Mitigating Harmful SDOH

Provided by: Vincent Guilamo-Ramos, PhD, MSN, Johns Hopkins School of Nursing

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.