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Klocek A, Premus J, Řiháček T. Applying dynamic systems theory and complexity theory methods in psychotherapy research: A systematic literature review. Psychother Res 2024; 34:828-844. [PMID: 37652751 DOI: 10.1080/10503307.2023.2252169] [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: 01/31/2023] [Revised: 08/18/2023] [Accepted: 08/21/2023] [Indexed: 09/02/2023] Open
Abstract
OBJECTIVE Dynamic systems theory and complexity theory (DST/CT) is a framework explaining how complex systems change and adapt over time. In psychotherapy, DST/CT can be used to understand how a person's mental and emotional state changes during therapy incorporating higher levels of complexity. This study aimed to systematically review the variability of DST/CT methods applied in psychotherapy research. METHODS A primary studies search was conducted in the EBSCO and Web of Knowledge databases, extracting information about the analyzed DST/CT phenomena, employed mathematical methods to investigate these phenomena, descriptions of specified dynamic models, psychotherapy phenomena, and other information regarding studies with empirical data (e.g., measurement granularity). RESULTS After screening 38,216 abstracts and 4,194 full texts, N = 41 studies published from 1990 to 2021 were identified. The employed methods typically included measures of dynamic complexity or chaoticity. Computational and simulation studies most often employed first-order ordinary differential equations and typically focused on describing the time evolution of client-therapist dyadic influences. Eligible studies with empirical data were usually based on case studies and focused on data with high time intensity of within-session dynamics. CONCLUSION This review provides a descriptive synthesis of the current state of the proliferation of DST/CT methods in the psychotherapy research field.
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Affiliation(s)
- Adam Klocek
- Faculty of Social Studies, Psychology Research Institute, Masaryk University, Brno, Czech Republic
| | | | - Tomáš Řiháček
- Faculty of Social Studies, Department of Psychology, Masaryk University, Brno, Czech Republic
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Sharma S, Davies C, Mana HRT, Baker M, Kvalsvig A, Walton M. Supporting whānau during COVID-19 pandemic in Aotearoa New Zealand: a systems thinking case study. BMC Health Serv Res 2024; 24:717. [PMID: 38858664 PMCID: PMC11165734 DOI: 10.1186/s12913-024-11164-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/12/2023] [Accepted: 05/31/2024] [Indexed: 06/12/2024] Open
Abstract
BACKGROUND The Aotearoa New Zealand COVID-19 pandemic response has been hailed as a success story, however, there are concerns about how equitable it has been. This study explored the experience of a collective of Māori health and social service providers in the greater Wellington region of Aotearoa New Zeland delivering COVID-19 responses. METHODS The study was a collaboration between a large urban Māori health and social service provider, Tākiri Mai Te Ata whānau ora collective, and public health researchers in Aotearoa New Zealand. Two online workshops were held with staff of the Māori service provider, collectively developing a qualitative causal loop diagram and generating systemic insights. The causal loop diagram showed interactions of various factors affecting COVID-19 response for supporting whānau (Māori family/households) at a community level. The iceberg model of systems thinking offered insights for action in understanding causal loop diagrams, emphasizing impactful changes at less visible levels. RESULTS Six interacting subsystems were identified within the causal loop diagram that highlighted the systemic barriers and opportunities for effective COVID-19 response to Māori whānau. The medical model of health service produces difficulties for delivering kaupapa Māori services. Along with pre-existing vulnerability and health system gaps, these difficulties increased the risk of negative impacts on Māori whānau as COVID-19 cases increased. The study highlighted a critical need to create equal power in health perspectives, reducing dominance of the individual-focused medical model for better support of whānau during future pandemics. CONCLUSIONS The study provided insights on systemic traps, their interactions and delays contributing to a relatively less effective COVID-19 response for Māori whānau and offered insights for improvement. In the light of recent changes in the Aotearoa New Zealand health system, the findings emphasize the urgent need for structural reform to address power imbalances and establish kaupapa Māori approach and equity as a norm in service planning and delivery.
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Affiliation(s)
- Sudesh Sharma
- Institute of Environmental Science and Research, 27 Creyke Road, Ilam, Christchurch, 8041, New Zealand.
| | - Cheryl Davies
- Kōkiri Marae Hauora and Te Rōpū Rangahau Hauora A Eru Pōmare, University of Otago, 7-9 Barnes Street, Seaview, Lower Hutt , Wellington, 5010, New Zealand
| | - Helena Rattray-Te Mana
- Institute of Environmental Science and Research, 34 Kenepuru Drive, Porirua, Wellington, 5022, New Zealand
| | - Michael Baker
- University of Otago, 23A Mein Street, Newtown, Wellington, 6021, New Zealand
| | - Amanda Kvalsvig
- University of Otago, 23A Mein Street, Newtown, Wellington, 6021, New Zealand
| | - Mat Walton
- Institute of Environmental Science and Research, 34 Kenepuru Drive, Porirua, Wellington, 5022, New Zealand
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Souza Filho AND, Bezerra TA, Bandeira PFR, Cabral LG, Brito A, Guerra PH, Martins CMDL, Carvalho FO. Association between the environment for physical activity in public schools and childhood obesity: a view in the light of complex systems. CIENCIA & SAUDE COLETIVA 2024; 29:e05162023. [PMID: 38896672 DOI: 10.1590/1413-81232024296.05162023] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/26/2023] [Accepted: 08/21/2023] [Indexed: 06/21/2024] Open
Abstract
This article aims to analyse the relationship between physical activity (PA) environment at schools, sex, age, and obesity in children, using a network approach. This is a cross-sectional study, with 1,200 children (8.1±1.0 years old) from eight public schools in the same municipality. Weight and height measurements were assessed to calculate the Body Mass Index (BMI) and classified as healthier weight or overweight. To assess the PA environment at school, a interview with the school´s manager was conducted. The association between the PA environment at school and obesity was tested using a Network Analysis performed on the Jasp software. Positive associations between BMI and Physical Education classes (0.847), physical education teacher (0.349), break duration (0.564), and indoor sports court (0.662) were observed. Negative associations were seen with sex (-0.212) age (-0.387), extracurricular PA (-0.492), and playground (-0.557). Additionally, the centrality indicators highlighted extracurricular PA (1.789) as the variables with the highest betweenness values, and BMI with the highest closeness (2.239) and strength (1.230) values. Extracurricular PA and the presence of playgrounds in school´s environment are associated with healthier weight in low-income children.
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Affiliation(s)
- Anastácio Neco de Souza Filho
- Departamento de Educação Física, Universidade Regional do Cariri. R. Cel. Antônio Luíz 1161, Pimenta. 63105-010 Crato CE Brasil.
| | - Thaynã Alves Bezerra
- Departamento de Educação Física, Universidade Regional do Cariri. R. Cel. Antônio Luíz 1161, Pimenta. 63105-010 Crato CE Brasil.
| | - Paulo Felipe Ribeiro Bandeira
- Departamento de Educação Física, Universidade Regional do Cariri. R. Cel. Antônio Luíz 1161, Pimenta. 63105-010 Crato CE Brasil.
| | - Luciana Gatto Cabral
- Departamento de Educação Física, Universidade Federal da Paraíba. João Pessoa PB Brasil
| | - André Brito
- Departamento de Educação Física, Universidade Federal do Vale do São Francisco. Petrolina PE Brasil
| | - Paulo Henrique Guerra
- Departamento de Medicina, Universidade Federal de Fronteira do Sul. Chapecó RS Brasil
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Coetzer JA, Loukili I, Goedhart NS, Ket JCF, Schuitmaker-Warnaar TJ, Zuiderent-Jerak T, Dedding C. The potential and paradoxes of eHealth research for digitally marginalised groups: A qualitative meta-review. Soc Sci Med 2024; 350:116895. [PMID: 38710135 DOI: 10.1016/j.socscimed.2024.116895] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/03/2023] [Revised: 04/10/2024] [Accepted: 04/15/2024] [Indexed: 05/08/2024]
Abstract
Whilst the transformation towards digital healthcare is accelerating, there is still a substantial risk of excluding people with a distance to the online world. Groups like people with a low socioeconomic position, people with a migrant background or the elderly, who are already most at risk of experiencing health inequalities, are simultaneously experiencing increased digital exclusion. Researchers play a role in determining how eHealth access is framed and can thus impact how the barriers to its use are addressed. This qualitative meta-review critically evaluates the way researchers (as authors) discuss eHealth use in digitally marginalised groups. Specifically, it seeks to understand how eHealth is framed to address existing health systems problems; how the barriers to eHealth use are presented and which solutions are provided in response; and who authors suggest should be responsible for making eHealth work. The results of this review found four paradoxes in how current literature views eHealth use. Firstly, that health systems problems are complex and nuanced, yet eHealth is seen as a simple answer. Secondly, that there are many political, social and health systems-based solutions suggested to address eHealth use, however most of the identified barriers are individually framed. This focus on personal deficits results in misallocating responsibility for making these systemic improvements. Thirdly, although eHealth is meant to simplify the tasks of patients and healthcare workers, these are the groups most often burdened with the responsibility of ensuring its success. Lastly, despite tailoring eHealth to the user being the most suggested solution, researchers generally speak about groups as a homogenous entity - thus rendering tailoring difficult. Ultimately, this review finds that a shift to focus research on addressing systemic issues on a systems level is necessary to prevent further exacerbating existing health inequalities.
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Affiliation(s)
- Jessica A Coetzer
- Athena Institute, Faculty of Science, VU University, De Boelelaan 1085, 1081HV, Amsterdam, the Netherlands.
| | - Ibrahim Loukili
- Department of Ethics, Law & Humanities, Amsterdam UMC, De Boelelaan 1089a, F-vleugel medische faculteit, Amsterdam, The Netherlands.
| | - Nicole S Goedhart
- Department of Ethics, Law & Humanities, Amsterdam UMC, De Boelelaan 1089a, F-vleugel medische faculteit, Amsterdam, The Netherlands.
| | - Johannes C F Ket
- VUmc, Medische Bibliotheek, De Boelelaan 1117, 1081 HV, Amsterdam, the Netherlands.
| | | | - Teun Zuiderent-Jerak
- Athena Institute, Faculty of Science, VU University, De Boelelaan 1085, 1081HV, Amsterdam, the Netherlands.
| | - Christine Dedding
- Department of Ethics, Law & Humanities, Amsterdam UMC, De Boelelaan 1089a, F-vleugel medische faculteit, Amsterdam, The Netherlands.
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Wai JM, Blevins D, Hunt T, Gilbert L, Campbell ANC, Levin FR, El-Bassel N, Nunes E. An Approach to Enhancing Medication Treatment for Opioid Use Disorder in the HEALing Communities Study. Psychiatr Serv 2024; 75:580-588. [PMID: 38347814 DOI: 10.1176/appi.ps.20230159] [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] [Indexed: 04/13/2024]
Abstract
The HEALing (Helping to End Addiction Long-term) Communities Study (HCS) aims to test the effectiveness of the Communities That HEAL intervention in decreasing opioid overdose deaths in 67 communities across four U.S. states. This intervention enlists a collaborative team of researchers, academic experts, and community coalitions to select and implement interventions from a menu of evidence-based practices, including medications for opioid use disorder (MOUD). The HCS's New York team developed an integrated network systems (INS) approach with a mapping tool to coach coalitions in the selection of strategies to enhance medication treatment. With the INS approach, community coalitions develop a map of service delivery venues in their local county to better engage people with medication treatment wherever this need arises. The map is structured around core services that can provide maintenance MOUD and satellite services, which include all settings where people with opioid use disorder are encountered and can be identified, possibly given medication, and referred to core programs for ongoing MOUD care. This article describes the rationale for the INS mapping tool, with a discussion framed by the consolidated framework for implementation research, and provides a case example of its application.
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Affiliation(s)
- Jonathan M Wai
- Department of Psychiatry, Columbia University Vagelos College of Physicians and Surgeons, and Division on Substance Use Disorders, New York State Psychiatric Institute, New York City (Wai, Blevins, Campbell, Levin, Nunes); School of Social Work, Columbia University, New York City (Hunt, Gilbert, El-Bassel)
| | - Derek Blevins
- Department of Psychiatry, Columbia University Vagelos College of Physicians and Surgeons, and Division on Substance Use Disorders, New York State Psychiatric Institute, New York City (Wai, Blevins, Campbell, Levin, Nunes); School of Social Work, Columbia University, New York City (Hunt, Gilbert, El-Bassel)
| | - Tim Hunt
- Department of Psychiatry, Columbia University Vagelos College of Physicians and Surgeons, and Division on Substance Use Disorders, New York State Psychiatric Institute, New York City (Wai, Blevins, Campbell, Levin, Nunes); School of Social Work, Columbia University, New York City (Hunt, Gilbert, El-Bassel)
| | - Louisa Gilbert
- Department of Psychiatry, Columbia University Vagelos College of Physicians and Surgeons, and Division on Substance Use Disorders, New York State Psychiatric Institute, New York City (Wai, Blevins, Campbell, Levin, Nunes); School of Social Work, Columbia University, New York City (Hunt, Gilbert, El-Bassel)
| | - Aimee N C Campbell
- Department of Psychiatry, Columbia University Vagelos College of Physicians and Surgeons, and Division on Substance Use Disorders, New York State Psychiatric Institute, New York City (Wai, Blevins, Campbell, Levin, Nunes); School of Social Work, Columbia University, New York City (Hunt, Gilbert, El-Bassel)
| | - Frances R Levin
- Department of Psychiatry, Columbia University Vagelos College of Physicians and Surgeons, and Division on Substance Use Disorders, New York State Psychiatric Institute, New York City (Wai, Blevins, Campbell, Levin, Nunes); School of Social Work, Columbia University, New York City (Hunt, Gilbert, El-Bassel)
| | - Nabila El-Bassel
- Department of Psychiatry, Columbia University Vagelos College of Physicians and Surgeons, and Division on Substance Use Disorders, New York State Psychiatric Institute, New York City (Wai, Blevins, Campbell, Levin, Nunes); School of Social Work, Columbia University, New York City (Hunt, Gilbert, El-Bassel)
| | - Edward Nunes
- Department of Psychiatry, Columbia University Vagelos College of Physicians and Surgeons, and Division on Substance Use Disorders, New York State Psychiatric Institute, New York City (Wai, Blevins, Campbell, Levin, Nunes); School of Social Work, Columbia University, New York City (Hunt, Gilbert, El-Bassel)
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Fell SE, Bowie P, Spalding K, Medves J. Preliminary adaptation of the systems thinking for everyday work cue card set in a US healthcare system: a pragmatic and participatory co-design approach. BMJ Open Qual 2024; 13:e002655. [PMID: 38782484 PMCID: PMC11116854 DOI: 10.1136/bmjoq-2023-002655] [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: 10/19/2023] [Accepted: 05/02/2024] [Indexed: 05/25/2024] Open
Abstract
INTRODUCTION Healthcare is a highly complex adaptive system, requiring a systems approach to understand its behaviour better. We adapt the Systems Thinking for Everyday Work (STEW) cue cards, initially introduced as a systems approach tool in the UK, in a US healthcare system as part of a study investigating the feasibility of a systems thinking approach for front-line workers. METHODS The original STEW cards were adapted using consensus-building methods with front-line staff and safety leaders. RESULTS Each card was examined for relevance, applicability, language and aesthetics (colour, style, visual cues and size). Two sets of cards were created due to the recognition that systems thinking was relatively new in healthcare and that the successful use of the principles on the cards would need initial facilitation to ensure their effective application. Six principles were agreed on and are presented in the cards: Your System outlines the need to agree that problems belong to a system and that the system must be defined. Viewpoints ensure that multiple voices are heard within the discussion. Work Condition highlights the resources, constraints and barriers that exist in the system and contribute to the system's functions. Interactions ask participants to understand how parts of the system interact to perform the work. Performance guides users to understand how work can be performed daily. Finally, Understanding seeks to promote a just cultural environment of appreciating that people do what makes sense to them. The two final sets of cards were scored using a content validity survey, with a final score of 1. CONCLUSIONS The cards provide an easy-to-use guide to help users understand the system being studied, learn from problems encountered and understand the everyday work involved in providing excellent care. The cards offer a practical 'systems approach' for use within complex healthcare systems.
