Developing a whole systems action plan promoting Dutch adolescents' sleep health

Inadequate sleep health is a public health problem among Dutch adolescents with detrimental effects on their physical and mental well-being. System approaches are increasingly being used to understand and address public health problems. Therefore, a recent study created a comprehensive Causal Loop Diagram (CLD) that integrated all relevant determinants of adolescent sleep health, underlying system dynamics and potential leverage points. Building on that, the current study aims to design a 'whole systems action plan' to promote sleep health of Dutch adolescents, combining systems science with a participatory approach.

Five (multi)stakeholder sessions with adolescents (N = 40, 12-15 years), parents (N = 14) and professionals (N = 13) were organized to co-create actions addressing preselected leverage points derived from the previously mapped CLD. Subsequently, three sessions with multidisciplinary representatives of regional and national oriented (health) organizations (N = 27) were held using the World Café Methodology to identify intervention actions as well as potential implementers. The Action Scales Model (ASM), a tool to understand and change the system at different levels (i.e., event, structure, goal, belief) of the system, was used to create a coherent whole systems action plan.

The created whole systems action plan consisted of 66 (sets of) actions across different ASM levels (i.e., event, structure, goal, belief) targeting 42 leverage points across five subsystems: school environment N = 24; mental wellbeing N = 17; digital environment N = 9; family & home environment N = 9; personal system N = 7. Per action potential implementers were identified, which included amongst others schools and public health services. The previously mapped CLD visualizing system dynamics shaping adolescent sleep health were supplemented with how dynamics can be changed via the actions identified.

The resulting whole systems action plan provides a subsequent step in applying a whole systems approach to understand and promote adolescent sleep health. Combining a systems approach, using the ASM, and a co-creation approach was found to be mutually reinforcing and helpful in developing a comprehensive action plan. This action plan can guide strategic planning and implementation of actions that promote systemic change. With this, it is important to ensure coherence between actions being developed and implemented to increase the potential for lasting systems change.