A system dynamic perspective of stop–start prevention interventions in Australia

Abstract Time-limited prevention initiatives are frequently used to address complex and persisting public health issues, such as non-communicable diseases. This often creates issues in terms of achieving sustainable change. In this study, we use a system dynamic perspective to explore the effects of stop–start funding over system behaviour in two community-based initiatives designed to prevent chronic diseases and obesity. We conducted a qualitative exploratory study using complexity theory as an analytical lens of two Healthy Together Communities (HTCs) initiatives in Victoria, Australia. Data were generated from 20 semi-structured interviews with health promotion practitioners and managers, from community health and local government organizations. Template analysis based on properties of complex systems informed the inductive identification of system behaviour narratives across the stop–start life-course of HTCs. A central narrative of system behaviour emerged around relationships. Within it, we identified pre-existing contextual conditions and intervention design elements that influenced non-linearity of system self-organization and adaptation, and emergence of outcomes. Examples include cynicism, personal relationships and trust, and history of collaboration. Feedback loops operated between HTCs and these conditions, in a way that could influence long-term system behaviour. Taking a dynamic life-course view of system behaviour helps understand the pre-existing contextual factors, design and implementation influences, and feedback loops which shape the long-term legacy of short-lived interventions aimed at solving complex issues. In turn, greater awareness of such interactions can inform better design and implementation of community-based interventions.

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Sustaining community-based interventions for people affected by dementia long term: the SCI-Dem realist review

BMJ Open ◽

10.1136/bmjopen-2020-047789 ◽

2021 ◽

Vol 11 (7) ◽

pp. e047789

Author(s):

Thomas Morton ◽

Geoff Wong ◽

Teresa Atkinson ◽

Dawn Brooker

Keyword(s):

Financial Management ◽

Local Community ◽

Grey Literature ◽

Realist Review ◽

Social Needs ◽

Support Network ◽

Small Scale ◽

Community Based Interventions ◽

Community Based

ObjectivesCommunity-based support for people with earlier-stage dementia and their care partners, such as regularly meeting groups and activities, can play an important part in postdiagnostic care. Typically delivered piecemeal in the UK, by a variety of agencies with inconsistent funding, provision is fragmented and many such interventions struggle to continue after only a short start-up period. This realist review investigates what can promote or hinder such interventions in being able to sustain long term.MethodsKey sources of evidence were gathered using formal searches of electronic databases and grey literature, together with informal search methods such as citation tracking. No restrictions were made on article type or study design; only data pertaining to regularly meeting, ongoing, community-based interventions were included. Data were extracted, assessed, organised and synthesised and a realist logic of analysis applied to trace context–mechanism–outcome configurations as part an overall programme theory. Consultation with stakeholders, involved with a variety of such interventions, informed this process throughout.ResultsAbility to continually get and keep members; staff and volunteers; the support of other services and organisations; and funding/income were found to be critical, with multiple mechanisms feeding into these suboutcomes, sensitive to context. These included an emphasis on socialising and person-centredness; lowering stigma and logistical barriers; providing support and recognition for personnel; networking, raising awareness and sharing with other organisations, while avoiding conflict; and skilled financial planning and management.ConclusionsThis review presents a theoretical model of what is involved in the long-term sustainability of community-based interventions. Alongside the need for longer-term funding and skilled financial management, key factors include the need for stigma-free, person-centred provision, sensitive to members’ diversity and social needs, as well as the need for a robust support network including the local community, health and care services. Challenges were especially acute for small scale and rural groups.

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The role of public health in addressing child maltreatment in Canada

Chronic Diseases in Canada ◽

10.24095/hpcdp.31.1.07 ◽

2010 ◽

Vol 31 (1) ◽

pp. 39-44 ◽

Cited By ~ 5

Author(s):

SM Jack

Keyword(s):

Public Health ◽

Child Maltreatment ◽

Surveillance Systems ◽

Long Term Outcomes ◽

Community Based Interventions ◽

Community Based ◽

Complex Issue ◽

Short And Long Term

Child maltreatment is a significant health and social issue given its prevalence across the general population and the significant short- and long-term outcomes associated with maltreatment in childhood. There is a need for a comprehensive, collaborative and multisectoral approach for identification, prevention and intervention of this complex issue. Within this multisectoral collaboration, it is essential for public health in Canada to define its role in addressing and preventing child maltreatment. This commentary summarizes how public health can address the issue of child maltreatment in Canada by specifically: 1) measuring the magnitude of maltreatment through public health surveillance systems such as the Canadian Incidence Study of Reported Child Abuse and Neglect; 2) identifying modifiable risk factors; 3) identifying and evaluating community-based interventions to prevent violence; and 4) implementing evidence-based primary prevention strategies.

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A diversity of patterns: 10-year trajectories of men and women diagnosed with psychosis for the first time. A time-geographic approach

Moravian Geographical Reports ◽

10.2478/mgr-2020-0021 ◽

2020 ◽

Vol 28 (4) ◽

pp. 283-298

Author(s):

Gunnel Andersson ◽

Katerina Vrotsou ◽

Anne Denhov ◽

Alain Topor ◽

Per Bülow ◽

...

Keyword(s):

Mental Illness ◽

Western World ◽

Community Based Interventions ◽

Community Based ◽

Common Pattern ◽

Men And Women ◽

Institutional Experience ◽

Third Sphere ◽

First Time

AbstractPeople with severe mental illness face a different ‘interventional’ landscape compared to some decades ago, when mental hospitals were dominant, in Sweden as well as in the rest of the Western world. The aim of the research reported in this article was to follow men and women diagnosed with psychosis for the first time over a 10-year period, and to explore what interventions they experienced. The interventions, here defined as “spheres”, were either community-based or institutional. A third sphere represents no interventions. Based on data from registers and using a time-geographic approach, the individuals were visualised as 10- year trajectories where their transitions between the different spheres were highlighted. The results show a great diversity of trajectories. Two main categories were detected: two-spheres (community-based and no interventions) and three-spheres (adding institutional interventions). One third of the population experienced only community-based interventions, with a higher proportion of men than women. Consequently, more women had institutional experience. Two sub-categories reveal trajectories not being in the interventional sphere in a stepwise manner before the 10th year, and long-term trajectories with interventions in the 10th year. The most common pattern was long-term trajectories, embracing about half of the population, while one-fifth left the institutional sphere before the 5th year.

