System Dynamics Approaches and Collective Action for Community Health: An Integrative Review.

System dynamics (SD) methods, from qualitative causal loop diagramming to quantitative simulation modeling, have the potential to be powerful tools for engaging community stakeholders interested in improving health. However, the extent to which SD drives collective action to improve community health is unclear. The objective of this review was to understand how often, why, and how SD has been used by cross-sector community collectives. Of 409 identified manuscripts describing application of SD to community health, only 31 (7.6%) documented cross-sector collective use of these tools. All 31 had as a purpose using SD to better understand community health problems, but only seven (22.6%) documented a collective action taken as the result. In nine of the 31 articles (29.0%), no learning, decisions, or action was documented. The most common form of collective participation in SD work among the seven collectives reporting resulting action was building the SD model, with implementing a new program or practice the most frequently mentioned collective action resulting. Cost and access were the most common system outcomes studied, and chronic diseases and prevention were commonly mentioned as the focal health outcomes. Overall, SD methods seem underutilized for engaging cross-sector collectives in addressing complex community health problems.

Assessing capacity and measuring performance in maternal and child health.

OBJECTIVES: To understand the similarities, differences, and relationships between three tools for performance and capacity assessment currently available for Maternal and Child Health (MCH) programs and for state and local health agencies. METHODS: Three tools for performance and capacity assessment currently available for Maternal and Child Health (MCH) programs and for state and local health agencies, the Title V MCH Block Grant Performance and Outcome Measures (Title V "24"), CAST-5, and the National Public Health Performance Standards Program (NPHPSP) were compared using two metrics, a conceptual model of the public health system, and a set of attributes related to the use of the instruments. RESULTS: Both CAST-5 and the NPHPSP are focused on the capacity and key processes (10 Essential Public Health Services) of the public health system, although CAST-5 is intended for capacity assessment and the NPHPSP is intended for performance measurement. The Title V "24" tool is also intended for performance measurement; however, its focus is on the outputs and outcomes of the health system. The Title V "24" tool is the only one of the three that is mandatory, and the only one whose results at the current time can be used to compare across entities. In addition, both the Title V "24" and the NPHPSP include explicit standards, while CAST-5 does not specify explicit standards against which to compare findings. CONCLUSIONS: While there are various tools available to MCH practitioners for capacity assessment and performance measurement, knowing how the tools relate to each other, and their defining characteristics, should lead to more effective and productive use.