Improving Equity in Healthcare through Multilevel Interventions

Abstract

Recently there has been recognition that interventions to improve health equity must conceptualize health disparities interventions at multiple levels. Multilevel interventions simultaneously address more than one aspect of the socioecological framework of health (i.e., the individual, the provider, the healthcare setting, healthcare system, and/or community) in order to address a variety of factors that influence health outcomes (e.g., discrimination, culture, education). Existing multilevel intervention studies show positive health outcomes in racial/ethnic minority populations for a wide range of conditions, including diabetes, cancer, and cardiovascular disease. However, the field of multilevel interventions has yet to reconcile how the diverse intervention elements of the various sectors are connected to individual health outcomes. In this chapter, we offer a comprehensive review of the current literature on multilevel interventions in order to evaluate their effectiveness in addressing health disparities. We then discuss methodological challenges to the design and statistical evaluation of multilevel interventions. Challenges arise during the evaluation process due to the complexity of intervention effects, with researchers having to decide whether to compare the combined effect of the multiple interventions together, to analyze separately the impact of each single level intervention, or to assess whether there are interactive effects between the interventions. We also consider challenges to the implementation and sustainability of interventions, such as engaging important community stakeholders and building community capacity before, during, and after the research project. Although more research is needed to determine whether multilevel interventions are more effective than single-level interventions, we conclude the chapter by offering recommendations for addressing health disparities through multilevel research based on the promising evidence outlined throughout the chapter

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