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Systems Thinking In Public Health Quiz Answers

Week 01: Systems Thinking In Public Health Coursera Quiz Answers

Quiz 01: Quiz Module 1

Q1. Which of the following are NOT characteristics of complex systems? Check all that apply.

• Comprised of a few elements
• Facilitates the easy, system-wide replication of interventions proven to work on a small scale.
• Comprised of many, interrelated elements
• Cannot learn or self-organize.

Q2. According to Peters (2014), which of these are reasons to apply systems thinking in health? Check all that apply.

• To guide where more data collection is needed to learn about emerging hypotheses
• To predict exactly what would happen once a new health intervention is introduced.
• To identify one-size-fits-all solutions that can be rapidly scaled up
• To map out events, actors, and relationships and to describe how various elements are connected

Q3. According to Epstein (2008), which of the following are true statements about why one might model? Check all that apply

• Modelling always has prediction as its main goal.
• Modelling does not generate true results, instead we should only analyze data that are on hand now.
• Modelling can expose prevailing wisdom as incompatible with available data
• Modelling can illuminate core dynamics and uncertainties and help to discover new questions.

“Q4. How a Tsunami in Japan endangered Children in Cambodia” is an example of which of the following?

• Evolution
• The Butterfly Effect
• Participatory Model Building
• Reductionist theories

Q5. Which of the following is a benefit of stakeholder participation?

• It results in setback, especially in contexts where there is a lack of capacity.
• It raises stakeholder expectations, leading to disillusionment
• It results in increased stakeholder support.
• It is costly in terms of time and resources for all (including stakeholders)

Q6. Which of the following are important when applying systems thinking in public health?

• Not engaging stakeholders
• Setting ambitious targets
• Setting common targets across countries
• Adapting interventions based on learning from implementation

Q7. Improvements in access to maternal and child health care are critical for the achievement of the Sustainable Development Goals. Country X has just announced that all mothers would receive free pre-natal health services, if they attend their appointments accompanied by their husbands or boyfriends. Mothers whose husbands were at work during the time of the appointments, or single mothers who did not have a partner started paying their taxi driver to play the role of the husband or boyfriend.

Which complex adaptive system phenomenon is this an example of?

• The Butterfly Effect.
• Path dependence
• Emergent behavior
• Scale-free networks

Q8. Improvements in access to maternal and child health care are critical for the achievement of the Sustainable Development Goals. Country X has just announced that all mothers would receive free pre-natal health services, if they attend their appointments accompanied by their husbands or boyfriends. Mothers whose husbands were at work during the time of the appointments, or single mothers who did not have a partner started paying their taxi driver to play the role of the husband or boyfriend.

What would applying systems thinking to the policy re-design entail?

• Reviewing a similar policy that was successfully implemented in Country Y and replicating it for Country X.
• Reviewing a similar policy that was successfully implemented in Country Y and replicating it for County X, based on consultations only with men, who are the decision-makers in the household.
• Conducting periodic stakeholder consultations with facility staff and community stakeholders, including with mothers, specifically those who may face additional barriers to access to services (monetary, social), and other local (e.g. transporters).
• Conducting periodic stakeholder consultations with facility staff only, so that they may be able to identify the women who do not comply.

Q9. Which of the following are goals of building a causal map with stakeholders? Check all that apply.

• Prioritize stakeholders’ different mental maps of a problem
• Take ownership of research and programs, and any solutions that will be prioritized.
• Reveal the social construction of a problem
• Integrate stakeholders’ diverse mental maps of a problem.

Q10. Which of the following is a stakeholder mapping tool that can help to identify who the stakeholders are for a particular issue and context?

• Lorenz attractors
• Participatory Impact Pathways Analysis
• Causal loop diagrams
• Stock and flow diagrams

Systems Thinking In Public Health Week 02 Quiz Answers

Quiz 01: Quiz Module 2

Q1. Which of the following statements is TRUE of feedback loops?

• Positive if the variables influence each other in a clockwise direction.
• Negative if the overall effect of the variables is amplifying.
• Reinforcing if it has an even number of negative loops.
• Balancing if it is positive.

Q2. Which of the statements below is FALSE?

• The link from A to B is positive if a decrease in A produces an increase in B.
• The link from A to B is negative if a decrease in A produces an increase in B.
• The link from A to B is negative if a change in A produces a change in B in the opposite direction.
• The link from A to B is positive if a change in A produces a change in B in the same direction.

