Transdisciplinary Research to Solve Complex Public Health Problems: Identifying Unique Outcomes in Two National Institutes of Health-funded Transdisciplinary Initiatives

Abstract

Background: In research and academic institutions, health problems are commonly examined within the confines of a single discipline. Yet, a combination of various biological, genetic, social, and environmental factors influences public health problems, including obesity, cancer, cardiovascular disease and health disparities. In this setting, it is necessary to involve transdisciplinary teams—those with a wide range of disciplinary expertise who must often work across operational, disciplinary, and institutional boundaries—to holistically understand the complexities of public health problems and their solutions. Transdisciplinary collaborations can comprehensively address complex public health challenges by examining all facets of the health domain from basic biology to public health impact. Transdisciplinary research methods are relatively new to public health, and although conceptual frameworks have been developed for transdisciplinary research that addresses environmental problems, none have been adapted or developed for transdisciplinary public health research. The overall goal of the proposed research is to investigate the field of transdisciplinary research for public health challenges using as our model two NIH-funded initiatives, the Transdisciplinary Research on Energetics and Cancer (TREC) and Centers for Population Health and Health Disparities (CPHHD) initiatives. Methods: This dissertation utilizes a multi- and mixed-method approach to assess contexts and outcomes of transdisciplinary research in two center grant initiatives funded by the NIH between 2010-2016. First, I employed a sequential mixed-method approach that involved a web-based survey, semi-structured interviews, and focus groups to establish collaborative transdisciplinary outcomes and assess perceptions of the public health impact of the outcomes among participating investigators in the TREC initiative. Second, I used longitudinal quantitative survey data collected from TREC investigators four times over a 5-year period to assess changes over time in attitudes towards and behaviors that promote transdisciplinary collaboration. I used linear mixed models with fixed and random effects to assess how changes differed by career stage and primary discipline. Third, I used a multi-method parallel convergent study design and applied constant comparative analysis to document data and semi-structured interviews to compare context and outcomes between TREC and CPHHD. Results: In 2014, twenty-three invited TREC members completed a web-based survey and 26 participated in a semi-structured interview. Investigators described nine outcomes they perceived to result from their transdisciplinary collaborations in TREC: 1) new transdisciplinary team and consortia formation; 2) integrated theoretical framework development; 3) multi-level intervention model development and testing; 4) development and adaptation of relevant statistical models; 5) translation of findings across levels of influence; 6) public policy influence; 7) transdisciplinary manuscript publication; 8) transdisciplinary grant awards; and 9) training the next generation of transdisciplinary researchers. Although the outcomes identified were similar to those expected from non-transdisciplinary approaches, they are distinguished by their involvement of team members representing diverse disciplines, reliance on integrated theoretical frameworks, and a social-problem-oriented focus. In 2011-2015, between 57 (2015) and 78 (2011) TREC investigators completed a survey regarding behavior and attitudes towards collaborative transdisciplinary research. Transdisciplinary orientation, interpersonal collaboration, participation in collaborative activities scale scores increased at a constant rate across disciplines and career stages over time. Compared to senior career investigators, early career investigators had significantly lower scores on transdisciplinary orientation, interpersonal collaboration, and participation in collaborative activities. In 2015-2016, 51 TREC and CPHHD investigators participated in a semi-structured interview. Multiple and similar transdisciplinary outcomes emerged from the efforts of TREC and CPHHD investigators, but the nature of those outcomes and the contexts that supported them differed between initiatives. Interview and document analyses revealed two thematic areas six sub-themes. The thematic area culture shifts includes three sub-themes: scientific community awareness, institutional commitment, and collaborative partnerships and sustainability. The thematic area integrative and innovative products also includes three sub-themes: integrated theoretical frameworks, multilevel models, and transdisciplinary training. Conclusion: The comprehensive set of transdisciplinary outcomes established in this dissertation, combined with the understanding of attitudes, behaviors, and contexts that influence transdisciplinary collaboration offer the public health research and practice community three tools to advance transdisciplinary research. First, the work proposes a conceptual framework for planning and evaluation of transdisciplinary research to address public health problems. Second, it demonstrates the diverse data sources and analytic techniques that can be used to evaluate such initiatives. Finally, it provides evidence regarding how and where to invest in and prioritize resources in a transdisciplinary initiative for the greatest potential of achieving desired outcomes.