Group Model Building Research Articles

Understanding Perinatal Mental Health: A Systems Science Approach to Identify Common Drivers and Opportunities for Intervention.

PNDA are complex health conditions affecting up to one in five women. The causes of PNDA are not well understood and no proven prevention exists. This study aimed: (1) to understand health professionals' perspectives of the common drivers contributing to PNDA amongst women from regional and rural areas in Australia; (2) to identify clinical practice related to PNDA-associated challenges; (3) to identify and inform areas for intervention. We conducted four online Group Model Building (GMB) workshops with health professionals from the southwest of Victoria, Australia. Informed by local data, participants built a model that progressed from connection circles to causal loop diagrams (CLD) to capture a shared understanding of the key drivers of PNDA rates within the region. The CLD was thematically analysed and common drivers were grouped. The GMB transcripts were thematically analysed inductively identifying emergent themes about PNDA drivers and intervention ideas. The CLD revealed 28 drivers and four key themes that stakeholders perceived to be driving the increasing rates of PNDA. An additional three major themes were identified from the GMB transcripts: (1) Social determinants of women's health; (2) Health system issues; (3) Negative birth experiences. Three key intervention themes were proposed, to improve collaboration between health services and departments, increase training availability, and increase continuity of care. Our findings suggest that dedicated training and pathways for collaboration between large regional and smaller rural services are necessary to address the rising rates of PNDA in the region.

Identifying mechanisms that shape the food environment in long-term healthcare facilities in the Netherlands: a participatory system dynamics approach

BackgroundCreating healthy and sustainable food environments within long-term healthcare facilities asks for a systemic approach. This study aimed to: (1) identify system dynamics underlying the food environment of long-term healthcare facilities, (2) formulate actions for changing the system to promote a healthy and sustainable food environment and (3) evaluate stakeholder perspectives about the process and progress towards action implementation up to one-year follow-up.MethodsA group model building (GMB) approach was used during two workshops with stakeholders of five different long-term healthcare facilities in the Netherlands. Stakeholders created a causal loop diagram (CLD) and formulated actions for change. Interviews were conducted at six- and twelve months to evaluate perspectives on the GMB process and progress towards action implementation.ResultsThe developed CLD consisted of 30 factors influencing the food environment in long-term healthcare facilities and four interrelated subsystems (patient; healthcare organization; national governance and policy; purchasing, procurement and budget). Stakeholders formulated 40 corresponding actions. After one year follow-up, small steps towards action implementation were observed (e.g., agenda setting, raising internal awareness, formulating plans), with several barriers hindering implementation being noted (e.g., lack of time, budget, priority).ConclusionsThis study gained a comprehensive, collectively acknowledged understanding of the system dynamics underlying the food environment in Dutch long-term healthcare institutions. The results underscore the importance of crafting a coherent set of actions that addresses various factors and underlying mechanisms to initiate systemic change. However, achieving actual system changes in long-term healthcare facilities requires prolonged efforts and overcoming barriers towards implementation.

Timely access to specialist outpatient care: can applying systems thinking unblock our waiting lists?

