Evaluating Impact 311 developing exchanges where faculty and students as well as policymakers can move between these settings through internships, sabbatical programs, or other arrange- ments; and inviting policymakers to teach or advise research teams. In many cases, the trust and goodwill developed in one collaborative venture can provide a starting point for subsequent efforts on other topics. Finally, universities can encourage faculty researchers to engage in interdisciplin- ary and policy research and to cross the research/advocacy divide by rewarding this work through its promotion and tenure practices, pilot interdisciplinary research grant programs, and the creation of academic spaces for interdisciplinary discussions and research. EVALUATING IMPACT The fi nal stage in the cycle for interdisciplinary work shown in Figure 12.1 is evaluat- ing the impact of the changes that the research or intervention stimulated. This assess- ment can take place at a variety of levels, asking such questions as ■ Did the research lead to new understanding of an urban health problem that suggested new directions for further research or for policy or practice? ■ Did the intervention contribute to improvements in population health or to more health - promoting environments? ■ Did the research lead to new theoretical frameworks, methodological approaches, or analytic strategies that offered researchers new tools or insights? ■ Did the process of interdisciplinary collaboration lead to new understanding of how researchers can work together across disciplines, sectors, or institutions? In several chapters, including Chapters Two, Five, Seven, and Eleven, the authors discuss these questions and offer lessons that their experiences suggest. The heteroge- neity of their conclusions refl ects both the particulars of the research problems and studies they describe and analyze and the challenges of evaluating interdisciplinary research. In a recent review, Klein enumerated some of the unique issues in evaluating interdisciplinary health research. 33 These included the variability of research goals; the variability of criteria and indicators for quality of research; the necessity of integrating organizational, methodological, and epistemological components of a project; the interaction of social and cognitive factors in collaboration; the challenges of manage- ment and coaching an interdisciplinary team; the development of transparent processes for iteration of models, theories, and fi ndings; and the development of fl exible but consistent measures of impact and effectiveness that consider both intended and unin- tended outcomes. Lest readers become overwhelmed by this daunting list of challenges, it is also true that for the most part evaluators of interdisciplinary research projects or processes face the same scientifi c and logistical problems that evaluators of other types of c12.indd Sec5:311c12.indd Sec5:311 6/3/09 12:07:58 PM6/3/09 12:07:58 PM 312 Using Interdisciplinary Approaches to Strengthen Urban Health Research interventions face. These include assuring validity, reliability, and generalizability while at the same time acknowledging the importance of context. Several recent reviews provide an overview of these issues. 34 , 35 , 36 , 37 Some approaches to evaluation may be particularly suitable to interdisciplinary health research. These include portfolio evaluation, in which researchers assess a vari- ety of interventions designed to reduce a problem; 38 health impact assessment, which examines retrospectively or prospectively the health consequences of health and non- health policies and programs; 39 and goal - free evaluation, which allows investigators to consider unintended as well as intended effects. 40 Future work on interdisciplinary health research should carefully examine the value and costs of these emerging approaches to evaluation. Finally, the results of evaluation studies provide feedback to all the stakeholders involved in the problem under study, providing an opportunity to redefi ne the problem based on new understanding or changing contexts. This fi nal step begins the cycle again, emphasizing the dynamic and iterative dimensions of interdisciplinary urban health research. WANTED: INTERDISCIPLINARY RESEARCHERS AND PRACTITIONERS In our view, more interdisciplinary approaches to public health research and practice hold great promise for better understanding and reducing the complex health problems that face people living in cities. Both neophyte and experienced researchers and stu- dents entering the fi elds that contribute to healthier urban populations will enhance their potential to make contributions if they develop the capacity to use interdisciplin- ary methods, concepts, and frameworks. In our work as teachers, researchers, and advocates, we are frequently asked, “ So how do I become an interdisciplinary researcher? What can I do now to develop my skills and competencies? ” We close