vision (with an accompanying set of interventions) for improving population health behaviors and health outcomes. Similarly, many research and evaluation questions seek to identify the best intervention or to examine interventions in the context of a single behavioral or health outcome. And, in the field, approaches to policy and practice change often reflect the interests of the institutions or organizations leading the efforts (e.g., government agencies, community-based organizations, or advocacy groups).
Current approaches tend to focus on individual rather than comprehensive interventions, to attribute changes in health behaviors and health outcomes to specific interventions instead of multiple or synergistic efforts, to not assess effectiveness and costs in terms of the collective value of multi-component intervention approaches, and to guide decisions about priorities and allocate resources intervention by intervention in line with these types of evidence. As such, prevailing approaches fall short in depicting the collective impact of community-based prevention efforts (Hanleybrown et al., 2012; Kania and Kramer, 2011).
However, there has been a growing amount of attention paid to new approaches to address these dynamic and complex systems (Homer and Hirsch, 2006; Luke and Stamatakis, 2012; Mabry et al., 2008; Madon et al., 2007). Examples include the community transformation grants from the Centers for Disease Control and Prevention (CDC); intervention and applied research efforts such as community-based participatory research; the dissemination and implementation research supported by the NIH National Heart, Lung, and Blood Institute and the Office of Behavioral and Social Sciences Research; and cross-sector and multidisciplinary interventions, such as the CDC Communities Putting Prevention to Work program and the Healthy Kids Healthy Communities program (BSSR/NIH, 2012; CDC, 2012a,b; Horowitz et al., 2009; NHLBI/NIH, 2012; RWJF, 2012).
Systems science methods have the potential for overcoming some of the problems with current approaches. Systems science is the study of “dynamic interrelationships of variables at multiple levels of analysis (e.g., from cells to society) simultaneously (often through causal feedback processes), while also studying the impact on the behavior of the system as a whole over time.”1 For purposes of this report, a system will refer to the interrelationships of relevant elements, resources, and processes that characterize community-based prevention. Systems science approaches excel at identifying nonlinear relationships, bidirectional feedback loops, time-delayed effects, emergent properties of systems, and oscillating system behavior (Mabry et al., 2010).
1 As defined by the Office of Behavioral and Social Sciences Research at the National Institutes of Health: http://obssr.od.nih.gov/scientific_areas/methodology/systems_science/index.aspx (accessed July 5, 2012).