Three Essays on Systems Thinking and Dynamic Modeling in Obesity Prevention Interventions
Essay #1 - Parental Social Influence in Childhood Obesity Interventions: a Systematic Review
The objective of this study is to understand the pathways through which social influence at the family level moderates childhood obesity interventions. We conducted a systematic review of obesity interventions in which parents' behaviors are targeted to change children's obesity outcomes, due to the potential social and environmental influence of parents on the nutrition and physical activity behaviors of children. Results for existing mechanisms that moderate parents' influence on children's behavior are discussed and a causal pathway diagram is developed to map out social influence mechanisms that affect childhood obesity. We provide health professionals and researchers with recommendations to leverage family-based social influence mechanisms for increasing the efficacy of the obesity intervention programs.
Essay #2 - Dynamics of Obesity Interventions inside Organizations: a Case Study of Food Carry-Outs in Baltimore
A large number of obesity prevention interventions, from upstream (policy and environmental) to downstream (individual level), have been put forward to curb the obesity trend; however, not all those interventions have been successful. Overall effectiveness of obesity prevention interventions relies not only on the average efficacy of a generic intervention, but also on the successful Reach, Effectiveness, Adoption, Implementation, and Maintenance (RE-AIM) of that intervention. In this study, we aim to understand how effectiveness of organizational level obesity prevention interventions depends on dynamics of AIM. We focus on an obesity prevention intervention, implemented in food carry-outs in low-income urban areas of Baltimore city, which aims to improve dietary behavior for adults through better food access to healthier foods and point-of-purchase prompts. Building on data from interviews and the literature we develop a dynamic model of the key processes of AIM. We first develop a contextualized map of causal relationships integral to the dynamics of AIM, and then quantify those mechanisms using a system dynamics simulation model. With simulation analysis, we show how as a result of several reinforcing loops that span stakeholder motivation, communications, and implementation quality and costs, small changes in the process of AIM can make a big difference in impact. We present how the dynamics surrounding communication, motivation, and depreciation of interventions can create tipping dynamics in AIM. Specifically, small changes in allocation of resources to an intervention could have a disproportionate long-term impact if those additional resources can turn stakeholders into allies of the intervention, reducing the depreciation rates and enhancing sustainability. We provide researchers with a set of recommendations to increase the sustainability of the interventions.
Essay #3 - Dynamics of Implementation and Maintenance of Organizational Health Interventions: Case Studies of Obesity Interventions
In this study, we present case studies to explore the dynamics of implementation and maintenance of obesity interventions. We analyze how specific obesity prevention interventions are built and eroded, how the building and erosion mechanisms are interconnected, and why we can see significantly different erosion rates across otherwise similar organizations. We use multiple comparative case studies to provide empirical information on the mechanisms of interest, and use qualitative systems modeling to integrate our evolving understanding into an internally consistent and transparent theory of the phenomenon. Our preliminary results identify reinforcing feedback mechanisms, including design of organizational processes, motivation of stakeholders, and communication among stakeholders, which influence implementation and maintenance of intervention components. Over time, these feedback mechanisms may drive a wedge between otherwise similar organizations, leading to distinct configurations of implementation and maintenance processes.