4

Impacting Complex Systems That Can Influence Obesity

The second session in Part II of the workshop explored how complex systems may influence obesity and considered opportunities for systems change as they relate to obesity solutions. Sara Czaja, professor of gerontology and director of the Center on Aging and Behavioral Research at Weill Cornell Medicine and emeritus professor of psychiatry and behavioral sciences at the University of Miami, moderated the first half of the session, during which two speakers discussed the participatory nature of interventions and education. Ihuoma Eneli, professor of clinical pediatrics at The Ohio State University, moderated the second half of the session, during which two additional speakers discussed obesity-related opportunities for systems change.

ENGAGED AND PARTICIPATORY SYSTEMS THINKING

Leah Frerichs, assistant professor in the Department of Health Policy and Management at the University of North Carolina at Chapel Hill, discussed engaged and participatory systems thinking. She began by explaining the rationale for combining engaged and participatory research with systems thinking and systems science approaches. Synergies exist between the two, she pointed out, elaborating that both are rooted in seeking more holistic, less reductionist understanding; both emphasize socioecological frameworks and invite consideration of multilevel influences; both feature an inherent desire for capacity building and co-learning; and both involve translational synergy (Frerichs et al., 2016).

Combining the two approaches can take a variety of forms, Frerichs suggested, highlighting structured facilitated exercises—such as group model building, a systems science approach—that are designed to generate better understanding and decision making in the context of complex systems. She explained that the processes of engaged and participatory systems thinking and community engagement both reflect increasing levels of community involvement, impact, trust, and communication flow as they move through the stages of outreach, consultation, involvement, collaboration, and ultimately shared leadership. In the outreach stage, she elaborated, the researcher retains most of the power, but may conduct formative research with stakeholders to shape and refine plans. As a project moves through

the later stages, she continued, researchers and community members become more equitable partners as they work together to define the issues and develop models, and perhaps even create new processes to build each other’s capacity for systems thinking and action.

Frerichs then described two projects that exemplify the combining of engaged and participatory research with systems science approaches. She first displayed process flow diagrams that resulted from engaging health care providers from several community health centers in systems science work focused on processes for colorectal cancer screening. The resulting diagrams help identify health-related decision points, responsible parties for various processes, and potential gaps or bottlenecks. The formative research that led to the diagrams also informed a microsimulation model, Frerichs continued, that has been used to answer questions about the potential impact of changes in health insurance coverage on reducing the incidence of colorectal cancer and screening disparities, as well as to identify evidence-based, cost-effective interventions that can advance those goals (Davis et al., 2019; Powell et al., 2020).

Frerichs’ second example was an effort to engage youth with systems science approaches in research focused on understanding complex system influences on physical activity. She described her research team’s use of a shared leadership approach in working with high school students, self-titled the Young Visionaries for Health, in a rural eastern North Carolina community. The students helped the team formulate research questions and establish study protocols at the project’s outset, she elaborated, and took gradually increasing responsibility for planning meetings and facilitating activities.

Frerichs explained how the project leveraged storytelling concepts to make its systems modeling components more relatable for the students. The researchers linked five storytelling elements with agent-based modeling concepts, starting by comparing conflict to the health issue (i.e., physical activity). Through simple exercises, the youth helped the researchers understand their perspectives on barriers to and supports for physical activity. Characters were equated with agents, Frerichs continued, and character development was equated with aspects of the properties and rules in the model that guided decision making. For this exercise, the students interviewed each other to elicit information about factors influencing their decisions around physical activity. The story’s setting was equated with the environment; students mapped their daily routines and activity hubs on large maps of their community. Frerichs explained that the fifth element, plot, represented how the simulation played out over time. The five storytelling elements and their associated qualitative exercises contributed to the final model structure, Frerichs said, which was supplemented by youth-collected data on activities, social interactions, and locations over time. She

reported that the model will soon be used to forecast the relative impact of different solutions for increasing physical activity among youth.

Concerning future directions, Frerichs expressed hope in strategies for enabling engaged systems thinking to focus on deeper, higher-impact leverage points. Referencing a continuum of increasingly greater leverage points in a system (see Figure 4-1), she remarked that leverage points at the farther end of that continuum have strong potential to create sustainable change and better address inequities relative to those at the lower end.

