Urban Health and Society: Interdisciplinary Approaches to Research and Practice - Part 34 doc

This assess-ment can take place at a variety of levels, asking such questions as ■ Did the research lead to new understanding of an urban health problem that suggested new directions fo

developing exchanges where faculty and students as well as policymakers can move

between these settings through internships, sabbatical programs, or other

arrange-ments; and inviting policymakers to teach or advise research teams In many cases, the

trust and goodwill developed in one collaborative venture can provide a starting point

for subsequent efforts on other topics

Finally, universities can encourage faculty researchers to engage in interdisciplin-ary and policy research and to cross the research/advocacy divide by rewarding this

work through its promotion and tenure practices, pilot interdisciplinary research grant

programs, and the creation of academic spaces for interdisciplinary discussions and

research

EVALUATING IMPACT

The fi nal stage in the cycle for interdisciplinary work shown in Figure 12.1 is

evaluat-ing the impact of the changes that the research or intervention stimulated This

assess-ment can take place at a variety of levels, asking such questions as

■ Did the research lead to new understanding of an urban health problem that

suggested new directions for further research or for policy or practice?

■ Did the intervention contribute to improvements in population health or to more

health - promoting environments?

■ Did the research lead to new theoretical frameworks, methodological approaches,

or analytic strategies that offered researchers new tools or insights?

■ Did the process of interdisciplinary collaboration lead to new understanding of

how researchers can work together across disciplines, sectors, or institutions?

In several chapters, including Chapters Two, Five, Seven, and Eleven, the authors discuss these questions and offer lessons that their experiences suggest The

heteroge-neity of their conclusions refl ects both the particulars of the research problems and

studies they describe and analyze and the challenges of evaluating interdisciplinary

research In a recent review, Klein enumerated some of the unique issues in evaluating

interdisciplinary health research 33 These included the variability of research goals; the

variability of criteria and indicators for quality of research; the necessity of integrating

organizational, methodological, and epistemological components of a project; the

interaction of social and cognitive factors in collaboration; the challenges of

manage-ment and coaching an interdisciplinary team; the developmanage-ment of transparent processes

for iteration of models, theories, and fi ndings; and the development of fl exible but

consistent measures of impact and effectiveness that consider both intended and

unin-tended outcomes

Lest readers become overwhelmed by this daunting list of challenges, it is also true that for the most part evaluators of interdisciplinary research projects or processes

face the same scientifi c and logistical problems that evaluators of other types of

312 Using Interdisciplinary Approaches to Strengthen Urban Health Research

interventions face These include assuring validity, reliability, and generalizability

while at the same time acknowledging the importance of context Several recent

reviews provide an overview of these issues 34 , 35 , 36 , 37

Some approaches to evaluation may be particularly suitable to interdisciplinary health research These include portfolio evaluation, in which researchers assess a

vari-ety of interventions designed to reduce a problem; 38 health impact assessment, which

examines retrospectively or prospectively the health consequences of health and

non-health policies and programs; 39 and goal - free evaluation, which allows investigators to

consider unintended as well as intended effects 40 Future work on interdisciplinary

health research should carefully examine the value and costs of these emerging

approaches to evaluation

Finally, the results of evaluation studies provide feedback to all the stakeholders involved in the problem under study, providing an opportunity to redefi ne the problem

based on new understanding or changing contexts This fi nal step begins the cycle

again, emphasizing the dynamic and iterative dimensions of interdisciplinary urban

health research

WANTED: INTERDISCIPLINARY RESEARCHERS

AND PRACTITIONERS

In our view, more interdisciplinary approaches to public health research and practice

hold great promise for better understanding and reducing the complex health problems

that face people living in cities Both neophyte and experienced researchers and

stu-dents entering the fi elds that contribute to healthier urban populations will enhance

their potential to make contributions if they develop the capacity to use

interdisciplin-ary methods, concepts, and frameworks In our work as teachers, researchers, and

advocates, we are frequently asked, “ So how do I become an interdisciplinary

researcher? What can I do now to develop my skills and competencies? ” We close this

volume by offering some suggestions

First, we encourage aspiring researchers to practice crossing boundaries Perhaps one defi ning characteristic of an interdisciplinary researcher is someone who can

suc-cessfully cross multiple borders In the previous chapters, the authors describe how

they worked across a variety of divides, including institutions, service sectors, levels

of social organization, roles, translational stages, and disciplines Just as the White

Queen urged Alice in Wonderland to practice imagining impossible things, we urge

readers to practice looking at the problems they study from across one or more

bor-ders Questions that might stimulate such thinking include

■ What would this problem look like if I viewed it from another discipline, say, as

an epidemiologist rather than as a sociologist or as an urban planner rather than

as an anthropologist?

