Causal Loops and Qualitative Research

Causal-loop diagramming, a method from system dynamics, is increasingly used in evaluation to describe individuals' understanding of how policies or programs do or could work ("mental models"). The use of qualitative interviews to inform model development is common, but guidance for how to design and conduct these interviews to elicit causal information in participant mental models is scant. A key strength of semi-structured qualitative interviews is that they let participants speak freely; they are not, however, designed to elicit causal information...

The purpose of this report is to provide a perspective on the use of qualitative systems mapping, provide examples of physical activity (PA) systems maps, discuss the role of PA systems mapping in the context of iterative learning to derive breakthrough interventions, and provide actionable recommendations for future work. Systems mapping methods and applications for PA are emerging in the scientific literature in the study of complex health issues and can be used as a prelude to mathematical/computational modeling where important factors and relationships can be elucidated, data needs can be prioritized and guided, interventions can be tested and (co)designed, and metrics and evaluations can be developed...

BACKGROUND: Youth experiencing homelessness (YEH) suffer from poorer physical and mental health outcomes than stably housed youth. Additionally, YEH are forced to navigate fragmented health and social service systems on their own, where they often get lost between systems when transitioning or post-discharge. Inevitably, YEH require support with health system navigation and healthcare coordination. The aim of this study is to understand interactions within and between the emergency youth shelter (EYS) and health systems that affect healthcare coordination for YEH in Toronto, Canada, and how these interactions can be targeted to improve healthcare coordination for YEH...

AIMS: Continuous glucose monitoring (CGM) use remains low in older adults. We aimed to develop a conceptual model of CGM integration among older adults with type 1 and type 2 diabetes. METHODS: We previously engaged older adults with type 1 diabetes using participatory system science methods to develop a model of the system of factors that shape CGM integration. To validate and expand the model, we conducted semi-structured interviews with 17 older adults with type 1 and type 2 diabetes and 3 caregivers...

Frequent potentially avoidable presentations to Emergency Departments (EDs) represent a complex problem, driven by multiple interdependent and interacting factors that change over time and influence one another. We sought to describe and map the drivers of frequent potentially avoidable presentations to a regional ED, servicing regional and rural areas, and identify possible solutions from the perspectives of key stakeholders. This study used a qualitative, community-based systems dynamics approach utilising Group Model Building (GMB)...

BACKGROUND: It is known from previous studies that university students in sub-Saharan Africa (sSA) engage in sexual risk-taking behaviour (SRTB). However, there is paucity of data on factors contributing to SRTB among university students (emerging adults) at the Kenyan Coast thus hindering intervention planning. This study seeks to provide an in-depth qualitative understanding of the factors contributing to SRTB and their interconnectedness among university students at the Kenyan Coast combining qualitative research with a systems thinking approach...

BACKGROUND: Chlamydia Trachomatis (CT) is among the most prevalent sexually transmitted diseases (STDs) globally. According to the World Health Organization, more than 131 million people get infected with CT annually. CT is usually transmitted via sexual contact or perinatal exposure and can result in severe long-term complications. In developing nations, particularly, the prevention and control of CT is challenging. Hence, this study will explore the feedback mechanisms of chlamydia prevention and control, as well as identify the essential factors affecting the control and prevention of this infection in China...

System dynamics, and specifically qualitative participatory applications of system dynamics, have potential to benefit public health research, scholarship, and practice. A systematic review was conducted to examine the existing applications of participatory system dynamics (PSD) to public health research. Three databases were searched using unique search terms related to PSD and methodological applications in public health research. A total of 57 unique articles met inclusion criteria and were included for review...

BACKGROUND AND OBJECTIVES: Falls among older adults are a significant health problem globally. Studies of multicomponent fall prevention programs in randomized controlled trials demonstrate effectiveness in reducing falls; however, the translation of research into the community remains challenging. Although there is an increasing interest to understand the factors contributing to implementation barriers, the dynamic relationships between factors are less well examined. Furthermore, evidence on implementation barriers from Asia is lacking as most of these studies originate from the West...

BACKGROUND: People with schizophrenia have a higher risk of mortality compared to the general population, which has not improved over time. The majority of premature deaths are due to comorbid physical diseases, driven by interrelated factors operating at the individual level, through health systems and influenced by social determinants of health. A holistic understanding of this problem and the causal pathways linking these factors together is lacking. AIMS: This study aims to understand why the mortality gap between people with schizophrenia and the general population is not improving by developing a causal loop diagram (CLD), a systems thinking approach which enables empirical research and theoretical knowledge to be combined into a visual representation of causal relationships and feedback loops...

