---
title: "Key factors for equitable UBI-based health interventions for low-income Black men with chronic ill"
id: "plos-one-10-key-factors-for-an-equitable-health-intervention-for-black-men-with-low-income"
canonical_url: "https://medichelpline.com/clinical-feed/plos-one-10-key-factors-for-an-equitable-health-intervention-for-black-men-with-low-income"
content_type: "clinical_feed_article"
specialty: "General"
source_name: "PLOS ONE (Medicine)"
source_url: "https://journals.plos.org/plosone/article?id=10.1371/journal.pone.0358797"
published_at: "2026-09-22T14:00:00.000Z"
evidence_level: "Journal Feed"
license: "CC-BY-NC-4.0 / Informational Use"
---
# Key factors for equitable UBI-based health interventions for low-income Black men with chronic ill
## Provenance & Clinical Metadata
- **Canonical URL:** https://medichelpline.com/clinical-feed/plos-one-10-key-factors-for-an-equitable-health-intervention-for-black-men-with-low-income
- **Specialty:** [General](https://medichelpline.com/clinical-feed/general.md)
- **Primary Source:** PLOS ONE (Medicine)
- **Source URL:** [Original Journal Publication](https://journals.plos.org/plosone/article?id=10.1371/journal.pone.0358797)
- **Published At:** 2026-09-22T14:00:00.000Z
- **Evidence Rating:** Journal Feed
## Executive GIST (TL;DR)
- This qualitative study explored stakeholders' perceptions about using **universal basic income (UBI)** to improve healthcare access and promote health equity for **Black men** with low incomes and chronic illnesses in a southern U.S. state. - Semi-structured interviews were conducted with 31 purposively selected interest holders between November 2022 and January 2023, including healthcare providers, criminal justice professionals, community leaders, HIV-related advocates, and members of the priority population. - The Socioecological Model (SEM) guided conventional content analysis; transcripts were coded for pre-implementation issues and then mapped to SEM levels (individual, interpersonal, institutional, community, societal). - Five overarching themes emerged: (1) individual-level delays in care driven by trauma, competing priorities, and resource scarcity; (2) strained interpersonal supports due to **incarceration** and poverty and distrust in healthcare relationships; (3) institutional shortcomings, notably correctional health and fragmented healthcare systems unsuited to support this population; (4) multiple community-level barriers to health and healthcare access; and (5) entrenched societal factors—**structural racism** and generational poverty—that compound barriers to health. - Participants emphasized that a UBI intervention must address needs across individual, interpersonal, community, and institutional levels to be effective; societal-level drivers may be too entrenched to be fully remedied by a single intervention. - Methodologic details: interviews lasted 60–90 minutes, verbal consent was recorded, transcripts were analyzed in MAXQDA22 with multiple coders and consensus processes to enhance rigor; deidentified data are available by request to the University of Arkansas for Medical Sciences IRB. - The study did not report specific UBI design parameters, quantitative outcomes, or implementation logistics; it focused on pre-implementation contextual factors identified by stakeholders. - Funding and compliance: the project received NIMHD grant support though the grant was terminated in March 2025; authors reported no competing interests.