BackgroundThe purpose of this qualitative study was to focus on review and repeat review outpatients and the structural role they play in exacerbating waitlists for Specialist Outpatient (SOP) services in Queensland. Waitlists, which record the number of patients waiting for an initial consultation (new appointment), are an indicator of a health system under strain. Waiting too long to access SOP can have a detrimental effect on people’s health outcomes. Not tackling the structural drivers of waitlists can result in non-systemic, non-sustainable fixes that perpetuate waitlists and detrimental outcomes. Patients should be discharged from specialist care when the episode of care is completed, provided appropriate care is available. When review patients remain in the SOP system, they impact the number of new appointments available.MethodsThis paper uses a feedback systems approach to make transparent the touchpoints, dynamics and impact of review and repeat review appointments on waitlists. The evidence used to construct the causal loop diagrams (CLD) in this paper was an output of Group Model Building (GMB). Two facilitated half-day participatory workshops were held in April and June 2023. The project brought together researchers, consumers, hospital and health services (HHS) specialty clinical leads, General Practitioners (GPs), Executive sponsors, HHS outpatient service managers and analysts to provide hospital and healthcare expert stakeholders an opportunity to translate their collective mental models into meaningful system diagrams which communicated how the outpatient system was working.ResultsThe CLD provided a cross-boundary visual of how the review and repeat review appointment contributes to the waitlist. It shows that the review and repeat review outpatients are a hidden feedback loop contributing to growing waiting lists. In the absence of a discharge planning intervention, they have the potential to become a vicious cycle that grows review appointment demand, consuming the availability of new appointments.ConclusionsA feedback systems approach can enhance SOP system understanding, ultimately shifting policy response in health away from local “firefighting” fixes towards more sustainable systemic solutions which promote timely outpatient access. The results suggest that the review patient process impacts the waitlists and should be viewed as a leverage point in the management of growing specialist outpatient waitlists.

Using group model building to frame the commercial determinants of dietary behaviour in adolescence – findings from online system mapping workshops with adolescents, policymakers and public health practitioners in the Southwest of England

BackgroundIn England, 23% of children aged 11 start their teenage years living with obesity. An adolescent living with obesity is five times more likely to live with obesity in adult life. There is limited research and policy incorporating adolescents’ views on how they experience the commercial determinants of dietary behaviour and obesity, which misses an opportunity to improve services and policies that aim to influence the prevalence of childhood obesity. This study reports the findings from online Group Model Building system mapping workshops in which we explored the mechanisms by which commercial drivers influence adolescents’ dietary behaviour.MethodsWe ran a series of 3 online Group Model Building workshops with adolescents and one Group Model Building workshop with policymakers and public health practitioners. Adolescents portrayed their views on how food and beverage industries influence what they choose to buy and eat in a system map, and then proposed a set of policy actions to promote healthier food environments. We shared the system map created by adolescents with policymakers and public health practitioners to reflect on how current policy interventions match adolescents’ views on the most influential factors.ResultsThe system map contains 37 elements connected by 70 hypothesised causal links and five feedback loops. These elements were grouped into six themes that portray the complexity of factors that influence adolescents’ food choices in their physical and digital environments, disproportionately encouraging the consumption of unhealthy products. Policymakers and public health practitioners reflected on the power and the deep level of influence food companies exert on adolescents’ behaviour. They recognised that the coexisting influence of food marketing and social media on mental health and body image is not well reflected in current policy and research efforts.ConclusionsThis study highlights the need for public health policymaking processes to provide youth with a space to voice influential elements and consequences, thereby co-creating policies and designing interventions to buffer risk factors and increase well-being in this critical transitional stage.

A systemic approach to identifying sustainable community-based interventions for improving adolescent mental health: a participatory group model building and design protocol

BackgroundThe deteriorating mental health of children and young people in the United Kingdom poses a challenge that services and policy makers have found difficult to tackle. Kailo responds to this issue with a community-based participatory and systemically informed strategy, perceiving mental health and well-being as a dynamic state shaped by the interplay of broader health determinants. The initiative works to explore, define and implement locally relevant solutions to challenges shaping the mental health and well-being of young people. Kailo unfolds in three stages within each locale. These stages encompass: “early discovery”, “deeper discovery and co-design” and “implementation”. This document delves into the participatory group model building and design protocol occurring in the “deeper discovery and co-design” stage of the project.MethodsParticipatory methods, such as group model building, are effective in articulating and building consensus on complex issues like the social determinants of adolescent mental health. This paper describes the protocol for application of group model building within the Kailo design process to develop causal loop diagrams and pinpoint leverage points for improving adolescent mental health. It also suggests a method for considering modifications to delivery within a unique project context and in alignment with participants’ needs. This paper sets out to define the approach and clarify the objectives these engagements aim to fulfil. The method adapts existing group model building (GMB) protocols for use in a community setting. The engagements will involve groups of local young people and existing community members. To assess the success of the session’s implementation post-delivery, the study utilizes existing frameworks for fidelity evaluations, which define a core and flex model.DiscussionThe method described enables an integration of diverse local understandings of complex processes which provides a platform for creating co-designed interventions. This protocol can be used to further strengthen research and design through incorporating complexity and participation into the formulation of contextually relevant policies and practices. The strengths and limitations of the approach are discussed.

