Applying system dynamics method to understand implementation determinants for whole-of-community child health promotion in rural and remote contexts.

Background: Whole-of-community child health promotion initiatives are an effective and equitable approach to improving child nutrition and physical activity. However, there are some challenges with implementation of these approaches. Systems-based methods may help with understanding implementation determinants for such interventions. This study describes the application of methods from system dynamics, specifically group model building (GMB) and causal loop diagrams (CLDs), to: (1) identify implementation determinants, and (2) describe system structures shaping implementation over time, in the context of a whole-of-community child health initiative in rural and remote communities.Methods: The research team facilitated GMB workshops with community-based prevention teams in five rural and remote communities in Northeast Victoria to develop reference modes (representing hoped and feared trends of implementation progress) and CLDs of implementation determinants. Using a qualitative meta-synthesis approach, two researchers worked with the broader team to iteratively develop CLDs linked to each domain of the Interactive Systems Framework (ISF), that outlines both general and action-specific factors influencing implementation over time.Results: The team developed three CLDs to represent the dynamic interaction of factors related to interorganizational partnerships, resource sufficiency, and alignment with community values that were perceived as key determinants to implementation of whole-of-community child health programs for rural and remote communities. Each CLD included feedback loops outlining processes where a change in one part of factors influences other parts, which then in turn affect the original change (either reinforcing (amplifying) or balancing (stabilising) it). This demonstrates areas in which implementation can be supported or hindered and provides suggested areas to enact implementation strategies.Conclusions: This study demonstrates how methods from system dynamics help to understand the dynamic and evolving nature of implementation determinants. We believe this study is a promising approach to informing the design of implementation strategies that are both equitable and grounded in real-world contexts.