities targeting different leverage points at all system levels to induce system change.
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Affiliation(s)
- Danique M Heemskerk
- Department of Health Sciences, Faculty of Science and Amsterdam Public Health Research Institute, Vrije Universiteit Amsterdam, Amsterdam, The Netherlands.
- Department of Healthy Living, Public Health Service (GGD), Sarphati Amsterdam, City of Amsterdam, The Netherlands.
| | - Vincent Busch
- Department of Healthy Living, Public Health Service (GGD), Sarphati Amsterdam, City of Amsterdam, The Netherlands
| | - Jessica T Piotrowski
- Amsterdam School of Communication Research ASCoR, University of Amsterdam, Amsterdam, The Netherlands
| | - Wilma E Waterlander
- Department of Public and Occupational Health, Amsterdam Public Health Research Institute, Amsterdam UMC Location University of Amsterdam, Amsterdam, The Netherlands
| | - Carry M Renders
- Department of Health Sciences, Faculty of Science and Amsterdam Public Health Research Institute, Vrije Universiteit Amsterdam, Amsterdam, The Netherlands
| | - Maartje M van Stralen
- Department of Health Sciences, Faculty of Science and Amsterdam Public Health Research Institute, Vrije Universiteit Amsterdam, Amsterdam, The Netherlands.
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Raghoebar S, Mesch A, Gulikers J, Winkens LHH, Wesselink R, Haveman-Nies A. Experts' perceptions on motivators and barriers of healthy and sustainable dietary behaviors among adolescents: The SWITCH project. Appetite 2024; 194:107196. [PMID: 38154577 DOI: 10.1016/j.appet.2023.107196] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/13/2023] [Revised: 12/15/2023] [Accepted: 12/24/2023] [Indexed: 12/30/2023]
Abstract
The interplay of influences shaping dietary behaviors of adolescents needs to be well-understood to develop effective strategies stimulating healthy and sustainable behaviors. This study aimed to identify the most relevant, urgent, changeable and effective motivators and barriers of healthy and sustainable dietary behaviors among adolescents (10-19 years), as perceived by an inter- and transdisciplinary expert panel. Experts working in practice (N = 19) and academia (N = 13) - in the field of sustainability, health, nutrition and/or education - participated in this exploratory mixed-methods study. Five online semi-structured focus groups were conducted (6-7 participants). Data was thematically analyzed by two coders independently, using the socioecological framework. Subsequently, the same experts individually selected the five most relevant determinants and rated those on their urgency, changeability and effectiveness through an online questionnaire (N = 21). Participants revealed a wide system of 31 main determinants including 173 sub-determinants that motivate or hinder healthy and sustainable eating among adolescents. This system of determinants was mapped on the different layers of the socioecological model: individual factors (25 motivators; 30 barriers), social environments (15 motivators; 13 barriers), physical environments (18 motivators; 15 barriers), macro-level environments (19 motivators; 38 barriers). 'Role of peers' (social environment) was selected most as a determinant to be targeted in interventions (N = 13; urgency (M = 6.38) changeability (M = 3.85), effectiveness (M = 5.62)), followed by 'food environment around school' (N = 9; urgency (M = 5.78) changeability (M = 3.44), effectiveness (M = 5.44)), 'social influences' (N = 7; urgency (M = 5.43) changeability (M = 4.00), effectiveness (M = 5.71)), 'autonomy in development' (N = 7; urgency (M = 6.00) changeability (M = 4.29), effectiveness (M = 5.86)) and 'food availability' (N = 7; urgency (M = 6.29) changeability (M = 3.29), effectiveness (M = 6.29)). The prioritized determinants indicate that adolescents should be provided more supportive social and physical environments that promote healthy and sustainable dietary behaviors, taking into account their growing autonomy.
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Affiliation(s)
- Sanne Raghoebar
- Wageningen University & Research, Education & Learning Sciences Group, Wageningen, the Netherlands; Wageningen University & Research, Consumption & Healthy Lifestyles Group, Wageningen, the Netherlands.
| | - Anouk Mesch
- Wageningen University & Research, Education & Learning Sciences Group, Wageningen, the Netherlands; Wageningen University & Research, Consumption & Healthy Lifestyles Group, Wageningen, the Netherlands.
| | - Judith Gulikers
- Wageningen University & Research, Education & Learning Sciences Group, Wageningen, the Netherlands
| | - Laura H H Winkens
- Wageningen University & Research, Consumption & Healthy Lifestyles Group, Wageningen, the Netherlands
| | - Renate Wesselink
- Wageningen University & Research, Education & Learning Sciences Group, Wageningen, the Netherlands
| | - Annemien Haveman-Nies
- Wageningen University & Research, Consumption & Healthy Lifestyles Group, Wageningen, the Netherlands; GGD Noord- en Oost-Gelderland, Academic Collaborative Center AGORA, Zutphen, the Netherlands
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8
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Luna Pinzon A, Waterlander W, de Pooter N, Altenburg T, Dijkstra C, Emke H, van den Eynde E, Overman ML, Busch V, Renders CM, Halberstadt J, Nusselder W, den Hertog K, Chinapaw M, Verhoeff A, Stronks K. Development of an action programme tackling obesity-related behaviours in adolescents: a participatory system dynamics approach. Health Res Policy Syst 2024; 22:30. [PMID: 38429775 PMCID: PMC10908105 DOI: 10.1186/s12961-024-01116-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/30/2023] [Accepted: 02/02/2024] [Indexed: 03/03/2024] Open
Abstract
System dynamics approaches are increasingly addressing the complexity of public health problems such as childhood overweight and obesity. These approaches often use system mapping methods, such as the construction of causal loop diagrams, to gain an understanding of the system of interest. However, there is limited practical guidance on how such a system understanding can inform the development of an action programme that can facilitate systems changes. The Lifestyle Innovations Based on Youth Knowledge and Experience (LIKE) programme combines system dynamics and participatory action research to improve obesity-related behaviours, including diet, physical activity, sleep and sedentary behaviour, in 10-14-year-old adolescents in Amsterdam, the Netherlands. This paper illustrates how we used a previously obtained understanding of the system of obesity-related behaviours in adolescents to develop an action programme to facilitate systems changes. A team of evaluation researchers guided interdisciplinary action-groups throughout the process of identifying mechanisms, applying the Intervention Level Framework to identify leverage points and arriving at action ideas with aligning theories of change. The LIKE action programme consisted of 8 mechanisms, 9 leverage points and 14 action ideas which targeted the system's structure and function within multiple subsystems. This illustrates the feasibility of developing actions targeting higher system levels within the confines of a research project timeframe when sufficient and dedicated effort in this process is invested. Furthermore, the system dynamics action programme presented in this study contributes towards the development and implementation of public health programmes that aim to facilitate systems changes in practice.
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Affiliation(s)
- Angie Luna Pinzon
- Department of Public and Occupational Health, Amsterdam UMC Location University of Amsterdam, Meibergdreef 9, Amsterdam, The Netherlands.
- Health Behaviors and Chronic Diseases, Amsterdam Public Health Research Institute, Amsterdam, The Netherlands.
| | - Wilma Waterlander
- Department of Public and Occupational Health, Amsterdam UMC Location University of Amsterdam, Meibergdreef 9, Amsterdam, The Netherlands
- Health Behaviors and Chronic Diseases, Amsterdam Public Health Research Institute, Amsterdam, The Netherlands
| | - Naomi de Pooter
- Department of Public and Occupational Health, Amsterdam UMC Location University of Amsterdam, Meibergdreef 9, Amsterdam, The Netherlands
- Health Behaviors and Chronic Diseases, Amsterdam Public Health Research Institute, Amsterdam, The Netherlands
| | - Teatske Altenburg
- Health Behaviors and Chronic Diseases, Amsterdam Public Health Research Institute, Amsterdam, The Netherlands
- Department of Public and Occupational Health, Amsterdam UMC Location Vrije Universiteit Amsterdam, De Boelelaan 1117, Amsterdam, The Netherlands
| | - Coosje Dijkstra
- Health Behaviors and Chronic Diseases, Amsterdam Public Health Research Institute, Amsterdam, The Netherlands
- Department of Health Sciences, Faculty of Science, Vrije Universiteit Amsterdam, 1081HV, Amsterdam, The Netherlands
| | - Helga Emke
- Health Behaviors and Chronic Diseases, Amsterdam Public Health Research Institute, Amsterdam, The Netherlands
- Department of Public and Occupational Health, Amsterdam UMC Location Vrije Universiteit Amsterdam, De Boelelaan 1117, Amsterdam, The Netherlands
- Department of Health Sciences, Faculty of Science, Vrije Universiteit Amsterdam, 1081HV, Amsterdam, The Netherlands
| | - Emma van den Eynde
- Division of Endocrinology, Department of Pediatrics, Erasmus MC-Sophia Children's Hospital, University Medical Centre Rotterdam, Rotterdam, The Netherlands
| | - Meredith L Overman
- Department of Health Promotion, NUTRIM School of Nutrition and Translational Research in Metabolism, Maastricht University, 6229ER, Maastricht, The Netherlands
| | - Vincent Busch
- Sarphati Amsterdam, Public Health Service (GGD), City of Amsterdam, Nieuwe Achtergracht 100, 1018WT, Amsterdam, The Netherlands
| | - Carry M Renders
- Health Behaviors and Chronic Diseases, Amsterdam Public Health Research Institute, Amsterdam, The Netherlands
- Department of Health Sciences, Faculty of Science, Vrije Universiteit Amsterdam, 1081HV, Amsterdam, The Netherlands
| | - Jutka Halberstadt
- Health Behaviors and Chronic Diseases, Amsterdam Public Health Research Institute, Amsterdam, The Netherlands
- Department of Health Sciences, Faculty of Science, Vrije Universiteit Amsterdam, 1081HV, Amsterdam, The Netherlands
| | - Wilma Nusselder
- Department of Public Health, Erasmus MC, University Medical Center Rotterdam, 3015CN, Rotterdam, The Netherlands
| | - Karen den Hertog
- Amsterdam Healthy Weight Approach, Public Health Service (GGD), City of Amsterdam, Nieuwe Achtergracht 100, 1018WT, Amsterdam, The Netherlands
| | - Mai Chinapaw
- Health Behaviors and Chronic Diseases, Amsterdam Public Health Research Institute, Amsterdam, The Netherlands
- Department of Public and Occupational Health, Amsterdam UMC Location Vrije Universiteit Amsterdam, De Boelelaan 1117, Amsterdam, The Netherlands
| | - Arnoud Verhoeff
- Sarphati Amsterdam, Public Health Service (GGD), City of Amsterdam, Nieuwe Achtergracht 100, 1018WT, Amsterdam, The Netherlands
- Department of Sociology, University of Amsterdam, 1018WV, Amsterdam, The Netherlands
| | - Karien Stronks
- Department of Public and Occupational Health, Amsterdam UMC Location University of Amsterdam, Meibergdreef 9, Amsterdam, The Netherlands
