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Causal Loop diagrams

Jin Xu, Anne Mills
BACKGROUND: Gatekeeping involves a generalist doctor who controls patients' access to specialist care, and has been discussed as an important policy option to rebalance the primary care and hospital sectors in low- and middle-income countries, despite thin evidence. A gatekeeping pilot in a Chinese rural setting launched in 2013 has offered an opportunity to study the functioning of gatekeeping under such conditions. METHODS: In this qualitative study within a mixed-method evaluation of the gatekeeping pilot, we developed an innovative systems analysis method, combining the World Health Organisation categorisation of health system building blocks, the "Framework" approach of policy analysis and causal loop analysis...
July 1, 2017: International Journal for Equity in Health
Parisa Salimi, Mohsen Hamedi, Nima Jamshidi, Milad Vismeh
Diabetes and its associated complications are realized as one of the most challenging medical conditions threatening more than 29 million people only in the USA. The forecasts suggest a suffering of more than half a billion worldwide by 2030. Amid all diabetic complications, diabetic foot ulcer (DFU) has attracted much scientific investigations to lead to a better management of this disease. In this paper, a system thinking methodology is adopted to investigate the dynamic nature of the ulceration. The causal loop diagram as a tool is utilized to illustrate the well-researched relations and interrelations between causes of the DFU...
April 2017: Medical Hypotheses
Sachiko Ozawa, Ligia Paina, Mary Qiu
BACKGROUND: Trust is critical to generate and maintain demand for vaccines in low and middle income countries. However, there is little documentation on how health system insufficiencies affect trust in vaccination and the process of re-building trust once it has been compromised. We reflect on how disruptions to immunizations systems can affect trust in vaccination and can compromise vaccine utilization. We then explore key pathways for overcoming system vulnerabilities in order to restore trust, to strengthen the resilience of health systems and communities, and to promote vaccine utilization...
November 15, 2016: BMC Health Services Research
Jaimie McGlashan, Michael Johnstone, Doug Creighton, Kayla de la Haye, Steven Allender
Causal loop diagrams developed by groups capture a shared understanding of complex problems and provide a visual tool to guide interventions. This paper explores the application of network analytic methods as a new way to gain quantitative insight into the structure of an obesity causal loop diagram to inform intervention design. Identification of the structural features of causal loop diagrams is likely to provide new insights into the emergent properties of complex systems and analysing central drivers has the potential to identify leverage points...
2016: PloS One
Lukas K Schoenenberger, Steffen Bayer, John P Ansah, David B Matchar, Rajagopal L Mohanavalli, Sean Sw Lam, Marcus Eh Ong
OBJECTIVES: Emergency Department crowding is a serious and international health care problem that seems to be resistant to most well intended but often reductionist policy approaches. In this study, we examine Emergency Department crowding in Singapore from a systems thinking perspective using causal loop diagramming to visualize the systemic structure underlying this complex phenomenon. Furthermore, we evaluate the relative impact of three different policies in reducing Emergency Department crowding in Singapore: introduction of geriatric emergency medicine, expansion of emergency medicine training, and implementation of enhanced primary care...
2016: SAGE Open Medicine
Bonhee Chung
Poor subsistence farmers who live in a semi-arid area of northern Ethiopia build irrigation systems to overcome water shortages. However, there is a high risk of malaria transmission when increased standing water provides more favorable habitats for mosquito breeding. This is a serious problem because there are many barriers to malaria control measures and health care systems in the area. Using a causal loop diagram and computer simulations, the author attempted to visually illustrate positive and negative feedbacks between mosquito and human populations in the context of Simret, which is a small village located in northern Ethiopia and is generally considered a malaria-free area...