Leveraging group model building to operationalize implementation strategies across implementation phases: an exemplar related to child maltreatment intervention selection

BackgroundImplementation strategies can help support the adoption and implementation of health interventions that are appropriate for a local context and acceptable to decision makers and community members. Implementation strategies should be designed to handle the complexity of the multi-level, dynamic contexts in which interventions are implemented. Systems science theories and methods explicitly attend to complexity and can be valuable for specifying implementation strategies. Group Model Building (GMB) combines research partner engagement strategies with systems science to support researchers’ and partners’ learning about complex problems and to identify solutions through consensus. This paper specifies how GMB can operationalize implementation strategies — methods for supporting evidence implementation in real-world practice — and describes how GMB can aid in selecting and tailoring both health interventions and implementation strategies. A case study in child maltreatment prevention planning is provided to illustrate how GMB was used to specify the “actions” — strategy activities — for three implementation strategies (conduct local consensus discussions; build a coalition; model and simulate change) during the earliest implementation phases, with the goal of supporting intervention selection decisions. Examples are provided of generalizable research products that can be produced concurrently through GMB, in addition to contextually-driven implementation support.MethodsParticipants (n = 8) were engaged over four sessions using tailored GMB activities. Participants generated a qualitative system dynamics model that described their theory of change for how to prevent child maltreatment in their communities. This theory of change reflected a dynamic understanding of the interconnected determinants of child maltreatment.ResultsGMB was acceptable to participants and resulted in products that could be used for implementation planning (e.g., to model and simulate change) and future research. GMB fostered trust and idea sharing between participants.ConclusionGMB can facilitate learning about which outcomes are (or are not) impacted by interventions, which resources and approaches are required for quality implementation (e.g., implementation strategies), and tradeoffs in outcomes and resources between interventions. GMB also provides a structured, effective process to generate a shared implementation vision amongst participants. Lessons learned include methods for developing trust with and between participants, and the need for researchers to tailor GMB actions for participant and project needs.

Triangulation for causal loop diagrams: constructing biopsychosocial models using group model building, literature review, and causal discovery

The complex nature of many health problems necessitates the use of systems thinking tools like causal loop diagrams (CLDs) to visualize the underlying causal network and facilitate computational simulations of potential interventions. However, the construction of CLDs is limited by the constraints and biases of specific sources of evidence. To address this, we propose a triangulation approach that integrates expert and theory-driven group model building, literature review, and data-driven causal discovery. We demonstrate the utility of this triangulation approach using a case example focused on the trajectory of depressive symptoms in response to a stressor in healthy adults. After triangulation with causal discovery, the CLD exhibited (1) greater comprehensiveness, encompassing multiple research fields; (2) a modified feedback structure; and (3) increased transparency regarding the uncertainty of evidence in the model structure. These findings suggest that triangulation can produce higher-quality CLDs, potentially advancing our understanding of complex diseases.