this volume by offering some suggestions. First, we encourage aspiring researchers to practice crossing boundaries. Perhaps one defi ning characteristic of an interdisciplinary researcher is someone who can suc- cessfully cross multiple borders. In the previous chapters, the authors describe how they worked across a variety of divides, including institutions, service sectors, levels of social organization, roles, translational stages, and disciplines. Just as the White Queen urged Alice in Wonderland to practice imagining impossible things, we urge readers to practice looking at the problems they study from across one or more bor- ders. Questions that might stimulate such thinking include ■ What would this problem look like if I viewed it from another discipline, say, as an epidemiologist rather than as a sociologist or as an urban planner rather than as an anthropologist? ■ How would I approach this problem from another role, say, as a community activist or a city offi cial rather than as a health researcher? c12.indd Sec5:312c12.indd Sec5:312 6/3/09 12:07:58 PM6/3/09 12:07:58 PM Wanted: Interdisciplinary Researchers and Practitioners 313 ■ How would I approach it if I were based at a different type of institution, say, a hospital rather than a university or a community organization rather than a health department? ■ What if I worked in a different sector, say, housing or education or environmental protection rather than public health? What might look different to me from that perspective? ■ What new understanding would I gain from focusing on a different level of organization? For example, what would I gain if I considered the biological pathways that contributed to overeating as well as the food industry practices that have been associated with obesity? The White Queen encouraged Alice to develop her skills by imagining six impos- sible things before breakfast. By engaging in similar thought exercises, interdisciplin- ary aspirants can strengthen their capacity to think and act across the boundaries that often constrain them. Second, researchers and practitioners would benefi t from some study of the meth- ods and theories of another discipline. This need not require earning another graduate degree in another discipline but simply some systematic introduction to the history, theories, and methods of a second discipline. By having a point of comparison, research- ers gain insights into the limitations — and strengths — of their own discipline. The goal is not for sociologists to become epidemiologists but rather to understand more deeply and specifi cally that the world looks different through other disciplinary eyes. Another way to achieve this goal is to bring together researchers and students from different disciplines to consider a single problem from different perspectives. At City University of New York, for example, we have offered a doctoral level course on interdisciplinary research in urban health that examines the concept of health equity and health disparities from different disciplinary perspectives. Third, those seeking to move beyond their home discipline can read widely out- side their own professional journals and books. With the proliferation of scientifi c journals and easy electronic access to a variety of information sources, it is hard enough to stay current with one ’ s own discipline. But immersing oneself in a single disciplin- ary perspective can limit one ’ s ability to think creatively or to consider a problem from another perspective. One obvious starting point for this wider scan is the problem of concern. Thus, nutritionists studying diabetes or political scientists investigating legis- lative approaches to controlling obesity can read in the medical, sociological, anthro- pological, and epidemiological literatures to expand their understanding of the problem and the methods used to study and intervene. Fourth, readers are encouraged to seek placements in interdisciplinary research teams. The best preparation for doing interdisciplinary research is doing it. By com- pleting fi eld placements, fellowships, sabbaticals, or other temporary assignments within existing teams, participants gain the experience and skills of working across disciplines. Several fellowship programs, including those sponsored by the Kellogg Foundation, the Robert Wood Johnson Foundation, and several National Institutes of c12.indd Sec6:313c12.indd Sec6:313 6/3/09 12:07:59 PM6/3/09 12:07:59 PM 314 Using Interdisciplinary Approaches to Strengthen Urban Health Research Health initiatives, provide support for these placements. Finding a mentor on this team who is experienced in interdisciplinary work or, better yet, fi nding a few mentors who are trained in different disciplines allows aspiring investigators to analyze their experi- ences as they live them. Finally, we encourage students, researchers, and practitioners who want to move toward more interdisciplinary approaches to start that process