KeywordsCoronary Heart Disease Traffic Accident Community Leader Lifestyle Behavior Multiple Risk Factor
This term can refer to two concepts. First, a multilevel intervention (MLI) refers to addressing various risk factors in one intervention, either at the prevention stage or at the treatment stage of an illness. Second, an MLI refers to an intervention which involves several levels of people or entities such as individual patients, groups, and communities. Both definitions reflect that illnesses and health are a multifactorial problem, requiring either to modify several risk factors or to involve several levels in one’s social and health context. In coronary heart disease (CHD) prevention, the Minnesota Heart Health Project (MHHP) combined both meanings of the MLI concept. First, they aimed to conduct a lifestyle behavior change program, targeting diet, physical activity, smoking, and alcohol reduction. Second, this was achieved by involving individuals, community leaders, teachers, physicians, the media, classes, and schools. Thus, they addressed the multiple risk factor aspect of MLI as well as various levels of intervention units, the social-organizational aspect of the MLI. Mittelmark et al. (1986) revealed the implementation of the MLI, in which they conducted the MLI on three towns/cities and compared that to matched control towns/cities over time. However, follow-up studies found modest effects of the MHHP, mainly due to control communities possibly also receiving health education and due to overall increases in certain risk factors such as obesity over time. Another MLI is the Ornish lifestyle change program, where CHD patients learned to alter their diet, physical activity, smoking, and stress responses. Compared to controls, the MLI-treated group showed regression in atherosclerosis (Ornish et al. 1990). Other types of public health hazards such as traffic accidents could indeed benefit from an MLI approach, where students, teachers, universities, community leaders, safety authorities, schools, and communities can be involved in risk factor modification. This is especially needed because traffic accidents occur because of many factors and affect large segments of society. Thus, an MLI approach is suitable for problems involving multiple risk factors or multiple social contexts.