Applying participatory systems approaches to enhance child mental health in local communities in Denmark: a process evaluation.

backgroundGroup model building (GMB) based on systems approaches is increasingly used to facilitate a shared understanding of complex problems, structures and relationships. GMB helps to create consensus on the drivers of problems, identify local opportunities and barriers, and develop context-specific actions. This feasibility study aims to investigate the use of GMB and a participatory systems approach in two small local communities, focusing on process, mechanisms of change and capacity building, before designing a larger trial.

methodA qualitative feasibility evaluation using semi-structured interviews with participants from the two communities, Havndal (six informants) and Moen (five informants), was performed after three GMB workshops. A purposive sampling strategy was used to gain an in-depth perspective on the experience of participating in the GMB process. The informants included, for example, municipal employees, local citizens and schoolteachers. The interviews were conducted 3-6 months after the GMB process, and a thematic analysis was conducted.

resultsThe participants' experience with the GMB process was generally positive. They felt actively engaged and motivated, as the process allowed them to contribute meaningfully to discussions and decisions throughout the process. Their involvement sparked a strong commitment to address child health within their community, and many expressed a sense of ownership over the initiatives that emerged from the workshops. Some participants, however, reported concerns about unequal representation of voices within the communities and the workload associated with the developed initiatives. Most of the participants reported the mechanisms of change initiated by the GMB process as: a common understanding and goal; the identification of unique needs; involvement, ownership, trust and confidence; a common voice; and communication and visibility. Participants also reported that community capacity was built throughout the GMB process.

conclusionsThe process of using GMB and participatory approaches proved to be feasible in the two Danish local communities. Participants had a positive experience, identifying key mechanisms, gaining valuable capacity-building skills, and improving collaboration, which benefited their communities. The integration of these approaches appears to have the potential for scaling up in similar contexts.