Integrated methods for public health action tracking (IMPAcT): to understand and evaluate systems change in a public health context.

Background: Approaches from systems science are increasingly being trialed in public health because the drivers of poor health are complex, unpredictable and difficult to disentangle. While a broad range of methods is available to study systems science, one method alone is often insufficient for evaluation, as each offer only a limited perspective. Yet, few examples exist showing how several methods can be pragmatically integrated to generate new and meaningful insights, which is vital within systems changes. This paper describes, exemplifies and discusses the Integrated Methods for Public Health action Tracking (IMPAcT) process, which integrates group model building, Causal Loop Diagramming (CLD), the Action Scales Model (ASM), an Action Registry (AR) and Ripple Effects Mapping (REM), to better understand and address complexity within public health interventions.

Methods: We used common approaches for understanding system organization and interconnections (e.g. through CLD), identifying places to intervene in the system (e.g. ASM), tracking actions implemented within the system (e.g. REM) and understanding the impact at individual level of actions. We illustrate how the IMPAcT process can be applied via a case from a Danish project, the Healthy Active Children Study.

Results: We present a development process, that combines the above-mentioned approaches, to capture the behaviour, and allow tracking and evaluation of a system following several intervention efforts. Integrating complementary, participatory methods enabled a formative evaluation process that supported continuous learning, adaptation and improvement across complex systems. In the IMPAcT process, methods served both as evaluation tools and as means of stakeholder engagement and knowledge co-production. Embedding reflection and dialogue allowed stakeholders to examine practice and shape next steps. Visuals and narratives enhanced the clarity and impact of the evaluation.

Conclusions: The new process supports both those working at the front-line of systems change efforts, but also researchers, municipality staff and none the least, policymakers.