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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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Evans WD, Gerard R, Symington L, Shaikh H, Agha S. Implementation practice models for development in low- and middle-income countries: systematic review of peer-reviewed literature. BMC Public Health 2022; 22:1157. [PMID: 35681165 PMCID: PMC9181891 DOI: 10.1186/s12889-022-13530-0] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/06/2021] [Accepted: 05/18/2022] [Indexed: 02/08/2023] Open
Abstract
Introduction This study operationally defines a relatively small, but growing field of study on implementation practice models for health behavior change in the context of international development. We define ‘implementation practice models’ as theoretical models that take a practical and practitioner-focused approach to behavior change, and we illustrate how these models have been developed and applied. The paper examines the continuum of behavioral theories and their application in the context of development programs and research in low- and middle-income countries (LMICs). We describe implementation practice models, examine how they have been used to design and evaluate theory-based interventions in LMIC, and describe the state of evidence in this field of study. Methods The authors conducted a systematic search of the published, peer-reviewed literature following the widely accepted PRISMA methods for systematic reviews. We aimed to identify all relevant manuscripts published in the English language in health, social science, and business literature that apply implementation practice models, located in an LMIC, with a behavior change objective. We located 1,078 articles through database searching and 106 through other means. Ultimately, we identified 25 relevant articles for inclusion. Results We found that the peer-reviewed literature on implementation practice models for development has been growing in recent years, with 80% of reviewed papers published since 2015. There was a wide range of different models revealed by this review but none demonstrated clear-cut evidence of being most effective. However, the models found in this review share common characteristics of focusing on the three central tenets of Opportunity, Ability, and Motivation (OAM). Conclusions This review found that implementation practice models for development are a promising and growing approach to behavior change in LMICs. Intervention practice models research should be expanded and applied in new domains, such as vaccination.
Supplementary Information The online version contains supplementary material available at 10.1186/s12889-022-13530-0.
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Affiliation(s)
- William Douglas Evans
- Milken Institute School of Public Health, The George Washington University, 950 New Hampshire Ave, Washington, DC, NW, 20037, USA.
| | - Raquel Gerard
- Milken Institute School of Public Health, The George Washington University, 950 New Hampshire Ave, Washington, DC, NW, 20037, USA
| | | | - Hina Shaikh
- Milken Institute School of Public Health, The George Washington University, 950 New Hampshire Ave, Washington, DC, NW, 20037, USA
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McGill E, Er V, Penney T, Egan M, White M, Meier P, Whitehead M, Lock K, Anderson de Cuevas R, Smith R, Savona N, Rutter H, Marks D, de Vocht F, Cummins S, Popay J, Petticrew M. Evaluation of public health interventions from a complex systems perspective: A research methods review. Soc Sci Med 2021; 272:113697. [PMID: 33508655 DOI: 10.1016/j.socscimed.2021.113697] [Citation(s) in RCA: 72] [Impact Index Per Article: 24.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Revised: 08/27/2020] [Accepted: 01/07/2021] [Indexed: 02/09/2023]
Abstract
INTRODUCTION Applying a complex systems perspective to public health evaluation may increase the relevance and strength of evidence to improve health and reduce health inequalities. In this review of methods, we aimed to: (i) classify and describe different complex systems methods in evaluation applied to public health; and (ii) examine the kinds of evaluative evidence generated by these different methods. METHODS We adapted critical review methods to identify evaluations of public health interventions that used systems methods. We conducted expert consultation, searched electronic databases (Scopus, MEDLINE, Web of Science), and followed citations of relevant systematic reviews. Evaluations were included if they self-identified as using systems- or complexity-informed methods and if they evaluated existing or hypothetical public health interventions. Case studies were selected to illustrate different types of complex systems evaluation. FINDINGS Seventy-four unique studies met our inclusion criteria. A framework was developed to map the included studies onto different stages of the evaluation process, which parallels the planning, delivery, assessment, and further delivery phases of the interventions they seek to inform; these stages include: 1) theorising; 2) prediction (simulation); 3) process evaluation; 4) impact evaluation; and 5) further prediction (simulation). Within this framework, we broadly categorised methodological approaches as mapping, modelling, network analysis and 'system framing' (the application of a complex systems perspective to a range of study designs). Studies frequently applied more than one type of systems method. CONCLUSIONS A range of complex systems methods can be utilised, adapted, or combined to produce different types of evaluative evidence. Further methodological innovation in systems evaluation may generate stronger evidence to improve health and reduce health inequalities in our complex world.
