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Shuffle methodological deck chairs or abandon theoretical ship? The complexity turn in injury prevention
  1. Sheree Bekker
  1. Department for Health, University of Bath, Bath, UK
  1. Correspondence to Sheree Bekker, Department for Health, University of Bath, Bath BA2 7AY, UK; s.bekker{at}

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Injury prevention theory, research, policy and practice have provided a rich basis for the consensus that injuries are not unavoidable ‘accidents’, but rather the result of predictable and preventable events.1–8 Yet unintentional injuries remain a leading cause of morbidity and mortality worldwide.9 Thus, there remains a persistent global burden of injury that appears resistant to the efforts of conventional science, and a growing recognition that injury is a complex problem requiring complex solutions.10–12

The move to systems thinking

In response to the recognition of this complexity, recent authors have noted the advantages of systems thinking approaches to injury prevention research.13–15 This shift holds that intrapersonal, interpersonal, organisational, community and societal determinants combine together into a highly complex ‘web of determinants’ that influences the likelihood of injury occurrence.13–16 Systems thinking thus offers much promise for further improvements in understanding injury and its prevention as a complex problem.

The move to systems thinking is a promising one. However, the growing support for systems thinking as a valid way to approach complex, intractable injury problems has an unintended unhelpful consequence. This being an overemphasis on the epistemological question of how multifactorialism is accounted for in research, and a corresponding underemphasis on the ontological considerations and assumptions we make about the world.

This dissonance in how complexity is understood and applied has been explored in a recent systematic review of systems thinking approaches in public health, which concluded that (1) close to half the papers identified by the review process are commentaries, (2) systems thinking in public health suffers from methodological weaknesses that need to be addressed, (3) …

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  • Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.

  • Competing interests None declared.

  • Patient consent Not required.

  • Provenance and peer review Not commissioned; externally peer reviewed.