识别塑造荷兰长期医疗机构食物环境的机制：一种参与式系统动力学方法。

Identifying mechanisms that shape the food environment in long-term healthcare facilities in the Netherlands: a participatory system dynamics approach.

作者信息

Wierda Joline J, Dijkstra S Coosje, Wopereis Tamika M, Djojosoeparto Sanne K, Poelman Maartje P

机构信息

Chair group Consumption and Healthy Lifestyles, Wageningen University & Research, Wageningen, The Netherlands.

Amsterdam UMC, Location Vrije Universiteit Amsterdam, Public and Occupational Health, De Boelelaan 1117, Amsterdam, Netherlands.

出版信息

BMC Public Health. 2025 Jan 29;25(1):372. doi: 10.1186/s12889-024-21124-1.

DOI:10.1186/s12889-024-21124-1

PMID:39881282

原文链接:https://pmc.ncbi.nlm.nih.gov/articles/PMC11780851/

Abstract

BACKGROUND

Creating healthy and sustainable food environments within long-term healthcare facilities asks for a systemic approach. This study aimed to: (1) identify system dynamics underlying the food environment of long-term healthcare facilities, (2) formulate actions for changing the system to promote a healthy and sustainable food environment and (3) evaluate stakeholder perspectives about the process and progress towards action implementation up to one-year follow-up.

METHODS

A group model building (GMB) approach was used during two workshops with stakeholders of five different long-term healthcare facilities in the Netherlands. Stakeholders created a causal loop diagram (CLD) and formulated actions for change. Interviews were conducted at six- and twelve months to evaluate perspectives on the GMB process and progress towards action implementation.

RESULTS

The developed CLD consisted of 30 factors influencing the food environment in long-term healthcare facilities and four interrelated subsystems (patient; healthcare organization; national governance and policy; purchasing, procurement and budget). Stakeholders formulated 40 corresponding actions. After one year follow-up, small steps towards action implementation were observed (e.g., agenda setting, raising internal awareness, formulating plans), with several barriers hindering implementation being noted (e.g., lack of time, budget, priority).

CONCLUSIONS

This study gained a comprehensive, collectively acknowledged understanding of the system dynamics underlying the food environment in Dutch long-term healthcare institutions. The results underscore the importance of crafting a coherent set of actions that addresses various factors and underlying mechanisms to initiate systemic change. However, achieving actual system changes in long-term healthcare facilities requires prolonged efforts and overcoming barriers towards implementation.

摘要

背景

在长期医疗保健机构中创建健康且可持续的食品环境需要一种系统的方法。本研究旨在：（1）识别长期医疗保健机构食品环境背后的系统动态；（2）制定改变系统的行动，以促进健康且可持续的食品环境；（3）评估利益相关者对行动实施过程及进展的看法，随访期长达一年。

方法

在荷兰五个不同长期医疗保健机构的利益相关者参与的两次研讨会上，采用了群体模型构建（GMB）方法。利益相关者创建了因果循环图（CLD）并制定了变革行动。在六个月和十二个月时进行了访谈，以评估对GMB过程及行动实施进展的看法。

结果

所构建的CLD由30个影响长期医疗保健机构食品环境的因素和四个相互关联的子系统（患者；医疗保健组织；国家治理与政策；采购、供应和预算）组成。利益相关者制定了40项相应行动。随访一年后，观察到在行动实施方面有一些小的进展（例如，设定议程、提高内部意识、制定计划），同时也注意到了一些阻碍实施的因素（例如，缺乏时间、预算、优先级）。