A SYSTEMS SCIENCE APPROACH TO EDUCATION AND HEALTH

Matt Kasman, assistant research director at the Brookings Institution Center on Social Dynamics and Policy, discussed the use of systems science approaches to explore links between education and health. He began by highlighting two prominent efforts that situate obesity in the context of broader systems of social life: the UK Foresight Group’s obesity systems map depicting the web of interconnected causal factors that affect the prevalence of obesity (see Figure 2-1 in Chapter 2), and the Lancet Commission’s depiction of the global syndemic of obesity, undernutrition, and climate change, which describes how influences at multiple levels and scales link these health and ecological outcomes (see Figure 4-2). Kasman narrowed his focus within the broader systems in these figures to the connections between education and health. He offered three categories into

which these connections can be placed and shared examples of systems science approaches in each category.

Kasman explained that the first category, direct relationships, includes the ways in which school environments and interactions in the school setting can impact student health, such as through access to healthy school meals and appropriate physical activity options. During the past decade or two, he remarked, many health-related systems science approaches have focused on or incorporated direct educational influences. He highlighted the National Institutes of Health (NIH)-funded COMPACT (Childhood Obesity Modeling for Prevention and Community Transformation) collaboration as a recent example, explaining that one of the key insights gained from that project is how community members from different settings, including educational institutions, can work together to effect meaningful changes that result in substantial and sustainable prevention of childhood obesity within their communities (Kasman et al., 2019; Korn et al., 2018). He suggested that COMPACT could be extended and emulated elsewhere to explore other influences on additional health outcomes.

Kasman then turned to the second category, indirect connections, or the ways in which educational outcomes relate to later health outcomes. As an example, he referenced a strong, consistent body of evidence indicating

that college attendance and completion can influence later employment, place of residence, and social connections, which in turn can have important health implications. He noted that much uncertainty exists with regard to how policies and programs can make access to higher education more equitable and reduce persistent attendance gaps overall, as well as at selected institutions, by race and socioeconomic status. He mentioned a research project that created an agent-based model of college enrollment to ask and answer such questions, commenting that it is one of relatively few efforts to use systems science approaches to disentangle the myriad determinants of educational outcomes (Reardon et al., 2018). He noted the considerable potential to expand on this project and undertake similar efforts to explore other educational outcomes and treatments.

Kasman continued by describing the third category, the causal influences of health on educational outcomes, as a nascent area for research. Because of the clear linkages between education and health, he explained, causal mechanisms in the opposite direction may represent important feedback loops that operate over the long term. He suggested that these feedback loops could be critical intervention points for improving population health outcomes and reducing disparities, adding that systems science approaches could help illuminate key dynamics, disentangle interconnected causal mechanisms, and identify promising policies and interventions to promote improved outcomes.

Kasman ended his presentation by suggesting three actions to facilitate the use of systems science approaches to help understand the complex, dynamic relationships among health, educational activities, and outcomes. The first is to advocate for and use appropriate, high-quality systems science approaches to explore education and public health connections, which he said could help build familiarity with and enthusiasm for such work. The second is to increase capacity for systems science approaches, such as by developing courses and promoting mentoring relationships between experienced and new researchers. Third, Kasman urged the development of a strong community of systems science modelers, researchers, policy makers, intervention experts, and practitioners who can share inputs and expertise from a variety of backgrounds.

PANEL DISCUSSION

Czaja moderated a panel discussion with the two speakers following their presentations. She began by asking Frerichs how the integration of engaged and participatory research with systems science approaches can be tailored for different audiences. Frerichs provided three suggestions for adapting this integrated approach. The first is to use the project’s goals and research questions as guideposts, she said, and adapt them as

needed when thinking about how the project activities will pursue those goals. Second, she pointed to bringing in additional critical theories and frameworks as lenses through which to view project activities and consider potential adaptations. Third, she advocated for early, equitable involvement of stakeholders in the development of project activities. Referring to the youth project she had described earlier, she mentioned experiencing tension related to overcoming the researchers’ influence, explaining that it took time and flexibility to elevate the youth voices and reject the biases she had regarding the relative importance of the contributions of the researchers and youth going into the project.

Czaja next asked Kasman to offer an explanation for the lag in the uptake of the use of systems science approaches to disentangle the relationships between education and health. Kasman pointed to what he called a supply and demand issue. He described the supply as the creation of opportunities to convene experts from multiple disciplines such as education, public health, and systems science approaches. He admitted that it is a challenge to convene the right combination of people, generate a productive discussion of potential systems science approaches, and then implement a specific method. With regard to demand, Kasman postulated that funders, large research organizations, publication venues, and policy makers will have heightened interest in systems science approaches as they become aware of the power and potential of those approaches to aid in examining complex issues. As these approaches reveal important linkages between education and health, he submitted, the demand for additional systems science research will grow.

