All Systems are Interrelated: Multilevel Interventions with Indigenous Communities

For generations, the health of Indigenous communities has been shaped by the lasting effects of colonial trauma and ongoing systemic racism. These forces have created deep health disparities that persist today.

Yet Indigenous peoples have not been passive in the face of these challenges. Working alongside Indigenous and allied research scientists, they have taken part in clinical trials that operate on multiple levels — addressing individual, community, and systemic factors at once — and these efforts have shown real promise.

In a 2020 paper, a team of NIH-funded researchers in Indigenous health set out to explain why these multilevel approaches are so valuable and needed in Indigenous communities (Jernigan et al., 2020). They point out that existing frameworks for understanding health, often based on a socioecological model, have limits. So the authors offer a new way of thinking: a dynamic, interconnected framework that shifts the focus away from the individual and toward the relationships between communities and their environments.

The paper closes with a clear set of calls to action for advancing multilevel clinical trial research going forward.

Abstract

Colonial historical trauma and ongoing structural racism have impacted Indigenous peoples for generations and explain the ongoing health disparities. However, Indigenous peoples have been engaging in multilevel, clinical trial interventions with Indigenous and allied research scientists resulting in promising success. In this paper, National Institutes of Health funded scientists in the field of Indigenous health have sought to describe the utility and need for multilevel interventions across Indigenous communities (Jernigan et al., 2020). We posit limitations to the existing socioecological, multilevel frameworks and propose a dynamic, interrelated heuristic framework, which focuses on the inter-relationships of the collective within the environment and de-centers the individual. We conclude with identified calls for action within multilevel clinical trial research.