A Theory of Change for Community-Based Systems Interventions to Prevent Obesity

Andrew D. Brown, MSW • Jillian Whelan, PhD • Kristy A. Bolton, PhD • Phoebe Nagorcka-Smith, BHSc (Hons) • Joshua Hayward, PhD • Penny Fraser, B App Sci (P&O) • Claudia Strugnell, PhD • Tiana Felmingham, MPH • Melanie Nichols, PhD • Colin Bell, PhD • Ha N.D. Le, MHE • Steven Allender, PhD

Open Access • Published: 02 December 2021
American Journal of Preventive Medicine, 2021, ISSN 0749-3797
DOI: https://doi.org/10.1016/j.amepre.2021.10.006

ABSTRACT

Introduction

Applying systems science in public health trials is a recent innovation in childhood obesity prevention. This paper aims to use systems science conventions to propose a theory of change for community-based interventions aiming to build capacity and use exemplars from systems science for obesity prevention to describe how this approach works.

Methods

Participants were community-based researchers. A dynamic hypothesis was created in workshops conducted in 2020 and 2021 by identifying variables critical to building community capacity for systems thinking. These were used to develop stock and flow diagrams representing individual causal relationships, feedback loops, and the overall theory of change.

Results

The resultant model identified 9 stocks and 4 pairs of central balancing and reinforcing feedback loops. These represented building commitment through relationships, mutual learning, strengthening collaboration, and embedding capacity. The model is described using examples from 3 trials involving 25 communities across Victoria, Australia.

Conclusions

This nonlinear and practice-based model illustrates the process of community-based obesity prevention. The model integrates >20 years of community-based intervention implementation experience, providing an overarching theory of how such interventions work to create change and prevent obesity.

Referenced by Science Direct: https://www.sciencedirect.com/science/article/pii/S0749379721005614