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      Precision Health: The Role of the Social and Behavioral Sciences in Advancing the Vision

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          Abstract

          Background

          In 2015, Collins and Varmus articulated a vision for precision medicine emphasizing molecular characterization of illness to identify actionable biomarkers to support individualized treatment. Researchers have argued for a broader conceptualization, precision health. Precision health is an ambitious conceptualization of health, which includes dynamic linkages between research and practice as well as medicine, population health, and public health. The goal is a unified approach to match a full range of promotion, prevention, diagnostic, and treatment interventions to fundamental and actionable determinants of health; to not just address symptoms, but to directly target genetic, biological, environmental, and social and behavioral determinants of health.

          Purpose

          The purpose of this paper is to elucidate the role of social and behavioral sciences within precision health.

          Main body

          Recent technologies, research frameworks, and methods are enabling new approaches to measure, intervene, and conduct social and behavioral science research. These approaches support three opportunities in precision health that the social and behavioral sciences could colead including: (a) developing interventions that continuously “tune” to each person’s evolving needs; (b) enhancing and accelerating links between research and practice; and (c) studying mechanisms of change in real-world contexts. There are three challenges for precision health: (a) methods of knowledge organization and curation; (b) ethical conduct of research; and (c) equitable implementation of precision health.

          Conclusions

          Precision health requires active coleadership from social and behavioral scientists. Prior work and evidence firmly demonstrate why the social and behavioral sciences should colead with regard to three opportunity and three challenge areas.

          Abstract

          Developing interventions that provide support that is matched to each person, healthcare system, or community’s needs, which is being called “precision health,” requires active co-leadership from the social and behavioral sciences along with others, such as biomedical research. Specifically, the social and behavioral sciences are needed to meaningfully target and improve root cause determinants of health, such as behavioral, social, and environmental factors.

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          Most cited references176

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          Fostering implementation of health services research findings into practice: a consolidated framework for advancing implementation science

          Background Many interventions found to be effective in health services research studies fail to translate into meaningful patient care outcomes across multiple contexts. Health services researchers recognize the need to evaluate not only summative outcomes but also formative outcomes to assess the extent to which implementation is effective in a specific setting, prolongs sustainability, and promotes dissemination into other settings. Many implementation theories have been published to help promote effective implementation. However, they overlap considerably in the constructs included in individual theories, and a comparison of theories reveals that each is missing important constructs included in other theories. In addition, terminology and definitions are not consistent across theories. We describe the Consolidated Framework For Implementation Research (CFIR) that offers an overarching typology to promote implementation theory development and verification about what works where and why across multiple contexts. Methods We used a snowball sampling approach to identify published theories that were evaluated to identify constructs based on strength of conceptual or empirical support for influence on implementation, consistency in definitions, alignment with our own findings, and potential for measurement. We combined constructs across published theories that had different labels but were redundant or overlapping in definition, and we parsed apart constructs that conflated underlying concepts. Results The CFIR is composed of five major domains: intervention characteristics, outer setting, inner setting, characteristics of the individuals involved, and the process of implementation. Eight constructs were identified related to the intervention (e.g., evidence strength and quality), four constructs were identified related to outer setting (e.g., patient needs and resources), 12 constructs were identified related to inner setting (e.g., culture, leadership engagement), five constructs were identified related to individual characteristics, and eight constructs were identified related to process (e.g., plan, evaluate, and reflect). We present explicit definitions for each construct. Conclusion The CFIR provides a pragmatic structure for approaching complex, interacting, multi-level, and transient states of constructs in the real world by embracing, consolidating, and unifying key constructs from published implementation theories. It can be used to guide formative evaluations and build the implementation knowledge base across multiple studies and settings.
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            A new initiative on precision medicine.

            President Obama has announced a research initiative that aims to accelerate progress toward a new era of precision medicine, with a near-term focus on cancers and a longer-term aim to generate knowledge applicable to the whole range of health and disease.
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              The Psychological Meaning of Words: LIWC and Computerized Text Analysis Methods

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                Author and article information

                Journal
                Ann Behav Med
                Ann Behav Med
                abm
                Annals of Behavioral Medicine: A Publication of the Society of Behavioral Medicine
                Oxford University Press (US )
                0883-6612
                1532-4796
                November 2020
                27 April 2020
                27 April 2020
                : 54
                : 11
                : 805-826
                Affiliations
                [1 ] Department of Family Medicine and Public Health, School of Medicine, UC San Diego , La Jolla, CA, USA
                [2 ] Center for Wireless and Population Health Systems, Qualcomm Institute, UC San Diego , La Jolla, CA, USA
                [3 ] Design Lab, UC San Diego , La Jolla, CA, USA
                [4 ] Department of Population and Data Sciences, University of Texas Southwestern Medical Center , Dallas, TX, USA
                [5 ] Harold C. Simmons Comprehensive Cancer Center , Dallas, TX, USA
                [6 ] Office of Behavioral and Social Sciences Research, National Institutes of Health , Bethesda, MD, USA
                Author notes
                Author information
                http://orcid.org/0000-0002-7434-0775
                http://orcid.org/0000-0001-6819-1796
                Article
                kaaa018
                10.1093/abm/kaaa018
                7646154
                32338719
                87e8cc8c-2aa9-42ad-b3ad-24f2f73c6bf2
                © The Author(s) 2020. Published by Oxford University Press on behalf of the Society of Behavioral Medicine.

                This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License ( http://creativecommons.org/licenses/by-nc/4.0/), which permits non-commercial re-use, distribution, and reproduction in any medium, provided the original work is properly cited. For commercial re-use, please contact journals.permissions@oup.com

                History
                Page count
                Pages: 22
                Funding
                Funded by: National Cancer Institute, DOI 10.13039/100000054;
                Award ID: 2P30CA142543-08
                Categories
                Regular Articles
                AcademicSubjects/MED00860
                AcademicSubjects/SCI02170
                AcademicSubjects/SCI01880

                Neurology
                precision medicine,precision health,social and behavioral sciences,research methods,implementation science,research ethics

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