ArticleHealth research policy and systems2018
The value of a causal loop diagram in exploring the complex interplay of factors that influence health promotion in a multisectoral health system in Australia.
Article in Health research policy and systems, 2018. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 56 papers, 2 of them syntheses that pooled it.
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Who cites it
56 citing papers in PubMed, 2 syntheses or guidelines pooled it.
- Success of community-based system dynamics in prevention interventions: A systematic review of the literature.Frontiers in public health · 2023Pooled it
- Strengthening complex systems for chronic disease prevention: a systematic review.BMC public health · 2019Pooled it
- Sustaining Health Promotion in Australian Supermarkets: Qualitative Perspectives From the Reach for the Stars Programme.Health promotion journal of Australia : official journal of Australian Association of Health Promotion Professionals · 2026Article
- Antimicrobial resistance in the Northern Territory, Australia: insights from a systems thinking approach to human health.One health outlook · 2026Article
- Why healthy eating is not equally attainable for all: a participatory systems perspective on dietary behaviour of people living on a low income in the Netherlands, and recommendations for systemic change.Archives of public health = Archives belges de sante publique · 2026Article
- Charge Your Brainzzz: the systematic development of a whole systems action program promoting sleep health in adolescents.BMC public health · 2025Article
- A regional One Health approach to mapping antimicrobial resistance interactions via systems thinking.One health outlook · 2025Article
- Mapping the interactions of critical factors in China's first-contact healthcare systems using causal loop diagrams.BMC public health · 2025Article
- Using causal loop diagrams to examine the interrelationships between factors influencing family planning utilisation in urban east central Uganda.BMJ global health · 2025Article
- Exploring the Contextual Factors That Influence Polio Supplementary Immunisation Activities in the WHO African Region: A Rapid Review.Vaccines · 2025Review
- How can health be further integrated in urban development policymaking in the United Kingdom? A systems mapping approach.Health research policy and systems · 2025Article
- Identifying the active ingredients in payment for performance programmes using system dynamics modelling.SSM - health systems · 2025Article
- Understanding healthcare demand and supply through causal loop diagrams and system archetypes: policy implications for kidney replacement therapy in Thailand.BMC medicine · 2025Article
- Developing a whole systems action plan promoting Dutch adolescents' sleep health.The international journal of behavioral nutrition and physical activity · 2025Article
- Article
- Mapping the Dynamic Complexity of Hypertension Management in São Paulo, Brazil.International journal of public health · 2025Article
- Contextual Factors Affecting Continuity of Follow-Up Care After Hospital Discharge for Patients with Chronic Diseases in Sudan: A Qualitative Study with Causal Loop Diagram Insights.Health services insights · 2025Article
- Supporting One Health policies to manage antibiotic resistance in Senegal: a systems analysis using group model building.Frontiers in public health · 2025Article
- Implementation of Clinical Services for Adults with Obesity in Different Health Systems: A Scoping Review and Causal Loop Diagram.Diabetes, metabolic syndrome and obesity : targets and therapy · 2025Review
- Systems thinking for local food environments: a participatory approach identifying leverage points and actions for healthy and sustainable transformations.Health research policy and systems · 2024Article
Corrections and comments
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Authors and funding
4 authors.
Funding
No grant is acknowledged in the PubMed record.
Abstract
backgroundDespite calls for the application of complex systems science in empirical studies of health promotion, there are very few examples. The aim of this paper was to use a complex systems approach to examine the key factors that influenced health promotion (HP) policy and practice in a multisectoral health system in Australia.
methodsWithin a qualitative case study, a schema was developed that incorporated HP goals, actions and strategies with WHO building blocks (leadership and governance, financing, workforce, services and information). The case was a multisectoral health system bounded in terms of geographical and governance structures and a history of support for HP. A detailed analysis of 20 state government strategic documents and interviews with 53 stakeholders from multiple sectors were completed. Based upon key findings and dominants themes, causal pathways and feedback loops were established. Finally, a causal loop diagram was created to visualise the complex array of feedback loops in the multisectoral health system that influenced HP policy and practice.
resultsThe complexity of the multisectoral health system was clearly illustrated by the numerous feedback mechanisms that influenced HP policy and practice. The majority of feedback mechanisms in the causal loop diagram were vicious cycles that inhibited HP policy and practice, which need to be disrupted or changed for HP to thrive. There were some virtuous cycles that facilitated HP, which could be amplified to strengthen HP policy and practice. Leadership and governance at federal-state-local government levels figured prominently and this building block was interdependently linked to all others.
conclusionCreating a causal loop diagram enabled visualisation of the emergent properties of the case health system. It also highlighted specific leverage points at which HP policy and practice can be improved. This paper demonstrates the critical importance of leveraging leadership and governance for HP and adds urgency to the need for increased and strong advocacy efforts targeting all levels of government in multisectoral health systems.
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Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the OpenQuestion graph.