Stakeholders described a pattern of delayed healthcare use among the priority population: Black men with low incomes and chronic conditions frequently postpone care until conditions become acute. Contributors to this delay included prior traumas, fear and distrust of healthcare systems (with some participants referencing historical injustices), and competing immediate needs such as housing, employment, or criminal-justice crises.
Participants emphasized that basic needs often take precedence over chronic disease management. Limited discretionary funds, lack of transportation, unpaid time off work, and co-pays were cited as reasons routine appointments are deferred. Several interest holders noted that when people prioritize survival needs, preventive or routine care is less likely to occur. Interviewees suggested that supplemental income could increase discretionary resources and thereby reduce the opportunity cost of attending to non-emergent health needs.
However, stakeholders also made clear that simply providing money does not automatically change health behaviors; addressing the underlying trauma, fear of care, and prioritization of basic needs is necessary for long-term improvements in healthcare engagement.
Interpersonal networks that might facilitate healthcare use were frequently compromised. Participants reported that family and social supports are often weakened by histories of incarceration, generational poverty, and relationship disruption. While some stakeholders described women in patients’ lives as effective prompts to seek care, many interviewees observed that many men lack such support.
Trust and relationships with healthcare providers were also identified as fragile. Distrust—rooted in past injustices and personal experiences—undermined willingness to seek or continue care. Stakeholders highlighted the importance of rebuilding sincere, culturally responsive clinical relationships and leveraging existing trusted community ties to support engagement.
Participants described institutional barriers within correctional and community healthcare systems that impede continuity of care. Correctional settings and reentry processes were characterized as ill-suited to support long-term management of chronic illness. The mass incarceration of Black men was discussed as producing long-term health sequelae that persist after release and complicate healthcare access.
Interviewees noted that reentry challenges—such as numerous collateral consequences that limit employment, housing, and benefits—create institutional obstacles to stability and health. Institutional fragmentation between criminal justice, social services, and healthcare sectors reduced the capacity of systems to coordinate care and address social needs that affect health outcomes.
At the community level, stakeholders identified multiple impediments to health and healthcare access. These included food insecurity, environmental hazards, residential segregation, limited local services, transportation gaps, and over-policing. Community resource deficits make it difficult for individuals to meet basic needs and to maintain engagement with healthcare.
Participants emphasized that community-based organizations and local leaders can be important facilitators for outreach and engagement, but these organizations often operate with limited capacity. Community-level stigma, norms, and mistrust of institutions also shaped health-seeking behaviors among the priority population.
Stakeholders framed many barriers as rooted in structural racism and intergenerational poverty. These societal-level drivers manifest across domains—healthcare access, housing, employment, and criminal justice—and create compounding disadvantages that undermine health equity.
While participants agreed that UBI represents a structural policy change with potential cascading benefits across ecological levels, many expressed that societal factors such as entrenched racism and generational poverty are deeply embedded and may be beyond the scope of a single intervention to fully remediate. The study reports that societal drivers should be acknowledged and considered when designing interventions but may not be fully addressable within a UBI pre-implementation plan.
Interest holders concluded that for a UBI intervention aimed at improving healthcare access among low-income Black men with chronic illness to be effective and equitable, it must be designed with attention to multiple SEM levels. Practical implications drawn from stakeholder input include:
Integrate strategies that address immediate basic needs so that recipients can prioritize preventive and routine healthcare without sacrificing housing, food, or legal stability.
Pair financial supports with culturally responsive outreach and trust-building efforts to address fear and distrust of the healthcare system.
Coordinate across correctional, reentry, social service, and healthcare systems to reduce institutional fragmentation and support continuity of care after incarceration.
Strengthen community organizations and leverage trusted local relationships to facilitate engagement and delivery of supportive services.
Recognize and explicitly acknowledge societal drivers—structural racism and generational poverty—in planning and evaluation, understanding that UBI alone may not resolve these entrenched barriers.
Methodological notes reported in the source: the study used semi-structured interviews (60–90 minutes) with 31 stakeholders conducted November 2022–January 2023 in a southern state. Transcripts were professionally transcribed, coded deductively and inductively in MAXQDA22, and analyzed using the SEM framework. Verbal consent was recorded to protect anonymity; deidentified data are available by request from the University of Arkansas for Medical Sciences IRB. The study did not provide quantitative estimates of UBI effects or an implementation blueprint; it focused on pre-implementation contextual factors identified by stakeholders.