A qualitative evaluation from a complex systems perspective of a whole systems approach to obesity in an English local authority

Abstract

Aims: Current thinking suggests that whole systems approaches (WSAs) may be required to tackle obesity. WSAs are policy approaches designed to address problems in the context of the complex system in which they occur. Evaluating a WSA is a key challenge and there is a significant lack of knowledge on this topic. The aim of this study was to carry out an evaluation, from a complex systems perspective, of the impact of a WSA to obesity implemented in the English county of East Sussex. This study addresses gaps in knowledge regarding methodological approaches to evaluating WSAs in general, and specifically the use of qualitative methods to evaluate system change.

Methods: Semi-structured interviews were conducted with 17 professionals in East Sussex County Council and eight partner organisations. Analysis was guided by a complex systems evaluation framework developed by McGill et al., with analytical output presented as a narrative of the system undergoing change. In an original addition, a local obesity system map was used to depict the location of changes within the system.

Results: Three key changes, all located in the ‘Workforce development’ area of the system map, were identified following implementation of the WSA: (a) it significantly influenced the creation of a new post at the County Council to address environmental determinants of obesity, (b) it increased knowledge of the role of wider determinants of obesity and (c) it improved partnership working.

Conclusions: This study illustrates how a WSA to obesity can be evaluated from a complex systems perspective using qualitative methods and offers practical insights for designing future evaluations of WSAs, particularly in relation to data analysis and the use of system mapping.