Mapping interrelated factors in Health in All Policies implementation in local governments: A complexity-informed...

The implementation of Health in All Policies (HiAP) in local governments is particularly relevant given the influence of this level of governance on the social determinants of health and on advancing health equity at the municipal level. However, HiAP implementation remains challenging, especially as local government contexts can be understood as complex adaptive systems. Systems thinking offers an analytical approach that facilitates understanding the relationships among the multiple components influencing HiAP implementation and provides a set of tools that are useful for revealing the interconnections shaping complex policy problems. A complexity-informed scoping review was conducted to identify and organize key factors involved in the implementation of HiAP at the local level, as well as to explore and visualize the interrelationships among these factors. Nineteen factors were identified and classified into five categories: factors related to recognizing the need for change; organisational resources; planning, implementation, and evaluation processes; organisational commitment and support; and external factors supporting change. These factors were organised into a conceptual model. Their interrelationships were examined, and a diagram was developed to illustrate the underlying complexity of these interconnections. Political commitment emerged as a highly interconnected endogenous component within HiAP implementation processes. Future research should examine the extent to which the proposed conceptual model can be applied across different contexts and explore opportunities to further refine the diagram, including its potential development into causal loop diagrams and system dynamics simulation models.