Kasman also argued for the importance of both formal and informal means of collaboration and encouraged involving educators and students in systems thinking. As an example of cross-sector collaboration, he shared that school administrators and educators in San Francisco were willing to collaborate with him on his doctoral dissertation examining the relationships of school choice and student assignment policies with levels of racial segregation in schools. The education stakeholders provided valuable data and helped shape the research questions, he explained, noting that had his research involved a public health question, he would have needed to involve public health stakeholders to provide another layer of buy-in, content expertise, and data.

Finally, Czaja asked the two speakers for thoughts on integrating their approaches. Kasman suggested that the participatory nature of Frerichs’ approach could help elicit valuable research questions and insights for integration in a simulation model, and that data from single settings could be generalized to suggest what might work to achieve similar outcomes in different contexts. Frerichs echoed the notion that important linkages could be made between education and health, recalling that educational factors,

such as emotional stressors of school, have been raised in her work to support physical activity among youth.

AUDIENCE DISCUSSION

Following their panel discussion, Frerichs and Kasman answered workshop participants’ questions about engaging stakeholders in systems science approaches, cultivating diverse skill sets to succeed with those approaches, and addressing the potential for disparities due to virtual schooling and physical activity programs.

Engaging Stakeholders in Systems Science Approaches

Frerichs highlighted scripts for group model building, such as Scriptapedia,¹ in response to a request for resources with which to engage stakeholders in systems science approaches. She also mentioned the Creative Learning Exchange,² which aims to develop “systems citizens” in K–12 education, pointing to the potential use of its resources for engaging stakeholders in the education system. Kasman suggested engaging audiences by showing them the results of systems science approaches, such as dynamic visualizations. He highlighted two examples of these products: a resource focused on the effect of college subsidies on recipients’ enrollment,³ and the Tobacco Town modeling (see the summary of Douglas Luke’s presentation in Chapter 2). According to Kasman, these resources help stakeholders answer questions about which policies might work for their specific contexts, and then disseminate that information in a vivid way to generate enthusiasm.

Cultivating Diverse Skill Sets to Succeed with Systems Science Approaches

A workshop participant commented on the emerging challenge of an implied need for systems science researchers to have a range of skills, such as robust mathematics and computation abilities, as well as strengths in understanding people, including themselves. These are classically siloed skill sets, Czaja pointed out, and she asked Frerichs and Kasman to suggest solutions for overcoming unintended consequences of classic disciplinary boundaries. Frerichs voiced her own challenges with striving to build skills in multiple areas, and suggested the strategies of creating multidisciplinary teams and working with youth to build a pipeline of systems thinkers.

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¹ See https://en.wikibooks.org/wiki/Scriptapedia (accessed October 9, 2020).

² See www.clexchange.org (accessed September 17, 2020).

³ See www.brookings.edu/interactives/education-subsidies-code (accessed September 17, 2020).

Kasman stated that education and public health are areas in which traditional boundaries between quantitative and qualitative work are breaking down in a good way. He pointed to a growing understanding of the importance of using qualitative findings to build a sense of external validity and an intuition about how causal mechanisms operate, as well as a recognition of how quantitative methodologies can help identify tipping points and time scales.

Addressing the Potential for Disparities Due to Virtual Schooling and Physical Activity Programs

A workshop participant asked whether virtual fitness programs to encourage movement regardless of location or social or cultural background are an effective way to help the most vulnerable people. Frerichs related the question to the relationship between social distancing and health, saying that her work with youth has revealed the importance of social connections to being healthy and active. Kasman urged remaining alert to unintended consequences of virtual programs that could exacerbate existing disparities, referencing emerging evidence of a growing divide in educational progress and academic achievement due to widespread remote schooling amid the coronavirus disease 2019 (COVID-19) pandemic. Uninterrupted access to virtual learning supports is unevenly distributed among the population, he explained, and he advocated for more equitable access to resources and user supports. He pointed out as well that equitable access to virtual physical activity resources is an important aspect of preventing a worsening of disparities in that realm.

