A System Dynamics and Participatory Action Research Approach to Promote Healthy Living and a Healthy Weight among 10–14-Year-Old Adolescents in Amsterdam: The LIKE Programme

Wilma Waterlander ,Angie Luna Pinzon,Coosje Dijkstra,Helga Emke,Emma Van Den Eynde,Manou Anselma,Lieke Van Houtum,Jutka Halberstadt,Susan Van De Vlasakker,Erica Van Den Akker,Karien Stronks,Vincent Busch,Karen Den Hertog,Roel C.j Hermans ,Teatske M Altenburg ,Arnoud P Verhoeff ,Stef Kremers ,Amika S Singh ,Meredith L Overman ,Mai J M Chinapaw ,Wilma Nusselder ,Jacob C Seidell ,Carry M Renders ,Tanja G M Vrijkotte

doi:10.3390/ijerph17144928

Abstract

This paper describes the design of the LIKE programme, which aims to tackle the complex problem of childhood overweight and obesity in 10–14-year-old adolescents using a systems dynamics and participatory approach. The LIKE programme focuses on the transition period from 10-years-old to teenager and was implemented in collaboration with the Amsterdam Healthy Weight Programme (AHWP) in Amsterdam-East, the Netherlands. The aim is to develop, implement and evaluate an integrated action programme at the levels of family, school, neighbourhood, health care and city. Following the principles of Participatory Action Research (PAR), we worked with our population and societal stakeholders as co-creators. Applying a system lens, we first obtained a dynamic picture of the pre-existing systems that shape adolescents’ behaviour relating to diet, physical activity, sleep and screen use. The subsequent action programme development was dynamic and adaptive, including quick actions focusing on system elements (quick evaluating, adapting and possibly catalysing further action) and more long-term actions focusing on system goals and/or paradigm change. The programme is supported by a developmental systems evaluation and the Intervention Level Framework, supplemented with routinely collected data on weight status and health behaviour change over a period of five years. In the coming years, we will report how this approach has worked to provide a robust understanding of the programme’s effectiveness within a complex dynamic system. In the meantime, we hope our study design serves as a source of inspiration for other public health intervention studies in complex systems.

Highlights

The prevention of childhood overweight and obesity and related determinants, including poor diet, poor sleep, excessive screen use and insufficient physical activity, are considered complex health problems
3.1 What type of changes occurred in the living context, what were potential unintended consequences, and how can these be related to the LIKE programme?
This evaluation question relates to the types of actions that are developed during the LIKE programme and where they fit on the Intervention

Summary

Introduction

The prevention of childhood overweight and obesity and related determinants, including poor diet, poor sleep, excessive screen use and insufficient physical activity, are considered complex health problems. The drivers are multiple, diverse, and dynamic, ranging from biological factors and personal behaviours to aspects of the physical, economic, sociocultural and political environments [1,2]. This applies to adolescents as they go through major physical, emotional and social changes. An important reason for this lack of effect is that interventions generally have a narrow public health focus and target a limited number of determinants at a single environmental level, such as a school, instead of more systemic actions including multiple levels, which are required to achieve a meaningful effect on a complex problem such as overweight [7]

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Discussion

Conclusion