Community-based System Dynamics Research Articles

Community-Based Participatory Research and System Dynamics Modeling for Improving Retention in Hypertension Care

The high prevalence of hypertension calls for broad, multisector responses that foster prevention and care services, with the goal of leveraging high-quality treatment as a means of reducing hypertension incidence. Health care system improvements require stakeholder input from across the care continuum to identify gaps and inform interventions that improve hypertension care service, delivery, and retention; system dynamics modeling offers a participatory research approach through which stakeholders learn about system complexity and ways to model sustainable system-level improvements. To assess the association of simulated interventions with hypertension care retention rates in the Nigerian primary health care system using system dynamics modeling. This decision analytical model used a participatory research approach involving stakeholder workshops conducted in July and October 2022 to gather insights and inform the development of a system dynamics model designed to simulate the association of various interventions with retention in hypertension care. The study focused on the primary health care system in Nigeria, engaging stakeholders from various sectors involved in hypertension care, including patients, community health extension workers, nurses, pharmacists, researchers, administrators, policymakers, and physicians. Simulated intervention packages. Retention rate in hypertension care at 12, 24, and 36 months, modeled to estimate the effectiveness of the interventions. A total of 16 stakeholders participated in the workshops (mean [SD] age, 46.5 [8.6] years; 9 [56.3%] male). Training of health care workers was estimated to be the most effective single implementation strategy for improving retention in hypertension care in Nigeria, with estimated retention rates of 29.7% (95% CI, 27.8%-31.2%) at 12 months and 27.1% (95% CI, 26.0%-28.3%) at 24 months. Integrated intervention packages were associated with the greatest improvements in hypertension care retention overall, with modeled retention rates of 72.4% (95% CI, 68.4%-76.4%), 68.1% (95% CI, 64.5%-71.7%), and 67.1% (95% CI, 64.5%-71.1%) at 12, 24, and 36 months, respectively. This decision analytical model study showed that community-based participatory research could be used to estimate the potential effectiveness of interventions for improving retention in hypertension care. Integrated intervention packages may be the most promising strategies.

Unraveling the Complexity of Food and Nutrition Security for College Students in the United States: A Qualitative Community-Based System Dynamics Modeling Protocol

Unraveling the Complexity of Food and Nutrition Security for College Students in the United States: A Qualitative Community-Based System Dynamics Modeling Protocol

Mapping food system drivers of the double burden of malnutrition using community-based system dynamics: a case study in Peru

BackgroundPeru is facing a double burden of malnutrition (DBM), characterized by the co-existence of undernutrition and overnutrition. Double-duty actions that concurrently target common drivers of undernutrition and overnutrition, while ensuring no unintended side effects, are recommended to effectively address the DBM. To understand these complex common mechanisms and design context-specific double-duty actions, there is a need for participatory systems approaches. This paper provides a case study of applying a community-based system dynamics approach to capture stakeholder perspectives of food system drivers of the DBM in two regions in Peru.MethodsWe implemented a multi-stage community-based system dynamics approach, which included processes for research capacity building for systems approaches, and the designing, piloting, and implementation of stakeholder workshops. A total of 36 stakeholders, representing diverse perspectives, participated in five group model building workshops. Stakeholder views are presented in a causal loop diagram that showcases the feedback mechanisms between key food system drivers of overweight and stunting in Peru.ResultsThe causal loop diagram highlights that prioritization of undernutrition over overnutrition in the policymaking process, due to Peru’s historically high levels of undernutrition, may undermine action against the DBM. It also describes potential mechanisms of unintended impacts of undernutrition policies on the DBM in Peru, including impacts related to within-family distribution and quality of food provided through food assistance programs, and unintended impacts due to regional dynamics.ConclusionsThis paper highlights the importance of a participatory approach to understand local needs and priorities when recommending double-duty actions in Peru and shares practical methodological guidance on applying participatory systems approaches in public health.

Mapping the Dynamic Complexity of Sexual and Gender Minority Healthcare Disparities: A Systems Thinking Approach.