- Health Behaviors and Chronic Diseases, Amsterdam Public Health Research Institute, Amsterdam, The Netherlands
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Chinapaw MJM, Klaufus LH, Oyeyemi AL, Draper C, Palmeira AL, Silva MN, Van Belle S, Pawlowski CS, Schipperijn J, Altenburg TM. Youth-centred participatory action approach towards co-created implementation of socially and physically activating environmental interventions in Africa and Europe: the YoPA project study protocol. BMJ Open 2024; 14:e084657. [PMID: 38387985 PMCID: PMC10882351 DOI: 10.1136/bmjopen-2024-084657] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/24/2024] [Accepted: 02/08/2024] [Indexed: 02/24/2024] Open
Abstract
INTRODUCTION The majority of adolescents do not meet guidelines for healthy behaviours, posing major risks for developing multiple non-communicable diseases. Unhealthy lifestyles seem more prevalent in urban than rural areas, with the neighbourhood environment as a mediating pathway. How to develop and implement sustainable and effective interventions focused on adolescent health and well-being in urban vulnerable life situations is a key challenge. This paper describes the protocol of a Youth-centred Participatory Action (YoPA) project aiming to tailor, implement, and evaluate social and physical environmental interventions. METHODS AND ANALYSIS In diverse urban environments in Denmark, the Netherlands, Nigeria and South Africa, we will engage a dynamic group of 15-20 adolescents (12-19 years) growing up in vulnerable life situations and other key stakeholders (eg, policy makers, urban planners, community leaders) in local co-creation communities. Together with academic researchers and local stakeholders, adolescents will take a leading role in mapping the local system; tailoring; implementing and evaluating interventions during participatory meetings over the course of 3 years. YoPA applies a participatory mixed methods design guided by a novel Systems, User perspectives, Participatory co-creation process, Effects, Reach, Adoption, Implementation and Maintenance framework assessing: (i) the local systems, (ii) user perspectives, (iii) the participatory co-creation process, (iv) effects, (v) reach, (vi) adoption, (vii) implementation and (viii) maintenance of interventions. Through a realist evaluation, YoPA will explore why and how specific outcomes were reached (or not) in each setting (n=800-1000 adolescents in total). ETHICS AND DISSEMINATION This study received approval from the ethics committees in Denmark, the Netherlands, Nigeria and South Africa and will be disseminated via various collaborative dissemination activities targeting multiple audiences. We will obtain informed consent from all participants. We envision that our YoPA co-creation approach will serve as a guide for participation of adolescents in vulnerable life situations in implementation of health promotion and urban planning in Europe, Africa and globally. TRIAL REGISTRATION NUMBER NCT06181162.
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Affiliation(s)
- Mai J M Chinapaw
- Public and Occupational Health, Amsterdam UMC Location VUmc, Amsterdam, The Netherlands
- Health Behaviours and Chronic Diseases, Amsterdam Public Health Research Institute, Amsterdam, The Netherlands
| | - Leonie H Klaufus
- Public and Occupational Health, Amsterdam UMC Location VUmc, Amsterdam, The Netherlands
- Health Behaviours and Chronic Diseases, Amsterdam Public Health Research Institute, Amsterdam, The Netherlands
| | - Adewale L Oyeyemi
- College of Health Solutions, Arizona State University, Phoenix, Arizona, USA
- Department of Physiotherapy, Redeemer's University, Ede, Nigeria
| | - Catherine Draper
- SAMRC Developmental Pathways for Health Research Unit, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
| | - António L Palmeira
- CIDEFES, Universidade Lusófona, Lisboa, Portugal
- CIFI2D, Universidade do Porto, Porto, Lisbon
| | - Marlene Nunes Silva
- CIDEFES, Universidade Lusófona, Lisboa, Portugal
- Programa Nacional para a Promoção da Atividade Física, Direcção-Geral da Saúde, Lisboa, Portugal
| | - Sara Van Belle
- Department of Public Health, Institute of Tropical Medicine, Antwerpen, Belgium
| | - Charlotte S Pawlowski
- Department of Sports Science and Clinical Biomechanics, University of Southern Denmark, Odense, Denmark
| | - Jasper Schipperijn
- Department of Sports Science and Clinical Biomechanics, University of Southern Denmark, Odense, Denmark
| | - Teatske M Altenburg
- Public and Occupational Health, Amsterdam UMC Location VUmc, Amsterdam, The Netherlands
- Health Behaviours and Chronic Diseases, Amsterdam Public Health Research Institute, Amsterdam, The Netherlands
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10
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Heinze C, Hartmeyer RD, Sidenius A, Ringgaard LW, Bjerregaard AL, Krølner RF, Allender S, Bauman A, Klinker CD. Developing and Evaluating a Data-Driven and Systems Approach to Health Promotion Among Vocational Students: Protocol for the Data Health Study. JMIR Res Protoc 2024; 13:e52571. [PMID: 38319698 PMCID: PMC10879971 DOI: 10.2196/52571] [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: 09/11/2023] [Revised: 12/15/2023] [Accepted: 12/17/2023] [Indexed: 02/07/2024] Open
Abstract
BACKGROUND Vocational school students exhibit significant risk behaviors in terms of poor diet, frequent use of nicotine products, inadequate fruit and vegetable intake, low levels of physical activity, and poor mental health. This makes vocational students vulnerable to the development of noncommunicable diseases. Therefore, effective health promotion programs targeting vocational students are required. OBJECTIVE The Danish study "Data-driven and Systems Approach to Health Promotion Among Vocational Students" (Data Health) aims to develop, implement, and evaluate a systems approach to support vocational schools, municipalities, and local communities in implementing locally relevant health promotion actions among and for vocational students. This paper describes the Data Health program and how implementation and preliminary effectiveness will be evaluated. METHODS The Data Health program offers an iterative 5-step process to develop changes in the systems that shape health behavior and well-being among vocational students. The program will be implemented and evaluated in 8 Danish vocational schools in 4 municipalities. The implementation of the process and actions will be explored using a systems-based evaluation design that assesses contextual differences and the mechanisms through which the program leads to changes in the systems. Preliminary effectiveness at the individual level (students' self-reported health behavior and well-being) and organizational level (school organizational readiness reported by school staff) will be assessed using a quasi-experimental design, and cross-sectional data will be collected at all 8 schools simultaneously 4 times during the 2-year study period. RESULTS This study was launched in 2021, and data collection is expected to be completed in June 2024. The first results are expected to be submitted for publication in January 2024. CONCLUSIONS We expect that the Data Health study will make significant contributions to complex intervention research by contributing to the paucity of research studies that have used systems approaches in school settings. The study will also provide evidence of successful elements for systems change and effectiveness to determine whether a national scale-up can be recommended. TRIAL REGISTRATION ClinicalTrials.gov NCT05308459; https://clinicaltrials.gov/study/NCT05308459. INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID) DERR1-10.2196/52571.
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Affiliation(s)
- Clara Heinze
- Department of Prevention, Health Promotion and Community Care, Copenhagen University Hospital - Steno Diabetes Center Copenhagen, Herlev, Denmark
- National Institute of Public Health, University of Southern Denmark, Copenhagen, Denmark
| | - Rikke Dalgaard Hartmeyer
- Department of Prevention, Health Promotion and Community Care, Copenhagen University Hospital - Steno Diabetes Center Copenhagen, Herlev, Denmark
| | - Anne Sidenius
- Department of Prevention, Health Promotion and Community Care, Copenhagen University Hospital - Steno Diabetes Center Copenhagen, Herlev, Denmark
| | - Lene Winther Ringgaard
- Department of Prevention, Health Promotion and Community Care, Copenhagen University Hospital - Steno Diabetes Center Copenhagen, Herlev, Denmark
| | | | | | - Steven Allender
- Institute for Health Transformation, Deakin University, Melbourne, Australia
| | - Adrian Bauman
- Department of Prevention, Health Promotion and Community Care, Copenhagen University Hospital - Steno Diabetes Center Copenhagen, Herlev, Denmark
- School of Public Health, Sydney University, Sydney, Australia
| | - Charlotte Demant Klinker
- Department of Prevention, Health Promotion and Community Care, Copenhagen University Hospital - Steno Diabetes Center Copenhagen, Herlev, Denmark
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11
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Baugh Littlejohns L, Rasali D, McKee G, Naiman D, Faulkner G. Elusive boundaries: using an attribute framework to describe systems for population physical activity promotion. Health Promot Int 2024; 39:daae003. [PMID: 38305640 PMCID: PMC10836056 DOI: 10.1093/heapro/daae003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/03/2024] Open
Abstract
The cost of physical inactivity is alarming, and calls for whole-of-system approaches to population physical activity promotion (PPAP) are increasing. One innovative approach to PPAP is to use a framework of interdependent attributes and associated dimensions of effective systems for chronic disease prevention. Describing system boundaries can be an elusive task, and this article reports on using an attribute framework as a first step in describing and then assessing and strengthening a provincial system for PPAP in British Columbia, Canada. Interviews were conducted with provincial stakeholders to gather perspectives regarding attributes of the system. Following this, two workshops were facilitated to document important stories about the current system for PPAP and link story themes with attributes. Results from interviews and workshops were summarized into key findings and a set of descriptive statements. One hundred and twenty-one statements provide depth, breadth and scope to descriptions of the system through the lens of an adapted framework including four attributes: (i) implementation of desired actions, (ii) resources, (iii) leadership and (iv) collaborative capacity. The attribute framework was a useful tool to guide a whole-of-system approach and turn elusive boundaries into rich descriptors of a provincial system for PPAP. Immediate implications for our research are to translate descriptive statements into variables, then assess the system through group model building and identify leverage points from a causal loop diagram to strengthen the system. Future application of this approach in other contexts, settings and health promotion and disease prevention topics is recommended.