today. In this book, we have shown that disciplinary/interdisciplinary is not a polarity but rather a continuum. Everyone who is working to improve the health of urban populations can take some steps on that continuum. Perhaps it means inviting someone from another discipline to the next team meeting or expanding an advisory board to include more diverse roles or considering interventions at other levels of organization, even if others will be assigned implementation responsibilities. By taking small steps to move from more disciplinary to more interdisciplinary and assessing the success of these steps as they are carried out, we may be able to create momentum for a more transformative change. Ultimately, these small steps can lead to a “ tipping point ” where the disciplinary eventually becomes truly interdisciplinary. The chapters in this book show that it is possible for researchers, practitioners, community residents, public offi cials, and others to design, implement, and evaluate interdisciplinary studies and interventions that can improve the health of urban popu- lations. We hope readers will join us in this quest. DISCUSSION QUESTIONS 1. Choose a specifi c urban health problem that concerns you. What are the advantages and disadvantages of using unidisciplinary versus interdisciplinary approaches to addressing this problem? In this chapter, we considered the central themes that run through this volume. Our focus is on doing interdisciplinary rese- arch and practice in urban health. We seek to help readers move from an apprecia- tion of interdisciplinary research to a capacity to do it — to apply the principles, concepts, and skills described in the pre- vious chapters and developed elsewhere in recent years to their roles as urban health professionals and researchers. We examined what we have learned about the practical application of the approaches, methods, and frameworks the authors of previous chapters have described and how our readers can apply these lessons in the settings in which they work. We described several stages of interdisciplin- ary work — defi ning the problem, creating and implementing a research process, choosing partners, infl uencing policy and practice, and evaluating impact — and dis- cussed the key tasks and challenges in each stage. We conclude by urging read- ers concerned with improving the health of urban populations to begin the process of moving from more disciplinary to more interdisciplinary research and practice. SUMMARY c12.indd Sec6:314c12.indd Sec6:314 6/3/09 12:07:59 PM6/3/09 12:07:59 PM Notes 315 2. How did the authors of Chapters Two, Seven, and Eight frame the problems they were studying, and how did these decisions affect how they moved through the various stages of research described in this chapter? 3. Use the stages of interdisciplinary research shown in Figure 12.1 to design an intervention to reduce type 2 diabetes in an African American urban neighbor- hood. What information would you need to guide this process? 4. How will you use interdisciplinary approaches to urban health research and intervention in your professional career? What obstacles might you encounter in using these methods and how might you overcome them? NOTES 1. Kessel, F., Rosenfi eld, P. L., and Anderson, N. B., eds. Expanding the Boundaries of Health and Social Science: Case Studies in Innovation. New York: Oxford University Press, 2003. 2. Committee on Facilitating Interdisciplinary Research. Facilitating Interdis- ciplinary Research. Washington, D.C.: National Academies Press, 2005. 3. Kessel, F., and Rosenfi eld, P. L. Toward transdisciplinary research: Historical and contemporary perspectives. American Journal of Preventative Medicine, 35, no. 2, Suppl (August 2008): S225 – 234. 4. Hirsh - Hadorn, G., Hoffman - Riem, H., Biber - Klemm, S., et al., eds. Handbook of Transdisciplinary Research. Springer, 2008. 5. Higginbotham, N., Briceno - Leon, R., and Johnson, N. Africa. In Applying Health Social Science: Best Practice in the Developing World, pp. 99 – 100. London: Zed, 2001. 6. Higginbotham, N., Briceno - Leon, R., and Johnson, N. Latin America. In Applying Health Social Science: Best Practice in the Developing World, pp. 183 – 184. London: Zed, 2001. 7. Higginbotham, N., Briceno - Leon, R., and Johnson, N. Asia and the Pacifi c. In Applying Health Social Science: Best Practice in the Developing World, pp. 15 – 16. London: Zed, 2001. 8. Rutter, M., and Plomin, R. Pathways from science fi ndings to health benefi ts. Psychological Medicine (2008): 1 – 14. 9. Dorfman, L., Wallack, L., and Woodruff, K. More than a message: Framing pub- lic health advocacy to change corporate practices. Health Education & Behavior, 32, no. 3 (2005): 320 – 336. 10. Entman, R. Framing: Toward a clarifi cation of a fractured paradigm. Journal of Communication, 43, no. 4 (1993): 53 – 57. c12.indd Sec7:315c12.indd Sec7:315 6/3/09 12:07:59 PM6/3/09 12:07:59 PM 316 Using Interdisciplinary Approaches to Strengthen Urban Health Research 11. Narayan, K. M., Boyle, J. P., Thompson, T. J., Sorensen, S. W., and Williamson, D. F. Lifetime risk for diabetes mellitus in the United States. JAMA, 290, no. 14 (2003): 1884 – 1890. 