■ How would I approach this problem from another role, say, as a community

activist or a city offi cial rather than as a health researcher?

■ How would I approach it if I were based at a different type of institution, say, a

hospital rather than a university or a community organization rather than a health department?

■ What if I worked in a different sector, say, housing or education or environmental

protection rather than public health? What might look different to me from that perspective?

■ What new understanding would I gain from focusing on a different level of

organization? For example, what would I gain if I considered the biological pathways that contributed to overeating as well as the food industry practices that have been associated with obesity?

The White Queen encouraged Alice to develop her skills by imagining six impos-sible things before breakfast By engaging in similar thought exercises,

interdisciplin-ary aspirants can strengthen their capacity to think and act across the boundaries that

often constrain them

Second, researchers and practitioners would benefi t from some study of the meth-ods and theories of another discipline This need not require earning another graduate

degree in another discipline but simply some systematic introduction to the history,

theories, and methods of a second discipline By having a point of comparison,

research-ers gain insights into the limitations — and strengths — of their own discipline The goal

is not for sociologists to become epidemiologists but rather to understand more deeply

and specifi cally that the world looks different through other disciplinary eyes

Another way to achieve this goal is to bring together researchers and students from different disciplines to consider a single problem from different perspectives At

City University of New York, for example, we have offered a doctoral level course on

interdisciplinary research in urban health that examines the concept of health equity

and health disparities from different disciplinary perspectives

Third, those seeking to move beyond their home discipline can read widely out-side their own professional journals and books With the proliferation of scientifi c

journals and easy electronic access to a variety of information sources, it is hard enough

to stay current with one ’ s own discipline But immersing oneself in a single

disciplin-ary perspective can limit one ’ s ability to think creatively or to consider a problem from

another perspective One obvious starting point for this wider scan is the problem of

concern Thus, nutritionists studying diabetes or political scientists investigating

legis-lative approaches to controlling obesity can read in the medical, sociological,

anthro-pological, and epidemiological literatures to expand their understanding of the problem

and the methods used to study and intervene

Fourth, readers are encouraged to seek placements in interdisciplinary research teams The best preparation for doing interdisciplinary research is doing it By

com-pleting fi eld placements, fellowships, sabbaticals, or other temporary assignments

within existing teams, participants gain the experience and skills of working across

disciplines Several fellowship programs, including those sponsored by the Kellogg

Foundation, the Robert Wood Johnson Foundation, and several National Institutes of

314 Using Interdisciplinary Approaches to Strengthen Urban Health Research

Health initiatives, provide support for these placements Finding a mentor on this team

who is experienced in interdisciplinary work or, better yet, fi nding a few mentors who

are trained in different disciplines allows aspiring investigators to analyze their

experi-ences as they live them

Finally, we encourage students, researchers, and practitioners who want to move toward more interdisciplinary approaches to start that process today In this book, we

have shown that disciplinary/interdisciplinary is not a polarity but rather a continuum

Everyone who is working to improve the health of urban populations can take some

steps on that continuum Perhaps it means inviting someone from another discipline to

the next team meeting or expanding an advisory board to include more diverse roles or

considering interventions at other levels of organization, even if others will be assigned

implementation responsibilities By taking small steps to move from more disciplinary

to more interdisciplinary and assessing the success of these steps as they are carried

out, we may be able to create momentum for a more transformative change Ultimately,

these small steps can lead to a “ tipping point ” where the disciplinary eventually becomes

truly interdisciplinary

The chapters in this book show that it is possible for researchers, practitioners, community residents, public offi cials, and others to design, implement, and evaluate

interdisciplinary studies and interventions that can improve the health of urban

popu-lations We hope readers will join us in this quest

1 Choose a specifi c urban health problem that concerns you What are the

advantages and disadvantages of using unidisciplinary versus interdisciplinary approaches to addressing this problem?

