Читать книгу The Science of Health Disparities Research - Группа авторов - Страница 70

Researchers conducting studies that seek to understand or change health behavior today think globally and act locally. Recognized more frequently and more broadly today as central to achieving public health goals, behavioral determinants of health hold high places in the hierarchy of health variables capable of changing a population's health trajectory. Researchers' concerns, including obesity and smoking, are often shared worldwide, and today's mobile and electronic health (mhealth/ehealth) technologies not only make it possible for researchers to share findings but also to incorporate novel communication strategies to deliver in‐time messages about behavior to study participants. Smartphones and web applications belonging to former drug users in recovery programs may alert their owners to risks, warning them to avoid neighborhoods where they previously bought drugs. Similarly, weight‐conscious individuals may actively use health applications to help monitor daily activity, food and calorie intake, and heart rate.

The methods researchers employ to promote healthy behaviors, or to engage in prevention to reduce disease, include:

 surveillance, epidemiologic study, or other traditional public health tools;

 randomized controlled trials, ecological study, or another tested design;

 re‐analysis of existing data; and

 meta‐analyses or systematic reviews of completed investigations.

What the best studies have in common:

 attention directed at a prioritized problem (e.g., adolescent smoking);

 a commitment to the most rigorous design applicable (e.g., the randomized controlled trial);

 thoughtful statistical approach (e.g., particularly determining the size of the study group so that findings have statistical meaning);

 a team of dedicated and well‐trained investigators who may represent many disciplines (e.g., epidemiology, statistics, public health, medicine, nursing, and social work);

 recruitment that creates a representative subject population able to produce generalizable results; and

 a plan for prompt dissemination of findings and/or replication of successful interventions.

Some samples include:

 a randomized trial to test a physical activity intervention for Latinas;

 a statistical study to identify and characterize a minority population with high rates of colorectal cancer;

 a re‐analysis of national survey data to identify differences in behavioral factors and breast cancer status according to race and ethnicity; and

 an experiment with computer simulation to create a reliable model of behavior change.

A foundational premise must be a commitment to appreciating and respecting all aspects of the beliefs, values, and traditions of the communities of interest, and being responsible in obtaining the cultural competence to work with them. Any researcher needs to be concerned about the effect of participation on the community and whether necessary and sufficient support is available to communities to sustain any changed behavior introduced by an intervention.

This is especially true in terms of precision medicine and precision prevention. Making precision medicine and prevention available to large populations requires the participation and inclusion of a diverse patient population, and not just those who can afford it and have ready access to care. Most research data are extracted from uniform study populations composed largely of White men, though the minority population of the United States is approaching 40%. Members of these groups cannot fully benefit from advances in cancer treatment, especially in this era of precision medicine. Minority representation in clinical trials is less than 5%, and according to a review of clinical trials from 2000 to 2010, only 2.2% of participants were Latino [27]. This calls for a large area of improvement to empower minority communities toward positive attitudes and beliefs in research and clinical practices through increased promotion and knowledge of clinical trials, active participation in research protocols, and involvement in transdisciplinary and translational partnerships for better minority health outcomes.