A system dynamics approach for examining the health implications of male out-migration on non-migrating household members in the Western Highlands of Guatemala

The departure of men and boys from rural communities significantly affects the lives of those "left behind". Drawing on qualitative data from a rural community in the Western Highlands of Guatemala and guided by a systems thinking approach, the objectives of this study were: 1) to examine the multifaceted health determinants, risks, outcomes, and impacts associated with male out-migration for non-migrating household members; and 2) to apply a causal loop diagram to describe and model the system dynamics shaping health in a high-volume migrant-sending community. Semi-structured interviews were conducted with community members (n = 38) and individuals involved in community health provision (n = 10). Interviews were audio-recorded, transcribed, and thematically analyzed to inform a causal loop analysis to examine how male out-migration influenced health determinants, risks, outcomes, and impacts among non-migrants. Seven feedback loops were delineated to model overall system behaviour. Results suggest that a central element governing the system is declining trust in public healthcare, mediated by social and financial remittances, as well as changing household roles and care responsibilities. As the primary population left behind, women are disproportionately experiencing adverse acute and chronic health impacts, particularly psychosocial issues. This modelling exercise indicates that efforts to improve health should focus on leveraging community assets, such as a volunteer health committee and existing women's health knowledge networks. This study represents a novel approach to model the interrelated factors that impact health for left-behind populations in high out-migration contexts, and can be used to describe and guide analyses of similar dynamics in other settings.