Ethnicity & health · 2026
The dynamic complexity of cardiovascular severe maternal morbidity among Black women in North Texas: insights from a system dynamics group model building study.
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Lemke Michael K, Brown Kyrah K, Fallah-Fini Saeideh, Ojo Rhoda, Lounsbury David W, Obasanya Mercy, Kindratt Tiffany, Lambert Thanayi, Robinson Deneen
Аннотация
OBJECTIVES: Black women in North Texas experience persistently elevated rates of cardiovascular severe maternal morbidity (CSMM). To generate novel insights into the dynamic complexity of CSMM, the study was grounded in four primary research questions: (1) What are the most important causes and consequences of CSMM?; (2) How, and why, have those causes and consequences changed over time?; (3) What is the structure of the systems that drive these outcomes?; and (4) What actionable solutions may mitigate CSMM?
DESIGN: Participatory system dynamics group model building (SD GMB) was conducted with 15 community-based stakeholders in North Texas. Two SD GMB sessions were conducted during March 2024, which cumulatively spanned two and a half days and generated four key outputs: (1) key variables ('5 R's') that were prioritized ('model boundary chart'); (2) graphs of key variables over time ('behavior-over-time graphs' [BOTGs]); (3) qualitative maps of system structure ('causal loop diagrams' [CLDs]); and (4) potential leverage points for interventions ('targets for action').
RESULTS: Stakeholders identified a total of 252 variables across the 5 R's: 47 results, 109 roles, 46 relationships, 27 rules, and 23 resources. Cumulatively, 64 themes emerged across these five categories. The 11 BOTGs exhibited a high degree of diversity across the five attributes analyzed. Two CLDs were developed that included numerous feedback loops and captured multiple causal mechanisms. Finally, 27 targets for action were elicited and rated, based on cost-effectiveness.
CONCLUSION: The application of SD GMB provided novel complex systems-grounded insights into the causes and consequences of CSMM among Black women in North Texas, and these insights were leveraged by stakeholders to identify potential preventive solutions to curb these outcomes. These insights led to initial answers to the four primary research questions, illustrating the dynamic complexity of the drivers of CSMM and identifying coherent preventive strategies.
DESIGN: Participatory system dynamics group model building (SD GMB) was conducted with 15 community-based stakeholders in North Texas. Two SD GMB sessions were conducted during March 2024, which cumulatively spanned two and a half days and generated four key outputs: (1) key variables ('5 R's') that were prioritized ('model boundary chart'); (2) graphs of key variables over time ('behavior-over-time graphs' [BOTGs]); (3) qualitative maps of system structure ('causal loop diagrams' [CLDs]); and (4) potential leverage points for interventions ('targets for action').
RESULTS: Stakeholders identified a total of 252 variables across the 5 R's: 47 results, 109 roles, 46 relationships, 27 rules, and 23 resources. Cumulatively, 64 themes emerged across these five categories. The 11 BOTGs exhibited a high degree of diversity across the five attributes analyzed. Two CLDs were developed that included numerous feedback loops and captured multiple causal mechanisms. Finally, 27 targets for action were elicited and rated, based on cost-effectiveness.
CONCLUSION: The application of SD GMB provided novel complex systems-grounded insights into the causes and consequences of CSMM among Black women in North Texas, and these insights were leveraged by stakeholders to identify potential preventive solutions to curb these outcomes. These insights led to initial answers to the four primary research questions, illustrating the dynamic complexity of the drivers of CSMM and identifying coherent preventive strategies.