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Sustainability of community-based interventions for people affected by dementia: a protocol for the SCI-Dem realist review

BMJ Open ◽

10.1136/bmjopen-2019-032109 ◽

2019 ◽

Vol 9 (7) ◽

pp. e032109

Author(s):

Thomas Morton ◽

Teresa Atkinson ◽

Dawn Brooker ◽

Geoffrey Wong ◽

Shirley Evans ◽

...

Keyword(s):

Real Life ◽

Realist Review ◽

Stakeholder Group ◽

Community Based Interventions ◽

Community Based ◽

Funding Model ◽

People With Dementia ◽

Ethical Approval ◽

Academic Search

IntroductionWith numbers set to increase globally, finding ways to better support people with dementia and their families is a matter of growing concern. Community-based interventions can play a key role in supporting people with early to moderate stage dementia postdiagnosis, helping delay decline and hospitalisation. However, provision of such interventions is fragmented, with significant gaps and no reliable funding model, hence innovative groups and schemes catering for a genuine need can struggle long term and frequently fold.Methods and analysisThis realist review aims to expand our understanding of how best to implement and facilitate community-based interventions to run sustainably, focusing on contextually relevant explanations. We will gather and synthesise literature using a realist approach designed to accommodate and account for the complexity of ‘real life’ programmes, as implemented under different conditions in different settings, aiming to draw transferable conclusions about their sustainability that explain how and why context can influence outcomes. Our review will iteratively progress through five steps: (1) locate existing theories; (2) search for evidence (using Academic Search, AMED, CINAHL, EMBASE, MEDLINE, ProQuest, PsycINFO, PubMed, Scopus and Social Care Online, between May and September 2019); (3) article selection; (4) extracting and organising data; (5) synthesising the evidence and drawing conclusions. Data analysis will use a realist logic to explain what works, for whom, in what circumstances, in what respects, how and why. A stakeholder group will provide guidance and feedback throughout.Ethics and disseminationEthical approval was not required. Recommendations drawn from results are likely to be of interest to a range of stakeholders including those commissioning, planning, running, supporting or attending such interventions, as well as policymakers, healthcare professionals and researchers. We will draw on the expertise of our stakeholder group regarding tailoring dissemination to each audience using a variety of materials, formats and channels.

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Faltering growth

InnovAiT Education and inspiration for general practice ◽

10.1177/1755738017733502 ◽

2017 ◽

Vol 10 (12) ◽

pp. 734-739 ◽

Cited By ~ 1

Author(s):

Emma Roche ◽

Baneera Shrestha

Keyword(s):

Primary Care ◽

Growth And Development ◽

Health Visitor ◽

Dietary Advice ◽

Community Based Interventions ◽

Community Based ◽

Parental Concern ◽

Long Term Consequences ◽

In Infants And Children

Faltering growth is a common paediatric presentation in primary care; it often presents following routine health visitor surveillance or is highlighted by parental concern. It is important to recognise, as it may be the presentation of an underlying medical or social problem, and because there may be long-term consequences for growth and development. Reassuringly, however, most children with faltering growth do not fall into these groups and will improve with community-based interventions including dietary advice and health visitor input. This article describes the recognition, causes, assessment and management of faltering growth in infants and children.

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Maximizing Outcomes in Group Treatment of Aphasia: Lessons Learned From a Community-Based Center

Perspectives on Neurophysiology and Neurogenic Speech and Language Disorders ◽

10.1044/nnsld24.3.100 ◽

2014 ◽

Vol 24 (3) ◽

pp. 100-105 ◽

Cited By ~ 1

Author(s):

Darlene Williamson

Keyword(s):

Group Treatment ◽

Treatment Protocol ◽

Lessons Learned ◽

Group Program ◽

Community Based ◽

Multiple Treatment ◽

Use Of Technology ◽

Communication Impairments ◽

Treatment Settings

Given the potential of long term intervention to positively influence speech/language and psychosocial domains, a treatment protocol was developed at the Stroke Comeback Center which addresses communication impairments arising from chronic aphasia. This article presents the details of this program including the group purposes and principles, the use of technology in groups, and the applicability of a group program across multiple treatment settings.

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From Volunteering to Academic Programming: A Case Example

Perspectives of the ASHA Special Interest Groups ◽

10.1044/persp1.sig17.7 ◽

2016 ◽

Vol 1 (17) ◽

pp. 7-11 ◽

Cited By ~ 2

Author(s):

Cindy Gill ◽

Sneha Bharadwaj ◽

Nancy Quick ◽

Sarah Wainscott ◽

Paula Chance

Keyword(s):

Special Needs ◽

Cultural Relevance ◽

Master's Program ◽

Speech Language Pathology ◽

Community Based ◽

Charitable Organization ◽

Language Pathology ◽

The University

A speech-language pathology master's program that grew out of a partnership between the University of Zambia and a U.S.-based charitable organization, Connective Link Among Special needs Programs (CLASP) International, has just been completed in Zambia. The review of this program is outlined according to the suggested principles for community-based partnerships, a framework which may help evaluate cultural relevance and sustainability in long-term volunteer efforts (Israel, Schulz, Parker, & Becker, 1998).

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