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Affiliation(s)
- Samantha E Fell
- Healthcare Quality, Queen's University, Kingston, Ontario, Canada
| | - Paul Bowie
- NHS Education for Scotland, Edinburgh, UK
| | | | - Jennifer Medves
- School of Nursing, Queens University, Kingston, Ontario, Canada
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Beenackers MA, Kruize H, Barsties L, Acda A, Bakker I, Droomers M, Kamphuis CBM, Koomen E, Nijkamp JE, Vaandrager L, Völker B, Luijben G, Ruijsbroek A. Urban densification in the Netherlands and its impact on mental health: An expert-based causal loop diagram. Health Place 2024; 87:103218. [PMID: 38564990 DOI: 10.1016/j.healthplace.2024.103218] [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: 10/13/2023] [Revised: 01/30/2024] [Accepted: 02/21/2024] [Indexed: 04/04/2024]
Abstract
Urban densification is a key strategy to accommodate rapid urban population growth, but emerging evidence suggests serious risks of urban densification for individuals' mental health. To better understand the complex pathways from urban densification to mental health, we integrated interdisciplinary expert knowledge in a causal loop diagram via group model building techniques. Six subsystems were identified: five subsystems describing mechanisms on how changes in the urban system caused by urban densification may impact mental health, and one showing how changes in mental health may alter urban densification. The new insights can help to develop resilient, healthier cities for all.
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Affiliation(s)
- Mariëlle A Beenackers
- Department of Public Health, Erasmus MC, University Medical Center Rotterdam, Rotterdam, the Netherlands.
| | - Hanneke Kruize
- National Institute for Public Health and the Environment (RIVM), Bilthoven, the Netherlands; HU University of Applied Sciences Utrecht, Utrecht, the Netherlands.
| | - Lisa Barsties
- National Institute for Public Health and the Environment (RIVM), Bilthoven, the Netherlands.
| | - Annelies Acda
- Annelies Acda Advies - public health, policy and the built environment, Bussum, the Netherlands.
| | - Ingrid Bakker
- Department of Urban Innovation, Research Centre of Social Innovations Flevoland, Windesheim University of Applied Sciences, Almere, the Netherlands.
| | - Mariël Droomers
- Department of Public Health, City of Utrecht, Utrecht, the Netherlands.
| | - Carlijn B M Kamphuis
- Department of Interdisciplinary Social Science, Utrecht University, Utrecht, the Netherlands.
| | - Eric Koomen
- Department of Spatial Economics, Vrije Universiteit Amsterdam, Amsterdam, the Netherlands.
| | - Jeannette E Nijkamp
- Department of Healthy Cities, Research Centre for Built Environment NoorderRuimte, Hanze University of Applied Sciences Groningen, Groningen, the Netherlands.
| | - Lenneke Vaandrager
- Health and Society, Wageningen University and Research, Wageningen, the Netherlands.
| | - Beate Völker
- Department Human Geography and Spatial Planning, Utrecht University, Utrecht, the Netherlands; Netherlands Centre for the Study of Crime and Law Enforcement (NSCR), Amsterdam, the Netherlands.
| | - Guus Luijben
- National Institute for Public Health and the Environment (RIVM), Bilthoven, the Netherlands.
| | - Annemarie Ruijsbroek
- National Institute for Public Health and the Environment (RIVM), Bilthoven, the Netherlands.
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Chong DWQ, Jayaraj VJ, Ab Rahim FI, Syed Soffian SS, Azmi MF, Mohd Yusri MY, Mohamed Sidek AS, Azmi N, Md Said R, Md Salleh MF, Abu Bakar N, Shahar H, Abdul Rashid RM, Samad SA, Ahmad Z, Ismail MS, A. Bakar A, Hj Jobli NM, Sararaks S. Study protocol for a mixed methods approach to optimize colorectal cancer screening in Malaysia: Integrating stakeholders insights and knowledge-to-action framework. PLoS One 2024; 19:e0299659. [PMID: 38593177 PMCID: PMC11003698 DOI: 10.1371/journal.pone.0299659] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/24/2023] [Accepted: 02/12/2024] [Indexed: 04/11/2024] Open
Abstract
INTRODUCTION Colorectal cancer is a growing global health concern and the number of reported cases has increased over the years. Early detection through screening is critical to improve outcomes for patients with colorectal cancer. In Malaysia, there is an urgent need to optimize the colorectal cancer screening program as uptake is limited by multiple challenges. This study aims to systematically identify and address gaps in screening service delivery to optimize the Malaysian colorectal cancer screening program. METHODS This study uses a mixed methods design. It focuses primarily on qualitative data to understand processes and strategies and to identify specific areas that can be improved through stakeholder engagement in the screening program. Quantitative data play a dual role in supporting the selection of participants for the qualitative study based on program monitoring data and assessing inequalities in screening and program implementation in healthcare facilities in Malaysia. Meanwhile, literature review identifies existing strategies to improve colorectal cancer screening. Additionally, the knowledge-to-action framework is integrated to ensure that the research findings lead to practical improvements to the colorectal cancer screening program. DISCUSSION Through this complex mix of qualitative and quantitative methods, this study will explore the complex interplay of population- and systems-level factors that influence screening rates. It involves identifying barriers to effective colorectal cancer screening in Malaysia, comparing current strategies with international best practices, and providing evidence-based recommendations to improve the local screening program.
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Affiliation(s)
- Diane Woei-Quan Chong
- Institute for Health Systems Research, National Institutes of Health, Centre for Health Services Research, Ministry of Health Malaysia, Shah Alam, Malaysia
| | - Vivek Jason Jayaraj
- National Institutes of Health, Sector for Biostatistics and Data Repository, NIH Manager’s Office, Ministry of Health Malaysia, Shah Alam, Malaysia
| | - Fathullah Iqbal Ab Rahim
- Institute for Health Systems Research, National Institutes of Health, Centre for Health Equity Research, Ministry of Health Malaysia, Shah Alam, Malaysia
| | | | | | - Mohd Yusaini Mohd Yusri
- Bandar Sri Jempol Health Clinic, Ministry of Health Malaysia, Bandar Seri Jempol, Negeri Sembilan, Malaysia
| | - Ahmad Shanwani Mohamed Sidek
- Department of General Surgery, Hospital Raja Perempuan Zainab II, Ministry of Health Malaysia, Kota Bahru, Kelantan, Malaysia
| | - Norfarizan Azmi
- Department of General Surgery, Hospital Tuanku Ja’afar, Ministry of Health Malaysia, Seremban, Negeri Sembilan, Malaysia
| | - Rosaida Md Said
- Department of Medicine, Hospital Serdang, Ministry of Health Malaysia, Kajang, Selangor, Malaysia
| | - Muhammad Firdaus Md Salleh
- Department of Medicine, Hospital Sultanah Aminah, Ministry of Health Malaysia, Johor Bahru, Johor, Malaysia
| | - Norasiah Abu Bakar
- Department of Medicine, Hospital Raja Perempuan Zainab II, Ministry of Health Malaysia, Kota Bahru, Kelantan, Malaysia
| | - Hamiza Shahar
- Department of Medicine, Hospital Tengku Ampuan Rahimah, Ministry of Health Malaysia, Klang, Selangor, Malaysia
| | | | - Shazimah Abdul Samad
- Family Health Development Division, Ministry of Health Malaysia, Putrajaya, Malaysia
| | - Zanita Ahmad
- Family Health Development Division, Ministry of Health Malaysia, Putrajaya, Malaysia
| | - Mohd Safiee Ismail
- Family Health Development Division, Ministry of Health Malaysia, Putrajaya, Malaysia
| | - Adilah A. Bakar
- Medical Development Division, Ministry of Health Malaysia, Putrajaya, Malaysia
| | | | - Sondi Sararaks
- Institute for Health Systems Research, National Institutes of Health, Director’s Office, Ministry of Health Malaysia, Shah Alam, Malaysia
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Constantino H, Pistollato F, Seidle T. Transitioning biomedical research toward human-centric methodologies: systems-based strategies. Drug Discov Today 2024; 29:103947. [PMID: 38460569 DOI: 10.1016/j.drudis.2024.103947] [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: 11/14/2023] [Revised: 02/26/2024] [Accepted: 03/05/2024] [Indexed: 03/11/2024]
Abstract
Human-centric methodologies like microphysiological systems and in silico methods have shown promise in addressing the limitations of animal models in understanding human biology and responding to public health priorities. However, the prevailing paradigm based on animal research persists. The article proposes a systemic thinking approach, endorsed by the OECD and the EU, as a tool to leverage innovation to reframe the issue and achieve transformative policies. By identifying the complex factors shaping method selection in basic and biomedical research, a simplified model is presented to illuminate the systemic nature of this decision-making process. The goal is not to prescribe solutions but to offer policymakers a new framework for more-effective strategies, emphasizing collaboration among stakeholders and the need for robust data.
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Affiliation(s)
| | | | - Troy Seidle
- Research & Toxicology, Humane Society International, Toronto, Canada
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Joyce A. A Settings and Systems Approach to Promoting the Health and Wellbeing of People with an Intellectual Disability. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2024; 21:409. [PMID: 38673322 PMCID: PMC11050249 DOI: 10.3390/ijerph21040409] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/12/2024] [Revised: 03/20/2024] [Accepted: 03/25/2024] [Indexed: 04/28/2024]
Abstract
Research has shown that people with an intellectual disability have higher rates of certain preventable health conditions and a higher rate of avoidable mortality relative to the general population. With respect to health behaviours, they also have lower levels of physical activity and poorer nutrition. Despite the increased health needs, this population cohort is less likely to have the opportunity to participate in health promotion programs. The interventions that have been delivered are programmatic and individual in focus and have lacked a broader ecological and settings focus, which makes them very difficult to scale. Health promotion programs designed for the general population, such as lifestyle campaigns, rarely reach people with an intellectual disability. This increases the importance of ensuring that the settings in which they live and engage with are as health promoting as possible. Interventions have been particularly absent in the workplace for people with an intellectual disability. This paper highlights gaps in a settings-and-systems-based approach to promoting the health and wellbeing of people with an intellectual disability, particularly with respect to workplace health promotion. The paper concludes with recommendations for a systems approach that integrates approaches across multiple settings to better promote the health of this population cohort.
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Affiliation(s)
- Andrew Joyce
- Centre for Social Impact, Swinburne University of Technology, Hawthorn, VIC 3122, Australia
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Bryant M, Burton W, Collinson M, Martin A, Copsey B, Groves-Williams D, Foster A, Willis TA, Garnett P, O'Cathain A. Effectiveness and cost-effectiveness of a sustainable obesity prevention programme for preschool children delivered at scale 'HENRY' (Health, Exercise, Nutrition for the Really Young): protocol for the HENRY III cluster randomised controlled trial. BMJ Open 2024; 14:e081861. [PMID: 38531586 DOI: 10.1136/bmjopen-2023-081861] [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: 03/28/2024] Open
Abstract
INTRODUCTION One-fifth of children start school already overweight or living with obesity, with rates disproportionately impacting those living in the most deprived areas. Social, environmental and biological factors contribute to excess weight gain and programmes delivered in early years settings aim to support families to navigate these in order to prevent obesity. One of these programmes (Health, Exercise and Nutrition for the Really Young, HENRY) has been delivered in UK community venues (hereon named 'centres') in high deprivation areas since 2008 and aims to help families to provide a healthy start for their preschool children. We aim to establish the effectiveness and cost-effectiveness of HENRY, including its potential role from a wider systems perspective. METHODS AND ANALYSIS This is a multicentre, open-labelled, two-group, prospective, cluster randomised controlled trial, with cost-effectiveness analysis, systems-based process evaluation and internal pilot. Primary analysis will compare body mass index (BMI) z-score at 12 months in children (n=984) whose parents have attended HENRY to those who have not attended. Secondary outcomes include parent and staff BMI and waist circumference, parenting efficacy, feeding, eating habits, quality of life, resource use and medium term (3 years) BMI z-scores (child and siblings). 82 centres in ~14 local authority areas will be randomised (1:1) to receive HENRY or continue with standard practice. Intention-to-treat analysis will compare outcomes using mixed effects linear regression. Economic evaluation will estimate a within-trial calculation of cost-per unit change in BMI z-score and longer-term trajectories to determine lifelong cost savings (long-term outcomes). A systems process evaluation will explore whether (and how) implementation of HENRY impacts (and is impacted by) the early years obesity system. An established parent advisory group will support delivery and dissemination. ETHICS AND DISSEMINATION Ethical approval has been granted by the University of York, Health Sciences' Research Governance Committee (HSRGC/2022/537/E). Dissemination includes policy reports, community resources, social media and academic outputs. TRIAL REGISTRATION NUMBER ISRCTN16529380.
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Affiliation(s)
- Maria Bryant
- Hull York Medical School, University of York, York, UK
- Department of Health Sciences, University of York, York, UK
| | - Wendy Burton
- Department of Health Sciences, University of York, York, UK
| | - Michelle Collinson
- Clinical Trials Research Unit, Leeds Institute for Clinical Trials Research, University of Leeds, Leeds, UK
| | - Adam Martin
- Academic Unit of Health Economics Leeds Institute of Health Sciences, University of Leeds, Leeds, UK
| | - Bethan Copsey
- Clinical Trials Research Unit, Leeds Institute for Clinical Trials Research, University of Leeds, Leeds, UK
| | - Dawn Groves-Williams
- Clinical Trials Research Unit, Leeds Institute for Clinical Trials Research, University of Leeds, Leeds, UK
| | - Alexis Foster
- Sheffield centre for Health and Related Research, University of Sheffield, Sheffield, UK
| | - Thomas A Willis
- Leeds Institute for Health Sciences, University of Leeds, Leeds, UK
| | - Philip Garnett
- School for Business and Society, University of York, York, UK
| | - Alicia O'Cathain
- Sheffield centre for Health and Related Research, University of Sheffield, Sheffield, UK
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Koorts H, Ma J, Swain CTV, Rutter H, Salmon J, Bolton KA. Systems approaches to scaling up: a systematic review and narrative synthesis of evidence for physical activity and other behavioural non-communicable disease risk factors. Int J Behav Nutr Phys Act 2024; 21:32. [PMID: 38515118 PMCID: PMC10958859 DOI: 10.1186/s12966-024-01579-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/07/2023] [Accepted: 02/24/2024] [Indexed: 03/23/2024] Open
Abstract
BACKGROUND Non-communicable diseases (NCDs) are the leading causes of death worldwide. Systems approaches have potential for creating sustainable outcomes at scale but have rarely been used to support scale up in physical activity/nutrition promotion or NCD prevention more generally. This review aimed to: (i) synthesise evidence on the use of systems approaches in scaling up interventions targeting four behavioural risk factors for NCDs; and (ii) to explore how systems approaches have been conceptualised and used in intervention implementation and scale up. METHOD Seven electronic databases were searched for studies published 2016-2021. Eligible studies targeted at least one of four NCD behavioural risk factors (physical inactivity, tobacco use, alcohol consumption, diet), or described evaluation of an intervention planned for or scaled up. Studies were categorised as having a (i) high, (ii) moderate, or (iii) no use of a systems approach. A narrative synthesis of how systems approaches had been operationalised in scale up, following PRISMA guidelines. RESULTS Twenty-one intervention studies were included. Only 19% (n = 4) of interventions explicitly used systems thinking to inform intervention design, implementation and scale up (targeting all four risk factors n = 2, diet n = 1, tobacco use n = 1). Five studies ('high use') planned and implemented scale up with an explicit focus on relations between system elements and used system changes to drive impact at scale. Seven studies ('moderate use') considered systems elements impacting scale-up processes or outcomes but did not require achieving system-level changes from the outset. Nine studies ('no use') were designed to work at multiple levels among multiple agencies in an intervention setting, but the complexity of the system and relations between system elements was not articulated. We synthesised reported barriers and facilitators to scaling up, and how studies within each group conceptualised and used systems approaches, and methods, frameworks and principles for scaling up. CONCLUSION In physical activity research, and NCD prevention more broadly, the use of systems approaches in scale up remains in its infancy. For researchers, practitioners and policymakers wishing to adopt systems approaches to intervention implementation at scale, guidance is needed on how to communicate and operationalise systems approaches in research and in practice. TRIAL REGISTRATION PROSPERO (CRD42021287265).
