Cover: Multilevel and Community-Level Interventions with Native Americans

Multilevel and Community-Level Interventions with Native Americans

Challenges and Opportunities

Published in: Prevention Science [Epub June 2018]. doi:10.1007/s11121-018-0916-3

Posted on Jun 28, 2018

by Valarie Blue Jernigan, Elizabeth J. D'Amico, Bonnie Duran, Dedra Buchwald

Research Question

  1. What types of interventions and health measurement tools are needed to address health disparities in Native American communities?

Multilevel and community-level interventions that target the social determinants of health and ultimately health disparities are seldom conducted in Native American communities. To contextualize the importance of multilevel and community-level interventions, major contributors to and causes of health disparities in Native communities are highlighted. Among the many documented socioeconomic factors influencing health are poverty, low educational attainment, and lack of insurance. Well-recognized health disparities include obesity, diabetes, and hypertension. Selected challenges of implementing community-level and multilevel interventions in Native communities are summarized such as the shortage of high-quality population health data and validated measurement tools. To address the lack of multilevel and community-level interventions, the National Institutes of Health created the Intervention Research to Improve Native American Health (IRINAH) program which solicits proposals that develop, adapt, and test strategies to address these challenges and create interventions appropriate for Native populations. A discussion of the strategies that four of the IRINAH grantees are implementing underscores the importance of community-based participatory policy work, the development of new partnerships, and reconnection with cultural traditions. Based on the work of the nearly 20 IRINAH grantees, ameliorating the complex social determinants of health disparities among Native people will require (1) support for community-level and multilevel interventions that examine contemporary and historical factors that shape current conditions; (2) sustainability plans; (3) forefronting the most challenging issues; (4) financial resources and time to collaborate with tribal leaders; and (5) a solid evidence base.

Key Findings

  • Interventions that focus on individual and community-based disease management and simultaneously work at multiple policy levels are rare—but needed—in Native American communities.
  • Grantees of the Intervention Research to Improve Native American Health (IRINAH) program have been conducting studies that develop, adapt, and test ways to make existing interventions and health measures culturally relevant for Native communities.
  • For studies to address health disparities among this population and build a solid evidence base, they must work on multiple policy levels, plan for sustainability, and consider the substantial resources needed to collaborate with tribal leaders.


  • Multilevel intervention studies, such as those under way through IRINAH, should continue to be developed to address the complex contemporary and historical factors behind social determinants of health in Native American communities.
  • Such studies should use evidence-based practices that have been designed or adapted for use in the Native context.

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