Complex Systems Approaches to Advance Maternal Health Research and Prevention: Developing a System Dynamics Simulation Model of Severe Maternal Morbidity among Black Women in North Texas.

University Of Texas Arlington, Arlington TX

Investigators

Abstract

PROJECT SUMMARY OR ABSTRACT Non-Hispanic Black women (NHBW) experience high levels of severe maternal morbidity (SMM), which increases risk for maternal mortality. The causes of SMM are multifactorial. Despite the breadth of knowledge and existing preventive strategies, continuously high rates of SMM outcomes suggest that current efforts alone are insufficient to address this issue Thus, alternate approaches are needed to transform understanding of the causes of SMM and to generate breakthroughs in prevention. We argue that SMM outcomes are best conceptualized as dynamically complex systems, consisting of tightly coupled elements that continually evolve over time. Thus, to address SMM outcomes among NHBW, we will apply complex systems approaches – namely, system dynamics (SD) modeling and system dynamics group model building (SD GMB) – to answer complexity-informed research questions and enable more efficacious prevention strategies. The overall aim of this project is to apply complex systems approaches to generate a holistic understanding of the dynamically complex systems underlying SMM outcomes among NHBW, and then translate this understanding into a novel, evidence-based simulation model to be used for evaluating the effectiveness of interventions that can curb these outcomes. Our specific aims are as follows: 1) to use SD GMB to create a qualitative SD model of the dynamically complex systems that generate SMM outcomes among NHBW; 2) to translate the qualitative SD model into a quantitative SD simulation model; 3) to identify, evaluate, and enhance the effectiveness of existing and plausible interventions that can reduce SMM outcomes among NHBW; and 4) to disseminate the quantitative SD model as a simulation-based dashboard for stakeholders and researchers aiming to reduce SMM outcomes among NHBW. The successful completion of this project is expected to transform understanding of the development and perpetuation of SMM outcomes by: a) using systems science methods to identify effective solutions to reduce gaps in maternal health; b) disseminating insights to diverse stakeholders to guide broader community level healthcare and social policy decision-making in the presence of dynamic complexity; and c) providing an initial SD model of maternal health that can spur replication across other contexts. This project will also impact maternal health research more broadly by: a) demonstrating the potential of convening multiple perspectives in maternal health, complex systems science, and participatory research methods in maternal health research; b) providing transformative evidence of the utility of complex systems approaches in maternal health research and prevention; and c) generating the first SD model of SMM outcomes that can be expanded or adapted to other contexts (e.g. as a national model), with anticipated and plausible impacts for the broader public and population health fields.