## Clinical Analysis & Structured Key Points
Key factors for an equitable health intervention for Black men with low income and chronic illness in a southern state in the United States | PLOS One Browse Subject Areas ? Click through the PLOS taxonomy to find articles in your field. For more information about PLOS Subject Areas, click here . Article Authors Metrics Comments Media Coverage Reader Comments Figures Figures Abstract Black men’s health continues to be worse than that of many other groups in the United States. This study’s purpose was to explore interest holders’ perceptions about an intervention proposed to use universal basic income (UBI) to facilitate healthcare access and promote health equity of Black men with chronic conditions, including HIV, and low incomes in a southern state. Semi-structured interviews with 31 interest holders, including members of the priority population, were conducted via phone or Zoom. Pre-implementation factors were identified using the Socioecological Model as a framework for conventional content analysis. Participants noted that certain factors must be considered for any intervention to be successful in improving the health status of the priority population. The following themes were identified: 1) The priority population typically delays healthcare. 2) Relationships are strained due to incarceration or poverty. 3) Correctional health and healthcare systems are not structured to help. 4) Many barriers to health/healthcare exist within the community. 5) Racism and poverty are often intertwined and are entrenched barriers to health. Equitable interventions, such as providing a UBI, which are designed to improve the health and well-being of the priority population, should address the identified factors at the individual, interpersonal, community, and institutional levels to be effective. Societal factors, such as structural racism and generational poverty, may be too difficult to address in such an intervention. Citation: Marshall SA, Johnson O, Pro G, Williams A, Zaller N, Montgomery BEE (2026) Key factors for an equitable health intervention for Black men with low income and chronic illness in a southern state in the United States. PLoS One 21(9): e0358797. https://doi.org/10.1371/journal.pone.0358797 Editor: Sungwoo Lim, New York City Department of Health and Mental Hygiene, UNITED STATES OF AMERICA Received: March 9, 2026; Accepted: September 4, 2026; Published: September 22, 2026 Copyright: © 2026 Marshall et al. This is an open access article distributed under the terms of the Creative Commons Attribution License , which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited. Data Availability: Data cannot be shared publicly to protect confidentiality of research participants. Deidentified data can be requested from the University of Arkansas for Medical Sciences Institutional Review Board (contact via 501-686-5667 or irb@uams.edu ). Funding: The project described was supported by a grant (R01MD017509) through the National Institute on Minority Health and Health Disparities (NIMHD) at the National Institutes of Health (NIH), although the grant for this study was terminated in March 2025 pursuant to the 2024 NIH Grants Policy Statement and 2 C.F.R. § 200.340(a)(2). The content presented is solely the responsibility of the authors and does not represent the official views of NIH. The funders had no role in study design, data collection and analysis, decision to publish, or preparation of the manuscript. Competing interests: The authors have declared that no competing interests exist. Introduction Black men in the United States face persistent and significant health disparities, exhibiting worse outcomes than nearly every other demographic group. Compared to White men, Black men have higher rates of chronic illness, lower life expectancy, and disproportionate exposure to adverse social determinants of health [ 1 ]. Black men in the U.S. are more likely to have higher rates of hypertension [ 2 ], type II diabetes [ 2 , 3 ], heart disease [ 2 , 3 ], prostate cancer [ 3 ], and HIV [ 4 ], compared to White men. Despite greater disease burden, historically Black men report lower use of ambulatory healthcare services than White men [ 5 ]. Economically, Black men earn only 63.6% of what White men earn, are more than twice as likely to live below the poverty line, and nearly five times more likely to be incarcerated [ 6 ]. These disparities are not simply individual or behavioral but are deeply rooted in structural racism and discrimination (SRD) [ 7 , 8 ]. SRD refers to systemic policies, institutional practices, and societal norms that produce and reinforce racial inequities across domains—healthcare access, employment, housing, and criminal justice [ 9 ]. For Black men with low incomes and chronic conditions, SRD often manifests in limited access to quality healthcare, food insecurity, over-policing, environmental hazards, residential segregation, and heightened vulnerability to incarceration [ 10 ]. These interlocking disadvantages disrupt basic human needs—such as safety, housing, and community—obstructing opportunities for self-actualization and long-term health [ 7 ]. The mass incarceration of Black men is a clear consequence of SRD, with long-term health and social impacts. Though the 2018 First Step Act expanded rehabilitative and reentry programs for justice-impacted (JI) individuals in federal systems, reentry challenges remain substantial [ 11 ]. Black men often return to communities facing over 430 collateral consequences that limit access to employment, healthcare, housing, and social services—factors critical for stability and health equity [ 12 ]. Additionally, a history of incarceration has well-documented deleterious impacts on both health status and health-related outcomes, particularly among Black men who have historically been disproportionately impacted by mass incarceration in the United States [ 13 , 14 ]. Health sequelae often persist long after release from incarceration [ 15 , 16 ] and are exacerbated by economic and related insecurities [ 17 ]. In response to these compounded inequities, there is an urgent need for interventions that address not only clinical needs but also broader structural barriers to health and healthcare access. This study sought to identify interest holders’ perspectives on universal basic income (UBI) [ 18 ] –also known as guaranteed supplemental income—as a potential intervention to improve healthcare access and promote health equity for Black men with low incomes and chronic illnesses [ 19 – 21 ]. While previous studies have examined the effects of unconditional cash transfers with various individuals with low incomes in the U.S., including those formerly incarcerated [ 22 ], few have examined the multilevel factors that members of the priority population as well as the community-based partners and service providers that serve them consider essential before implementing UBI intervention so that adoption, implementation, and sustainability are maximized. The goal of this manuscript is not to describe why UBI is needed nor to describe the intervention’s design. These are related yet different questions. Instead, we aim to examine factors across the Social Ecological Model that must be accounted for during the pre-implementation phase for a UBI intervention to be successful in real-world settings among Black men with chronic illness. Interest holder input, particularly from those in service delivery, regulation, and advocacy, is essential for developing effective, community-based interventions. Understanding their views may inform future health policy and practice aimed at advancing health justice for this priority population. Materials and methods This study followed the consolidated criteria for reporting qualitative research (COREQ) checklist. Members of the research team collaborated with existing contacts and new referrals in the healthcare system, criminal justice system, and community-based organizations that typically serve the priority population—i.e., Black men with low incomes (defined as living 11.5% below the poverty line) and chronic health conditions who are not engaged in healthcare and possible involvement in the criminal justice system; and representatives of the priority population themselves were also invited to participate. The University of Arkansas for Medical Sciences’ Institutional Review Board (IRB) approved the study. Information about the study was provided in flyers and email communications to recruit interview participants within the systems or organizations of interest. Individual interviews were conducted with the following categories of purposively selected interest holders: 1) healthcare system workers, 2) criminal justice professionals, 3) community leaders, 4) HIV-related community leaders, and 5) members of the priority population (i.e., Black men with low incomes, chronic health conditions, not engaged in healthcare, and possible involvement in the criminal justice system). Of note, HIV-related interest holders were added to the study sample through supplemental funding to the parent grant to explore the potential benefits of a UBI on engaging out of care Black men living with HIV into HIV care. Members of the research team conducted the semi-structured interviews between November 2022 and January 2023 with an interview guide that explored perceptions about providing UBI to Black men with low incomes and chronic illness and that gathered information about culturally acceptable methods through which to implement a future UBI intervention. Interview participants were asked about the factors that may influence the overall health and well-being and the healthcare-use decisions of low-income Black men. Participants were told that this information would be used to inform the development and testing of a UBI intervention focused on increasing healthcare use among low-income Black men living with a chronic disease who were not engaged in healthcare. Interviews were scheduled for 60–90 minutes, depending on the amount of time the participant was willing to give, and were conducted via telephone or Zoom; all were audio recorded. Each participant verbally consented before beginning the interview. Written consent was not obtained to protect participant anonymity, and the university’s IRB approved the use of verbal consent, which was recorded by the interviewee. Because the interviews were conducted via telephone or Zoom, participants were able to choose a location that allowed privacy. No identifying information was reported in the interview findings, and any individual identifiers have been removed or changed in the presentation of the results. Each interview participant was given a check for $50 after