Czaja asked the speakers which factors contribute to remote schooling–induced disparities in educational outcomes. Kasman stressed that empirical evidence of such disparities is only now emerging, but suggested that they result from a confluence of factors. He mentioned in particular the reliability of Internet access, the conduciveness of the residential setting to learning (e.g., noise level, interruptions), and access to technology and user support for that technology. Frerichs agreed and appealed for approaching issues from an asset-based approach focused on leveraging community resilience and other strengths.

HUMANISTIC SYSTEMS SCIENCE TO FOSTER BEHAVIOR CHANGE

Eric Hekler, director of the Center for Wireless & Population Health Systems and associate professor in the Department of Family Medicine & Public Health at the University of California, San Diego, spoke about using systems science approaches to foster behavior change. Before starting his

presentation, he noted that the university resides on the unceded territory of the Kumeyaay Nation.

Hekler recalled a quote from Albert Einstein, “as simple as possible, but not simpler,” as he recounted the moment when he recognized the tremendous mismatch between the complexity of trying to help people live healthy lives and the randomized controlled trials being applied to the problem. He outlined three dimensions to consider with regard to behavior change: the importance of contextual factors, the dynamic nature of those factors, and the idiosyncratic nature of how different factors influence an individual. The complexity of these dimensions calls for solutions that are as simple as possible, he argued, but not simpler.

Heckler then turned to three lessons from his evolving thinking about advancing systems science approaches to match the complexity of human behavior change. First, he espoused a focus on verbs (i.e., dynamics, interconnectivity, and flows within and across systems) instead of nouns (i.e., interventions, levels, and outcomes). He elaborated on this lesson by giving an overview of control systems engineering, which he described as a large, pervasive field focused on dynamic decision making in complex environments. Control systems focus on the dynamics of each individual system involved in a process, he explained, and he gave the example of the role of a health coach as a control system for weight management. A health coach represents a theoretical model of health behavior change, he elaborated, and selects from a variety of tools to promote that change, such as goal setting or reward programs. Health coaches also have tools to help people monitor their activities, he noted, and can make adjustments based on how people respond.

Control systems use a technique called system identification to build dynamic models based on data from an actual person or other unit of interest, Hekler continued, and the models feed into simulations of how the person will respond in future scenarios. He used as an example that stress prompts some people to walk more and others to walk less, a difference that can be incorporated into a model. Because models specify decision points mathematically, he explained, they can account for changing contexts and honor interpersonal differences as they determine the best decisions over a specified timeline in order to reach a goal.

Hekler cautioned that an unintended consequence of building control algorithms is that they can manipulate people, a recognition that he said led him to his second lesson: whoever defines success and categories has the power. Such decisions are better left to the people being served by systems science tools, he maintained, and he urged opening innovation pathways for nontraditional researchers and experts to contribute to these tools. As an example, he described how a nonengineering colleague with type 1 diabetes working outside of her discipline was able to build and distribute the plans for an artificial pancreas system.

The third lesson, Hekler continued, is the importance of humanistic systems science training, which combines training in mathematics, computation, modeling, and algorithm development with the cultivation of humanistic scientists characterized by appropriate mindsets, processes, and interpersonal skills. Noting that scientists tend to have systematic biases and privileges, he shared his personal experience with overcoming what he called “confident ignorance and emotional blindness.” Recalling situations in which he stepped back and allowed nontraditional partners to drive efforts, he said the result was greater capacity to build equitable participation. Hekler espoused the qualities of curiosity, humility, and compassion as key ingredients for recognizing one’s biases and building awareness of others’ lived experiences. He urged attention to the processes of triangulation, study of root causes, and iteration, and advocated for building skills in fusion and defusion, listening, and synthesizing.

Another facet of the third lesson, Hekler continued, is that humanistic systems science would benefit from acting more like a GPS and less like a yardstick. The latter approach specifies an end goal, he explained, but dynamic systems are constantly managing inputs that warrant different goals based on the context. He urged that behavior change processes be attuned to context to determine what outcomes are most desirable under different circumstances (Schraefel and Hekler, 2020).

OBESITY-RELATED OPPORTUNITIES FOR SYSTEMS CHANGE IN COMMUNITIES

Erin Hennessy, assistant professor in the Friedman School of Nutrition Science and Policy at Tufts University, discussed the use of systems thinking and systems science approaches to advance community-level obesity prevention. An iceberg model is often used to explain systems thinking and systems change, Hennessy began, because it is an apt illustration of how a visible outcome, such as obesity, is the manifestation of an underlying collection of factors that lie below the surface (see Figure 4-3). She explained that these factors include trends (e.g., poor diet and inactivity), structures (e.g., policies, practices, resource flows), and relational aspects (relationships and connections, power dynamics) that drive obesity-related trends and events, as well as mental models, which she described as deeply held beliefs, assumptions, and operating styles that influence one’s thoughts, speech, and actions (Kania et al., 2018).

