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Journal of Correctional Health Care logoLink to Journal of Correctional Health Care
. 2022 Aug 4;28(4):243–251. doi: 10.1089/jchc.20.09.0082

Gathering Health Perspectives of the Justice Involved: A Multisite Needs Assessment Survey

Elena Diller 1,*, Gail Kouame 2, David M Young 3,4, J Aaron Johnson 5,6
PMCID: PMC9529364  PMID: 35649191

Abstract

The well-being of justice-involved individuals must be of high priority to achieve health equity, reduce health disparities, and improve community health. To better understand the health interests and needs of justice-involved individuals, a survey was administered inquiring about health information-seeking behavior and health topics of interest. The survey was administered using secure tablet computers and completed by 1,888 incarcerated participants in 35 jails in 17 states. Salient themes that emerged from this research include the relatively equal use of the internet and health care providers as resources for health information; the extensive interest in learning about multiple health care topics; and demographic variations in health information-seeking behaviors and health topics of interest. Tailoring correctional health education programs to coincide with the interests and needs of the justice-involved population may attract more participants and thus result in better self-care management skills and health outcomes upon reentering communities.

Keywords: justice involved, health information seeking, health literacy, correctional health care

Introduction

Over 2.3 million men and women are incarcerated in either a jail or prison in the United States (Sawyer & Wagner, 2020). With nearly five million individuals on probation and parole, the total population under correctional supervision is approximately seven million. Nearly 95% of all justice-involved individuals will reenter society after incarceration (Hughes & Wilson, 2003). Yet, 83% of these individuals will be rearrested within 9 years of reentry (Alper et al., 2018).

This ongoing cycle of imprisonment significantly impacts the health and well-being of families and neighborhoods. For example, family members of the incarcerated (deVuono-Powell et al., 2015) and never-incarcerated individuals living in neighborhoods with high incarceration rates (Hatzenbuehler et al., 2015) have an increased risk of generalized anxiety disorder and major depressive disorder, two diseases strongly associated with economic loss (Chisholm et al., 2016). This is only one example of how health and related economic and social burdens of incarceration extend far beyond the lives of justice-involved individuals.

Incarceration is a known social determinant, so much so that Healthy People 2030, the national public health goals for the next decade, identifies incarceration as a key issue in the Social and Community Context domain (Lou, 2020). To improve the health of both the incarcerated population and the communities to which they eventually return, it is imperative that evidence-based, cost-efficient health interventions be implemented within jails and prisons before release (Adams & Leath, 2002; Pew Charitable Trusts, 2017; Ross, 2011).

Interventions aimed at improving the health and well-being of justice-involved persons are highly warranted given the well-documented health disparities between the incarcerated and nonincarcerated populations (Wang et al., 2017; Wildeman & Wang, 2017). Although the correctional setting may offer some protective services, such as access to health care, incarceration is associated with the contraction of disease.

For example, a recent study by the UCLA Law COVID-19 Behind Bars Data Project revealed that the COVID-19 case rate for incarcerated individuals was 5.5 times higher than the U.S. population case rate (Saloner et al., 2020). In conjunction with limited protective equipment and crowded facilities, infectious respiratory illnesses, such as COVID-19, influenza, and tuberculosis, spread easily and further exacerbate the risk of contracting other illnesses while incarcerated (Kinner et al., 2020).

Moreover, incarceration is also associated with the general decline of health (e.g., obesity; Gates & Bradford, 2015). Chronic diseases such as diabetes and asthma, as well as acute conditions such as stroke, have been linked to prior incarceration (Maruschak et al., 2015). Even young justice-involved persons are at higher risk for hypertension and left ventricular hypertrophy, both of which are predictors of morbidity and mortality (Wang et al., 2009).

Not surprisingly, incarceration similarly causes physiological and psychological duress upon both the justice-involved individuals and their family. Never-incarcerated residents of neighborhoods with high incarceration rates are at greater risk for cardiometabolic disease (Topel et al., 2018). When parents are incarcerated, not only does their psychological state deteriorate but also their adolescents are at increased risk for behavioral and mental health problems while their parents are away (Wildeman & Wang, 2017). Because of higher rates of incarceration among Black and Latino populations, ethnic and racial minority communities are subjected more frequently to the physical and mental stresses of incarceration and, therefore, bear a greater health burden than their White counterparts (Golembeski & Fullilove, 2008; Wildeman & Wang, 2017).