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Affiliation(s)
- Harriet Koorts
- School of Exercise and Nutrition Sciences, Deakin University, Institute for Physical Activity and Nutrition (IPAN), 221 Burwood Highway, Burwood Geelong, VIC, 3125, Australia.
| | - Jiani Ma
- School of Exercise and Nutrition Sciences, Deakin University, Institute for Physical Activity and Nutrition (IPAN), 221 Burwood Highway, Burwood Geelong, VIC, 3125, Australia
| | - Christopher T V Swain
- Cancer Epidemiology Division, Cancer Council Victoria, Melbourne, Australia
- Department of Physiotherapy, Faculty of Medicine Dentistry and Health Sciences, Melbourne School of Health Sciences, University of Melbourne, Melbourne, Australia
| | - Harry Rutter
- Department of Social and Policy Sciences, University of Bath, Claverton Down, Bath, UK
| | - Jo Salmon
- School of Exercise and Nutrition Sciences, Deakin University, Institute for Physical Activity and Nutrition (IPAN), 221 Burwood Highway, Burwood Geelong, VIC, 3125, Australia
| | - Kristy A Bolton
- School of Exercise and Nutrition Sciences, Deakin University, Institute for Physical Activity and Nutrition (IPAN), 221 Burwood Highway, Burwood Geelong, VIC, 3125, Australia
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Fairman CM, Kava CM, Beima-Sofie K, Sakhuja M, Masud M, Dias E, Sheng J, Gorzelitz J, Morshed A, Green BB, Skiba MB, Madhivanan P, Parthasarathy N, Hirschey R, Vander Weg MW, Hebert J. Addressing differences in cancer: a framework for synergistic programming in cancer prevention and control. RESEARCH SQUARE 2024:rs.3.rs-4046415. [PMID: 38562683 PMCID: PMC10984020 DOI: 10.21203/rs.3.rs-4046415/v1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 04/04/2024]
Abstract
Background Cancer remains a leading cause of death worldwide and continues to disproportionately impact certain populations. Several frameworks have been developed that illustrate the multiple determinants of cancer. Expanding upon the work of others, we present an applied framework for cancer prevention and control designed to help clinicians, as well as public health practitioners and researchers, better address differences in cancer outcomes. Methods The framework was developed by the Cancer Prevention and Control Research Network's Health Behaviors Workgroup. An initial framework draft was developed based on workgroup discussion, public health theory, and rapid literature review on the determinants of cancer. The framework was refined through interviews and focus groups with Federally Qualified Health Center providers (n=2) and cancer patients (n=2); participants were asked to provide feedback on the framework's causal pathways, completeness, and applicability to their work and personal life. Results The framework provides an overview of the relationships between sociodemographic inequalities, social and structural determinants, and key risk factors associated with cancer diagnosis, survivorship, and cancer morbidity and mortality across the lifespan. The framework emphasizes how health-risk behaviors like cigarette smoking interact with psychological, psychosocial, biological, and psychosocial risk factors, as well as healthcare-related behavior and other chronic diseases. Importantly, the framework emphasizes addressing social and structural determinants that influence health behaviors to reduce the burden of cancer and improve health equity. Aligned with previous theory, our framework underscores the importance of addressing co-occurring risk factors and disease states, understanding the complex relationships between factors that influence cancer, and assessing how multiple forms of inequality or disadvantage intersect to increase cancer risk across the lifespan. Conclusions This paper presents an applied framework for cancer prevention and control to address cancer differences. Because the framework highlights determinants and factors that influence cancer risk at multiple levels, it can be used to inform the development, implementation, and evaluation of interventions to address cancer morbidity and mortality.
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Affiliation(s)
| | | | | | | | | | - E Dias
- UTHealth Houston School of Public Health
| | - J Sheng
- University of Wisconsin-Madison
| | | | | | - B B Green
- Kaiser Permanente Washington Health Research Institute
| | | | | | | | - R Hirschey
- University of North Carolina and Lineberger Comprehensive Cancer Center
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Stewart-Evans J, Koksal C, Chang M. Can the implementation of net gain requirements in England's planning system be applied to health? Lancet Planet Health 2024; 8:e188-e196. [PMID: 38453384 DOI: 10.1016/s2542-5196(24)00001-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/03/2023] [Revised: 01/04/2024] [Accepted: 01/09/2024] [Indexed: 03/09/2024]
Abstract
This Personal View considers the relationship between spatial planning and health and the potential benefits of requiring health net gain from land use decisions and new developments. We explore how a health net gain objective could be applied in spatial planning policy and practice to improve people's health and wellbeing, using England's implementation of a biodiversity net gain objective as a model. This Personal View emphasises the need for a systems approach to the definition and strategic coordination of health gains, recognising the breadth of health determinants and inter-related economic, environmental, and social policy objectives. By considering the potential application of a net gain principle to health in spatial planning, we offer valuable insights into how the spatial planning system could be used to build the conditions of health creation. A road map is provided for exploration of health net gain in other national contexts in support of the operationalisation of global urban health initiatives.
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Affiliation(s)
- James Stewart-Evans
- Nottingham Centre for Public Health and Epidemiology, University of Nottingham, Nottingham, UK.
| | - Caglar Koksal
- Planning, Property and Environmental Management, University of Manchester, Manchester, UK
| | - Michael Chang
- Department of Civil Engineering, University of Bristol, Bristol, UK
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Mudd AL, Bal M, Verra SE, Poelman MP, de Wit J, Kamphuis CBM. The current state of complex systems research on socioeconomic inequalities in health and health behavior-a systematic scoping review. Int J Behav Nutr Phys Act 2024; 21:13. [PMID: 38317165 PMCID: PMC10845451 DOI: 10.1186/s12966-024-01562-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/13/2023] [Accepted: 01/14/2024] [Indexed: 02/07/2024] Open
Abstract
BACKGROUND Interest in applying a complex systems approach to understanding socioeconomic inequalities in health is growing, but an overview of existing research on this topic is lacking. In this systematic scoping review, we summarize the current state of the literature, identify shared drivers of multiple health and health behavior outcomes, and highlight areas ripe for future research. METHODS SCOPUS, Web of Science, and PubMed databases were searched in April 2023 for peer-reviewed, English-language studies in high-income OECD countries containing a conceptual systems model or simulation model of socioeconomic inequalities in health or health behavior in the adult general population. Two independent reviewers screened abstracts and full texts. Data on study aim, type of model, all model elements, and all relationships were extracted. Model elements were categorized based on the Commission on Social Determinants of Health framework, and relationships between grouped elements were visualized in a summary conceptual systems map. RESULTS A total of 42 publications were included; 18 only contained a simulation model, 20 only contained a conceptual model, and 4 contained both types of models. General health outcomes (e.g., health status, well-being) were modeled more often than specific outcomes like obesity. Dietary behavior and physical activity were by far the most commonly modeled health behaviors. Intermediary determinants of health (e.g., material circumstances, social cohesion) were included in nearly all models, whereas structural determinants (e.g., policies, societal values) were included in about a third of models. Using the summary conceptual systems map, we identified 15 shared drivers of socioeconomic inequalities in multiple health and health behavior outcomes. CONCLUSIONS The interconnectedness of socioeconomic position, multiple health and health behavior outcomes, and determinants of socioeconomic inequalities in health is clear from this review. Factors central to the complex system as it is currently understood in the literature (e.g., financial strain) may be both efficient and effective policy levers, and factors less well represented in the literature (e.g., sleep, structural determinants) may warrant more research. Our systematic, comprehensive synthesis of the literature may serve as a basis for, among other things, a complex systems framework for socioeconomic inequalities in health.
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Affiliation(s)
- Andrea L Mudd
- Department of Interdisciplinary Social Science- Public Health, Utrecht University, PO Box 80140, 3508 TC, Utrecht, The Netherlands.
| | - Michèlle Bal
- Department of Interdisciplinary Social Science- Public Health, Utrecht University, PO Box 80140, 3508 TC, Utrecht, The Netherlands
| | - Sanne E Verra
- Department of Interdisciplinary Social Science- Public Health, Utrecht University, PO Box 80140, 3508 TC, Utrecht, The Netherlands
| | - Maartje P Poelman
- Chair Group Consumption and Healthy Lifestyles, Wageningen University & Research, Hollandseweg 1, 6706 KN, Wageningen, the Netherlands
| | - John de Wit
- Department of Interdisciplinary Social Science- Public Health, Utrecht University, PO Box 80140, 3508 TC, Utrecht, The Netherlands
| | - Carlijn B M Kamphuis
- Department of Interdisciplinary Social Science- Public Health, Utrecht University, PO Box 80140, 3508 TC, Utrecht, The Netherlands
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Crosland P, Ho N, Hosseini SH, Vacher C, Skinner A, Natsky AN, Rosenberg S, Hasudungan R, Huntley S, Song YJC, Lee GY, Marshall DA, Occhipinti JA, Hickie IB. Cost-effectiveness of system-level mental health strategies for young people in the Australian Capital Territory: a dynamic simulation modelling study. Lancet Psychiatry 2024; 11:123-133. [PMID: 38245017 DOI: 10.1016/s2215-0366(23)00396-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/19/2023] [Revised: 11/15/2023] [Accepted: 11/15/2023] [Indexed: 01/22/2024]
Abstract
BACKGROUND Regional mental health planning is a key challenge for decision makers because mental health care is a complex, dynamic system. Economic evaluation using a system dynamics modelling approach presents an opportunity for more sophisticated planning and important evidence on the value of alternative investments. We aimed to investigate the cost-effectiveness of eight systems-based interventions targeted at improving the mental health and wellbeing of children, adolescents, and young adults in the Australian Capital Territory (ACT). METHODS We assessed eight interventions for children and young people (aged ≤25 years) with low, moderate, and high-to-very-high psychological distress: technology-enabled integrated care, emergency department-based suicide prevention, crisis response service, family education programme, online parenting programme, school-based suicide prevention programme, trauma service for youths, and multicultural-informed care. We developed a system dynamics model for the ACT through a participatory process and calibrated the model with historical data, including population demographics, the prevalence of psychological distress, and mental health services provision. We calculated incremental cost-effectiveness ratios compared with business as usual for cost (AU$) per: quality-adjusted life-year (QALY), suicide death avoided, self-harm related hospital admissions avoided, and mental health-related emergency department presentation, using a 10-year time horizon for health-care and societal perspectives. We investigated uncertainty through probabilistic sensitivity analysis and deterministic sensitivity analysis, including using a 30-year timeframe. FINDINGS From a societal perspective, increased investment in technology-enabled integrated care, family education, an online parenting programme, and multicultural-informed care were expected to improve health outcomes (incremental QALYs 4517 [95% UI -3135 to 14 507] for technology-enabled integrated care; 339 [91 to 661] for family education; 724 [114 to 1149] for the online parenting programme; and 137 [88 to 194] for multicultural-informed care) and reduce costs ($-91·4 million [-382·7 to 100·7]; $-12·8 million [-21·0 to -6·6]; $-3·6 million [-6·3 to 0·2]; and $-3·1 million [-4·5 to -1·8], respectively) compared with business as usual using a 10-year time horizon. The incremental net monetary benefit for the societal perspective for these four interventions was $452 million (-351 to 1555), $40 million (14 to 74), $61 million (9 to 98), and $14 million (9 to 20), respectively, compared with business as usual, when QALYs were monetised using a willingness to pay of $79 930 per QALY. Synergistic effects are anticipated if these interventions were to be implemented concurrently. The univariate and probabilistic sensitivity analyses indicated a high level of certainty in the results. Although emergency department-based suicide prevention and school-based suicide prevention were not cost effective in the base case (41 QALYs [0 to 48], incremental cost $4·1 million [1·2 to 8·2] for emergency department-based suicide prevention; -234 QALYs [-764 to 12], incremental cost $90·3 million [72·2 to 111·0] for school-based suicide prevention) compared with business as usual, there were scenarios for which these interventions could be considered cost effective. A dedicated trauma service for young people (9 QALYs gained [4 to 16], incremental cost $8·3 million [6·8 to 10·0]) and a crisis response service (-11 QALYs gained [-12 to -10], incremental cost $7·8 million [5·1 to 11·0]) were unlikely to be cost effective in terms of QALYs. INTERPRETATION Synergistic effects were identified, supporting the combined implementation of technology-enabled integrated care, family education, an online parenting programme, and multicultural-informed care. Synergistic effects, emergent outcomes in the form of unintended consequences, the capability to account for service capacity constraints, and ease of use by stakeholders are unique attributes of a system dynamics modelling approach to economic evaluation. FUNDING BHP Foundation.
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Affiliation(s)
- Paul Crosland
- Youth Mental Health and Technology, Brain and Mind Centre, Faculty of Medicine and Health, Translational Research Collective, University of Sydney, Sydney, NSW, Australia.
| | - Nicholas Ho
- Youth Mental Health and Technology, Brain and Mind Centre, Faculty of Medicine and Health, Translational Research Collective, University of Sydney, Sydney, NSW, Australia
| | - Seyed Hossein Hosseini
- Youth Mental Health and Technology, Brain and Mind Centre, Faculty of Medicine and Health, Translational Research Collective, University of Sydney, Sydney, NSW, Australia
| | - Catherine Vacher
- Youth Mental Health and Technology, Brain and Mind Centre, Faculty of Medicine and Health, Translational Research Collective, University of Sydney, Sydney, NSW, Australia
| | - Adam Skinner
- Youth Mental Health and Technology, Brain and Mind Centre, Faculty of Medicine and Health, Translational Research Collective, University of Sydney, Sydney, NSW, Australia
| | - Andrea N Natsky
- Youth Mental Health and Technology, Brain and Mind Centre, Faculty of Medicine and Health, Translational Research Collective, University of Sydney, Sydney, NSW, Australia
| | - Sebastian Rosenberg
- Youth Mental Health and Technology, Brain and Mind Centre, Faculty of Medicine and Health, Translational Research Collective, University of Sydney, Sydney, NSW, Australia
| | - Raphael Hasudungan
- Youth Mental Health and Technology, Brain and Mind Centre, Faculty of Medicine and Health, Translational Research Collective, University of Sydney, Sydney, NSW, Australia
| | - Sam Huntley
- Youth Mental Health and Technology, Brain and Mind Centre, Faculty of Medicine and Health, Translational Research Collective, University of Sydney, Sydney, NSW, Australia
| | - Yun Ju Christine Song
- Youth Mental Health and Technology, Brain and Mind Centre, Faculty of Medicine and Health, Translational Research Collective, University of Sydney, Sydney, NSW, Australia
| | - Grace Yeeun Lee
- Youth Mental Health and Technology, Brain and Mind Centre, Faculty of Medicine and Health, Translational Research Collective, University of Sydney, Sydney, NSW, Australia
| | - Deborah A Marshall
- Cumming School of Medicine, University of Calgary and Alberta Children's Hospital Research Institute, Calgary, AB, Canada
| | - Jo-An Occhipinti
- Youth Mental Health and Technology, Brain and Mind Centre, Faculty of Medicine and Health, Translational Research Collective, University of Sydney, Sydney, NSW, Australia
| | - Ian B Hickie
- Youth Mental Health and Technology, Brain and Mind Centre, Faculty of Medicine and Health, Translational Research Collective, University of Sydney, Sydney, NSW, Australia
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Stewart E, Such E. Evaluating participant experiences of Community Panels to scrutinise policy modelling for health inequalities: the SIPHER Consortium. RESEARCH INVOLVEMENT AND ENGAGEMENT 2024; 10:4. [PMID: 38191500 PMCID: PMC10775539 DOI: 10.1186/s40900-023-00521-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/17/2023] [Accepted: 11/27/2023] [Indexed: 01/10/2024]
Abstract
Data-intensive research, including policy modelling, poses some distinctive challenges for efforts to mainstream public involvement into health research. There is a need for learning about how to design and deliver involvement for these types of research which are highly technical, and where researchers are at a distance from the people whose lives data depicts. This article describes our experiences involving members of the public in the SIPHER Consortium, a data-intensive policy modelling programme with researchers and policymakers working together over five years to try to address health inequalities. We focus on evaluating people's experiences as part of Community Panels for SIPHER. Key issues familiar from general public involvement efforts include practical details, careful facilitation of meetings, and payment for participants. We also describe some of the more particular learning around how to communicate technical research to non-academic audiences, in order to enable public scrutiny of research decisions. We conclude that public involvement in policy modelling can be meaningful and enjoyable, but that it needs to be carefully organised, and properly resourced.
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Henson RM, Purtle J, Headen I, Stankov I, Langellier BA. Methods and measures to evaluate the impact of participatory model building on public policymakers: a scoping review protocol. BMJ Open 2024; 14:e074891. [PMID: 38184315 PMCID: PMC10773324 DOI: 10.1136/bmjopen-2023-074891] [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: 04/19/2023] [Accepted: 12/10/2023] [Indexed: 01/08/2024] Open
Abstract
INTRODUCTION Public policymakers are increasingly engaged in participatory model building processes, such as group model building. Understanding the impacts of policymaker participation in these processes on policymakers is important given that their decisions often have significant influence on the dynamics of complex systems that affect health. Little is known about the extent to which the impacts of participatory model building on public policymakers have been evaluated or the methods and measures used to evaluate these impacts. METHODS AND ANALYSIS A scoping review protocol was developed with the objectives of: (1) scoping studies that have evaluated the impacts of facilitated participatory model building processes on public policymakers who participated in these processes; and (2) describing methods and measures used to evaluate impacts and the main findings of these evaluations. The Joanna Briggs Institute's Population, Concept, Context framework was used to formulate the article identification process. Seven electronic databases-MEDLINE (Ovid), ProQuest Health and Medical, Scopus, Web of Science, Embase (Ovid), CINAHL Complete and PsycInfo-will be searched. Identified articles will be screened according to inclusion and exclusion criteria and the Preferred Reporting Items for Systematic Reviews and Meta-Analyses extension for Scoping Reviews checklist for scoping reviews will be used and reported. A data extraction tool will collect information across three domains: study characteristics, methods and measures, and findings. The review will be conducted using Covidence, a systematic review data management platform. ETHICS AND DISSEMINATION The scoping review produced will generate an overview of how public policymaker engagement in participatory model building processes has been evaluated. Findings will be disseminated through peer-reviewed publications and to communities of practice that convene policymakers in participatory model building processes. This review will not require ethics approval because it is not human subject research.