Q3. Which of the following are the components, or building blocks of causal loop diagrams? Please check all that apply.

• Stakeholder maps
• Feedback loops
• Illustration of delays
• Polarity

Q4. Which of the following represents the correct sequence of an ideal group modelling session?

• • Core modeling team planning and capacity building -> Problem scoping -> Evaluation and reporting
  • Problem scoping -> Actual group modeling workshop -> Evaluation and reporting
  • Problem scoping -> Core modeling team planning and capacity building -> Actual group modeling workshop -> Evaluation and reporting
  • Core modeling team planning and capacity building -> Actual group modeling workshop -> Evaluation and reporting

 

Q 5. See the figure below, from Figure 4, Rwashana (2014). How many feedback loops (of each kind) are there?

• 1 balancing loop and 1 reinforcing loop
• 3 balancing loops and 2 reinforcing loops
• 4 balancing loops and 1 reinforcing loop
• 1 balancing loop and 4 reinforcing loops

Q6. An important health system goal is for mothers to be able to deliver their newborns safely, and, where appropriate, in well-equipped, accessible health facilities. Trust in facility-based MCH services is a key facilitator. Trust develops when mothers who attend facility-based MCH services receive adequate care and have safe deliveries. Over time, the more women have safe deliveries, the greater their trust becomes in facility-based services. Increasing trust leads to more mothers seeking facility-based MCH services. However, often this trust is compromised by inadequate facility services. One of the reasons behind this is resource inadequacy, which leads to long waiting times, for example, among other challenges. Long waiting times, in turn, lead to greater frustration among mothers seeking services there. This frustration can reverse mothers’ decision to seek care in facilities, therefore reducing the mothers availing facility based MCH services. How many mothers attend such services also impacts the available resources. In a system with finite resource, the more mothers attend facility services, the greater the resource inadequacy becomes. (Source: Rwashana 2014)

Which delay correctly describes the scenario presented above?

• Trust in health care services –||–> Mothers delivering in hospital
• Safe deliveries & PNC –||–> Trust in health care services
• Mothers delivering in hospital –||–> Safe deliveries & PNC
• Safe deliveries & PNC –||–> Mothers delivering in hospital

Q7. An important health system goal is for mothers to be able to deliver their newborns safely, and, where appropriate, in well-equipped, accessible health facilities. Trust in facility-based MCH services is a key facilitator. Trust develops when mothers who attend facility-based MCH services receive adequate care and have safe deliveries. Over time, the more women have safe deliveries, the greater their trust becomes in facility-based services. Increasing trust leads to more mothers seeking facility-based MCH services. However, often this trust is compromised by inadequate facility services. One of the reasons behind this is resource inadequacy, which leads to long waiting times, for example, among other challenges. Long waiting times, in turn, lead to greater frustration among mothers seeking services there. This frustration can reverse mothers’ decision to seek care in facilities, therefore reducing the mothers availing facility based MCH services. How many mothers attend such services also impacts the available resources. In a system with finite resource, the more mothers attend facility services, the greater the resource inadequacy becomes. (Source: Rwashana 2014)

Q8. Based on the reading in Paina (2014), what should the missing variable be?

• Health outcomes
• Dual practice opportunities
• Private practice
• Government providers

Q9. Please see the diagram below, based on the CLD in Paina (2014). Please select the statement(s) which correctly fill(s) in the blank for the missing polarity in the diagram above: (Check all that apply)

• Increasing professional associations’ advocacy causes government to strengthen restrictions to dual practice.
• Increasing government restrictions to dual practice lead to greater provider protest/resignation.
• Increasing professional associations’ advocacy causes government to ease restrictions to dual practice.
• Increasing government restrictions to dual practice lead to decreasing professional association advocacy.

Q10. In group model building, what are “scripts”?

• Scripts are a type of model.
• Scripts are “playbooks”, outlining the step-by-step process of a group modeling activity.
• Scripts are “playbooks”, outlining an illustrative case study that can inform your group modeling.
• Scripts represent a list of actors and the exact lines they are supposed to say.

Systems Thinking In Public Health Week 03 Quiz Answers

Quiz 01: Quiz Module 3

Q1. Which of the following provide an accurate representation of the basic system dynamics equation that follows?