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Affiliation(s)
- Lori Baugh Littlejohns
- BC Centre for Disease Control, Population and Public Health, 655 W 12th Avenue, Vancouver, BC V5Z 4R4, Canada
- School of Kinesiology, University of British Columbia, 210-6081 University Boulevard, Vancouver, BC V6T 1Z1, Canada
| | - Drona Rasali
- School of Population and Public Health, University of British Columbia, 2206 E Mall, Vancouver, BC V6T 1Z3, Canada
| | - Geoffrey McKee
- School of Population and Public Health, University of British Columbia, 2206 E Mall, Vancouver, BC V6T 1Z3, Canada
- Population and Public Health, BC Centre for Disease Control, 655 W 12th Avenue, Vancouver, BC V5Z 4R4, Canada
| | - Daniel Naiman
- Healthy Schools and Physical Activity, BC Ministry of Health, Stn Prov Gov, PO Box 9646, Victoria, BC V8W 9P1, Canada
| | - Guy Faulkner
- School of Kinesiology, University of British Columbia, 210-6081 University Boulevard, Vancouver, BC V6T 1Z1, Canada
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12
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Vandevijvere S, De Pauw R, Djojosoeparto S, Gorasso V, Guariguata L, Løvhaug AL, Mialon M, Van Dam I, von Philipsborn P. Upstream Determinants of Overweight and Obesity in Europe. Curr Obes Rep 2023; 12:417-428. [PMID: 37594616 DOI: 10.1007/s13679-023-00524-1] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 07/20/2023] [Indexed: 08/19/2023]
Abstract
PURPOSE OF REVIEW To review the upstream determinants of overweight and obesity in Europe, including food and built environments, and political, commercial, and socioeconomic determinants. RECENT FINDINGS Overweight and obesity affect 60% of European adults, and one in three children, and are more common in individuals with low compared to high socioeconomic position (SEP). Individuals in low SEP groups are more exposed to unhealthy built and food environments, including higher exposure to unhealthy food marketing. Industries influencing the food system have much economic power, resulting in ignoring or silencing the role of ultra-processed foods and commercial practices in weight gain. Overall, effective policies to address overweight and obesity have been insufficiently implemented by governments. To accelerate implementation, strengthened political commitment is essential. Policies must also focus on the upstream, structural, and systemic drivers of overweight and obesity; be comprehensive; and target socioeconomic inequalities in diets and physical activity.
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Affiliation(s)
- Stefanie Vandevijvere
- Department of Epidemiology and Public Health, Sciensano, J. Wytsmanstraat 14, 1050, Brussels, Belgium.
| | - Robby De Pauw
- Department of Epidemiology and Public Health, Sciensano, J. Wytsmanstraat 14, 1050, Brussels, Belgium
| | - Sanne Djojosoeparto
- Consumption and Healthy Lifestyles Chair Group, Wageningen University and Research, Wageningen, The Netherlands
| | - Vanessa Gorasso
- Department of Epidemiology and Public Health, Sciensano, J. Wytsmanstraat 14, 1050, Brussels, Belgium
| | - Leonor Guariguata
- Department of Epidemiology and Public Health, Sciensano, J. Wytsmanstraat 14, 1050, Brussels, Belgium
| | - Anne Lene Løvhaug
- Department of Nursing and Health Promotion, OsloMet-Oslo Metropolitan University, Oslo, Norway
| | | | - Iris Van Dam
- Department of Epidemiology and Public Health, Sciensano, J. Wytsmanstraat 14, 1050, Brussels, Belgium
| | - Peter von Philipsborn
- Pettenkofer School of Public Health, Ludwig-Maximilians-Universität München, Munich, Germany
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13
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Crielaard L, Quax R, Sawyer ADM, Vasconcelos VV, Nicolaou M, Stronks K, Sloot PMA. Using network analysis to identify leverage points based on causal loop diagrams leads to false inference. Sci Rep 2023; 13:21046. [PMID: 38030634 PMCID: PMC10687004 DOI: 10.1038/s41598-023-46531-z] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/01/2022] [Accepted: 11/02/2023] [Indexed: 12/01/2023] Open
Abstract
Network analysis is gaining momentum as an accepted practice to identify which factors in causal loop diagrams (CLDs)-mental models that graphically represent causal relationships between a system's factors-are most likely to shift system-level behaviour, known as leverage points. This application of network analysis, employed to quantitatively identify leverage points without having to use computational modelling approaches that translate CLDs into sets of mathematical equations, has however not been duly reflected upon. We evaluate whether using commonly applied network analysis metrics to identify leverage points is justified, focusing on betweenness- and closeness centrality. First, we assess whether the metrics identify the same leverage points based on CLDs that represent the same system but differ in inferred causal structure-finding that they provide unreliable results. Second, we consider conflicts between assumptions underlying the metrics and CLDs. We recognise six conflicts suggesting that the metrics are not equipped to take key information captured in CLDs into account. In conclusion, using betweenness- and closeness centrality to identify leverage points based on CLDs is at best premature and at worst incorrect-possibly causing erroneous identification of leverage points. This is problematic as, in current practice, the results can inform policy recommendations. Other quantitative or qualitative approaches that better correspond with the system dynamics perspective must be explored.
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Affiliation(s)
- Loes Crielaard
- Department of Public and Occupational Health, Amsterdam UMC Location University of Amsterdam, Amsterdam, The Netherlands.
- Institute for Advanced Study, University of Amsterdam, Amsterdam, The Netherlands.
| | - Rick Quax
- Institute for Advanced Study, University of Amsterdam, Amsterdam, The Netherlands
- Computational Science Lab, Informatics Institute, University of Amsterdam, Amsterdam, The Netherlands
| | - Alexia D M Sawyer
- Department of Public and Occupational Health, Amsterdam UMC Location University of Amsterdam, Amsterdam, The Netherlands
- MRC Epidemiology Unit, Institute of Metabolic Science, University of Cambridge School of Clinical Medicine, Cambridge, UK
| | - Vítor V Vasconcelos
- Institute for Advanced Study, University of Amsterdam, Amsterdam, The Netherlands
- Computational Science Lab, Informatics Institute, University of Amsterdam, Amsterdam, The Netherlands
- POLDER, Institute for Advanced Study, University of Amsterdam, Amsterdam, The Netherlands
- Center for Urban Mental Health, University of Amsterdam, Amsterdam, The Netherlands
| | - Mary Nicolaou
- Department of Public and Occupational Health, Amsterdam UMC Location University of Amsterdam, Amsterdam, The Netherlands
- Institute for Advanced Study, University of Amsterdam, Amsterdam, The Netherlands
- Center for Urban Mental Health, University of Amsterdam, Amsterdam, The Netherlands
| | - Karien Stronks
- Department of Public and Occupational Health, Amsterdam UMC Location University of Amsterdam, Amsterdam, The Netherlands
- Institute for Advanced Study, University of Amsterdam, Amsterdam, The Netherlands
- Center for Urban Mental Health, University of Amsterdam, Amsterdam, The Netherlands
| | - Peter M A Sloot
- Institute for Advanced Study, University of Amsterdam, Amsterdam, The Netherlands
- Computational Science Lab, Informatics Institute, University of Amsterdam, Amsterdam, The Netherlands
- Center for Urban Mental Health, University of Amsterdam, Amsterdam, The Netherlands
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14
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Li B, He Z, Peters R, Allender S, Zou Y, Zhou W, Lao J, Poh BK, Swinburn B. Cultural adaptations and methodological innovations to group model building for the systems actions to reduce malnutrition in all its forms in Southeast Asian countries and China (SYSTAM CHINA-SEACS International Consortium) project. Int J Behav Nutr Phys Act 2023; 20:111. [PMID: 37723534 PMCID: PMC10506199 DOI: 10.1186/s12966-023-01510-5] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2023] [Accepted: 09/02/2023] [Indexed: 09/20/2023] Open
Abstract
BACKGROUND Group Model Building (GMB) is a participatory system dynamics method increasingly used to address complex public health issues like obesity. GMB represents a set of well-defined steps to engage key stakeholders to identify shared drivers and solutions of a given problem. However, GMB has not yet been applied specifically to develop multi-duty interventions that address multiple inter-related issues such as malnutrition in all its forms (MIAIF). Moreover, a recent systematic review of empirical applications of a systems approach to developing obesity interventions found no published work from non-western, low- and middle-income countries (LMICs). In this paper we describe adaptations and innovations to a common GMB process to co-develop systemic MIAIF interventions with Chinese decision-makers. METHODS We developed, piloted and implemented multiple cultural adaptations and two methodological innovations to the commonly used GMB process in Fang Cheng Gang city, China. We included formal, ceremonial and policy maker engagement events before and between GMB workshops, and incorporated culturally tailored arrangements during participant recruitment (officials of the same seniority level joined the same workshop) and workshop activities (e.g., use of individual scoring activities and hand boards). We made changes to the commonly used GMB activities which enabled mapping of shared drivers of multiple health issues (in our case MIAIF) in a single causal loop diagram. We developed and used a 'hybrid' GMB format combining online and in person facilitation to reduce travel and associated climate impact. RESULTS Our innovative GMB process led to high engagement and support from decision-makers representing diverse governmental departments across the whole food systems. We co-identified and prioritised systemic drivers and intervention themes of MIAIF. The city government established an official Local Action Group for long-term, inter-departmental implementation, monitoring and evaluation of the co-developed interventions. The 'hybrid' GMB format enabled great interactions while reducing international travel and mitigating limitations of fully online GMB process. CONCLUSIONS Cultural and methodological adaptations to the common GMB process for an Asian LMIC setting were successful. The 'hybrid' GMB format is feasible, cost-effective, and more environmentally friendly. These cultural adaptations could be considered for other Asian settings and beyond to address inter-related, complex issues such as MIAIF.
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Affiliation(s)
- Bai Li
- Centre for Exercise, Nutrition and Health Sciences, School for Policy Studies, University of Bristol, Bristol, UK.