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Affiliation(s)
- Rosie Mae Henson
- Health Management and Policy, Drexel University Dornsife School of Public Health, Philadelphia, Pennsylvania, USA
| | - Jonathan Purtle
- Department of Public Health Policy and Management, New York University, New York, New York, USA
| | - Irene Headen
- Community Health and Prevention, Drexel University Dornsife School of Public Health, Philadelphia, Pennsylvania, USA
| | - Ivana Stankov
- Urban Health Collaborative, Drexel University Dornsife School of Public Health, Philadelphia, Pennsylvania, USA
- University of South Australia Allied Health and Human Performance Academic Unit, Adelaide, South Australia, Australia
| | - Brent A Langellier
- Health Management and Policy, Drexel University Dornsife School of Public Health, Philadelphia, Pennsylvania, USA
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Wulczyn F, Kaligotla C, Hummel J, Wagner A, MacLeod A. Agent-based simulation and child protection systems: Rationale, implementation, and verification. CHILD ABUSE & NEGLECT 2024; 147:106578. [PMID: 38128373 DOI: 10.1016/j.chiabu.2023.106578] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/24/2022] [Revised: 10/16/2023] [Accepted: 11/23/2023] [Indexed: 12/23/2023]
Abstract
BACKGROUND AND OBJECTIVE Simulation models are an important tool used in health care and other disciplines to support operational research and decision-making. In the child protection literature, simulation models are an under-utilized source of research evidence. PARTICIPANTS AND SETTING In this paper, we describe the rationale for and the development of an agent-based simulation of a child protection system in the US. Using the investigation, prevention service, and placement histories of 600,000 children served in an urban child welfare system, we walk the reader through the development of a prototype known as OSPEDALE. METHODS The governing equations built into OSPEDALE probabilistically simulate the onset of investigations. Then, drawing from empirical survival distributions, the governing equations trace the probability of subsequent interactions with the system (recurrence of maltreatment, service referrals, and placement) conditional on the characteristics of children, their assessed risk level, and prior child protection system involvement. RESULTS As an initial test of OSPEDALE's utility, we compare empirical admission counts with counts generated from OSPEDALE. Though the verification step is admittedly simple, the comparison shows that OSPEDALE replicates the empirical count of new admissions closely enough to justify further investment in OSPEDALE. CONCLUSIONS Management of public child protection systems is increasingly research evidence-dependent. The emphasis on research evidence as a decision-support tool has elevated evidence acquired through randomized clinical trials. Though important, the evidence from clinical trials represents only one type of research evidence. Properly specified, simulation models are another source of evidence with real-world relevance.
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Affiliation(s)
- Fred Wulczyn
- Center for State Child Welfare Data, Chapin Hall, University of Chicago, United States of America.
| | | | - John Hummel
- Argonne National Laboratory, University of Chicago, United States of America
| | - Amanda Wagner
- Argonne National Laboratory, University of Chicago, United States of America
| | - Alex MacLeod
- Beedie School of Business, Simon Fraser University, Canada
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Deutsch AR, Jalali MS, Stout S, Frerichs L. Equitable Policies Need Equitable Practices: Alcohol- and Substance-Exposed Pregnancy as a Case Study. Health Promot Pract 2024; 25:17-21. [PMID: 35778898 PMCID: PMC10071566 DOI: 10.1177/15248399221107605] [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] [Indexed: 11/16/2022]
Abstract
There is clear need for more effective public health policies. Coupled with calls for more effective policies, increasing demand to address public health disparities experienced by systemically marginalized and historically oppressed groups emphasizes the long-standing need for policies that improve public health equity. Such need is highlighted when examining public health issues such as alcohol- and substance-exposed pregnancy (ASEP): Current policies are ineffective at reducing ASEP, and marginalized groups experience disproportionately lower benefits and higher negative consequences as a result of such policies. Powerful strategies to develop more effective policies that can account for the complexity of such issues, such as systems science methods (SSMs), are becoming popular. However, current best practices for such methods often do not emphasize the additional efforts that will be required to develop equitable, not just effective policies. Using ASEP as an example of a crucial complex issue requiring new policy, we suggest additional steps to include in SSM projects for developing more effective policies that will also help stakeholders determine high-equity policies to reduce health disparities. These steps include modeling structural differences experienced by marginalized groups via systemic racism and oppression, incorporating existing cultural and community sources of strength and resilience as key areas for policy development, and evaluating the sustainability of policies as a dimension of efficacy. We also discuss using community-based participatory approaches as a framework for all SSM processes to ensure that policy development itself is grounded in equitable shared decision-making for marginalized individuals.
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Affiliation(s)
- Arielle R Deutsch
- Avera Health, Sioux Falls, SD, USA
- University of South Dakota, Vermillion, SD, USA
| | - Mohammad S Jalali
- Harvard Medical School, Boston, MA, USA
- Massachusetts Institute of Technology, Cambridge, MA, USA
| | | | - Leah Frerichs
- The University of North Carolina at Chapel Hill, NC, USA
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Green C, Joyce A, Hutton RWA, Dembek K, Carey G. A systems science leverage point analysis of climate change advocacy. Health Promot Int 2023; 38:daad168. [PMID: 38128082 DOI: 10.1093/heapro/daad168] [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] [Indexed: 12/23/2023] Open
Abstract
Failure of governments across the world to address climate change has fuelled social movements focused on climate-related policy and action. Research analysing these movements has focused mainly on the types of strategies employed including blockades and occupations, marches and petitions, divestment, boycotts and litigation as well as how groups are framing climate change as a problem. What has been largely missed are the ways these groups are framing the change they want to see, that is their demands to governments. Not all demands and actions have the same potential to create the changes needed to mitigate climate change. Used in public health and health promotion, the systems science Intervention Level Framework (ILF) is a tool that can help analyse to what extent different demands have the leverage to create change in a system. We use the ILF to analyse 131 demands from 35 different climate-related advocacy groups in Australia. Results show demands are more focused on lower system leverage points, such as stopping particular projects, rather than on more impactful leverage points, such as the governance structures that determine climate-related policy and decision-making mechanisms. Further, the results highlight the lack of attention on public health related topics of transport and food systems. This paper shows how a systems science framework used in health promotion, the ILF, could enable climate advocacy groups to more effectively target demands to achieve more impactful outcomes from governments, corporations and the public.
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Affiliation(s)
- Celia Green
- School of Management and Governance, Business School, UNSW Sydney, High St, Kensington, NSW 2052, Australia
| | - Andrew Joyce
- School of Business, Law and Entrepreneurship, Centre for Social Impact, Swinburne University of Technology, Level 2, AGSE Building Cnr John and, Wakefield St, Hawthorn, VIC 3122, Australia
| | - Rebecca Willow-Anne Hutton
- School of Business, Law and Entrepreneurship, Centre for Social Impact, Swinburne University of Technology, Level 2, AGSE Building Cnr John and, Wakefield St, Hawthorn, VIC 3122, Australia
| | - Krzysztof Dembek
- School of Business, Law and Entrepreneurship, Centre for Social Impact, Swinburne University of Technology, Level 2, AGSE Building Cnr John and, Wakefield St, Hawthorn, VIC 3122, Australia
| | - Gemma Carey
- Centre for Social Impact, UNSW, 704, Level 7, Science Engineering Building, Sydney, NSW 2052, Australia
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Kenzie ES, Seater M, Wakeland W, Coronado GD, Davis MM. System dynamics modeling for cancer prevention and control: A systematic review. PLoS One 2023; 18:e0294912. [PMID: 38039316 PMCID: PMC10691687 DOI: 10.1371/journal.pone.0294912] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/10/2023] [Accepted: 11/13/2023] [Indexed: 12/03/2023] Open
Abstract
Cancer prevention and control requires consideration of complex interactions between multilevel factors. System dynamics modeling, which consists of diagramming and simulation approaches for understanding and managing such complexity, is being increasingly applied to cancer prevention and control, but the breadth, characteristics, and quality of these studies is not known. We searched PubMed, Scopus, APA PsycInfo, and eight peer-reviewed journals to identify cancer-related studies that used system dynamics modeling. A dual review process was used to determine eligibility. Included studies were assessed using quality criteria adapted from prior literature and mapped onto the cancer control continuum. Characteristics of studies and models were abstracted and qualitatively synthesized. 32 studies met our inclusion criteria. A mix of simulation and diagramming approaches were used to address diverse topics, including chemotherapy treatments (16%), interventions to reduce tobacco or e-cigarettes use (16%), and cancer risk from environmental contamination (13%). Models spanned all focus areas of the cancer control continuum, with treatment (44%), prevention (34%), and detection (31%) being the most common. The quality assessment of studies was low, particularly for simulation approaches. Diagramming-only studies more often used participatory approaches. Involvement of participants, description of model development processes, and proper calibration and validation of models showed the greatest room for improvement. System dynamics modeling can illustrate complex interactions and help identify potential interventions across the cancer control continuum. Prior efforts have been hampered by a lack of rigor and transparency regarding model development and testing. Supportive infrastructure for increasing awareness, accessibility, and further development of best practices of system dynamics for multidisciplinary cancer research is needed.
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Affiliation(s)
- Erin S. Kenzie
- OHSU-PSU School of Public Health, Oregon Health & Science University, Portland, Oregon, United States of America
- Systems Science Program, Portland State University, Portland, Oregon, United States of America
- Oregon Rural Practice-Based Research Network, Oregon Health & Science University, Portland, Oregon, United States of America
| | - Mellodie Seater
- Oregon Rural Practice-Based Research Network, Oregon Health & Science University, Portland, Oregon, United States of America
| | - Wayne Wakeland
- Systems Science Program, Portland State University, Portland, Oregon, United States of America
| | - Gloria D. Coronado
- Kaiser Permanente Center for Health Research, Portland, Oregon, United States of America
| | - Melinda M. Davis
- OHSU-PSU School of Public Health, Oregon Health & Science University, Portland, Oregon, United States of America
- Department of Family Medicine, Oregon Health & Science University, Portland, Oregon, United States of America
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Taheem R, Woods-Townsend K, Lawrence W, Baird J, Godfrey KM, Hanson M. How do local authority plans to tackle obesity reflect systems thinking? Perspect Public Health 2023; 143:324-336. [PMID: 35796525 PMCID: PMC10683337 DOI: 10.1177/17579139221106337] [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: 11/17/2022]
Abstract
AIMS A whole systems approach to tackling obesity has been recommended by Public Health England for several years. This qualitative study aimed to investigate whether systems thinking is reflected in local authority plans and strategies to tackle obesity, using the leverage points for intervention in a complex system, as a framework. METHOD We sought to identify obesity strategies/plans for Southampton and 19 other local authority comparators (based on children's services and Office for National Statistics data). A healthy weight strategy was available for 10 local authorities and a qualitative document analysis was undertaken. The policy actions proposed in the plans were coded against the leverage points for intervention in a complex system and themes were developed to characterise interventions in each category. RESULTS A majority of actions included in the plans were categorised as 'Numbers, Constants and Parameters' which reflect downstream measures. However, there were examples of actions that could act on higher leverage points. In addition, some local authority plans included interventions that could act on 10 of the 12 leverage points suggesting incorporation of systems thinking. CONCLUSIONS Some local authority plans to tackle obesity do reflect systems thinking when viewed through the lens of the leverage points for intervention in a complex system. Interventions at higher leverage points should be prioritised by public health decision-makers, especially in a climate of competing agendas and limited resources.
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Affiliation(s)
- R Taheem
- NIHR Southampton Biomedical Research Centre, University Hospital Southampton NHS Foundation Trust, Southampton, UK
- Institute of Developmental Sciences, University of Southampton, Southampton, UK
| | - K Woods-Townsend
- NIHR Southampton Biomedical Research Centre, University of Southampton and University Hospital Southampton NHS Foundation Trust, Southampton, UK
- Southampton Education School, Faculty of Social Sciences, University of Southampton, Southampton, UK
| | - W Lawrence
- NIHR Southampton Biomedical Research Centre, University of Southampton and University Hospital Southampton NHS Foundation Trust, Southampton, UK
- Medical Research Council Lifecourse Epidemiology Unit, University of Southampton, Southampton, UK
| | - J Baird
- NIHR Southampton Biomedical Research Centre, University Hospital Southampton NHS Foundation Trust, Southampton, UK
- Medical Research Council Lifecourse Epidemiology Unit, University of Southampton, Southampton, UK
| | - KM Godfrey
- NIHR Southampton Biomedical Research Centre, University of Southampton and University Hospital Southampton NHS Foundation Trust, Southampton, UK
- Medical Research Council Lifecourse Epidemiology Unit, University of Southampton, Southampton, UK
| | - M Hanson
- NIHR Southampton Biomedical Research Centre, University of Southampton and University Hospital Southampton NHS Foundation Trust, Southampton, UKInstitute of Developmental Sciences, University of Southampton, Southampton, UK
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Sponselee HCS, ter Beek L, Renders CM, Kroeze W, Fransen MP, van Asselt KM, Steenhuis IHM. Letting people flourish: defining and suggesting skills for maintaining and improving positive health. Front Public Health 2023; 11:1224470. [PMID: 37900021 PMCID: PMC10602807 DOI: 10.3389/fpubh.2023.1224470] [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: 05/17/2023] [Accepted: 09/26/2023] [Indexed: 10/31/2023] Open
Abstract
Background The concept of "positive health" emerged from the need for a holistic and more dynamic perspective on health, emphasising the ability of individuals to adapt and self-manage. The positive health conversation tool helps understand how people score on six positive health dimensions. However, skills within these dimensions to maintain or improve health have not yet been described. This is important for enabling individuals to put health advice into practise. Therefore, this paper aims to define and suggest skills for maintaining and improving positive health. Subsections Suggestions for definitions of skills within the positive health dimensions are described using the functional, interactive, and critical health literacy framework. Additionally, executive functions and life skills were incorporated. Moreover, the environment's role in these individual skills was noted, mentioning organisational health literacy that emphasises organisations' responsibility to provide comprehensible health information to all individuals. We propose that health promotion interventions can incorporate the proposed skills in practical exercises while aligning intervention materials and implementation tools with end-users and implementers. Discussion and conclusion The suggested skills for maintaining and improving positive health are a first step towards a more comprehensive understanding and open to discussion. These skills may also be applied to other practical conversation tools for maintaining or improving health. Increasing positive health through the defined skills may be especially relevant to those with a lower socioeconomic position who also have limited health literacy and thereby may contribute to reducing health inequalities. Taken together, strengthening the defined skills may hopefully contribute to allowing people to flourish in life.