Exploring the perceived dynamic system driving inequities in the community obesogenic environment

Abstract Introduction Persons in socioeconomically disadvantaged situations (PSEDS) are more susceptible and disproportionally exposed to obesogenic environments, resulting in poorer dietary outcomes and lower levels of physical activity. This study aimed to map the complex dynamic system within the community obesogenic environment driving unhealthy eating and insufficient physical activity among PSEDS in Flanders, and to identify potential local actions. Methods Participatory group model building (GMB), a qualitative system dynamics method, was used to engage PSEDS (n = 7), local decision makers (n = 7) and local stakeholders (n = 5) in two Flemish municipalities. A two-day GMB session was held in each municipality during which a causal loop diagram (CLD) was created and potential local actions were identified by considering causal pathways and reinforcing loops in the system. Results The CLD was designed around two main variables (i) healthy eating and (ii) physical activity among PSEDS. Seven sub-systems could be identified: 1) social environment, 2) facilities and activities, 3) mobility options, 4) information, 5) affordability, 6) safety (specifically for physical activity), and 7) industry and advertisement (specifically for eating behaviour). Several actions to improve the local environment to promote eating behaviour and physical activity among PSEDS were identified. Conclusions The CLD illustrates the complex interactions between individual and environmental determinants contributing to inequalities in eating behaviour and physical activity by including multiple perspectives of community members in socioeconomically disadvantaged situations, local decision makers and local stakeholders. Both the participatory GMB approach and the final CLD visualization can provide the basis for planning local actions for promoting healthy eating behaviour and physical activity among PSEDS. Key messages • Group model building is an effective approach to explore and understand a dynamic complex system through a shared understanding among diverse stakeholders. • A systems approach is valuable to provide a more comprehensive and context-specific understanding of the perceived factors contributing to inequities in the obesogenic environment.

Transcending disciplinary boundaries: NbS for Caribbean coastal resilience

Caribbean small island developing states are experiencing multiple interconnected crises, including susceptibility to natural hazards, increased vulnerability to climate change, biodiversity loss and reduced accessibility to development funding. Nature-based solutions (NbS) can provide an integrated approach to boost Caribbean coastal resilience as they are economic and practical solutions that capably balance competing interests. This study used a participatory method (group model building) to engage stakeholders across varying disciplines and levels of decision making to collaboratively identify the underlying causes of low uptake of NbS regionally and potential intervention mechanisms. Six overarching factors were found to contribute to low adoption, including data and knowledge limitations, a propensity towards hard engineering, low collaborative engagement and limited implementation capacity. Some areas identified for intervention were comprehensive data collection, reducing uncertainty surrounding the implementation of NbS, effective collaboration, using case studies and best practices, and knowledge translation and dissemination. The outputs demonstrate a critical role for engineers in mainstreaming NbS through adopting a systematic and holistic design approach. Concomitant to this is the need for engineers to operate successfully within transdisciplinary teams to enhance transformative communication skills and ensure that solutions not only minimise environmental impact but also support the conservation of biodiversity and ecosystem services.

Adapting Group Model Building for Mental Healthcare: A Participatory Co-Design Approach.

Countries around the world are experiencing both a growing need for mental health services and major gaps in the delivery of mental healthcare. The World Health Organisation's 2022 report on mental health emphasised co-designed and systems-level innovations responsive to the voice of those with lived experience. However, evidence for implementing such methodologies is sparse. Group model building (GMB), a participatory systems-based approach, has been used in various fields, but its application is limited within mental healthcare settings. It is recognised as a valuable tool for engaging stakeholders, including those with lived experience, in understanding and redesigning health systems and services. The participatory approach aligns with the mental health sector's shift towards co-design and person-centred care. This study assessed the acceptability of GMB as a method for co-design within mental healthcare, aiming to explore its potential for meaningful collaborative improvement and systems-level insights. Participants from a regional Mental Health and Drug and Alcohol Service (MHDAS) engaged in GMB workshops and focus groups. Eighteen individuals, including lived experience workers and healthcare professionals, provided feedback that informed adjustments to the workshops' design, language, timing and facilitation techniques, enhancing GMB's relevance for mental health co-design. The findings demonstrate the value and acceptability of the adapted GMB process in acute mental healthcare, marking a significant step towards evidence-based, person-centred service improvement. This study highlights the potential effectiveness of participatory methods in identifying and addressing systemic challenges, paving the way for future mental health reforms. Future work will focus on implementing and evaluating co-designed interventions, aiming for more inclusive and effective mental healthcare and advancing innovation and reform in the field.