- School of Public Health, Guangxi Medical University, Nanning, Guangxi, China.
| | - Zouyan He
- School of Public Health, Guangxi Medical University, Nanning, Guangxi, China
| | - Remco Peters
- Centre for Exercise, Nutrition and Health Sciences, School for Policy Studies, University of Bristol, Bristol, UK
| | - Steven Allender
- Global Centre for Preventive Health and Nutrition (GLOBE), Institute for Health Transformation, Faculty of Health, Deakin University, Geelong, VIC, Australia
| | - Yunfeng Zou
- School of Public Health, Guangxi Medical University, Nanning, Guangxi, China.
| | - Weiwen Zhou
- Institute of Nutrition and School Health, Guangxi Zhuang Autonomous Region Center for Disease Control and Prevention, Nanning, Guangxi, China
| | - Jianfeng Lao
- Fang Cheng Gang Health Commission, Fangchenggang, Guangxi, China
| | - Bee Koon Poh
- Centre for Community Health Studies (ReaCH), Faculty of Health Sciences, Universiti Kebangsaan Malaysia, Kuala Lumpur, Malaysia
| | - Boyd Swinburn
- School of Population Health, University of Auckland, Auckland, New Zealand
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15
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Emke H, Dijkstra C, Kremers S, Chinapaw MJM, Altenburg T. Is the transition from primary to secondary school a risk factor for energy balance-related behaviours? A systematic review. Public Health Nutr 2023; 26:1754-1774. [PMID: 37138344 PMCID: PMC10478069 DOI: 10.1017/s1368980023000812] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/24/2022] [Revised: 03/20/2023] [Accepted: 04/23/2023] [Indexed: 05/05/2023]
Abstract
OBJECTIVE The substantial changes in the physical and social environment during the transition from primary to secondary school may significantly impact adolescents' energy balance-related behaviours (i.e. dietary behaviour, sedentary behaviour, sleep behaviour and physical activity (PA)). This is the first review systematically summarising evidence on changes in four energy balance-related behaviours of adolescents across the school transition from primary to secondary school. DESIGN For this systematic review, the electronic databases Embase, PsycINFO and SPORTDiscus were searched for relevant studies from inception to August 2021. PubMed was searched for relevant studies from inception to September 2022. Inclusion criteria were: (i) longitudinal studies reporting; (ii) one or more energy balance-related behaviours; and (iii) across the school transition, that is, with measurement(s) during both primary and secondary school. SETTING Transition from primary to secondary school. PARTICIPANTS Adolescents across the transition from primary to secondary school. RESULTS Thirty-four studies were eligible. We found strong evidence for an increase in sedentary time, moderate evidence for a decrease in fruit and vegetable consumption, and inconclusive evidence for a change in total, light, and moderate-to-vigorous PA, active transport, screen time, unhealthy snack consumption, and sugar-sweetened beverages consumption among adolescents across the school transition. CONCLUSIONS During the transition from primary to secondary school, sedentary time and fruit and vegetable consumption tend to change unfavourably. More high-quality, longitudinal research is needed specifically on changes in energy balance-related behaviour across the school transition, especially regarding sleep behaviour. (Prospero registration: CRD42018084799).
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Affiliation(s)
- Helga Emke
- Vrije Universiteit Amsterdam, Department of Health Sciences, Faculty of Science, De Boelelaan 1117Amsterdam, The Netherlands
- Amsterdam Public Health Research Institute, Health Behaviour and Chronic Diseases and Methodology, Amsterdam, The Netherlands
- Amsterdam UMC location Vrije Universiteit Amsterdam, Public and Occupational Health, De Boelelaan 1117, Amsterdam, The Netherlands
| | - Coosje Dijkstra
- Vrije Universiteit Amsterdam, Department of Health Sciences, Faculty of Science, De Boelelaan 1117Amsterdam, The Netherlands
- Amsterdam Public Health Research Institute, Health Behaviour and Chronic Diseases and Methodology, Amsterdam, The Netherlands
| | - Stef Kremers
- Maastricht University Medical Centre, Department of Health Promotion, NUTRIM School of Nutrition and Translational Research in Metabolism, P. Debyelaan 25, Maastricht, The Netherlands
| | - Mai JM Chinapaw
- Amsterdam Public Health Research Institute, Health Behaviour and Chronic Diseases and Methodology, Amsterdam, The Netherlands
- Amsterdam UMC location Vrije Universiteit Amsterdam, Public and Occupational Health, De Boelelaan 1117, Amsterdam, The Netherlands
| | - Teatske Altenburg
- Amsterdam Public Health Research Institute, Health Behaviour and Chronic Diseases and Methodology, Amsterdam, The Netherlands
- Amsterdam UMC location Vrije Universiteit Amsterdam, Public and Occupational Health, De Boelelaan 1117, Amsterdam, The Netherlands
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16
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Aguiar A, Önal F, Hendricks G, Blanchard L, Romanenko E, Fismen AS, Nwosu E, Herstad S, Savona N, Harbron J, Knai C, Samdal O, Rutter H, Lien N, Jalali MS, Kopainsky B. Understanding the dynamics emerging from the interplay among poor mental wellbeing, energy balance-related behaviors, and obesity prevalence in adolescents: A simulation-based study. Obes Rev 2023; 24 Suppl 2:e13628. [PMID: 37753604 DOI: 10.1111/obr.13628] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/04/2023] [Revised: 06/16/2023] [Accepted: 07/18/2023] [Indexed: 09/28/2023]
Abstract
Both obesity and poor mental wellbeing have a high prevalence in European youth. Adolescents in six countries identified mental wellbeing factors as main drivers of youth obesity through systems mapping. This study sought to (1) explore the dynamics of the interplay between poor mental wellbeing, energy balance-related behaviors, and adolescent overweight and obesity prevalence and (2) test the effect of intervention point scenarios to reduce adolescent obesity. Drawing on the youth-generated systems maps and a literature synthesis, we built a simulation model that represents the links from major feedback pathways for poor mental wellbeing to changes in dietary, physical activity, and sleep behaviors. The model was calibrated using survey data from Norway, expert input, and literature and shows a good fit between simulated behavior and available statistical data. The simulations indicate that adolescent mental wellbeing is harmed by socio-cultural pressures and stressors, which trigger reinforcing feedback mechanisms related to emotional/binge eating, lack of motivation to engage in physical activity, and sleep difficulty. Targeting a combination of intervention points that support a 25% reduction of pressure on body image and psychosocial stress showed potentially favorable effects on mental wellbeing-doubling on average for boys and girls and decreasing obesity prevalence by over 4%.
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Affiliation(s)
- Anaely Aguiar
- System Dynamics Group, Department of Geography, University of Bergen, Bergen, Norway
| | - Furkan Önal
- System Dynamics Group, Department of Geography, University of Bergen, Bergen, Norway
| | | | - Laurence Blanchard
- Faculty of Public Health Policy, London School of Hygiene and Tropical Medicine, London, UK
| | - Eduard Romanenko
- Department of Nutrition, Institute of Basic Medical Sciences, University of Oslo, Oslo, Norway
| | - Anne-Siri Fismen
- Department of Health and Caring Services, Western Norway University of Applied Science, Bergen, Norway
| | - Emmanuel Nwosu
- Department of Human Biology, University of Cape Town, Cape Town, South Africa
| | - Sondre Herstad
- Department of Nutrition, Institute of Basic Medical Sciences, University of Oslo, Oslo, Norway
| | - Natalie Savona
- Faculty of Public Health Policy, London School of Hygiene and Tropical Medicine, London, UK
| | - Janetta Harbron
- Department of Human Biology, University of Cape Town, Cape Town, South Africa
| | - Cécile Knai
- Faculty of Public Health Policy, London School of Hygiene and Tropical Medicine, London, UK
| | - Oddrun Samdal
- Department of Health Promotion and Development, Faculty of Psychology, University of Bergen, Bergen, Norway
| | - Harry Rutter
- Department of Social & Policy Sciences, University of Bath, Bath, UK
| | - Nanna Lien
- Department of Nutrition, Institute of Basic Medical Sciences, University of Oslo, Oslo, Norway
| | - Mohammad S Jalali
- MGH Institute for Technology Assessment, Harvard Medical School, Harvard University, Boston, Massachusetts, USA
| | - Birgit Kopainsky
- System Dynamics Group, Department of Geography, University of Bergen, Bergen, Norway
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17
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Li B, Alharbi M, Allender S, Swinburn B, Peters R, Foster C. Comprehensive application of a systems approach to obesity prevention: a scoping review of empirical evidence. Front Public Health 2023; 11:1015492. [PMID: 37614454 PMCID: PMC10442543 DOI: 10.3389/fpubh.2023.1015492] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/09/2022] [Accepted: 06/12/2023] [Indexed: 08/25/2023] Open
Abstract
A systems approach to obesity prevention is increasingly urged. However, confusion exists on what a systems approach entails in practice, and the empirical evidence on this new approach is unclear. This scoping review aimed to identify and synthesise studies/programmes that have comprehensively applied a systems approach to obesity prevention in intervention development, delivery/implementation, and evaluation. By searching international databases and grey literature, only three studies (10 publications) met inclusion criteria, which might be explained partially by suboptimal reporting. No conclusion on the effectiveness of this approach can be drawn yet due to the limited evidence base. We identified common features shared by the included studies, such as measuring ongoing changes, in addition to endpoint outcomes, and supporting capacity building. Some facilitators and barriers to applying a comprehensive systems approach in practice were identified. More well-designed and reported studies are needed, especially from low- and middle-income countries.