In this chapter, we considered the central

themes that run through this volume Our

focus is on doing interdisciplinary

rese-arch and practice in urban health We seek

to help readers move from an

apprecia-tion of interdisciplinary research to a

capacity to do it — to apply the principles,

concepts, and skills described in the

pre-vious chapters and developed elsewhere

in recent years to their roles as urban

health professionals and researchers We

examined what we have learned about the

practical application of the approaches,

methods, and frameworks the authors of

previous chapters have described and how our readers can apply these lessons

in the settings in which they work We described several stages of interdisciplin-ary work — defi ning the problem, creating and implementing a research process, choosing partners, infl uencing policy and practice, and evaluating impact — and dis-cussed the key tasks and challenges in each stage We conclude by urging read-ers concerned with improving the health

of urban populations to begin the process

of moving from more disciplinary to more interdisciplinary research and practice

SUMMARY

2 How did the authors of Chapters Two, Seven, and Eight frame the problems

they were studying, and how did these decisions affect how they moved through the various stages of research described in this chapter?

3 Use the stages of interdisciplinary research shown in Figure 12.1 to design an

intervention to reduce type 2 diabetes in an African American urban neighbor-hood What information would you need to guide this process?

4 How will you use interdisciplinary approaches to urban health research and

intervention in your professional career? What obstacles might you encounter in using these methods and how might you overcome them?

NOTES

1 Kessel, F., Rosenfi eld, P L., and Anderson, N B., eds Expanding the Boundaries

of Health and Social Science: Case Studies in Innovation New York: Oxford

University Press, 2003

2 Committee on Facilitating Interdisciplinary Research Facilitating

Interdis-ciplinary Research Washington, D.C.: National Academies Press, 2005

3 Kessel, F., and Rosenfi eld, P L Toward transdisciplinary research: Historical

and contemporary perspectives American Journal of Preventative Medicine, 35,

no 2, Suppl (August 2008): S225 – 234

4 Hirsh - Hadorn, G., Hoffman - Riem, H., Biber - Klemm, S., et al., eds Handbook of

Transdisciplinary Research Springer, 2008

5 Higginbotham, N., Briceno - Leon, R., and Johnson, N Africa In Applying Health

Social Science: Best Practice in the Developing World, pp 99 – 100 London:

Zed, 2001

6 Higginbotham, N., Briceno - Leon, R., and Johnson, N Latin America In Applying

Health Social Science: Best Practice in the Developing World, pp 183 – 184

London: Zed, 2001

7 Higginbotham, N., Briceno - Leon, R., and Johnson, N Asia and the Pacifi c

In Applying Health Social Science: Best Practice in the Developing World,

pp 15 – 16 London: Zed, 2001

8 Rutter, M., and Plomin, R Pathways from science fi ndings to health benefi ts

Psychological Medicine (2008): 1 – 14

9 Dorfman, L., Wallack, L., and Woodruff, K More than a message: Framing

pub-lic health advocacy to change corporate practices Health Education & Behavior,

32, no 3 (2005): 320 – 336

10 Entman, R Framing: Toward a clarifi cation of a fractured paradigm Journal of

Communication, 43, no 4 (1993): 53 – 57

316 Using Interdisciplinary Approaches to Strengthen Urban Health Research

11 Narayan, K M., Boyle, J P., Thompson, T J., Sorensen, S W., and Williamson,

D F Lifetime risk for diabetes mellitus in the United States JAMA, 290, no 14

(2003): 1884 – 1890

12 Horowitz, C R., Colson, K A., Hebert, P L., and Lancaster, K Barriers to

buy-ing healthy foods for people with diabetes: Evidence of environmental

dispari-ties American Journal of Public Health, 94, no 9 (2004): 1549 – 1554

13 Brownson, R C., Haire - Joshu, D., and Luke, D A Shaping the context of health:

A review of environmental and policy approaches in the prevention of chronic

diseases Annual Review of Public Health, 27 (2006): 341 – 370

14 Haire - Joshu, D., and Fleming, C An ecological approach to understanding

con-tributions to disparities in diabetes prevention and care Current Diabetes Reports,