completing the interview. A professional transcription service transcribed the audio recording of each interview. Transcribed data were uploaded into MAXQDA22, a qualitative data analysis package, and members of the research team used conventional methods for content analysis [ 23 ]. The research team used the interview guide to deductively derive the initial codebook. The researchers who conducted the interviews independently coded the deidentified interview transcripts; multiple coders enhanced the rigor of the analysis [ 24 ]. The group met multiple times in the spring of 2023 to discuss their understanding and application of the coding definitions in the preliminary codebook; discrepancies in coding were resolved, and consensus was achieved for revising coding definitions and adding emergent codes. Coding was completed in two phases. In phase 1, segments of transcripts were coded with “pre-implementation” in the summer of 2023 if the participant described factors that may affect the perceived need, acceptability, and feasibility of a UBI intervention or other health-improvement efforts. This included responses relevant to factors that affect healthcare, personal health, or a UBI intervention. In phase 2, the segments already coded as “pre-implementation” were further categorized and coded according to the factors of the socioecological model (SEM) (i.e., individual factors, interpersonal factors, institutional factors, community factors, and societal factors) in the fall of 2023. Coding definitions for each of the SEM factors are shown in Fig 1 . Download: PNG larger image TIFF original image Fig 1. Socioecological Model with Coding Definitions. https://doi.org/10.1371/journal.pone.0358797.g001 One researcher used MAXQDA22 for a complex coding query that pulled text segments dually coded as “pre-implementation” and each of the five SEM factors. This process resulted in five dually-coded text documents that contained each of the five sets of complex coding queries (e.g., pre-implementation + individual factors). From each of the five sets of complex coding queries, themes emerged that were discussed and articulated by the research team. Theoretical framework The socioecological model (SEM) is a valuable framework for qualitative research in health because it helps researchers understand the complex interplay of factors that influence health behaviors and outcomes [ 25 ]. Thus, the SEM has been used in previous studies examining chronic disease interventions [ 26 ]. By considering individual, interpersonal, institutional, community, and policy levels, the SEM provides a holistic perspective that is well-suited for exploring qualitative data and understanding the lived experiences of individuals and communities [ 27 ]. The SEM provides a framework for analysis by considering the different levels of influence that contribute to a health issue or behavior [ 25 , 27 , 28 ]. Qualitative methods are particularly useful for exploring the contextual factors highlighted by the SEM. The SEM emphasizes the reciprocal relationship between individuals and their environments, allowing researchers to examine how different factors interact to influence health behaviors and outcomes. By identifying the specific levels and factors that influence health behaviors, the SEM can inform the development of effective interventions, including UBI, that address the root causes of health disparities. Assessing how some ecological levels affect subgroups differently is a critical component of health disparities measurement [ 29 ]. Applying the SEM to studies of UBI will lead to more thorough investigation of disparities, for example, how the conditions of the lives of individuals with a history of incarceration have led to the need for supplemental income in the first place. UBI is thought to provide a structural policy change that enables positive cascading effects across the multiple nested levels of influence of the SEM on the health disparities experienced by communities [ 30 ]. Results A total of 31 interest holders were interviewed, including healthcare providers (n = 6), individuals in the criminal justice system (n = 6), community leaders (n = 7), HIV-related advocates (n = 5), and members of the priority population (n = 7) (i.e., Black men with chronic conditions, including HIV, no healthcare engagement, low incomes and possible justice involvement). See Table 1 for characteristics of interview participants. Analysis revealed five key themes, using the SEM as a theoretical framework. Download: PNG larger image TIFF original image Table 1. Characteristics of individual interview participants. https://doi.org/10.1371/journal.pone.0358797.t001 Theme 1: Individual factors – delaying care due to individual experiences of trauma or hardship The priority population has the following set of common characteristics and/or experiences: they will frequently delay care; they typically have experienced traumas or hardships; and they must have their basic needs met first. Many participants indicated that these factors must be considered when developing an intervention to improve the health and healthcare use of Black men, such as UBI. A community leader put it plainly: “What I’ve found is that a lot of the chronically ill, low-income Black males do not go to the doctor as often as they should …unless something major happens. In other