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Affiliation(s)
- Bai Li
- Centre for Exercise, Nutrition and Health Sciences, School for Policy Studies, University of Bristol, Bristol, United Kingdom
| | - Mohammed Alharbi
- Centre for Exercise, Nutrition and Health Sciences, School for Policy Studies, University of Bristol, Bristol, United Kingdom
| | - Steve Allender
- Global Centre for Preventive Health and Nutrition (GLOBE), Institute for Health Transformation, Faculty of Health, Deakin University, Geelong, VIC, Australia
| | - Boyd Swinburn
- School of Population Health, University of Auckland, Auckland, New Zealand
| | - Remco Peters
- Centre for Exercise, Nutrition and Health Sciences, School for Policy Studies, University of Bristol, Bristol, United Kingdom
| | - Charlie Foster
- Centre for Exercise, Nutrition and Health Sciences, School for Policy Studies, University of Bristol, Bristol, United Kingdom
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Bogt MJJT, Bevelander KE, Tholen L, Molleman GRM, van den Muijsenbergh M, Fransen GAJ. Leverage point themes within Dutch municipalities' healthy weight approaches: A qualitative study from a systems perspective. PLoS One 2023; 18:e0287050. [PMID: 37310977 DOI: 10.1371/journal.pone.0287050] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/17/2023] [Accepted: 05/30/2023] [Indexed: 06/15/2023] Open
Abstract
INTRODUCTION Despite all efforts of national and local approaches, obesity rates continue to rise worldwide. It is increasingly recognized that the complexity of obesity should be further addressed by incorporating a systems perspective when implementing approaches. Such an approach has four interconnected system levels: events, structures, goals, and beliefs, in which small changes ('leverage points') can lead to substantial changes in the functioning of the entire system. The current research examined the functioning of five Dutch municipalities' healthy weight approaches (HWAs) and the leverage point themes that can be identified in their system. METHODS Thirty-four semi-structured interviews were conducted with various stakeholders about the HWA, including policy advisors, care professionals, practice professionals, and citizens. An inductive thematic analysis was performed. RESULTS Three main themes were identified: 1) HWA organization structure, 2) collaboration between professionals, and 3) citizen participation. Across all system levels, we identified leverage point themes. The upper-levels events and structures occurred the most and were explained by underlying goals and beliefs. Leverage point themes regarding "HWA organization structure" were municipal processes, such as perceived impact; diversity of themes, activities, and tasks; network; and communication strategies, such as messages about the HWA. Leverage point themes regarding "collaboration between professionals" were linking pins, indicating central players within the network; motivation and commitment including support base; and stimulating one another to work on the HWA by spurring other professionals into action. Lastly, leverage point themes under "citizen participation" included reaching the target group, e.g., look for entry points; and citizens' motivation, including customization. DISCUSSION This paper provides unique insights into HWAs' leverage point themes that can lead to substantial changes in how the entire system functions and makes suggestions about underlying leverage points to help stakeholders improve their HWA. Future research could focus on studying leverage points within leverage point themes.
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Affiliation(s)
- Maud J J Ter Bogt
- Primary and Community Care, Radboud University Medical Centre, Nijmegen, The Netherlands
- AMPHI Academic Collaborative Centre, Nijmegen, The Netherlands
| | - Kirsten E Bevelander
- Primary and Community Care, Radboud University Medical Centre, Nijmegen, The Netherlands
- AMPHI Academic Collaborative Centre, Nijmegen, The Netherlands
| | - Lisa Tholen
- Primary and Community Care, Radboud University Medical Centre, Nijmegen, The Netherlands
| | - Gerard R M Molleman
- Primary and Community Care, Radboud University Medical Centre, Nijmegen, The Netherlands
- AMPHI Academic Collaborative Centre, Nijmegen, The Netherlands
| | - Maria van den Muijsenbergh
- Primary and Community Care, Radboud University Medical Centre, Nijmegen, The Netherlands
- Pharos, The Dutch Centre of Expertise on Health Disparities, Utrecht, The Netherlands
| | - Gerdine A J Fransen
- Primary and Community Care, Radboud University Medical Centre, Nijmegen, The Netherlands
- AMPHI Academic Collaborative Centre, Nijmegen, The Netherlands
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Luna Pinzon A, Stronks K, Emke H, van den Eynde E, Altenburg T, Dijkstra SC, Renders CM, Hermans R, Busch V, Chinapaw MJM, Kremers SPJ, Waterlander W. Understanding the system dynamics of obesity-related behaviours in 10- to 14-year-old adolescents in Amsterdam from a multi-actor perspective. Front Public Health 2023; 11:1128316. [PMID: 37304107 PMCID: PMC10248031 DOI: 10.3389/fpubh.2023.1128316] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/17/2023] [Accepted: 04/28/2023] [Indexed: 06/13/2023] Open
Abstract
Introduction and Methods To develop an understanding of the dynamics driving obesity-related behaviours in adolescents, we conducted systems-based analysis on a causal loop diagram (CLD) created from a multi-actor perspective, including academic researchers, adolescents and local stakeholders. Results The CLD contained 121 factors and 31 feedback loops. We identified six subsystems with their goals: (1) interaction between adolescents and the food environment, with profit maximisation as goal, (2) interaction between adolescents and the physical activity environment, with utility maximisation of outdoor spaces as goal, (3) interaction between adolescents and the online environment, with profit maximisation from technology use as goal, (4) interaction between adolescents, parenting and the wider socioeconomic environment, with a goal focused on individual parental responsibility, (5) interaction between healthcare professionals and families, with the goal resulting in treating obesity as an isolated problem, and (6) transition from childhood to adolescence, with the goal centring around adolescents' susceptibility to an environment that stimulates obesity-related behaviours. Discussion Analysis showed that inclusion of the researchers' and stakeholders' perspectives contributed to an understanding of how the system structure of an environment works. Integration of the adolescents' perspective enriched insights on how adolescents interact with that environment. The analysis further showed that the dynamics driving obesity-related behaviours are geared towards further reinforcing such behaviours.
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Affiliation(s)
- Angie Luna Pinzon
- Amsterdam UMC location University of Amsterdam, Department of Public and Occupational Health, Amsterdam, Netherlands
- Amsterdam Public Health Research Institute, Health Behaviors and Chronic Diseases, Amsterdam, Netherlands
| | - Karien Stronks
- Amsterdam UMC location University of Amsterdam, Department of Public and Occupational Health, Amsterdam, Netherlands
- Amsterdam Public Health Research Institute, Health Behaviors and Chronic Diseases, Amsterdam, Netherlands
| | - Helga Emke
- Amsterdam Public Health Research Institute, Health Behaviors and Chronic Diseases, Amsterdam, Netherlands
- Amsterdam UMC location Vrije Universiteit Amsterdam, Department of Public and Occupational Health, Amsterdam, Netherlands
- Department of Health Sciences, Faculty of Science, Vrije Universiteit Amsterdam, Amsterdam, Netherlands
| | - Emma van den Eynde
- Obesity Center CGG, Erasmus MC, University Medical Center Rotterdam, Rotterdam, Netherlands
| | - Teatske Altenburg
- Amsterdam Public Health Research Institute, Health Behaviors and Chronic Diseases, Amsterdam, Netherlands
- Amsterdam UMC location Vrije Universiteit Amsterdam, Department of Public and Occupational Health, Amsterdam, Netherlands
| | - S. Coosje Dijkstra
- Amsterdam Public Health Research Institute, Health Behaviors and Chronic Diseases, Amsterdam, Netherlands
- Department of Health Sciences, Faculty of Science, Vrije Universiteit Amsterdam, Amsterdam, Netherlands
| | - Carry M. Renders
- Amsterdam Public Health Research Institute, Health Behaviors and Chronic Diseases, Amsterdam, Netherlands
- Department of Health Sciences, Faculty of Science, Vrije Universiteit Amsterdam, Amsterdam, Netherlands
| | - Roel Hermans
- Department of Health Promotion, NUTRIM School of Nutrition and Translational Research in Metabolism, Maastricht University, Maastricht, Netherlands
| | - Vincent Busch
- Sarphati Amsterdam, Public Health Service (GGD), Amsterdam, Netherlands
| | - Mai J. M. Chinapaw
- Amsterdam Public Health Research Institute, Health Behaviors and Chronic Diseases, Amsterdam, Netherlands
- Amsterdam UMC location Vrije Universiteit Amsterdam, Department of Public and Occupational Health, Amsterdam, Netherlands
| | - Stef P. J. Kremers
- Department of Health Promotion, NUTRIM School of Nutrition and Translational Research in Metabolism, Maastricht University, Maastricht, Netherlands
| | - Wilma Waterlander
- Amsterdam UMC location University of Amsterdam, Department of Public and Occupational Health, Amsterdam, Netherlands
- Amsterdam Public Health Research Institute, Health Behaviors and Chronic Diseases, Amsterdam, Netherlands
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20
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Riley T, Hopkins L, Gomez M, Davidson S, Jacob J. System Action Learning: Reorientating Practice for System Change in Preventive Health. SYSTEMIC PRACTICE AND ACTION RESEARCH 2023:1-16. [PMID: 37359404 PMCID: PMC10060912 DOI: 10.1007/s11213-023-09638-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/07/2023] [Indexed: 03/31/2023]
Abstract
It is now widely accepted that many of the problems we face in public health are complex, from chronic disease to COVID-19. To grapple with such complexity, researchers have turned to both complexity science and systems thinking to better understand the problems and their context. Less work, however, has focused on the nature of complex solutions, or intervention design, when tackling complex problems. This paper explores the nature of system intervention design through case illustrations of system action learning from a large systems level chronic disease prevention study in Australia. The research team worked with community partners in the design and implementation of a process of system action learning designed to reflect on existing initiatives and to reorient practice towards responses informed by system level insights and action. We were able to observe and document changes in the mental models and actions of practitioners and in doing so shine a light on what may be possible once we turn our attention to the nature and practice of system interventions.
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Affiliation(s)
- Therese Riley
- The Australian Prevention Partnership Centre, The Sax Institute, Sydney, Australia
| | - Liza Hopkins
- The Australian Prevention Partnership Centre, The Sax Institute, Sydney, Australia
| | - Maria Gomez
- The Australian Prevention Partnership Centre, The Sax Institute, Sydney, Australia
| | - Seanna Davidson
- The Australian Prevention Partnership Centre, The Sax Institute, Sydney, Australia
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21
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Baugh Littlejohns L, Near E, McKee G, Rasali D, Naiman D, Faulkner G. A scoping review of complex systems methods used in population physical activity research: do they align with attributes of a whole system approach? Health Res Policy Syst 2023; 21:18. [PMID: 36864409 PMCID: PMC9979563 DOI: 10.1186/s12961-023-00961-3] [Citation(s) in RCA: 6] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/06/2022] [Accepted: 02/11/2023] [Indexed: 03/04/2023] Open
Abstract
BACKGROUND Complex systems approaches are increasingly used in health promotion and noncommunicable disease prevention research, policy and practice. Questions emerge as to the best ways to take a complex systems approach, specifically with respect to population physical activity (PA). Using an Attributes Model is one way to understand complex systems. We aimed to examine the types of complex systems methods used in current PA research and identify what methods align with a whole system approach as reflected by an Attributes Model. METHODS A scoping review was conducted and two databases were searched. Twenty-five articles were selected and data analysis was based upon the following: the complex systems research methods used, research aims, if participatory methods were used and evidence of discussion regarding attributes of systems. RESULTS There were three groups of methods used: system mapping, simulation modelling and network analysis. System mapping methods appeared to align best with a whole system approach to PA promotion because they largely aimed to understand complex systems, examined interactions and feedback among variables, and used participatory methods. Most of these articles focused on PA (as opposed to integrated studies). Simulation modelling methods were largely focused on examining complex problems and identifying interventions. These methods did not generally focus on PA or use participatory methods. While network analysis articles focused on examining complex systems and identifying interventions, they did not focus on PA nor use participatory methods. All attributes were discussed in some way in the articles. Attributes were explicitly reported on in terms of findings or were part of discussion and conclusion sections. System mapping methods appear to be well aligned with a whole system approach because these methods addressed all attributes in some way. We did not find this pattern with other methods. CONCLUSIONS Future research using complex systems methods may benefit from applying the Attributes Model in conjunction with system mapping methods. Simulation modelling and network analysis methods are seen as complementary and could be used when system mapping methods identify priorities for further investigation (e.g. what interventions to implement or how densely connected relationships are in systems).
