Using Participatory System Dynamics Approaches to Improve Community-Based Oral Healthcare Delivery: A Case Study of the ElderSmile Program

This study leveraged system dynamics approaches to improve community-based oral healthcare delivery via the ElderSmile program. Insights and inferences from focus groups and key informant interviews with older adults and their service providers, respectively, were integral to understanding feedback mechanisms articulated in participatory modelling exercises. Twenty-four focus groups were conducted at community sites with racial/ethnic minority older adults, and 16 key informant interviews were conducted at senior centres with staff. Annual one- to two-day group model-building (GMB) workshops held at partner institutions with project team members shaped the structure and scope of dynamic models simulating health promotion and care-seeking behaviours of older adults. The GMB process involved causal mapping exercises that were conducted over multiple sessions and incorporated novel physical materials. Five new GMB participant roles are proposed for future study: disruptor, sceptic, spectator, convert and enthusiast. In-person data collection and hands-on exercises maximized participation and yielded shared ownership.