2. What is community dynamics?
Characteristics and properties of community
dynamics
Community dynamics and health care delivery
system
Different health Care models for management
Dynamics of participation of community in health
care
3. Community are mini universes of complex social,
political, associational, economic, power and
cultural dynamics, providing a different theatre
for providing health services and facilitating
behaviour change.
Some communities may consist of relatively
homogenous populations (same tribe, cultural
group or religious affiliation)
Other communities may be heterogeneous.
Some communities may be stable, while others
have high levels of migration in certain seasons.
4. Community structure is not static, but changes
over time as a result of things like:
the arrival and loss of species
the effects of outside forces
E.g.: disease, natural calamity, advances in the
society, etc
5. Disturbance and succession are two common
causes of change in community structure.
Disturbance is "any relatively discrete event in
time that disrupts ecosystem, community, or
population structure and changes resources,
substrate availability, or the physical
environment.”
results from forces originating outside the
community.
includes hurricanes, volcanoes, floods and fire.
Succession is the repeatable change in
community composition through time following a
disturbance.
6. DIET
Poor diet using fast foods and poor foods leads
to problems like malnutrition, underweight and
obesity increasing risk of cardiovascular
diseases.
STUDY
Study is the exercise of soul.
Placing study as a factor in lifestyle may lead to
more physical and mental health.
Its affection increases the process of dementia.
7. Application of modern technologies:
Misuse of technology may result in unpleasant
consequences.
For example: excess use of computer and addiction of
mobile phone.
Sexual behaviour
Normal sex relation is necessary in healthy life.
Dysfunction of sex relation is the problem of most of
societies and it has a significant effect on mental and
physical health.
Substance abuse
Addiction is considered as an unhealthy life style.
Smoking and using other substance may result in
various problems; cardiovascular disease, asthma,
cancer, brain injury.
8. Recreation:
Leisure pass time is a sub factor of life style.
Neglecting leisure can bring negative consequences.
Medication abuse
Unhealthy behaviours such as using medication are as
followed:
▪ self-treatment
▪ sharing medication
▪ using medications without prescription
▪ prescribing too many drugs
▪ prescribing the large number of each drug
▪ unnecessary drugs
▪ bad handwriting in prescription
disregard to the contradictory drugs, disregard to harmful
effects of drugs, not explaining the effects of drugs.
9. Exercise
For treating general health problems, the exercise
is included in life style. The continuous exercise
along with a healthy diet increases the health.
Sleep:
One of the bases of healthy life is the sleep. Sleep
cannot be apart from life.
Sleep disorders have several social, psychological,
economical and healthy consequences.
Lifestyle may effect on sleep and sleep has a clear
influence on mental and physical health
10.
11.
12. Increase in
population
growth
➢High fertility rate
➢Availability of
medicines and
advanced hospital care
➢ Migration
Affects the progress
of Sustainable
Development Goal
Climate change
Hospital care
Craze for
city life
Use of more
natural
resources
Affects
provision of
basic
services
poverty
Reduced
economic
development
ILLNESS
Increases
industrialization
greenhouse
gases
deforestation
Climate change
➢ global temperature
➢unpredictable weather pattern
availability
of natural
resources
CHRONIC
ILLNESS
DISABIILITY DEATH
13.
14. Adaptation
of static
posture
TECHNOLOGY
IT
professionals
Late bed time
Shorter sleep
duration
Impaired day
time
functioning
DEVELOPMENT OF A VIRTUAL COMMUNITY
Use in dim
light
Positive aspects
• fast
•Accurate
•Time saving
“DIGITAL INDIA”
Development of
the nation
Negative aspects
Public
Disturbance
in circadian
system
bad postures
adapted at
work site
Night shifts
stress
Addiction
No
mobility
Walk to the
market
SWIGGY
Co-morbid
factors
15. 4R’s and 1P
Resistance
❑ How resistant is the community to disturbance?
❑ How big of a change did the disturbance cause?
Return Time
❑ Return time is the amount of time it takes for the
community to stop changing (reach an
equilibrium) after the disturbance.
❑ How quickly did the community recover from the
change?
16. Resilience
❑ How closely did the post-recovery community
resemble the pre-disturbance community?
Response to Disturbance
❑ Communities differ in their response to
disturbance.
❑ Different responses for different
disturbances.
