BackgroundAt least 145 urban health indicator (UHI) tools exist internationally. Previous studies have shown that public health researchers and practitioners produce them to inform built environment policy and decision making. Little research exists on their use and how it affects policy. This study used qualitative system dynamics to investigate the benefit and use of UHI tools to promote health in the complex context of urban planning policy and decision making. MethodsThis qualitative system dynamics study involved semistructured interviews with indicator producers (typically public health professionals) and indicator users (typically urban planners) in case study settings of San Francisco (CA, USA), Melbourne (VIC, Australia), and Sydney (NSW, Australia) to ascertain experts’ understandings (or mental models) of the use (ie, direct reporting of) and value (ie, knowledge gained leading to policy changes) of UHI tools in urban planning policy and decision making. Exemplifying cases of UHI tools (ie, those designed with characteristics to support policy makers) were selected from the literature and we used purposive sampling to approach potential interview participants through departmental websites and the professional network of HP. We did a thematic analysis using collaborative rationality and systems theories. We constructed causal loop diagrams (CLDs) using system dynamics methods (CLDs represented participants’ mental models). We tested whether our preliminary CLDs corresponded to experts’ views through a participatory workshop. FindingsInterviews took place on April 5–7, 2016, with six participants in the USA, and March 13–22, 2018, with 16 participants in Australia, and the workshop was on Jan 16, 2019, with six participants in the USA. Indicator users and producers had overlapping mental models of the value and use of UHI tools, and workshop participants broadly agreed with the CLDs. The thematic analysis produced five themes that were represented in CLDs, summarised as follows. Developing and applying UHI tools increases knowledge of the social determinants of health and intersectoral relationships. This supports actors to better understand each other's perspectives and helps create new advocates for health in diverse organisations, supporting health-in-all-policies or whole-of-society approaches. Community involvement in UHI tools and having effective advocates for health reduces obstacles to health-promoting policy. However, the high number of available indicators can create confusion and reduce indicator use. InterpretationUHI tools influence local urban planning when they are embedded in policy processes, networks, and institutions, which often requires long-term funding. Indicator producers should consider such resource requirements and the potential for co-producing indicators to create intersectoral relationships and better respond to users’ information needs. Further research is needed to explore how UHI tools affect the power of different actors in governance processes, particularly of under-represented communities. FundingThe Building Research Establishment (BRE) and BRE Trust.
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