FERTILITY CARE IN LOW AND MIDDLE INCOME COUNTRIES: Implementing fertility care: insights from a participatory workshop in The Gambia.

The Gambia, West Africa, has made recent progress on infertility, a component of sexual and reproductive health that is lagging behind others. Since 2016, there is favourable policy environment stemming from infertility research and partnership building with national stakeholders and local civil society organisations focussing on infertility. Here, we report outcomes from a participatory workshop on infertility policy implementation in The Gambia and provide insights on setting national priorities for fertility care in resource-limited settings. We conducted a participatory workshop involving 29 participants from Gambia's public and private health sectors. Using selected participatory group work tools, stakeholders identified and prioritised key activities within the framework of five pre-defined areas of action, including (i) creating guidelines/regulations; (ii) recording/reporting data; (iii) building public-private partnerships; (iv) training health providers; and (v) raising awareness and health-seeking. A total of 17 prioritised activities were proposed across the five action areas, according to short-, medium-, and long-term timeframes. Three were further prioritised from the overall pool, through group consensus. A group model building activity helped to envision the complexity by elucidating links, loops, and connections between each activity and their expected outcomes. The participatory workshop identified actionable interventions for fertility care in The Gambia, with stakeholders setting a clear path ahead. Despite challenges, the continued engagement of Gambian policymakers, practitioners, researchers, and activists in efforts to move beyond policy creation to its implementation is essential. Improving fertility care in The Gambia and other low- and middle-income countries is feasible with effective collaboration and financial support. In The Gambia, a partnership of stakeholders from various domains, including research, grassroots activism, clinicians, and policymakers, contributed to an increased awareness of infertility. This, in turn, led to the inclusion of infertility in the national reproductive health strategic plan. An in-country participatory workshop involving participants from both public and private health sectors was held in October 2023 with the objective of identifying priorities for moving beyond planning to implementation, within the context of resource constraints. The top three identified priorities were: (i) training about infertility for health providers; (ii) harmonisation of data collection; and (iii) the development of clinical guidelines for infertility management. It is important for the Gambian Ministry of Health to implement these proposed locally relevant fertility care activities. Despite current and future challenges, having a clear vision and pathway will help establish fertility care in the country, with Gambia potentially leading the way among many other countries.

Determinants and facilitators of community coalition diffusion of prevention efforts

This study examines how individual characteristics and network features of coalition participation in an intervention predict coalition members’ diffusion of Knowledge and Engagement in childhood obesity prevention. The study involved six communities in the U.S. measured across two to five time points from 2018 to 2021. Each community participated in the Stakeholder-driven Community Diffusion theory-informed intervention, a three-phase intervention that employs group model building and technical assistance with convened stakeholders to build Knowledge, Engagement, and utilize research evidence in community-led, childhood obesity prevention actions. Findings indicate that key individual-level characteristics (e.g., years of experience, gender, eigenvector centrality) and network-level features (e.g., hierarchy, clustering) are associated with higher increases in intervention outcomes of Knowledge and Engagement in childhood obesity prevention. We attend to issues of perceived influence and power in community coalitions, finding that younger, less experienced women who are not well connected to other well-connected coalition members experience smaller increases in intervention outcomes. Our discussion focuses on how individual- and network-level characteristics are associated with coalition support for evidence-based practice adoption and implementation.

ACL Injury Etiology in Its Context: A Systems Thinking, Group Model Building Approach.