words, there’s no prevention… until an issue occurs that makes them have to go to the doctor,” (Participant #7). A member of the priority population offered this as an explanation for why low-income Black men with a chronic condition may not seek healthcare: “…a lot of ’em just afraid to go to the doctor. They’re afraid, scared to death” (Participant #28). This participant and others referred to past injustices like the Tuskegee experiment as an underlying reason for being afraid to seek healthcare services. Additionally, a healthcare provider who frequently provides care for this priority population offered the following as a barrier that prevents Black men from getting the healthcare they need: “Usually that’s because they had other competing challenges at home… ‘It [the patient’s health condition] doesn’t really matter to me because I need to support my family, so managing my diabetes is lower on the problem list. Until it becomes a problem that impairs my ability to care for my family.’ That’s usually what I see,” (Participant #24). The notion of competing priorities was mentioned by multiple interviewees. One participant put it this way, “I honestly think the primary thing is when you are in crisis and when you are dealing with a housing crisis, job crisis, I-might-be-going-back-to-jail crisis, everything is an emergency. Especially a long-term health issue that you’ve been dealing with for a long time, you don’t deal with that until it rises to the level of also an emergency” (Participant #5). Several participants also reported that this population routinely delays care, often because of an inability to afford it. As mentioned across several interviews, members of the priority population did not perceive their chronic health conditions as emergencies and therefore were less likely to allocate their limited resources, such as transportation, time off work, and co-pays, to attend doctor’s appointments. Their resources, including time, income, and attention, were allocated to issues and situations they perceived as true emergencies, such as housing and criminal justice system involvement. However, receipt of additional funds through UBI had the potential of improving health promoting behaviors (i.e., healthcare access) by increasing access to discretionary funds and allowing non-emergency health-related issues to be addressed. This highlights the importance of addressing the basic needs of the priority population through a UBI intervention to improve health and well-being. Theme 2: Interpersonal factors – otherwise supportive relationships are strained Interpersonal relationships that might otherwise be instrumental in facilitating the health and well-being of the priority population are difficult. Family relationships often have been devastated by incarceration and/or generational poverty. Additionally, relationships with medical care providers are strained due to distrust and/or lack of a sincere connection. A few participants mentioned that relationships could be instrumental in supporting the health and well-being of Black men. For instance, one healthcare provider said, “Many times, it is the women in their lives who notice a change and say, ‘You’ve got to get this checked out. You’ve got to go and get this looked at,’” (Participant #23). This same participant mentioned that the lack of such supportive relationships can be problematic. The other thing, relationships are big. If they don’t have a support system, they don’t have a spouse or a girlfriend or a friendship or whatever it is, that support system can be one of the factors that stresses people because they don’t have an outlet if you will. That can also cause issues. (Participant #23) For the priority population, cr
## Related Clinical Research

- [Handshake in Medicine: Why Clinicians Should Reconsider Shaking Hands](https://medichelpline.com/clinical-feed/stat-news-4-opinion-medicine-stopped-shaking-hands-we-should-start-again.md)
- [EHR capacity for adaptive multimorbidity care in Zimbabwe: assessment of the Impilo system](https://medichelpline.com/clinical-feed/medrxiv-14-assessing-electronic-health-record-potential-for-adaptive-learning-in.md)
- [Medication adherence tools in Africa: scoping review of methods, validation, and reported rates](https://medichelpline.com/clinical-feed/bmj-open-0-mapping-medication-adherence-tools-in-africa-a-scoping-review.md)
- [Adverse neonatal outcomes after operative vaginal delivery in Gondar, Ethiopia: prevalence and ass](https://medichelpline.com/clinical-feed/plos-one-17-adverse-neonatal-outcomes-and-associated-factors-among-births-through-operative.md)
- [Hormonal Management in Older Transgender and Gender Diverse Adults: Case-Based Considerations](https://medichelpline.com/clinical-feed/pubmed-42274359.md) (DOI: 10.1210/clinem/dgag231)

## Navigation
- [← Back to General Feed](https://medichelpline.com/clinical-feed/general.md)
- [← All Clinical Specialties](https://medichelpline.com/clinical-feed.md)
## Medical & Regulatory Disclaimer

> [!CAUTION]
> MedicHelpline content is structured for research, educational, and professional discovery purposes. It does not constitute individual medical advice, clinical diagnosis, or treatment recommendations.
> Always verify dosing, contraindications, and regulatory alerts against official product labeling and primary regulatory sources before clinical decision-making.