ArticleBMC public health2025
Identifying mechanisms that shape the food environment in long-term healthcare facilities in the Netherlands: a participatory system dynamics approach.
Article in BMC public health, 2025. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 3 papers.
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Who cites it
3 citing papers in PubMed.
- Systems Science in Nutrition and Dietetics Research: A Practical Lens for Applying Systems Approaches in Research.Journal of human nutrition and dietetics : the official journal of the British Dietetic Association · 2026Review
- 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
- MEET-eaters: An agent-based model of food consumption practices at the household level.PloS one · 2026Article
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Authors and funding
5 authors.
Funding
No grant is acknowledged in the PubMed record.
Abstract
backgroundCreating healthy and sustainable food environments within long-term healthcare facilities asks for a systemic approach. This study aimed to: (1) identify system dynamics underlying the food environment of long-term healthcare facilities, (2) formulate actions for changing the system to promote a healthy and sustainable food environment and (3) evaluate stakeholder perspectives about the process and progress towards action implementation up to one-year follow-up.
methodsA group model building (GMB) approach was used during two workshops with stakeholders of five different long-term healthcare facilities in the Netherlands. Stakeholders created a causal loop diagram (CLD) and formulated actions for change. Interviews were conducted at six- and twelve months to evaluate perspectives on the GMB process and progress towards action implementation.
resultsThe developed CLD consisted of 30 factors influencing the food environment in long-term healthcare facilities and four interrelated subsystems (patient; healthcare organization; national governance and policy; purchasing, procurement and budget). Stakeholders formulated 40 corresponding actions. After one year follow-up, small steps towards action implementation were observed (e.g., agenda setting, raising internal awareness, formulating plans), with several barriers hindering implementation being noted (e.g., lack of time, budget, priority).
conclusionsThis study gained a comprehensive, collectively acknowledged understanding of the system dynamics underlying the food environment in Dutch long-term healthcare institutions. The results underscore the importance of crafting a coherent set of actions that addresses various factors and underlying mechanisms to initiate systemic change. However, achieving actual system changes in long-term healthcare facilities requires prolonged efforts and overcoming barriers towards implementation.
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Registered trials
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