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Affiliation(s)
- Lori Baugh Littlejohns
- BC Centre for Disease Control, 655 W 12th Ave, Vancouver, BC, V5Z 4R4, Canada. .,School of Kinesiology, University of British Columbia, 210-6081 University Boulevard, Vancouver, BC, V6T 1Z1, Canada.
| | - Erin Near
- grid.34429.380000 0004 1936 8198Department of Population Medicine, University of Guelph, Stewart Building, Building #45, Rm 2509, Guelph, ON N1G 2W1 Canada
| | - Geoff McKee
- grid.418246.d0000 0001 0352 641XBC Centre for Disease Control, 655 W 12th Ave, Vancouver, BC V5Z 4R4 Canada ,grid.17091.3e0000 0001 2288 9830School of Population and Public Health, University of British Columbia, 2206 E Mall, Vancouver, BC V6T 1Z3 Canada
| | - Drona Rasali
- grid.418246.d0000 0001 0352 641XBC Centre for Disease Control, 655 W 12th Ave, Vancouver, BC V5Z 4R4 Canada ,grid.17091.3e0000 0001 2288 9830School of Population and Public Health, University of British Columbia, 2206 E Mall, Vancouver, BC V6T 1Z3 Canada
| | - Daniel Naiman
- grid.453059.e0000000107220098BC Ministry of Health, Stn Prov Govt, PO Box 9646, Victoria, BC V8W 9P1 Canada
| | - Guy Faulkner
- grid.17091.3e0000 0001 2288 9830School of Kinesiology, University of British Columbia, 210-6081 University Boulevard, Vancouver, BC V6T 1Z1 Canada
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22
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Toft U, Buch-Andersen T, Bloch P, Reinbach HC, Jensen BB, Mikkelsen BE, Aagaard-Hansen J, Glümer C. A Community-Based, Participatory, Multi-Component Intervention Increased Sales of Healthy Foods in Local Supermarkets-The Health and Local Community Project (SoL). INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2023; 20:2478. [PMID: 36767845 PMCID: PMC9915330 DOI: 10.3390/ijerph20032478] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 12/04/2022] [Revised: 01/14/2023] [Accepted: 01/16/2023] [Indexed: 06/18/2023]
Abstract
Project SoL was a 19-month (September 2012 to April 2014) community-based multi-component intervention based on the supersetting approach that was designed to promote healthier eating and physical activity among children and their families. The aim of this study was to examine the effects of a multi-component intervention (level 1) and a mass media intervention alone (level 2) compared to a control area (level 3) on food sales. The design was quasi-experimental. Weekly sales data for all Coop supermarkets in the intervention and control areas were analysed via longitudinal linear mixed-effects analyses. Significant increases in the sales of fish (total) (29%; p = 0.003), canned fish (31%; p = 0.025) and oatmeal (31%; p = 0.003) were found for the level 1 intervention area compared to the control area. In the level 2 intervention area, significant increases in the sales of vegetables (total) (17%; p = 0.038), fresh vegetables (20%; p = 0.01), dried fruit (51%; p = 0.022), oatmeal (19%; p = 0.008) and wholegrain pasta (58%; p = 0.0007) were found compared to the control area. The sales of canned fish increased by 30% in the level 1 area compared to the level 2 area (p = 0.025). This study demonstrated significant increases in the sales of healthy foods, both in the areas with multi-component and mass media interventions alone compared to the control area.
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Affiliation(s)
- Ulla Toft
- Center for Clinical Research and Prevention, Bispebjerg and Frederiksberg Hospital, Nordre Fasanvej 57, 2000 Frederiksberg, Denmark
- Department of Public Health, Section of Social Medicine, University of Copenhagen, Øster Farimagsgade 5, 1353 Copenhagen, Denmark
| | - Tine Buch-Andersen
- Center for Clinical Research and Prevention, Bispebjerg and Frederiksberg Hospital, Nordre Fasanvej 57, 2000 Frederiksberg, Denmark
| | - Paul Bloch
- Health Promotion Research, Steno Diabetes Center Copenhagen, Borgmester Ib Juuls Vej 83, 2730 Herlev, Denmark
| | - Helene Christine Reinbach
- Department of Food Science, Section for Food Design and Consumer Behaviour, University of Copenhagen, Rolighedsvej 30, Building 2-74, 5th Floor, Room C505, 1958 Frederiksberg C, Denmark
| | - Bjarne Bruun Jensen
- Health Promotion Research, Steno Diabetes Center Copenhagen, Borgmester Ib Juuls Vej 83, 2730 Herlev, Denmark
| | - Bent Egberg Mikkelsen
- Department of Geosciences and Natural Resource Management, University of Copenhagen, Rolighedsvej 23, 1958 Frederiksberg C, Denmark
| | - Jens Aagaard-Hansen
- Health Promotion Research, Steno Diabetes Center Copenhagen, Borgmester Ib Juuls Vej 83, 2730 Herlev, Denmark
- SA MRC Developmental Pathways for Health Research Unit, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg 2000, South Africa
| | - Charlotte Glümer
- Center for Diabetes, Copenhagen Municipality, Vesterbrogade 121, 1620 Copenhagen, Denmark
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23
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Arts J, Drotos E, Singh AS, Chinapaw MJM, Altenburg TM, Gubbels JS. Correlates of Physical Activity in 0- to 5-year-olds: A Systematic Umbrella Review and Consultation of International Researchers. Sports Med 2023; 53:215-240. [PMID: 36219386 PMCID: PMC9807466 DOI: 10.1007/s40279-022-01761-5] [Citation(s) in RCA: 10] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/28/2022] [Indexed: 01/13/2023]
Abstract
BACKGROUND Many children aged 0-5 years do not meet the WHO physical activity guidelines. To develop effective, evidence-based interventions, it is necessary to understand which factors are associated with physical activity in early childhood. OBJECTIVE To summarize the current evidence on correlates of physical activity in 0- to 5-year-old children. METHODS First, a systematic umbrella review was conducted following PRISMA guidelines. PubMed, Embase, PsycINFO, and SPORTDiscus were searched up to May 2020 for systematic reviews examining the association between potential correlates and quantitatively measured physical activity in children aged 0-5.9 years. Included reviews were assessed on methodological quality, and results were categorized according to the socio-ecological model. Second, 31 international researchers of physical activity in young children participated in an expert panel to reflect on the outcomes of the umbrella review and propose directions for future research. RESULTS Twenty-one reviews were included that examined a total of 98 potential correlates. When synthesizing all reviews, 23 correlates were found with consistent evidence for an association with a physical activity outcome. For most other potential correlates there was inconsistent evidence across reviews for associations with physical activity in young children. Although there was little overlap between the correlates identified in the umbrella review and determinants suggested by the expert panel, both confirmed the importance of socio-cultural, policy, and physical environmental factors in general. CONCLUSION Multiple correlates of young children's physical activity were identified. However, various methodological challenges (e.g., measurement instruments) and the large heterogeneity (e.g., study samples, correlates, and outcome measures) hindered formulating definitive conclusions. Moreover, none of the reviews reported on the interrelatedness between correlates, which would align with more holistic understandings of behavior. Our findings indicate the urgent need for establishing a common ground in definitions, assessment methods, and analytical methods to further the field of physical activity research in this tremendously important age group. PROSPERO REGISTRATION NUMBER CRD42020184159.
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Affiliation(s)
- Jelle Arts
- Department of Public and Occupational Health, Amsterdam Public Health, Amsterdam UMC, Vrije Universiteit Amsterdam, De Boelelaan 1117, Amsterdam, The Netherlands.
| | - Elizabeth Drotos
- Department of Health Promotion, NUTRIM School of Nutrition and Translational Research in Metabolism, Maastricht University, Maastricht, The Netherlands
| | - Amika S Singh
- Mulier Institute, Utrecht, The Netherlands
- Center for Physically Active Learning, Faculty of Education, Arts and Sports, Western Norway University of Applied Sciences, Sogndal, Norway
| | - Mai J M Chinapaw
- Department of Public and Occupational Health, Amsterdam Public Health, Amsterdam UMC, Vrije Universiteit Amsterdam, De Boelelaan 1117, Amsterdam, The Netherlands
| | - Teatske M Altenburg
- Department of Public and Occupational Health, Amsterdam Public Health, Amsterdam UMC, Vrije Universiteit Amsterdam, De Boelelaan 1117, Amsterdam, The Netherlands
| | - Jessica S Gubbels
- Department of Health Promotion, NUTRIM School of Nutrition and Translational Research in Metabolism, Maastricht University, Maastricht, The Netherlands
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24
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Systems Mapping of the New Zealand Free and Healthy School Lunch Programme: Perspectives from Lunch Providers. Nutrients 2022; 14:nu14204336. [DOI: 10.3390/nu14204336] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/29/2022] [Revised: 10/13/2022] [Accepted: 10/13/2022] [Indexed: 11/16/2022] Open
Abstract
As part of the COVID-19 economic recovery package, the Aotearoa New Zealand Government rolled out a universal free and healthy lunch programme to the 25% least advantaged schools nationwide. This study explored experiences of school lunch providers in the Hawke’s Bay region. The aim was to create a systems map identifying points of intervention through which the lunch programme could be improved to meet the goal of reducing child food insecurity. Twelve lunch providers were interviewed to generate casual loop diagrams which were examined and integrated to form a single systems map. Seven themes arose during analysis: teacher support, principal support, nutrition guidelines and government support, supply chain, ingredient suppliers, student feedback and food waste. Teacher support was important for getting students to try new foods and eat the nutritious lunches. Principal support was a strong theme impacting opportunities for broader student engagement. This study employed systems science to highlight the importance of support from different stakeholders within the lunch programme to achieve the goal of reduced child food insecurity. Further work is needed to ensure the programme meets the wider goals of the government and community, and to determine the potential broader benefits of the programme.
