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A Hybrid Pragmatic and Factorial Cluster Randomized Controlled Trial for an Anti-racist, Multilevel Intervention to Improve Mental Health Equity in High Schools.

Publication ,  Journal Article
Mulawa, MI; Docherty, SL; Bailey, DE; Gonzalez-Guarda, RM; Lipkus, IM; Randolph, SD; Yang, Q; Pan, W
Published in: Prevention science : the official journal of the Society for Prevention Research
January 2024

Systemic racism is pervasive in US society and disproportionately limits opportunities for education, work, and health for historically marginalized and minoritized racial and ethnic groups, making it an urgent issue of social justice. Because systemic racism is a social determinant of health prevalent across multiple social and institutional structures, it requires multilevel intervention approaches using effective designs and analytic methods to measure and evaluate outcomes. Racism is a fundamental cause of poor health outcomes, including mental health outcomes; thus, mental health services and programs that address racism and discrimination are key to promoting positive mental health of racial and ethnic minority youth. While multilevel interventions are well-suited for improving outcomes like youth mental health disparities, their evaluation poses unique methodological challenges, requiring specialized design and analytic approaches. There has been limited methodological guidance provided to researchers on how to test multilevel interventions using approaches that balance methodological rigor, practicality, and acceptability across stakeholder groups, especially within communities most affected by systemic racism. This paper addresses this gap by providing an example of how to rigorously evaluate a hypothetical, theoretically based, multilevel intervention promoting mental health equity in three US school systems using an anti-racist approach intervening at the macro- (i.e., school system), meso- (i.e., school), and micro- (i.e., family and student) levels to improve mental health in adolescents. We describe the design, sample size considerations, and analytic methods to comprehensively evaluate its effectiveness while exploring the extent to which the components interact synergistically to improve outcomes. The methodological approach proposed can be adapted to other multilevel interventions that include strategies addressing macro-, meso-, and micro-levels of influence.

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Published In

Prevention science : the official journal of the Society for Prevention Research

DOI

EISSN

1573-6695

ISSN

1389-4986

Publication Date

January 2024

Related Subject Headings

  • Substance Abuse
  • 5203 Clinical and health psychology
  • 4206 Public health
  • 1117 Public Health and Health Services
 

Citation

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Mulawa, M. I., Docherty, S. L., Bailey, D. E., Gonzalez-Guarda, R. M., Lipkus, I. M., Randolph, S. D., … Pan, W. (2024). A Hybrid Pragmatic and Factorial Cluster Randomized Controlled Trial for an Anti-racist, Multilevel Intervention to Improve Mental Health Equity in High Schools. Prevention Science : The Official Journal of the Society for Prevention Research. https://doi.org/10.1007/s11121-023-01626-x
Mulawa, Marta I., Sharron L. Docherty, Donald E. Bailey, Rosa M. Gonzalez-Guarda, Isaac M. Lipkus, Schenita D. Randolph, Qing Yang, and Wei Pan. “A Hybrid Pragmatic and Factorial Cluster Randomized Controlled Trial for an Anti-racist, Multilevel Intervention to Improve Mental Health Equity in High Schools.Prevention Science : The Official Journal of the Society for Prevention Research, January 2024. https://doi.org/10.1007/s11121-023-01626-x.
Mulawa MI, Docherty SL, Bailey DE, Gonzalez-Guarda RM, Lipkus IM, Randolph SD, et al. A Hybrid Pragmatic and Factorial Cluster Randomized Controlled Trial for an Anti-racist, Multilevel Intervention to Improve Mental Health Equity in High Schools. Prevention science : the official journal of the Society for Prevention Research. 2024 Jan;
Mulawa, Marta I., et al. “A Hybrid Pragmatic and Factorial Cluster Randomized Controlled Trial for an Anti-racist, Multilevel Intervention to Improve Mental Health Equity in High Schools.Prevention Science : The Official Journal of the Society for Prevention Research, Jan. 2024. Epmc, doi:10.1007/s11121-023-01626-x.
Mulawa MI, Docherty SL, Bailey DE, Gonzalez-Guarda RM, Lipkus IM, Randolph SD, Yang Q, Pan W. A Hybrid Pragmatic and Factorial Cluster Randomized Controlled Trial for an Anti-racist, Multilevel Intervention to Improve Mental Health Equity in High Schools. Prevention science : the official journal of the Society for Prevention Research. 2024 Jan;
Journal cover image

Published In

Prevention science : the official journal of the Society for Prevention Research

DOI

EISSN

1573-6695

ISSN

1389-4986

Publication Date

January 2024

Related Subject Headings

  • Substance Abuse
  • 5203 Clinical and health psychology
  • 4206 Public health
  • 1117 Public Health and Health Services