Using Participatory Systems Modeling to Understand Community Influences on Cardiovascular Health

使用参与系统模型了解社区对心血管健康的影响

• 批准号: 9897647
• 负责人: Brita Roy
• 金额: $ 16.77万
• 依托单位: YALE UNIVERSITY
• 依托单位国家: 美国
• 财政年份: 2019
• 资助国家: 美国
• 起止时间: 2019-04-01 至 2022-03-31
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/9897647
• 关键词: Adoption; Affect; Award; Behavior; Biological Models; Cardiovascular Diseases; Cardiovascular system; Cause of Death; Censuses; Characteristics; Clinical Oncology Supplement (K12); Collaborations; Communities; Complex; Connecticut; Data; Development Plans; Engineering; Environment; Family; Feedback; Fostering; Frequencies; Geography; Goals; Green space; Health; Health Promotion; Health behavior; Individual; Internist; Intervention; Intervention Trial; Joints; Knowledge; Learning; Life; Link; Measures; Medicine; Mental Depression; Mentors; Methodology; Methods; Modeling; Morbidity - disease rate; Neighborhoods; Nonlinear Dynamics; Outcome; Outcomes Research; Patients; Perception; Personal Satisfaction; Physical activity; Physical environment; Play; Policies; Process; Public Health; Reporting; Request for Proposals; Research; Research Design; Research Personnel; Resources; Safety; Shapes; Social Environment; Social Interaction; Social support; Socioeconomic Status; Sum; System; Techniques; Testing; Time; Training; Translations; United States; Variant; Work; base; cardiovascular disorder risk; cardiovascular health; career development; community intervention; contextual factors; design; experience; follow-up; good diet; health disparity; implementation science; improved; indexing; intervention effect; member; model building; model development; mortality; optimism; prevent; response; skills; social; social norm; theories; tool; uptake; walkability

Approximately 30% of cardiovascular (CV) mortality is potentially preventable through the adoption of healthy behaviors, such as regular physical activity, healthy diet, and not smoking. Adoption of these behaviors is influenced by the community environments where patients reside and variation in these environments is associated with disparities in CV mortality. Eliminating these placed-based disparities has been elusive because a community is comprised of multiple interrelated parts, including the physical and the social environment, which are further influenced by contextual factors such as state policies, urbanicity, and socioeconomic status. As such, although aspects of the physical and social community environment have been independently associated with lower CV morbidity and mortality, interventions aiming improve a single one have had variable effects. This proposal requests three years of support for Dr. Brita Roy to complete targeted training in complex systems modeling – a set of methods that effectively captures these dynamic community relationships – to explore the various effects changes in the physical and social environments of a community together have in shaping CV health-related behaviors. These methods are critical tools for implementation science, as they enable the translation of current evidence towards real-world interventions by elucidating the mechanisms by which change occurs, better anticipating results before testing expensive interventions. Dr. Roy is a board-certified general internist with a strong quantitative background in engineering and with expertise in healthy behavior promotion. This proposal describes a career development plan that will allow Dr. Roy to develop skills in group model building (i.e., a participatory approach to model development) applied to two complementary methods necessary to understand the complexity of community environments: (1) agent- based modeling, a method that characterizes bidirectional resident-environment interactions; and (2) system dynamics modeling, a method that captures positive and negative dynamic feedback loops among many community factors. Dr. Roy will develop these methodologic skills and hone other skills needed to become an independent investigator under the guidance of Drs. Harlan Krumholz, an expert in CV health outcomes research; Leslie Curry, an expert in implementation science; Marcella Nunez-Smith, an expert in community-engaged research and CV health disparities; and Margaret Weeks, an expert in group model building. The primary mentor, Dr. Krumholz, has been Dr. Roy’s mentor on her current K12 award and has successfully mentored multiple K awardees. Completion of this award will help Dr. Roy achieve her long-term goal of establishing herself as an independent investigator who develops interventions to effectively mitigate place-based disparities in CV health using assets-based, participatory approaches. The knowledge gained and models created in this proposal will be used to support an R21 and an R01 proposal that estimate the most efficient set of interventions to achieve desired health outcomes in two local, low-resource communities.

大约30%的心血管（CV）死亡率可以通过采用 健康的行为，如定期的体育活动，健康的饮食，不吸烟。通过 这些行为受到患者居住的社区环境和 这些环境与CV死亡率的差异有关。消除这些基于位置的 差异是难以捉摸的，因为社区是由多个相互关联的部分组成的， 包括物理和社会环境，这进一步受到上下文的影响 国家政策、城市化和社会经济地位等因素。因此，尽管 物理和社会社区环境与低CV独立相关 尽管在发病率和死亡率之间存在着差异，但旨在改善其中一个方面的干预措施产生了不同的效果。这 一项提案要求为Brita Roy博士提供三年的支持，以完成复杂的有针对性的培训 系统建模-一套有效地捕捉这些动态社区关系的方法 - 探索一个社区的物质和社会环境变化的各种影响 共同塑造CV健康相关行为。这些方法是关键工具， 实施科学，因为它们能够将当前的证据转化为现实世界 通过阐明发生变化的机制，更好地预测结果， 在测试昂贵的干预措施之前。 博士罗伊是一个委员会认证的一般内科医生与工程的强大的定量背景 并在健康行为推广方面有专业知识。本建议书描述了职业发展计划 这将使罗伊博士发展小组模型构建的技能（即，参与式方法 模型开发）应用于理解复杂性所需的两种互补方法 基于Agent的建模方法，这种方法的特点是双向的， 居住环境的相互作用;（2）系统动力学建模，一种方法，捕捉 许多社区因素之间的正、负动态反馈回路。罗伊医生会发展出 这些方法学技能和磨练其他技能需要成为一个独立的调查员， 在心血管健康结果研究专家哈兰Krumholz博士的指导下， 执行科学专家; Marcella Nunez-Smith，社区参与研究专家 和CV健康差异;以及玛格丽特·威克斯，一位群体模型构建专家。主 导师Krumholz博士一直是Roy博士目前K12奖的导师，并成功地 多名K获奖者。完成这一奖项将有助于罗伊博士实现她的长期目标 将自己打造成一名独立调查员， 使用基于资产的参与式方法，减轻CV健康方面基于地点的差异。的 在本建议书中获得的知识和创建的模型将用于支持R21和R 01 估计实现预期健康结果的最有效干预措施的提案 在两个当地资源匮乏的社区