Ripple effects mapping: capturing the wider impacts of systems change efforts in public health

Abstract

Background Systems approaches are currently being advocated and implemented to address complex challenges in Public Health. These approaches work by bringing multi-sectoral stakeholders together to develop a collective understanding of the system, and then to identify places where they can leverage change across the system. Systems approaches are unpredictable, where cause-and-effect cannot always be disentangled, and unintended consequences – positive and negative – frequently arise. Evaluating such approaches is difficult and new methods are warranted. Methods Ripple Effects Mapping (REM) is a qualitative method which can capture the wider impacts, and adaptive nature, of a systems approach. Using a case study example from the evaluation of a physical activity-orientated systems approach in Gloucestershire, we: a) introduce the adapted REM method; b) describe how REM was applied in the example; c) explain how REM outputs were analysed; d) provide examples of how REM outputs were used; and e) describe the strengths, limitations, and future uses of REM based on our reflections. Results Ripple Effects Mapping is a participatory method that requires the active input of programme stakeholders in data gathering workshops. It produces visual outputs (i.e., maps) of the programme activities and impacts, which are mapped along a timeline to understand the temporal dimension of systems change efforts. The REM outputs from our example were created over several iterations, with data collected every 3–4 months, to build a picture of activities and impacts that have continued or ceased. Workshops took place both in person and online. An inductive content analysis was undertaken to describe and quantify the patterns within the REM outputs. Detailed guidance related to the preparation, delivery, and analysis of REM are included in this paper. Conclusion REM may help to advance our understanding and evaluation of complex systems approaches, especially within the field of Public Health. We therefore invite other researchers, practitioners and policymakers to use REM and continuously evolve the method to enhance its application and practical utility.

Navigating the river(s) of systems change: a multi-methods, qualitative evaluation exploring the implementation of a systems approach to physical activity in Gloucestershire, England

“… 37 Here, we will report on the findings from a set of stakeholder interviews and Ripple Effects Mapping (REM) workshops. In brief, REM is a participatory, qualitative method for understanding and visualising the wider intended and unintended impacts of a project or programme (described in depth later and elsewhere 38 ). The data pertaining to these two methods were drawn on here as they provide in depth insights into how WCM functions, the contextual factors which influence its implementation, and to highlight an array of impacts associated with WCM.…”

“…The adaptations to this method have been reported elsewhere. 38 In brief, data were gathered via participatory workshops with the implementation team, and were led by an experienced facilitator (JN). The facilitator guided participants through a series of activities ( table 3 ) that created a visual REM output which documented the actions and activities undertaken, along a timeline, and their associated initial and wider impacts.…”

“…Further details on how we applied REM in the WCM evaluation is available in a methodological paper. 38 See figure 1 for a simplified and illustrative REM output.…”

“…More information regarding the analysis of REM outputs is available in a methodological paper. 38 All data were analysed by the lead researcher (JN) and supported by a second researcher (CFox) to minimise bias. To increase the dependability of the findings, a researcher (JN) had regular discussions with the implementation team and the wider stakeholders to ensure preliminary findings resonated with their experiences.…”

Embedded Researchers as Part of a Whole Systems Approach to Physical Activity: Reflections and Recommendations

“…This meant being familiar with a range of traditional methods (e.g., semi-structured interviews, focus groups, document analyses, observations) and learning about new methods (e.g., systems mapping, social network analyses, realist evaluation). Another key aspect was having the opportunity and confidence to creatively adapt or advance methods to enhance their appropriateness for evaluating systems approaches (e.g., ripple effects mapping [20], participatory action research [21], action scales model [22]). Importantly, we did not work in isolation; we were all connected to, and supported by, wider research and evaluation teams either through our host institutions or through existing research connections.…”