Uncovering the key working mechanisms of a complex community-based prevention programme using ripple effects mapping

Background: Much remains unknown about how complex community-based programmes can successfully achieve long-term impact. Additional insight is needed to understand the key mechanisms through which these programmes work.

Purpose: to explore potential working mechanisms of the Healthy Youth, Healthy Future (JOGG) approach, a Dutch community-based programme for promoting physical activity and healthy nutrition. Therefore we identified the outcomes and long-term impacts as perceived by local stakeholders and causal pathways to impact.

Methods: we studied five JOGG communities using Ripple Effects Mapping (REM), a qualitative participatory method to map outcomes and causal pathways with stakeholders. We involved 26 stakeholders – professionals and policymakers affiliated with the local JOGG approach – in eight REM sessions and conducted 24 additional interviews. We comparatively analysed causal pathways across communities.

Results: over the long term (5-9 years) participants perceived that JOGG had improved stakeholder ownership, policy, intersectoral collaboration and the social norms towards promoting healthy lifestyles. Although the exact actions that were implemented varied widely between communities, we identified five common working mechanisms: 1) creating a positive connotation with JOGG, 2) mobilising stakeholders to participate in the JOGG approach, 3) facilitating projects to promote knowledge and awareness among stakeholders and create success experiences with promoting healthy lifestyles, 4) connecting stakeholders, stimulating the intersectoral collaboration that is needed to effectively promote healthy lifestyles, and 5) sharing successes from stakeholders that promote healthy lifestyles, which over time created a social norm of participation.

Conclusions: the identified key working mechanisms appeared essential in activating initial stakeholder participation and bolstering the process towards ownership, policy change and intersectoral collaboration for promoting healthy lifestyles. Analysing REM output across communities enabled us to uncover common working mechanisms.
Practical implications: results can inform further development of the JOGG approach and other community-based prevention programmes.

Funding: the national JOGG organisation