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25
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van Erpecum CPL, van Zon SKR, Bültmann U, Smidt N. The association between the presence of fast-food outlets and BMI: the role of neighbourhood socio-economic status, healthy food outlets, and dietary factors. BMC Public Health 2022; 22:1432. [PMID: 35897088 PMCID: PMC9331587 DOI: 10.1186/s12889-022-13826-1] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/09/2022] [Accepted: 07/15/2022] [Indexed: 12/01/2022] Open
Abstract
Background Evidence on the association between the presence of fast-food outlets and Body Mass Index (BMI) is inconsistent. Furthermore, mechanisms underlying the fast-food outlet presence-BMI association are understudied. We investigated the association between the number of fast-food outlets being present and objectively measured BMI. Moreover, we investigated to what extent this association was moderated by neighbourhood socio-economic status (NSES) and healthy food outlets. Additionally, we investigated mediation by frequency of fast-food consumption and amount of fat intake. Methods In this cross-sectional study, we used baseline data of adults in Lifelines (N = 149,617). Geo-coded residential addresses were linked to fast-food and healthy food outlet locations. We computed the number of fast-food and healthy food outlets within 1 kilometre (km) of participants’ residential addresses (each categorised into null, one, or at least two). Participants underwent objective BMI measurements. We linked data to Statistics Netherlands to compute NSES. Frequency of fast-food consumption and amount of fat intake were measured through questionnaires in Lifelines. Multivariable multilevel linear regression analyses were performed to investigate associations between fast-food outlet presence and BMI, adjusting for individual and environmental potential confounders. When exposure-moderator interactions had p-value < 0.10 or improved model fit (∆AIC ≥ 2), we conducted stratified analyses. We used causal mediation methods to assess mediation. Results Participants with one fast-food outlet within 1 km had a higher BMI than participants with no fast-food outlet within 1 km (B = 0.11, 95% CI: 0.01, 0.21). Effect sizes for at least two fast-food outlets were larger in low NSES areas (B = 0.29, 95% CI: 0.01, 0.57), and especially in low NSES areas where at least two healthy food outlets within 1 km were available (B = 0.75, 95% CI: 0.19, 1.31). Amount of fat intake, but not frequency of fast-food consumption, explained this association for 3.1%. Conclusions Participants living in low SES neighbourhoods with at least two fast-food outlets within 1 km of their residential address had a higher BMI than their peers with no fast-food outlets within 1 km. Among these participants, healthy food outlets did not buffer the potentially unhealthy impact of fast-food outlets. Amount of fat intake partly explained this association. This study highlights neighbourhood socio-economic inequalities regarding fast-food outlets and BMI. Supplementary Information The online version contains supplementary material available at 10.1186/s12889-022-13826-1.
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Affiliation(s)
- Carel-Peter L van Erpecum
- Department of Epidemiology, University of Groningen, University Medical Center Groningen, Hanzeplein 1, 9700 RB, Groningen, the Netherlands.
| | - Sander K R van Zon
- Department of Health Sciences, Community and Occupational Medicine, University of Groningen, University Medical Center Groningen, Hanzeplein 1, 9700 RB, Groningen, the Netherlands
| | - Ute Bültmann
- Department of Health Sciences, Community and Occupational Medicine, University of Groningen, University Medical Center Groningen, Hanzeplein 1, 9700 RB, Groningen, the Netherlands
| | - Nynke Smidt
- Department of Epidemiology, University of Groningen, University Medical Center Groningen, Hanzeplein 1, 9700 RB, Groningen, the Netherlands
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26
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Wilderink L, Bakker I, Schuit AJ, Seidell JC, Pop IA, Renders CM. A Theoretical Perspective on Why Socioeconomic Health Inequalities Are Persistent: Building the Case for an Effective Approach. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:8384. [PMID: 35886234 PMCID: PMC9317352 DOI: 10.3390/ijerph19148384] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 05/10/2022] [Revised: 06/24/2022] [Accepted: 06/30/2022] [Indexed: 12/10/2022]
Abstract
Despite policy intentions and many interventions aimed at reducing socioeconomic health inequalities in recent decades in the Netherlands and other affluent countries, these inequalities have not been reduced. Based on a narrative literature review, this paper aims to increase insight into why socioeconomic health inequalities are so persistent and build a way forward for improved approaches from a theoretical perspective. Firstly, we present relevant theories focusing on individual determinants of health-related behaviors. Thereafter, we present theories that take into account determinants of the individual level and the environmental level. Lastly, we show the complexity of the system of individual determinants, environmental determinants and behavior change for low socioeconomic position (SEP) groups and describe the next steps in developing and evaluating future effective approaches. These steps include systems thinking, a complex whole-system approach and participation of all stakeholders in system change.
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Affiliation(s)
- Lisa Wilderink
- Department of Health Sciences, Faculty of Sciences, Amsterdam Public Health Research Institute, Vrije Universiteit Amsterdam, 1081 HV Amsterdam, The Netherlands; (J.C.S.); (C.M.R.)
- Department of Healthy Society, Windesheim University of Applied Sciences, 8017 CA Zwolle, The Netherlands;
| | - Ingrid Bakker
- Department of Healthy Society, Windesheim University of Applied Sciences, 8017 CA Zwolle, The Netherlands;
| | - Albertine J. Schuit
- School of Social and Behavioral Sciences, Tilburg University, 5037 AB Tilburg, The Netherlands; (A.J.S.); (I.A.P.)
| | - Jacob C. Seidell
- Department of Health Sciences, Faculty of Sciences, Amsterdam Public Health Research Institute, Vrije Universiteit Amsterdam, 1081 HV Amsterdam, The Netherlands; (J.C.S.); (C.M.R.)
| | - Ioana A. Pop
- School of Social and Behavioral Sciences, Tilburg University, 5037 AB Tilburg, The Netherlands; (A.J.S.); (I.A.P.)
| | - Carry M. Renders
- Department of Health Sciences, Faculty of Sciences, Amsterdam Public Health Research Institute, Vrije Universiteit Amsterdam, 1081 HV Amsterdam, The Netherlands; (J.C.S.); (C.M.R.)
- Department of Healthy Society, Windesheim University of Applied Sciences, 8017 CA Zwolle, The Netherlands;
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27
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A Theory of Change for Community-Based Systems Interventions to Prevent Obesity. Am J Prev Med 2022; 62:786-794. [PMID: 34865936 DOI: 10.1016/j.amepre.2021.10.006] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/27/2021] [Revised: 09/27/2021] [Accepted: 10/19/2021] [Indexed: 12/12/2022]
Abstract
INTRODUCTION Applying systems science in public health trials is a recent innovation in childhood obesity prevention. This paper aims to use systems science conventions to propose a theory of change for community-based interventions aiming to build capacity and use exemplars from systems science for obesity prevention to describe how this approach works. METHODS Participants were community-based researchers. A dynamic hypothesis was created in workshops conducted in 2020 and 2021 by identifying variables critical to building community capacity for systems thinking. These were used to develop stock and flow diagrams representing individual causal relationships, feedback loops, and the overall theory of change. RESULTS The resultant model identified 9 stocks and 4 pairs of central balancing and reinforcing feedback loops. These represented building commitment through relationships, mutual learning, strengthening collaboration, and embedding capacity. The model is described using examples from 3 trials involving 25 communities across Victoria, Australia. CONCLUSIONS This nonlinear and practice-based model illustrates the process of community-based obesity prevention. The model integrates >20 years of community-based intervention implementation experience, providing an overarching theory of how such interventions work to create change and prevent obesity.
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28
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[Weight stigma, Mediterranean diet and obesity]. NUTR HOSP 2022; 39:554-561. [PMID: 35485380 DOI: 10.20960/nh.03908] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/02/2022] Open
Abstract
INTRODUCTION obesity is a disease that affects a high percentage of the world's population. Although its origin is multicausal and multifactorial, less attention has been paid to psychological and behavioral variables. AIM to determine whether psychological variables (weight stigma, stress and depressive symptomatology) and behavioral variable (Mediterranean diet index) predict obesity according to body mass index (BMI), controlling for the effect of physiological variables (HDL cholesterol, triglycerides, glucose and blood pressure) and sociodemographic variables (sex, income, educational level). METHODS non-experimental, cross-sectional, correlational design. By means of a non-probabilistic convenience sampling, 344 persons were selected from the general Chilean population from the Araucanía region (Mage = 55.7 years; SD = 5.1 years; 55.8 % women). A blood sample, anthropometric measurement of weight and height, and self-report measures of psychological and behavioral variables were obtained. RESULTS a 5-block hierarchical multiple regression analysis was performed. Sociodemographic covariates did not significantly predict BMI, however physiological covariates, the behavioral variable and weight stigma, were significantly associated with BMI, with weight stigma being the predictor that explained the most variance. CONCLUSIONS the findings allow us to verify the role of psychological and behavioral variables in the multifactorial etiology of obesity. The findings are discussed in the light of the biopsychosocial approach, and a multidisciplinary approach to obesity is suggested.
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Luna Pinzon A, Stronks K, Dijkstra C, Renders C, Altenburg T, den Hertog K, Kremers SPJ, Chinapaw MJM, Verhoeff AP, Waterlander W. The ENCOMPASS framework: a practical guide for the evaluation of public health programmes in complex adaptive systems. Int J Behav Nutr Phys Act 2022; 19:33. [PMID: 35346233 PMCID: PMC8962023 DOI: 10.1186/s12966-022-01267-3] [Citation(s) in RCA: 17] [Impact Index Per Article: 8.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/04/2021] [Accepted: 02/17/2022] [Indexed: 11/10/2022] Open
Abstract
Background Systems thinking embraces the complexity of public health problems, including childhood overweight and obesity. It aids in understanding how factors are interrelated, and it can be targeted to produce favourable changes in a system. There is a growing call for systems approaches in public health research, yet limited practical guidance is available on how to evaluate public health programmes within complex adaptive systems. The aim of this paper is to present an evaluation framework that supports researchers in designing systems evaluations in a comprehensive and practical way. Methods We searched the literature for existing public health systems evaluation studies. Key characteristics on how to conduct a systems evaluation were extracted and compared across studies. Next, we overlaid the identified characteristics to the context of the Lifestyle Innovations Based on Youth Knowledge and Experience (LIKE) programme evaluation and analyzed which characteristics were essential to carry out the LIKE evaluation. This resulted in the Evaluation of Programmes in Complex Adaptive Systems (ENCOMPASS) framework. Results The ENCOMPASS framework includes five iterative stages: (1) adopting a system dynamics perspective on the overall evaluation design; (2) defining the system boundaries; (3) understanding the pre-existing system to inform system changes; (4) monitoring dynamic programme output at different system levels; and (5) measuring programme outcome and impact in terms of system changes. Conclusions The value of ENCOMPASS lies in the integration of key characteristics from existing systems evaluation studies, as well as in its practical, applied focus. It can be employed in evaluating public health programmes in complex adaptive systems. Furthermore, ENCOMPASS provides guidance for the entire evaluation process, all the way from understanding the system to developing actions to change it and to measuring system changes. By the nature of systems thinking, the ENCOMPASS framework will likely evolve further over time, as the field expands with more completed studies.