August 2016: Korean Journal of Parasitology
Gustavo Nigenda, Luz María González-Robledo, Clara Juárez-Ramírez, Taghreed Adam
BACKGROUND: In 2003, Mexico's Seguro Popular de Salud (SPS), was launched as an innovative financial mechanism implemented to channel new funds to provide health insurance to 50 million Mexicans and to reduce systemic financial inequities. The objective of this article is to understand the complexity and dynamics that contributed to the adaptation of the policy in the implementation stage, how these changes occurred, and why, from a complex and adaptive systems perspective. METHODS: A complex adaptive systems (CAS) framework was used to carry out a secondary analysis of data obtained from four SPS's implementation evaluations...
May 13, 2016: Implementation Science: IS
Alexandra Macmillan, Michael Davies, Clive Shrubsole, Naomi Luxford, Neil May, Lai Fong Chiu, Evelina Trutnevyte, Yekatherina Bobrova, Zaid Chalabi
BACKGROUND: The UK government has an ambitious goal to reduce carbon emissions from the housing stock through energy efficiency improvements. This single policy goal is a strong driver for change in the housing system, but comes with positive and negative "unintended consequences" across a broad range of outcomes for health, equity and environmental sustainability. The resulting policies are also already experiencing under-performance through a failure to consider housing as a complex system...
March 8, 2016: Environmental Health: a Global Access Science Source
A K Wittenborn, H Rahmandad, J Rick, N Hosseinichimeh
BACKGROUND: Depression is a complex public health problem with considerable variation in treatment response. The systemic complexity of depression, or the feedback processes among diverse drivers of the disorder, contribute to the persistence of depression. This paper extends prior attempts to understand the complex causal feedback mechanisms that underlie depression by presenting the first broad boundary causal loop diagram of depression dynamics. METHOD: We applied qualitative system dynamics methods to map the broad feedback mechanisms of depression...
February 2016: Psychological Medicine
Navid Ghaffarzadegan, Richard C Larson
Despite a wide range of studies and medical progress, it seems that we are far from significantly mitigating the problem of posttraumatic stress disorder (PTSD). The problem has major social and behavioral components. Developing innovative and effective policies requires a broad scope of analysis and consideration of the highly interconnected social, behavioral, and medical variables. In this article, we take a systems approach and offer an illustrative causal loop diagram which includes individual and social dynamics...
October 2015: U.S. Army Medical Department Journal
Margaret Wilson, Tyler Pavlowich, Michael Cox
Like many small-scale fishing communities around the world, the community of Buen Hombre in the Dominican Republic is dealing with a set of challenges to reconcile its fishing activities with the ecology on which it depends. Also like many such communities, this case has been examined at a particular period in time by a group of social scientists, but not over substantial lengths of time in order to examine the longitudinal validity of the conclusions made during this period. In this paper we combine data from previous anthropological work with our own primary social and ecological data to conduct a longitudinal case study of the Buen Hombre fishery...
March 2016: Ambio
Steven Allender, Brynle Owen, Jill Kuhlberg, Janette Lowe, Phoebe Nagorcka-Smith, Jill Whelan, Colin Bell
INTRODUCTION: Application of system thinking to the development, implementation and evaluation of childhood obesity prevention efforts represents the cutting edge of community-based prevention. We report on an approach to developing a system oriented community perspective on the causes of obesity. METHODS: Group model building sessions were conducted in a rural Australian community to address increasing childhood obesity. Stakeholders (n = 12) built a community model that progressed from connection circles to causal loop diagrams using scripts from the system dynamics literature...
2015: PloS One
Yu Gil Song, Eun Kyoung Yun
PURPOSE: In this study a system dynamics methodology was used to identify correlation and nonlinear feedback structure among factors affecting unplanned extubation (UE) of ICU patients and to construct and verify a simulation model. METHODS: Factors affecting UE were identified through a theoretical background established by reviewing literature and preceding studies and referencing various statistical data. Related variables were decided through verification of content validity by an expert group...
April 2015: Journal of Korean Academy of Nursing
Jennifer Wieczorek Moreland
BACKGROUND: In 2010, Denver Public Health at Denver Health was awarded a Robert Wood Johnson Foundation Healthy Kids, Healthy Communities (HKHC) grant that supported policy, system, and environmental changes to expand healthy food access through gardens and large-chain grocery stores and expand environments that are safe for all children to play, walk, and bike. Systems-thinking approaches enhanced the Denver partnership's work to identify and address the multiple and complex factors affecting the environment changes implemented to increase active living and healthy eating...