6, no 2 (April 2006): 123 – 129

15 Saegert, S., and Evans, G Poverty, housing niches, and health in the United

States Journal of Social Issues, 59 (2003): 569 – 589

16 Galea, S., Freudenberg, N., and Vlahov, D Cities and population health Social

Science & Medicine, 60, no 5 (March 2005): 1017 – 1033

17 Green, L W Public health asks of system science: To advance our evidence

based practice, can you help us get more practice - based evidence? American

Journal of Public Health, 96 (2006): 403 – 405

18 Leischow, S J., Best, A., Trochim, W M., Clark, P I., Gallagher, R S., Marcus,

S E., and Matthews, E Systems thinking to improve public health American

Journal of Preventative Medicine, 35, no 2S (2008): S196 – S203

19 Trochim, W M., Cabrera, D A., Milstein, B., Gallagher, R S., and Leischow,

S J Practical challenges of systems thinking and modeling in public health

American Journal of Public Health, 96, no 3 (2006): 538 – 546

20 Freudenberg, N Jails, prisons and the health of urban populations: Review of the

impact of the correctional system on community health Journal of Urban Health,

78 (2001): 214 – 240

21 Freudenberg, N., Daniels, J., Crum, M., Perkins, T., and Richie, B E Coming

home from jail: The social and health consequences of community reentry for

women, male adolescents, and their families and communities American Journal

of Public Health, 95 (2005): 1725 – 1736

22 Stokols, D., Hall, K L., Taylor, B K., and Moser, R P The science of team

sci-ence: Overview of the fi eld and introduction to the supplement American Journal

of Preventative Medicine, 35, no 2S (2008): S77 – S89

23 Metzler, M M., Higgins, D L., Beeker, C G., Freudenberg, N., et al Addressing

urban health in Detroit, New York City, and Seattle through community - based

participatory research partnerships American Journal of Public Health, 93,

no 5 (2003): 803 – 811

24 Israel, B A., Eng, E., Schulz, A J., and Parker, E A., eds Methods in Community

Based Participatory Research for Health San Francisco: Jossey - Bass, 2005

25 Minkler, M., and Wallerstein, N., eds Community - Based Participatory Research

for Health San Francisco: Jossey Bass, 2003

26 Klein, J T Interdisciplinarity: History, Theory and Practice Detroit, Mich.:

Wayne State University Press, 1990

27 Freudenberg, N., and Klitzman, S Teaching urban health In S Galea and

D Vlahov, eds., Handbook of Urban Health, pp 521 – 538 New York : Springer

Verlag, 2005

28 Piven, F F., and Cloward, R A Poor People ’ s Movements: Why They Succeed,

How They Fail New York: Vintage, 1979

29 Nathanson, C A Social movements as catalysts for policy change: The case of

smoking and guns Journal of Health Politics, Policy and Law, 24, no 3 (1999):

421 – 488

30 Brown, P., Zavestoski, S., McCormick, S., Mayer, B., Morello - Frosch, R., and

Gasior Altman, R Embodied health movements: New approaches to social

movements in health Social Health and Illness, 26, no 1 (2004): 50 – 80

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impact of four health - based social movements on health and social policies

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Wiley - Blackwell, 2005

33 Klein, J T Evaluation of interdisciplinary and transdisciplinary research: A

litera-ture review American Journal of Prev Med, 35, no 2, Suppl (2008): S116 – 123

34 Butterfoss, F D Process evaluation for community participation Annual Review

of Public Health, 27 (2006): 323 – 340

35 Evans, D B, Adam, T., Edejer, T T., Lim, S S., Cassels, A., and Evans, T G

WHO: Choosing Interventions That Are Cost Effective (CHOICE) millennium development goals team Time to reassess strategies for improving health in

devel-oping countries British Medical Journal, 331, no 7525 (2005): 1133 – 1136

36 Jackson, N., and Waters, E Guidelines for systematic reviews in health

promo-tion and public health taskforce Criteria for the systematic review of health

promotion and public health interventions Health Promotion International, 20,

no 4 (2005): 367 – 374

318 Using Interdisciplinary Approaches to Strengthen Urban Health Research

37 Ogilvie, D., Egan, M., Hamilton, V., and Petticrew, M Systematic reviews of

health effects of social interventions: 2 Best available evidence: How low should

you go? Journal of Epidemiology and Community Health, 59, no 10 (2005):

886 – 892

38 Sendi, P., Al, M J., Gafni, A., and Birch, S Portfolio theory and the alternative

decision rule of cost effectiveness analysis: Theoretical and practical

consider-ations Social Science & Medicine, 58 (2004): 1853 – 1855

39 Cole, B L., and Fielding, J E Health impact assessment: A tool to help policy

makers understand health beyond health care Annual Review of Public Health

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40 Scriven, M Prose and cons about goal - free evaluation American Journal of

Evaluation, 12, no 1 (1991): 55 – 62

In this glossary, we defi ne some of the key concepts and terms that are used in this book Because the book is intended

for students and researchers of different disciplines, we have included terms that are basic in some fi elds but may be

unfamiliar to those in other disciplines Interested readers should consult the endnotes at the end of this section for a

more detailed discussion of these terms Words in italics within defi nitions are also defi ned separately

