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community-based system dynamics modelling of stigmatized public health issues: Increasing diverse representation of individuals with personal experiences

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systemS RESEARCH AND BEHAVIORAL SCIENCE 2022年第4期39卷 734-749页

作者： Deutsch, Arielle R. Lustfield, Rebecca Jalali, Mohammad S. Avera Res Inst Sioux Falls SD 57108 USA Univ South Dakota Dept Pediat Sch Med Vermillion SD USA Harvard Med Sch Boston MA 02115 USA Massachusetts Gen Hosp Inst Technol Assessment Boston MA 02114 USA

Utility of community-based system dynamics (CBSD) models on stigmatized public health issues and health disparities depends upon how representative the model is to real-world experience within the community. 'Personal experience' participants (PEP), especially from marginalized groups, are essential model contributors but are often underrepresented in modelling groups due to multiple barriers. This study details a method to increase PEP representation for models on stigmatized issues. We use a case study from a CBSD project on health disparities within the association between alcohol misuse (AM) and intimate partner violence (IPV) for Northern Plains Indigenous women. Short group model building sessions were held at three community organizations providing relevant resources. Each model contributed unique system components, and there were few similarities between models. A consolidated model provided a rich picture of the complex system. Adding brief PEP-based group modelling sessions can enhance PEP representation in model development for stigmatized public health issues.

关键词： alcohol misuse community-based system dynamics health disparities intimate partner violence

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Dementia Risk and Social Determinants of Health Among Adults Racialized as Black: A community-based system dynamics Perspective

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JOURNAL OF RACIAL AND ETHNIC HEALTH DISPARITIES 2024年 1-11页

作者： Trani, Jean-Francois Hart, Robbie Walker, Alexis I. B. Safi, Meena Singh, Ramkrishna K. Zhu, Yiqi Babulal, Ganesh M. Washington Univ St Louis Brown Sch Social Work St Louis MO USA Univ Johannesburg Dept Psychol Johannesburg South Africa Washington Univ Sch Med St Louis Inst Publ Hlth St Louis MO 63110 USA Natl Conservatory Arts & Crafts Paris France William L Brown Ctr Missouri Bot Garden St Louis MO USA Adelphi Univ Sch Social Work Garden City NY USA Washington Univ Sch Med Dept Neurol St Louis MO 63110 USA

BackgroundThe aging population in the USA is projected to increase significantly, with a corresponding rise in dementia cases, particularly among racial minorities. This study examines the key drivers of racial disparities in dementia risk among older Black adults in the St. Louis area, a region characterized by entrenched structural racism. Utilizing a community-based system dynamics (CBSD) approach, we engaged cognitively normal Black adults (age >= 45) to explore the complex interplay of social and structural determinants of health (S/SDOH) affecting dementia *** CBSD workshops were conducted, during which participants identified and analyzed various factors influencing dementia risk through group model-building techniques. These workshops revealed multiple reinforcing and balancing feedback loops, highlighting the intricate relationships between trauma, health literacy, social isolation, education, healthcare access, and systemic *** were 59 participants with an average age of 64, a majority of women (88%) and college-educated (15.9 years) residing in areas with moderately severe deprivation. The resulting Causal Loop Diagrams underscored the impact of poverty, discrimination, and limited access to quality education and healthcare on dementia risk across the lifespan. Participants proposed actionable interventions, including health information campaigns, community mobilization, and improvements in public transportation and healthcare *** study emphasizes the necessity of addressing S/SDOH to mitigate dementia risk among Black Americans. The findings call for targeted public health initiatives and policy changes to improve socioeconomic conditions and reduce racial disparities in dementia outcomes.

