Using Participatory Systems Modeling to Understand Community Influences on Cardiovascular Health

大约30%的心血管(CV)死亡率可以通过采用 健康行为，如规律的体育活动、健康的饮食和不吸烟。采用 这些行为受到患者所居住的社区环境和社区环境变化的影响 这些环境与心血管死亡率的差异有关。消除这些基于放置的 差异一直难以捉摸，因为一个社区由多个相互关联的部分组成， 包括物质和社会环境，这些环境进一步受到语境的影响 国家政策、城市化程度和社会经济地位等因素。因此，尽管在某些方面 物质和社会社区环境已经独立地与较低的简历相关联 发病率和死亡率，旨在改善单一因素的干预措施产生了不同的效果。这 提案要求为Brita Roy博士提供三年的支持，以在Complex完成有针对性的培训 系统建模--一组有效捕获这些动态社区关系的方法 -探索社区物理和社会环境变化的各种影响 在塑造简历健康相关行为方面有共同作用。这些方法是关键的工具 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进行干预，更好地预测结果 在测试昂贵的干预措施之前。 罗伊博士是一名获得董事会认证的普通内科医生，在工程学方面有很强的量化背景。 并具有促进健康行为的专业知识。该提案描述了一项职业发展计划 这将使罗伊博士能够发展建立团队模型的技能(即，参与式方法 建模开发)应用于理解复杂性所必需的两种互补方法 社区环境：(1)基于代理的建模，一种具有双向特征的方法 以及(2)系统动力学建模，这是一种捕捉 正、负动态反馈在众多社区因素之间循环。罗伊医生会发展成 这些方法技能和磨练的其他技能需要成为一名独立的调查员在 心血管健康结果研究专家哈兰·克鲁姆霍尔茨博士的指导；莱斯利·库里，一位 实施科学专家；Marcella Nunez-Smith，社区参与研究专家 和健康差距；以及小组建模专家玛格丽特·威克斯。初级阶段 导师克鲁姆霍尔茨博士一直是罗伊博士目前K12奖项的导师，并成功地 指导了多名K奖获得者。完成这一奖项将帮助罗伊博士实现她的长期目标 将自己确立为独立调查员，制定有效的干预措施 使用以资产为基础的参与式方法，减少个人简历健康方面的地域差异。这个 在本计划书中获得的知识和创建的模型将用于支持R21和R01 评估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。

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.