Applying Participatory Systems Approaches to Enhance Child Health in Local Communities in Denmark: A Process Evaluation

BACKGROUND : Group Model Building (GMB) based on system approaches is increasingly used to facilitate a shared understanding of complex problems, structures and relationships. GMB helps create a consensus on the problem drivers, identify local opportunities and barriers, and develop context-specific actions. This feasibility study aims to investigate the use of GMB and a participatory system approach in two smaller local communities focusing on process, mechanisms of change, and capacity building, before designing a larger trial. METHOD : A qualitative feasibility evaluation using semi-structured interviews with participants from the two communities, Havndal (six informants) and Moen (five informants), were performed after three GMB workshops. A purposeful sampling strategy was used to get an in-depth perspective into the experience of participating in the GMB process. The informants included e.g. municipal employees, local citizens, and schoolteachers). The interviews were conducted 3-6 months after the GMB process, and a thematic analysis was used. RESULTS : The 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 voices of the communities and the workload of the developed initiatives. Most of the participants reported the mechanisms of change initiated by the GMB process as; a common understanding/goal, identifying unique needs, involvement, ownership, trust and confidence, common voice, as well as communication and visibility. Participants also reported that community capacity was built throughout the GMB process. CONCLUSION : The 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 and gaining valuable capacity-building skills and better their collaboration that benefited their communities. The integration of these approaches appears to have the potential for scaling up in similar contexts.