Navigating systems ideas for health practice: Towards a common learning device

Reynolds, Martin; Sarriot, Eric; Swanson, R. Chad; Rusoja, Evan

doi:10.1111/jep.12872

Cited by 14 publications

(12 citation statements)

References 31 publications

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“…How can a scientific approach to evaluation help in moving toward such an iterative approach? In recent years, the field of evaluation [3,6,7] has undergone a shift in thinking from a purely summative exercise ('does an intervention work?') toward a recognition that evaluations in complex systems [7][8][9] require a focus on helping an intervention or a system learn to develop more completely.…”

Section: Evaluations Of Quality Of Care In a Sustainable Development Goal (Sdg) Eramentioning

confidence: 99%

The role of evaluation in iterative learning and implementation of quality of care interventions

Shah

Mathew

Pereira

et al. 2021

Global Health Action

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Background:The Lancet Global Health Commission (LGHC) has argued that quality of care (QoC) is an emergent property that requires an iterative process to learn and implement. Such iterations are required given that health systems are complex adaptive systems. Objective: This paper explores the multiple roles that evaluations need to play in order to help with iterative learning and implementation. We argue evaluation needs to shift from a summative focus toward an approach that promotes learning in complex systems. A framework is presented to help guide the iterative learning, and includes the dimensions of clinical care, person-centered care, continuum of care, and 'more than medicine. Multiple roles of evaluation corresponding to each of the dimensions are discussed. Methods: This paper is informed by reviews of the literature on QoC and the roles of evaluation in complex systems. The proposed framework synthesizes the multiple views of QoC. The recommendations of the roles of evaluation are informed both by review and experience in evaluating multiple QoC initiatives. Results: The specific roles of different evaluation approaches, including summative, realist, developmental, and participatory, are identified in relationship to the dimensions in our proposed framework. In order to achieve the potential of LGHC, there is a need to discuss how different evaluation approaches can be combined in a coherent way to promote iterative learning and implementation of QoC initiatives. Conclusion:One of the implications of the QoC framework discussed in the paper is that time needs to be spent upfront in recognizing areas in which knowledge of a specific intervention is not complete at the outset. This, of course, implies taking stock of areas of incompleteness in knowledge of context, theory of change, support structures needed in order for the program to succeed in specific settings. The role of evaluation should not be limited to only providing an external assessment, but an important goal in building evaluation capacity should be to promote adaptive management among planners and practitioners. Such iterative learning and adaptive management are needed to achieve the goals of sustainable development goals.

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Section: Evaluations Of Quality Of Care In a Sustainable Development Goal (Sdg) Eramentioning

confidence: 99%

The role of evaluation in iterative learning and implementation of quality of care interventions

Shah

Mathew

Pereira

et al. 2021

Global Health Action

View full text Add to dashboard Cite

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“…The STiP heuristic underpins one of the two core modules in the postgraduate STiP program at the Open University. The heuristic has also been used for informing complementary approaches to intervention in different sectors; including climate-smart village food production (Jagustović et al 2019) and generic systems thinking for health practice (Reynolds et al 2018).…”

Section: Postscript (Martin Reynolds)mentioning

confidence: 99%

Critical Systems Heuristics: The Idea and Practice of Boundary Critique

Ulrich

Reynolds

2020

Systems Approaches to Making Change: A Practical Guide

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Section: Introductionmentioning

confidence: 99%

“…While both concepts of system developed as responses for dealing with complexity (Reynolds, 2011), the underlying assumptions and the ways of “doing” systems thinking are fundamentally different (Reynolds et al, 2018). As an ontological device, the “object system” is the subject of inquiry; as an epistemological device, the system is the process of inquiry (Reynolds et al, 2018). This latter understanding of systems thinking is arguably more suited to the goals of social marketing as it focuses on understanding behaviors through a system lens that is formulated in terms of research purpose rather than on understanding behaviors of systems.…”

Section: Introductionmentioning

confidence: 99%

Eating Behaviors in Australian Military Personnel: Constructing a System of Interest for a Social Marketing Intervention

Anibaldi

Carins

Rundle‐Thiele

2020

Social Marketing Quarterly

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Background: Eating behaviors are complex and have particular significance for military personnel who require sound nutrition to support health and physical fitness for job performance. Policies and guidelines for the provision of nutritionally appropriate food/drink on base and in the field do exist; however, many military personnel have poor dietary habits, and these habits are evident early in their career. Social marketing could assist in changing unhealthy eating behaviors of personnel through implementation of feasible interventions co-created with stakeholders that are valued by Australian Defence Force (ADF) personnel. : The article reports the first phase of a systemic co-inquiry into unhealthy eating behaviors of military personnel. This study aimed to gain an initial framing of the problem situation and thus hypothesize a “system of interest” in which to conduct future work. Research questions What components (e.g., ideas, objects, attributes, activities) are perceived to be relevant for eating behaviors in military personnel? Do interrelationships and interconnections among components suggest how unhealthy eating behaviors may emerge? Are there places that suggest viable leverage points as opportunities for changing unhealthy eating behaviors through delivery of offerings that ADF personnel value? Program Design/Approach: This study was part of a systemic inquiry approach. Methods: Data for the study included document analysis and 14 semi-structured depth interviews with ADF stakeholders. Data were thematically analyzed to construct a system of interest in which to explore how eating behaviors emerge among personnel and ADF-controlled leverage points that can be used to increase healthy eating for ADF personnel through social marketing intervention. Results: The data analysis identified alternative systems of interest in which to explore how eating behaviors emerge among personnel. Demand and supply side leverage points were identified. On the supply side, the encouragement of patronage through menu innovation, investment in facilities, cooking skills training, and auditing provision were opportunities for social marketing intervention. On the demand side, education and training coupled with communications that challenge cultural and regulatory norms and link to military values were areas that programs seeking to increase healthy eating in ADF personnel could focus on. Importance to the Social Marketing Field: As an approach for addressing “wicked” problems, the application of systems thinking in social marketing has privileged an ontological concept of system as a metaphor for reality. This approach assists in expanding the focus of change beyond the individual to include factors in social, economic, and policy environments. By using systems thinking as an epistemological device, this article offers an approach that may be applied to overcome practical and philosophical limitations in the application of systems thinking. Recommendations for Research or Practice: Research on alternative methods for applying systems thinking is recommended to strengthen the potential of system approaches in the field of social marketing. Limitations: This study is part of a broader program, and its findings on the problem of unhealthy eating behaviors in ADF are preliminary. Limitations specific to the study include the possibility of “reductionism” in stakeholder identification and self-selection bias in participation.

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Navigating systems ideas for health practice: Towards a common learning device

Cited by 14 publications

References 31 publications

The role of evaluation in iterative learning and implementation of quality of care interventions

The role of evaluation in iterative learning and implementation of quality of care interventions

Critical Systems Heuristics: The Idea and Practice of Boundary Critique

Eating Behaviors in Australian Military Personnel: Constructing a System of Interest for a Social Marketing Intervention

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