Sexual and gender minority (SGM) populations experience extensive health disparities compared to their straight and cisgender counterparts. The importance of addressing these disparities is paramount, as SGM groups often encounter significant barriers to accessing comprehensive healthcare, including societal stigma, provider bias, and financial constraints. This study utilizes a community-based system dynamics approach to understand and visualize the barriers to and facilitators of healthcare engagement for SGM groups across their life course. It aims to identify core constructs, relationships, and dynamic feedback mechanisms related to the experiences of connection/disconnection with physical, mental, and dental healthcare of SGM individuals. Barriers to access, such as discriminatory practices and the limited availability of SGM-informed healthcare professionals, exacerbate these disparities, underscoring the urgency of developing targeted interventions. System dynamics, a complex systems science (CSS) methodology, was used for this research. Group model building sessions were conducted with diverse SGM groups, including youth, older adults, and trans and gender-expansive community members. Causal loop diagrams were developed according to an iterative process, and a meta-model of their collective experiences was created. The study revealed extensive, dynamic, and shifting structural barriers for SGM community members accessing healthcare. Societal and structural stigma, provider bias, and pathologization were identified as significant barriers throughout their life course. Community-led interventions and SGM-focused holistic healthcare were identified as critical facilitators of SGM healthcare connection. The findings highlight the need for SGM-affirming and culturally responsive healthcare settings. This paper calls for a concerted effort from SGM health researchers to use CSS in developing interventions to reduce SGM health disparities.

Student engagement and attendance are central mechanisms interacting with inclusive and equitable quality education: Evidence from Afghanistan and Pakistan

Despite considerable progress in the field of education science, there is currently no consensus on the components that define inclusive and equitable quality education, how they are articulated with one another, and what are the best interventions to foster inclusive and equitable quality education. Current research investigates separately components of what appears to be a complex dynamic system with feedback interactions. To characterize this system and identify structures that encompass inclusive and equitable quality education, we used a community-based system dynamics approach. This approach hypothesizes that community perceptions of the local school system is essential to define it. We therefore conducted 648 participatory Group Model Building workshops with school stakeholders (children, teachers, parents and members of school management committees) resulting in as many models in 99 schools of Afghanistan and Pakistan. To identify common components across models built by participants in two waves of schools’ model building workshops, we applied techniques from multivariate analysis of ecological communities. Even across wide differences in participants’ situations and roles in the educational process, their models expressed a common reinforcing feedback loop which connected child inclusive and equitable quality education to two other components: 1) child engagement in and motivation for education, and 2) child attendance. Increases in any of these three components were perceived to drive increases in the others. We also found that child focus on learning was commonly expressed as interacting with this generic structure. Any educational reform should simultaneously and primarily embrace learners’ diversity, combine policy principles of ensuring easy equitable access to foster attendance, and promote student interest and engagement in learning through child centered pedagogy and non-discriminatory teaching practices while giving school communities power for implementation.

Systems dynamics for healthy and sustainable local food environments

Abstract Background Current food environments steer unhealthy food choices, increasing the risk for diet-related non-communicable diseases. Changing food environments is complex and underlying system dynamics of local food environments are relatively unclear. This study aimed to identify factors and leverage points that shape local food environments and to develop systemic actions with local stakeholders to improve food environments. Methods Two workshops (in 2022) were held in a Dutch municipality using a community-based system dynamics approach in which a variety of stakeholders (n = 13) participated (e.g., policy maker, retailers, health coach, citizens). Group model building exercises were used to identify factors shaping the local food environment and to develop a causal loop diagram. Subsequently, leverage points and actions to improve food environments were identified by the stakeholders. Results Based on the first workshop, a total of 46 factors influencing the local food environment were identified and categorized into four subsystems including commercial-, political-, global- and societal factors. The leverage points included the anti-lobby from food industry, food industry's willingness to change, Government/consumer priority on healthy food, food policy, e-commerce and platform economy, demand for healthy food, time to prepare/consume meals. In correspondence, 20 actions to improve the local food environment were identified during the second workshop. Moreover, the exercises initiated dialogues and collaborations between the participating stakeholders to adapt their local food environment. Conclusions This research yielded one of the first causal loop diagrams showing the multiple and varied factors influencing the local food environment. It underlines the importance of using a systems approach to adapt and improve food environments. More work is needed to implement the developed actions and to translate the system dynamics approach for use by non-academics. Key messages • Food environments are complex adaptive systems, which require a systems dynamic approach to generate change. • Food environments need to be adapted at multiple levels requiring multiple pathways and stakeholders to succeed, and thus move away from single component interventions.