• Vj is the rate variable
• If Delta t becomes very small the rate of change will become very small
• V ̇jk is the rate of growth of V between time j and time k.
• Vj is an auxiliary variable
• If Delta t becomes very large the rate of change will become very large.

Q2. Which of the statements below is TRUE?

• All arrows mean the same thing in stock and flow diagrams.
• Stock and flow diagrams are exactly the same as causal loop diagrams.
• It is important to never change any of the settings on a system dynamics model or else you will break it.
• The best system dynamics models have dozens and dozens of stocks to depict reality in detail.
• If all of the parameters are not changed, the model will produce the exact same output every time it is run.

Q3. What will happen to a stock variable that has no inflow rate and only a stable outflow rate?

• It will always oscillate.
• It will decay.
• It will grow exponentially.
• It will never reach an equilibrium

Q4. Which problem is best suited for system dynamics modeling?

• Multiple interrelated causes of behavior that feed back to each other.
• People react to each other and change each other over time.
• One must predict the burden of a certain disease with high accuracy.
• People do not react each other and do not change each other over time.

Q5. How do system dynamics models help their users become better at systems thinking?

• Good systems dynamics models can depict all of the details of reality and mastering the models implies mastering reality.
• Systems dynamics models make their users think about the world using numbers and when numbers are used, that is systems thinking.
• Only people who are already good at systems thinking go on to use system dynamics tools so it is just a self-selection process.
• Trying things out in different ways again and again illustrates feedback and unanticipated consequences.

Q6. In a model that tries to show that spending on lobbying increases political influence and helps a group acquire public funds which it can then use to spend more money on lobbying, which of the following diagrams properly conveys the structure of the loop and properly labels it as balancing or reinforcing?

Q7. Based on the diagram below, which of the statements is true?

• Doctor power is a stock; “consultation fees” is an auxiliary; “private pay to doctors” is a rate.
• Doctor power is a stock; “consultation fees” is a stock; “private pay to doctors” is a rate.
• Doctor power is an auxiliary; “consultation fees” is a stock; “private pay to doctors” is a rate.
• Doctor power is an auxiliary; “consultation fees” is an auxiliary; “private pay to doctors” is an auxiliary.

Q8. Participatory modeling remains important to using system dynamics. Which of the following will lead to greater success when using participatory model building for reform?

• Having the technical experts defer to stakeholders when there is a disagreement about how the model should be structured.
• Making sure there are valid empirical estimates for the numbers used in the model
• Finding mechanisms for participants to voice their perception of the which model features matter the most.
• Using a recording device to capture and transcribe all of the deliberation.

Q9. You want to initiate a participatory group model building process to develop a system dynamics model to lead to system reform. Which of the following approaches is least likely to succeed at achieving reform?

• Conduct focus groups, in-depth interviews, and a systematic literature review and present stakeholders with a fully developed model.
• Begin with initial “blank slate” discussions to help you frame variables in the local language, because you are concerned that some members need an intro to SD.
• Begin to assemble a team that has good facilitators, modelers, recorders, and stakeholders who can adequately represent the perspectives you want to include.
• Develop a basic stock-and-flow diagram and ask participants to identify variables that influence the transition between stocks and flows.

Q10. What can be done in group model building to avoid generating an incoherent model with too many concepts, actions, relationships?

• Work in several small groups so you can select the best model to emerge and eliminate the ones that are too complicated.
• Spend time teaching participants about negotiating where to draw system boundaries.
• Tell participants not to focus on depicting realism in their models.
• Give the participants a well-designed pre-fabricated model to examine, tweak, and comment on.

Systems Thinking In Public Health Week 04 Quiz Answers

Quiz 01: Quiz Module 4

Q1. What is the best way to bring the benefits of system thinking to improve the lives of the population?

• Teach more citizens how to interpret computer simulations of complex systems
• Invest in artificial intelligence systems so that more people are nudged to live healthier lives
• Do a really good job making simulation models and communicating their findings to policy makers so they will listen to the scientists
• Train lawyers, lawmakers and judges in systems thinking so that better laws go on the books and get enforced
• Create ecostructures that involve the scientists, politicians, and citizens all together in conceptualizing the problem and thinking through the solutions

Q2. If Federalists like Alexander Hamilton were in charge, how would systems thinking be applied in public policy?

