Last year, we first piloted Behavioural Systems Mapping (BSM) at DG:Cities and reflected on the experience in a blog exploring the methodology and our initial learnings from it. In a nutshell, BSM is a collaborative approach that brings together different stakeholders to map behaviours and drivers of behaviour within a system – the goal being a shared understanding of complex challenges and, building on this, the collective development of appropriate and effective solutions. From encouraging active travel choices and tackling loneliness among older adults to supporting young people’s digital wellbeing, the method can be applied to a broad range of issues. 

When we embarked on a large-scale trial of the method across five different neighbourhoods as part of the DSIT Digital Inclusion Fund, healthcare challenges were not our starting point.

Our focus was digital inclusion: community infrastructure, access to devices and connectivity, and the growing challenge of navigating increasingly digital public services. However, in every one of the five neighbourhoods we worked with, health sooner or later emerged as a cornerstone of the conversations around the table as well as the maps themselves. Participants in our workshops spoke frequently – and unprompted – about the interaction of health literacy and digital literacy, the effect of digital health systems such as the NHS app on digital inclusion, the growing administrative burden in digital-first systems, and the adverse health outcomes resulting from crisis-driven engagement.

We saw this as further evidence that it is, indeed, impossible to separate digital inclusion from equitable healthcare access. So when the opportunity arose to facilitate a BSM workshop at the LOTI Digital Inclusion Symposium in May, we were keen to tackle a health-related issue that interacts with digital inclusion: annual flu vaccine uptake among older adults in digital-first systems.

Compressing complexity into one hour

This workshop was something of an experiment. We previously ran the method across four workshops of two and a half hours each, with time in between sessions for reflection, iteration, and validation. At the Digital Inclusion Symposium, we condensed the process into a single one-hour workshop… with around four times the number of participants.

In other words, the resulting challenge was not only time but also scale: is it possible to aggregate a wide variety of expertise on digital inclusion while capturing nuance?

As it turns out – yes!

In just one hour, the group collectively mapped and reviewed a total of 32 behaviours and 22 drivers that influence annual flu vaccine uptake among digitally excluded older adults – including a hand-drawn sketch of a person screaming at a laptop, an experience we are likely all familiar with. Around the tables sat healthcare professionals, service designers and VCSE (Voluntary, Community, and Social Enterprise) representatives, many of whom work directly with digitally excluded people. Each participant brought a different perspective to the conversation that is reflected in the map.

What emerged on the map

Across four clusters of relevant actors in the system (service users, primary care frontline staff, service and system designers, and community intermediaries) participants highlighted the importance of informal support networks: friends and family members helping navigate digital systems, trusted community figures explaining confusing processes, and conversations at local events shaping attitudes towards vaccination. In fact, service users attending local events emerged as one of the most prioritised behaviours in the room, underlining the crucial role of offline social infrastructure. 

Another insight was that reassurance and continuity in face-to-face interactions with primary care frontline staff were seen as just as important as the digital infrastructure itself. Fragmented healthcare systems forcing residents to navigate multiple, disconnected platforms were named as crucial barriers; pleasant patient experiences and social networks promoting vaccine use as critical enablers.

Beyond individual behaviour

It is important to note that BSM is not intended to produce a complete or quantifiable model of reality. Instead, the methodology is designed to create space for different forms of expertise to interact and build on one another: frontline operational knowledge, service design perspectives and lived experience all come together into a visual system that surfaces nuances that are often difficult to capture through traditional engagement methods or quantitative analysis alone.

This feels particularly relevant in the context of healthcare. As the NHS embarks on its planned shift from hospitals into communities, digital systems become more and more embedded into everyday healthcare access. As a result, challenges such as vaccine uptake can no longer be understood solely through the lens of individual choice or responsibility – they exist within a complex system shaped by digital infrastructure, service design, and social networks.

From workshop exercise to practical tool

Importantly, the provisional map we created from our rapid mapping session should be understood as a starting point rather than as a finished product.

We attempted to showcase the value of the methodology under significant time constraints. While the rapid mapping process was in itself a valuable exercise to help a variety of different stakeholders develop a shared understanding of the issue, the map has not yet undergone the crucial next steps that would typically follow in a full BSM process. This includes, for example, reflection and refinement sessions, validation with residents and other stakeholders, or triangulation with geospatial data.

With further development, however, a map such as this one could prove a valuable strategic tool. Combined with behavioural frameworks, existing service data, and more detailed local insight, it could support local governments or healthcare providers to (1) identify leverage points in the system where relatively small interventions might produce wider systemic effects, and (2) design these interventions with local realities and idiosyncrasies in mind. It’s also important to keep in mind that, even after undergoing refinement and validation, Behavioural System Maps should not be viewed as finished products but as a living resource: the systems they represent are dynamic and continue to evolve – and so should the maps as new evidence emerges.

In summary, BSM offers something increasingly valuable for digital healthcare challenges: a way of rendering complexity visible instead of resorting to oversimplified narratives about hard-to-reach groups or individual responsibility and translating this complexity into action. BSM recognises that the issue often goes beyond whether someone wants to engage with healthcare services and shifts the focus onto whether the system around them makes engagement possible, easy, and beneficial to them in the first place.

Find the latest updates on our DSIT Digital Inclusion Fund work on our website.