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

Objectives: Complex systems thinking methods are increasingly called for and used as analytical lenses in public health research. The use of qualitative system mapping and in particular, causal loop diagrams (CLDs) is described as one promising method or tool. To our knowledge there are no published literature reviews that synthesize public health research regarding how CLDs are created and used.Methods: We conducted a scoping review to address this gap in the public health literature. Inclusion criteria included: 1) focused on public health research, 2) peer reviewed journal article, 3) described and/or created a CLD, and 4) published in English from January 2018 to March 2021. Twenty-three articles were selected from the search strategy.Results: CLDs were described as a new tool and were based upon primary and secondary data, researcher driven and group processes, and numerous data analysis methods and frameworks. Intended uses of CLDs ranged from illustrating complexity to informing policy and practice.Conclusion: From our learnings we propose nine recommendations for building knowledge and skill in creating and using CLDs for future public health research.

Bootstrapping tourism post-COVID-19: A systems thinking approach

The coronavirus pandemic has disturbed industries globally. Unlike agriculture and manufacturing, the services sector, particularly tourism, which primarily involves social activities requiring human interaction, is devastated. Against the backdrop of measures to contain the pandemic, travel behaviors have altered. Without an effective recovery plan, the effect of the pandemic on tourism may be felt over a prolonged period of time. With the objective of contributing to a better understanding of how tourism can recover, we use systems thinking to recommend interventions to help restart local tourism. Through causal loop diagrams, we argue that rebooting tourism is key to rebooting the economy. We propose insights for policy action well before the crisis deepens and permanently derails the tourism industry.

The value of system dynamics' diagrams for business model innovation

PurposeSystem dynamics (SD) is emerging as a powerful approach to understand, analyse, simulate and predict complex and dynamic business processes. In particular, it is true in the process of business model innovation (BMI) and not only as a computational approach. Due to the visual and diagrammatic tools employed by SD, innovation managers overcome humans' mental limitations and improve knowledge management in the BMI. This paper discloses the value of SD's visual tools, i.e. causal loop diagrams and stock and flow diagrams, to contribute to the “Knowldege Visualization” research line, and promote the application of SD as a powerful approach to support decisions in BMI.Design/methodology/approachGiven the explorative nature and the “how” question driving the research, the methodology involved is a single, holistic case study. In particular, the case is about a business model (BM) diversification, in which an information and communication technology service provider has added to its existing business model a new BM based on a digital multi-sided platform, for passengers transportation.FindingsThe diagrammatic tools of SD, that is causal loop diagrams and stock and flow diagrams, allowed entrepreneurs to overcome the complexity of the business parameters concurring in the design of the BM.Originality/valueThe value of this research is in the exploratory approach and in the originality of the perspective by which SD is analysed: the visual knowledge perspective.

Using systems thinking and causal loop diagrams to identify cascading climate change impacts on bioenergy supply systems

Increased use of bioenergy, driven by ambitious climate and energy policies, has led to an upsurge in international bioenergy trade. Simultaneously, it is evident that every node of the bioenergy supply chain, from cultivation of energy crops to production of electricity and heat, is vulnerable to climate change impacts. However, climate change assessments of bioenergy supply chains neither account for the global nature of the bioenergy market, nor the complexity and dynamic interconnectivity between and within different sub-systems in which the bioenergy supply chain is embedded, thereby neglecting potential compounding and cascading impacts of climate change. In this paper, systems thinking is utilised to develop an analytical framework to address this gap, and aided by causal loop diagrams, cascading impacts of climate change are identified for a case study concerning imports of wood pellets from the United States to the European Union. The findings illustrate how the complexity and interconnectivity of the wood pellet supply system predispose the supply chain to various cascading climate change impacts stemming from environmental, social, political and economic domains, and highlight the value of using system-based analysis tools for studying such complex and dynamic systems.

How do participatory methods shape policy? Applying a realist approach to the formulation of a new tuberculosis policy in Georgia

ObjectivesThis paper presents the iterative process of participatory multistakeholder engagement that informed the development of a new national tuberculosis (TB) policy in Georgia, and the lessons learnt.MethodsGuided by realist evaluation methods, a multistakeholder dialogue was organised to elicit stakeholders’ assumptions on challenges and possible solutions for better TB control. Two participatory workshops were conducted with key actors, interspersed by reflection meetings within the research team and discussions with policymakers. Using concept mapping and causal mapping techniques, and drawing causal loop diagrams, we visualised how actors understood TB service provision challenges and the potential means by which a results-based financing (RBF) policy could address these.SettingThe study was conducted in Tbilisi, Georgia.ParticipantsA total of 64 key actors from the Ministry of Labour, Health and Social Affairs, staff of the Global Fund to Fight AIDS, TB and Malaria Georgia Project, the National Centre for Disease Control and Public Health, the National TB programme, TB service providers and members of the research team were involved in the workshops.ResultsFindings showed that beyond provider incentives, additional policy components were necessary. These included broadening the incentive package to include institutional and organisational incentives, retraining service providers, clear redistribution of roles to support an integrated care model, and refinement of monitoring tools. Health system elements, such as effective referral systems and health information systems were highlighted as necessary for service improvement.ConclusionsDeveloping policies that address complex issues requires methods that facilitate linkages between multiple stakeholders and between theory and practice. Such participatory approaches can be informed by realist evaluation principles and visually facilitated by causal loop diagrams. This approach allowed us leverage stakeholders’ knowledge and expertise on TB service delivery and RBF to codesign a new policy.

Use of co-created causal loop diagrams and fuzzy-cognitive scenario analysis for water quality management

<p>Current understanding is fragmented of the environmental, economic, and social processes involved in water quality issues. The fragmentation is particularly evident for coastal water quality, impacted both by local land catchment and larger-scale marine pressures and impacts. Research and policy so far has primarily addressed coastal water quality issues from either a land-based or a sea-based perspective, which does not support integrated management of the coupled land-coast-sea systems affecting coastal waters. For example, mitigation measures for improving the severe Baltic Sea eutrophication have mostly focused on land-based drivers, and not yet managed to sufficiently improve coastal or marine water quality. The strong human dimension involved in these water quality issues also highlights a need for participatory approaches to facilitate knowledge integration and drive synergistic strategic planning for sustainable management of coastal water quality. Considering the Swedish water management district of Northern Baltic Proper, including its main Norrström drainage basin and surrounding coastal catchment areas and waters, this study has used a participatory approach to evaluate various land-sea water quality interactions and associated management measures. A causal loop diagram has been co-created with different stakeholder groups, following a problem-oriented system thinking approach. This has been further used in fuzzy-cognitive scenario analysis to assess integrated land-coast-sea system behavior under changing human pressures and hydro-climatic conditions. Results show that synergy of several catchment measures is needed to improve coastal water quality locally, while cross-system/sector cooperation is also needed among all contributing national catchments to mitigate coastal eutrophication at the scale of the whole Baltic Sea. Furthermore, large-scale hydro-climatic changes and long-lived nutrient legacy sources also need to be accounted for in water quality management strategies and measures. System dynamics modelling, based on co-created causal loop diagrams and fuzzy-cognitive scenario analysis like those developed in this study, can support further quantification and analysis of the impacts of various mitigation strategies and measures on regional water quality problems and their possible sustainable solutions.</p>