12. Horowitz, C. R., Colson, K. A., Hebert, P. L., and Lancaster, K. Barriers to buy- ing healthy foods for people with diabetes: Evidence of environmental dispari- ties. American Journal of Public Health, 94, no. 9 (2004): 1549 – 1554. 13. Brownson, R. C., Haire - Joshu, D., and Luke, D. A. Shaping the context of health: A review of environmental and policy approaches in the prevention of chronic diseases. Annual Review of Public Health, 27 (2006): 341 – 370. 14. Haire - Joshu, D., and Fleming, C. An ecological approach to understanding con- tributions to disparities in diabetes prevention and care. Current Diabetes Reports, 6, no. 2 (April 2006): 123 – 129. 15. Saegert, S., and Evans, G. Poverty, housing niches, and health in the United States. Journal of Social Issues, 59 (2003): 569 – 589. 16. Galea, S., Freudenberg, N., and Vlahov, D. Cities and population health. Social Science & Medicine, 60, no. 5 (March 2005): 1017 – 1033. 17. Green, L. W. Public health asks of system science: To advance our evidence - based practice, can you help us get more practice - based evidence? American Journal of Public Health, 96 (2006): 403 – 405. 18. Leischow, S. J., Best, A., Trochim, W. M., Clark, P. I., Gallagher, R. S., Marcus, S. E., and Matthews, E. Systems thinking to improve public health. American Journal of Preventative Medicine, 35, no. 2S (2008): S196 – S203. 19. Trochim, W. M., Cabrera, D. A., Milstein, B., Gallagher, R. S., and Leischow, S. J. Practical challenges of systems thinking and modeling in public health. American Journal of Public Health, 96, no. 3 (2006): 538 – 546. 20. Freudenberg, N. Jails, prisons and the health of urban populations: Review of the impact of the correctional system on community health. Journal of Urban Health, 78 (2001): 214 – 240. 21. Freudenberg, N., Daniels, J., Crum, M., Perkins, T., and Richie, B. E. Coming home from jail: The social and health consequences of community reentry for women, male adolescents, and their families and communities. American Journal of Public Health, 95 (2005): 1725 – 1736. 22. Stokols, D., Hall, K. L., Taylor, B. K., and Moser, R. P. The science of team sci- ence: Overview of the fi eld and introduction to the supplement. American Journal of Preventative Medicine, 35, no. 2S (2008): S77 – S89. 23. Metzler, M. M., Higgins, D. L., Beeker, C. G., Freudenberg, N., et al. Addressing urban health in Detroit, New York City, and Seattle through community - based c12.indd Sec7:316c12.indd Sec7:316 6/3/09 12:07:59 PM6/3/09 12:07:59 PM Notes 317 participatory research partnerships. American Journal of Public Health, 93, no. 5 (2003): 803 – 811. 24. Israel, B. A., Eng, E., Schulz, A. J., and Parker, E. A., eds. Methods in Community - Based Participatory Research for Health. San Francisco: Jossey - Bass, 2005. 25. Minkler, M., and Wallerstein, N., eds. Community - Based Participatory Research for Health. San Francisco: Jossey Bass, 2003. 26. Klein, J. T. Interdisciplinarity: History, Theory and Practice. Detroit, Mich.: Wayne State University Press, 1990. 27. Freudenberg, N., and Klitzman, S. Teaching urban health. In S. Galea and D. Vlahov, eds., Handbook of Urban Health, pp. 521 – 538. New York : Springer Verlag, 2005. 28. Piven, F. F., and Cloward, R. A. Poor People ’ s Movements: Why They Succeed, How They Fail. New York: Vintage, 1979. 29. Nathanson, C. A. Social movements as catalysts for policy change: The case of smoking and guns. Journal of Health Politics, Policy and Law, 24, no. 3 (1999): 421 – 488. 30. Brown, P., Zavestoski, S., McCormick, S., Mayer, B., Morello - Frosch, R., and Gasior Altman, R. Embodied health movements: New approaches to social movements in health. Social Health and Illness, 26, no. 1 (2004): 50 – 80. 31. Keefe, R. H., Lane, S. D., and Swarts, H. J. From the bottom up: Tracing the impact of four health - based social movements on health and social policies. Journal of Health & Social Policy, 21, no. 3 (2006): 55 – 69. 32. Brown, P., and Zavestoski, S., eds., Social Movements in Health. San Francisco: Wiley - Blackwell, 2005. 33. Klein, J. T. Evaluation of interdisciplinary and transdisciplinary research: A litera- ture review. American Journal of Prev Med, 35, no. 2, Suppl (2008): S116 – 123. 34. Butterfoss, F. D. Process evaluation for community participation. Annual Review of Public Health, 27 (2006): 323 – 340. 35. Evans, D. B, Adam, T., Edejer, T. T., Lim, S. S., Cassels, A., and Evans, T. G. WHO: Choosing Interventions That Are Cost Effective (CHOICE) millennium development goals team. Time to reassess strategies for improving health in devel- oping countries. British Medical Journal, 331, no. 7525 (2005): 1133 – 1136. 