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A Systems Thinking Methodology for Studying Prevention Efforts in Communities

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Abstract

The turn to complexity in public health over the past 20 years has come as practitioners, policy makers and scholars lament the lack of progress in addressing wicked problems such as obesity, chronic disease and the social determinants of health. Systems science may be well suited to tackle such wicked problems. While there is a growing application of systems thinking tools and resources in public health, there are fewer examples that incorporate both systems tools and systemic inquiry processes. Prevention Tracker offered an opportunity to trial the combination of systems tools and systems thinking at the level of community chronic disease prevention efforts. Our methodology comprised four Domains of Inquiry. 1. Describing a prevention system 2. Guiding system change efforts 3. Monitoring change 4. Cross case comparison. We applied systems tools and methods to investigate each domain of inquiry such as group model building, social network analysis, graphic illustration, causal loop diagrams and system action learning. These methods were connected through the application of systemic inquiry processes that elevated the ongoing interrogation of boundary judgments, awareness of diverse and multiple perspectives, interrelationships and the importance of social learning. Prevention Tracker demonstrated that it is possible to apply a range of systems methods while also keeping focus on the overall systems science and the need for theoretical consistency. The four domains of inquiry enabled flexibility to adapt our approach in each context to learn and improve. This methodological capacity to learn and adapt may also be useful in tackling other health and social problems, such as the COVID19 pandemic. The overall findings from the study will be presented in separate publications.

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Notes

  1. The illustration was developed by members of the research team with graphic artist Kirsty Moegerlein, www.kirstymoegerlein.com

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Acknowledgments

The Prevention Tracker project could not have been completed without the generous help of numerous contributors. We would like to acknowledge the contribution of the entire Prevention Tracker team: Sonia Wutzke, Therese Riley, Liza Hopkins, Maria Gomez, Daniel Chamberlain, Kathleen Conte, Seanna Davidson, Pippy Walker, Tayhla Ryder, Jean Zhuo Jing Wang, Jessica Jacob, Penny Hawe, Nick Roberts, Michelle Kehoe and Andrew Wilson.

We also wish to thank the following colleagues who contributed their expertise to the project in various ways: Fabian Held, Rose Ryan, Cynthia Webster, Thomas Astell-Burt, Xiaoqi Feng, Andrew Brown, Joshua Hayward, Jaimie McGlashan, Nicola Fortune, Kirsty Moegerlein. Thanks are also due to: our partners and local advisory group members in each community, the International Scientific Advisory Committee and the participants who generously gave up their time to help us complete the project.

We acknowledge the traditional owners of the lands on which this work was written: the Wurundjeri people of the Kulin nation and the Gadigal and Guring-gai people of the Eora Nation, as well as the traditional owners and custodians of the lands of each of the communities where the fieldwork was carried out. We pay our respects to the Elders, past, present and emerging, acknowledging them as the traditional custodians of knowledge for these places.

We dedicate this paper to our colleague, mentor and friend Sonia Wutzke (1970-2017).

Funding

This project was funded by the NHMRC, Australian Government Department of Health, NSW Ministry of Health, ACT Health and the HCF Research Foundation. Grant ID: GNT9100001. Tasmanian Department of Health.

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Author notes

  1. Therese Riley

    Present address: Therese Riley Consulting, Melbourne, Australia

  2. Seanna Davidson

    Present address: The Systems School, Melbourne, Australia

Authors and Affiliations

  1. The Australian Prevention Partnership Centre, The Sax Institute, Sydney, Australia

    Therese Riley, Liza Hopkins, Maria Gomez, Seanna Davidson, Daniel Chamberlain & Sonia Wutzke

  2. LaTrobe University, Melbourne, Australia

    Daniel Chamberlain

  3. McMaster University, Hamilton, Canada

    Jessica Jacob

Authors
  1. Therese Riley
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  2. Liza Hopkins
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  3. Maria Gomez
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  4. Seanna Davidson
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  6. Jessica Jacob
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  7. Sonia Wutzke
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Contributions

TR and SW led the overall scientific design and management of the project. LH, MG, SD, DC and TR were involved in the design and implementation of various components of Prevention Tracker. JJ led a review of the system action learning literature. TR drafted the overall manuscript. All authors (with the exception of SW) reviewed, edited and approved the final version of the manuscript.

Corresponding author

Correspondence to Therese Riley.

Ethics declarations

The overall study had Human Research Ethics Committee (HREC) approval from the University of Sydney (ID 2016/418). Additional Human Research Ethics Committee approval was gained for specific communities as required.

Conflicts of Interest/Competing Interests

No conflicts of interest have been declared.

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Additional information

Sonia Wutzke is deceased.

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Riley, T., Hopkins, L., Gomez, M. et al. A Systems Thinking Methodology for Studying Prevention Efforts in Communities. Syst Pract Action Res 34, 555–573 (2021). https://doi.org/10.1007/s11213-020-09544-7

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