Applying System Dynamics Method to Understand Implementation Determinants for Whole-of-Community Child Health Promotion in Rural and Remote Contexts
Sze Lin Yoong, Gloria KW Leung, Andrew D. Brown, Monique Hillenaar, Colin Bell, Steven Allender, Anna Chapman, Miranda R. Blake, Rachel Tabak, Joshua HaywardBackground
Whole-of-community child health promotion is an effective and equitable approach to improve child nutrition and physical activity. However, challenges often emerge during the implementation of these initiatives, which systems-based methods may be well-suited to understanding. This study describes the application of methods from system dynamics, specifically group model building (GMB) and causal loop diagrams (CLDs) to understand implementation progress and describe implementation determinants in the context of a whole-of-community child health initiative in rural and remote communities.
Method
The research team facilitated separate 5-h workshops using GMB methods in five rural communities in North-East Victoria. In these workshops, the prevention teams were supported to develop CLDs of implementation determinants. Using a qualitative meta-synthesis approach, two researchers worked with the broader research team to develop CLDs linked to each system of the Interactive Systems Framework (ISF), which included general and action-specific functions influencing anticipated implementation trends. The merged CLDs were presented back to all participating communities.
Results
The team developed three CLDs to represent the interaction of factors related to interorganisational partnerships, resource sufficiency and alignment with community values, which were perceived as key determinants to implementation. Each CLD included feedback loops outlining how interconnected parts of the system respond to change (i.e., introduction of a new child health initiative). Reinforcing loops amplified the original change (e.g., growth in implementation progress) while balancing loops counteracted change (e.g., the impact of competing demands).
Conclusion
This study demonstrates how methods from system dynamics can be applied to understand the dynamic nature of implementation determinants for whole-of-community child health initiatives in rural and remote communities.