Dynamics of solar energy entrepreneurship in rural Bihar, India

Access to energy provides numerous opportunities to enhance well-being and alleviate poverty. In rural and energy-poor areas, alternative technology solutions such as solar off-grid products, storage systems and energy-efficient devices can complement the unreliable electric grid to fulfil energy needs. Localized entrepreneurship in rural areas can play a significant role in increasing energy access. However, studies on the dynamics of rural entrepreneurship and low-cost energy access in poor households are scarce. This paper explores the local entrepreneurs' perception of social, economic, and technological factors that impact entrepreneurship dynamics in rural poor communities of India, and to identify strategies to help further improve the existing institutional support. A community-based system dynamics (CBSD) approach was used to engage community members to understand their perspective of entrepreneurial development. The study participants were twelve local rural retailers in the state of Bihar in India who were previously trained and employed in a decentralized solar project, and have since become solar entrepreneurs. Participants were engaged in group model-building sessions to develop a causal loop diagram (CLD). Based on the basic structure identified in CLD, a simulation model was developed and calibrated using data from solar project operations and surveys of solar users and entrepreneurs. Results indicate that training and subsequent experience in the project and business helped reinforce the entrepreneur's skills. Repair service and sales of energy products contributed in building trust and awareness in the community, thereby increasing demand for solar and energy-efficient products. The simulation-based scenario analysis shows the positive impact of better business practices, bulk procurement, and continued repair services on the income of the solar entrepreneurs. Findings from this study can inform subsequent energy entrepreneurial development in rural Bihar.

Implementing a stakeholder-driven community diffusion-informed intervention to create healthier, more equitable systems: a community case study in Greenville County, South Carolina.

This case study describes the application of a theory-informed, stakeholder-driven intervention with a group of 19 multi-sector stakeholders from an existing coalition to promote whole-of-community change that supports childhood obesity prevention. The intervention applied community-based system dynamics to design and implement activities that promoted insights into the systems driving childhood obesity prevalence and helped participants prioritize actions to influence those systems. This led to three new priority areas for the coalition: addressing food insecurity; building power among historically marginalized voices within the community; and supporting advocacy efforts to promote community-wide change beyond the coalition's previous focus on organizational-level policy, systems and environment change. The intervention spurred the application of community-based system dynamics to other health issues and in partner organizations, which demonstrates paradigm shifts about how to address complex public health issues in the community.

Measuring Shifts in Mental Models in the Prevention of Childhood Obesity in Rural Australia.

Group model building is a participatory workshop technique used in system dynamics for developing community consensus to address complex problems by consensus building on individual assumptions. This study examines changes in individual mental models of the complex problem of childhood obesity following participation in group model building (GMB), as part of a larger community-based system dynamics project. Data are drawn from GMB participants across six community sites in the Whole of Systems Trial of Prevention Strategies for Childhood Obesity (WHO STOPS) in rural and regional Victoria, Australia. Each community participated in two GMB sessions resulting in a causal loop diagram (CLD) of drivers of childhood obesity for each community. Presurvey and postsurvey captured participants' perspectives before and after (n = 25) participation in both GMB sessions and a blend of inductive and deductive qualitative content analysis was used to code individual responses. Three calculations were used to determine the number of responses, whether responses were a result of persuasion from others, and comparison of responses to those found in the CLD. Our study found participant mental models shifted during the course of the GMB sessions, with some responses persuaded by others and 75% of new insights identified in CLDs created by communities. The GMB process created a platform for participants to share ideas and learn from each other. In addition, participants listed new insights about childhood obesity in their community through developing CLDs.