36. Jackson, N., and Waters, E. Guidelines for systematic reviews in health promo- tion and public health taskforce. Criteria for the systematic review of health promotion and public health interventions. Health Promotion International, 20, no. 4 (2005): 367 – 374. c12.indd Sec7:317c12.indd Sec7:317 6/3/09 12:07:59 PM6/3/09 12:07:59 PM 318 Using Interdisciplinary Approaches to Strengthen Urban Health Research 37. Ogilvie, D., Egan, M., Hamilton, V., and Petticrew, M. Systematic reviews of health effects of social interventions: 2. Best available evidence: How low should you go? Journal of Epidemiology and Community Health, 59, no. 10 (2005): 886 – 892. 38. Sendi, P., Al, M. J., Gafni, A., and Birch, S. Portfolio theory and the alternative decision rule of cost effectiveness analysis: Theoretical and practical consider- ations. Social Science & Medicine, 58 (2004): 1853 – 1855. 39. Cole, B. L., and Fielding, J. E. Health impact assessment: A tool to help policy makers understand health beyond health care. Annual Review of Public Health (2007): 393 – 412. 40. Scriven, M. Prose and cons about goal - free evaluation. American Journal of Evaluation, 12, no. 1 (1991): 55 – 62. c12.indd Sec7:318c12.indd Sec7:318 6/3/09 12:08:00 PM6/3/09 12:08:00 PM GLOSSARY In this glossary, we defi ne some of the key concepts and terms that are used in this book. Because the book is intended for students and researchers of different disciplines, we have included terms that are basic in some fi elds but may be unfamiliar to those in other disciplines. Interested readers should consult the endnotes at the end of this section for a more detailed discussion of these terms. Words in italics within defi nitions are also defi ned separately. Action research (or participatory action research) is a form of research that seeks to engage researchers and participants in a collective process of refl ection, data collection, analysis, and action for the purposes of increasing understanding and improving upon research practices and, in the case of public health, promoting participants ’ health and reducing disparities and disease. 1 Advocacy is the application of information and resources to promote institutional, community, and policy changes. Public health advocacy is advocacy that is intended to change policies or practices that infl uence the occurrence or severity of health problems among groups of people. 2 Allostatic load refers to the cumulative wear and tear on the body ’ s systems owing to repeated adaptation to stressors. 3 , 4 Analytic strategies describe various approaches to analyzing data. Examples include logistic regression, stratifi - cation, and searching for recurrent themes in interview transcripts. Research methods usually refer to approaches to collecting data, whereas analytic strategies are used to organize and interpret these data. Community - based participatory research (CBPR) is a collaborative approach to research that equitably involves all partners in the research process and recognizes the unique strengths that each brings. CBPR begins with a research topic of importance to the community with the aim of combining knowledge and action for social change to improve community health and eliminate health disparities. 5 Conceptual models are used in research to theorize, explain, and predict complex relationships among variables of interest. 6 Culture describes the shared characteristics of a group of people, which may include patterns of health and social behavior, beliefs, customs, traditions, artistic expression, and language. Developmental perspective (see Life course perspective ) Disciplines (academic) are branches of scholarly instruction that provide a structure through which successive generations of students are trained and socialized. Faculty carry out research, teaching, and administration within these disciplines. Examples include sociology, psychology, anthropology, biology, and chemistry. Disciplines provide systematic approaches to understanding the world and uncovering new knowledge. Traditionally, disci- plines have been considered separate and distinct from each other. Among the elements required for the presence of a discipline are the presence of a community of scholars, a tradition of inquiry, a mode of inquiry that defi nes how data are collected and interpreted, requirements for what constitutes new knowledge, and the existence of a communications network. 7 Ecological models consider the interaction and integration of multiple infl uences at multiple levels of social organization (e.g., individual, interpersonal, organizational, community, and societal) in attempting to understand and improve population health. 