May 2015: Journal of Public Health Management and Practice: JPHMP
Ian M Thomas, Stacia R Reilly
BACKGROUND: Between 2008 and 2012, the multidisciplinary Healthy Community Partnership of Columbia, Missouri, participated in a national program to address child obesity. This article describes a systems-level evaluation of their work to implement healthy eating and active living policy, system, and environmental changes to support healthier communities for children. METHODS: In 2011, the partnership participated in a Group Model Building session, consisting of 2 primary activities...
May 2015: Journal of Public Health Management and Practice: JPHMP
David A Nelson, Christopher J Simenz, Sarah P OʼConnor, Yvonne D Greer, Ann L Bachrach, Tony Shields, Brett A Fuller, Katie Horrigan, Kathleen Pritchard, Judy B Springer, John R Meurer
BACKGROUND: Despite increased attention, conventional views of obesity are based upon individual behaviors, and children and parents living with obesity are assumed to be the primary problem solvers. Instead of focusing exclusively on individual reduction behaviors for childhood obesity, greater focus should be placed on better understanding existing community systems and their effects on obesity. The Milwaukee Childhood Obesity Prevention Project is a community-based coalition established to develop policy and environmental change strategies to impact childhood obesity in Milwaukee, Wisconsin...
May 2015: Journal of Public Health Management and Practice: JPHMP
Patricia Keane, Alejandro Ortega, Jeanette Linville
BACKGROUND: Healthy Kids, Healthy Cuba (HKHCuba) is 1 of 49 community partnerships that participated in the national Healthy Kids, Healthy Communities program of the Robert Wood Johnson Foundation. One method of evaluation was to introduce systems thinking at the community level by identifying the essential parts of the HKHCuba system and how it influences policy and environmental changes to promote healthy eating and active living as well as to prevent childhood obesity in this unique, triethnic, rural community in New Mexico...
May 2015: Journal of Public Health Management and Practice: JPHMP
Laura K Brennan, Nasim S Sabounchi, Allison L Kemner, Peter Hovmand
BACKGROUND: Community partnerships to promote healthy eating and active living in order to prevent childhood obesity face a number of challenges. Systems science tools combined with group model-building techniques offer promising methods that use transdisciplinary team-based approaches to improve understanding of the complexity of the obesity epidemic. This article presents evaluation methods and findings from 49 Healthy Kids, Healthy Communities sites funded to implement policy, system, and environmental changes from 2008 to 2014...
May 2015: Journal of Public Health Management and Practice: JPHMP
Eric Sarriot, Melanie Morrow, Anne Langston, Jennifer Weiss, Justine Landegger, Laban Tsuma
Expansion of community health services in Rwanda has come with the national scale up of integrated Community Case Management (iCCM) of malaria, pneumonia and diarrhea. We used a sustainability assessment framework as part of a large-scale project evaluation to identify factors affecting iCCM sustainability (2011). We then (2012) used causal-loop analysis to identify systems determinants of iCCM sustainability from a national systems perspective. This allows us to develop three high-probability future scenarios putting the achievements of community health at risk, and to recommend mitigating strategies...
April 2015: Social Science & Medicine
Leah Frerichs, Jeri Brittin, Dina Sorensen, Matthew J Trowbridge, Amy L Yaroch, Mohammad Siahpush, Melissa Tibbits, Terry T-K Huang
We examined evidence regarding the influence of school physical environment on healthy-eating outcomes. We applied a systems perspective to examine multiple disciplines' theoretical frameworks and used a mixed-methods systematic narrative review method, considering both qualitative and quantitative sources (published through March 2014) for inclusion. We developed a causal loop diagram from 102 sources identified. We found evidence of the influence of many aspects of a school's physical environment on healthy-eating outcomes...
April 2015: American Journal of Public Health
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