Community-based system dynamics modelling of stigmatized public health issues: Increasing diverse representation of individuals with personal experiences.

Utility of community-based system dynamics (CBSD) models on stigmatized public health issues and health disparities depends upon how representative the model is to real-world experience within the community. "Personal experience" participants (PEP), especially from marginalized groups, are essential model contributors, but are often underrepresented in modeling groups due to multiple barriers. This study details a method to increase PEP representation for models on stigmatized issues. We use a case study from a CBSD project on health disparities within the association between alcohol misuse (AM) and intimate partner violence (IPV) for Northern Plains Indigenous women. Short group model building sessions were held at three community organizations providing relevant resources. Each model contributed unique system components, and there were few similarities between models. A consolidated model provided a rich picture of the complex system. Adding brief PEP-based group modeling sessions can enhance PEP representation in model development for stigmatized public health issues.

Where there's a will, there's a way? Strategies to reduce or abstain from alcohol use developed by Northern Plains American Indian women participating in a brief, alcohol-exposed pregnancy preconceptual intervention.

BACKGROUND: Alcohol-exposed pregnancy (AEP) is an ongoing concern, especially within low-resource, high-risk areas such as rural American Indian/Alaska Native (AIAN) communities. Brief, preconceptual AEP-reduction interventions are popular in such areas but have a small impact on alcohol use. Developing a strategic alcohol change plan is a key program component; however, there is little research on strategy selection, especially within contexts that positively or negatively impact selection (e.g., cultural strengths, trauma, collective efficacy within AIAN communities). This study qualitatively analyzed strategies chosen to reduce alcohol use by AIAN women participating in a culturally tailored, brief, preconceptual AEP-reduction intervention. METHODS: One hundred-sixty Northern Plains AIAN women who were participating in a brief AEP-reduction program developed a plan to accomplish an alcohol reduction/abstention goal at the first and last program sessions. The plan included choosing 1 or more strategies to (1) achieve the goal, (2) mitigate barriers, and (3) use cultural strengths. Qualitative analysis of the data involved thematic open and structured coding of all 3 strategies separately. We also examined how many different themes (different individual strategies) participants reported for each strategy component. RESULTS: Most participants reported only 1 strategy (theme) for each of the 3 components. Common goal-achieving and barrier-mitigation strategies included positive social supports and avoiding negative or alcohol-involved social environments. Other strategies involved circular logic (e.g., the strategy to reduce drinking was to drink less). Both traditional and western cultural strengths were reported as important resources, although many participants had no cultural resource strategy. CONCLUSION: Programs aimed at reducing AEPs may need to provide participants more support to develop strong strategies to reduce alcohol use when implemented within areas with high levels of trauma and contextual barriers that can impact strategy selection. Such support could include ways to improve health on both interpersonal and community levels.