In a grant from the Community Research for Health Equity (CRHE) program, awarded in 2022 with support from the Robert Wood Johnson Foundation and managed by AcademyHealth, the Institute for Social Policy and Understanding (ISPU) used community-based system dynamics to explore unique health-related inequities faced by the minoritized Muslim communities in southeast Michigan and to generate potential solutions to these problems with the community.
When Principal Investigator Dr. Ayaz Hyder was considering how to examine the health care system challenges that Muslim communities face in southeast Michigan, he knew that he would employ a community-based system dynamics (CBSD) approach. Dr. Hyder, who specializes in this relatively new research method, considers CBSD a “mashup” of community-based participatory research and system dynamics modeling. It involves facilitated group discussions in a workshop format, conducting a qualitative analysis of diagrams and written content generated from the workshops, and developing a quantitative model of the relationship between factors identified by workshop participants from the community and scientific data and knowledge.
Community-based system dynamics was first conceptualized by Dr. Peter Hovmand in his 2014 book of the same name. In it, he illustrates that CBSD, “is about engaging communities, helping communities cocreate the models that lead to system insights and recommendations, empowerment, and mobilizing communities to advocate for and implement changes based on these insights.”
Phase 1: Planning and Scoping
The first phase of the ISPU project’s CBSD approach involved planning and scoping. Before beginning their project, ISPU engaged community experts as part of their advisory team. They sought counsel from the leadership at the HUDA Clinic, a free clinic that serves the uninsured in Metro Detroit. The HUDA Clinic’s leaders and ISPU work closely with the Muslim population, and many identify as Muslims themselves and are thus considered trusted members of the community. These established connections allowed the ISPU team to integrate more seamlessly into the community of focus, and also helped them reach out to potential members of the Core Modeling Team (CMT).
The CMT is essentially a steering committee for the project, which helps the project team by assisting with community buy-in. “We made sure to cast a wide net to find members of the CMT,” Hyder says. “We wanted to make sure that we were asking people at all levels of health care related organizations ...including health care centers, health departments, and nonprofits of all sizes [and community members with lived experience].”
Phase 2: Group Model-Building Workshops & Modeling
After establishing the CMT, ISPU then looked to create Group Model-Building Workshops. Group model building is a qualitative approach aimed at facilitating shared understanding of the structures and relationships that cause complex issues. The workshops included community members who identify as Muslim and have been directly impacted by and involved with the health care system. They were facilitated by the ISPU team. Participants also included frontline public health practitioners of all types, from doctors to patient intake coordinators, and local nonprofit representatives.
The research team conducted four half-day sessions both in-person and online depending on the participant's availability. During these sessions, the participants explored the health care system structure in southeast Michigan, used visual activities such as causal loop diagrams, behavior over time graphs, and targets for action to understand underlying patterns of behavior and root causes of the issues faced by Muslim communities, and identified a plan of action.
Dr. Hyder reported that these visual data collection mechanisms were revelatory to the participants. He notes how the participants had not seen the issues with the health care system presented in a concrete way, and that the workshops, “Highlighted the connections that are still missing...[such as] where the Muslim community can coordinate better as a community or co-locate services that help them optimize breaking down negative feedback loops that continue across generations.”
A portion of the GMB workshop’s draft causal loop diagram (CLD). This diagram illustrates how ISPU worked with community members to map cause-and-effect relationships between key variables. While the specifics of the model may not be fully visible here, the sketch highlights the collaborative and participatory nature of the process.
After conducting the group model-building workshops, the ISPU team created descriptive models to identify the portions of the established systems that allow for inequities to exist, and subsequently constructed computer models to evaluate the impact of potential solutions to these problems that were generated by the group model building participants.
Phase 3: Dissemination & Implementation of Findings
The final step of a community-based system dynamics approach is translation and dissemination of the findings in a way that empowers the community. In ISPU’s case, this phase is ongoing.
“We wanted to leave the community with the knowledge, skills, and tools that we developed with them,” Dr. Hyder says. At present, ISPU is working on completing a final report and other accessible communication tools to disseminate their study findings.
The CBSD approach was not always easy for the ISPU team. A particular challenge ISPU faced was recruiting African American Muslims to be part of the project, as most of the participants identified as South Asian American or Arab American. Dr. Hyder notes that despite consulting the CMT and other community member contacts, it was difficult to reach this part of the community. “Our research team was insistent on trying to include African American Muslims in the project. Despite looming deadlines, we listened and said that we have to try reaching out again and try to explain our case and reduce the time burden. For example, instead of doing four half-day sessions, we could do two half-day sessions, or a one-hour virtual interview.” And while the ISPU team reached fewer African American Muslims than they initially planned, modifying their original outreach design proved to be effective.
These challenges notwithstanding, Dr. Hyder posits that the flexibility of the CBSD is the reason his team could take the time to consider the needs and concerns of the many diverse perspectives in the Muslim community in southeast Michigan.
“[CBSD] takes time, and it’s not the solution for every community or every problem...but [it was beneficial to] take a systems view in a marginalized community that often doesn’t have the capacity or time to look at these issues and leave something behind in the community that can be empowering to them,” he says. “This was a lot of work, but it was a labor of love...I think if other researchers who are in academia like me want to do this kind of work, they should be able to do it...[they] can give back, build community power, and not always have to do [traditional] research.”
If you would like to read more about the ISPU’s CRHE grant, you can view that here. If you would like to watch an interview with ISPU’s Research Project Manager, Erum Ikramullah, reflecting on the value of community-led research, you can view that here. This work is made possible with a grant from the Robert Wood Johnson Foundation (RWJF). The views expressed here do not necessarily reflect the views of RWJF.