8 According to Gebbie and colleagues, the use of ecological models in public health comes out of a recognition that the “ health of individuals and the community is determined relatively little by bgloss.indd 319bgloss.indd 319 6/5/09 2:17:08 PM6/5/09 2:17:08 PM 320 Glossary health care per se and far more by multiple other factors, and by their interactions. These factors include biology (e.g., genetics), the social and physical environment, education, employment, and behavior (e.g., healthy behaviors such as exercise and unhealthy ones such as overeating). ” 9 Ecological models also consider the way that media, economic systems, historical patterns of discrimination, public policies not related to health, and other societal fac- tors exert infl uence on health and contribute to midlevel factors such as behavior, employment, and education. Embodiment describes the biological and social processes by which living conditions and social conditions “ get under our skins ” and infl uence our health. 10 Environment describes the complex of physical, chemical, biological, and social factors that act upon an organ- ism or a population and ultimately determine its form and survival. It also describes the aggregate of conditions that infl uence the life of an individual or community Environment, physical refers to the human - built environment as well as the air, water, plants and animals, climate, and geological conditions that infl uence a population. Environment, social describes the structure and characteristics of relationships among people within a community. Components of the social environment include social networks, social capital, and social support. Environmental justice, a s d e fi ned by the U.S. Environmental Protection Agency, is “ the fair treatment and mean- ingful involvement of all people regardless of race, color, national origin, culture, education, or income with respect to the development, implementation, and enforcement of environmental laws, regulations, and policies. ” 11 Essentialism is a philosophical concept that states that certain characteristics of a group are universal and not dependent on context. It is often contrasted with social constructionism. Framing is the process by which we select, emphasize, present, and communicate information in such a way as to promote a particular problem defi nition, causal interpretation, moral evaluation, and/or treatment recom- mendation. 12 , 13 Fundamental causes are root or primary explanations of a phenomenon or problem. In public health, many fundamental cause explanations focus on the primacy of social conditions as underlying causes of health inequali- ties. This line of inquiry comes in part from a recognition that socioeconomic gradients in nearly all health out- comes persist after adjusting for well - established individual - level risk factors. 14 The concept also calls attention to unequal distributions of resources and opportunities that put people “ at risk for risk. ” Geographic Information Sciences is a discipline grounded in geographic spatial analytic theory that provides the intellectual framework for geographic information systems. 15 Geographic information systems (GIS) are computer applications used to store, view, analyze, and map geographic information. Health disparities refer to gaps in the health status and quality of health care across racial (see race ), ethnic, gender, and socioeconomic groups. The U.S. Department of Health and Human Services has defi ned health disparities as “ population - specifi c differences in the presence of disease, health outcomes, or access to health care. ” One of the stated goals of Healthy People 2010 is the elimination of health disparities in the United States by 2010. 16 Health equity describes the goal of reducing disparities in health or, in other words, achieving equity in health among different population groups. Health promotion i s d e fi ned by the World Health Organization as the process of enabling people to increase control over, and to improve, their health. 17 In the United States, health promotion is often defi ned more narrowly as “ the science and art of helping people change their lifestyle to move toward a state of optimal health. ” 18 Interdisciplinary research has been defi ned by the National Academy of Sciences as “ a mode of research by teams or individuals that integrates information, data, techniques, tools, perspectives, concepts, and/or theories from two or more disciplines or bodies of specialized knowledge to advance fundamental understanding or to solve problems whose solutions are beyond the scope of a single discipline or fi eld of research practice. ” 19 bgloss.indd 320bgloss.indd 320 6/5/09 2:17:08 PM6/5/09 2:17:08 PM . is on doing interdisciplinary rese- arch and practice in urban health. We seek to help readers move from an apprecia- tion of interdisciplinary research to a capacity to do it — to apply the. interdisciplinary urban health research. WANTED: INTERDISCIPLINARY RESEARCHERS AND PRACTITIONERS In our view, more interdisciplinary approaches to public health research and practice hold great. interdisciplin- ary and policy research and to cross the research/ advocacy divide by rewarding this work through its promotion and tenure practices, pilot interdisciplinary research grant programs, and