These results are based on two LC groups, but the CLD dynamics were coherent in both groups. Figure 1 (more readable in Kumu [50]) shows that the CLD consisted of 50 perceived connections between 35 variables describing both behaviors (e.g., provide LC input) and perceptions (e.g., open atmosphere in LC) (Additional file 5). Most importantly, 13 reinforcing feedback loops were found to strengthen initial LC experiences, and one balancing loop was found to counteract initial LC experiences.Footnote 1 The CLD included three themes, indicated by the colored diamonds: “Group dynamics in LC”, “Gaining insights through exchange in LC”, and “Conditions to execute LC actions”.

Fig. 1

Causal loop diagram about Learning Communities’ starting phase in five Dutch municipalities, 2022

Arrows with a solid line indicate positive polarity, meaning that the direction of change stays the same. In other words, when a cause was perceived to increase (was perceived to decrease), the effect also was perceived to increase (was perceived to decrease). Arrows with a dotted line indicate negative polarity, meaning that the direction of change becomes the opposite. In other words, when a cause was perceived to increase (was perceived to decrease), the effect was perceived to decrease (was perceived to increase). The color of the arrow indicates the theme to which it belongs. Variable names of the CLD appear in the written text in italic. See Kumu for the more readable CLD [50].

Group dynamics in LC

Several feedback loops within the theme “Group dynamics in LC”, partially overlapped and covered mostly different ways in which the LC may match with members’ desires, such as the variables research role in LC, right partners participate in the LC, LC is concrete, and open atmosphere in LC. The CLD revealed the importance of a democratic approach to decision making in the LC by more jointly arranging the LC, which was perceived to relate to members’ LC participation involvement and feeling committed to a common HWA LC goal, and consisted of three pathways.

First, when the LC was arranged jointly (i.e., the LC members and facilitator together) to a bigger extent, it was believed to result in more involved appropriate partners in the LC, which was perceived to result in more useful conversations with multidisciplinary members. This was perceived to result in both an increased importance of members’ HWA involvement and an increased feeling of commitment to a common HWA LC goal, the latter of which is illustrated by the following quote:

And of course we started with healthy weight. We have opened it up a bit by agreeing that we should not focus only on healthy weight, so I think we want to achieve the same goal together. And that is best for the citizens. So that’s going well and I think we are with a nice group of people.

Both an increased importance of members’ HWA involvement and an increased feeling of commitment to a common HWA LC goal was perceived to increase members’ motivation to execute actions, leading to more executed LC actions. This increased the LC input members provided and subsequently was perceived to led to a LC that was jointly arranged to a higher degree. All polarities described in the results section also apply the other way around, in this example meaning that when less LC input was provided, this was perceived to led to a LC that was jointly arranged to a lesser extent.

Second, the more the LC was jointly arranged, the more it was perceived that the LC matched with members’ wishes. A better match between the LC and members wishes resulted in a more open atmosphere within the LC, thereby increasing members’ LC participation involvement. Therefore, more useful conversations with members took place, increasing members’ feeling of commitment to a common HWA LC goal and consequently increasing members’ LC participation involvement. More useful conversations with multidisciplinary members was also perceived to increase the importance of HWA involvement, increasing members’ urgency to strengthen the HWA. Perceiving HWA involvement as more important, and feeling more commitment to a common HWA LC goal both were perceived to led to more motivation to execute LC actions, as illustrated by the following quote:

It helps. Yes, I mean, now I sit here again… I sit with like-minded people, so everyone also thinks it’s important that you are busy with lifestyle. … Otherwise, I’m a loner. And it feels like a kind of warm bath to be with people who also think: yes, I believe there is still a lot to be gained here.

This was perceived to led to more executed LC actions, then to providing more LC input, and consequently to more joint arrangement of the LC.

Third, jointly arranging the LC was also perceived to influence the role of research in the LC and the guidance provided by the facilitator. More specifically, if the LC was arranged with LC members to a higher degree, this was perceived to led to a smaller role for research in the LC (where research refers to a structured LC, e.g., using stickers to vote and set priorities). On the one hand, this resulted in a more open atmosphere in the LC, which subsequently was perceived to increase members’ LC participation involvement. On the other hand, a smaller research role in the LC resulted in less guidance provided by the facilitator, which increased the extent to which the LC was jointly arranged. Simultaneously, the less guidance the facilitator provided, the less the LC was perceived as efficient. This was perceived to increase the extent to which the LC was concrete (e.g., members had more possibilities to share examples and opinions), thereby increasing members’ LC participation involvement. This polarity also appeared the other way around, meaning that, when the LC was less concrete, this was perceived to decrease members’ LC participation involvement, as illustrated by the following quote: “I just get itchy from talking too much and not making things concrete enough, so yes, I find that difficult, so to speak.” The increased members’ LC participation involvement then was perceived to led to jointly arranging the LC more via the same variables as described in the second pathway (in the previous paragraph).

