Abstract IA36: Multilevel interventions that work: Introduction and overview
Authors: Thompson Beti 
Published: October 2015

Abstract
Health behavior change interventions have typically focused on one level of society, often the individual. Although many of these interventions have been successful in achieving behavior change of the individual, behavior change tends to degrade over time as the individual faces real world conflicts and environments that are not conducive to the new behavior. Further, changing an individual's behavior does not lead to large-scale behavior change at the societal level. For that to occur, changes need to be made at other levels of society as well so that positive behavior change is encouraged and made possible.
The National Institutes of Health, through the National Cancer Institutes and the National Heart Lung and Blood Institute, developed an initiative, Centers for Population Health and Health Disparities (CPHHD), in 2005 and renewed it in 2010. The past eight and current 10 centers all have an intervention project that includes multi-level interventions to achieve wide-spread behavior change. Although the projects vary by topic (e.g., health eating, eliminating food deserts, reducing breast cancer, reducing cervical cancer), they all focus on more than one level of society. Individual intervention activities are complemented with organizational level activities (as for, example, inclusion of activities in federally qualified health centers), community activities (such as re-making neighborhood grocery stores into stores that provide healthy options), and societal interventions (such as changing attitudes about health disparities).
Adapting interventions to more than one level often means taking a comprehensive approach that addresses upstream factors as well as downstream factors. As an example, women who are out of compliance for cervical cancer screening may suffer from poverty making it difficult to pay for screening; from lack of a medical home, making it difficult to have a facility to conduct the screening; from having a provider who does not recommend cervical cancer screening; to individual barriers that keep the woman from being screened. Attention to all of these factors will not only be likely to increase the women's screening, but will also help other women who face similar barriers.
Multi-level interventions are especially appropriate for underserved populations that are more likely to face critical barriers in behavior change. In this session, we examine a number of projects from CPHHD that have had a positive effect in terms of behavior change. This presentation begins with an overview of the need for multi-level interventions and a description of such interventions. It will be followed by three presentations on specific multi-level interventions that have been successful.
Citation Format: Beti Thompson. Multilevel interventions that work: Introduction and overview. [abstract]. In: Proceedings of the Seventh AACR Conference on The Science of Health Disparities in Racial/Ethnic Minorities and the Medically Underserved; Nov 9-12, 2014; San Antonio, TX. Philadelphia (PA): AACR; Cancer Epidemiol Biomarkers Prev 2015;24(10 Suppl):Abstract nr IA36.