Implementation of a multi-level intervention in underserved communities: Prevention RCT in the Cherokee Nation

Abstract

Despite advances in prevention science in recent decades, the U.S. continues to struggle with significant alcohol-related risks and consequences among youths, especially among vulnerable rural and American Indian communities. The Prevention Trial in the Cherokee Nation is a partnership between prevention/implementation scientists and Cherokee Nation Behavioral Health to implement and evaluate an integrated multi-level intervention designed to prevent underage drinking and associated negative health outcomes among American Indian and other youths living in rural high-risk underserved communities. The primary partnership is augmented with partnerships with Oklahoma public school districts, the Oklahoma Department of Human Services, and a local nonprofit organization. The intervention builds directly on results of multiple previous RCTs of two conceptually distinct approaches. The first is an updated version of an evidence-based community environmental change intervention, and the second is our newly developed population-wide implementation of screening, brief intervention and referral to treatment delivered within high schools by school service providers hired through the Department of Human Services. Six key research design elements optimize causal inference and experimental evaluation of effects of intervention implementation, including purposive selection of towns, random assignment of towns to study condition, controlled interrupted time-series, nested cohorts as well as repeated cross-sectional observations, a factorial design crossing two conceptually distinct interventions, and multiple comparison groups. Interim results indicate a high uptake of intervention implementation with some variation by community, as well as trends toward decreased alcohol use among youths in the intervention conditions compared to the control condition. The trial demonstrates the effectiveness of scientists building strong partnerships for implementation of evidence-based strategies within underserved communities. Our collaborative partnerships also demonstrate it is feasible to implement a rigorous scientific trial while incorporating community-based participatory research methods.

Research was supported by the National Institute on Alcohol Abuse and Alcoholism of the National Institutes of Health under Award Number R01AA020695.

Full text

M E E T I N G A B S T R A C T Open Access
Implementation of a multi-level intervention in
underserved communities: Prevention RCT in
the Cherokee Nation
Kelli A Komro
1,2*
, Misty L Boyd
3
, Melvin D Livingston
1,2
, Terrence Kominsky
3
, Dallas Pettigrew
3
, Brady Garrett
1,2,3
,
Alexander C Wagenaar
1,2
From 7th Annual Conference on the Science of Dissemination and Implementation in Health
North Bethesda, MD, USA. 8-9 December 2014
Despite advances in prevention science in recent
decades, the U.S. continues to struggle with significant
alcohol-related risks and consequences among youths,
especially among vulnerable rural and American Indian
communities. The Prevention Trial in the Cherokee
Nation is a partnership between prevention/implementa-
tion scientists and Cherokee Nation Behavioral Health
to implement and evaluate an integrated multi-level
intervention designed to prevent underage drinking and
associated negative health outcomes among American
Indian and other youths living in rural high-risk under-
served communities. The primary partnership is aug-
mented with partnerships with Oklahoma public school
districts, the Oklahoma Department of Human Services,
and a local nonprofit organization. The intervention
builds directly on results of multiple previous RCTs of
two conceptually distinct approaches. The first is an
updated version of an evidence-based community envir-
onmental change intervention, and the second is our
newly developed population-wide implementation of
screening, brief intervention and referral to treatment
delivered within high schools by school service providers
hired through the Department of Human Services. Six
key research design elements optimize causal inference
and experimental evaluation of effects of intervention
implementation, including purposive selection of towns,
random assignment of towns to study condition, con-
trolled interrupted time-series, nested cohorts as well as
repeated cross-sectional observations, a factorial design
crossing two conceptually distinct interventions, and
multiple comparison groups. Interim results indicate
a high uptake of intervention implementation with some
variation by community, as well as trends toward
decreased alcohol use among youths in the intervention
conditions compared to the control condition. The trial
demonstrates the effectiveness of scientists building
strong partnerships for implementation of evidence-
based strategies within underserved communities. Our
collaborative partnerships also demonstrate it is feasible
to implement a rigorous scientific trial while incorporat-
ing community-based participatory research methods.
Research was supported by the National Institute on
Alcohol Abuse and Alcoholism of the National Insti-
tutes of Health under Award Number R01AA020695.
Authors’details
1
Department of Health Outcomes and Policy, College of Medicine, University
of Florida, Gainesville, FL 32608, USA.
2
Institute for Child Health Policy,
University of Florida, Gainesville, FL 32608, USA.
3
Cherokee Nation Behavioral
Health, Tahlequah, OK 74465, USA.
Published: 20 August 2015
doi:10.1186/1748-5908-10-S1-A54
Cite this article as: Komro et al.: Implementation of a multi-level
intervention in underserved communities: Prevention RCT in
the Cherokee Nation. Implementation Science 2015 10(Suppl 1):A54.
* Correspondence: komro@ufl.edu
1
Department of Health Outcomes and Policy, College of Medicine, University
of Florida, Gainesville, FL 32608, USA
Full list of author information is available at the end of the article
Komro et al.Implementation Science 2015, 10(Suppl 1):A54
http://www.implementationscience.com/content/10/S1/A54
Implementation
Science
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zero/1.0/) applies to the data made availabl e in this article, unless otherw ise stated.