Multilevel and Community-Level Interventions with Native Americans: Challenges and Opportunities

Abstract

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.

(Re)constructing Conceptualizations of Health and Resilience among Native Hawaiians

“…Resilience factors were identified as internal factors that were utilized by the individual in addition to community and cultural resources that were externally available to the interviewee. These findings align with other research that has addressed social determinants of health, and thus, health disparities through multilevel and community-level approaches and interventions (Blue Bird Jernigan et al 2018). In support of previous literature that has cited social support as a pertinent factor of health and resilience (Macdonald et al 2013;McMullin 2005), relational ties through social support, specifically from close friends and family members, were identified as important factors of health and thus, resilience.…”

Substance Use Research with Indigenous Communities: Exploring and Extending Foundational Principles of Community Psychology

“…For example, the field of CP could be helpful through the development of measures of cultural continuity, community effects of colonization, and the role of spirituality in individual and community wellness, as well through the development of methods for analyzing small samples and innovative quasi‐experimental research design alternatives to RCTs. It may also be useful to develop CP research guidelines for working with Indigenous Peoples in particular; we recommend, however, for guidelines to be flexible in order to emphasize and empower the leadership of diverse local communities (see Blue Bird Jernigan et al., ; Toombs et al., ). Finally, Indigenous SU studies could potentially benefit from a hallmark of ecological thinking in CP: greater attention to and advocacy for structural, systems‐level change (e.g., Worton et al., ).…”

“…Given this context, the survival and cultural continuity of Indigenous Peoples in North America is a testament of their resiliency. At the same time, colonization has had an alarming impact on Indigenous Nations, resulting in entrenched poverty, intergenerational trauma, and health disparities (Blue Bird Jernigan, D'Amico, Duran, & Buchwald, ; Davis, Roscigno, & Wilson, ; Gone et al., ).…”

What is the prevalence of current alcohol dependence and how is it measured for Indigenous people in Australia, New Zealand, Canada and the United States of America? A systematic review

“…There is a need for more studies on prevalence of current alcohol dependence to inform prevention and treatment efforts in Indigenous communities internationally [42]. Assessing current prevalence is more useful than lifetime dependence for estimating current treatment needs.…”