249 Addressing Structural Racism Using Community Based System Dynamics

OBJECTIVES/GOALS: 1. Describe method of Community Based System Dynamics. 2. Describe CBSD as used in addressing structural racism in a previously redlined community. 3. Review example causal loop diagrams and simulation models developed using CBSD focused on structural racism as a social determinant of health. METHODS/STUDY POPULATION: Community Based System Dynamics (group model building and computer simulation development). Cuyahoga County, Ohio, a previously redlined community of more than 1.2 million people. RESULTS/ANTICIPATED RESULTS: Actionable Community identified leverage points for action to mitigate structural racism. Computer simulation models built on causal loop diagrams built by Community members with loved experience. DISCUSSION/SIGNIFICANCE: Structural and social determinants of health, such as racism, have profound impacts on the health of individuals and populations, however they remain challenging to address in pragmatic ways. CBSD is a novel method to engage community members not proximal to the impact of structural racism in generating maps of the complex, dynamic system they live in.Precision Medicine/Health

When primary healthcare meets queerstory: community-based system dynamics influencing regional/rural LGBTQ + people’s access to quality primary healthcare in Australia

BackgroundLesbian, gay, bisexual, transgender, Queer, and people of any other minority sexuality or gender identity (LGBTQ + or “Queer”) are often marginalised from accessing quality primary healthcare (PHC) in their local community. This is largely due to Queerphobic, cis-heteronormative/sexist systems pathologising Queer life and identities. The study aims were to: (1) identify key priorities for increasing Queer people’s access to quality PHC as told by Queer people themselves, (2) identify the feedback loops that reduce or support Queer people’s access to quality PHC in non-metropolitan, regional/rural communities, and (3) identify potential action areas to improve system structures to increase Queer people’s access to quality PHC.MethodsGroup Model Building (GMB) workshops were held with a small group (n = 8) of LGBTQ + people in regional Victoria with lived experience of using PHC services. This participatory approach permits exploration and visual mapping of local structures causing behaviour patterns of community concern over time – in this case, Queer people’s ability to access quality PHC in the Geelong-Barwon region. This is the first study that specially applies GMB in Queer PHC in the non-metropolitan regional/rural context.ResultsKey community identified PHC priorities were: (a) providers’ level of Queer Literacy, (b) the responsibility of Queer Advocacy (at individual, systemic, and collective levels), (c) support from safe Queer Spaces, (d) strength from a Queer Presence, and (e) power from Intersectional Queer Life. These priorities interconnected, creating system-level feedback loops reinforcing barriers and enablers to Queer people’s access to quality PHC in the Geelong-Barwon region; with potential action areas identified.ConclusionsImproving Queer people’s access to quality PHC in the Geelong-Barwon region requires embedding principles of Queer Literacy, Queer Advocacy, Queer Space, Queer Presence, and Intersectional Queer Life within practices and service systems. The study findings were distilled into a novel, preliminary set of Queer Equity Principles. These need to be taken back to regional Queer communities for further co-design and planning for translation across PHC practices and systems, with potential applicability in other areas of the healthcare spectrum.

Determinants of Food Waste in Cluj-Napoca (Romania): A Community-Based System Dynamics Approach.

This study identifies the most relevant causes of food waste according to the perceptions of key stakeholders in Cluj-Napoca, Romania. Community-Based System Dynamics (CBSD), a qualitative approach, was used to reveal the determinants of food waste. CBSD was intended to encourage the system thinking of participants in the field of food waste. Consequently, CBSD helped us map and visualize the role of each identified cause in the system and the nature of their interactions. For the present study, four categories of stakeholders were involved: consumers, public administration, food waste business, and the NGO sector involved in food waste reduction. The result of each modeling session was a loop diagram of the main food waste determinants. A common perception reflected within each stakeholder group was that food waste could be minimized through upstream actions. The participants highlighted pro-environmental knowledge, awareness, and values as the prerequisites for fighting food waste. It was found that the lack of education and awareness of food waste directly impacted food waste generation. In addition, the role of education was underlined by participants as a contributor to changing individual and household practices, such as overbuying. The lack of connection between consumers and the food production process, coupled with consumerist practices and the rejection of 'ugly food', contributed to the decrease in the overall value people attributed to food. Governmental intervention, through legislation, was indicated by the CBSD participants as being key to increasing societal awareness and shaping the behavior of food chain actors. We concluded that food waste is a 'wicked problem' and the interlocking of the economic, social, political, and environmental spheres and the multitude of stakeholders' interests, values, and perceptions should be considered in designing sustainable solutions to combat food waste. Finally, this research testifies to the importance of engaging with diverse panels of stakeholders who, through the multitude of opinions and perspectives on the causes of food waste, can further create knowledge about the most appropriate ways to combat the food waste phenomenon.

