Transforming Community Health with Disruptive Innovations

Contextual factors create significant health disparities in prevalence, diagnosis, and treatment of the comorbid physical and mental health conditions that are typically managed in primary care settings. The current NIH Director’s unified strategy calls for moving beyond documenting such disparities to focus on a solution-oriented approach. There are shockingly few evidence-based interventions to address such contextual factors. New paradigms are needed to intervene on, and not just document, health disparities in primary care where behavioral health is managed. We propose to develop and test a transformative paradigm for translating basic behavioral and social science into new interventions to improve health disparities in primary care settings. The proposed paradigm is the first of its kind to integrate community-based participatory research, systems science, diffusion of innovation theory, and item response theory, leveraging an established framework of early phase translational behavioral and social science to rigorously define new strategies to address contextual factors within complex health systems and rigorously develop measures to assess impact. Addressing contextual factors in integrated primary care systems in the United States is an innovation that can be rigorously mapped using community-engaged systems science methods. This map identifies “inflection points” likely to result in the most impactful intervention targets, and then established pathways can be used to translate fundamental behavioral and social science discoveries into new interventions at these points. Systems science modeling can then simulate potential interventions and produce mathematical standards for intervention efficacy in future trials. This transformative paradigm will also detail innovative methods to develop efficient and effective measurement tools to ensure scientifically valid, measurable health outcomes as delineated in the unified strategy.