Understanding health needs from the perspective of justice-involved individuals is crucial to harnessing internal motivation, and thus designing successful health interventions (Seifert et al., 2012; Woods et al., 2013). With an ever-expanding older incarcerated population, correctional health care costs in the United States have risen exorbitantly over the years, exceeding $12 billion annually (Ahalt et al., 2013; Psick et al., 2017; Wagner & Rabuy, 2017). For example, in 2019, the Texas Department of Justice spent $750 million on correctional health care, compared with 500 million in 2012. This increase occurred despite a 3% decrease in total population. This surge was likely due to a 65% increase in incarcerated individuals aged 55 years and older (Rich, 2019).

As the incarcerated population ages, there is increased importance in implementing cost-effective public health interventions that engage program participants and protect other incarcerated individuals and correctional staff. Similar to correctional education programs (Tewksbury & Stengel, 2006), patient-centered health interventions, designed with their wants and needs in mind, will likely increase participation in health-promoting behaviors and, potentially, reduce correctional health care costs and recidivism.

Although there is abundant literature on health disparities of the incarcerated population, few studies have assessed the health concerns and interests of the incarcerated. Little is known about how justice-involved persons seek health information, let alone what type of information they are seeking. Some studies investigating health literacy as a potential intervention have aimed to identify health needs through focus groups (Dinkel & Schmidt, 2014; Hawkins et al., 2010). Results show justice-involved individuals want to learn more about health, particularly topics such as chronic health conditions, self-care management, communicable disease transmission, nutrition, and navigating the health care system (Dinkel & Schmidt, 2014; Hawkins et al., 2010).

Although the previous literature demonstrates that justice-involved individuals desire to learn more about their health and self-care management, no study to date has quantitatively analyzed the perceived health needs of incarcerated populations. Our project aims to fulfill this gap through investigating the health concerns of incarcerated individuals, how they currently receive their information, and the health topics about which they would like more information.

Method

Data for this study are taken from a health needs assessment survey completed as part of a 3-year project funded by the National Library of Medicine and National Institutes of Health for the purpose of providing health education and improving health literacy for justice-involved persons. The intent of this survey was to identify the unique health information needs of currently incarcerated individuals. Information collected was used to design 12 health education modules that were then made available to justice-involved individuals through the use of electronic tablets.1

These health education modules aimed to enable users to access community-based health information and services upon release. Our partner throughout the project was Edovo, a Chicago-based mission-driven organization providing quality education to the incarcerated using secure tablet technology (Mandell, 2019).

The electronic survey was made available to all individuals housed in a U.S.-based jail or prison that had contracted with Edovo to provide these educational tablets to their population. At the time the survey was distributed, Edovo had deployed over 5,500 tablets in 56 correctional facilities in 20 states. The number of tablets in each facility is based on the size of its population. Although each tablet may be used by multiple individuals, each user has unique login credentials. Data collection for the health needs assessment survey was conducted from January 2018 through April 2018. The article was reviewed and approved by the Augusta University Institutional Review Board.

Sample

The sample was self-selected, as any individual (18 years or older) residing in an Edovo-partnered facility who logged into the Edovo tablet during the data collection period received the notification that the survey was available and, if interested, they could navigate to the survey to complete it. A total of 1,888 individuals completed the survey while incarcerated. The sample comprises individuals from 35 jails in 17 states, including Georgia, North Carolina, and California. The sample includes more men (n = 1,486) than women (n = 344); 58 respondents elected not to disclose their gender.

Design and Measures

Through its secure tablet technology, Edovo was able to push notifications to each tablet. Depending on the purpose of the notification, these notifications appeared upon login or within specific educational areas of the tablet. In this study, a notification alerted individuals to the survey opportunity upon login. Users were prompted by the tablet to either complete the survey, receive a reminder to complete it in a future session, or skip and continue to Edovo's main content page. Respondents were allowed to complete the survey only once.

The survey was divided into four sections, and all questions were optional. The survey first collected demographic information using six questions based on the Behavioral Risk Factor Surveillance System (Centers for Disease Control and Prevention, 2019). Respondents were then asked three questions about how they accessed health information, which were adapted from the Health Information National Trends Survey (National Cancer Institute, 2020) and Young and Weinert (2013).

Next, the survey asked respondents four questions about health topics in which they are interested. The health topics listed in the survey were chosen because of their relevance to the incarcerated population; for example, topics mentioned in the focus groups assessing incarcerated individuals' interest in health education were included in this list (Dinkel & Schmidt, 2014; Hawkins et al., 2010). An open text field allowed participants to enter additional health topics not included in the topic list. After completing these three sections, respondents were asked whether they would be interested in providing more information about themselves. If they answered yes, participants were then given the final set of questions related to social factors of health (two items adapted from Page-Reeves et al. [2016]).

