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: 10162320
• 负责人: Brita Roy
• 金额: $ 16.67万
• 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 2022-05-31
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/10162320
• 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 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 engaged research; community engagement; community intervention; contextual factors; design; experience; follow-up; good diet; health disparity; implementation science; implementation tool; improved; indexing; intervention effect; member; model building; model development; mortality; optimism; prevent; response; skills; social; social norm; theories; 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来预防 健康的行为，例如定期体育锻炼，健康饮食和不吸烟。采用 这些行为受患者居住和差异的社区环境的影响 这些环境与简历死亡率的差异有关。消除这些基于这些放置的位置 差异是难以捉摸的，因为一个社区包括多个相互关联的部分， 包括身体和社会环境，这些环境进一步受到上下文的影响 国家政策，城市性和社会经济地位等因素。因此，尽管 物理和社会社区环境与较低的简历独立相关 发病率和死亡率，干预措施的目的改善单一的效果。这 建议要求Brita Roy博士完成三年的支持，以完成复杂的目标培训 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中的各种影响变化 共同塑造与简历健康相关的行为。这些方法是关键的工具 实施科学，因为它们能够将当前证据转化为现实世界 通过阐明发生变化的机制来进行干预，更好地预期结果 在测试昂贵的干预措施之前。 Roy博士是一位经过董事会认证的普通国际医生，具有强大的工程背景 并具有在健康行为促进方面的专业知识。该建议描述了一项职业发展计划 这将使罗伊博士能够发展小组模型建设的技能（即参与方法 用于建模开发）应用于需要的两种完善方法，以了解复杂性 社区环境：（1）基于代理的建模，一种字符双向的方法 居民与环境相互作用； （2）系统动态建模，一种捕获的方法 许多社区因素之间的积极和负面动态反馈循环。罗伊博士将发展 这些方法论技巧和尊重其他技能才能成为独立研究者 博士的指导。简历健康结果研究专家Harlan Krumholz；莱斯利·库里（Leslie Curry） 实施科学实验； Marcella Nunez-Smith，社区参与研究专家 和简历健康差异；和玛格丽特·周（Margaret Weeks），是团体模型建设专家。主要 导师Krumholz博士一直是Roy博士当前K12奖的导师，并已成功 指导了多个K获奖者。该奖项的完成将有助于罗伊博士实现她的长期目标 建立自己是独立研究者，他们开发干预措施以有效 使用基于资产的参与方法来减轻CV健康中基于地方的差异。这 获得的知识和本提案中创建的模型将用于支持R21和R01 提案估算最有效的干预措施以实现所需的健康结果 在两个本地低资源社区中。

项目成果

Can a collective-impact initiative improve well-being in three US communities? Findings from a prospective repeated cross-sectional study.

• DOI: 10.1136/bmjopen-2020-048378
• 发表时间: 2021-12-22
• 期刊: BMJ open
• 影响因子: 2.9
• 作者: Riley C;Roy B;Lam V;Lawson K;Nakano L;Sun J;Contreras E;Hamar B;Herrin J
• 通讯作者: Herrin J

Trends and geographical variation in population thriving, struggling and suffering across the USA, 2008-2017: a retrospective repeated cross-sectional study.

• DOI: 10.1136/bmjopen-2020-043375
• 发表时间: 2021-07-14
• 期刊: BMJ open
• 影响因子: 2.9
• 作者: Riley C;Herrin J;Lam V;Hamar B;Witters D;Liu D;Krumholz HM;Roy B
• 通讯作者: Roy B

Trends and Variation in the Gap Between Current and Anticipated Life Satisfaction in the United States, 2008-2020.

2008-2020 年美国当前生活满意度与预期生活满意度之间差距的趋势和变化。

• DOI: 10.2105/ajph.2021.306589
• 发表时间: 2022
• 期刊: American journal of public health
• 影响因子: 12.7
• 作者: Riley,Carley;Herrin,Jeph;Lam,Veronica;Parsons,AllisonA;Kaplan,GeorgeA;Liu,Diana;Witters,Dan;Krumholz,HarlanM;Roy,Brita
• 通讯作者: Roy,Brita

The association of neighborhood walkability with health outcomes in older adults after acute myocardial infarction: The SILVER-AMI study.

• DOI: 10.1016/j.pmedr.2021.101391
• 发表时间: 2021-09
• 期刊: Preventive medicine reports
• 影响因子: 2.8
• 作者: Roy B;Hajduk AM;Tsang S;Geda M;Riley C;Krumholz HM;Chaudhry SI
• 通讯作者: Chaudhry SI

Five-Year Mortality among Americans Incarcerated in Privatized Versus Public Prisons: the Mortality Disparities in American Communities Project.

被监禁在私有监狱与公立监狱的美国人的五年死亡率：美国社区的死亡率差异项目。

• DOI: 10.1007/s11606-020-06057-w
• 发表时间: 2020
• 期刊: Journal of general internal medicine
• 影响因子: 5.7
• 作者: Hawks,Laura;Cosgrove,Candace;Neiman,Mathew;Roy,Brita;Wildeman,Christopher;Coady,Sean;Wang,EmilyA
• 通讯作者: Wang,EmilyA