An Intervention Science to Advance Underrepresented Perspectives and Indigenous Self-Determination in Health

  • 201 Accesses

  • 3 Citations


This concluding article to the Supplemental Issue on Promoting Health Equity through Rigorous, Culturally Informed Intervention Science: Innovations with Indigenous Populations in the United States draws themes and conclusions from the innovative practices implemented by the National Institutes of Health Intervention Research to Improve Native American Health (IRINAH) consortium. The IRINAH work highlights promising practices for advancing the diverse and underrepresented perspectives essential to develop and test culturally appropriate, effective health interventions in American Indian, Alaska Native, and Native Hawaiian settings. Four emergent themes appear through the IRINAH work. First, community-based participatory research (CBPR) has provided projects an intersectional worldview for bridging cultures and informing an ethics of local control. Second, culture is fundamental as a central organizing principle in IRINAH research and intervention implementation. Third, crucial demands for sustainability of interventions in Indigenous intervention science require a rethinking of the intervention development process. Finally, tensions persist in Indigenous health research, even as significant strides are made in the field. These themes collectively inform an ethical and rigorous Indigenous intervention science. Collectively, they suggest a roadmap for advancing Indigenous perspectives and self-determination in health intervention research. IRINAH studies are leading innovation in intervention science by advancing applications of CBPR in intervention science, promoting new directions in small populations health research, and demonstrating value of participatory team science.

This is a preview of subscription content, log in to check access.

Access options

Buy single article

Instant unlimited access to the full article PDF.

US$ 39.95

Price includes VAT for USA

Subscribe to journal

Immediate online access to all issues from 2019. Subscription will auto renew annually.

US$ 99

This is the net price. Taxes to be calculated in checkout.


  1. Airhihenbuwa, C. O., Ford, C. L., & Iwelunmor, J. I. (2014). Why culture matters in health interventions: Lessons from HIV/AIDS stigma and NCDs. Health Education & Behavior, 41, 78–84.

  2. Allen, J., Mohatt, G. V., Markstrom, C. A., Byers, L., Novins, D. K. (2012). “Oh No, We are Just Getting to Know You”: The relationship in research with children and youth in indigenous communities. Child Dev Perspect, 6, 55–60.

  3. Barrera, M., Jr., Berkel, C., & Castro, F. G. (2017). Directions for the advancement of culturally adapted preventive interventions: Local adaptations, engagement, and sustainability. Prevention Science, 18, 640–648.

  4. Bernal, G., & Adames, C. (2017). Cultural adaptations: Conceptual, ethical, contextual, and methodological issues for working with ethnocultural and majority-world populations. Prevention Science, 18, 681–688.

  5. Chambers, D. A., Glasgow, R. E., & Stange, K. C. (2013). The dynamic sustainability framework: Addressing the paradox of sustainment amid ongoing change. Implementation Science, 8, 117.

  6. Cooper, L. A., Ortega, A. N., Ammerman, A. S., Buchwald, D., Paskett, E. D., Powell, L. H., … Williams, D. R. (2015). Calling for a bold new vision of health disparities intervention research. American journal of public health, 105(Suppl 3), S374–S376.

  7. Crump, A. D., Etz, K., Arroyo, J. A., Hemberger, N., & Srinivasan, S. (2017). Accelerating and strengthening Native American health research through a collaborative NIH initiative. Prevention Science.

  8. Deaton, A., & Cartwright, N. (2018). Understanding and misunderstanding randomized controlled trials. Social Science & Medicine, 210, 2–21.

  9. Dickerson, D., Baldwin, J. A., Belcourt, A., Belone, L., Gittelsohn, J., Kaholokula, J. K., … Wallerstein, N. (2018). Encompassing cultural contexts within scientific research methodologies in the development of health promotion interventions. Prevention Science.

  10. Eldridge, S. M., Ashby, D., & Kerry, S. (2006). Sample size for cluster randomized trials: Effect of coefficient of variation of cluster size and analysis method. International Journal of Epidemiology, 35, 1292–1300.

  11. Etz, K. E., & Arroyo, J. A. (2015). Small sample research: Considerations beyond statistical power. Prevention Science, 16, 1033–1036.

