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However, the available cadre of rigorously evaluated evidence-based interventions for SDOH mitigation remains underdeveloped relative to the magnitude of historic and current health inequities. The proposed manuscript addresses this gap in two ways: first, by introducing a heuristic framework to inform decisions in multilevel intervention development, study design, and selection of analytic methods and, second, by providing a roadmap for future applications of the framework in multilevel intervention research through an exemplar application using the ongoing NIH-funded evaluation study of the Nurse-Community-Family Partnership (NCFP) intervention. NCFP leverages individual, family, institutional, and system factors to shape COVID-19 mitigation outcomes at the individual and household levels. NCFP takes an approach informed by the heuristic framework to addressing and mitigating unjust social processes and other harmful SDOH. We discuss the application of a two-arm parallel explanatory group randomized trial to evaluate the efficacy of NCFP in improving the primary (COVID-19 testing uptake) and secondary (adoption of COVID-19 control measures, COVID-19 vaccine uptake, mutual aid capacity, etc.) outcomes at the individual and household levels. The analysis approach relies on random-intercept models, and we calculate 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.<\/jats:p>","DOI":"10.1007\/s11121-024-01658-x","type":"journal-article","created":{"date-parts":[[2024,4,12]],"date-time":"2024-04-12T09:01:57Z","timestamp":1712912517000},"page":"446-458","update-policy":"https:\/\/doi.org\/10.1007\/springer_crossmark_policy","source":"Crossref","is-referenced-by-count":11,"title":["Application of a Heuristic Framework for Multilevel Interventions to Eliminate the Impact of Unjust Social Processes and Other Harmful\u00a0Social Determinants of Health"],"prefix":"10.1007","volume":"25","author":[{"given":"Vincent","family":"Guilamo-Ramos","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Marco","family":"Thimm-Kaiser","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Adam","family":"Benzekri","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Celia","family":"Johnson","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Desiree","family":"Williams","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Nash","family":"Wilhelm-Hilkey","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Melody","family":"Goodman","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Holly","family":"Hagan","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"297","published-online":{"date-parts":[[2024,4,12]]},"reference":[{"issue":"Suppl 1","key":"1658_CR1","doi-asserted-by":"publisher","first-page":"86","DOI":"10.2105\/AJPH.2018.304730","volume":"109","author":"T Agurs-Collins","year":"2019","unstructured":"Agurs-Collins, T., Persky, S., Paskett, E. 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Retrieved from https:\/\/www.afro.who.int\/sites\/default\/files\/2017-06\/SDH_conceptual_framework_for_action.pdf"}],"container-title":["Prevention Science"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/link.springer.com\/content\/pdf\/10.1007\/s11121-024-01658-x.pdf","content-type":"application\/pdf","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/link.springer.com\/article\/10.1007\/s11121-024-01658-x\/fulltext.html","content-type":"text\/html","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/link.springer.com\/content\/pdf\/10.1007\/s11121-024-01658-x.pdf","content-type":"application\/pdf","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2024,7,11]],"date-time":"2024-07-11T10:50:07Z","timestamp":1720695007000},"score":1,"resource":{"primary":{"URL":"https:\/\/link.springer.com\/10.1007\/s11121-024-01658-x"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2024,4,12]]},"references-count":59,"journal-issue":{"issue":"S3","published-print":{"date-parts":[[2024,7]]}},"alternative-id":["1658"],"URL":"https:\/\/doi.org\/10.1007\/s11121-024-01658-x","relation":{},"ISSN":["1389-4986","1573-6695"],"issn-type":[{"value":"1389-4986","type":"print"},{"value":"1573-6695","type":"electronic"}],"subject":[],"published":{"date-parts":[[2024,4,12]]},"assertion":[{"value":"20 February 2024","order":1,"name":"accepted","label":"Accepted","group":{"name":"ArticleHistory","label":"Article History"}},{"value":"12 April 2024","order":2,"name":"first_online","label":"First Online","group":{"name":"ArticleHistory","label":"Article History"}},{"order":1,"name":"Ethics","group":{"name":"EthicsHeading","label":"Declarations"}},{"value":"The NCFP study was approved by the institutional review boards at Duke University and New York University. All procedures involving human participants were in accordance with the ethical standards of the institutional and\/or national research committee and with the 1964 Helsinki Declaration and its later amendments or comparable ethical standards.","order":2,"name":"Ethics","group":{"name":"EthicsHeading","label":"Ethics Approval"}},{"value":"Informed consent was obtained from all participants included in the NCFP study. Additional informed consent was obtained from all participants for whom images are included in the supplemental materials.","order":3,"name":"Ethics","group":{"name":"EthicsHeading","label":"Consent to Participate"}},{"value":"VGR reports grants and personal fees from ViiV Healthcare outside the submitted work, and he serves on the US Presidential Advisory Council on HIV\/AIDS; the CDC\/HRSA Advisory Committee on HIV, Viral Hepatitis and STD Prevention and Treatment; and the NASEM Committee on Unequal Treatment Revisited. All other authors declare that they have no competing interests.","order":4,"name":"Ethics","group":{"name":"EthicsHeading","label":"Conflict of Interest"}}]}}