Bauer Kyla L, Haapanen Krista A, Demeke Nathaniel, Fort Meredith P, Henderson Kamal H
Department of Health Systems, Management and Policy, Colorado School of Public Health, University of Colorado Anschutz Medical Campus, Aurora, CO, United States.
Department of Human and Organizational Development, Vanderbilt University, Nashville, TN, United States.
Front Cardiovasc Med. 2023 Jul 13;10:1216436. doi: 10.3389/fcvm.2023.1216436. eCollection 2023.
Marginalized communities shoulder a disproportionate burden of cardiovascular disease (CVD) driven by concentrated neighborhood social risk factors. We provide a case study of systems science application to address geographic CVD health disparities at the community level - informing the science of CVD health disparities research.
We conducted a two-phased, multi-methods needs assessment in the Denver, Colorado area. Phase I consisted of a social network analysis to map a two-mode network of existing CVD prevention interventions and their implementing organizations. In Phase II, group model building (GMB) sessions with key community, public health, and healthcare provider stakeholders, were utilized to identify and visualize community factors contributing to disparities in CVD risk, producing a consensus-based causal loop diagram.
Between May 2021 and June 2022, we conducted 24 virtual, semi-structured interviews in Phase I to describe CVD prevention interventions, and 7 virtual GMB sessions in Phase II to describe experiences of disparities in CVD risk. For the purposes of this paper, we focus on a subset of results for both phases. In Phase I we identified 89 active CVD prevention interventions, 29 of which addressed tobacco use. In Phase II, causal loop diagrams revealed root causes of disparities in CVD risk. We provide an example of a causal loop diagram that focuses on the community prevalence of tobacco use, identifying stress as a key underlying factor driving disparities. The integration of findings from both phases highlighted the alignment and misalignment between quit tobacco intervention goals and how they are being experienced in marginalized communities.
Systems science methods were useful to organize a large number of CVD prevention efforts, and evaluate the root causes of CVD health disparities in a high risk community. By integrating these two aspects, interventions may be reoriented to more effectively address the root causes of CVD health disparities.
边缘化社区因邻里集中的社会风险因素而承担着不成比例的心血管疾病（CVD）负担。我们提供了一个系统科学应用的案例研究，以解决社区层面的心血管疾病健康差异问题——为心血管疾病健康差异研究提供科学依据。
我们在科罗拉多州丹佛地区进行了一个两阶段的多方法需求评估。第一阶段包括社会网络分析，以绘制现有心血管疾病预防干预措施及其实施组织的双模网络。在第二阶段，与关键的社区、公共卫生和医疗服务提供者利益相关者进行了群体模型构建（GMB）会议，以识别和可视化导致心血管疾病风险差异的社区因素，生成基于共识的因果循环图。
在2021年5月至2022年6月期间，我们在第一阶段进行了24次虚拟的半结构化访谈，以描述心血管疾病预防干预措施，并在第二阶段进行了7次虚拟GMB会议，以描述心血管疾病风险差异的经历。在本文中，我们关注两个阶段结果的一个子集。在第一阶段，我们确定了89项积极的心血管疾病预防干预措施，其中29项涉及烟草使用。在第二阶段，因果循环图揭示了心血管疾病风险差异的根本原因。我们提供了一个因果循环图的示例，该图关注烟草使用的社区患病率，将压力确定为导致差异的关键潜在因素。两个阶段结果的整合突出了戒烟干预目标与它们在边缘化社区中的实际情况之间的一致和不一致之处。
系统科学方法有助于组织大量的心血管疾病预防工作，并评估高风险社区中心血管疾病健康差异的根本原因。通过整合这两个方面，干预措施可能会重新调整方向，以更有效地解决心血管疾病健康差异的根本原因。