关键词： Dementia Racial disparities Social and structural determinants of health Structural racism community-based system dynamics

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Ageing among Black and non-Hispanic White older adults: A community-based system dynamics approach to examining quality of life

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systemS RESEARCH AND BEHAVIORAL SCIENCE 2024年第1期41卷 30-51页

作者： Trani, Jean-Francois Giesecke, Megan Hovmand, Peter Miller, Nicholas Cartmill, Mary Kate Mandujano Acevedo, Nicandro Lee, Sandra Liem, William Gillani, Braveheart Babulal, Ganesh Washington Univ St Louis Brown Sch Social Work St Louis MO USA Natl Ctr Arts & Crafts Paris France Case Western Reserve Univ Ctr Community Hlth Integrat Sch Med Cleveland OH USA Washington Univ St Louis Anthropol Dept St Louis MO USA Northwestern Univ Feinberg Sch Med Evanston IL USA Case Western Reserve Univ Joseph & Morton Mandel Sch Appl Social Sci Cleveland OH USA Washington Univ Sch Med Dept Neurol St Louis MO USA Washington Univ Sch Med Knight Alzheimers Dis Res Ctr St Louis MO USA Washington Univ St Louis Brown Sch Social Work One Brookings Dr Campus Box 1196 St Louis MO 63130 USA

Older adults are living longer in the United States and the proportion of those belonging to minoritized groups is growing. The value and characteristics of quality of life (QoL) at an older age have becoming of central concern to policy makers. To investigate the wicked problem of ageing and QoL, we conducted and compared two group model building workshops in St. Louis City, one with 16 White and another with 10 Black American older adults, age 65 and older. Group model building workshops involve communities in the identification and testing of shared solutions to pressing and complex problems. Findings demonstrated that racial disparities in terms of material and environmental resources represent significant barriers to QoL for both Black and White participants. Results underscore the need to address social determinants of health that impede healthy ageing and damage well-being and QoL of older adults.

关键词： ageing community-based system dynamics group model building quality of life racial disparities

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Opportunities in Programs and Policies to Address the Underlying Drivers of Sugary Drink and Water Consumption in the Washington, DC, Metro Area: A Qualitative community-based system dynamics Approach

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Journal of the Academy of Nutrition and Dietetics 2025年

作者： Estradé, Michelle Mui, Yeeli Witting, Lillian Burgos-Gil, Rosalina Calancie, Larissa Gittelsohn, Joel Colón-Ramos, Uriyoán Johns Hopkins Bloomberg School of Public Health Baltimore Maryland United States National Health Council Washington District of Columbia United States CentroNia Washington District of Columbia United States Friedman School of Nutrition Science and Policy Tufts University Boston Massachusetts United States Milken Institute School of Public Health George Washington University Washington District of Columbia United States

Background: Although the Dietary Guidelines for Americans recommend that individuals drink water instead of sugar-sweetened beverages (SSBs), this behavior is influenced and reinforced by a complex network of structures and systems. Objective: The objectives of this study were to develop a shared understanding among multiple stakeholders about the structural and underlying, interconnected drivers of SSB and water consumption in the Washington, DC, metro area and to have them identify feasible and influential policy levers. Design: A community-based system dynamics approach was used during a 2-day group model building workshop where stakeholders engaged to develop a shared visual representation of the underlying, interconnected drivers of SSB and water intake and to identify what they believed were influential and feasible policy levers. Participants/setting: Stakeholders were purposively recruited from diverse sectors (early childhood education [n = 6], nutrition assistance programs [n = 2], food policy council and advocacy groups [n =4], city government officials including municipal water [n = 4], and food and beverage retail [n = 1]) to participate in a group model building workshop during July 2022 in Washington, DC. Statistical analysis: Using member checking and iterative feedback, the research team synthesized the outputs from the workshop into 1 causal loop diagram and ranked policy levers. Results: Stakeholders visualized 7 subsystems that drive water and SSB consumption, then identified and ranked 5 policy levers by potential impact and ease of implementation, including increase public health spending (high impact/hard to do);invest in new and updated infrastructure for public water (high impact/hard to do);implement coordinated public health campaigns to promote drinking safe, palatable water as an alternative to SSB (low impact/easy to do);provision of tap water filters (low impact/easy to do);and limits on SSB marketing (high impact/debated easy or hard

关键词： community-based system dynamics Drinking water Latino Qualitative research Sugar-sweetened beverages

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Using a community-based system dynamics approach for understanding inclusion and wellbeing: a case study of special needs education in an eastern African refugee camp

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CONFLICT AND HEALTH 2021年第1期15卷 58-58页

