Developing Model-Based Theories: Improving the Quality of Conversations About How To Implement New Health Innovations

摘要

While there are many models of what would constitute effective health practice, the 'theories' that people use to implement them are less well articulated. However, those charged with designing the implementation programmes for these models of health practice have internal mental models that comprise their 'theories of change' and which guide their actions. System Dynamics is a powerful tool to develop explicit representations of these theories. This study uses in-depth interviews with seven clinical, management and policy leaders within the New Zealand health sector to develop a 'theory of change' which is then described using system dynamics. The study uses cognitive mapping to elicit the key components of the 'expert' theories by analysing both the individual maps and a composite map developed by combining data from all seven interviews. A thematic analysis is conducted of this composite map and the resulting themes are used to inform the development of a system dynamics model. The system dynamics model highlights the key causal connections within the map, projections of how they evolve over time and the key modifiable variables that affect the future pathway. This paper describes in detail the development of one core component of that model, engagement and is part of a larger research effort which aims to develop a fully quantified system dynamics model that explores the dynamics of change in the implementation of chronic care management programmes.