Integrating Systems Science and Community-Based Participatory Research to Achieve Health Equity

摘要

Unanswered questions about racial and socioeconomic health disparities may be addressed using community-based participatory research and systems science. Community-based participatory research is an orientation to research that prioritizes developing capacity, improving trust, and translating knowledge to action. Systems science provides research methods to study dynamic and interrelated forces that shape health disparities. Community-based participatory research and systems science are complementary, but their integration requires more research. We discuss paradigmatic, socioecological, capacity-building, colearning, and translational synergies that help advance progress toward health equity. Despite a research emphasis on addressing health disparities, there are persistent and widening gaps in health outcomes. 1 Research evidence has led to recognizing that interactions among biology, behaviors, socioeconomic status, and environments over time give rise to health disparities in a manner not easily understood or addressed using reductionist approaches (e.g., regression, randomized controlled trials). 2 There is a critical need for new research approaches that can improve knowledge about forces shaping health disparities and advance the translation of knowledge into action in real-world systems. Community-based participatory research (CBPR) is recognized for its capacity to effectively engage with communities suffering from health disparities. 3 CBPR includes the participatory and equitable involvement of community members and researchers, colearning processes and local capacity building, systems development that builds on community strengths, and empowering processes that achieve a balance between research and action. 4 This approach has produced many benefits, including improved research quality, increased dissemination, the implementation of interventions, and enhanced community and academic research capacity. 5 Minkler states, “CBPR is not a research method, but an orientation to research.” 6 (pS81) CBPR not only acknowledges complexity and the need to engage diverse perspectives, 6,7 but it also draws tools from other disciplines to understand or analyze the complex forces shaping health disparities. Systems science is an interdisciplinary field that involves a diverse array of theories and methodologies with the purpose of improving our ability to understand complex problems. 8 Complex problems are composed of heterogeneous and interacting parts that influence the overall behavior of the system in ways that cannot be easily reduced to a single (or even several) mechanism. 9 Systems science methods provide both structured qualitative and computational techniques to navigate complex systems. Qualitative techniques integrate relevant theory and experiential “mental models” to support transdisciplinary learning and collaboration. Computational techniques provide analytic tools to improve understanding of characteristics of complex problems, including changes over time, delays between cause and effect, nonlinear relationships, and feedback (i.e., “ripple effects” that are reinforced or balanced). 8 Although systems science is known for its potential to understand complexities associated with health disparities, 2 most systems science research in public health does not meaningfully focus on developing community capacity to address health challenges over time. CBPR and systems science have seldom been considered for their combined potential to address health disparities. 2,3 The fit between these diverse, but likely synergistic, approaches has been recognized with limited application to community development issues. 10–12 Public health can benefit from these efforts and advance the use of an approach that integrates CBPR and systems science. We introduce systems science and highlight its prospective synergy with CBPR.