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Affiliation(s)
- Elizabeth McGill
- Department of Health Services, Research and Policy, London School of Hygiene & Tropical Medicine, London, United Kingdom.
| | - Vanessa Er
- Department of Health Services, Research and Policy, London School of Hygiene & Tropical Medicine, London, United Kingdom
| | - Tarra Penney
- MRC Epidemiology Unit, Centre for Diet and Activity Research (CEDAR) and University of Cambridge, Cambridge, United Kingdom
| | - Matt Egan
- Department of Public Health, Environments and Society, London School of Hygiene & Tropical Medicine, London; United Kingdom
| | - Martin White
- MRC Epidemiology Unit, Centre for Diet and Activity Research (CEDAR) and University of Cambridge, Cambridge, United Kingdom
| | - Petra Meier
- Public Health, School of Health and Related Research (ScHARR), University of Sheffield, Sheffield, United Kingdom
| | - Margaret Whitehead
- Department of Public Health, Policy and Systems, University of Liverpool, Liverpool, United Kingdom
| | - Karen Lock
- University of Exeter Medical School, Exeter, United Kingdom
| | | | - Richard Smith
- University of Exeter Medical School, Exeter, United Kingdom
| | - Natalie Savona
- Department of Health Services, Research and Policy, London School of Hygiene & Tropical Medicine, London, United Kingdom
| | - Harry Rutter
- Department of Social & Policy Sciences, University of Bath, Bath, United Kingdom
| | - Dalya Marks
- Department of Public Health, Environments and Society, London School of Hygiene & Tropical Medicine, London; United Kingdom
| | - Frank de Vocht
- Population Health Sciences, Bristol Medical School, University of Bristol, Bristol, United Kingdom
| | - Steven Cummins
- Department of Public Health, Environments and Society, London School of Hygiene & Tropical Medicine, London; United Kingdom
| | - Jennie Popay
- Division of Health Research, Faculty of Health and Medicine, Lancaster University, Lancaster, United Kingdom
| | - Mark Petticrew
- Department of Public Health, Environments and Society, London School of Hygiene & Tropical Medicine, London; United Kingdom
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Francisco MTR, Fonte VRFD, Spindola T, Pinheiro CDP, Costa CMA, Rocha FCSD. Testagem para o HIV e profilaxia pós-exposição entre homens que fazem/ não fazem sexo com homens. ESCOLA ANNA NERY 2021. [DOI: 10.1590/2177-9465-ean-2020-0236] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
Abstract
Resumo Objetivos identificar a realização da testagem para o HIV e o conhecimento sobre profilaxia pós-exposição (PEP) entre homens; e comparar os dados entre homens que fazem (ou não) sexo com homens. Método estudo transversal realizado com 271 homens participantes do carnaval no Rio de Janeiro, selecionados através da amostragem por conveniência. Os dados foram coletados no sambódromo, com auxílio de um questionário em fevereiro de 2017. A análise foi realizada por meio do software SPSS. Resultados houve disparidades na realização de testagem para o HIV e conhecimentos sobre PEP entre homens que fazem (ou não) sexo com homens. Homens que fazem sexo com homens possuem comportamentos e conhecimento melhores de enfrentamento ao HIV. Conclusão e implicações para a prática as políticas de enfrentamento ao HIV têm conseguido alcançar uma das populações-chave da epidemia, os homens que fazem sexo com homens, contudo homens que não fazem sexo com homens continuam vulneráveis.
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Qualitative process evaluation from a complex systems perspective: A systematic review and framework for public health evaluators. PLoS Med 2020; 17:e1003368. [PMID: 33137099 PMCID: PMC7605618 DOI: 10.1371/journal.pmed.1003368] [Citation(s) in RCA: 39] [Impact Index Per Article: 9.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/13/2020] [Accepted: 09/11/2020] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND Public health evaluation methods have been criticized for being overly reductionist and failing to generate suitable evidence for public health decision-making. A "complex systems approach" has been advocated to account for real world complexity. Qualitative methods may be well suited to understanding change in complex social environments, but guidance on applying a complex systems approach to inform qualitative research remains limited and underdeveloped. This systematic review aims to analyze published examples of process evaluations that utilize qualitative methods that involve a complex systems perspective and proposes a framework for qualitative complex system process evaluations. METHODS AND FINDINGS We conducted a systematic search to identify complex system process evaluations that involve qualitative methods by searching electronic databases from January 1, 2014-September 30, 2019 (Scopus, MEDLINE, Web of Science), citation searching, and expert consultations. Process evaluations were included if they self-identified as taking a systems- or complexity-oriented approach, integrated qualitative methods, reported empirical findings, and evaluated public health interventions. Two reviewers independently assessed each study to identify concepts associated with the systems thinking and complexity science traditions. Twenty-one unique studies were identified evaluating a wide range of public health interventions in, for example, urban planning, sexual health, violence prevention, substance use, and community transformation. Evaluations were conducted in settings such as schools, workplaces, and neighborhoods in 13 different countries (9 high-income and 4 middle-income). All reported some utilization of complex systems concepts in the analysis of qualitative data. In 14 evaluations, the consideration of complex systems influenced intervention design, evaluation planning, or fieldwork. The identified studies used systems concepts to depict and describe a system at one point in time. Only 4 evaluations explicitly utilized a range of complexity concepts to assess changes within the system resulting from, or co-occurring with, intervention implementation over time. Limitations to our approach are including only English-language papers, reliance on study authors reporting their utilization of complex systems concepts, and subjective judgment from the reviewers relating to which concepts featured in each study. CONCLUSION This study found no consensus on what bringing a complex systems perspective to public health process evaluations with qualitative methods looks like in practice and that many studies of this nature describe static systems at a single time point. We suggest future studies use a 2-phase framework for qualitative process evaluations that seek to assess changes over time from a complex systems perspective. The first phase involves producing a description of the system and identifying hypotheses about how the system may change in response to the intervention. The second phase involves following the pathway of emergent findings in an adaptive evaluation approach.
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