December 18, 2021
Authors: Professor Bronwyn Fredericks, Dr Sue McAvoy, Professor James Ward, Troy Combo, Shea Spierings, Agnes Toth-Peter, Dr Abraham Bradfield
About the Project: This innovative, systems thinking study was conducted at the University of Queensland and was funded through the National Health and Medical Research Council Centre of Research Excellence (NHMRC CRE), the Australian Partnership for Preparedness Research on Infectious Disease Emergencies (APPRISE, AppID 1116530) through a donation from the Paul Ramsay Foundation.
Study Rationale: Systems thinking provides an “intuitive language” that enables specialists from different fields and professions to speak on common terms to better understand complex problems that require a multi-faceted approach. By exploring the relationship between system structure and behaviour, practitioners and policy makers can better understand how complex systems work, assess the efficacy of existing practices, and identify what levers can be pulled to result in better behaviour patterns.
Study Methodology: Participatory System Dynamics (PSD) is an evidence-based methodology and a tool that uses systems maps or causal loop diagrams (influence diagrams). By adopting this approach, this study has provided insights into the current determinants of COVID-19 transmission in urban Indigenous settings, their interrelationships, and implications for intervention. The research involved three workshops, which were held on the 25th of June, the 7th of September, and 7th of October 2021.
Engagement: The systems map was constructed using input from a large group of Indigenous and non-Indigenous experts, comprising of 14 health system stakeholders and 6 research team members. There was Indigenous representation from Federal, State, Local, and community jurisdictions as well as from Aboriginal and Torres Strait Islander Community Controlled Health Organisations (ACCHOs).
Impact: Through the lens of systems theory, this study encouraged stakeholders to see and think differently about COVID-19, providing a tool through which to visually map the interlocking parts within the urban Indigenous health system which enable or mitigate transmissions of disease. This study identified that Indigenous health workers and Community Controlled Health Organisations are best positioned to provide culturally informed and integrative responses that are tailored towards local needs. Building Indigenous and non-Indigenous capacity and recognising the educational value of “service” touch points and the voice of Elders and leaders can provide the trust needed for effective health responses including prevention, intervention, and mitigation.