Hennessy noted that the structural, relational, and mental model elements exist with varying degrees of visibility to players in the system, yet typically play a significant role in such problems as obesity. Therefore, she argued, they are promising leverage points for effecting systems change. Although the less explicit factors (such as relationships and connections,

power dynamics, and mental models) are challenging to clarify, she maintained that their tremendous potential to shift a system warrants their consideration in efforts to effect change.

Hennessy next turned to discussing the promise of whole-of-community approaches for effecting systems changes to prevent obesity. These approaches are multilevel, multifaceted, and implemented holistically throughout an entire community, she explained, and target multiple levels of influence and behaviors through policy, practice, and resource flows. They have the potential to be effective and equitable when focused on structural components, she added, as well as when intervention strategies target a variety of contexts and when the community is engaged.

Hennessy cited community engagement as a key element of a second opportunity for systems changes to prevent obesity—leveraging community coalitions, which she described as groups of leaders and stakeholders from diverse organizations, settings, and sectors working collectively on a common objective within the local context, perhaps even within a whole-of-community approach. This combination is particularly promising, Hennessy asserted, because coalition members can devote energy and resources to implementing structural changes and share critical information and resources specific to local contexts. Furthermore, she noted, coalitions have been observed to collaborate, build relationships and community capacity, and plan and diffuse tailored interventions (Korn et al., 2018).

Hennessy described the Shape Up Somerville study as an example of a community-wide intervention that leveraged a community-based participatory research approach to make structural and relational changes to prevent obesity. She explained that the intervention’s policy and environmental changes were designed and diffused through a community coalition, the Shape Up Somerville Taskforce, and resulted in a significant decrease in body mass index (BMI) z-scores among children living in an intervention community (Hennessy et al., 2020). She then displayed a systems map of Somerville’s dynamics of community change, which she described as a qualitative systems modeling approach to visualizing the entire system’s interactions and success factors. She flagged the map’s inclusion of the stakeholders’ mental models with regard to underlying processes that drove the adoption, dissemination, implementation, and sustainability of the intervention (Hennessy et al., 2020).

Hennessy reported that the Shape Up Somerville systems map also alerted the investigators to the role of the Shape Up Taskforce in the intervention’s success (Hennessy et al., 2020). This realization helped articulate a new theory called stakeholder-driven community diffusion, she explained, which posits that community coalitions drive successful interventions by leveraging social network structures to diffuse their knowledge and engagement with the public health prevention effort across the broader community. That diffusion creates community readiness to implement and sustain change, Hennessy added, and mobilizes change agents who can catalyze bottom-up demand. She noted that efforts are under way to generate empirical evidence on the contributions of coalitions to whole-of-community interventions for improving childhood obesity outcomes.

Hennessy moved on to share a third opportunity for systems change at the community level: sharing and shifting mental models. Mental models inform decision-making processes, she stated, but if those models are not explicit, stakeholders may harbor different perspectives and beliefs about a problem and develop disparate, siloed solutions. Systems science approaches such as community-based system dynamics (CBSD) provide a method for involving communities in the process of understanding and changing systems. Hennessy explained that CBSD is a means of community capacity building and a technique for equalizing power among group members, enabling input from all participants and promoting group cohesion. She cited group model building as another approach for involving stakeholders in the modeling process, in which trained facilitators follow scripted group exercises to lead diverse stakeholders through a process of defining and eventually visualizing a complex and dynamic system, allowing them to develop and prioritize action steps and build connections across time and scale (Calancie et al., 2020).

Hennessy identified integrating systems science approaches as a fourth opportunity for community-level systems change, enabling expansion of the research questions that can be asked and yielding novel insights. She described her team’s use of multiple approaches to help understand the mechanisms by which community coalitions diffuse evidence-based interventions in a community (Hennessy et al., 2020). The team used systems mapping to generate an initial hypothesis, she recounted, then expanded that hypothesis to a full mechanistic theory that was tested with agent-based modeling.