17. Persistence
❑ The overall degree to which a community
stays the same over time, especially (but not
exclusively) after disturbances, is called the
community's persistence.
18. Community dynamics
A part of public health
Commonly known as “system dynamics”,
“complex systems”, “population dynamics”
Definition: a system that is adaptive to changes
in its local environment, is composed of other
complex systems, behaves in a non-linear
fashion and exhibits emergent behavior
Emergent behavior: refers to novel and coherent
structure, patterns and properties that arise from
the interactions of the parts of a complex
system.
19. Basic principle: the complex behaviors of
organizational and social systems are the
result of on going accumulations--of people,
material or financial assets, information or
even biological or psychological states—and
both balancing and reinforcing feedback
mechanisms.
Complex
behaviours
Decisions and choices are
by the people
The service has to be
customized depending
upon the needs of people
20. Made up of large number of heterogeneous
elements
These elements interact with each other
These interactions produce an emergent
effect that is different from the effects of all
the individual elements
This effect persists over time and adapts to
changing circumstances
Every intervention, from the simplest to the
most complex, will have an effect on the
overall community system.
21. Architecture of Community is dynamic and
builds on opportunities and interactions both
within the community and between the
community and outside forces, such as the
health system.
Health care delivery system are inherently
complex and fragmented social system
including multiple complex systems consisting
of government, NGO’S, health care providers at
different level patients(payers) and multiple
providers in defined regions.
22.
23.
24. 3 key methods for studying complex systems
1. Dynamic Simulation Model Or System Dynamic Model
It uses informal and formal models with computer
simulation to uncover and understand endogenous
sources of complex system behaviour.
2. Network Analysis
It is the measurement and the analysis of relationships
and flows among actors including people, organizations
and other information processing entities.
3. Agent Based Modelling
It uses computer simulations to examine how elements of
a system(agents) behave as a function of their
interactions with each other and their environment
25. It is a simulation modeling method used for
representing the structure of complex
systems and understanding their behavior
over time
Advantages:
Recent advances
Research conduction
Use of technology
Analysis of data
Thus, simulation on community
26.
27. Helps to identify why a system behaves the way it
does
It increases the focus on patient centeredness as
a priority. Example: The institute of medicines
seminal report,” Crossing the Quality Chasm: A
new health system for the 21st century”
Highlights PATIENT CENTERED CARE as a necessary
component of good practice, emphasizing the
importance of continuous health relationships,
knowledge sharing and fee information flow
across segments of the health care system.
28. It is helpful in designing and evaluation of health
care delivery systems and interventions needed to
resolve their inherent problems
It enables evaluators and policymakers to report
and identify resistance in a system and thus, design
and test interventions that can overcome it.
It allows conduction of experiments and
intervention to evaluate system and observe the
effects it can have on system.
It tests ‘what-if’ scenarios
It also allows redesigning of a
system and implementation of
evidence based practice.
30. S-SYSTEM Modelling multiple events, relationships and stake
holders representing health care delivery processes
I-INTERACTIONS Non-linear
Influences behaviours and outcomes in the system
M-MULTILEVEL Modelling a health care delivery problem from
strategic, tactical or operational perspectives
U-UNDERSTANDING Modelling a complex problem to improve a patient
centred care
L-LOOPS Modelling feedback loops that change the beahviour
of future interactions and the consequences of
delivery system
A-AGENTS Modelling multiple stake holders with behvioural
properties that interact and change the performance
of system
T-TIME Time dependent and dynamic transitions either
between or within health care delivery system levels
E-EMERGENCE Considering the intended and unintended
consequences of health system interventions to
address resistance and achieve target outcomes
31. Patients diagnosed with osteoarthritis(OA)---
OA delivery system
Addressing problem At respective time
Delivering right care
Cost effective care
32. Entire health care delivery system
Includes different health care entities and
patients in the system
multiple events: primary care visit for joint pain
and disability
relationships: referral from PHC to secondary
care or tertiary care
Multiple events: joint replacement
stake holders: patients, family doctor,
orthopaedic surgeons and allied health
professionals
34. Strategic level:
Aims at cost-
effectiveness of OA
care
Accounting for
interactions with health
care providers
Tactical or operational
level
Aims at
behaviour of the
patient towards
disease progression
Interactions with their
family, doctor, allied
health providers, etc
The overall data is accumulated and there is formulation of policies and
plan for health services that are:
✓ effective
✓Efficient
✓Sustainable over the long term
35. Understanding the interactions among
system components and behaviours
It is difficult to anticipate outcomes
associated with particular changes such as
1. Incidence of OA and obesity
2. OA in younger population or older one
36. FEEDFORWARD LOOPS
Improvement in
function, mobility, pain
relief before surgery
Pre-surgical care
Modifications
Diet, exercise
This may in turn delay
the need for surgery
and prevent
rehospitalisation
FEEDBACK LOOPS
The health care system
may adapt to changes
from past experiences
or new policies.
