In Pursuit of Health: Implementation Science and Community-Engaged Research in Cardiovascular Medicine

The cardiovascular community has a robust armamentarium of scientific evidence for disease prevention, medical therapies, and devices. Yet, cardiovascular disease continues to be a leading cause of morbidity and mortality worldwide, with significant gaps in health care equity, quality, outcomes, and value. The vast gaps between research evidence and medical practice are well documented. But how will we bridge these gaps? In a recent presentation, Dr Gary Gibbons, Director of the National Heart, Lung, and Blood Institute at the National Institutes of Health, issued a call to action to spur more research and innovation using methodologies like implementation science and community-engaged research, stating that we have a moral obligation as healers to accelerate the current slow trajectory of translating research findings into real-world practice and policy.¹

Newer methodologies are critical to bridging the gap between the research world and the real world. But this is not easy given the complexity of health care systems and their challenges. Both implementation science and community-engaged research are emerging fields designed to understand complex, multilevel processes. Implementation science is the scientific study of methods and strategies to promote the adoption and use of evidence-based interventions and practices in real-world, clinical, and public health settings to improve the quality of care.² The focus on stakeholder engagement and barriers to implementation is crucial in designing effective interventions for implementation and dissemination. The goal is to implement changes in health care that will work across multiple settings and be sustained over time. Community-engaged research is an approach by academic and community partners to develop and test interventions that are sensitive to the needs of the community, strengthen community facilitators, and address community barriers. As a result, these interventions often focus upstream of traditional individual determinants of health to address the adverse social determinants that influence the community’s health.³ Meeting people where they are and working with them to develop possible solutions that will be sustainable in their community is very powerful. But even more so, community-engaged research also has the potential to address social justice issues in health. It can use research data generated through community-academic partnerships to change local, state, and federal policy via advocacy, agenda-setting, and identifying policies affecting minoritized groups.⁴ Community-engaged research is one approach to addressing structural racism, one of the core goals of AHA.⁵

Circulation: Cardiovascular Quality and Outcomes has long recognized that implementation science and community-engaged research are critical methodologies necessary to shift our current health care paradigm. In this special issue, we are excited to highlight work from the cardiovascular community focusing on multiple research platforms utilizing these approaches to transform and disrupt current gaps in cardiovascular care particularly around health inequities. This collection is composed of different article formats. It includes commentaries about community-engaged research as well as envisioning the evolution of a learning health care community. It also encompasses original research articles, including a cluster randomized trial of clinical and functional measures among older rural women, qualitative insights from a decision aid trial of implantable cardioverter defibrillators, a pilot community-partnered heart failure training course for home health care workers, an intervention to improve uptake of depression screening and treatment guidelines in cardiac patients, and a photovoice study to share the lived experience of Black Baltimore Residents with hypertension to stimulate discussion about structural racism.

We hope this special issue reaches many readers—especially early career investigators—to help increase understanding or apply these methodologies to their work. As is apparent from this collection, implementation science and community-engaged research are not about a single tool or technique, but a broad set of study designs and procedures. Since these are emerging fields in health services and outcomes research, highlighting their wide-ranging methodologies will help address the complex, vexing challenges we face in curtailing cardiovascular morbidity and mortality. If we are truly to advance health and health care in the future, it is becoming clear that we must intercede earlier and address critical issues, including social determinants of health and barriers to getting treatments to the right people, in the right way, at the right time. To face challenges like health inequities head-on, our research paradigm must shift to promote collaborative partnerships, centering on the needs of communities, health systems, and populations in which the research is intended to help. This is the promise of implementation science and community-engaged research, and we believe the work highlighted in this issue will achieve that and inspire others to do the same.

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