Participatory systems modeling in implementation research: Exploring benefits, facilitators, and future needs

Background: Implementation science increasingly uses participatory systems modeling (PSM) approaches to handle the complexity inherent to implementation science issues. To support the process of integrating PSM with implementation science, we aimed to understand and explicate the benefits, facilitators, and future needs of applying PSM to implementation research. Methods: We conducted semi-structured qualitative interviews with 23 researchers (n = 18) and practitioners (n = 5). We purposively sampled participants and identified additional participants through recommendations. Interviews were inductively analyzed. Key concepts were identified via iterative description, comparison, and conceptualization. Results: Engagement with people in the system was typically focused in earlier stages of PSM approaches, while engagement with decision makers occurred throughout a project. PSM approaches benefited researchers (e.g., improving the relevance of research) and practitioners (e.g., promoting systems thinking). Both benefited from the visual, intuitive nature of PSM and the ability of PSM to reflect partners' input transparently. Facilitators included trusting relationships and conducting practice-driven research. Participants emphasized the need to improve funding opportunities for engagement and increase training in systems modeling facilitation. Conclusions: Our findings can help move the field towards fully partnered and impactful implementation research that addresses the systems problems. While PSM approaches are promising, if not done according to best practices of partnered research, they will reproduce existing power imbalances and consultative engagement patterns between community partners and academics.