Use of qualitative systems mapping and causal loop diagrams to understand food environments, diet and obesity: a scoping review protocol

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TL;DR

This protocol describes a scoping review that will map the literature on qualitative systems mapping approaches (specifically causal loop diagrams developed by stakeholders) used to understand food environments, diet, and obesity. The review will summarize the methods, populations, settings, and key findings from these studies, and identify gaps in knowledge and implications for policy and practice. No results are reported as this is a protocol for a review that was ongoing as of December 2022.

Full summary

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**Background:** Food systems shape dietary behavior and obesity in complex, non-linear ways that are difficult to capture with traditional research methods. Complexity theory provides a lens for understanding these systems as comprising highly interconnected components and feedback loops. Qualitative systems mapping, particularly causal loop diagrams (CLDs), visually depicts these relationships using directional arrows with polarity (positive/negative) that form reinforcing and balancing feedback loops. CLDs are created by eliciting stakeholders' mental models through facilitated, iterative processes such as group model building and community-based system dynamics. These approaches are increasingly used to support knowledge creation, consensus building, intervention design, and policymaking, especially for understanding inequities affecting disadvantaged and minority communities. However, no prior review has systematically examined how qualitative systems mapping has been applied to engage stakeholders in developing CLDs focused on food environments, diet, and obesity. This represents a barrier to advancement, as there is no unified body of knowledge characterizing the methods, contexts, participants, outcomes, and intended uses of these approaches.

**Methods:** This protocol describes a scoping review guided by the Joanna Briggs Institute manual, the framework by Khalil and colleagues, and the PRISMA-ScR checklist. The review will follow a five-stage process: (1) identifying research questions; (2) identification of relevant studies; (3) study selection; (4) data extraction; and (5) summarizing findings. Six research questions are specified, covering how qualitative systems mapping has been used, geographical and stakeholder contexts, variables and feedback loops represented, intended/reported uses of CLDs, evaluation processes employed, and limitations described. The search strategy was iteratively developed with two academic librarians and will be applied to six databases: Ovid MEDLINE, Embase, EmCare, Web of Science, Scopus, and ProQuest Central. The Population, Concept, Context (PCC) framework guided search strategy formulation. Inclusion criteria require studies to: (a) focus on food environments, food access/availability/supply/(in)security, or food purchasing from a consumer-based perspective, and/or dietary behavior, obesity, or related interventions/policymaking; (b) feature a CLD created by stakeholders using a described qualitative systems mapping approach; and (c) be original research published in English in a peer-reviewed journal or conference proceeding. Exclusion criteria include studies focused on agricultural/production perspectives, diabetes, hypertension, eating disorders, food waste, food packaging, sanitation, and clean drinking. Studies featuring diagrams that do not conform to CLD conventions (no closed feedback loop, no directional causal links with polarity) are excluded, as are studies where CLDs are created from literature reviews or simulations without stakeholder engagement. No restrictions on population, geography, or publication year are imposed. Two independent reviewers will screen citations by title/abstract and then full text. Reference lists of included studies and relevant systematic reviews will be searched for additional papers. Data extraction will cover three domains: (1) study characteristics (title, year, purpose, geographical context, population context, justification for CLD development); (2) process (mapping method, stakeholder recruitment strategy, types of stakeholders and facilitators, workshop details including number, duration, participants, facilitation roles and activities); and (3) outputs (number and names of variables and loops, action ideas, CLD image, process outcomes including limitations, evaluation tools, methods of reporting back findings, and intended future use of CLDs). The extraction table will be pilot tested by two independent reviewers on five articles. Quality appraisal will not be performed, as no agreed-upon metrics exist for systems mapping studies and scoping reviews generally do not include quality assessment. Findings will be summarized using tables, figures, and descriptive/numerical summaries. A frequency plot will capture how often each variable appeared across CLDs, and feedback loops will be synthesized and grouped by theme.

**Key Results:** This is a protocol paper; no results are reported. The review was ongoing as of December 2022, with citation screening in progress. Completion of data extraction was anticipated by end of January/early February 2023, with full review completion expected in March 2023.

**Clinical Implications:** The scoping review will provide an overview of how CLDs developed by stakeholders have been used to understand food environments, diet, and obesity, including the insights gained and how CLDs have been applied. It will highlight gaps in knowledge and implications for policy and practice. The findings are expected to be of interest to academic researchers, community advocates, and policymakers seeking to understand and intervene on food systems. The review will be disseminated through publication in a peer-reviewed scientific journal and conference presentations. No ethics approval is required as the review involves screening and extraction of publicly available information.