Evidence map›Paper›PMID 40506701›Full record

ReviewThe international journal of behavioral nutrition and physical activity2025

Systems approaches in public health: beyond mapping the causes.

Loes Crielaard, Mary Nicolaou, Andrew D Brown, S Coosje Dijkstra, Fleur Ter Ellen, Leonie K Elsenburg, Angie Luna Pinzon, Wilma E Waterlander, Karien Stronks

Abstract readReview
PubMed Full text at PMC Publisher
In one paragraph

Review in The international journal of behavioral nutrition and physical activity, 2025. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 8 papers.

0numbers the graph read from it
0cells of the map it votes in
8citing papers in PubMed
–field-weighted citation impact
1 · What the graph read from it

What it found

Each row is one number read from the abstract, on the scale the paper reported it, with its interval. Left of the dashed line favours the treatment, right favours the comparator. Under each row is the sentence it came from. New to these charts? A ten-minute tutorial.

The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.

2 · The registry

The trial behind it

Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.

Neither the registry nor the abstract names a trial number. If this is a trial report, that itself is worth knowing.

3 · Its place in the literature

Who cites it

8 citing papers in PubMed.

  1. Response to LTE "Bridging the Gap Between Patient Experience and System-Level Review: A Call for Discipline-Specific Communication in Hospital-to-Home Transitions.Health expectations : an international journal of public participation in health care and health policy · 2026
    Article
  2. Systems Science in Nutrition and Dietetics Research: A Practical Lens for Applying Systems Approaches in Research.Journal of human nutrition and dietetics : the official journal of the British Dietetic Association · 2026
    Review
  3. Article
  4. Article
  5. Dietitians as System Builders: Advancing Equity, Sustainability and Health in Community Nutrition and Primary Care.Journal of human nutrition and dietetics : the official journal of the British Dietetic Association · 2026
    Article
  6. Article
  7. Review
  8. Article
4 · The record

Corrections and comments

PubMed lists nothing against this paper. Absence here is not a guarantee, only a check that was made.

5 · Who and what money

Authors and funding

9 authors.

Loes CrielaardAmsterdam UMC, Department Public and Occupational Health, University of Amsterdam, Amsterdam Public Health Research Institute, Van der Boechorststraat 7, Amsterdam, 1081 BT, The Netherlands. l.crielaard@amsterdamumc.nl.
Mary NicolaouAmsterdam UMC, Department Public and Occupational Health, University of Amsterdam, Amsterdam Public Health Research Institute, Van der Boechorststraat 7, Amsterdam, 1081 BT, The Netherlands.
Andrew D BrownFaculty of Health, Global Centre for Preventive Health and Nutrition (GLOBE), Institute for Health Transformation, Deakin University, 221 Burwood Highway Burwood VIC 3125, Geelong, VIC, Australia.
S Coosje DijkstraAmsterdam UMC, Department Public and Occupational Health, University of Amsterdam, Amsterdam Public Health Research Institute, Van der Boechorststraat 7, Amsterdam, 1081 BT, The Netherlands.
Fleur Ter EllenDepartment of Public Health, Erasmus MC, University Medical Center, Dr. Molewaterplein 40, Rotterdam, 3015 GD, The Netherlands.
Leonie K ElsenburgAmsterdam UMC, Department Public and Occupational Health, University of Amsterdam, Amsterdam Public Health Research Institute, Van der Boechorststraat 7, Amsterdam, 1081 BT, The Netherlands.
Angie Luna PinzonAmsterdam UMC, Department Public and Occupational Health, University of Amsterdam, Amsterdam Public Health Research Institute, Van der Boechorststraat 7, Amsterdam, 1081 BT, The Netherlands.
Wilma E WaterlanderAmsterdam UMC, Department Public and Occupational Health, University of Amsterdam, Amsterdam Public Health Research Institute, Van der Boechorststraat 7, Amsterdam, 1081 BT, The Netherlands.
Karien StronksAmsterdam UMC, Department Public and Occupational Health, University of Amsterdam, Amsterdam Public Health Research Institute, Van der Boechorststraat 7, Amsterdam, 1081 BT, The Netherlands.

Funding

No grant is acknowledged in the PubMed record.

6 · The paper itself

Abstract

backgroundSystems approaches are increasingly adopted in public health, commonly operationalised using system dynamics (SD). In public health, systems approaches have prioritised understanding the current system by describing the causes of a complex problem - e.g. obesity - as a system. It remains challenging to advance from understanding the current system producing undesired outcomes, towards responses to improve outcomes. Rather than creating models of the (entire) system, SD traditionally emphasises specific models to support policy development. While core concepts from SD have effectively been adopted in public health, there may be more to learn from SD when it comes to designing systems approaches that can fulfil the purpose of informing problem responses.

methodsWe reviewed seminal SD literature for clues on how to refine the focus of systems approaches, so that they lead to specific models supporting policy development. We conducted a narrative review, seeking a strategy that can be leveraged in systems approaches in public health. We concentrated on SD's problem framing strategy, leading to two insights.

resultsInsight 1: Alongside the complex problem at stake (e.g. obesity), consider the intended result of the systems approach (coordination, learning, analysis or transformation). This helps recognise which system components are relevant to problem responses and make methodological decisions accordingly. Insight 2: If investigation of the current system reveals that only radical change can lead to improved outcomes, then proceed to envisioning how the system could be fundamentally transformed to support those desired outcomes. This next step helps to anticipate policy resistance, unintended consequences and counterintuitive behaviour by contemplating how the system would react due to proposed problem responses.

conclusionsApplying a problem framing strategy, as is commonly done in SD, could make systems approaches in public health better positioned to inform problem responses. Problem framing stimulates the contribution of systems approaches to health policy, prioritising system components relevant to problem responses (Insight 1), which may not be part of the system (Insight 2).

Indexed as

Health PolicyPublic HealthSystems AnalysisHumansObesityPolicy MakingCausal loop diagramsCounterintuitive behaviourPolicy resistanceProblem framingProblem responseResearch questionSystem dynamicsSystems scienceSystems thinkingUnintended consequences

Identifiers

PMID40506701
PMCPMC12164216

What Socratic holds

Textmetadata
LicenceCC BY
Read underepoch 390

Registered trials

None linked

Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the Socratic graph.