Implementing online group model building to unravel complex geriatric problems, a methodological description

BACKGROUND

Group model building (GMB), is a qualitative focus group like study design from the field of system dynamics, that leads a group of topic experts (often key stakeholders of a problem), through a set of scripted activities to create a conceptual model of their shared view on this problems' key contributing factors and their interactions. By offering a specific step wise approach to the complexity of a problem, GMB has provided better understanding and overview of complex problems across different scientific domains, in addition to traditional research methods. As the development of geriatric syndromes and organization of geriatric care are often complex issues that are difficult to research, understand and resolve, GMB might be a useful methodology to better address these issues. This study aimed to describe the methodology of online GMB using a geriatric case study.

METHODS

Four online GMB sessions were designed by two clinician researchers. A GMB methodology expert was consulted for optimal design. Scriptapedia scripts formed the core of the sessions. These scripts were adapted to the online format. Experts were recruited purposefully and included seven local health care professionals, one patient representative and one healthcare insurance data analyst. The outcome was a conceptual model of older adults' emergency department visits, which was discussed in a separate article.

RESULTS

During implementation of these four sessions, the sessions were adjusted and two extra (non-scripted) sessions were added because defining unambiguous contributing factors to the geriatric case was challenging for the experts. Paraphrasing, categorizing, iterative plenary reflection, and reserving extra time were used to help experts overcome this challenge. All sessions were held in April and May 2021.

CONCLUSION

This study shows that GMB can help unravel complex problems in geriatrics, both pathophysiological as organizational, by creating step wise overview of their key contributing factors and interactions. Furthermore, it shows that GMB can be used by clinicians, researchers and health policy makers to better understand complex geriatric problems. Moreover, this paper can help to overcome specific implementational challenges in the geriatric field.

Using a community-based system dynamics approach for understanding inclusion and wellbeing: a case study of special needs education in an eastern African refugee camp

BACKGROUND

Children with disabilities face unique challenges in humanitarian aid settings and education may provide protective measures against abuse and exploitation. There are growing calls for inclusive education of children with disabilities in formal education, but little guidance exists on how to enhance inclusion in complex and resource-constrained contexts of humanitarian settings.

CASE PRESENTATION

This study used a community-based system dynamics approach to understand key stakeholders' perspectives of the drivers and effects of inclusion and wellbeing for children with disabilities, and to elicit recommendations to enhance educational inclusion in a refugee camp in Eastern Africa. Community-based system dynamics sessions, designed based on group model building scripts and facilitated by a team of four people, took place with organization staff, community leaders, and parents and caregivers of children with disabilities. The process produced a causal loop diagram depicting the stakeholders' perspectives of how multiple components interact in a system to drive inclusion and wellbeing of children with disabilities over time.

CONCLUSIONS

Findings indicate participants have a broad conceptualization of inclusion, highlighting the value of community interaction and importance of meeting basic needs, and also demonstrate that including children in mainstream educational settings in a complex humanitarian context requires a more nuanced approach given the lack of existing resources to support Western models of educational inclusion fully.

Learning to think together: Creativity, interdisciplinary collaboration and epistemic control

The world's current struggles with the health, economic and social impacts of the horrific Covid-19 pandemic and Australia's recent experience of climate crises, fire and flood, remind us that developing proficiency in addressing complex problems and working in interdisciplinary collaborative contexts are extraordinarily urgent. This worldwide pandemic poses potential social, political, economic and cultural catastrophes in addition to the immediate tragic outcomes for individuals and public health. Now more than ever we need to focus on developing our skills of creative and collaborative thinking. In this paper, I synthesise the research around creative collaboration, from a range of disciplines, and outline a framework to scaffold collaborative thinking in educational contexts to help students generate creative responses to complex problems. The framework develops students metacognitive understanding and epistemic awareness to enable meaningful epistemic shifting, perspective taking and cross disciplinary communication. Moving from epistemic awareness, through epistemic humility and epistemic empathy, students develop epistemic control. The article ends by calling for further research into the benefits of interdisciplinary metacognition across a range of learning contexts and a consideration of the need to go beyond often fixed adversarial critical thinking approaches and to develop an epistemic position based on inclusive collaboration and emergent creativity.

The urgent need for integrated science to fight COVID-19 pandemic and beyond

The COVID-19 pandemic has become the leading societal concern. The pandemic has shown that the public health concern is not only a medical problem, but also affects society as a whole; so, it has also become the leading scientific concern. We discuss in this treatise the importance of bringing the world's scientists together to find effective solutions for controlling the pandemic. By applying novel research frameworks, interdisciplinary collaboration promises to manage the pandemic's consequences and prevent recurrences of similar pandemics.

Elaborating a systems methodology for cascading climate change impacts and implications

New research is drawing attention to the potential for climate change to generate cascading impacts and implications across linked human-environment systems, requiring closer accounting of these interactions to anticipate the emergence of surprises and feedbacks. However, there is little practical guidance for those interested in characterising, identifying or assessing cascades, and few empirical examples. In this paper, we elaborate a systems-based methodology to identify and evaluate cascading climate change impacts and implications. We illustrate its application using the case of a participatory process with urban infrastructure managers, facing the legacy effects of damaging earthquakes and the prospect of future climate change. The results show the proposed approach and visualisation of cascades as causal diagrams provides a robust and flexible analytical framework. The use of systems thinking, visual aids, interactive discussion and expert elicitation generated valuable information about potential cascades, their interactions across domains of interest, and the implications for management. The process can provide a basis for further empirical application and advance methodological and conceptual development. Specifically, the systems methodology:•Identifies interdependencies and interconnections which may serve as transmission pathways for climate-related impacts;•Enhanced stakeholders' understanding of multiple causes and effects of climate change; and•Produced a useful visual aid for stakeholders to explore cascading impacts and implications, and opportunities for intervention.