Background/Objectives: Given the complex nature of Anterior Cruciate Ligament (ACL) injury, it is important to analyze its etiology with suitable approaches in order to formulate intervention strategies for effective prevention. The present study employs system thinking techniques to develop a Causal Loop Diagram (CLD) Model for investigating the risk factors for ACL Injury (CLD-ACLI), through a Group Model Building approach. Methods: A two-stage procedure was applied involving a comprehensive literature review followed by several systems thinking group-modeling co-creation workshops with stakeholders. Results: Based on input from experts and stakeholders, combined with the latest scientific findings, the derived CLD-ACLI model revealed a series of interesting complex nonlinear interrelationships causal loops between the likelihood of ACL injury and the number of risk factors. Particularly, the interaction among institutional, psychological, neurocognitive, neuromuscular, malalignment factors, and trauma history seem to affect neuromuscular control, which subsequently may alter the biomechanics of landing, predisposing the ACL to injury. Further, according to the proposed CLD-ACLI model, the risk for injury may increase further if specific environmental and anatomical factors affect the shear forces imposed on the ACL. Conclusions: The proposed CLD-ACLI model constitutes a rigorous useful conceptual presentation agreed upon among experts on the dynamic interactions among potential intrinsic and extrinsic risk factors for ACL injury. The presented causal loop model constitutes a vital step for developing a validated quantitative system dynamics simulation model for evaluating ACL injury-prevention strategies prior to implementation.

ARCHIVE PAPER: Micro worlds versus boundary objects in group model building: evidence from the literature on problem definition and model conceptualization (2007)

Foreword by David AndersenWhen I saw the call for papers for the Special Issue on Qualitative Aspects of System Dynamics Modeling, I immediately thought of the unpublished work completed by my graduate student Aldo Zagonel. I nominated it for consideration as an Archives paper. I believe this 2007 working paper (originally posted on the Sandia website) may be one of the best unpublished pieces of early work on the qualitative nature of our client‐based modeling efforts. (Although Dr. Zagonel included me as an author of the 2007 working paper, my involvement was simply that of a graduate advisor. He deserves all the credit for this work and manuscript.) Zagonel developed this work in his doctoral program and presented an earlier version at the 2002 International System Dynamics Conference (Zagonel 2002). That version of the paper won the Dana Meadows Award for the best student paper.Zagonel's doctoral work was part of our early efforts at UAlbany to develop group model building (GMB) as a technique in system dynamics. These approaches to model conceptualization and formulation blend quantitative and qualitative methods with strong scripted facilitation techniques. Zagonel was the first to note how this combination of approaches creates the ideal‐type dichotomy between “micro worlds” and “boundary objects” that he describes in this paper. His suggestion that much of the good work in system dynamics draws on both of these ideal types was prescient. The ideas discussed here have influenced many others over the years. I am pleased they will now be more easily accessible for our field.I am especially pleased that this paper is being published in the same issue as Laura Black's (2024) thoughtful reflection on Dr. Zagonel's paper and extension of the ideal‐type dichotomy he presents. Her paper offers an update on the idea of Zagonel's “straw man” comparison of micro worlds and boundary objects, suggesting that these are two points on a continuum of models that contribute to decision making and stakeholder interaction. She shows how this aspect of our field has developed in the last few decades and provides a clear framework for how to think about our work.Black, LJ. 2024. Reflecting on Zagonel's Dichotomy of Microworlds and Boundary Objects. System Dynamics Review.Zagonel AA. 2002. Model conceptualization in Group Model Building: A review of the literature exploring the tension between representing reality and negotiating a social order. Proceedings of the 20th International Conference of the System Dynamics Society. Palermo, Italy (July 28‐August 1).AbstractBased upon participant observation in group model building and content analysis of the system dynamics literature, I postulate that modeling efforts have a dual nature. On one hand, the modeling process aims to create a useful representation of a real‐world system. This must be done, however, while aligning the clients' mental models around a shared view of the system. There is significant overlap and confusion between these two goals and how they play out on a practical level. This research clarifies these distinctions by establishing an ideal‐type dichotomy. To highlight the differences, I created two straw men: “micro world” characterizes a model that represents reality and “boundary object” represents a socially negotiated model. Using this framework, the literature was examined, revealing evidence for several competing views on problem definition and model conceptualization. The results are summarized in the text of this article, substantiated with strikingly polarized citations, often from the same authors. I also introduce hypotheses for the duality across the remaining phases of the modeling process. Understanding and appreciation of the differences between these ideal types can promote constructive debate on their balance in system dynamics theory and practice. © 2024 System Dynamics Society.