作者： Werner, Kelsey St Arnold, Gregory Crea, Thomas M. Boston Coll Sch Social Work 140 Commonwealth Ave Chestnut Hill MA 02467 USA Jesuit Refugee Serv Int Off Borgo Santo Spirito 4 I-00193 Rome Italy

Background Children with disabilities face unique challenges in humanitarian aid settings and education may provide protective measures against abuse and exploitation. There are growing calls for inclusive education of children with disabilities in formal education, but little guidance exists on how to enhance inclusion in complex and resource-constrained contexts of humanitarian settings. Case presentation This study used a community-based system dynamics approach to understand key stakeholders' perspectives of the drivers and effects of inclusion and wellbeing for children with disabilities, and to elicit recommendations to enhance educational inclusion in a refugee camp in Eastern Africa. community-based system dynamics sessions, designed based on group model building scripts and facilitated by a team of four people, took place with organization staff, community leaders, and parents and caregivers of children with disabilities. The process produced a causal loop diagram depicting the stakeholders' perspectives of how multiple components interact in a system to drive inclusion and wellbeing of children with disabilities over time. Conclusions Findings indicate participants have a broad conceptualization of inclusion, highlighting the value of community interaction and importance of meeting basic needs, and also demonstrate that including children in mainstream educational settings in a complex humanitarian context requires a more nuanced approach given the lack of existing resources to support Western models of educational inclusion fully.

关键词： Humanitarian setting Special needs education Inclusion community-based system dynamics Complex problems Causal loop diagram

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

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BMC global and public health 2024年第1期2卷 15页

作者： Carmen Quinteros-Reyes Paraskevi Seferidi Laura Guzman-Abello Christopher Millett Antonio Bernabé-Ortiz Ellis Ballard CRONICAS Center of Excellence in Chronic Diseases Universidad Peruana Cayetano Heredia Lima Peru. Public Health Policy Evaluation Unit School of Public Health Imperial College London London UK. paraskevi.seferidi14@imperial.ac.uk. Department of Design School of Architecture and Design Universidad de los Andes Bogota Colombia. Public Health Policy Evaluation Unit School of Public Health Imperial College London London UK. Comprehensive Health Research Center (CHRC) and Public Health Research Centre National School of Public Health NOVA University Lisbon Portugal. Social System Design Lab Brown School at Washington University in St. Louis St. Louis USA.

BACKGROUND:Peru 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. METHODS:We 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. RESULTS:The 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. CONCLUSIONS:This 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.

关键词： community-based system dynamics Double burden of malnutrition Double-duty actions Food system Group model building Peru

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Promoting knowledge to policy translation for urban health using community-based system dynamics in Brazil

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HEALTH RESEARCH POLICY AND systemS 2021年第1期19卷 53-53页

作者： Morais, Lidia Maria de Oliveira Kuhlberg, Jill Ballard, Ellis Indvik, Katherine Rocha, Solimar Carnavalli Sales, Denise Marques de Oliveira Cardoso, Leticia Gouveia, Nelson de Lima Friche, Amelia Augusta Caiaffa, Waleska Teixeira Univ Fed Minas Gerais Observ Urban Hlth Belo Horizonte Av Pres Antonio Carlos 6627 BR-31270901 Belo Horizonte MG Brazil Syst Stars St Louis MO USA Washington Univ St Louis Social Syst Design Lab Brown Sch 1 Brookings Dr St Louis MO 63130 USA Drexel Univ Dornsife Sch Publ Hlth Urban Hlth Collaborat 3215 Market St Philadelphia PA 19104 USA Fundacao Oswaldo Cruz Natl Sch Publ Hlth R Leopoldo Bulhoes 1480Room 813 BR-21041210 Manguinho RJ Brazil Univ Sao Paulo Dept Prevent Med Med Sch Av Dr Arnaldo 455 BR-01246903 Sao Paulo SP Brazil