Example:
time of surgery
type of implant to be
used, etc
39. Time dependent
Target on performance
In OA care, this will lead to reduction in joint
replacement and also decrease the waiting
time for surgery
Presence of dynamic transitions too!!!
Example: Alternative treatment, negligence, etc
40. Non-linearities and interactions among agents
over time and space leading to complexity
This usually occurs when the goal is to target
outcomes and achieve new results
Emergent behaviours can range from valuable
innovations to unfortunate events.
Example: prevention of OA→ encouragement of
physical activity in younger population→ sport
related injuries→ increase in the incidence of OA
in younger population
41. Focuses on relationship among set of actors.
Actors can be any type of entity that have
relationship with other entities:
❑ Persons
❑ Animals
❑ Organizations
❑ Countries
❑ Websites
❑ Documents
❑ Genes
42. NA uses one or more of three different analytic
modes:
Network visualisation:
NA has the ability to examine a given network
visually, especially if its small to medium sized
Network description:
It is the bulk of NA and can be flexibly used to
address a wide variety of scientific questions
Statistical modelling of networks:
Advanced NA allows to examine multiple networks,
relationships among multiple types of network
ties, changes in network over time.
Thus helps in building and testing of statistical
models and hypotheses of network processes
and structures
43. Over the past 2 decades, NA is being widely
used in public health especially in 5 areas:
1. Disease transmission
2. Social support and social capital
3. Network influence on health behaviour
4. Public health service and organizational
networks
5. Social structure of information diffusion
44. HIV epidemic
Epidemiologists have used network analytic
methods to chart the spread of disease and to
plan how to counter disease outbreaks.
This moved the basic model of
to pure population level model by incorporating
local social network information
susceptible infectious recovered
45. Recent study by Christakis and Fowler
suggested that a wide variety of health
behaviours and functioning including
smoking, obesity and happiness are “socially
contagious” and are directly linked by social
networks
46. ABM is the youngest of these
three systems science methods
Agent-based modelling (ABM)
uses computer simulation to study complex
systems from the ground up by examining
how individual elements of a system (agents)
behave as a function of individual properties,
their environment, and their interactions with
each other.
47. used to study disease transmission at multiple scales,
from individual communities to global pandemics.
used to study chronic disease and health behaviour,
including drinking and smoking as well as complex
public health and health care systems.
Conceptually, these models have been useful in
suggesting possible mechanisms by which contexts
(e.g., neighbourhoods, communities, residential
environments) influence health and health behaviour
helped move epidemiology beyond the traditional
S-I-R model and have demonstrated the importance
of examining the role of social networks,
transportation systems, local geography, and diverse
behavioural responses to changing contexts on the
spread of diseases.
48.
49. Communities are composed of different people
at different times, and depending on the
needs and capacities of community members,
participation runs a continuum from response
to empowerment.
50. Although community participation is situational, it is
critical to health improvement for the following
reasons:
People are more likely to use and respond positively
to health services if they have been involved in
decisions about how these services are delivered.
People have individual and collective resources (time,
money, materials and energy) to contribute toward
their individual and collective health goals.
People are more likely to change risky behaviours
when they are involved in deciding how that change
might take place.
People gain information, skills and experience in
community involvement that help them take control
of their own lives and challenge social systems.
51. No matter what approach is used along the
community participation continuum, it will
only be effective if it is responsive to
community needs and implemented well.
The challenge is
❑ to maintain the momentum of engagement
over time
❑ assessing the environment
❑ and adjusting the program to respond
appropriately to social and political realities.
52. COMMUNITY DYNAMICS IS ALL ABOUT..
...What seems like an obvious solution to a
problem may sometimes worsen the
problem or have unanticipated effects
because the problem is part of a wider
dynamic system.
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