A Systems Thinking Methodology for Studying Prevention Efforts in Communities

The turn to complexity in public health over the past 20 years has come as practitioners, policy makers and scholars lament the lack of progress in addressing wicked problems such as obesity, chronic disease and the social determinants of health. Systems science may be well suited to tackle such wicked problems. While there is a growing application of systems thinking tools and resources in public health, there are fewer examples that incorporate both systems tools and systemic inquiry processes. Prevention Tracker offered an opportunity to trial the combination of systems tools and systems thinking at the level of community chronic disease prevention efforts. Our methodology comprised four Domains of Inquiry. 1. Describing a prevention system 2. Guiding system change efforts 3. Monitoring change 4. Cross case comparison. We applied systems tools and methods to investigate each domain of inquiry such as group model building, social network analysis, graphic illustration, causal loop diagrams and system action learning. These methods were connected through the application of systemic inquiry processes that elevated the ongoing interrogation of boundary judgments, awareness of diverse and multiple perspectives, interrelationships and the importance of social learning. Prevention Tracker demonstrated that it is possible to apply a range of systems methods while also keeping focus on the overall systems science and the need for theoretical consistency. The four domains of inquiry enabled flexibility to adapt our approach in each context to learn and improve. This methodological capacity to learn and adapt may also be useful in tackling other health and social problems, such as the COVID19 pandemic. The overall findings from the study will be presented in separate publications.