Centre for Social Impact, Faculty of Business and Law, Swinburne University of Technology, P.O. Box 218, Mail H25, Hawthorn, VIC 3122, Australia.
Int J Environ Res Public Health. 2021 Feb 8;18(4):1618. doi: 10.3390/ijerph18041618.
Prevention systems improve the performance of health promotion interventions. This research describes the establishment of the Australian state government initiative, Healthy Together Victoria's (HTV) macro infrastructure for the delivery of large-scale prevention interventions.
This paper reports on findings of 31 semi-structured interviews about participants' understanding of systems thinking and their reflections of the strengths and weaknesses of the HTV prevention system. A chronic disease prevention framework informed the coding that was used to create a causal loop diagram and a core feedback loop to illustrate the results.
Findings highlighted that HTV created a highly connected prevention system that included a sizeable workforce, significant funding and supportive leadership. Operating guidelines, additional professional development and real-time evaluation were significant gaps, which hindered systems practice. For inexperienced systems thinkers, these limitations encouraged them to implement programs, rather than interact with the seemingly ambiguous systems methods.
HTV was an innovative attempt to strengthen health promotion infrastructure, creating a common language and shared understanding of prevention system requirements. However, the model was inadequate for HTV to achieve population-level reductions in chronic disease as system oversight was missing, as was an intervention delivery focus. Clarity was needed to define the systems practice that HTV was seeking to achieve. Importantly, the HTV prevention system needed to be understood as complex and adaptive, and not prioritized as individual parts.
预防系统可提高健康促进干预措施的效果。本研究描述了澳大利亚州政府倡议“维多利亚健康共同体”（HTV）大规模预防干预措施的宏观基础设施的建立。
本文报告了对 31 次半结构化访谈的结果，这些访谈涉及参与者对系统思维的理解，以及他们对 HTV 预防系统的优势和劣势的反思。慢性疾病预防框架为编码提供了信息，用于创建因果关系图和核心反馈循环，以说明结果。
研究结果强调，HTV 建立了一个高度互联的预防系统，其中包括大量的劳动力、大量的资金和支持性的领导。操作指南、额外的专业发展和实时评估是明显的差距，这阻碍了系统实践。对于经验不足的系统思考者来说，这些限制鼓励他们实施项目，而不是与看似模糊的系统方法进行互动。
HTV 是加强健康促进基础设施的一项创新尝试，创造了一种共同的语言和对预防系统要求的共同理解。然而，由于缺乏系统监督，以及缺乏干预措施交付的重点，该模式不足以使 HTV 实现降低慢性病的人口水平目标。需要明确 HTV 所寻求的系统实践。重要的是，需要将 HTV 预防系统理解为复杂和适应性的系统，而不是优先考虑其各个部分。