Lastly, although prominence of the municipality in the LC was not part of a feedback loop, it was perceived to inhibit the open atmosphere. This polarity also appeared the other way around, meaning that, when the municipality was less prominent in the LC, this was perceived to increase the open atmosphere. Another variable that was not part of a feedback loop was group size. Group size inhibited concreteness of the LC, meaning that, if the group size was bigger, the LC was perceived as less concrete.

Gaining insights through exchange in LC

The theme “Gaining insights through exchange in LC” emphasized the importance of high LC participation and useful conversations during LCs. The theme showed that when members felt more involved in LC participation, this was perceived to led to more useful conversations with multidisciplinary LC participants during LC meetings. On the one hand, more useful conversations were perceived to lead to feeling more connected to useful LC contacts, which resulted in better understanding how HWAs overlapped between municipalities and partners. On the other hand, when more members perceived their conversations as useful, this was perceived to led to more reflecting. This was perceived to lead to better understanding of HWA complexity (e.g., insights into HWA initiatives, HWA points of improvement), which also led to a better understanding of how HWAs overlapped between municipalities and HWA partners. These insights were perceived to lead to more formulated individual or shared LC actions, which further increased LC participation involvement.

Conditions to execute LC actions

LC actions included for instance brainstorming with members and applying tools in members’ own practice. The “Conditions to execute LC actions” theme described three pathways related to motivation to execute LC actions. First, the more LC actions were executed by members, the more they perceived LC output. This increased their motivation to execute LC actions, which then was perceived to lead to more executed LC actions.

Second, fewer executed LC actions was perceived to lead to the HWA being less effective, which was viewed as increasing overweight prevalence in the long term. This perception increased members’ perceived importance of HWA involvement, which then was perceived to increase their motivation to execute LC actions and therefore increased the executed LC actions, as illustrated by the following quote: “Then we are asked to participate, and we do so because we think it is important,” which thus balances the initial variable. This pathway illustrates that less executed LC actions were perceived to eventually stimulate more executed LC actions.

Third, the more members executed LC actions, the more they perceived to provide LC input, as illustrated by the following quote regarding an action to formulate a municipality-wide vision:

Well, with one another that shared vision or that shared framework [i.e., our shared LC action], next Monday we happen to get together again. … Actually formulating that together, setting it up, and taking it to the learning community next time and discuss it there, this is our view.

Members providing more LC input was perceived to result in a LC that was jointly arranged to a higher degree, which was believed to lead to a better match between the LC and members’ own work. This perception increased the extent to which members felt responsible for LC actions, thereby again increasing the extent to which members executed LC actions. Simultaneously, feeling responsible for LC actions also indirectly increased the LC actions executed by members through members being more involved in LC participation, resulting in more useful conversations with multidisciplinary LC participants and therefore was perceived to increase the importance of HWA involvement.

Lastly, several variables that were not part of a feedback loop were also perceived to influence the extent to which members executed LC actions. For example, some municipalities had a more operational municipal HWA policy (e.g., health was covered to a greater extent in municipal policies), which was believed to increase the extent to which LC actions were executed by members. This positive polarity between these variables also indicated that municipalities with less operational municipal HWA policy were perceived to inhibit the extent to which LC actions were executed, as indicated by the following quote:

Well, partly also the confirmation that there really needs to be a foundation before anything else can be built. This confirms once again that we still have to get a lot of things in order in [municipality name].

Interconnected themes

The themes were interconnected, which elucidates the importance of members setting the LC agenda and involving external HWA partners in LC action execution. More specifically, when members executed more LC actions, members also perceived to provide more LC input, which then was perceived to increase the extent to which the LC was jointly arranged. This was perceived to cause more appropriate partners to become involved in the LC, resulting in two pathways. First, more appropriate partners in the LC was perceived to lead to more useful conversations with multidisciplinary LC participants, which then led members to feel better connected to one another. This was perceived to result in a better understanding of how HWAs overlapped between municipalities and then led to the formulation of more LC actions. Second, more appropriate partner involvement in the LC was also perceived to increase the HWA knowledge in the LC, as illustrated by the following quote:

I think what I have gotten the most out of it [the learning community] so far actually is the input from those partners. What comes to their mind among certain questions and what do they think about certain things? And then I don’t really mean [names], because I actually do know it from them. But then especially those that are a little further away or the citizens who thought along.

This greater HWA knowledge in the LC was also perceived to increase the understanding of HWA complexity. Therefore, members involved more partners outside the LC during LC action execution. Both pathways were believed to further increase LC action execution, as also illustrated by the following quote:

You have then done a kind of quite extensive inventory and exploration together and perhaps put together some solutions. Then you really have to professionalize at that moment and really go involving parties and implementation in order to actually realize this and ensure that concrete actions are being taken in that municipality.