Elaborating a systems methodology for cascading climate change impacts and implications

New research is drawing attention to the potential for climate change to generate cascading impacts and implications across linked human-environment systems, requiring closer accounting of these interactions to anticipate the emergence of surprises and feedbacks. However, there is little practical guidance for those interested in characterising, identifying or assessing cascades, and few empirical examples. In this paper, we elaborate a systems-based methodology to identify and evaluate cascading climate change impacts and implications. We illustrate its application using the case of a participatory process with urban infrastructure managers, facing the legacy effects of damaging earthquakes and the prospect of future climate change. The results show the proposed approach and visualisation of cascades as causal diagrams provides a robust and flexible analytical framework. The use of systems thinking, visual aids, interactive discussion and expert elicitation generated valuable information about potential cascades, their interactions across domains of interest, and the implications for management. The process can provide a basis for further empirical application and advance methodological and conceptual development. Specifically, the systems methodology:•Identifies interdependencies and interconnections which may serve as transmission pathways for climate-related impacts;•Enhanced stakeholders' understanding of multiple causes and effects of climate change; and•Produced a useful visual aid for stakeholders to explore cascading impacts and implications, and opportunities for intervention.

Complex cases - Complex representations of problems

Many Danish drug users do not only require services related to drug use, but face other obstacles such as mental illnesses and unemployment. The services are constituted by different types of policies, which represent both overlapping and sometimes conflicting ideas of how to frame, intervene and 'fix' problems. Policy research has mainly focused on these fields separately, however, in this article, we scrutinize policies in the fields drug use and treatment, unemployment and mental health separately and we bring together our findings to conduct a cross-sectorial analysis of how and why citizens with a mix of problems related to the three fields are produced into particular 'kinds' of subjects amenable to particular kind of tools, interventions and outcomes. Methodologically, we apply an explorative, descriptive policy analysis strategy of key policy documents. We conduct an analysis of the content of policy documents in which data sources are coded focusing on key concepts and arguments as well as examining how problem representations are embedded. Analytically, we draw on constructivist approaches exploring how problems and citizens in need of help are represented in different types of policy documents as well as how interventions are legitimized and how methods, tools and outcomes of interventions are represented. The article shows how policies altogether problematize drug users with complex problems as both morally obliged to find inner motivation and willpower and as victims of poor circumstances depriving them the benefits of leading a 'normal' life. This should be 'fixed' by treatment and interventions, resulting in that socially marginalized citizens 'get better' and, hence, are being transformed into 'someone else'. Finally, we discuss the potential benefits and limitations of the ways in which the proposed problems, solutions and expected outcomes are represented.

Does problem complexity matter for environmental policy delivery? How public authorities address problems of water governance

Problem complexity is often assumed to hamper effective environmental policy delivery. However, this claim is hardly substantiated, given the dominance of qualitative small-n designs in environmental governance research. We studied 37 types of contemporary problems defined by German water governance to assess the impact of problem complexity on policy delivery through public authorities. The analysis is based on a unique data set related to these problems, encompassing both in-depth interview-based data on complexities and independent official data on policy delivery. Our findings show that complexity in fact tends to delay implementation at the stage of planning. However, different dimensions of complexity (goals, variables, dynamics, interconnections, and uncertainty) impact on the different stages of policy delivery (goal formulation, stages and degrees of implementation) in various ways.

Community based system dynamic as an approach for understanding and acting on messy problems: a case study for global mental health intervention in Afghanistan

Background

Afghanistan lacks suitable specialized mental healthcare services despite high prevalence of severe mental health disorders which are aggravated by the conflict and numerous daily stressors. Recent studies have shown that Afghans with mental illness are not only deprived of care but are vulnerable in many other ways. Innovative participatory approaches to the design of mental healthcare policies and programs are needed in such challenging context.

Methods

We employed community based system dynamics to examine interactions between multiple factors and actors to examine the problem of persistently low service utilization for people with mental illness. Group model building sessions, designed based on a series of scripts and led by three facilitators, took place with NGO staff members in Mazar-I-Sharif in July 2014 and in Kabul in February 2015.

Results

We identified major feedback loops that constitute a hypothesis of how system components interact to generate a persistently low rate of service utilization by people with mental illness. In particular, we found that the interaction of the combined burdens of poverty and cost of treatment interact with cultural and social stigmatizing beliefs, in the context of limited clinical or other treatment support, to perpetuate low access to care for people with mental disorders. These findings indicate that the introduction of mental healthcare services alone will not be sufficient to meaningfully improve the condition of individuals with mental illness if community stigma and poverty are not addressed concurrently.

Conclusions

Our model highlights important factors that prevent persons with mental illness from accessing services. Our study demonstrates that group model building methods using community based system dynamics can provide an effective tool to elicit a common vision on a complex problem and identify shared potential strategies for intervention in a development and global health context. Its strength and originality is the leadership role played by the actors embedded within the system in describing the complex problem and suggesting interventions.