title: Group model building: a framework for organizing healthy community program and policy initiatives in Columbia, Missouri.
abstract: BACKGROUND
  Between 2008 and 2012, the multidisciplinary Healthy Community Partnership of Columbia, Missouri, participated in a national program to address child obesity. This article describes a systems-level evaluation of their work to implement healthy eating and active living policy, system, and environmental changes to support healthier communities for children.
  
  
  METHODS
  In 2011, the partnership participated in a Group Model Building session, consisting of 2 primary activities. First, participants sketched behavior-over-time graphs, illustrating the evolution of community variables related to child obesity, such as prevalence of walking to school or the marketing of high-sugar drinks. Later, the graphs were arranged on a large area of wall space and connections were drawn between those variables that were believed to influence each other--either positively (reinforcing connections) or negatively (opposing connections). The resulting causal loop diagram is a visual representation of the interacting systems, as perceived by the partnership.
  
  
  RESULTS
  In reviewing the diagram, the group identified areas where they felt the diagram "made sense" and other areas where there were inconsistencies between the diagram and their own mental model of the processes at work. To address the inconsistencies, participants were surveyed to determine which specific modifications should be made to the diagram so it would become an accurate representation of the group's shared concept of the relevant relationships.
  
  
  CONCLUSIONS
  The group felt that the final Modified causal loop diagram achieved this goal and that it provides useful insight into how their work addresses child obesity. They believe the diagram also has the potential to improve community engagement by serving as a visual model, improve planning through better resource allocation, improve implementation by identifying policy leverage points, and increase resources when used in grant applications.
authors.affiliation: PedNet Coalition (Dr Thomas) and Columbia/Boone County Department of Health and Human Services (Ms Reilly), Columbia, Missouri.
authors.forename: Ian M
authors.initials: IM
authors.lastname: Thomas
authors.forename: Stacia R
authors.initials: SR
authors.lastname: Reilly
mesh_terms: D003159:Community-Institutional Relations / Q000592:standards; D015444:Exercise / Q000523:psychology; D017144:Focus Groups; D015438:Health Behavior; D006291:Health Policy; D006293:Health Promotion / Q000379:methods*; D006801:Humans; D008923:Missouri; D063766:Pediatric Obesity / Q000517:prevention & control / Q000523:psychology; D016730:Program Development / Q000379:methods* / Q000592:standards; D015397:Program Evaluation / Q000379:methods; D011634:Public Health / Q000379:methods; D013597:Systems Analysis