Emke Helga, Chrifou Rabab, Dijkstra Coosje, Waterlander Wilma, Stronks Karien, Kremers Stef, Chinapaw Mai, Altenburg Teatske
Department of Health Sciences, Faculty of Science, Vrije Universiteit Amsterdam, Amsterdam, the Netherlands.
Amsterdam UMC location Vrije Universiteit Amsterdam, Public and Occupational Health, De Boelelaan 1117, Amsterdam, the Netherlands.
BMC Public Health. 2025 Jan 25;25(1):324. doi: 10.1186/s12889-025-21498-w.
Developing interventions along with the population of interest using systems thinking is a promising method to address the underlying system dynamics of overweight. The purpose of this study is twofold: to gain insight into the perspectives of adolescents regarding: (1) the system dynamics of energy balance-related behaviours (EBRBs) (physical activity, screen use, sleep behaviour and dietary behaviour); and (2) underlying mechanisms and overarching drivers of unhealthy EBRBs.
We conducted Participatory Action Research (PAR) to map the system dynamics of EBRBs together with adolescents aged 10-14 years old living in a lower socioeconomic, ethnically diverse neighbourhood in Amsterdam East, the Netherlands. For just over two years, we conducted weekly PAR sessions (45-120 min) with four dynamic groups - two in primary schools and two in secondary schools - each school year (n = 4-8 adolescents in each group (0-100% girls); n = 40-54 sessions in total per group). These adolescents acted as co-researchers and created Causal Loop Diagrams (CLDs) for each EBRB and explored important underlying mechanisms for unhealthy EBRBs. Based on the underlying mechanisms, three overarching drivers for unhealthy EBRBs were distinguished.
The three overarching drivers for unhealthy EBRBs are: (1) the physical environment, (2) social norms, and (3) unhealthy behaviours reinforcing each other. The adolescents explained that their physical environment fosters unhealthy behaviour by providing easy access to unhealthy food products while restricting physical activity. They explained the importance of social norms around EBRBs that are formed by their peers, friends, and family. The influence of their peers often led to unhealthier EBRBs, especially after the transition to secondary school. The adolescents explained that unhealthy behaviours reinforced each other, while healthy behaviour led to more healthy behaviour.
Our novel approach combining PAR with systems thinking gained valuable insights into the system dynamics of EBRBs from the adolescent perspective. These insights can inform future interventions targeting systems change regarding EBRBs.
运用系统思维与目标人群共同开发干预措施，是解决超重问题潜在系统动态的一种有前景的方法。本研究有两个目的：深入了解青少年对于以下方面的看法：（1）与能量平衡相关行为（EBRBs，即身体活动、屏幕使用、睡眠行为和饮食行为）的系统动态；（2）不健康EBRBs的潜在机制和总体驱动因素。
我们开展了参与式行动研究（PAR），与居住在荷兰阿姆斯特丹东部社会经济地位较低、种族多样社区的10至14岁青少年共同绘制EBRBs的系统动态图。在两年多的时间里，我们每个学年都与四个动态小组（两所小学各一组，两所中学各一组）进行每周一次的PAR会议（45 - 120分钟），每组有4 - 8名青少年（每组女孩占0 - 100%），每组总共进行40 - 54次会议。这些青少年作为共同研究者，为每种EBRB创建因果循环图（CLD），并探究不健康EBRBs的重要潜在机制。基于这些潜在机制，区分出了不健康EBRBs的三个总体驱动因素。
不健康EBRBs的三个总体驱动因素是：（1）物理环境，（2）社会规范，以及（3）不健康行为相互强化。青少年解释说，他们的物理环境通过提供便捷的不健康食品获取途径同时限制身体活动，助长了不健康行为；他们阐述了由同龄人、朋友和家人形成的围绕EBRBs的社会规范的重要性。同龄人的影响常常导致更不健康的EBRBs，尤其是在升入中学后。青少年解释说不健康行为相互强化，而健康行为则会带来更多健康行为。
我们将PAR与系统思维相结合的新方法，从青少年的角度获得了关于EBRBs系统动态的宝贵见解。这些见解可为未来针对EBRBs系统变化的干预措施提供参考。