  12. Frieden, T. R. (2017). Evidence for health decision making—beyond randomized, controlled trials. New England Journal of Medicine, 377, 465–475.

  13. Gittelsohn, J., Belcourt, A., Magarati, M., Booth-LaForce, C., Duran, B., Mishra, S. I., … Jernigan, V. V. B. (2018). Building capacity for productive indigenous community-university partnerships. Prevention Science.

  14. Hall, G. C., Yip, T., & Zarate, M. A. (2016). On becoming multicultural in a monocultural research world: A conceptual approach to studying ethnocultural diversity. The American Psychologist, 71, 40–51.

  15. Harding, A., Harper, B., Stone, D., O’Neill, C., Berger, P., Harris, S., & Donatuto, J. (2012). Conducting research with tribal communities: Sovereignty, ethics, and data-sharing issues. Environmental Health Perspectives, 120, 6–10.

  16. Hawe, P., Shiell, A., & Riley, T. (2004). Complex interventions: How far “out of control” can a randomised controlled trial be? British Medical Journal, 328, 1561–1563.

  17. Hemming, K., Girling, A. J., Sitch, A. J., Marsh, J., & Lilford, R. J. (2011). Sample size calculations for cluster randomised controlled trials with a fixed number of clusters. BMC Medical Research Methodology, 11, 102.

  18. Henry, D., Fok, C. C. T., & Allen, J. (2015). Why small is too small a term: Prevention science for health disparities, culturally distinct groups, and community-level intervention. Prevention Science, 16, 1026–1032.

  19. Henry, D., Tolan, P., Gorman-Smith, D., & Schoeny, M. (2017). Alternatives to randomized control trial designs for community-based prevention evaluation. Prevention Science, 18, 671–680.

  20. Ivanich, J., Mousseau, A. C., Walls, M., Whitbeck, L., & Whitesell, N. R. (2018). Pathways of adaptation: Two case studies with one evidence-based substance use prevention program tailored for indigenous youth. Prevention Science.

  21. Jernigan, V. B. B., D’Amico, E. J., & Kaholokula, J. K. (2018). Prevention research with indigenous communities to expedite dissemination and implementation efforts. Prevention Science.

  22. Jernigan, V. B. B., D’Amico, E. J., Duran, B., & Buchwald, D. (2019). Multilevel and community-level interventions with Native Americans: Challenges and opportunities. Prevention Science.

  23. Kagawa-Singer, M., Dressler, W., George, S., & Elwood, W. (2015). The cultural framework for health: An integrative approach for research and program design and evaluation. Bethesda: Office of Behavioral and Social Science Research, National Institutes of Health.

  24. Mohatt, G. V. (1989). The community as informant or collaborator? American Indian and Alaska Native Mental Health Research, 2, 64–70.

  25. Mohatt, N. V. (2014). Forward to ecological description of a multi-level community-based cultural intervention: Reflections on culturally-situated participatory research. American Journal of Community Psychology, 54, 81–82.

  26. National Academies of Sciences, Egineering, and Medicine. (2018). Improving health research on small populations: Proceedings of a workshop. Washington, DC: The National Academies Press.

  27. National Research Council. (2015). Enhancing the effectiveness of team science. Washington, DC: The National Academies Press.

  28. Pacheco, C. M., Daley, S. M., Brown, T., Filippi, M., Greiner, K. A., & Daley, C. M. (2013). Moving forward: Breaking the cycle of mistrust between American Indians and researchers. American Journal of Public Health, 103, 2152–2159.

  29. Rabin, B. A., Brownson, R. C., Haire-Joshu, D., Kreuter, M. W., & Weaver, N. L. (2008). A glossary for dissemination and implementation research in health. Journal of Public Health Management and Practice, 14, 117–123.

  30. Rasmus, S. M. (2014). Indigenizing CBPR: Evaluation of a community-based participatory research process implementation of the Elluam Tungiinun (Towards Wellness) program in Alaska. American Journal of Community Psychology, 54.

  31. Rearden, A., Jimmie, F., Kaganak, V., Chanar, D., Jaconsen, A., & Spark, L. (Eds.). (2009). Qanruyuteput iinruugut: Our teachings are medicine. Bethel: Alaska Association of Village Council Presidents with University of Alaska Fairbanks.

