Qualitative systems mapping for complex public health problems: A practical guide

Abstract

Systems mapping methods are increasingly used to study complex public health issues. Visualizing the causal relationships within a complex adaptive system allows for more than developing a holistic and multi-perspective overview of the situation. It is also a way of understanding the emergent, self-organizing dynamics of a system and how they can be influenced. This article describes a concrete approach for developing and analysing a systems map of a complex public health issue drawing on well-accepted methods from the field of social science while incorporating the principles of systems thinking and transdisciplinarity. Using our case study on HIV drug resistance in sub-Saharan Africa as an example, this article provides a practical guideline on how to map a public health problem as a complex adaptive system in order to uncover the drivers, feedback-loops and other dynamics behind the problem. Qualitative systems mapping can help researchers and policy makers to gain deeper insights in the root causes of the problem and identify complexity-informed intervention points.

Using systems-mapping to address Adverse Childhood Experiences (ACEs) and trauma: A qualitative study of stakeholder experiences

“…Therefore, systems thinking allows stakeholders and organizations connect upstream and downstream factors specific to a community and identify critical points for interventions across multiple societal levels [ 19 , 20 ]. One specific tool employed in systems thinking is the creation of a causal loop diagram, more commonly known as a systems map, of feedback loops that illustrate the patterns of forces that are causing and influencing observable outcomes [ 21 ]. Relationships between each element in a diagram are represented through arrows.…”

“…Relationships between each element in a diagram are represented through arrows. Positive relationships between elements where both elements progress in the same direction are represented through “pluses,” and negative relationships between elements where each element progress in opposite directions are represented through “minuses” next to the arrows [ 21 ]. Systems thinking, specifically systems mapping, has provided direction and novel insights for actions taken by community organizations and researchers [ 22 , 23 ] and have also significantly influenced program implementation and resource allocation of state-level and county-level health initiatives [ 24 , 25 ].…”

The need for a complex systems approach in rural health research

“…In response to the need for system-level evaluations of health interventions, there has been a recent groundswell of interest in epidemiology and public health around the use of complex systems approaches from the field of complexity science 16 21–27. Complex systems approaches are used to study discontinuous relations, complex forms of non-linear feedback between factors across multiple levels, networks between people, groups and their environment, and processes of exchange between individual actors in systems that give rise to emergent macro-level system behaviours 1 10 21 23–26 28–32.…”

“…Complex systems approaches are used to study discontinuous relations, complex forms of non-linear feedback between factors across multiple levels, networks between people, groups and their environment, and processes of exchange between individual actors in systems that give rise to emergent macro-level system behaviours 1 10 21 23–26 28–32. There is mounting evidence to suggest that a complex systems approach can be of practical assistance in both explaining mechanisms driving adverse health outcomes and system behaviour and also determining where and how to intervene through optimal leverage to achieve positive population health outcomes 18 23–25 27…”

“…Static complex systems methods, such as CLDs and socioecological models,2 27 30 33–35 39 47 48 53 can be used to:…”