Methods for Community Public Health Research by Burke Jessica;Albert Steven;Albert Steven M. PhD MSPH;

Author:Burke, Jessica;Albert, Steven;Albert, Steven M., PhD, MSPH;
Language: eng
Format: epub
Publisher: Springer Publishing Company, Incorporated

1An intimate partner screening approach in which all women are screened regardless of illness or high-risk presentations.

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Inferring the Meaning of Words

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System Dynamics and Community Health

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Kristen Hassmiller Lich, Karen Minyard,

Rebecca Niles, Gaurav Dave, and

Emily M. Gillen

Growing out of engineering and control theory, system dynamics (SD) offers an innovative and scalable approach for addressing complex systems problems. SD is not only a set of system modeling tools and methods for working collaboratively with stakeholders to improve understanding of how complex systems shape problems, but also a way of thinking. From the perspective of SD, stakeholders include “groups or individuals who can affect or are affected by the achievement of an organization’s mission” (Freeman, 1984; Gooyert, Rouwette, & van Kranenburg, 2013). An SD model is created by extracting, critiquing, and integrating stakeholders’ “mental models” into an explicit and testable system diagram or computer simulation model. Structuring, quantifying, testing, and analyzing the model can improve understanding of the problem, including otherwise hard-to-intuit behavior caused by the complexity of the system shaping the problem. For example, interconnected factors affect system behaviors over time with some “feeding back” to create reinforcing or balancing forces or heterogeneous delays between causes and effects. Collaborating on the development of a model—whether it is qualitative or quantitative—can develop a shared, holistic, systems-oriented understanding of the problem and improve the level of debate and buy-in on proposed interventions.

Once a simulation model is developed, it can be used as a simplified “virtual world” in which to test the effects of proposed actions or uncertainties and to identify the most promising leverage points for change. The “virtual world” allows one to test strategies quickly and can provide a formal business case for change. In one example that follows, we explain how such a simulation model has been used to test the effects of combining various health strategies, such as investing in healthy behaviors and coordinating medical care, in reducing health care costs while improving community health.

The field of SD has been in existence since the 1950s, when Jay Forrester began applying methods inspired by servomechanism theory to address complex business problems such as inventory management and workforce planning, two classes of problems rife with delays, feedbacks, and complexity (Forrester, 1958; Lane, 2007). Since then, the application of SD has advanced beyond understanding industrial, business, and economic problems to those in environment, development, social policy, and public health. Though the full implications for health have yet to be explored, Climate Interactive (http://climateinteractive.org), an organization that developed a simulation model and a suite of user-friendly resources to provide immediate feedback on the impact of alternative policies and strategies on a suite of related issues like energy, water, food, and disaster risk reduction, exemplifies the power of SD to support community engagement and learning. Arguably, the richest example to date squarely in the field of public health in which an SD model has been used extensively with communities involves the development, iteration, and use of a simulation model in many communities seeking to address local chronic disease epidemics (Loyo et al.

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