BACKGROUND: Home care is facing increasing demand due to an aging population. Several challenges have been identified in the provision of home care, such as the need for support and tailoring support to individual needs. Goal-oriented interventions, such as reablement, may provide a solution to some of these challenges. The reablement approach targets adaptation to disease and relearning of everyday life skills and has been found to improve health-related quality of life while reducing service use...

INTRODUCTION: Food systems can shape dietary behaviour and obesity outcomes in complex ways. Qualitative systems mapping using causal loop diagrams (CLDs) can depict how people understand the complex dynamics, inter-relationships and feedback characteristic of food systems in ways that can support policy planning and action. To date, there has been no attempt to review this literature. The objectives of this review are to scope the extent and nature of studies using qualitative systems mapping to facilitate the development of CLDs by stakeholders to understand food environments, including settings and populations represented, key findings and the methodological processes employed...

In December 2019, coronavirus disease (COVID-19) was detected in Wuhan, China. Due to the rapid spread of the disease, containment measures were adopted, which caused unprecedent shifts in individual mobility. Although some studies explored the impacts of the COVID-19 pandemic on travel patterns and resilience of transport systems based on different analysis techniques, there is a lack of studies addressing the impacts of the pandemic on the sustainability and resilience of urban mobility systems using in-depth and holistic methods, such as system dynamics...

OBJECTIVE: To present an approach to build capacity for the use of systems science to support local communities in municipal public health and well-being planning. DESIGN: Case study. SETTING: Local government authorities participating in the VicHealth Local Government Partnership in Victoria, Australia. PARTICIPANTS: Local government staff members were trained in community-based system dynamics (CBSD), and group model building (GMB) techniques to mobilise local community efforts...

BACKGROUND: Rural veterans experience more challenges than their urban peers in accessing primary care services, which can negatively impact their health and wellbeing. The factors driving this disparity are complex and involve patient, clinic, health system, community and policy influences. Federal policies over the last decade have relaxed requirements for some veterans to receive primary care services from community providers through their VA benefits, known as community care. METHODS: We used a participatory systems mapping approach involving causal-loop diagramming to identify interrelationships between variables underlying challenges to veteran access to primary care and potential opportunities for change-known as leverage points in systems science...

This paper presents a novel holistic modeling approach for investigating and analyzing the relationship of qualitative variables such as training and absenteeism with quantifiable shopfloor key performance indicators such as quality, inventory, and production rate. Soft variables, supervisor support and work environment, and their relationships with the hard variables, facility layout, and production strategies were investigated in this research. It was found in the literature that increasing absenteeism reduces the rate of production and causes a decrease in motivation, while training can increase the level of motivation if effective...

This study demonstrates an innovative approach to capture the complexity of individual workplace well-being, improving our understanding of multicausal relationships and feedback loops involved. The literature shows that a high number of interacting factors are related to individual workplace well-being. However, many studies focus on subsets of factors, and causal loops are seldomly studied. The aim of the current study was, therefore, to capture individual workplace well-being in a comprehensive conceptual causal loop diagram (CLD)...

Introduction: This paper explores the capabilities that contribute to community transformation and the common pathways followed by communities in the 100 Million Healthier Lives SCALE (Spreading Community Accelerators through Learning and Evaluation) initiative in their transformation journeys towards a "Culture of Health". Methods: Funded by the Robert Wood Johnson Foundation (RWJF), from 2016 to 2020, between 18 to 24 community coalitions nationwide participated in SCALE, the goal of which was to co-design, implement, test, and scale up a model called the Community of Solutions (COS) Framework, that built community capacity around a set of skills and behaviors to advance culture change and create sustainable improvement in health, well-being, and equity...

Behavioral health (BH) problems are common in the military and can adversely affect force readiness. Research suggests that primary care-behavioral health (PCBH) integration can improve BH outcomes by making high-quality BH care available in more accessible settings. However, sustaining high-quality implementation of PCBH is challenging. The authors conducted a process evaluation of the PCBH program in the military health system to understand why the program is working as it is and provide recommendations for quality improvement...

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...