• States rights would be asserted and states would be allowed to serve as policy labs where their successes and failures would inform other states.
• Town hall meetings would bring the wisdom of crowds to solve problems and produce insight into systems.
• All citizens would be encouraged to undertake bottom-up collective action to solve problems.
• Technocrats + Community Members + Politicians would serve as co-equals in thinking about social problems.
• Only very refined and sophisticated people would create models of systems problems and they would share their insight with wise leaders.

Q3. Which of the following characterize the market fundamentalist model. Check all that apply.

• Governments should stay out of the market as much as they can.
• Government should correct market externalities by taxing industries that pollute and subsidizing industries that make people better off
• Governments can make things better when they intervene.
• Income disparities are best corrected by having the government tax the rich and transfer money to the poor.
• The complex system of the invisible hand will make everyone better off as long as nobody meddles with it.

Q4. When systems thinking is applied to public health which one of the following will be true?

• The policy maker will expect that unintended things will happen and will build in regular listening and adaptation of the policy.
• Only qualified and competent policy makers who understand systems will be allowed to be involved in policy making.
• Communication strategies will help sell the community on the policy so they don’t meddle with it and mess it up.
• Brilliant models will be run that forecast all potential problems so that policies can be optimized and there will be little need for later amendments

Q5. What makes public health problems so amenable to systems thinking? Check all that apply.

• The value judgments of one group of people about health can affect other groups of people
• There are many kinds of diseases and so we need experts in the nervous system, the circulatory system, the GI system, etc.
• There are multiple perspectives about what the best thing to do and political actions can advance some perspectives at the expense of others.
• Thousands and thousands of individuals are involved in executing solutions, and they need to have multiple perspectives and values involved.
• Epidemiologists have quantified the burden of disease and whenever something is quantified we need to use systems models to understand quantitative data

Q6. Why are inclusive approaches to conceptualizing and addressing systems policies so rarely undertaken in public health?

• People are busy and distracted by the personal issues in their own lives and resist becoming engaged.
• Public health problems arise usually simply from too much risky behavior by people who don’t know what is good for them—inclusion lets people who are not sophisticated dictate policy
• Despite the strong role of values in public health problems, many experts like to believe that only experts should be involved in defining and solving such problems.
• Oppressive groups that undermine health (e.g. tobacco companies and gun makers) infiltrate their opposition so effectively that attempts to organize inclusive grass roots efforts to counter them are doomed.
• Computer simulations are so successful in identifying the optimal solution that community engagement is unnecessary.

Q7. What are appropriate roles of computer simulation models in getting public health systems to become more responsive to emerging issues in public health? Check all that apply.

• Proving that risk factors in the model actually cause disease.
• Conferring legitimacy on a course of action that is facing political obstacles.
• Generating new insights into unforeseen connections in systems.
• Tracing out the logical consequences and potential outcomes of new policies.

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About Systems Thinking In Public Health Course

This course is an introduction to systems thinking and public health systems models. Most problems in public health and health policy involve a lot of different people, organisations, and risks. Traditional statistical methods can’t be used to study or predict an outcome if it depends on a lot of parts and actors that work together and change. Systems thinking is an important part of public health. It helps policymakers create programmes and rules that are aware of and ready for unintended effects.

A big part of systems thinking is putting together different points of view into a framework or model that can describe and predict the different ways a system might respond to a change in policy. Systems thinking and systems models help people come up with ways to deal with the complexity of the real world.

With the help of a grant from the International Development Research Centre in Ottawa, Canada, the World Health Organization’s Alliance for Health Policy and Systems Research oversaw this project. The Department for International Development (DFID) gave Future Health Systems research consortium extra help in the form of a grant (PO5467).




All rights reserved by the World Health Organization. The names used and the way the information is presented in this publication do not mean that the World Health Organization has any opinion about the legal status of any country, territory, city, or area or its authorities, or about how its borders or borders should be drawn. Dotted and dashed lines on maps show border lines that are close but may not be completely agreed upon yet. When specific companies or products from those companies are mentioned, it doesn’t mean that the World Health Organization likes or recommends them more than other similar products that aren’t mentioned. Except for mistakes and omissions, the names of proprietary products start with a capital letter. The World Health Organization has taken all reasonable steps to make sure the information in this publication is correct. The published material, on the other hand, is being passed around without any kind of warranty, either express or implied. It’s up to the reader to figure out how to use and understand the information. In no way will the World Health Organization be responsible for any harm that comes from using it. The material can be used and copied by anyone, not just the Johns Hopkins University Bloomberg School of Public Health.

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