System approaches to childhood obesity prevention: ground up experience of adaptation and real-world context.

Childhood obesity prevention is critical to reducing the health and economic burden currently experienced by the Australian economy. System science has emerged as an approach to manage the complexity of childhood obesity and the ever-changing risk factors, resources and priorities of government and funders. Anecdotally, our experience suggests that inflexibility of traditional research methods and dense academic terminology created issues with those working in prevention practice. Therefore, this paper provides a refined description of research-specific terminology of scale-up, fidelity, adaptation and context, drawing from community-based system dynamics and our experience in designing, implementing and evaluating non-linear, community-led system approaches to childhood obesity prevention. We acknowledge the importance of using a practice lens, rather than purely a research design lens, and provide a narrative on our experience and perspectives on scale-up, fidelity, context and adaptation through a practice lens. Communities. Practice-based researcher experience and perspectives. Practice-based researchers highlighted the key finding that community should be placed at the centre of the intervention logic. This allowed communities to self-organise with regard to stakeholder involvement, capacity, boundary identification, and co-creation of actions implemented to address childhood obesity will ensure scale-up, fidelity, context and adaptation are embedded. We need to measure beyond primary anthropometric outcomes and focus on evaluating more about implementation, process and sustainability. We need to learn more from practitioners on the ground and use an implementation science lens to further understand how actions work. This is where solutions to sustained childhood obesity prevention will be found.

Building capacity for the use of systems science to support local government public health planning: a case study of the VicHealth Local Government Partnership in Victoria, Australia

ObjectiveTo present an approach to build capacity for the use of systems science to support local communities in municipal public health and well-being planning.DesignCase study.SettingLocal government authorities participating in the...

System dynamics modelling to engage community stakeholders in addressing water and sugar sweetened beverage consumption

BackgroundParticipatory approaches to develop community-based system dynamics models to tackle complexity are promising, but research is needed in how simulation models can be developed with community stakeholders to yield significant system insights. This study presents the results of a community-based system dynamics modelling process to increase water consumption and decrease sugar sweetened beverage consumption in Portland, Victoria, a regional town in Australia.MethodsA series of group model building workshops with 11 community stakeholders addressing the topic of water and sugar sweetened beverage consumption was conducted in Portland. A simulating system dynamics model was built with stakeholders to inform action planning.ResultsA system dynamics model was created to provide insight into water and sugar sweetened beverage consumption in Portland. The model included six feedback loops describing the causal effects of sugar sweetened beverage consumption habits and norms, water taste, water consumption norms, public water availability, and public health benefits. For example, the sugar sweetened beverage consumption norm loop modelled how people overestimating others’ consumption may motivate an increase in their own consumption, feeding back and further amplifying an increase in sugar sweetened beverage consumption. The model contributed to the foundation of a strong partnership to improve the taste of water and educate the public on water consumption.ConclusionsEngaging stakeholders in system dynamics modelling about water and sugar sweetened beverage consumption increased engagement and collaboration to address the problem among community stakeholders.

Community-based Systems Dynamics for Reproductive Health: An Example from Urban Ohio.

Health outcomes, risk factors, and policies are complexly related to the reproductive health system. Systems-level frameworks for understanding and acting within communities through community-engaged research are needed to mitigate adverse reproductive health outcomes more effectively within the community. To describe and share lessons learned from an ongoing application of a participatory modeling approach (community-based system dynamics) that aims to eliminate racial inequities in Black-White reproductive health outcomes. The community-based system dynamics approach involves conducting complementary activities, workshops, modeling, and dissemination. We organized workshops, co-developed a causal loop diagram of the reproductive health system with participants from the community, and created materials to disseminate workshop findings and preliminary models. Many opportunities exist for cross-fertilization of best practices between community-based system dynamics and community-based participatory research. Shared learning environments offer benefits for modelers and domain experts alike. Additionally, identifying local champions from the community helps manage group dynamics. Community-based system dynamics is well-suited for understanding complexity in the reproductive health system. It allows participants from diverse perspectives to identify strategies to eliminate racial inequities in reproductive health outcomes.