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Affiliation(s)
- Hanne C. S. Sponselee
- Department of Health Sciences, Faculty of Sciences, VU University Amsterdam and Amsterdam Public Health Research Institute, Amsterdam, Netherlands
| | - Lies ter Beek
- Department of Health Sciences, Faculty of Sciences, VU University Amsterdam and Amsterdam Public Health Research Institute, Amsterdam, Netherlands
| | - Carry M. Renders
- Department of Health Sciences, Faculty of Sciences, VU University Amsterdam and Amsterdam Public Health Research Institute, Amsterdam, Netherlands
| | - Willemieke Kroeze
- Department of Health Sciences, Faculty of Sciences, VU University Amsterdam and Amsterdam Public Health Research Institute, Amsterdam, Netherlands
- Care for Nutrition and Health Group, School of Nursing, Christian University of Applied Sciences, Ede, Netherlands
| | - Mirjam P. Fransen
- Department of Health Sciences, Faculty of Sciences, VU University Amsterdam and Amsterdam Public Health Research Institute, Amsterdam, Netherlands
- Department of Public and Occupational Health, Amsterdam UMC, Amsterdam, Netherlands
| | - Kristel M. van Asselt
- Department of Health Sciences, Faculty of Sciences, VU University Amsterdam and Amsterdam Public Health Research Institute, Amsterdam, Netherlands
- Department of General Practice, Amsterdam UMC, University of Amsterdam, Amsterdam, Netherlands
| | - Ingrid H. M. Steenhuis
- Department of Health Sciences, Faculty of Sciences, VU University Amsterdam and Amsterdam Public Health Research Institute, Amsterdam, Netherlands
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Walls H, Johnston D, Matita M, Kamwanja T, Smith R, Nanama S. The politics of agricultural policy and nutrition: A case study of Malawi's Farm Input Subsidy Programme (FISP). PLOS GLOBAL PUBLIC HEALTH 2023; 3:e0002410. [PMID: 37819904 PMCID: PMC10566744 DOI: 10.1371/journal.pgph.0002410] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/13/2022] [Accepted: 08/30/2023] [Indexed: 10/13/2023]
Abstract
The concept of food and nutrition policy has broadened from simply being an aspect of health policy, to policy interventions from across a wide range of sectors, but still with potentially important impact on nutritional outcomes. This wider and more complex conceptualisation involves policy with multiple objectives and stakeholder influences. Thus, it becomes particularly important to understand the dynamics of these policy processes, including policy design and implementation. To add to this literature, we apply the Kaleidoscope Model for understanding policy change in developing country contexts to the case-study of an agricultural input subsidy (AIS) programme in Malawi, the Farm Input Subsidy Programme (FISP), exploring the dynamics of the FISP policy process including nutritional impact. Over a three-month period between 2017 and 2019 we conducted in-depth interviews with key stakeholders at national and district levels, and focus groups with people from rural districts in Malawi. We also undertook a review of literature relating to the political economy of the FISP. We analysed the data thematically, as per the domains of the Kaleidoscope Model. The analysis across the FISP policy process including policy design and implementation highlights how stakeholders' ideas, interests and influence have shaped the evolution of FISP policy including constraints to policy improvement-and the nutritional impacts of this. This approach extends the literature on the tensions, contradictions and challenges in food and nutrition policy by examining the reasons that these occur in Malawi with the FISP. We also add to the political science and policy analysis literature on policy implementation, extending the concept of veto players to include those targeted by the policy. The findings are important for consideration by policymakers and other stakeholders seeking to address malnutrition in rural, food-insecure populations in Malawi and other low-income settings.
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Affiliation(s)
- Helen Walls
- Department of Global Heath and Development, Faculty of Public Health & Policy, London School of Hygiene & Tropical Medicine, London, United Kingdom
| | - Deborah Johnston
- Department of Economics, SOAS University of London, London, United Kingdom
| | - Mirriam Matita
- Department of Economics, University of Malawi, Zomba, Malawi
- Lilongwe University of Agriculture and Natural Resources, Lilongwe, Malawi
| | - Tayamika Kamwanja
- Department of Economics, University of Malawi, Zomba, Malawi
- School of Business, University of Leicester, Leicester, United Kingdom
| | - Richard Smith
- College of Medicine and Health, University of Exeter, Exeter, United Kingdom
| | - Simeon Nanama
- United Nations Children’s Fund (Unicef), Abuja, Nigeria
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Decker H, Wendel M. Applications of Participatory System Dynamics Methods to Public Health: A Systematic Review. FAMILY & COMMUNITY HEALTH 2023; 46:S6-S21. [PMID: 37696012 DOI: 10.1097/fch.0000000000000369] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 09/13/2023]
Abstract
System dynamics, and specifically qualitative participatory applications of system dynamics, have potential to benefit public health research, scholarship, and practice. A systematic review was conducted to examine the existing applications of participatory system dynamics (PSD) to public health research. Three databases were searched using unique search terms related to PSD and methodological applications in public health research. A total of 57 unique articles met inclusion criteria and were included for review. The studies included for review were conducted globally and represent a wide breadth of public health issues. The review identified several advantages to adopting PSD methods in public health scholarship and practice. The PSD methods provide innovative frameworks for conceptualizing complex and nuanced public health problems. The participatory nature of PSD allows for increased community engagement and empowerment to address public health problems, as well as to mitigate existing power dynamics between research institutions and marginalized communities that are disproportionately impacted by social and health inequities. Finally, causal loop diagrams developed using PSD methods have unique potential to convey complex concepts to policy makers and interventionists. This systematic review reports evidence for PSD's potential to advance equity in public health research and practice.
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Affiliation(s)
- Hallie Decker
- Health Equity Innovation Hub, University of Louisville, Louisville, Kentucky (Ms Decker); and Health Promotion & Behavioral Sciences, School of Public Health and Information Sciences, and Health Equity Innovation Hub, University of Louisville, Louisville, Kentucky (Dr Wendel)
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27
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Felmingham T, Bolton KA, Fraser P, Allender S, Brown AD. Measuring Shifts in Mental Models in the Prevention of Childhood Obesity in Rural Australia. HEALTH EDUCATION & BEHAVIOR 2023; 50:662-670. [PMID: 37128853 PMCID: PMC10492428 DOI: 10.1177/10901981231165339] [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: 05/03/2023]
Abstract
Group model building is a participatory workshop technique used in system dynamics for developing community consensus to address complex problems by consensus building on individual assumptions. This study examines changes in individual mental models of the complex problem of childhood obesity following participation in group model building (GMB), as part of a larger community-based system dynamics project. Data are drawn from GMB participants across six community sites in the Whole of Systems Trial of Prevention Strategies for Childhood Obesity (WHO STOPS) in rural and regional Victoria, Australia. Each community participated in two GMB sessions resulting in a causal loop diagram (CLD) of drivers of childhood obesity for each community. Presurvey and postsurvey captured participants' perspectives before and after (n = 25) participation in both GMB sessions and a blend of inductive and deductive qualitative content analysis was used to code individual responses. Three calculations were used to determine the number of responses, whether responses were a result of persuasion from others, and comparison of responses to those found in the CLD. Our study found participant mental models shifted during the course of the GMB sessions, with some responses persuaded by others and 75% of new insights identified in CLDs created by communities. The GMB process created a platform for participants to share ideas and learn from each other. In addition, participants listed new insights about childhood obesity in their community through developing CLDs.
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28
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Nyström ME, Tolf S, Sparring V, Strehlenert H. Systems thinking in practice when implementing a national policy program for the improvement of women's healthcare. Front Public Health 2023; 11:957653. [PMID: 37841746 PMCID: PMC10570416 DOI: 10.3389/fpubh.2023.957653] [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: 05/31/2022] [Accepted: 08/31/2023] [Indexed: 10/17/2023] Open
Abstract
Introduction Interest in applying systems thinking (ST) in public health and healthcare improvement has increased in the past decade, but its practical use is still unclear. ST has been found useful in addressing the complexity and dynamics of organizations and welfare systems during periods of change. Exploring how ST is used in practice in national policy programs addressing complex and ill-structured problems can increase the knowledge of the use and eventually the usefulness of ST during complex changes. In ST, a multi-level approach is suggested to coordinate interventions over individual, organizational, and community levels, but most attempts to operationalize ST focus on the individual level. This study aimed to investigate how ST is expressed in policy programs addressing wicked problems and describe the specific action strategies used in practice in a national program in Sweden, using a new conceptual framework comprising ST principles on the organizational level as an analytical tool. The program addresses several challenges and aims to achieve systems change within women's healthcare. Methods The case study used a rich set of qualitative, longitudinal data on individual, group, and organizational levels, collected during the implementation of the program. Deductive content analysis provided narrative descriptions of how the ST principles were expressed in actions, based on interviews, observations, and archival data. Results The results showed that the program management team used various strategies and activities corresponding to organizational level ST. The team convened numerous types of actors and used collaborative approaches and many different information sources in striving to create a joint and holistic understanding of the program and its context. Visualization tools and adaptive approaches were used to support regional contact persons and staff in their development work. Efforts were made to identify high-leverage solutions to problems influencing the quality and coordination of care before, during, and after childbirth, solutions adaptable to regional conditions. Discussion/conclusions The organizational level ST framework was useful for identifying ST in practice in the policy program, but to increase further understanding of how ST is applied within policy programs, we suggest a multi-dimensional model to identify ST on several levels.
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Affiliation(s)
- Monica E. Nyström
- Department of Learning, Informatics, Management and Ethics, Medical Management Centre, Karolinska Institute, Stockholm, Sweden
- Department of Epidemiology and Global Health, Umeå University, Umeå, Sweden
| | - Sara Tolf
- Department of Learning, Informatics, Management and Ethics, Medical Management Centre, Karolinska Institute, Stockholm, Sweden
| | - Vibeke Sparring
- Department of Learning, Informatics, Management and Ethics, Medical Management Centre, Karolinska Institute, Stockholm, Sweden
- Centre for Health Economics, Informatics and Health Services Research, Stockholm Health Care Services, Stockholm, Sweden
| | - Helena Strehlenert
- Department of Learning, Informatics, Management and Ethics, Medical Management Centre, Karolinska Institute, Stockholm, Sweden
- Stockholm Gerontology Research Centre Foundation, Stockholm, Sweden
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Milsom P, Tomoaia-Cotisel A, Smith R, Modisenyane SM, Walls H. Using System Dynamics to Understand Transnational Corporate Power in Diet-Related Non-communicable Disease Prevention Policy-Making: A Case Study of South Africa. Int J Health Policy Manag 2023; 12:7641. [PMID: 38618803 PMCID: PMC10590239 DOI: 10.34172/ijhpm.2023.7641] [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: 08/23/2022] [Accepted: 08/30/2023] [Indexed: 04/16/2024] Open
Abstract
BACKGROUND Complex interactions between political economy factors and corporate power are increasingly recognized to prevent transformative policy action on non-communicable disease (NCD) prevention. System science offers promising methods for analysing such causal complexity. This study uses qualitative system dynamics methods to map the political economy of diet-related NCD (DR-NCD) prevention policy-making aiming to better understand the policy inertia observed in this area globally. METHODS We interviewed 25 key policy actors. We analysed the interviews using purposive text analysis (PTA). We developed individual then combined casual loop diagrams to generate a shared model representing the DR-NCD prevention policy-making system. Key variables/linkages identified from the literature were also included in the model. We validated the model in several steps including through stakeholder validation interviews. RESULTS We identified several inter-linked feedback processes related to political economy factors that may entrench different forms of corporate power (instrumental, structural, and discursive) in DR-NCD prevention policy-making in South Africa over time. We also identified a number of feedback processes that have the potential to limit corporate power in this setting. CONCLUSION Using complex system methods can be useful for more deeply understanding DR-NCD policy inertia. It is also useful for identifying potential leverage points within the system which may shift the existing power dynamics to facilitate greater political commitment for healthy, equitable, and sustainable food system transformation.
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Affiliation(s)
- Penelope Milsom
- Department of Global Health and Development, Faculty of Public Health and Policy, London School of Hygiene and Tropical Medicine, London, UK
| | | | - Richard Smith
- College of Medicine and Health, University of Exeter, Exeter, UK
| | - Simon Moeketsi Modisenyane
- Department of Global Health and Development, Faculty of Public Health and Policy, London School of Hygiene and Tropical Medicine, London, UK
| | - Helen Walls
- Department of Global Health and Development, Faculty of Public Health and Policy, London School of Hygiene and Tropical Medicine, London, UK
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30
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Hackmann C, Komashie A, Handley M, Murdoch J, Wagner AP, Grünwald LM, Waller S, Kaminskiy E, Zeilig H, Jones J, Bray J, Bagge S, Simpson A, Dalkin SM, Clarkson J, Borghini G, Kipouros T, Rohricht F, Taousi Z, Haighton C, Rae S, Wilson J. Codesigning a systemic discharge intervention for inpatient mental health settings (MINDS): a protocol for integrating realist evaluation and an engineering-based systems approach. BMJ Open 2023; 13:e071272. [PMID: 37709323 PMCID: PMC10503342 DOI: 10.1136/bmjopen-2022-071272] [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: 12/21/2022] [Accepted: 04/26/2023] [Indexed: 09/16/2023] Open
Abstract
INTRODUCTION Transition following discharge from mental health hospital is high risk in terms of relapse, readmission and suicide. Discharge planning supports transition and reduces risk. It is a complex activity involving interacting systemic elements. The codesigning a systemic discharge intervention for inpatient mental health settings (MINDS) study aims to improve the process for people being discharged, their carers/supporters and staff who work in mental health services, by understanding, co-designing and evaluating implementation of a systemic approach to discharge planning. METHODS AND ANALYSIS The MINDS study integrates realist research and an engineering-informed systems approach across three stages. Stage 1 applies realist review and evaluation using a systems approach to develop programme theories of discharge planning. Stage 2 uses an Engineering Better Care framework to codesign a novel systemic discharge intervention, which will be subjected to process and economic evaluation in stage 3. The programme theories and resulting care planning approach will be refined throughout the study ready for a future clinical trial. MINDS is co-led by an expert by experience, with researchers with lived experience co-leading each stage. ETHICS AND DISSEMINATION MINDS stage 1 has received ethical approval from Yorkshire & The Humber-Bradford Leeds (Research Ethics Committee (22/YH/0122). Findings from MINDS will be disseminated via high-impact journal publications and conference presentations, including those with service user and mental health professional audiences. We will establish routes to engage with public and service user communities and National Health Service professionals including blogs, podcasts and short videos. TRIAL REGISTRATION NUMBER MINDS is funded by the National Institute of Health Research (NIHR 133013) https://fundingawards.nihr.ac.uk/award/NIHR133013. The realist review protocol is registered on PROSPERO. PROSPERO REGISTRATION NUMBER CRD42021293255.
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Affiliation(s)
- Corinna Hackmann
- Research and Development, Norfolk and Suffolk NHS Foundation Trust, Norwich, UK
- Noriwch Medical School, The University of East Anglia, Norwich, UK
| | - Alexander Komashie
- Department of Enginering, University of Cambridge School of Technology, Cambridge, UK
| | - Melanie Handley
- Centre for Research in Public Health and Community Care, University of Hertfordshire, Hatfield, UK
| | - Jamie Murdoch
- School of Life Course and Population Sciences, King's College London, London, UK
| | - Adam P Wagner
- NIHR Collaboration for Leadership in Applied Health Research & Care (CLAHRC) East of England, Cambridge, UK
- Norwich Medical School, University of East Anglia, Norwich, UK
| | - Lisa Marie Grünwald
- Research and Development, Norfolk and Suffolk NHS Foundation Trust, Norwich, UK
| | - Sam Waller
- Engineering Design Centre, University of Cambridge, Cambridge, UK
| | - Emma Kaminskiy
- School of Psychology and Sports Science, Anglia Ruskin University, Chelmsford, UK
| | - Hannah Zeilig
- London College of Fashion, University of the Arts London, London, UK
| | - Julia Jones
- Centre for Research in Primary & Community Care, University of Hertfordshire, Hatfield, UK
| | | | - Sophie Bagge
- Norfolk and Suffolk NHS Foundation Trust, Norwich, UK
| | - Alan Simpson
- Health Services and Population Research, King's College London, London, UK
| | - Sonia Michelle Dalkin
- Department of Social Work, Education & Community Wellbeing, Faculty of Health and Life Sciences, Northumbria University, Newcastle upon Tyne, UK
| | - John Clarkson
- Engineering Design Centre, University of Cambridge, Cambridge, UK
| | | | | | - Frank Rohricht
- Wolfson Institute of Population Health, Queen Mary University of London, London, UK
- East London NHS Foundation Trust, London, UK
| | - Zohra Taousi
- Hertfordshire and Peterborough NHS Foundation Trust, St Albans, UK
| | - Catherine Haighton
- Department of Social Work, Education & Community Wellbeing, Faculty of Health and Life Sciences, Northumbria University, Newcastle upon Tyne, UK
| | | | - Jon Wilson
- Research and Development, Norfolk and Suffolk NHS Foundation Trust, Norwich, UK
- Noriwch Medical School, The University of East Anglia, Norwich, UK
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31
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Höhn A, Stokes J, Pollack R, Boyd J, Chueca Del Cerro C, Elsenbroich C, Heppenstall A, Hjelmskog A, Inyang E, Kopasker D, Sonthalia S, Thomson RM, Zia K, Katikireddi SV, Meier P. Systems science methods in public health: what can they contribute to our understanding of and response to the cost-of-living crisis? J Epidemiol Community Health 2023; 77:610-616. [PMID: 37328262 PMCID: PMC10423532 DOI: 10.1136/jech-2023-220435] [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: 02/06/2023] [Accepted: 06/01/2023] [Indexed: 06/18/2023]
Abstract
BACKGROUND Many complex public health evidence gaps cannot be fully resolved using only conventional public health methods. We aim to familiarise public health researchers with selected systems science methods that may contribute to a better understanding of complex phenomena and lead to more impactful interventions. As a case study, we choose the current cost-of-living crisis, which affects disposable income as a key structural determinant of health. METHODS We first outline the potential role of systems science methods for public health research more generally, then provide an overview of the complexity of the cost-of-living crisis as a specific case study. We propose how four systems science methods (soft systems, microsimulation, agent-based and system dynamics models) could be applied to provide more in-depth understanding. For each method, we illustrate its unique knowledge contributions, and set out one or more options for studies that could help inform policy and practice responses. RESULTS Due to its fundamental impact on the determinants of health, while limiting resources for population-level interventions, the cost-of-living crisis presents a complex public health challenge. When confronted with complexity, non-linearity, feedback loops and adaptation processes, systems methods allow a deeper understanding and forecasting of the interactions and spill-over effects common with real-world interventions and policies. CONCLUSIONS Systems science methods provide a rich methodological toolbox that complements our traditional public health methods. This toolbox may be particularly useful in early stages of the current cost-of-living crisis: for understanding the situation, developing solutions and sandboxing potential responses to improve population health.
