Cultural adaptations and methodological innovations in developing systemic interventions to combat malnutrition in all its forms in China and Southeast Asian countries through Group Model Building – the SYSTAM CHINA SEACS project

Purpose
Different forms of malnutrition share common causes and solutions. They also co-exist at individual-, family-, community- and country-level. However, over-and under-nutrition interventions around the world are often developed in an isolated manner. To effectively tackle the double burden of malnutrition, which is a leading public health crisis in China and Southeast Asian (SEA) countries, this MRC-funded project explored whether and how Group Model Building (GMB) can be applied successfully to develop double-duty nutrition interventions in these countries.

Methods
Collaborating with national, regional, and local governments in China and Southeast Asian countries, we made cultural adaptations and methodological innovations to the standard GMB process to successfully co-develop double-duty interventions with leaders from 16 governmental departments and the food industry within a pilot city in China. Examples of cultural adaptations were including leaders of a similar seniority in the same workshop to avoid power dynamic issues; and providing hand boards for individual participants to express opposing views friendly. Examples of methodological innovations included development of hybrid methods for the GMB process; and expanding the 3-stage GMB process to include 9 stages. We hosted a high-level, online international forum to 1) share the pilot work with 26 Ministry of Health senior officials from 10 SEA countries, and 2) discuss the feasibility of applying the piloted approach in their countries through three focus groups (in breakout rooms).

Results
The culturally adapted, hybrid GMB process led to 1) collective prioritisation of inter-sectoral interventions targeting common drivers of over- and under nutrition in the pilot city within 2 themes: environmental pollution and the food supply chain. It also led to the establishment of local Action Groups consisting leaders of various governmental departments for sustainable intervention implementation. Senior SEA officials believe it is feasible to apply the piloted systems approach in their countries, and suggested country-specific issues (e.g. targeting the right level of authority and technical training) to be addressed to maximise success.

Conclusion
It is feasible to apply a systems approach to developing double-duty nutrition interventions in China and SEA countries. Country-level cultural adaptations and the hybrid GMB process are recommended for SEA countries.