Changes in systems thinking and health equity considerations across four communities participating in Catalyzing...

Childhood obesity is a persistent public health concern, and community-based interventions have become crucial for addressing it by engaging local communities and implementing comprehensive evidence-based strategies. The Catalyzing Communities intervention takes a "whole-of-community"approach to involve leaders from diverse sectors in thinking systematically about child healthy weights and implementing evidence-based solutions. Using systems thinking and the Getting to Equity framework to guide interview analysis, this study examines changes in participants' use of systems thinking concepts and health equity in 43 participants across four U.S. communities involved in the Catalyzing Communities intervention. Our findings reveal significant shifts in systems thinking concepts, as participants develop a deeper understanding of childhood obesity as a complex adaptive system, and system insights, as participants increasingly recognize the interconnections and leverage points within the system driving childhood obesity. Participants also experienced increases in health equity thinking and action, particularly when discussing social and structural determinants of health, commitment to targeted actions, and a focus on addressing barriers and enhancing resources. The intersection between systems insights and health equity action, such as explaining leverage points and interventions to reduce deterrents to health behaviors, suggests the need for systems thinking activities to be integrated into health equity planning. Future research is needed to develop measures to connect systems thinking concepts to health equity, and the impact of these to community-level policy, systems, and environmental changes in public health.