A community-based system dynamics approach suggests solutions for improving healthy food access in a low-income urban environment

Abstract

Little is known about the mechanisms through which neighborhood-level factors (e.g., social support, economic opportunity) relate to suboptimal availability of healthy foods in low-income urban communities. We engaged a diverse group of chain and local food outlet owners, residents, neighborhood organizations, and city agencies based in Baltimore, MD. Eighteen participants completed a series of exercises based on a set of pre-defined scripts through an interactive, iterative group model building process over a two-day community-based workshop. This process culminated in the development of causal loop diagrams, based on participants’ perspectives, illustrating the dynamic factors in an urban neighborhood food system. Synthesis of diagrams yielded 21 factors and their embedded feedback loops. Crime played a prominent role in several feedback loops within the neighborhood food system: contributing to healthy food being “risky food,” supporting unhealthy food stores, and severing social ties important for learning about healthy food. Findings shed light on a new framework for thinking about barriers related to healthy food access and pointed to potential new avenues for intervention, such as reducing neighborhood crime.

Cross-Sectional Associations of Neighborhood Perception, Physical Activity, and Sedentary Time in Community-Dwelling, Socioeconomically Diverse Adults

“…Providing communal gathering areas, encouraging mixed land use for walkable destinations, increasing transit stops, facilitating group activities, enhancing multi-generational engagement, and reducing perception of crime would likely improve the social environment and thereby reduce ST (57, 59). Determining which community solutions will succeed may be best accomplished through community engagement (60). The need for community engagement in medical research is well-described by Holzer and colleagues, who demonstrate the potential for enhanced trust and participation (61).…”

“…Furthermore, this study specifically identifies risk factors for increased ST, which are understudied in the literature. Our work, in conjunction with existing literature, is most relevant to designing physical activity and obesity interventions in and around Baltimore, MD (46, 60, 67, 68).…”

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

“…CBSD builds on the foundations of traditional system dynamics to integrate a participatory modelling approach that aims to build community capabilities to learn and address complex problems through the feedback lens of system dynamics [ 21 ]. Since the codification of the idea of CBSD, many of its applications in public health have aimed to generate insights about a particular complex problem, through the construction of a shared language and broad shared understanding of the problems stakeholders desire to change, using system dynamics modelling tools [ 22 – 24 ]. A number of studies have explored the impact of group model-building processes on participant mental models and planning outcomes [ 25 – 29 ], and recent studies have explored community and programmatic factors influencing the adoption of system dynamics approaches for health policy [ 30 ].…”

Understanding the factors enabling and blocking sustained implementation of cholera interventions in a fragile region of Nigeria: a multi-phase group model building study protocol

“…The qualitative nature of the GMB approach is often considered a limitation, hence there has been a call by researchers to go beyond the qualitative model to create a quantitative simulation model that allows for quantifying the postulated causal relationships established in the qualitative models 40 . As such, we will seek to conduct a post-GMB quantitative simulation model using historical cholera surveillance data from Nigeria CDC, published literature and other publicly available data (e.g.…”