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Crielaard L, Nicolaou M, Sawyer A, Quax R, Stronks K. Understanding the impact of exposure to adverse socioeconomic conditions on chronic stress from a complexity science perspective. BMC Med 2021; 19:242. [PMID: 34635083 PMCID: PMC8507143 DOI: 10.1186/s12916-021-02106-1] [Citation(s) in RCA: 25] [Impact Index Per Article: 8.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/24/2021] [Accepted: 08/25/2021] [Indexed: 11/17/2022] Open
Abstract
BACKGROUND Chronic stress increases chronic disease risk and may underlie the association between exposure to adverse socioeconomic conditions and adverse health outcomes. The relationship between exposure to such conditions and chronic stress is complex due to feedback loops between stressor exposure and psychological processes, encompassing different temporal (acute stress response to repeated exposure over the life course) and spatial (biological/psychological/social) scales. We examined the mechanisms underlying the relationship between exposure to adverse socioeconomic conditions and chronic stress from a complexity science perspective, focusing on amplifying feedback loops across different scales. METHODS We developed a causal loop diagram (CLD) to interpret available evidence from this perspective. The CLD was drafted by an interdisciplinary group of researchers. Evidence from literature was used to confirm/contest the variables and causal links included in the conceptual framework and refine their conceptualisation. Our findings were evaluated by eight independent researchers. RESULTS Adverse socioeconomic conditions imply an accumulation of stressors and increase the likelihood of exposure to uncontrollable childhood and life course stressors. Repetition of such stressors may activate mechanisms that can affect coping resources and coping strategies and stimulate appraisal of subsequent stressors as uncontrollable. We identified five feedback loops describing these mechanisms: (1) progressive deterioration of access to coping resources because of repeated insolvability of stressors; (2) perception of stressors as uncontrollable due to learned helplessness; (3) tax on cognitive bandwidth caused by stress; (4) stimulation of problem avoidance to provide relief from the stress response and free up cognitive bandwidth; and (5) susceptibility to appraising stimuli as stressors against a background of stress. CONCLUSIONS Taking a complexity science perspective reveals that exposure to adverse socioeconomic conditions implies recurrent stressor exposure which impacts chronic stress via amplifying feedback loops that together could be conceptualised as one vicious cycle. This means that in order for individual-level psychological interventions to be effective, the context of exposure to adverse socioeconomic conditions also needs to be addressed.
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Affiliation(s)
- Loes Crielaard
- Department of Public and Occupational Health, Amsterdam UMC, University of Amsterdam, Amsterdam Public Health Research Institute, Meibergdreef 9, Amsterdam, 1105 AZ, The Netherlands.
- Institute for Advanced Study, University of Amsterdam, Amsterdam, 1012 GC, The Netherlands.
| | - Mary Nicolaou
- Department of Public and Occupational Health, Amsterdam UMC, University of Amsterdam, Amsterdam Public Health Research Institute, Meibergdreef 9, Amsterdam, 1105 AZ, The Netherlands
- Institute for Advanced Study, University of Amsterdam, Amsterdam, 1012 GC, The Netherlands
- Centre for Urban Mental Health, University of Amsterdam, Amsterdam, 1012 GC, The Netherlands
| | - Alexia Sawyer
- Department of Public and Occupational Health, Amsterdam UMC, University of Amsterdam, Amsterdam Public Health Research Institute, Meibergdreef 9, Amsterdam, 1105 AZ, The Netherlands
| | - Rick Quax
- Institute for Advanced Study, University of Amsterdam, Amsterdam, 1012 GC, The Netherlands
- Computational Science Lab, University of Amsterdam, Amsterdam, 1098 XH, The Netherlands
| | - Karien Stronks
- Department of Public and Occupational Health, Amsterdam UMC, University of Amsterdam, Amsterdam Public Health Research Institute, Meibergdreef 9, Amsterdam, 1105 AZ, The Netherlands
- Institute for Advanced Study, University of Amsterdam, Amsterdam, 1012 GC, The Netherlands
- Centre for Urban Mental Health, University of Amsterdam, Amsterdam, 1012 GC, The Netherlands
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Savi MK, Callo-Concha D, Tonnang HEZ, Borgemeister C. Emerging properties of malaria transmission and persistence in urban Accra, Ghana: evidence from a participatory system approach. Malar J 2021; 20:321. [PMID: 34281554 PMCID: PMC8287558 DOI: 10.1186/s12936-021-03851-7] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/25/2021] [Accepted: 07/12/2021] [Indexed: 11/10/2022] Open
Abstract
Background Several studies that aim to enhance the understanding of malaria transmission and persistence in urban settings failed to address its underlining complexity. This study aims at doing that by applying qualitative and participatory-based system analysis and mapping to elicit the system’s emergent properties. Methods In two experts’ workshops, the system was sketched and refined. This system was represented through a causal loop diagram, where the identification of leverage points was done using network analysis. Results 45 determinants interplaying through 56 linkages, and three subsystems: urbanization-related transmission, infection-prone behaviour and healthcare efficiency, and Plasmodium resistance were identified. Apart from the number of breeding sites and malaria-positive cases, other determinants such as drug prescription and the awareness of householders were identified by the network analysis as leverage points and emergent properties of the system of transmission and persistence of malaria. Conclusion Based on the findings, the ongoing efforts to control malaria, such as the use of insecticide-treated bed nets and larvicide applications should continue, and new ones focusing on the public awareness and malaria literacy of city dwellers should be included. The participatory approach strengthened the legitimacy of the recommendations and the co-learning of participants. Supplementary Information The online version contains supplementary material available at 10.1186/s12936-021-03851-7.
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Affiliation(s)
| | - Daniel Callo-Concha
- Center for Development Research (ZEF), University of Bonn, 53113, Bonn, Germany.,Institute for Environmental Sciences (iES), University of Koblenz-Landau, 76829, Landau, Germany
| | - Henri E Z Tonnang
- International Centre for Insect Physiology and Ecology (Icipe), Nairobi, Kenya
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Waterlander WE, Singh A, Altenburg T, Dijkstra C, Luna Pinzon A, Anselma M, Busch V, van Houtum L, Emke H, Overman ML, Chinapaw MJM, Stronks K. Understanding obesity-related behaviors in youth from a systems dynamics perspective: The use of causal loop diagrams. Obes Rev 2021; 22:e13185. [PMID: 33369045 PMCID: PMC8243923 DOI: 10.1111/obr.13185] [Citation(s) in RCA: 31] [Impact Index Per Article: 10.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/28/2020] [Revised: 11/30/2020] [Accepted: 12/01/2020] [Indexed: 12/21/2022]
Abstract
This paper reports how we applied systems dynamics methods to gain insight into the complexity of obesity-related behaviors in youth, including diet, physical activity, sedentary behavior, and sleep, by integrating a literature review into causal loop diagrams (CLDs). Results showed that the CLDs consisted of multiple subsystems and three types of dynamics appeared, including (1) feedback loops, (2) connections between feedback loops and subsystems, and (3) mechanisms. We observed clear similarities in the dynamics for the four behaviors in that they relate to "traditional" subsystems, such as home and school environments, as well as to newly added subsystems, including macroeconomics, social welfare, and urban systems. The CLDs provided insights that can support the development of intervention strategies, including (1) the confirmation that a range of mechanisms cover and connect multiple levels and settings, meaning that there is no silver bullet to address obesity; (2) understanding of how interventions in one particular setting, such as school, might be influenced by the interactions with other settings, such as urban systems; and (3) a comprehensive view of (un)intended consequences. This way of framing the problem will assist moving towards public health interventions that respond to and operate in the complexity of the real world.
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Affiliation(s)
- Wilma E Waterlander
- Department of Public and Occupational Health, Amsterdam Public Health Research Institute, Amsterdam UMC, University of Amsterdam, Amsterdam, The Netherlands
| | - Amika Singh
- Department of Public and Occupational Health, Amsterdam Public Health Research Institute, Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam, The Netherlands.,Mulier Institute, Utrecht, The Netherlands
| | - Teatske Altenburg
- Department of Public and Occupational Health, Amsterdam Public Health Research Institute, Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam, The Netherlands
| | - Coosje Dijkstra
- Department of Health Sciences, Amsterdam Public Health Research Institute, Vrije Universiteit Amsterdam, Amsterdam, The Netherlands
| | - Angie Luna Pinzon
- Department of Public and Occupational Health, Amsterdam Public Health Research Institute, Amsterdam UMC, University of Amsterdam, Amsterdam, The Netherlands
| | - Manou Anselma
- Department of Public and Occupational Health, Amsterdam Public Health Research Institute, Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam, The Netherlands
| | - Vincent Busch
- Public Health Service Amsterdam, Sarphati Amsterdam, Amsterdam, The Netherlands
| | - Lieke van Houtum
- Public Health Service Amsterdam, Sarphati Amsterdam, Amsterdam, The Netherlands
| | - Helga Emke
- Department of Public and Occupational Health, Amsterdam Public Health Research Institute, Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam, The Netherlands
| | - Meredith L Overman
- Department of Health Promotion, NUTRIM School of Nutrition and Translational Research in Metabolism, Maastricht University, Maastricht, The Netherlands
| | - Mai J M Chinapaw
- Department of Public and Occupational Health, Amsterdam Public Health Research Institute, Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam, The Netherlands
| | - Karien Stronks
- Department of Public and Occupational Health, Amsterdam Public Health Research Institute, Amsterdam UMC, University of Amsterdam, Amsterdam, The Netherlands
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