Background Effectively bridging the knowledge-policy gap to support the development of evidence-based policies that promote health and well-being remains a challenge for both the research and policy communities. community-based system dynamics (CBSD) is a participatory modelling approach that aims to build stakeholders' capacity to learn and address complex problems collaboratively. However, limited evidence is available about the contributions of CBSD to knowledge-generating and policy processes across sectors and policy spheres. In the context of a multi-country research project focused on creating an evidence base to inform urban health policies across Latin America, a series of CBSD workshops convened stakeholders from research, policy-making, and other backgrounds working in food and transportation systems. Diverse participants were selected aiming to incorporate multiple perspectives relevant to understanding complex urban systems linked to food and transportation. This study focuses on one of these workshops, whose avenue was Sao Paulo, Brazil, assembling country-based participants representing local, regional, national, and international institutions with multidisciplinary backgrounds linked to food and transportation systems. Objective The aim of this case study is to explore the perceived influence of one of these workshops on attendees' understandings of food and transportation systems and their relationship to healthy urban environments, with attention to the role of the workshop in supporting knowledge to policy translation for urban health. Methods We conducted 18 semi-structured qualitative interviews with attendees one year after their participation in a CBSD workshop held in Sao Paulo, Brazil. A framework method approach was used to code participants' responses and identify emerging themes. Results Participants reported that the workshop's group model-building activities influenced their understanding of the knowledge-policy process as it relates to

关键词： Knowledge to policy translation community-based system dynamics Urban health Framework method Latin America systems thinking

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Capability Traps Impeding Homeless Services: A community-based system dynamics Evaluation

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JOURNAL OF SOCIAL SERVICE RESEARCH 2019年第3期45卷 348-359页

作者： Fowler, Patrick J. Wright, Kenneth Marcal, Katherine E. Ballard, Ellis Hovmand, Peter S. Washington Univ George Warren Brown Sch Social Work St Louis MO 63130 USA

Continuums of Care (CoCs) are the primary coordinating bodies for homeless services in the United States. However, the complexities involved in delivering homeless services across interagency networks challenges coordination and system improvement. CoC governance, planning, and service provision have received little attention in academic literature, and thus, Continuums attempt to manage complex systems with little guidance. This evaluation applied community-based system dynamics with homeless consumers and service providers to (1) identify capability traps that impede services delivery and to (2) engage stakeholders in a structured system improvement process. Results revealed organizational structures for governance and planning that inhibit system outcomes. Insights led to policy and practice recommendations for the homeless system.

关键词： Continuum of care homelessness network governance collaboration capability trap community-based system dynamics

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Using community-based system dynamics modeling to understand the complex systems that influence health in cities: The SALURBAL study

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HEALTH & PLACE 2019年 60卷 102215-000页

