All systems are interrelated: Multilevel interventions with indigenous communities

Contemp Clin Trials. 2023 Jan:124:107013. doi: 10.1016/j.cct.2022.107013. Epub 2022 Nov 16.


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.

Keywords: American Indian; Clinical trials; Indigenous health; Multilevel frameworks; Multilevel interventions; Native American.

Publication types

  • Research Support, N.I.H., Extramural
  • Research Support, Non-U.S. Gov't

MeSH terms

  • Clinical Trials as Topic*
  • Humans
  • Indigenous Peoples*
  • Patient Participation*