Systems thinking for local food environments: a participatory approach identifying leverage points and actions for healthy and sustainable transformations

BackgroundCurrent local food environments encourage poor diets, posing a significant threat to public and planetary health. Acknowledging and addressing its inherent complexity is vital to making meaningful improvements to the food environment. Using a participatory approach with local stakeholders, this study aims to gain insight into the factors and mechanisms underlying the local food environment and to identify leverage points and system-based actions to foster healthy and sustainable local food environments.MethodsA systems-thinking approach was used in a Dutch municipality in 2022. Two group model building (GMB) workshops were held with community stakeholders (e.g. local policymakers, retailers and residents). During the first workshop (June 2022), factors and mechanisms influencing the local food environment were identified and visualized through a causal loop diagram (CLD). During the second workshop, leverage points and system-based actions to improve food environments were identified by the stakeholders. Four months after (October 2022), an action-implementation meeting was organized to stimulate the implementation of selected actions. Progress was monitored through brief telephone interviews 6 and 12 months after the second workshop.ResultsThe CLD visualises the factors and mechanisms influencing the local food environment from the point of view of the community stakeholders. The CLD consists of 46 factors shaping the local food environment, which were categorized into four identified subsystems: societal factors, individual, socio-economic factors, commercial factors and political factors. Eight leverage points were identified within the CLD, for example, ‘lobby from food industry’, ‘governmental food policies’ and ‘e-commerce and platform economy’. Stakeholders formulated 20 actions targeting the identified leverage points. During the action-implementation meeting, long-term plans were created for five actions. After 1 year, only one participant (policy advisory role) remained actively engaged in three of these actions.ConclusionsThis study yields insight into the numerous factors and mechanisms underlying the local food environment and identified system-based actions as perceived by local stakeholders to improve this food environment locally. The CLD offers stakeholders valuable insights on employing a systems approach when enhancing food environments. More research is necessary, especially into the long-term processes and effects of implementing system-oriented actions to improve local food environments.

Socio-technical dynamics of carbon dioxide capture and storage: A systems view on enablers and barriers at North Sea Port

Carbon dioxide capture and storage (CCS) is considered an option for energy-intensive industry to reduce its greenhouse gas emissions. Although it is well known that CCS faces technological, economic and societal challenges, how these challenges interact in a real-life industry has not yet been investigated collectively in a place-specific context. This study fills that gap by looking at the dynamic interactions between technological, economic and societal aspects, with the aim of clarifying enablers for and barriers to the implementation of industrial CCS in the North Sea Port industrial cluster, and identifying a course of action. The analysis was based on literature, interviews and group model building. By using group model building, expert stakeholders were brought together from industry, government and environmental non-governmental organizations. The participants built a qualitative model of the system dynamics of the implementation of industrial CCS in the North Sea Port industrial cluster jointly and on the spot. Enablers and barriers, such as costs, government's decisiveness and public support, are strongly interrelated. Public support plays a key role in multiple feedback loops in the system of industrial CCS implementation. The interdependence of societal and techno-economical elements needs to be acknowledged and responded to. There is need for transparent public engagement to build public support for CCS, and decisiveness and commitment from industry and government to transform that public support into successful and responsible CCS implementation.

Reducing personal protective equipment waste in the emergency department of a large regional hospital: codesign informed by system science

BackgroundThis study aimed to bring together health workers from an emergency department (ED) and broader health system changemakers to cocreate a system-oriented understanding of the drivers of single-use personal protective...