Community-based system dynamics and group model building have been employed as intervention strategies, Hennessy continued, to guide multisector community coalitions through a process of extracting mental models, building collective understanding of a complex problem, and committing to actions to address the problem. She explained that her team’s agent-based model defines agents as community coalition stakeholders who possess knowledge, engagement, and position in a social network, which Hennessy said allows for a quantitative, computational strategy for understanding longitudinal change in these key metrics. She added that social network analysis is used to measure and test diffusion of the coalition’s knowledge and engagement.

In closing, Hennessy circled back to the iceberg model to reiterate how different systems science approaches facilitate a focus on the underlying elements that influence systems change (e.g., using social network analysis to study relational elements or group model building to explore mental models).

PANEL DISCUSSION

Eneli moderated a panel discussion with Hekler and Hennessy following their presentations, starting with a question about how and with whom power dynamics manifest within systems. She also asked for examples of systems science approaches that have been useful for addressing health equity in communities.

Hennessy referenced her training in community-based participatory research, which she said involves a perspective that all parties have expertise to contribute to addressing a complex problem such as obesity. She mentioned community-based system dynamics and group model building as systems science methods that her team has used with community coalitions across the United States, adding that researchers have had to be cognizant of their own biases to ensure that they are building sustainable capacity for the community to continue the work when researchers leave. She explained that researchers train coalition organizers and leaders in these methods and provide ongoing support so they can use the methods over time. She added that although these two methods help equalize power dynamics, tension exists as participants question each other’s inclusion in the process, the goals of the process, and what evidence-based strategies will be implemented.

Hekler cautioned that collective action can do harm even with the best intentions because people often do not realize the connections between generalization and colonization as constructs or recognize that micro-aggressions matter. He suggested that people could begin to recognize deep systemic issues by learning lessons from history, sociology, anthropology, and economics that focus on inequities. He suggested that building a safe space for others to provide feedback helps prevent people from propagating what he had referred to in his presentation as “confident ignorance,” and that such two-way conversations can be achieved by building safety and trust among participants. Referencing speakers who had reflected on their experiences that have imparted lessons for building humility, Hekler advocated for a commitment to values and virtues, as well as for building sufficient but not excess confidence in oneself so as to feel secure in conversations and have productive discussions.

AUDIENCE DISCUSSION

Next, Hekler and Hennessy responded to workshop participants’ questions about immutable versus evolving factors in systems, similarities and differences across communities as observed in experiences with community-engaged efforts to address obesity, and fusion and defusion skills.

Immutable Versus Evolving Factors in Systems

In response to a question about how researchers applying systems science approaches handle immutable factors, Hekler confirmed that some factors truly cannot be changed, but urged careful thought about the distinction between truly immutable and evolving factors. He suggested that some factors may appear immutable, but in reality are changing on a time scale that is slower than what the human mind typically encounters. He reiterated the importance of examining the dynamics of how factors are moving and changing. Hennessy concurred that tension exists in this area, noting that some systems models have been used to explore factors that have been framed by some researchers as nonmodifiable and by others as modifiable. She reiterated that combinations of systems science approaches are needed to tackle complex problems such as obesity.

Similarities and Differences Across Communities

Hennessy addressed a question about lessons learned from her work on the Shape Up Somerville initiative, stating that although no two communities are alike, sufficient similarities may exist across the contextual factors, practices, and policies that sustain obesity to produce a high-level

framework to guide the work of community coalitions like the Shape Up Somerville Taskforce. One aspect of such a framework, she noted, is to suggest which sectors and stakeholders are important to include in community coalitions. She also pointed to one similarity across communities—the ability to do powerful, dynamic work without substantial financial resources, instead leveraging relationships and resource flows to diffuse evidence-based interventions—while acknowledging that different contextual factors, such as political dynamics, certainly exist, and communities sometimes conceptualize problems differently.

Fusion and Defusion Skills

Another workshop participant asked Hekler to elaborate on his suggestion that scientists cultivate the skills of fusion and defusion. Hekler explained that the general concept involves cultivating the ability to fuse or defuse with one’s experiences. An example of fusing with one’s experience would be to say, “I am angry,” he said, whereas defusing the experience on multiple levels might look like saying, “I am having the experience of anger with others in my home.” The latter, higher-level perspective, he explained, allows people to see themselves as part of a system. He added that fusion is appropriate in certain situations, such as when trying to see oneself as part of a community or striving to be emotionally present with others, whereas other situations call for defusion, such as when examining the systemic biases that one may bring to a project. These skills go beyond simply trying to be objective, he maintained.