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Affiliation(s)
- Andreas Höhn
- MRC/CSO Social and Public Health Sciences Unit, University of Glasgow, Glasgow, UK
| | - Jonathan Stokes
- MRC/CSO Social and Public Health Sciences Unit, University of Glasgow, Glasgow, UK
| | - Roxana Pollack
- MRC/CSO Social and Public Health Sciences Unit, University of Glasgow, Glasgow, UK
| | - Jennifer Boyd
- MRC/CSO Social and Public Health Sciences Unit, University of Glasgow, Glasgow, UK
| | | | - Corinna Elsenbroich
- MRC/CSO Social and Public Health Sciences Unit, University of Glasgow, Glasgow, UK
| | - Alison Heppenstall
- MRC/CSO Social and Public Health Sciences Unit, University of Glasgow, Glasgow, UK
| | - Annika Hjelmskog
- MRC/CSO Social and Public Health Sciences Unit, University of Glasgow, Glasgow, UK
| | - Elizabeth Inyang
- MRC/CSO Social and Public Health Sciences Unit, University of Glasgow, Glasgow, UK
| | - Daniel Kopasker
- MRC/CSO Social and Public Health Sciences Unit, University of Glasgow, Glasgow, UK
| | - Shreya Sonthalia
- MRC/CSO Social and Public Health Sciences Unit, University of Glasgow, Glasgow, UK
| | - Rachel M Thomson
- MRC/CSO Social and Public Health Sciences Unit, University of Glasgow, Glasgow, UK
| | - Kashif Zia
- MRC/CSO Social and Public Health Sciences Unit, University of Glasgow, Glasgow, UK
| | | | - Petra Meier
- MRC/CSO Social and Public Health Sciences Unit, University of Glasgow, Glasgow, UK
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Lim RBT, Hoe KWB, Tan CGL, Zheng H. A Systematic Review on the Effectiveness of Systems-Based Practice Curricula in Health Professions Education. Eval Health Prof 2023; 46:242-254. [PMID: 37439658 DOI: 10.1177/01632787231188182] [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] [Indexed: 07/14/2023]
Abstract
This systematic review aims to evaluate the effectiveness of systems-based practice (SBP) curricula from the perspective of health professions students and workers. A total of 8468 citations were sourced from six electronic databases and manual searches conducted independently by two researchers, of which 44 studies were eventually included. A meta-analysis using a random effects model and a meta-synthesis using the thematic synthesis approach were conducted. Most studies targeted medical students, residents, and resident physicians from various clinical specialties. Almost half of all studies focused on didactic or knowledge-based interventions to teach SBP. About a third of all studies measured non-self-evaluated knowledge change, clinical abilities, and clinical outcomes. Both meta-analysis and meta-synthesis results revealed positive outcomes of increased knowledge of SBP, increased recognition of SBP as a core competency in one's profession, and increased application of SBP knowledge in one's profession. Meta-synthesis results also revealed negative outcomes at the institutional and teacher/health professions level. This review highlights the importance of SBP education and supports the effectiveness of SBP curricula. There is a need to address the negative outcomes at the institutional and teacher/health professions level. Moreover, future studies could investigate the integration of self-assessment outcomes with comparison to some external standard.
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Affiliation(s)
- Raymond Boon Tar Lim
- Saw Swee Hock School of Public Health, National University of Singapore and National University Health System, Singapore
| | - Kenneth Wee Beng Hoe
- Saw Swee Hock School of Public Health, National University of Singapore and National University Health System, Singapore
| | - Claire Gek Ling Tan
- Saw Swee Hock School of Public Health, National University of Singapore and National University Health System, Singapore
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Tracy M, Chong LS, Strully K, Gordis E, Cerdá M, Marshall BDL. A Systematic Review of Systems Science Approaches to Understand and Address Domestic and Gender-Based Violence. JOURNAL OF FAMILY VIOLENCE 2023; 38:1-17. [PMID: 37358982 PMCID: PMC10213598 DOI: 10.1007/s10896-023-00578-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Accepted: 05/16/2023] [Indexed: 06/28/2023]
Abstract
Purpose We aimed to synthesize insights from systems science approaches applied to domestic and gender-based violence. Methods We conducted a systematic review of systems science studies (systems thinking, group model-building, agent-based modeling [ABM], system dynamics [SD] modeling, social network analysis [SNA], and network analysis [NA]) applied to domestic or gender-based violence, including victimization, perpetration, prevention, and community responses. We used blinded review to identify papers meeting our inclusion criteria (i.e., peer-reviewed journal article or published book chapter that described a systems science approach to domestic or gender-based violence, broadly defined) and assessed the quality and transparency of each study. Results Our search yielded 1,841 studies, and 74 studies met our inclusion criteria (45 SNA, 12 NA, 8 ABM, and 3 SD). Although research aims varied across study types, the included studies highlighted social network influences on risks for domestic violence, clustering of risk factors and violence experiences, and potential targets for intervention. We assessed the quality of the included studies as moderate, though only a minority adhered to best practices in model development and dissemination, including stakeholder engagement and sharing of model code. Conclusions Systems science approaches for the study of domestic and gender-based violence have shed light on the complex processes that characterize domestic violence and its broader context. Future research in this area should include greater dialogue between different types of systems science approaches, consideration of peer and family influences in the same models, and expanded use of best practices, including continued engagement of community stakeholders. Supplementary Information The online version contains supplementary material available at 10.1007/s10896-023-00578-8.
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Affiliation(s)
- Melissa Tracy
- Department of Epidemiology and Biostatistics, University at Albany School of Public Health, State University of New York, 1 University Place, GEC 133, Rensselaer, NY 12144 USA
| | - Li Shen Chong
- Department of Psychology, University at Albany, State University of New York, 1400 Washington Ave, Albany, NY 12222 USA
| | - Kate Strully
- Department of Sociology, University at Albany, State University of New York, 1400 Washington Ave, Albany, NY 12222 USA
| | - Elana Gordis
- Department of Psychology, University at Albany, State University of New York, 1400 Washington Ave, Albany, NY 12222 USA
| | - Magdalena Cerdá
- Department of Population Health, New York University Grossman School of Medicine, 180 Madison Ave, New York, NY 10016 USA
| | - Brandon D. L. Marshall
- Department of Epidemiology, Brown University School of Public Health, 121 South Main St, Providence, RI 02912 USA
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Vujcich D, Roberts M, Selway T, Nattabi B. The Application of Systems Thinking to the Prevention and Control of Sexually Transmissible Infections among Adolescents and Adults: A Scoping Review. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2023; 20:ijerph20095708. [PMID: 37174226 PMCID: PMC10178699 DOI: 10.3390/ijerph20095708] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/21/2023] [Revised: 04/20/2023] [Accepted: 04/30/2023] [Indexed: 05/15/2023]
Abstract
Systems thinking is a mechanism for making sense of complex systems that challenge linear explanations of cause-and-effect. While the prevention and control of sexually transmissible infections (STIs) has been identified as an area that may benefit from systems-level analyses, no review on the subject currently exists. The aim of this study is to conduct a scoping review to identify literature in which systems thinking has been applied to the prevention and control of STIs among adolescent and adult populations. Joanna Briggs Institute guidelines for the conduct of scoping reviews were followed. Five databases were searched for English-language studies published after 2011. A total of n = 6102 studies were screened against inclusion criteria and n = 70 were included in the review. The majority of studies (n = 34) were conducted in African nations. Few studies focused on priority sub-populations, and 93% were focused on HIV (n = 65). The most commonly applied systems thinking method was system dynamics modelling (n = 28). The review highlights areas for future research, including the need for more STI systems thinking studies focused on: (1) migrant and Indigenous populations; (2) conditions such as syphilis; and (3) innovations such as pre-exposure prophylaxis and at-home testing for HIV. The need for conceptual clarity around 'systems thinking' is also highlighted.
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Affiliation(s)
- Daniel Vujcich
- Western Australian Sexual Health and Blood-Borne Virus Applied Research and Evaluation Network, School of Population Health, Curtin University, Perth, WA 6102, Australia
| | - Meagan Roberts
- Western Australian Sexual Health and Blood-Borne Virus Applied Research and Evaluation Network, School of Population Health, Curtin University, Perth, WA 6102, Australia
| | - Tyler Selway
- Western Australian Sexual Health and Blood-Borne Virus Applied Research and Evaluation Network, School of Population Health, Curtin University, Perth, WA 6102, Australia
| | - Barbara Nattabi
- School of Population and Global Health, University of Western Australia, Perth, WA 6009, Australia
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Tretter F, Peters EMJ, Sturmberg J, Bennett J, Voit E, Dietrich JW, Smith G, Weckwerth W, Grossman Z, Wolkenhauer O, Marcum JA. Perspectives of (/memorandum for) systems thinking on COVID-19 pandemic and pathology. J Eval Clin Pract 2023; 29:415-429. [PMID: 36168893 PMCID: PMC9538129 DOI: 10.1111/jep.13772] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/27/2022] [Revised: 09/08/2022] [Accepted: 09/13/2022] [Indexed: 11/29/2022]
Abstract
Is data-driven analysis sufficient for understanding the COVID-19 pandemic and for justifying public health regulations? In this paper, we argue that such analysis is insufficient. Rather what is needed is the identification and implementation of over-arching hypothesis-related and/or theory-based rationales to conduct effective SARS-CoV2/COVID-19 (Corona) research. To that end, we analyse and compare several published recommendations for conceptual and methodological frameworks in medical research (e.g., public health, preventive medicine and health promotion) to current research approaches in medical Corona research. Although there were several efforts published in the literature to develop integrative conceptual frameworks before the COVID-19 pandemic, such as social ecology for public health issues and systems thinking in health care, only a few attempts to utilize these concepts can be found in medical Corona research. For this reason, we propose nested and integrative systemic modelling approaches to understand Corona pandemic and Corona pathology. We conclude that institutional efforts for knowledge integration and systemic thinking, but also for integrated science, are urgently needed to avoid or mitigate future pandemics and to resolve infection pathology.
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Affiliation(s)
- Felix Tretter
- Bertalanffy Center for the Study of Systems ScienceViennaAustria
| | - Eva M. J. Peters
- Psychoneuroimmunology Laboratory, Department of Psychosomatic Medicine and PsychotherapyJustus‐Liebig‐UniversityGiessenHesseGermany
- Internal Medicine and DermatologyUniversitätsmedizin‐CharitéBerlinGermany
| | - Joachim Sturmberg
- College of Health, Medicine and WellbeingUniversity of NewcastleNewcastleNew South WalesAustralia
- International Society for Systems and Complexity Sciences for HealthPrincetonNew JerseyUSA
| | - Jeanette Bennett
- Department of Psychological Science, StressWAVES Biobehavioral Research LabUniversity of North CarolinaCharlotteNorth CarolinaUSA
| | - Eberhard Voit
- Wallace H. Coulter Department of Biomedical EngineeringGeorgia Institute of Technology and Emory UniversityAtlantaGeorgiaUSA
| | - Johannes W. Dietrich
- Diabetes, Endocrinology and Metabolism Section, Department of Medicine ISt. Josef Hospital, Ruhr PhilosophyBochumGermany
- Diabetes Centre Bochum/HattingenKlinik BlankensteinHattingenGermany
- Centre for Rare Endocrine Diseases (ZSE), Ruhr Centre for Rare Diseases (CeSER)BochumGermany
- Centre for Diabetes Technology, Catholic Hospitals BochumRuhr University BochumBochumGermany
| | - Gary Smith
- International Society for the Systems SciencesPontypoolUK
| | - Wolfram Weckwerth
- Vienna Metabolomics Center (VIME) and Molecular Systems Biology (MOSYS)University of ViennaViennaAustria
| | - Zvi Grossman
- Department of Physiology and Pharmacology, Faculty of MedicineTel Aviv UniversityTel AvivIsrael
| | - Olaf Wolkenhauer
- Department of Systems Biology & BioinformaticsUniversity of RostockRostockGermany
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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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Giabbanelli PJ, Vesuvala CX. Human Factors in Leveraging Systems Science to Shape Public Policy for Obesity: A Usability Study. INFORMATION 2023. [DOI: 10.3390/info14030196] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/31/2023] Open
Abstract
Background: despite a broad consensus on their importance, applications of systems thinking in policymaking and practice have been limited. This is partly caused by the longstanding practice of developing systems maps and software in the intention of supporting policymakers, but without knowing their needs and practices. Objective: we aim to ensure the effective use of a systems mapping software by policymakers seeking to understand and manage the complex system around obesity, physical, and mental well-being. Methods: we performed a usability study with eight policymakers in British Columbia based on a software tool (ActionableSystems) that supports interactions with a map of obesity. Our tasks examine different aspects of systems thinking (e.g., unintended consequences, loops) at several levels of mastery and cover common policymaking needs (identification, evaluation, understanding). Video recordings provided quantitative usability metrics (correctness, time to completion) individually and for the group, while pre- and post-usability interviews yielded qualitative data for thematic analysis. Results: users knew the many different factors that contribute to mental and physical well-being in obesity; however, most were only familiar with lower-level systems thinking concepts (e.g., interconnectedness) rather than higher-level ones (e.g., feedback loops). Most struggles happened at the lowest level of the mastery taxonomy, and predominantly on network representation. Although participants completed tasks on loops and multiple pathways mostly correctly, this was at the detriment of spending significant time on these aspects. Results did not depend on the participant, as their experiences with the software were similar. The thematic analysis revealed that policymakers did not have a typical workflow and did not use any special software or tools in their policy work; hence, the integration of a new tool would heavily depend on individual practices. Conclusions: there is an important discrepancy between what constitutes systems thinking to policymakers and what parts of systems thinking are supported by software. Tools may be more successfully integrated when they include tutorials (e.g., case studies), facilitate access to evidence, and can be linked to a policymaker’s portfolio.
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Stankov I, Henson RM, Headen I, Purtle J, Langellier BA. Use of qualitative systems mapping and causal loop diagrams to understand food environments, diet and obesity: a scoping review protocol. BMJ Open 2023; 13:e066875. [PMID: 36931683 PMCID: PMC10030560 DOI: 10.1136/bmjopen-2022-066875] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/22/2022] [Accepted: 02/20/2023] [Indexed: 03/19/2023] Open
Abstract
INTRODUCTION Food systems can shape dietary behaviour and obesity outcomes in complex ways. Qualitative systems mapping using causal loop diagrams (CLDs) can depict how people understand the complex dynamics, inter-relationships and feedback characteristic of food systems in ways that can support policy planning and action. To date, there has been no attempt to review this literature. The objectives of this review are to scope the extent and nature of studies using qualitative systems mapping to facilitate the development of CLDs by stakeholders to understand food environments, including settings and populations represented, key findings and the methodological processes employed. It also seeks to identify gaps in knowledge and implications for policy and practice. METHODS AND ANALYSIS This protocol describes a scoping review guided by the Joanna Briggs Institute manual, the framework by Khalil and colleagues and the Preferred Reporting Items for Systematic Reviews and Meta-Analyses extension for Scoping Reviews checklist reporting guidelines. A search strategy was iteratively developed with two academic librarians and the research team. This strategy will be used to search six databases, including Ovid MEDLINE, Embase, EmCare, Web of Science, Scopus and ProQuest Central. Identified citations will be screened by two independent reviewers; first, by title and abstract, and then full-text articles to identify papers eligible for inclusion. The reference lists of included studies and relevant systematic reviews will be searched to identify other papers eligible for inclusion. Two reviewers will extract information from all included studies and summarise the findings descriptively and numerically. ETHICS AND DISSEMINATION The scoping review will provide an overview of how CLDs developed by stakeholders have been elicited to understand food environments, diet and obesity, the insights gained and how the CLDs have been used. It will also highlight gaps in knowledge and implications for policy and practice. The review will be disseminated through publication in an academic journal and conference presentations.
