Applying Tools From Systems Science to Inform Public Health Decision-Making in North Carolina Elementary Schools During the COVID-19 Pandemic

Background: Communities consist of interconnected sub-systems, such as schools, healthcare organizations, and businesses, each fulfilling specific functions that contribute to the overall well-being of the community. Effective community responses to crises, such as the COVID-19 pandemic, require collaboration across these sectors. However, engaging stakeholders in decision-making processes during complex crises is challenging due to time pressures, uncertainty, and the need for multi-sector coordination.Objective: This dissertation aims to explore how systems thinking methods and the Levels of Leverage framework can inform stakeholder engagement and decision-making in community crisis response. The study hypothesizes that engaging stakeholders using these tools enhances their capacity to respond to future crises, and that these insights can help other communities plan more efficiently in similar situations.Methods: The research focuses on school board decision-making in two diverse communities within North Carolina. Data collection involved focus group discussions and key informant interviews with participants from two school districts. The analysis included the creation of rich pictures of the school system both with and without the introduction of an infectious disease, and causal loop diagrams to explore system dynamics and decision-making processes. These diagrams specifically examined thresholds for taking action in response to a new wave of COVID-19 and the efficacy of measures such as staff and student sick leave and mask mandates.Results: The study identifies key leverage points in community decision-making, highlighting what works and what does not during crises, and why certain actions are endorsed or opposed. Findings suggest that systems thinking and the Levels of Leverage framework are valuable tools for enhancing community response strategies, particularly when applied to complex, unpredictable situations.Conclusions: Engaging stakeholders in crisis response using systems thinking provides valuable insights that improve future decision-making and community preparedness. The findings have practical implications for crisis planning and response, offering a framework for other communities to adapt and refine their strategies in the face of similar challenges.