Table 3.

Examples of coherent actions across the ASM

	Events	Structures	Goals	Beliefs
What we observe	These are the issues (behaviours and outcomes) that can be observed around us in the modern world, and are symptoms which arise from the system functioning as designed (both intentionally and unintentionally).	This relates to the underlying structures and patterns that cause the events to occur. This includes the organisation of the system; the structures, information flows, processes and relationships between parts of the system.	These are the goals, targets or ambitions that the system – or parts of the system – is working to achieve. Goals often drive the system to be structured as it is and therefore to work as it does.	These are the deeply held beliefs, norms, attitudes and values (i.e. the mindset) of the individuals and organisations within the system. They are the foundations that cause the system to keep functioning as it does, and are reflected in the system goals.
Actions at this level	Aim to suppress the immediate event. They do this by reacting quickly to the visible issues – i.e. ‘quick fixes’. Quite often these actions are needed, but will not address the underlying issues which cause the issue to arise (i.e. the structures, goals and beliefs).	Aim to reduce the number or severity of the events occurring. They do this by reshaping or redesigning the organisational or relational system structures, and therefore require an understanding for how the system works.	Aim to re-orientate the goals that the system is working towards. They do this by changing the beliefs of those people setting the system goals.	Aim to change how individuals and organisations (who influence how the system works) think about the problem. They do this by challenging and changing the deeply held beliefs, norms, attitudes and values within the system.
Example actions	1.1. LAs provide cycling training to school children.	1.2. The LA assesses and improves the walkability of the environment surrounding the schools.	1.3. Schools work with parents and community to set a shared goal to reduce short car journeys to school by 20% in next 5 years.	1.4. LA creates a working group to champion and promote active transport to senior leaders in the council.
	2.1. Families can attend free workshops to learn how to cook healthy food.	2.2. Regulations are introduced that require food manufacturers to reformulate ready meals.	2.3. Supermarket chains set mandatory targets for suppliers on the nutritional quality of products.	2.4. Supermarkets work with suppliers to demonstrate that healthier food options can maintain company profits.
	3.1. GPs refer adults with obesity to commercial weight management programmes.	3.2. Medical students receive mandatory training about the complexity of obesity.	3.3. Ensure that everyone, regardless of their health status, has access to a GP within one week.	3.4. Senior clinicians reinforce across healthcare settings that obesity is the product of complex adaptive systems.
Evaluating actions using the ASMa	Using 1.1 as an example: LA assess the cycling self-efficacy of school children. Also able to monitor the number of trips to school via active transport. May also monitor wider impacts on child’s educational attainment and engagement in class.	Using 2.2 as an example: Audit the alterations made to food regulations, and assess the impact of these regulations on (a) nutritional quality of products and (b) purchasing patterns of consumers. Ensure that unintended consequences are captured.	Using 3.3 as an example: Evaluate the number of people accessing their GP within 1 week. Assess the impact of this policy on patients, GPs, healthcare managers and administrative staff. Analyse patient data to understand equity of care.	Using 1.4 as an example: Interview senior leaders in the LA to determine their beliefs towards active transport, and whether these beliefs have changed due to intervention effort. Examine voting patterns of councillors with regards to active transport proposals.

ASM: Action Scales Model; LA: local government authority.

^aWhen evaluating actions within a system, evaluators must ensure that they evaluate the collective impact of the actions, and the implications of these actions on their interdependencies (i.e. the parts of the system that may also be affected by these actions).