Action research (or participatory action research) is a form of research that seeks to engage researchers and

participants in a collective process of refl ection, data collection, analysis, and action for the purposes of increasing

understanding and improving upon research practices and, in the case of public health, promoting participants ’

changes Public health advocacy is advocacy that is intended to change policies or practices that infl uence the

Allostatic load refers to the cumulative wear and tear on the body ’ s systems owing to repeated adaptation to

stressors 3 , 4

Analytic strategies describe various approaches to analyzing data Examples include logistic regression, stratifi

-cation, and searching for recurrent themes in interview transcripts Research methods usually refer to approaches

to collecting data, whereas analytic strategies are used to organize and interpret these data

Community - based participatory research (CBPR) is a collaborative approach to research that equitably

involves all partners in the research process and recognizes the unique strengths that each brings CBPR begins

with a research topic of importance to the community with the aim of combining knowledge and action for social

Conceptual models are used in research to theorize, explain, and predict complex relationships among variables

Culture describes the shared characteristics of a group of people, which may include patterns of health and social

behavior, beliefs, customs, traditions, artistic expression, and language

Developmental perspective (see Life course perspective )

Disciplines (academic) are branches of scholarly instruction that provide a structure through which successive

generations of students are trained and socialized Faculty carry out research, teaching, and administration within

these disciplines Examples include sociology, psychology, anthropology, biology, and chemistry Disciplines

provide systematic approaches to understanding the world and uncovering new knowledge Traditionally,

disci-plines have been considered separate and distinct from each other Among the elements required for the presence

of a discipline are the presence of a community of scholars, a tradition of inquiry, a mode of inquiry that defi nes

how data are collected and interpreted, requirements for what constitutes new knowledge, and the existence of a

Ecological models consider the interaction and integration of multiple infl uences at multiple levels of social

organization (e.g., individual, interpersonal, organizational, community, and societal) in attempting to understand

comes out of a recognition that the “ health of individuals and the community is determined relatively little by

320 Glossary

health care per se and far more by multiple other factors, and by their interactions These factors include biology

(e.g., genetics), the social and physical environment, education, employment, and behavior (e.g., healthy behaviors

economic systems, historical patterns of discrimination, public policies not related to health, and other societal

fac-tors exert infl uence on health and contribute to midlevel facfac-tors such as behavior, employment, and education

Embodiment describes the biological and social processes by which living conditions and social conditions “ get

Environment describes the complex of physical, chemical, biological, and social factors that act upon an

organ-ism or a population and ultimately determine its form and survival It also describes the aggregate of conditions

that infl uence the life of an individual or community

Environment, physical refers to the human - built environment as well as the air, water, plants and animals,

climate, and geological conditions that infl uence a population

Environment, social describes the structure and characteristics of relationships among people within a community

Components of the social environment include social networks, social capital, and social support

Environmental justice, as defi ned by the U.S Environmental Protection Agency, is “ the fair treatment and

mean-ingful involvement of all people regardless of race, color, national origin, culture, education, or income with

Essentialism is a philosophical concept that states that certain characteristics of a group are universal and not

dependent on context It is often contrasted with social constructionism

Framing is the process by which we select, emphasize, present, and communicate information in such a way

as to promote a particular problem defi nition, causal interpretation, moral evaluation, and/or treatment

Fundamental causes are root or primary explanations of a phenomenon or problem In public health, many

fundamental cause explanations focus on the primacy of social conditions as underlying causes of health

inequali-ties This line of inquiry comes in part from a recognition that socioeconomic gradients in nearly all health

to unequal distributions of resources and opportunities that put people “ at risk for risk ”

Geographic Information Sciences is a discipline grounded in geographic spatial analytic theory that provides

geographic information

Health disparities refer to gaps in the health status and quality of health care across racial (see race ), ethnic,

gender, and socioeconomic groups The U.S Department of Health and Human Services has defi ned health

disparities as “ population - specifi c differences in the presence of disease, health outcomes, or access to health

care ” One of the stated goals of Healthy People 2010 is the elimination of health disparities in the United States

Health equity describes the goal of reducing disparities in health or, in other words, achieving equity in health

among different population groups

Health promotion is defi ned by the World Health Organization as the process of enabling people to increase

Interdisciplinary research has been defi ned by the National Academy of Sciences as “ a mode of research by

teams or individuals that integrates information, data, techniques, tools, perspectives, concepts, and/or theories

from two or more disciplines or bodies of specialized knowledge to advance fundamental understanding or to