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Affiliation(s)
- Ivana Stankov
- Urban Health Collaborative, Drexel University, Philadelphia, Pennsylvania, USA
- UniSA Allied Health & Human Performance, University of South Australia, Adelaide, South Australia, Australia
| | - Rosie Mae Henson
- Department of Health Management and Policy, Drexel University, Philadelphia, Pennsylvania, USA
| | - Irene Headen
- Department of Community Health and Prevention, Drexel University, Philadelphia, Pennsylvania, USA
| | - Jonathan Purtle
- Department of Public Health Policy and Management, New York University, New York, New York, USA
| | - Brent A Langellier
- Department of Health Management and Policy, Drexel University, Philadelphia, Pennsylvania, USA
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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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Thelen J, Sant Fruchtman C, Bilal M, Gabaake K, Iqbal S, Keakabetse T, Kwamie A, Mokalake E, Mupara LM, Seitio-Kgokgwe O, Zafar S, Cobos Muñoz D. Development of the Systems Thinking for Health Actions framework: a literature review and a case study. BMJ Glob Health 2023; 8:bmjgh-2022-010191. [PMID: 36931663 PMCID: PMC10030275 DOI: 10.1136/bmjgh-2022-010191] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/28/2022] [Accepted: 01/19/2023] [Indexed: 03/19/2023] Open
Abstract
BACKGROUND Systems thinking is an approach that views systems with a holistic lens, focusing on how components of systems are interconnected. Specifically, the application of systems thinking has proven to be beneficial when applied to health systems. Although there is plenty of theory surrounding systems thinking, there is a gap between the theoretical use of systems thinking and its actual application to tackle health challenges. This study aimed to create a framework to expose systems thinking characteristics in the design and implementation of actions to improve health. METHODS A systematised literature review was conducted and a Taxonomy of Systems Thinking Objectives was adapted to develop the new 'Systems Thinking for Health Actions' (STHA) framework. The applicability of the framework was tested using the COVID-19 response in Pakistan as a case study. RESULTS The framework identifies six key characteristics of systems thinking: (1) recognising and understanding interconnections and system structure, (2) identifying and understanding feedback, (3) identifying leverage points, (4) understanding dynamic behaviour, (5) using mental models to suggest possible solutions to a problem and (6) creating simulation models to test policies. The STHA framework proved beneficial in identifying systems thinking characteristics in the COVID-19 national health response in Pakistan. CONCLUSION The proposed framework can provide support for those aiming to applying systems thinking while developing and implementing health actions. We also envision this framework as a retrospective tool that can help assess if systems thinking was applied in health actions.
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Affiliation(s)
- Jenna Thelen
- Epidemiology and Public Health, Swiss Tropical and Public Health Institute, Allschwil, Switzerland
- University of Basel, Basel, Switzerland
| | - Carmen Sant Fruchtman
- Epidemiology and Public Health, Swiss Tropical and Public Health Institute, Allschwil, Switzerland
- University of Basel, Basel, Switzerland
| | - Muhammad Bilal
- Public Health, Child Advocacy International, Islamabad, Pakistan
| | - Kebabonye Gabaake
- Public Health, Institute of Development Management, Gaborone, Botswana
| | - Shahid Iqbal
- Public Health, Child Advocacy International, Islamabad, Pakistan
| | | | - Aku Kwamie
- Alliance for Health Policy and Systems Research, World Health Organization, Geneve, Switzerland
| | - Ellen Mokalake
- Public Health, Institute of Development Management, Gaborone, Botswana
| | | | - Onalenna Seitio-Kgokgwe
- Monitoring Evaluation and Quality Assurance, Ministry of Health Botswana, Gaborone, Botswana
| | - Shamsa Zafar
- Department of Obstetrics and Gynecology, Fazaia Medical College, Islamabad, Pakistan
| | - Daniel Cobos Muñoz
- Epidemiology and Public Health, Swiss Tropical and Public Health Institute, Allschwil, Switzerland
- University of Basel, Basel, Switzerland
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Astbury CC, Lee KM, McGill E, Clarke J, Egan M, Halloran A, Malykh R, Rippin H, Wickramasinghe K, Penney TL. Systems Thinking and Complexity Science Methods and the Policy Process in Non-communicable Disease Prevention: A Systematic Scoping Review. Int J Health Policy Manag 2023; 12:6772. [PMID: 37579437 PMCID: PMC10125079 DOI: 10.34172/ijhpm.2023.6772] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/10/2021] [Accepted: 01/14/2023] [Indexed: 08/16/2023] Open
Abstract
BACKGROUND Given the complex determinants of non-communicable diseases (NCDs), and the dynamic policy landscape, researchers and policymakers are exploring the use of systems thinking and complexity science (STCS) in developing effective policies. The aim of this review is to systematically identify and analyse existing applications of STCS-informed methods in NCD prevention policy. METHODS Systematic scoping review: We searched academic databases (Medline, Scopus, Web of Science, EMBASE) for all publications indexed by 13 October 2020, screening titles, abstracts and full texts and extracting data according to published guidelines. We summarised key data from each study, mapping applications of methods informed by STCS to policy process domains. We conducted a thematic analysis to identify advantages, limitations, barriers and facilitators to using STCS. RESULTS 4681 papers were screened and 112 papers were included in this review. The most common policy areas were tobacco control, obesity prevention and physical activity promotion. Methods applied included system dynamics modelling, agent-based modelling and concept mapping. Advantages included supporting evidence-informed decision-making; modelling complex systems and addressing multi-sectoral problems. Limitations included the abstraction of reality by STCS methods, despite aims of encompassing greater complexity. Challenges included resource-intensiveness; lack of stakeholder trust in models; and results that were too complex to be comprehensible to stakeholders. Ensuring stakeholder ownership and presenting findings in a user-friendly way facilitated STCS use. CONCLUSION This review maps the proliferating applications of STCS methods in NCD prevention policy. STCS methods have the potential to generate tailored and dynamic evidence, adding robustness to evidence-informed policymaking, but must be accessible to policy stakeholders and have strong stakeholder ownership to build consensus and change stakeholder perspectives. Evaluations of whether, and under what circumstances, STCS methods lead to more effective policies compared to conventional methods are lacking, and would enable more targeted and constructive use of these methods.
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Affiliation(s)
- Chloe Clifford Astbury
- Global Food System & Policy Research, School of Global Health, York University, Toronto, ON, Canada
| | - Kirsten M. Lee
- Global Food System & Policy Research, School of Global Health, York University, Toronto, ON, Canada
| | - Elizabeth McGill
- Department of Health Services Research and Policy, London School of Hygiene & Tropical Medicine, London, UK
| | - Janielle Clarke
- Global Food System & Policy Research, School of Global Health, York University, Toronto, ON, Canada
| | - Matt Egan
- Department of Public Health, Environments and Society, London School of Hygiene & Tropical Medicine, London, UK
| | - Afton Halloran
- World Health Organization European Office for the Prevention and Control of Noncommunicable Diseases, Moscow, Russian Federation
- Department of Nutrition, ExercDepartment of Nutrition, Exercise and Sports, University of Copenhagen, Copenhagen, Denmark.ise and Sports, University of Copenhagen, Copenhagen, Denmark
| | - Regina Malykh
- World Health Organization European Office for the Prevention and Control of Noncommunicable Diseases, Moscow, Russian Federation
| | - Holly Rippin
- World Health Organization European Office for the Prevention and Control of Noncommunicable Diseases, Moscow, Russian Federation
| | - Kremlin Wickramasinghe
- World Health Organization European Office for the Prevention and Control of Noncommunicable Diseases, Moscow, Russian Federation
| | - Tarra L. Penney
- Global Food System & Policy Research, School of Global Health, York University, Toronto, ON, Canada
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Termansen T, Bloch P, Tørslev MK, Vardinghus-Nielsen H. Tingbjerg Changing Diabetes: experiencing and navigating complexity in a community-based health promotion initiative in a disadvantaged neighbourhood in Copenhagen, Denmark. BMC Public Health 2023; 23:392. [PMID: 36841764 PMCID: PMC9958318 DOI: 10.1186/s12889-023-15291-w] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/07/2022] [Accepted: 02/20/2023] [Indexed: 02/27/2023] Open
Abstract
As a response to the complexity of reducing health inequity there has been a rise in community-based health promotion interventions adhering to the principles of complexity thinking. Such interventions often work with adaptive practice and constitute themselves in complex webs of collaborations between multiple stakeholders. However, few efforts have been made to articulate how complexity can be navigated and addressed by stakeholders in practice. This study explores how partners experience and navigate complexity in the partnership behind Tingbjerg Changing Diabetes (TCD), a community-based intervention addressing health and social development in the disadvantaged neighborhood of Tingbjerg in urban Copenhagen. The study provides important insights on the role of context and how it contributes complexity in community-based health promotion.The study is based on 18 months of ethnographic fieldwork in the local community including participant observations and 9 in-depth interviews with key partner representatives. Findings show that complexity in TCD can be characterized by unpredictability in actions and outcomes, undefined purpose and direction, and differing organizational logics. Factors that support partners' navigation in complexity include connectivity, embracing a flexible intervention framework, autonomy, and quick responsiveness. The study showcases the interdependency between the intervention and the context of the disadvantaged neighborhood of Tingbjerg and encourages stakeholders and researchers to embrace the messiness of complexity, and to pay attention to ways through which messiness and unpredictability can be handled.
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Affiliation(s)
- Tina Termansen
- Department of Health Promotion Research, Steno Diabetes Center Copenhagen, Borgmester Ib Juuls Vej 83, 2730, Herlev, Denmark. .,Department of Health Sciences and Technology, Aalborg University, Selma Lagerløfs Vej 249, 9260, Gistrup, Denmark.
| | - Paul Bloch
- Department of Health Promotion Research, Steno Diabetes Center Copenhagen, Borgmester Ib Juuls Vej 83, 2730, Herlev, Denmark
| | - Mette Kirstine Tørslev
- Department of Health Promotion Research, Steno Diabetes Center Copenhagen, Borgmester Ib Juuls Vej 83, 2730, Herlev, Denmark
| | - Henrik Vardinghus-Nielsen
- Department of Health Sciences and Technology, Aalborg University, Selma Lagerløfs Vej 249, 9260, Gistrup, Denmark
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The Future of Health and Science: Envisioning an Intelligent HealthScience System. Pharmaceut Med 2023; 37:1-6. [PMID: 36456682 PMCID: PMC9715402 DOI: 10.1007/s40290-022-00455-7] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/21/2022] [Indexed: 12/03/2022]
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Wilderink L, Visscher A, Bakker I, Schuit AJ, Seidell JC, Renders CM. Mechanisms and contextual factors related to key elements of a successful integrated community-based approach aimed at reducing socioeconomic health inequalities in the Netherlands: A realist evaluation perspective. PLoS One 2023; 18:e0284903. [PMID: 37195985 DOI: 10.1371/journal.pone.0284903] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/12/2021] [Accepted: 04/11/2023] [Indexed: 05/19/2023] Open
Abstract
BACKGROUND Reducing health inequalities is a challenge for policymakers and civil society. A multisectoral and multilevel approach is most promising to reduce those inequalities. Previous research showed what key elements of Zwolle Healthy City, an integrated community-based approach aimed at reducing socioeconomic health inequalities, are. To fully understand approaches that are complex and context dependent, questions as 'how does the intervention work' and 'in what context does it work' are just as important as 'what works'. The current study aimed to identify mechanisms and contextual factors associated with the key elements of Zwolle Healthy City, using a realist evaluation perspective. METHODS Transcripts of semi-structured interviews with a wide range of local professionals were used (n = 29). Following realist evaluation logic in the analysis of this primary data, context-mechanism-outcome configurations were identified and thereafter discussed with experts (n = 5). RESULTS How mechanisms (M) in certain contexts (C) were of influence on the key elements (O) of the Zwolle Healthy City approach are described. For example, how, in the context of the responsible aldermen embracing the approach (C), regular meetings with the aldermen (M) increased support for the approach among involved professionals (O). Or, how, in the context of available financial resources (C), assigning a program manager (M) contributed positively to coordination and communication (O). All 36 context-mechanism-outcome configurations can be found in the repository. CONCLUSION This study showed what mechanisms and contextual factors are associated with the key elements of Zwolle Healthy City. By applying realist evaluation logic in the analysis of primary qualitative data we were able to disentangle the complexity of processes of this whole system approach and show this complexity in a structured manner. Also, by describing the context in which the Zwolle Healthy City approach is implemented, we contribute to the transferability of this approach across different contexts.
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Affiliation(s)
- Lisa Wilderink
- Department of Health Sciences, Faculty of Sciences, Amsterdam Public Health Research Institute, Vrije Universiteit Amsterdam, Amsterdam, The Netherlands
- Department of Healthy Society, Windesheim University of Applied Sciences, Zwolle, The Netherlands
| | - Annemijn Visscher
- Research Department of the Municipal Public Health Service Organization Flevoland, Lelystad, The Netherlands
| | - Ingrid Bakker
- Department of Healthy Society, Windesheim University of Applied Sciences, Zwolle, The Netherlands
| | - Albertine J Schuit
- School of Social and Behavioral Sciences, Tilburg University, Tilburg, The Netherlands
| | - Jacob C Seidell
- Department of Health Sciences, Faculty of Sciences, Amsterdam Public Health Research Institute, Vrije Universiteit Amsterdam, Amsterdam, The Netherlands
| | - Carry M Renders
- Department of Health Sciences, Faculty of Sciences, Amsterdam Public Health Research Institute, Vrije Universiteit Amsterdam, Amsterdam, The Netherlands
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Jancey J, Vidler AC, Leavy JE, Chamberlain D, Riley T, Pollard CM, Milligan M, Blackford K. Understanding Prevention Networks in a Local Government Area: Insights From a Social Network Analysis Among Western Australian Nutrition, Physical Activity, and Obesity Prevention Programs. Health Promot Pract 2023; 24:103-110. [PMID: 34743627 DOI: 10.1177/15248399211050661] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/30/2022]
Abstract
This study aimed to use systems thinking tools to understand network relationships to inform discussions, policy, and practice to improve nutrition, physical activity, and overweight/obesity prevention activities in a Western Australian local government area. An audit of nutrition, physical activity, and obesity prevention activities was conducted, and identified organizations were invited to participate in an organizational network survey. Social network analysis (SNA) determined the extent to which organizations shared information, knowledge, and resources; engaged in joint program planning; applied for and shared funding; and identified operational barriers and contributors. SNA data were mapped and analyzed using UCINET 6 and Netdraw software. Five organizations within the network were identified as core; the remainder were periphery. The strongest networks were sharing information, and the weakest was funding. The connections were centralized to one organization, enabling them to readily influence other organizations and network operations. Remaining organizations indicated limited partnership across the networks. Strengthened collaborations and partnerships are essential to health promotion, as they extend reach and organizational capabilities. This study provides a process for undertaking network analysis, identifying leverage points to facilitate communication and information sharing, and reorienting of collaborations and partnerships to consolidate scarce resources and act strategically within a bounded area. There is a need for stronger relationships between organizations and a reorientation of partnerships to facilitate resource sharing within the local government area, to improve nutrition, physical activity, and obesity prevention practices. SNA can assist in understanding organizational prevention networks within a bounded area to support future planning of practices and policy.
