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Causal Loop diagrams

Ya-Tsune Sie, Pierre-Alexandre Château, Yang-Chi Chang, Shiau-Yun Lu
This paper describes a group model building activity designed to elicit the potential effects a projected multi-use deep water offshore platform may have on its local environment, including ecological and socio-economic issues. As such a platform is proposed for construction around the island of Hsiao-Liu-Chiu, Taiwan, we organized several meetings with the local stakeholders and structured the debates using group modeling methods to promote consensus. During the process, the participants iteratively built and revised a causal-loop diagram that summarizes their opinions...
February 6, 2018: International Journal of Environmental Research and Public Health
Alexandra Macmillan, James Woodcock
Background: Increasing urban bicycling has established net benefits for human and environmental health. Questions remain about which policies are needed and in what order, to achieve an increase in cycling while avoiding negative consequences. Novel ways of considering cycling policy are needed, bringing together expertise across policy, community and research to develop a shared understanding of the dynamically complex cycling system. In this paper we use a collaborative learning process to develop a dynamic causal model of urban cycling to develop consensus about the nature and order of policies needed in different cycling contexts to optimise outcomes...
December 2017: Journal of Transport & Health
Sharon Friel, Melanie Pescud, Eleanor Malbon, Amanda Lee, Robert Carter, Joanne Greenfield, Megan Cobcroft, Jane Potter, Lucie Rychetnik, Beth Meertens
INTRODUCTION: Systems thinking has emerged in recent years as a promising approach to understanding and acting on the prevention and amelioration of non-communicable disease. However, the evidence on inequities in non-communicable diseases and their risks factors, particularly diet, has not been examined from a systems perspective. We report on an approach to developing a system oriented policy actor perspective on the multiple causes of inequities in healthy eating. METHODS: Collaborative conceptual modelling workshops were held in 2015 with an expert group of representatives from government, non-government health organisations and academia in Australia...
2017: PloS One
Li Shen, Benchen Ye, Huimin Sun, Yuxin Lin, Herman van Wietmarschen, Bairong Shen
To date, most of the chronic diseases such as cancer, cardiovascular disease, and diabetes, are the leading cause of death. Current strategies toward disease treatment, e.g., risk prediction and target therapy, still have limitations for precision medicine due to the dynamic and complex nature of health. Interactions among genetics, lifestyle, and surrounding environments have nonnegligible effects on disease evolution. Thus a transition in health-care area is urgently needed to address the hysteresis of diagnosis and stabilize the increasing health-care costs...
2017: Advances in Experimental Medicine and Biology
O Alonge, S Lin, T Igusa, D H Peters
System dynamics methods were used to explore effective implementation pathways for improving health systems performance through pay-for-performance (P4P) schemes. A causal loop diagram was developed to delineate primary causal relationships for service delivery within primary health facilities. A quantitative stock-and-flow model was developed next. The stock-and-flow model was then used to simulate the impact of various P4P implementation scenarios on quality and volume of services. Data from the Afghanistan national facility survey in 2012 was used to calibrate the model...
December 1, 2017: Health Policy and Planning
Sudesh Raj Sharma, Shiva Raj Mishra, Kusum Wagle, Rachel Page, Anna Matheson, Danielle Lambrick, James Faulkner, David Lounsbury, Abhinav Vaidya
BACKGROUND: Prevalence of non-communicable diseases has been increasing at a greater pace in developing countries and, in particular, the South Asia region. Various behavioral, social and environmental factors present in this region perpetuate common metabolic risk factors of non-communicable diseases. This study will identify social determinants of common metabolic risk factors of major non-communicable diseases in the context of the South Asian region and map their causal pathway. METHODS: A systematic review of selected articles will be carried out following Cochrane guidelines...
September 7, 2017: Systematic Reviews
Dimitri Renmans, Nathalie Holvoet, Bart Criel
Increased attention on "complexity" in health systems evaluation has resulted in many different methodological responses. Theory-driven evaluations and systems thinking are two such responses that aim for better understanding of the mechanisms underlying given outcomes. Here, we studied the implementation of a performance-based financing intervention by the Belgian Technical Cooperation in Western Uganda to illustrate a methodological strategy of combining these two approaches. We utilized a systems dynamics tool called causal loop diagramming (CLD) to generate hypotheses feeding into a theory-driven evaluation...
September 3, 2017: International Journal of Environmental Research and Public Health
Gade Waqa, Marj Moodie, Wendy Snowdon, Catherine Latu, Jeremaia Coriakula, Steven Allender, Colin Bell
BACKGROUND: Obesity and non-communicable diseases are significant public health issues globally and particularly in the Pacific. Poor diet is a major contributor to this issue and policy change is a powerful lever to improve food security and diet quality. This study aims to apply systems thinking to identify the causes and consequences of poor evidence use in food-related policymaking in selected government ministries in Fiji and to illicit strategies to strengthen the use of evidence in policymaking...
August 29, 2017: Health Research Policy and Systems
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
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