A System Dynamics and Participatory Action Research Approach to Promote Healthy Living and a Healthy Weight among 10–14-Year-Old Adolescents in Amsterdam: The LIKE Programme

Abstract

<jats:p>This paper describes the design of the LIKE programme, which aims to tackle the complex problem of childhood overweight and obesity in 10–14-year-old adolescents using a systems dynamics and participatory approach. The LIKE programme focuses on the transition period from 10-years-old to teenager and was implemented in collaboration with the Amsterdam Healthy Weight Programme (AHWP) in Amsterdam-East, the Netherlands. The aim is to develop, implement and evaluate an integrated action programme at the levels of family, school, neighbourhood, health care and city. Following the principles of Participatory Action Research (PAR), we worked with our population and societal stakeholders as co-creators. Applying a system lens, we first obtained a dynamic picture of the pre-existing systems that shape adolescents’ behaviour relating to diet, physical activity, sleep and screen use. The subsequent action programme development was dynamic and adaptive, including quick actions focusing on system elements (quick evaluating, adapting and possibly catalysing further action) and more long-term actions focusing on system goals and/or paradigm change. The programme is supported by a developmental systems evaluation and the Intervention Level Framework, supplemented with routinely collected data on weight status and health behaviour change over a period of five years. In the coming years, we will report how this approach has worked to provide a robust understanding of the programme’s effectiveness within a complex dynamic system. In the meantime, we hope our study design serves as a source of inspiration for other public health intervention studies in complex systems.</jats:p>

Developing the logic framework underpinning a whole‐systems approach to childhood overweight and obesity prevention: Amsterdam Healthy Weight Approach

“…Qualitative systems mapping using iterative causal loop diagramming also provides opportunities embedded in a systems perspective. 10,16 This is a substantial divergence from traditional epidemiological methods of evaluation and does not guarantee the same degree of certainty in ascertaining impact using effect size and confidence intervals. However, in viewing obesity as an emergent outcome of an obesogenic complex adaptive system (encompassing micro, meso, and macro environments), it is entirely plausible that WSAs are best able to achieve sustainable changes to the system; we posit that traditional methods are not applicable to the evaluation of WSAs and the research community must develop and refine suitable methods.…”

“…14,15 Insights from an existing WSA to obesity prevention, with specific attention for the working principle of responsive adaptation, could inform the design of others and contribute to current discussion around methods to evaluate WSAs, which-being neither predefined nor assumed to cause predictable and static outcomes-are not amenable to traditional evaluative methods such as controlled trials. 16 Amsterdam Healthy Weight Approach (AHWA or Amsterdam Healthy Weight Programme; Amsterdamse Aanpak Gezond Gewicht in Dutch) aims to promote healthy weight development in children living in Amsterdam, the Netherlands, by stimulating healthy diet, physical activity, and sleep. AHWA constitutes a WSA since it adopts the following working principles:…”

Understanding obesity‐related behaviors in youth from a systems dynamics perspective: The use of causal loop diagrams

“…Such factors might need to be included to gain a more comprehensive understanding of a system. Here, it is also important to include the viewpoint of the target group itself (as well as important stakeholders), which we will do in the next stages of the LIKE program to build a more complete understanding of the system 19 …”

“…LIKE combines systems dynamics and participatory action research to develop, implement, and evaluate a dynamic action program focused on promoting healthy lifestyle habits in young adolescents in the transition from tween to teen (aged 10 to 14). LIKE is embedded in the Amsterdam Healthy Weight Programme (AHWP) and is situated in three lower socioeconomic neighborhoods in Amsterdam (Netherlands) 19 …”

“…Here, we aim to gain insight into the system from two different perspectives: the stakeholders' perspective that provides an inside view of the system and the researchers' perspective that provides a more outside view of the system, by building on existing evidence and interpreting the inside perspective. The different methods employed to gain insight into these perspectives are explained elsewhere 19 . The current paper presents the results already achieved in terms of understanding the system from the outside perspective through the use of CLDs developed by academic experts within the LIKE program.…”