S03-2 The Child-COOP Denmark study: using physical literacy to guide and evaluate a systemic approach to health promotion

BackgroundChildren’s health is generally considered a complex interplay between multiple factors. Interventions building on community-based participatory research and system dynamics have shown promising potential in improving children's health behavior and well-being. This presentation aims to present how physical literacy can be used to guide and evaluate a systemic approach to health promotion.MethodsSystem dynamics techniques such as group model building, is used to engage a whole community in a rural area of Denmark and develop local actions for enhancing among other physical activity. A central health outcome in The Child-COOP Denmark study is physical literacy, which is measured by using DAPL (the Danish version of CAPL). Physical literacy will be used as a central element to guide and evaluate the project. The evaluation design includes repeated measures of childhood health behavior, physical literacy and well-being among 100 children (6-13 y) attending the local primary school. With data collection at baseline and at 2 and 4 years of follow up.ResultsFurthermore, physical literacy results throughout the project period will also be used to guide new local actions in the environment aiming to enhance the local children’s health, well-being and physical activity.DiscussionThe potential of using physical literacy measures to guide and evaluate a participatory systems approach in order to solve complex health problems, is discussed and debated with the audience.

Applying the complementary knowledge bases of System Dynamics and Indigenous knowledge in public health research in Aotearoa, New Zealand

Systems Thinking is increasingly applied to address complex societal and public health issues in Aotearoa, New Zealand and has been proposed as a good fit with traditional wisdom and Mātauranga Māori (Indigenous knowledge) from Aotearoa, New Zealand. In this article, we delve into the theoretical underpinnings of Systems Thinking approaches used in Community-Based System Dynamics research and find parallels with Indigenous narratives and knowledge. The synergy created by combining these two knowledge systems and practices is proposed as an effective way to approach public health issues that emerge from complex adaptive systems, particularly in communities with large numbers of Indigenous peoples. Examples are given from an initiative to engage community to improve food security and nutrition in regional Aotearoa, New Zealand.

Using Community-Based System Dynamics to Address Structural Racism in Community Health Improvement.

Structural racism is a profound determinant of health resulting in pervasive health inequities for people of color. Despite the recognition of structural racism as a complex, dynamic system, we lack a shared vision of the system that would enable identification of solutions for equitable systems transformation. Through a public health-led community health improvement planning process, a cross-sector consortium implemented community-based system dynamics to provide a systems science lens to guide efforts to eliminate structural racism. In group model building sessions involving diverse stakeholders, community-based system dynamics was used to bring together cross-sector stakeholders to create causal loop diagrams of the system of structural racism. Participants identified potential leverage points for actionable focus to eliminate structural racism. Causal loop diagrams of structural racism generated through group model building demonstrate complex dynamics in the areas of criminal justice, education and economic opportunity, health and health care, quality of life, racial trauma and healing, and a promising system transformative solution through perspective transformation. Community-based system dynamics, employed in the context of local community health improvement planning, engages stakeholders in systems thinking through sharing lived experience to create system maps of structural racism and identify leverage points and transportable solutions that foster health equity. These informal maps serve as the foundation for formal computer simulation models that will guide systemic action on high-yield, community-driven solutions to eliminate structural racism.

How the Senior Community Service Employment Program Influences Participant Well-Being: A Participatory Research Approach With Program Recommendations.

The federal Senior Community Service Employment Program (SCSEP) provides on-the-job training to people 55years and older with incomes at or below 125% of the federal poverty level with multiple barriers to employment. This study examined the processes by which SCSEP may influence participant financial, physical, and mental well-being. We engaged 15 SCSEP participants and case managers over four virtual and one telephone session using a participatory research method called community-based system dynamics. Activities included identifying key problem trends, variable elicitation, developing a causal map, and identifying changes to the system to increase participant well-being. Respondents identified how individual, organizational, and program and policy factors relate to participant well-being (e.g., SCSEP participation reduces social isolation, which increases desire to participate) and suggested program and policy recommendations to strengthen SCSEP (e.g., benchmarks of success should include health and well-being outcomes). These findings highlight the benefits and potential of this long-running program.