![]() System dynamics modeling offers great promise for examining and addressing persistent problems like HIV and other sexually transmitted infection (STI) epidemics. ![]() Social and public health scientists are increasingly interested in applying system dynamics theory to improve understanding of and to harness the forces of change within complex, multilevel systems that impact upon intervention implementation, effects, and sustainability ( Foster-Fishman & Behrens, 2007 Hawe et al., 2009 Hirsch, Levine, & Miller, 2007 Homer et al., 2010 Latkin et al., 2010 Meadows, 2008 Trickett et al., 2011). Effective interventions aimed at reducing high risk behavior, such as having unprotected sex with multiple partners or sharing syringes and other drug injection paraphernalia, must include strategies to address the broader social, political, and environmental context in which these risk behaviors occur ( Latkin et al., 2010 Trickett et al., 2011). Over 30 years of HIV prevention research has demonstrated the need to take an ecological approach in order to understand and address the complex, layered factors that both generate and can eliminate the epidemic globally and locally ( Evans & Lambert, 2008 Hawe, Shiell, & Riley, 2009 Latkin, Weeks, Glasman, Galletly, & Albarracin, 2010 Schensul & Trickett, 2009 Trickett, 2005 Trickett et al., 2011). We present the conceptual system dynamics model and discuss how further testing in this and other settings can inform future community interventions to reduce HIV and STIs. Multiple feedback loops in the sex-work establishments, women’s social networks, and the health organization responsible for implementing HIV/STI interventions in each town and at the town level directly or indirectly influenced the FC intervention. ![]() ![]() To build this conceptual model, we drew on our experiences and findings from this intensive, longitudinal mixed ethnographic and quantitative four-town comparative case study (2007–2012) of the sex-work establishments, the intervention conducted in them, and factors likely to explain variation in process and outcomes in the four towns. The model reflects factors and forces affecting the study’s intervention implementation and effects. We generated a system dynamics model of a multilevel intervention we conducted to promote female condoms (FC) for HIV/STI prevention among Chinese women in sex-work establishments. System dynamics modeling offers great promise for addressing persistent problems like HIV and other sexually transmitted epidemics, particularly in complex rapidly developing countries like China. Building a system dynamics model based on ethnographic case study has the advantage of using empirically documented contextual factors and processes of change in a real world and real time setting that can then be tested in the same and other settings. Social and public health scientists are increasingly interested in applying system dynamics theory to improve understanding and to harness the forces of change within complex, multilevel systems that affect community intervention implementation, effects, and sustainability.
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