作者： Langellier, Brent A. Kuhlberg, Jill A. Ballard, Ellis A. Slesinski, S. Claire Stankov, Ivana Gouveia, Nelson Meisel, Jose D. Kroker-Lobos, Maria F. Sarmiento, Olga L. Caiaffa, Waleska Teixeira Roux, Ana V. Diez Alazraqui, Marcio Spinelli, Hugo Guevel, Carlos Di Cecco, Vanessa Tisnes, Adela Leveau, Carlos Santoro, Adrian Herkovits, Damian Gouveia, Nelson Barreto, Mauricio Santos, Gervasio Cardoso, Leticia de Menezes, Mariana Carvalho de Pina, Maria de Fatima Caiaffa, Waleska Teixeira de Lima Friche, Amelia Augusta de Souza Andrade, Amanda Cristina Frenz, Patricia Alfaro, Tania Cordova, Cynthia Ruiz, Pablo Fuentes, Mauricio Vives Vergara, Alejandra Salazar, Alejandro Cortinez-O'Ryan, Andrea Schmitt, Cristian Gonzalez, Francisca Baeza, Fernando Angelini, Flavia Sarmiento Duenas, Olga Lucia Higuera, Diana Gonzalez, Catalina Montes, Felipe Useche, Andres F. Guaje, Oscar Maria Jaramillo, Ana Angel Guzman, Luis Hessel, Philipp Lucumi, Diego David Meisel, Jose Martinez, Eliana Kroker-Lobos, Maria F. Ramirez-Zea, Manuel Martinez Folgar, Kevin Barrientos-Gutierrez, Tonatiuh Perez-Ferrer, Carolina Prado-Galbarro, Javier de Castro, Filipa Rojas-Martinez, Rosalba Jaime Miranda, J. Hernandez Vasquez, Akram Diez-Canseco, Francisco Hammond, Ross Rodriguez, Daniel Dronova, Iryna Wang, Xize Moran, Mika Hovmand, Peter Fuchs, Ricardo Jordan Braslow, Juliet Siri, Jose Roux, Ana Diez Auchincloss, Amy Bilal, Usama Garcia-Espana, Felipe Langellier, Brent Lovasi, Gina McClure, Leslie Michael, Yvonne Moore, Kari Quick, Harrison Quistberg, D. Alex Sanchez, Brisa N. Stankov, Ivana Granados, Jose Tapia Drexel Univ Dornsife Sch Publ Hlth Dept Hlth Management & Policy Philadelphia PA 19104 USA Univ N Carolina Gillings Sch Global Publ Hlth Dept Hlth Policy & Management Chapel Hill NC 27515 USA Washington Univ Brown Sch Social Syst Design Lab St Louis MO 63110 USA Drexel Univ Dornsife Sch Publ Hlth Urban Hlth Collaborat Philadelphia PA 19104 USA Univ Sao Paulo Fac Med Dept Med Prevent Sao Paulo SP Brazil Univ Ibague Fac Ingn Ibague Colombia INCAP Res Ctr Prevent Chron Dis Guatemala City Guatemala Univ Los Andes Fac Med Bogota Colombia Univ Fed Minas Gerais Fac Med Observ Saude Urbana Belo Horizonte Belo Horizonte MG Brazil Natl Univ Lanus Buenos Aires DF Argentina Univ Sao Paulo Sao Paulo SP Brazil Fundacao Oswaldo Cruz Salvador BA Brazil Fundacao Oswaldo Cruz Rio De Janeiro Brazil Univ Fed Minas Gerais Belo Horizonte MG Brazil Univ Chile Sch Publ Hlth Santiago Chile Pontificia Univ Catolica Chile Dept Publ Hlth Santiago Chile Univ Los Andes Sch Med Bogota Colombia Univ Los Andes Sch Engn Bogota Colombia Univ Los Andes Sch Govt Bogota Colombia Univ Ibague Ibague Colombia Univ Antioquia Medellin Colombia Inst Nacl Salud Publ Mexico City DF Mexico Univ Peruana Cayetano Heredia Sch Med Lima Peru Brookings Inst Washington DC 20036 USA Univ Calif Berkeley Dept City & Reg Planning Berkeley CA 94720 USA Washington Univ St Louis MO 63110 USA Comis Econ Amer Latina & Carib Santiago Chile UNU IIGH Kuala Lumpur Malaysia Drexel Univ Dornsife Sch Publ Hlth Philadelphia PA 19104 USA

We discuss the design, implementation, and results of a collaborative process designed to elucidate the complex systems that drive food behaviors, transport, and health in Latin American cities and to build capacity for systems thinking and community-based system dynamics (CBSD) methods among diverse research team members and stakeholders. During three CB SD workshops, 62 stakeholders from 10 Latin American countries identified 98 variables and a series of feedback loops that shape food behaviors, transportation and health, along with 52 policy levers. Our findings suggest that CBSD can engage local stakeholders, help them view problems through the lens of complex systems and use their insights to prioritize research efforts and identify novel solutions that consider mechanisms of complexity.

关键词： Latin America Diet Transport community-based system dynamics Group model building

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

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INTERNATIONAL JOURNAL OF MENTAL HEALTH NURSING 2024年第1期34卷 e13451页

作者： Forrester-Bowling, Tari Lucas, James J. Brown, Andrew D. Bennetts, Stephanie Carolin, Renae Hayward, Josh Scott, Debbie Peeters, Anna Mclure, James Deakin Univ Inst Hlth Transformat Fac Hlth Sch Hlth & Social Dev Geelong Australia Barwon Hlth Change Improve Mental Hlth CHIME Translat Res Part Geelong Australia Deakin Univ Geelong Australia Barwon Hlth Mental Hlth Drug & Alcohol Serv Geelong Australia

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.

关键词： co-creation co-design community-based system dynamics group model building lived experience mental healthcare

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