The Complex Interrelationships of the Risk Factors Leading to Hamstring Injury and Implications for Injury Prevention: A Group Model Building Approach

There is a gap in the literature regarding the complex interrelationships among hamstring injury (HI) risk factors. System dynamics (SD) modeling is considered an appropriate approach for understanding the complex etiology of HI for effective injury prevention. This study adopted the SD method and developed a causal loop model (CLD) to elucidate the intricate relationships among HI risk factors. This is performed by combining literature evidence and insights from expert stakeholders through a group model building (GMB) approach. The GMB methodology facilitated the identification of sixty-five critical factors influencing the HI risk, revealing the dynamic interplay between factors. Stakeholder engagement underscored the importance of previous injury characteristics (level of influence of previous injury, severity of previous injury, quality and size of scar tissue) and the quality of rehabilitation. HI-CLD revealed that many factors had indirect effects on HI risk. The HI-causal loop model establishes a foundation for a future stock and flow quantitative SD model aiming to advance HI prevention strategies through an interdisciplinary collaborative effort. These findings underscore the complexity of HI prevention, necessitating a holistic approach that integrates the views of diverse professional expertise. Appropriate inter-professional collaboration and continuous athlete screening are important for effective injury prevention strategies.

An analysis of participants' introductory experience with causal loop diagrams (CLDs) using group model building (GMB) scripts

AbstractComplex decision‐making processes benefit from involving people with different perspectives. We tested the hypothesis that group model building producing causal loop diagrams is a valuable tool to build shared understanding and hear diverse voices, even when project resources (e.g. data, funding, time) are limited. This was tested in two script‐based workshops involving stakeholders in water management issues in Aotearoa‐New Zealand. We collected data on their experience using a quantitative survey and semi‐structured interviews. Analysis shows that group model building met the participants' desire for something different, was found to be a refreshing new process, helped build social cohesion among stakeholders, and improved shared understanding of both the issue and the model they built. While the qualitative outputs were seen as useful, coupling them with quantitative analyses was seen as necessary by some participants, depending on the nature of the issue(s) and decision(s) being made. © 2024 System Dynamics Society.

Using qualitative system dynamics modeling to understand overdose bystander behavior in the context of Connecticut’s Good Samaritan Laws and identify effective policy options

BackgroundGood Samaritan Laws are a harm reduction policy intended to facilitate a reduction in fatal opioid overdoses by enabling bystanders, first responders, and health care providers to assist individuals experiencing an overdose without facing civil or criminal liability. However, Good Samaritan Laws may not be reaching their full impact in many communities due to a lack of knowledge of protections under these laws, distrust in law enforcement, and fear of legal consequences among potential bystanders. The purpose of this study was to develop a systems-level understanding of the factors influencing bystander responses to opioid overdose in the context of Connecticut’s Good Samaritan Laws and identify high-leverage policies for improving opioid-related outcomes and implementation of these laws in Connecticut (CT).MethodsWe conducted six group model building (GMB) workshops that engaged a diverse set of participants with medical and community expertise and lived bystander experience. Through an iterative, stakeholder-engaged process, we developed, refined, and validated a qualitative system dynamics (SD) model in the form of a causal loop diagram (CLD).ResultsOur resulting qualitative SD model captures our GMB participants’ collective understanding of the dynamics driving bystander behavior and other factors influencing the effectiveness of Good Samaritan Laws in the state of CT. In this model, we identified seven balancing (B) and eight reinforcing (R) feedback loops within four narrative domains: Narrative 1 - Overdose, Calling 911, and First Responder Burnout; Narrative 2 - Naloxone Use, Acceptability, and Linking Patients to Services; Narrative 3 - Drug Arrests, Belief in Good Samaritan Laws, and Community Trust in Police; and Narrative 4 - Bystander Naloxone Use, Community Participation in Harm Reduction, and Cultural Change Towards Carrying Naloxone.ConclusionsOur qualitative SD model brings a nuanced systems perspective to the literature on bystander behavior in the context of Good Samaritan Laws. Our model, grounded in local knowledge and experience, shows how the hypothesized non-linear interdependencies of the social, structural, and policy determinants of bystander behavior collectively form endogenous feedback loops that can be leveraged to design policies to advance and sustain systems change.