Enhancing Power and Rigor in a Test of the Efficacy and Mechanisms of Change of the Qungasvik (Tools for Life) Intervention through an Innovative Research to Service Partnership in Rural Alaska

Introduction: Suicide, often accompanied by alcohol use, is a significant public health concern for Alaska Native people, with youth at highest risk. The Qungasvik (Tools for Life) intervention builds protection from alcohol use disorder and suicide in Yup’ik Alaska Native youth ages 12-18 (http://www.qungasvik.org/preview/). Earlier feasibility studies demonstrated the approach as promising; however, due to logistical costs and ethical concerns, alternative strategies to RCT designs for measuring community-level impacts were needed for larger-scale studies.

Methods: The original Qungasvik study was funded through an NIH IRINAH (R01AA023754) grant to test intervention efficacy using a four-year interrupted time series design (ITSD) (Fok, Henry, & Allen, 2015). During Year 1 of the study, three Yup’ik communities outside of the R01 sampling frame, but involved in previous feasibility testing and a small prevention trial, received SAMHSA grants to sustain the Qungasvik intervention. These communities approached the research team requesting evaluation of outcomes of their efforts, utilizing the same measurement approach developed in prior studies, to determine local impacts on protective factors, reasons for life, and sobriety with new youth cohorts. Through an R01 administrative supplement, we proposed a cost-effective, similarly rigorous evaluation of efficacy in the three SAMHSA-funded communities that synergistically enhanced the overall rigor of both studies.

Results: The Qungasvik prevention trial is part of a long-term tribal-academic partnership that has developed collaborative and self-determined strategies for sustaining interventions and for growing research relationships and capacity at the local level. Through a partnering of NIH and SAMHSA, we have significantly increased the scientific rigor of our original small population studies, addressed ethical issues surrounding intervention research and clinical trials, and addressed long-term sustainability. This innovative research and service partnership allows us to leverage data from the original ITSD study to contribute to an expanded five-community test of Qungasvik intervention efficacy that uses a dynamic wait-listed design (DWLD),tripling the sample size and increasing statistical power.

Conclusions: Intervention research to reduce Alaska Native health disparities, as is the case for many other culturally distinct health disparities groups, is often challenged by factors requiring alternative approaches for designing and implementing studies at the community level. This presentation will describe our efforts to establish, through rigorous CBPR, evidence-based practices that come from Native communities, and ultimately, to understand how to sustain and scale-up these interventions.