Applying systems thinking to eating behaviours in the Australian Defence Force (ADF): Conceptual and practical insights for Social Marketing

Abstract

Social marketing is constantly growing and developing in response to ongoing health, social and environmental challenges (Andreasen, 2002; Dibb, 2014). The current environment is characterised by complexity, uncertainty, and interconnectedness (Urry, 2005) and many of the issues social marketers seek to address are characterised by situations where the boundaries are unclear, the overall complexity of issues appears overwhelming, and solutions are not readily available in circumstances of prevailing change and uncertainty (Head & Alford, 2015). An unhealthy diet is a leading global risk to health as it contributes to all forms of malnutrition and is associated with noncommunicable diseases including diabetes, cardiovascular diseases, some cancers and other conditions linked to obesity (WHO, 2020). The quality of eating behaviours is particularly significant for personnel of the Australian Defence Force (ADF) for which sound nutrition and physical fitness are essential for job performance, as well as long-term health. The ADF has policies and guidelines for the provision of nutritionally appropriate food/drink on base and in the field, however, many military personnel have poor dietary habits and these habits are evident early in their career (Booth et al., 2006; Forbes-Ewan et al., 2008; Kitunen et al., 2020). Eating behaviours are complex involving several inter-related acts occurring in response to internal and external factors, stimuli and cues (Bisogni et al., 2007; Michie & Johnston, 2012; Parkinson et al., 2017; Sobal et al., 2014). The complexity of changing eating behaviours therefore presents a challenge for design, implementation, and evaluation of behaviour change interventions (Michie & Johnston, 2012; Michie et al., 2015; Parkinson et al., 2017; Parkinson et al., 2016). Systematic reviews of social marketing interventions to improve eating behaviours (Aceves-Martins et al., 2016; Carins & Rundle-Thiele, 2014a; Truong, 2014; Truong & Dang, 2017) found that effectiveness could be enhanced through interventions that were more systematic in identifying factors for change, and more systemic in the inclusion of social and environmental influences on eating behaviours. Similar findings have been made in reviews of interventions to improve eating behaviours in military populations (Murray et al., 2017; Sanderson et al., 2011). Systems thinking has gained momentum as a powerful approach for understanding problems that are multi-causal and multi-level (macro/meso/micro), and which would best be addressed through interventions at upstream, midstream and downstream levels (Domegan et al., 2016; Truong et al., 2019). However, the integration of systems thinking in the development and delivery of change interventions presents several conceptual and practical dilemmas for establishing the relevant system, and for deciding where and how to act in the system. Systems thinking is not a unitary field; on the contrary, it includes multiple theories, specialised areas of interest, and hundreds of methods (Rousseau, 2015). Furthermore, social marketers most often act within the boundaries imposed by contractual and funding requirements, ambiguous mandates, and power discrepancies that influence problem formulations and methodologies, including the identification and/or access to all system components, actors and stakeholders (McHugh et al., 2018; Truong et al., 2019). Against this background, this PhD sought to contribute conceptual and practical insights on systems-thinking as an approach in social marketing to address complex issues. These insights were developed through research informed by systems thinking into the issue of unhealthy eating behaviours in ADF personnel. Therefore, this PhD included a procedural component in which a systems thinking methodology was applied in the ideation, design, execution, and analysis of studies in ADF personnel eating behaviours; and, a learning component in which awareness and reflection on the research process came to bear in forming insights on the value of systems thinking in social marketing. The research methodology was a systemic co-inquiry (Ison, 2017) in partnership with the Australian Defence Organisation (ADO). Two qualitative studies with participatory methods addressed the following research questions: RQ1: What is the system of interest in which unhealthy eating behaviours may be best situated for exploration, with a view to designing social marketing interventions? A) What components (e.g., ideas, objects, attributes, activities) are perceived to be relevant for eating behaviours in military personnel? B) Do interrelationships and interconnections among components suggest how unhealthy eating behaviours may emerge? RQ2: Are there viable leverage points that present opportunities for changing unhealthy eating behaviours through social marketing initiatives? Together the results of the studies suggested multiple systems for situating personnel eating behaviours in the ADF context and several leverage points for change action were identified. The opportunities and barriers for action were analysed and the implications for social marketing intervention discussed. Conceptual and practical insights formed in reflecting upon the process and outputs of the studies are included in the general discussion chapter of this thesis.