Building a Prevention System: Infrastructure to Strengthen Health Promotion Outcomes

Abstract

Prevention systems improve the performance of health promotion interventions. This research describes the establishment of the Australian state government initiative, Healthy Together Victoria’s (HTV) macro infrastructure for the delivery of large-scale prevention interventions. Methods: This paper reports on findings of 31 semi-structured interviews about participants’ understanding of systems thinking and their reflections of the strengths and weaknesses of the HTV prevention system. A chronic disease prevention framework informed the coding that was used to create a causal loop diagram and a core feedback loop to illustrate the results. Results: Findings highlighted that HTV created a highly connected prevention system that included a sizeable workforce, significant funding and supportive leadership. Operating guidelines, additional professional development and real-time evaluation were significant gaps, which hindered systems practice. For inexperienced systems thinkers, these limitations encouraged them to implement programs, rather than interact with the seemingly ambiguous systems methods. Conclusions: HTV was an innovative attempt to strengthen health promotion infrastructure, creating a common language and shared understanding of prevention system requirements. However, the model was inadequate for HTV to achieve population-level reductions in chronic disease as system oversight was missing, as was an intervention delivery focus. Clarity was needed to define the systems practice that HTV was seeking to achieve. Importantly, the HTV prevention system needed to be understood as complex and adaptive, and not prioritized as individual parts.

Diverse Approaches to Creating and Using Causal Loop Diagrams in Public Health Research: Recommendations From a Scoping Review

“…In terms of research aims found in the 23 articles, four themes emerged: 1) to examine the complexity of a public health topic and illustrate complex systems thinking [26][27][28][29][30][31][32][33][34]; 2) to discuss the complexity of a public health intervention [35][36][37][38][39][40]; 3) to describe study protocol and how CLDs were created [41][42][43][44]; and 4) to illustrate how CLDs can be used to monitor and track initiatives to improve population health or evaluate impact of interventions [45][46][47][48].…”

“…Both primary and secondary data were used for creating CLDs (Table 3). Most articles reported on primary data collection (18/ 23) and this included interviews [26,27,33,[35][36][37][38][39][40], group model building with stakeholders and/or community members [32,41,43,44,46,48], behavioral data [42,47], fieldnotes [37], and workshops with experts [31]. Twelve articles used primary data only.…”

“…Allender [47] ✓ ✓ Araz [45] ✓ ✓ Bensberg [35] ✓ ✓ Bradley [34] ✓ ✓ Brereton [28] ✓ ✓ Brown [48] ✓ ✓ Burrell [36] ✓ ✓ ✓ Clarke [37] ✓ ✓ ✓ Crielaard [26] ✓ ✓ ✓ Eker [27] ✓ ✓ Gerritsen [41] ✓ ✓ Hassmiller Lich [46] ✓ ✓ Jalali [38] ✓ ✓ ✓ Klement [29] ✓ ✓ Knai [30] ✓ ✓ Maitland [42] ✓ ✓ Osman [31] ✓ ✓ Owen [39] ✓ ✓ Parmar [40] ✓ ✓ ✓ Riley [43] ✓ ✓ Sahin [32] ✓ ✓ ✓ Swierad [44] ✓ ✓ Urwannachotima [33] ✓ ✓…”

Building an effective and enduring prevention system

“…3 However, the appointment of personnel without appropriate training in public health or health promotion, the prevalence of small teams dedicated to prevention, and staff turnover due to lack of role clarity and/or funding stability, has been found to significantly impair the quality and continuity of prevention programs in Australia. 9,10 This highlights the need for public health agencies to review criteria for staff selection, the size and structure of teams, duration of appointments, remuneration, training and opportunities for career advancement, which will affect the composition and continuity of the prevention workforce at the regional level.…”

Understanding Prevention Networks in a Local Government Area: Insights From a Social Network Analysis Among Western Australian Nutrition, Physical Activity, and Obesity Prevention Programs

“…Systems thinking can determine the relationships between actors (e.g. individuals or organisations), facilitating discussions which can lead to a better understanding of the shifting influences that exist and affect a network's operation (Bensberg, Joyce, & Wilson, 2021;Carey et al, 2015). A network's structure can be explored using social network analysis (SNA), which can assist in developing an understanding of the opportunities and constraints placed on individuals and organisations and the roles they play in the outcomes of the network (Borgatti, Everett, & Johnson, 2018;Valente, 2010).…”