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Affiliation(s)
- Jonine Jancey
- Curtin University, Perth, Western Australia, Australia
| | | | | | - Dan Chamberlain
- University of New South Wales, Sydney, New South Wales, Australia
| | - Therese Riley
- The Australian Prevention Partnership Centre, Sydney, Australia.,Therese Riley Consulting, Melbourne, Australia
| | | | - Megan Milligan
- East Metropolitan Health Service, Perth, Western Australia, Australia
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Felmingham T, Backholer K, Hoban E, Brown AD, Nagorcka-Smith P, Allender S. Success of community-based system dynamics in prevention interventions: A systematic review of the literature. Front Public Health 2023; 11:1103834. [PMID: 37033017 PMCID: PMC10080052 DOI: 10.3389/fpubh.2023.1103834] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/21/2022] [Accepted: 03/07/2023] [Indexed: 04/11/2023] Open
Abstract
Systems thinking approaches are increasingly being used to help communities understand and develop responses to preventing complex health problems. Less is known about how success is characterized and what influences success in these approaches. We present a systematic review of how concepts of success are understood and evaluated in the peer reviewed literature of studies using systems thinking in community prevention. We searched five databases for peer-reviewed literature published between 2000 and 2022, with search terms related to systems thinking, prevention and community. Studies were included if they; reported using community-based systems thinking to prevent a public health problem; described the engagement and empowerment of community members to address a public health issue; and, were published in English. Thirty-four articles were identified from 10 countries. Twenty-one aimed to prevent a chronic disease (e.g., obesity) and 16 measured success using specific tools, 10 of which used semi-structured interviews or surveys. Measures of success included implementation processes, cultural appropriateness, the number or type of actions implemented, effectiveness of community action, and changes in individual thinking or mental models, population health outcomes, data collected, or systems level measures. Implementation factors influencing success included the capacity to engage participants, composition and experience of facilitators, strength of coordination teams, allocation of resources, adaptation to participant feedback, use of multiple systems approaches, workshop process providing time and methods to allow new insights, flexible delivery, and diversity of perspectives. Findings from each of the articles indicated that approaches increased a range of outcomes including community action, strategic thinking, future planning and evaluation, community buy-in, community voice, contribution and leadership, in addition to developing shared visions and goals and creating new, ongoing collaborations, among many others. Measures of success varied, suggesting more empirical reporting of proposed outcomes of system science in communities would be valuable. While the measurement of success in the use of systems thinking in community-based prevention efforts is limited, there are helpful examples we can look to for future measurement of success.
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Affiliation(s)
- Tiana Felmingham
- Global Centre for Preventive Health and Nutrition, Institute for Health Transformation, Deakin University, Geelong, VIC, Australia
- School of Health and Social Development, Faculty of Health, Deakin University, Geelong, VIC, Australia
- *Correspondence: Tiana Felmingham,
| | - Kathryn Backholer
- Global Centre for Preventive Health and Nutrition, Institute for Health Transformation, Deakin University, Geelong, VIC, Australia
- School of Health and Social Development, Faculty of Health, Deakin University, Geelong, VIC, Australia
| | - Elizabeth Hoban
- School of Health and Social Development, Faculty of Health, Deakin University, Geelong, VIC, Australia
| | - Andrew D. Brown
- Global Centre for Preventive Health and Nutrition, Institute for Health Transformation, Deakin University, Geelong, VIC, Australia
- School of Health and Social Development, Faculty of Health, Deakin University, Geelong, VIC, Australia
| | - Phoebe Nagorcka-Smith
- Global Centre for Preventive Health and Nutrition, Institute for Health Transformation, Deakin University, Geelong, VIC, Australia
- School of Health and Social Development, Faculty of Health, Deakin University, Geelong, VIC, Australia
| | - Steven Allender
- Global Centre for Preventive Health and Nutrition, Institute for Health Transformation, Deakin University, Geelong, VIC, Australia
- School of Health and Social Development, Faculty of Health, Deakin University, Geelong, VIC, Australia
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Helme ZE, Morris JL, Nichols J, Chalkley AE, Bingham DD, McLoughlin GM, Bartholomew JB, Daly-Smith A. Assessing the Impacts of Creating Active Schools on Organisational Culture for Physical Activity. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:16950. [PMID: 36554831 PMCID: PMC9778943 DOI: 10.3390/ijerph192416950] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 11/18/2022] [Revised: 12/12/2022] [Accepted: 12/14/2022] [Indexed: 06/17/2023]
Abstract
BACKGROUND National and international guidance recommends whole-school approaches to physical activity, but there are few studies assessing their effectiveness, especially at an organisational level. This study assesses the impact of the Creating Active School's (CAS) programme on organisational changes to physical activity provision. METHODS In-school CAS leads completed a 77-item questionnaire assessing school-level organisational change. The questionnaire comprised 19 domains aligned with the CAS framework and COM-B model of behaviour change. Wilcoxon Signed Rank Tests assessed the pre-to-nine-month change. RESULTS >70% of schools (n = 53) pre-CAS had inadequate whole-school physical activity provision. After nine months (n = 32), CAS had a significant positive effect on organisational physical activity. The positive change was observed for: whole-school culture and ethos, teachers and wider school staff, academic lessons, physical education (PE) lessons, commute to/from school and stakeholder behaviour. CONCLUSIONS This study provides preliminary evidence that CAS is a viable model to facilitate system-level change for physical activity in schools located within deprived areas of a multi-ethnic city. To confirm the results, future studies are required which adopt controlled designs combined with a holistic understanding of implementation determinants and underlying mechanisms.
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Affiliation(s)
- Zoe E. Helme
- Faculties of Life Sciences and Health Studies, University of Bradford, Richmond Road, Bradford BD7 IDP, UK
- Centre for Applied Education Research, Wolfson Centre for Applied Health Research, Bradford Royal Infirmary, Bradford BD9 6TP, UK
| | - Jade L. Morris
- Faculties of Life Sciences and Health Studies, University of Bradford, Richmond Road, Bradford BD7 IDP, UK
- Centre for Applied Education Research, Wolfson Centre for Applied Health Research, Bradford Royal Infirmary, Bradford BD9 6TP, UK
| | - Joanna Nichols
- Faculties of Life Sciences and Health Studies, University of Bradford, Richmond Road, Bradford BD7 IDP, UK
- Centre for Applied Education Research, Wolfson Centre for Applied Health Research, Bradford Royal Infirmary, Bradford BD9 6TP, UK
| | - Anna E. Chalkley
- Centre for Applied Education Research, Wolfson Centre for Applied Health Research, Bradford Royal Infirmary, Bradford BD9 6TP, UK
- Centre for Physically Active Learning, Faculty of Education, Arts and Sports, Western Norway University of Applied Sciences, 5063 Bergen, Norway
| | - Daniel D. Bingham
- Faculties of Life Sciences and Health Studies, University of Bradford, Richmond Road, Bradford BD7 IDP, UK
- Centre for Applied Education Research, Wolfson Centre for Applied Health Research, Bradford Royal Infirmary, Bradford BD9 6TP, UK
- Born in Bradford, Bradford Institute for Health Research, Bradford Teaching Hospitals Foundation Trust, Bradford BD9 6RJ, UK
| | - Gabriella M. McLoughlin
- College of Public Health, Temple University, Philadelphia, PA 19140, USA
- Implementation Science Center for Cancer Control and Prevention Research Center, Brown School, Washington University, St. Louis, MO 63130, USA
| | - John B. Bartholomew
- Department of Kinesiology and Health Education, The University of Texas at Austin, Austin, TX 78712, USA
| | - Andrew Daly-Smith
- Faculties of Life Sciences and Health Studies, University of Bradford, Richmond Road, Bradford BD7 IDP, UK
- Centre for Applied Education Research, Wolfson Centre for Applied Health Research, Bradford Royal Infirmary, Bradford BD9 6TP, UK
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Schulte PA, Delclos GL, Felknor SA, Streit JMK, McDaniel M, Chosewood LC, Newman LS, Bhojani FA, Pana-Cryan R, Swanson NG. Expanding the Focus of Occupational Safety and Health: Lessons from a Series of Linked Scientific Meetings. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:15381. [PMID: 36430096 PMCID: PMC9690540 DOI: 10.3390/ijerph192215381] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 10/06/2022] [Revised: 11/14/2022] [Accepted: 11/16/2022] [Indexed: 06/16/2023]
Abstract
There is widespread recognition that the world of work is changing, and agreement is growing that the occupational safety and health (OSH) field must change to contribute to the protection of workers now and in the future. Discourse on the evolution of OSH has been active for many decades, but formalized support of an expanded focus for OSH has greatly increased over the past 20 years. Development of approaches such as the National Institute for Occupational Safety and Health (NIOSH)'s Total Worker Health® concept and the World Health Organization (WHO)'s Healthy Workplace Framework are concrete examples of how OSH can incorporate a new focus with a wider view. In 2019, NIOSH initiated a multi-year effort to explore an expanded focus for OSH. This paper is a report on the outputs of a three-year cooperative agreement between NIOSH and The University of Texas School of Public Health, which led to subject matter expert workshops in 2020 and an international conference of global interest groups in 2021. This article traces the background of these meetings and identifies and assesses the lessons learned. It also reviews ten thematic topics that emerged from the meetings: worker health inequalities; training new OSH professionals; future OSH research and practice; tools to measure well-being of workers; psychosocial hazards and adverse mental health effects; skilling, upskilling and improving job quality; socioeconomic influences; climate change; COVID-19 pandemic influences; and strategic foresight. Cross-cutting these themes is the need for systems and transdisciplinary thinking and operationalization of the concept of well-being to prepare the OSH field for the work of the future.
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Affiliation(s)
- Paul A. Schulte
- Advanced Technologies and Laboratories International, Inc., Gaithersburg, MD 20878, USA
| | - George L. Delclos
- Southwest Center for Occupational and Environmental Health, The University of Texas Health Science Center at Houston School of Public Health, Houston, TX 77030, USA
| | - Sarah A. Felknor
- National Institute for Occupational Safety and Health, Atlanta, GA 30333, USA
| | - Jessica M. K. Streit
- National Institute for Occupational Safety and Health, Cincinnati, OH 45226, USA
| | - Michelle McDaniel
- Southwest Center for Occupational and Environmental Health, The University of Texas Health Science Center at Houston School of Public Health, Houston, TX 77030, USA
| | - L. Casey Chosewood
- National Institute for Occupational Safety and Health, Atlanta, GA 30333, USA
| | - Lee S. Newman
- Center for Health, Work & Environment and Department of Environmental and Occupational Health, Colorado School of Public Health, CU Anschutz, University of Colorado, Aurora, CO 80045, USA
| | | | - Rene Pana-Cryan
- National Institute for Occupational Safety and Health, Washington, DC 20024, USA
| | - Naomi G. Swanson
- National Institute for Occupational Safety and Health, Cincinnati, OH 45226, USA
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Gaysynsky A, Heley K, Chou WYS. An Overview of Innovative Approaches to Support Timely and Agile Health Communication Research and Practice. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:15073. [PMID: 36429796 PMCID: PMC9690360 DOI: 10.3390/ijerph192215073] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/25/2022] [Revised: 11/04/2022] [Accepted: 11/14/2022] [Indexed: 06/16/2023]
Abstract
Innovative approaches are needed to make health communication research and practice more timely, responsive, and effective in a rapidly changing information ecosystem. In this paper we provide an overview of strategies that can enhance the delivery and effectiveness of health communication campaigns and interventions, as well as research approaches that can generate useful data and insights for decisionmakers and campaign designers, thereby reducing the research-to-practice gap. The discussion focuses on the following approaches: digital segmentation and microtargeting, social media influencer campaigns, recommender systems, adaptive interventions, A/B testing, efficient message testing protocols, rapid cycle iterative message testing, megastudies, and agent-based modeling. For each method highlighted, we also outline important practical and ethical considerations for utilizing the approach in the context of health communication research and practice, including issues related to transparency, privacy, equity, and potential for harm.
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Affiliation(s)
- Anna Gaysynsky
- Health Communication and Informatics Research Branch, Behavioral Research Program, Division of Cancer Control and Population Sciences, National Cancer Institute, Rockville, MD 20850, USA
- ICF Next, ICF, Rockville, MD 20850, USA
| | - Kathryn Heley
- Health Communication and Informatics Research Branch, Behavioral Research Program, Division of Cancer Control and Population Sciences, National Cancer Institute, Rockville, MD 20850, USA
| | - Wen-Ying Sylvia Chou
- Health Communication and Informatics Research Branch, Behavioral Research Program, Division of Cancer Control and Population Sciences, National Cancer Institute, Rockville, MD 20850, USA
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50
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Koorts H, Bauman A, Edwards N, Bellew W, Brown WJ, Duncan MJ, Lubans DR, Milat AJ, Morgan PJ, Nathan N, Searles A, Lee K, Plotnikoff RC. Tensions and Paradoxes of Scaling Up: A Critical Reflection on Physical Activity Promotion. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:ijerph192114284. [PMID: 36361159 PMCID: PMC9657872 DOI: 10.3390/ijerph192114284] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/15/2022] [Revised: 10/20/2022] [Accepted: 10/27/2022] [Indexed: 05/21/2023]
Abstract
Achieving system-level, sustainable 'scale-up' of interventions is the epitome of successful translation of evidence-based approaches in population health. In physical activity promotion, few evidence-based interventions reach implementation at scale or become embedded within systems for sustainable health impact. This is despite the vast published literature describing efficacy studies of small-scale physical activity interventions. Research into physical activity scale-up (through case-study analysis; evaluations of scale-up processes in implementation trials; and mapping the processes, strategies, and principles for scale-up) has identified barriers and facilitators to intervention expansion. Many interventions are implemented at scale by governments but have not been evaluated or have unpublished evaluation information. Further, few public health interventions have evaluations that reveal the costs and benefits of scaled-up implementation. This lack of economic information introduces an additional element of risk for decision makers when deciding which physical activity interventions should be supported with scarce funding resources. Decision-makers face many other challenges when scaling interventions which do not relate to formal research trials of scale-up; Methods: To explore these issues, a multidisciplinary two-day workshop involving experts in physical activity scale-up was convened by the University of Newcastle, Australia, and the University of Ottawa, Canada (February 2019); Results: In this paper we discuss some of the scale-up tensions (challenges and conflicts) and paradoxes (things that are contrary to expectations) that emerged from this workshop in the context of the current literature and our own experiences in this field. We frame scale-up tensions according to epistemology, methodology, time, and partnerships; and paradoxes as 'reach without scale', 'planned serendipity' and 'simple complexity'. We reflect on the implications of these scale-up tensions and paradoxes, providing considerations for future scale-up research and practice moving forward; Conclusions: In this paper, we delve deeper into stakeholders' assumptions, processes and expectations of scaling up, and challenge in what ways as stakeholders, we all contribute to desired or undesired outcomes. Through a lens of 'tensions' and 'paradoxes', we make an original contribution to the scale-up literature that might influence current perspectives of scaling-up, provide future approaches for physical activity promotion, and contribute to understanding of dynamic of research-practice partnerships.
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Affiliation(s)
- Harriet Koorts
- Institute for Physical Activity and Nutrition (IPAN), School of Exercise and Nutrition Sciences, Deakin University, Geelong, VIC 3220, Australia
| | - Adrian Bauman
- Prevention Research Collaboration, Sydney School of Public Health, The University of Sydney, Sydney, NSW 2006, Australia
- The Australian Prevention Partnership Centre, Sax Institute, Sydney, NSW 2037, Australia
| | - Nancy Edwards
- School of Nursing, University of Ottawa, Ottawa, ON K1H 8M5, Canada
| | - William Bellew
- Sydney Medical School & Sydney School of Public Health, The University of Sydney, Sydney, NSW 2006, Australia
| | - Wendy J. Brown
- School of Human Movement and Nutrition Sciences, University of Queensland, St Lucia, QLD 4072, Australia
| | - Mitch J. Duncan
- School of Public Health, University of Newcastle, Callaghan, NSW 2308, Australia
| | - David R. Lubans
- Centre for Active Living and Learning, College of Human and Social Futures, University of Newcastle, Callaghan, NSW 2308, Australia
- Hunter Medical Research Institute, New Lambton Heights, NSW 2305, Australia
- Faculty of Sport and Health Sciences, University of Jyväskylä, 40014 Jyvaskyla, Finland
| | - Andrew J. Milat
- Prevention Research Collaboration, Sydney School of Public Health, The University of Sydney, Sydney, NSW 2006, Australia
- Centre for Epidemiology and Evidence, NSW Ministry of Health, 1 Reserve Rd., St Leonards, NSW 2065, Australia
| | - Philip J. Morgan
- Centre for Active Living and Learning, College of Human and Social Futures, University of Newcastle, Callaghan, NSW 2308, Australia
- Hunter Medical Research Institute, New Lambton Heights, NSW 2305, Australia
| | - Nicole Nathan
- Hunter Medical Research Institute, New Lambton Heights, NSW 2305, Australia
- School of Medicine and Public Health, The University of Newcastle, Newcastle, NSW 2308, Australia
- Hunter New England Population Health, Hunter New England Area Health Service, Newcastle, NSW 2287, Australia
| | - Andrew Searles
- Hunter Medical Research Institute, New Lambton Heights, NSW 2305, Australia
| | - Karen Lee
- Prevention Research Collaboration, Sydney School of Public Health, The University of Sydney, Sydney, NSW 2006, Australia
- The Australian Prevention Partnership Centre, Sax Institute, Sydney, NSW 2037, Australia
| | - Ronald C. Plotnikoff
- Centre for Active Living and Learning, College of Human and Social Futures, University of Newcastle, Callaghan, NSW 2308, Australia
- Hunter Medical Research Institute, New Lambton Heights, NSW 2305, Australia
- Correspondence: ; Tel.: +61-(02)-49854465
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