Combining community-based system dynamics and design thinking to inform public health intervention: a case study optimizing community-clinical linkage design in Brooklyn, NY.

The underlying drivers and outcomes of social determinants of health are dynamically complex, making it difficult to design effective responses. This complexity has inspired a growing number of calls to move beyond mechanistic thinking and use systems science to engage directly with complexity and highlight opportunities for methodological innovation to enhance translation of insight into real world action. This case study describes a methodological innovation combining community-based system dynamics and design thinking to understand multi-level complexity of a public health challenge: optimizing the design of a community-clinical linkage in Brooklyn, New York. In-depth description of the case illustrates methods integration and resulting insights and recommendations. Results from the case demonstrate that integrating methods generates insight at multiple levels, including connecting holistic system understanding to individual experiences of system structure and operationalizing and translating insights into action. Combining community-based system dynamics and design thinking holds value for intervention planning, strategic implementation, and sustaining change.