Using group model building to frame the commercial determinants of dietary behaviour in adolescence – proposed methods for online system mapping workshops

Abstract

Background Group model building (GMB) is a participatory approach whereby diverse stakeholders can share their views about a problem to create a collective understanding of a complex system. In this article we report our methodological approach to adapt face-to-face GMB processes to an online format to explore the mechanisms by which commercial drivers influence adolescents’ dietary behaviour. We use our experiences to make recommendations on how online GMB could be delivered. Methods We planned, adapted, piloted, delivered, and evaluated a series of online GMB workshops with adolescents, policymakers and public health practitioners to create a system map of the commercial determinants of dietary behaviour in adolescence. We adapted face-to-face GMB workshops to a series of 3 online GMB workshops with 11 adolescents (16–18 years) living in the Southwest of England, and one GMB workshop with policymakers and public health practitioners. Results In our experience, adapting, and delivering GMB online is feasible, engaging, cost-saving and an enjoyable experience. Participants gave positive feedback in terms of engagement and enjoyment, and it allowed them to recognise different points of view about the same problem. Participants became familiarised with system thinking and system dynamics concepts, developed a shared understanding of a complex issue and portrayed it in a system map that depicted the most important factors in a causal structure as well as their interactions at various levels. Conclusions We recommend using process mapping to understand the overall GMB process in an online environment and piloting the workshops to test the timings and flow between online platforms. For facilitation and delivery, facilitators need to ensure they can create an inviting and engaging online environment, even for participants who decide to have their cameras off. Separating GMB activities into different workshops allowed participants to reflect on the problem being discussed and bring new ideas to subsequent workshops. Evaluating the workshops enabled us to build evidence on the trade-offs between the effectiveness, quality and efficiency of online GMB workshops, and how this might be enhanced to identify leverage points and achieve systemic changes in complex issues. Ethical approval The research was approved by the University of Bristol’s Faculty of Health Sciences Research Ethics Committee (Ref: 99,003) and written consent was received from all participants.

Applications of Participatory System Dynamics Methods to Public Health

“…Applying a systems thinking lens to public health problems allows for researchers and community stakeholders alike to gain a more holistic perspective of the issue. [23][24][25][26][27][28] Rather than simplifying a public health issue to a set of drivers and outcomes, systems methods instead place focus on the interconnectedness of drivers and outcomes to reconceptualize the issue as dynamic and occurring in feedback loop behavior. 25 This innovative framing of a problem organically encourages participants to think creatively about the problem, which fosters creative and innovative solutions for change.…”

“…[23][24][25][26][27][28] Rather than simplifying a public health issue to a set of drivers and outcomes, systems methods instead place focus on the interconnectedness of drivers and outcomes to reconceptualize the issue as dynamic and occurring in feedback loop behavior. 25 This innovative framing of a problem organically encourages participants to think creatively about the problem, which fosters creative and innovative solutions for change. 23 The PSD methods allow for the collection of rich and deep data, as well as deeply held meanings associated with a particular problem.…”

“…but also facilitates equitable and social learning processes among stakeholders. 25,27,28,30,34,[36][37][38][39][40][41] Causal loop diagrams are compelling because they offer the unique capability of conveying complex information effectively and parsimoniously and may also be more engaging and interesting than traditional graphs and charts. 37 The act of engaging in visual storytelling by building CLDs helps stakeholders understand the "potential for nonlinear relationships between contributing factors and unanticipated emergent behavior of complex systems," 38(p2) which allows for increased ability to identify leverage points for intervention that may not otherwise be obvious.…”

“…37 The act of engaging in visual storytelling by building CLDs helps stakeholders understand the "potential for nonlinear relationships between contributing factors and unanticipated emergent behavior of complex systems," 38(p2) which allows for increased ability to identify leverage points for intervention that may not otherwise be obvious. 25 Subtheme 1.2: Identifying innovative leverage points for intervention Among the most cited benefits of applying PSD to public health scholarship, research, and practice, is the capacity of PSD methods to aid participants in identifying innovative leverage points for intervention. Reconceptualizing public health issues as complex, dynamic, and adaptive systems broadens and shifts existing perspectives of the central issue, which allows for the identification of innovative leverage points of intervention.…”

“…Reconceptualizing public health issues as complex, dynamic, and adaptive systems broadens and shifts existing perspectives of the central issue, which allows for the identification of innovative leverage points of intervention. 23,25,30,32,33,[42][43][44][45][46][47][48][49][50][51] Another benefit of visualizing public health issues as complex and adaptive systems is that it allows participants to think creatively about solutions, and even identify meaningful solutions that otherwise may have seemed counterintuitive using conventional research approaches. 33,43 Engaging in PSD is thus helpful in developing creative approaches to intervention that avoid "band-aid" solutions.…”