Community-based System Dynamics Modeling of Sensitive Public Health Issues: Maximizing Diverse Representation of Individuals with Personal Experiences

Abstract

Community-based system dynamics (CBSD) models enhance our understanding of stigmatized public health issues and related health disparities. The accuracy and usefulness of these models depend upon the individuals who take part in group modeling sessions. Marginalized individuals that are personally impacted by these health issues are critical in the function and development of the models. However, the extent of inclusion varies between studies since such individuals are often hard to recruit. There is substantial diversity in how individuals experience a stigmatized public health issue and with the underrepresentation of individuals with personal experience, research may conclude in biased model development. The purpose of this study was to explore a method that would increase representation for individuals with personal experience of stigmatized issues in model development. We used a case study from a CBSD project on the association between alcohol misuse (AM) and intimate partner violence (IPV) within a Northern Plains American Indian community. Group model building sessions were held at three community organizations: a faith-based re-entry program, a substance use rehabilitation program for pregnant women and mothers, and a domestic violence shelter. Session participants (clients of these organizations) were quick to understand the systems method and were engaged in the modeling process. There were few similarities between the three CBSD models. Each model contributed unique system components, and a consolidated model provided a rich picture of the complex AM-IPV system, as well as the ways in which health disparities are maintained. Coupled with an emphasis on transparency and trust building between researchers and modelers, our approach illuminated the diversity of ways in which individuals with personal experience can perceive AM-IPV systems. Using similar strategies for model building can complement existing efforts to build representative models for stigmatized public health issues within communities.