Designing and Assessing Multilevel Interventions to Improve Minority Health and Reduce Health Disparities

Abstract

Multilevel interventions can be uniquely effective at addressing minority health and health disparities, but they pose substantial methodological, data analytic, and assessment challenges that must be considered when designing and applying interventions and assessment. To facilitate the adoption of multilevel interventions to reduce health disparities, we outline areas of need in filling existing operational challenges to the design and assessment of multilevel interventions. We discuss areas of development that address overarching constructs inherent in multilevel interventions, with a particular focus on their application to minority health and health disparities. Our approach will prove useful to researchers, as it allows them to integrate information related to health disparities research into the framework of broader constructs with which they are familiar. We urge researchers to prioritize building transdisciplinary teams and the skills needed to overcome the challenges in designing and assessing multilevel interventions, as even small contributions can accelerate progress toward improving minority health and reducing health disparities. To make substantial progress, however, a concerted and strategic effort, including work to advance analytic techniques and measures, is needed.

Funding of Hispanic/Latino Health-Related Research by the National Institutes of Health: An Analysis of the Portfolio of Research Program Grants on Six Health Topic Areas

“…At the same time, our analysis suggests that health services research, translational medicine, and/or CBPR are types of research that could be further developed within the context of the six health condition areas that were reviewed. Whereas the focus on implementation science and translational research at the NIH has been increasing (92,93), our findings suggest that future research could focus on understudied approaches in Hispanic/Latino health, including, but not limited to, deeper understanding of effectiveness of currently recommended therapies and potential differences among heritage groups (56,(94)(95)(96); participation and/or increased inclusion in genetics/genomic studies (97)(98)(99); innovative strategies to implement recommended guidelines of care, and especially those move beyond the "sideways" approach (100); the intersection (101-103) of social determinants of health other factors on disease risk and the effectiveness of clinical or multi-level interventions (104)(105)(106)(107); design and analysis of multi-level or multi-sectoral (108)(109)(110) interventions; implementation and dissemination studies in real-world settings (92,111); the role of health information technologies on health-care delivery and health outcomes (112)(113)(114)(115)(116)(117)(118); the impact of interventions or policies designed to reduce health and health-care disparities (119)(120)(121)(122)(123)(124)(125)(126); and the effects of national or local policies on healthcare services and health outcomes (e.g., natural experiments) (127,…”

Understanding the Family Doctor Concept in Public Primary Care Clinics in Malaysia: Objectives, Initiatives, Resources, and Expected Outcomes

“…Variation exists in different settings because there is no onesize-ts-all or one model for health intervention (44). Thus, in applying health concepts and interventions, differences in the contexts, populations, and even times must be taken into consideration (45)(46)(47). Here, the stakeholders' failure to mention this variation and to provide accepted standardized models might have muddled the implementation.…”

Evaluating Research Centers in Minority Institutions: Framework, Metrics, Best Practices, and Challenges

“…An evaluation framework not only aids each RCMI in assessing the achievement of the program's goals and objectives, which is essential to its viability and sustainability, but allows standardization and/or harmonization of common evaluation metrics across the centers. A well-devised evaluation model can improve program planning and development, as well as clarify programmatic goals and objectives [11][12][13][14].…”

“…An inclusive pragmatic conceptual framework is an evaluation best practice that enables continuous program improvement strategies and supports the centers in meeting goals at their respective institutional level. The RCMI Evaluation Conceptual Model provides a structure to facilitate the close monitoring and careful documentation of RCMI program activities and initiatives to better understand the value-added of this program for individual programs and across RCMI programs [14]. Moreover, establishing standard metrics strengthens the ability of the NIMHD to conduct national evaluation of the RCMI program.…”