Review and special article
Applied Social and Behavioral Science to Address Complex Health Problems

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Abstract

Complex and dynamic societal factors continue to challenge the capacity of the social and behavioral sciences in preventive medicine and public health to overcome the most seemingly intractable health problems. This paper proposes a fundamental shift from a research approach that presumes to identify (from highly controlled trials) universally applicable interventions expected to be implemented “with fidelity” by practitioners, to an applied social and behavioral science approach similar to that of engineering. Such a shift would build on and complement the recent recommendations of the NIH Office of Behavioral and Social Science Research and require reformulation of the research–practice dichotomy. It would also require disciplines now engaged in preventive medicine and public health practice to develop a better understanding of systems thinking and the science of application that is sensitive to the complexity, interactivity, and unique elements of community and practice settings. Also needed is a modification of health-related education to ensure that those entering the disciplines develop instincts and capacities as applied scientists.

Section snippets

The Prevailing Paradigm

Mabry et al.2 see a

growing recognition that the solutions to the most vexing public health problems are likely to be those that embrace the behavioral and social sciences as key players.

This places the onus for a solution on the shoulders of the most vexed of the sciences addressing the social complexities of emerging health problems. Mabry et al.2 conclude that

the simple, single-cause, single-discipline, and now, even single-level-of-analysis models—whether predominantly biomedical or

The Emergence of Complexity

The recognition of social determinants in health outcomes reflects much of the complexity inherent in public health and preventive medicine. As Toivanen and Modin14 observed about social determinants of health,

they vary across time and space, …they accumulate throughout the life course, and … they act on multiple levels in a society ranging from … social institutions and policies … [to] interpersonal social relationships and individual risk factors to … pathophysiologic bodily pathways.

Policy

The Need for New Science

The evolution of the social and behavioral sciences in both practice and philosophy differs from that of some physical sciences, such as engineering, which emphasizes application of multiple principles tailored to each unique situation. The prevailing, single-cause or conditional-probability research of social and behavioral health sciences aligned with biomedical science tradition seeks, by contrast, universal or highly generalizable results based on assumptions of linearity and on “all other

Systems Thinking and Applied Science

The increased emphasis on systems approaches has begun to highlight the fundamental difference between applied and basic science within the social and behavioral health field. In addition to the changes in design and methods discussed above, two other examples of systems thinking are worthy of note here. The first comes from the WHO report on Systems Thinking for Health Systems Strengthening.38 Although not widely circulated in the social and behavioral science literature, in November 2009, Dr.

Toward Applied-Science Approaches

Adopting an applied-science approach to the social and behavioral sciences in health has important implications for how we prepare researchers and practitioners. Current areas of training tend to be compartmentalized, with contrasts highlighted, rather than integrated. The call has been made40, 41 for more applied research, such as practice-based research, the training of reflective and “experimenting practitioners,” and attention to the synergies among types of interventions and hierarchies of

Conclusion

Current approaches to the social and behavioral aspects of preventive medicine and public health will continue to produce results with little generalizability, even though that is their professed hallmark and purpose. Scientific communities need to support the development and implementation of a more robust applied-science approach. High priority should be assigned to supporting such applied science and the pipeline by which a new generation of graduate and postgraduate scientist-practitioner

References (54)

  • R.I. Levy

    Overview 1980The Director's Report to the NHLBI Advisory Council

    Circulation

    (1982)
  • L.W. Green et al.

    Diffusion theory and knowledge dissemination, utilization, and integration

    Annu Rev Public Health

    (2009)
  • P.K. Whelton et al.

    Primary prevention of hypertension: clinical and public health advisory from the Committee on the National High Blood Pressure Education Program

    JAMA

    (2002)
  • L.W. Green

    Diffusion and adoption of innovations related to cardiovascular risk behavior in the public

  • G.R. Wilensky

    Developing a center for comparative effectiveness information

    Health Aff (Millwood)

    (2006)
  • C. Clancy et al.

    Patient-centered outcomes research institute: the intersection of science and health care

    Sci Transl Med

    (2010)
  • S.K. Kumanyika et al.

    Bridging the evidence gap in obesity prevention: a framework to inform decision making

    (2010)
  • F.S. Collins

    Research agenda: research opportunities and NIH

    Science

    (2010)
  • S. Toivanen et al.

    Social determinants of health at different phases of life

    Int J Behav Med

    (2011)
  • K.R. McLeroy et al.

    An ecological perspective on health promotion programs

    Health Educ Q

    (1988)

  • Who will keep the public healthy?Educating public health professionals for the 21st century

    (2003)
  • L.W. Green et al.

    Ecological foundations of health promotion

    Am J Health Promot

    (1996)
  • T.S. Kuhn

    The structure of scientific revolutions

    (1996)
  • A. Steckler et al.

    The importance of external validity

    Am J Public Health

    (2008)
  • E.A. Zerhouni

    Translational and clinical science—time for a new vision

    N Engl J Med

    (2005)

  • The third revolution: The convergence of the health sciences, physical sciences, and engineering

    (2011)

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