Quantitative health impact assessment methodology for societal initiatives: A scoping review

Reumers, Laurens; Bekker, Marleen; Jansen, Maria; Hilderink, Henk; Helderman, Jan-Kees; Ruwaard, Dirk

doi:10.1016/j.eiar.2020.106509

Cited by 2 publications

(3 citation statements)

References 27 publications

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“…Depending on the specific topic and the nature of the relationships in the model, it is likely that micro-level, longitudinal data will be needed for this. A combination of GMB using system dynamics (as shown in this study) and a different, micro-level estimation method can be used and would be appropriate in such an endeavour [ 9 ]. It should be stressed that a system works as a whole and should be regarded and quantified as such, although some simplifications to a full CLD are likely to be necessary for quantification.…”

Section: Discussionmentioning

confidence: 99%

“…Trying to tackle a wicked problem with a rational-technical approach will ignore the values and experiences of stakeholders and therefore the problem itself [ 8 ], likely resulting in a solution that attempts to fix the wrong issue with the wrong tools. A suitable way of approaching such wicked problems is deploying participatory methods combined with systems science, in which the knowledge of stakeholders, who are experts in experience, is used in order to capture the complexity of the system in a particular context [ 9 ]. Similar approaches have been used in several previous studies on social determinants of health [ 10 – 17 ].…”

Section: Introductionmentioning

confidence: 99%

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Qualitative modelling of social determinants of health using group model building: the case of debt, poverty, and health

Reumers

Bekker

Hilderink

et al. 2022

Int J Equity Health

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Background Social determinants of health (SDoH) are known to have a large impact on health outcomes, but their effects are difficult to make visible. They are part of complex systems of variables largely indirect effects on multiple levels, constituting so-called wicked problems. This study describes a participatory approach using group model building (GMB) with stakeholders, in order to develop a qualitative causal model of the health effects of SDoH, taking poverty and debt in the Dutch city of Utrecht as a case study. Methods With GMB we utilised the perspective of stakeholders who are directly involved in policy and practice regarding poverty, debt, and/or health. This was done using system dynamic modelling, in three interactive sessions lasting three hours each. In these sessions, they constructed a model, resulting in a system of variables with causal relationships and feedback loops. Subsequently, the results of these GMB sessions were compared to scientific literature and reviewed by a panel of researchers with extensive experience in relevant scientific fields. Results The resulting model contains 71 causal relationships between 39 variables, 29 of which are present in feedback loops. The variables of participation in society, stress, shame, social contacts and use of services/provisions appear to hold prominent roles in the model’s mechanisms. Most of the relationships in the model are supported by scientific literature. The researchers reviewing the model in the scientific meeting agreed that the vast majority of relationships would concur with scientific knowledge, but that the model constructed by the stakeholders consists mostly of individual-level factors, while important conditions usually relate to systemic variables. Conclusions Building a model with GMB helps grasp the complex situation of a wicked problem, for which it is unlikely that its interrelationships result in a fully intuitive understanding with linear mechanisms. Using this approach, effects of SDoH can be made visible and the body of evidence expanded. Importantly, it elicits stakeholders’ perspectives on a complex reality and offers a non-arbitrary way of formulating the model structure. This qualitative model is also well suited to serve as conceptual input for a quantitative model, which can be used to test and estimate the relationships.

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Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Qualitative modelling of social determinants of health using group model building: the case of debt, poverty, and health

Reumers

Bekker

Hilderink

et al. 2022

Int J Equity Health

Self Cite

View full text Add to dashboard Cite

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“…Individual-level data were used for quantification of the model, because the effects also occur on this level [ 25 ]. These data were derived from two datasets.…”

Section: Introductionmentioning

confidence: 99%

Quantifying reciprocal relationships between poverty and health: combining a causal loop diagram with longitudinal structural equation modelling

Reumers,

Hameleers,

Hilderink

et al. 2024

Int J Equity Health

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Background This study takes on the challenge of quantifying a complex causal loop diagram describing how poverty and health affect each other, and does so using longitudinal data from The Netherlands. Furthermore, this paper elaborates on its methodological approach in order to facilitate replication and methodological advancement. Methods After adapting a causal loop diagram that was built by stakeholders, a longitudinal structural equation modelling approach was used. A cross-lagged panel model with nine endogenous variables, of which two latent variables, and three time-invariant exogenous variables was constructed. With this model, directional effects are estimated in a Granger-causal manner, using data from 2015 to 2019. Both the direct effects (with a one-year lag) and total effects over multiple (up to eight) years were calculated. Five sensitivity analyses were conducted. Two of these focus on lower-income and lower-wealth individuals. The other three each added one exogenous variable: work status, level of education, and home ownership. Results The effects of income and financial wealth on health are present, but are relatively weak for the overall population. Sensitivity analyses show that these effects are stronger for those with lower incomes or wealth. Physical capability does seem to have strong positive effects on both income and financial wealth. There are a number of other results as well, as the estimated models are extensive. Many of the estimated effects only become substantial after several years. Conclusions Income and financial wealth appear to have limited effects on the health of the overall population of The Netherlands. However, there are indications that these effects may be stronger for individuals who are closer to the poverty threshold. Since the estimated effects of physical capability on income and financial wealth are more substantial, a broad recommendation would be that including physical capability in efforts that are aimed at improving income and financial wealth could be useful and effective. The methodological approach described in this paper could also be applied to other research settings or topics.

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Quantitative health impact assessment methodology for societal initiatives: A scoping review

Cited by 2 publications

References 27 publications

Qualitative modelling of social determinants of health using group model building: the case of debt, poverty, and health

Qualitative modelling of social determinants of health using group model building: the case of debt, poverty, and health

Quantifying reciprocal relationships between poverty and health: combining a causal loop diagram with longitudinal structural equation modelling

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