There is consensus about the importance of developing a strong cadre of effective multilevel interventions to address and mitigate the impacts of unjust social processes, such as structural racism and other social determinants of health (SDOH), on health inequities in the United States. However, the available cadre of rigorously evaluated evidence-based interventions for SDOH mitigation remains underdeveloped. 

To help address this gap, this presentation (1) introduces a heuristic framework to inform decisions in multilevel intervention development, study design, and selection of analytic methods; and (2) provides a road map for future applications of the framework in multilevel intervention research through an exemplar application using the NIH-funded evaluation study of the Nurse-Community-Family Partnership (NCFP) intervention. NCFP leverages individual, family, institutional, and systems factors to shape COVID-19 mitigation outcomes at the individual and household levels. Dr. Guilamo-Ramos discusses the application of a two-arm parallel explanatory group-randomized trial to evaluate the efficacy of NCFP in improving COVID-19 testing uptake at the individual and household levels. The analysis approach relies on random intercepts models, and Dr.  Guilamo-Ramos calculates the variance partitioning coefficient to estimate the extent to which household- and individual-level variables contribute to the outcome, allowing examination of NCFP effects at multiple levels.

Dr. Vincent Guilamo-Ramos is Executive Director of the Institute for Policy Solutions, Director of the Center for Latino Adolescent and Family Health, and the Leona B. Carpenter Chair in Health Equity and Social Determinants of Health at the Johns Hopkins School of Nursing. He is a nurse practitioner dually licensed in adult health and psychiatric–mental health nursing. Widely regarded as a scholar and leader in social determinants of health and developing, evaluating, and translating community-based interventions, his research has been funded for two decades by NIH, Centers for Disease Control and Prevention (CDC), and various federal agencies. His work has been published in leading scientific journals, including the New England Journal of Medicine, Lancet Infectious Diseases, Clinical Infectious Diseases, Nature Medicine, Prevention Science, and the American Journal of Public Health. He is a member of the National Academies of Sciences, Engineering, and Medicine Committee on Unequal Treatment Revisited and the CDC/Health Resources and Services Administration Advisory Committee on HIV, Viral Hepatitis and Sexually Transmitted Diseases Prevention and Treatment.