  32. Sanson-Fisher, R. W., Bonevski, B., Green, L. W., & D’Este, C. (2007). Limitations of the randomized controlled trial in evaluating population-based health interventions. American Journal of Preventive Medicine, 33, 155–161.

  33. Stanley, L. R., Swaim, R., Kaholokula, J. K., Kelly, K. J., Belcourt, A., & Allen, J. (2019). The imperative for research to promote health equity in indigenous communities. Prevention Science.

  34. Sterling, R. L. (2011). Genetic research among the Havasupai—a cautionary tale. Virtual Mentor, 13, 113–117.

  35. Tebes, J. K. (2018). Team science, justice, and the co-production of knowledge. American Journal of Community Psychology, 62, 13–22.

  36. Tebes, J. K., & Thai, N. D. (2018). Interdisciplinary team science and the public: Steps toward a participatory team science. American Psychologist, 73, 549–562.

  37. Trickett, E. J. (2011). Community-based participatory research as worldview or instrumental strategy: Is it lost in translation (al) research? American Journal of Public Health, 101, 1353–1355.

  38. Trickett, E. J., Beehler, S., Deutsch, C., Green, L. W., Hawe, P., McLeroy, K., … Trimble, J. E. (2011). Advancing the science of community-level interventions. American Journal of Public Health, 101, 1410–1419.

  39. Waldram, J. B. (2004). Revenge of the Windigo: The construction of the mind and mental health of North American Aboriginal Peoples. Toronto: University of Toronto Press.

  40. Wallerstein, N., Duran, B., Oetzel, J. G., & Minkler, M. (2018). Community-based participatory research for health: Advancing social and health equity (3rd ed.). San Francisco: Jossey-Bass.

  41. Walters, K., Johnson-Jennings, M., Stroud, S., Rasmus, S., Charles, B., John, S., … Boulafentis, J. (2018). Growing from our roots: Strategies for developing culturally grounded health promotion interventions in American Indian, Alaska Native, and Native Hawaiian communities. Prevention Science.

  42. West, S. G. (2009). Alternatives to randomized experiments. Current Directions in Psychological Science, 18, 299–304.

  43. West, S. G., Duan, N., Pequegnat, W., Gaist, P., Jarlais, D. C. D., Holtgrave, D., … Mullen, P. D. (2008). Alternatives to the randomized controlled trial. American Journal of Public Health, 98(8), 1359–1366.

  44. Whitesell, N. R., Mousseau, A. C., Parker, M. E., Rasmus, S., & Allen, J. (2018a). Evolution of research with indigenous populations: Promising practices for promoting health equity Prevention Science.

  45. Whitesell, N. R., Sarche, M., Keane, E. M., Mousseau, A. C., & Kaufman, C. E. (2018b). Advancing scientific methods in community and cultural context to promote health equity: Lessons from intervention outcomes research with American Indian and Alaska Native communities. American Journal of Evaluation, 39, 42–57.

  46. Wiltsey Stirman, S., Kimberly, J., Cook, N., Calloway, A., Castro, F., & Charns, M. (2012). The sustainability of new programs and innovations: A review of the empirical literature and recommendations for future research. Implementation Science, 7, 17.

Download references

Author information

Correspondence to Stacy M. Rasmus.

Ethics declarations

Conflict of Interest

The authors declare that they have no conflict of interest.

Ethical Approval

Not applicable; this paper provides a summary of other papers in this Supplemental Issue and does not report original research.

Informed Consent

Not applicable; this paper provides a summary of other papers in this Supplemental Issue and does not report original research.

Additional information

Publisher’s Note

Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

Rights and permissions

Reprints and Permissions

About this article

Verify currency and authenticity via CrossMark

Cite this article

Rasmus, S.M., Whitesell, N.R., Mousseau, A. et al. An Intervention Science to Advance Underrepresented Perspectives and Indigenous Self-Determination in Health. Prev Sci 21, 83–92 (2020).

Download citation


  • American Indian/Alaska Native/Native Hawaiian
  • Intervention science
  • Community-based participatory research
  • Team participatory science
  • Ethics
  • Sustainability
  • Indigenous knowledge systems