Analysis

Statistical analysis was performed using IBM SPSS Statistics Version 26 (IBM, 2019). Results include descriptive statistics and crosstabs to examine differences in health information needs by age, gender, sexual orientation, race and ethnicity, and education.

Results

Demographics

A total of 1,888 respondents took the survey. Demographic information (Table 1) was collected to explore whether these factors are related to health topics of interest and how health information is sought. As expected, the majority of respondents were male, although the female response rate was roughly three times the female incarceration rate (Federal Bureau of Prisons, 2022a). Three age groups (55–64, 65–74, and 75+ years) from the survey were collapsed to create a senior variable; this is consistent with the definition of incarcerated seniors used in previous studies and within correctional departments (Psick et al., 2017).

Table 1.

Demographics

  Frequency (n), valid %
Gender
 Male 1,486, 81.2%
 Female 344, 18.8%
Age (years)
 Senior 55+ 73, 5.4%
 Nonsenior
  18–24 222, 16.5%
  25–34 472, 35.1%
  35–44 392, 29.1%
  45–54 187, 13.9%
Race
 NH White 481, 63.5%
 NH Black 231, 30.5%
 NH American Indian/Alaska Native 27, 3.6%
 NH Asian 11, 1.5%
 NH Pacific Islander 7, 0.9%
Hispanic
 Hispanic 150, 16.5%
 Non-Hispanic 757, 83.5%
LGBTQ status
 Straight 889, 89.8%
 Gay or lesbian 25, 2.5%
 Bisexual 57, 5.8%
 Transgender 4, 0.4%
 Other 15, 1.5%
Education level
 Some high school or less 299, 30.1%
 High school graduate or GED 374, 37.6%
 Some college or degree 321, 32.3%
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LGBTQ, Lesbian, Gay, Bisexual, Transgender and Queer/Questioning; NH, Non-Hispanic.

To increase statistical power, race was collapsed to create a binary variable of White or non-White. Respondents who identified as Hispanic were not classified as either White or non-White, but rather had their own variable. This was done to encompass the multidimensional background with which many Latinos identify (Parker et al., 2015). Respondents were able to select only one racial or ethnic category with which to identify when taking the survey. Racial demographics of the sample are similar to those of nationwide incarceration (Federal Bureau of Prisons, 2022b), as are the rates of Lesbian, Gay, Bisexual, Transgender and Queer/Questioning (LGBTQ) incarceration (Meyer et al., 2017).

The sample has an overall high level of educational achievement: for example, 69.9% of survey participants had a high school diploma, General Educational Development, some postsecondary education, or a postsecondary degree, which is greater than that of the national local jail population at 53.5% (Harlow, 2003). This is to say, the national local jail population had a larger number of individuals with only some or less than a high school education compared with our sample. It should be noted that large numbers of respondents did not disclose their age (n = 542), race or ethnicity (n = 981), sexual orientation (n = 898), nor level of education (n = 894).

Sources of Health Information

Three questions were asked to assess how participants access health information (Table 2). The survey did not ask respondents to specify the time in which the information was accessed, meaning respondents affirmatively answering a question could have accessed the information and/or source before or during incarceration. Roughly half of all respondents indicated that they had looked at some point in their lives for health information. Seniors were more likely to have looked for health information (p = .037) as were females (p < .001). No significant relationships were observed between race or sexual orientation and health information seeking. Expectedly, those with at least some college or a college degree were more likely to have sought health information (p < .001).

Table 2.

Source of Health Information

Question   Frequency (n) of those indicating interest, valid %
Ever looked for health information?   1,028, 54.4%
Where did you go to find this information? The library 105, 5.6%
Magazine/TV/newspaper 141, 7.5%
A friend or neighbor 150, 7.9%
A pharmacist 182, 9.6%
My spouse/partner 228, 12.1%
A family member 318, 16.8%
Health information websites 340, 18.0%
A doctor or health care provider 579, 30.7%
The internet, Google search, etc. 669, 35.4%
The last time you looked for health information, where did you go first? Telephone information number, ex. calling 211 12, 1.0%
Library 15, 1.3%
Brochures, pamphlet, etc. 19, 1.7%
Complementary, alternative, or unconventional practitioner 48, 4.2%
Books/newspapers/magazines 52, 4.5%
Family, friend, or coworker 74, 6.4%
Health or medical organizations, department of public health, Planned Parenthood 77, 6.7%
Doctor or health care provider clinic, urgent care 333, 28.9%
Internet 521, 45.3%
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Respondents reported most often consulting the internet and health care providers when seeking health care information. The internet was the No. 1 resource used by participants when they last sought health information (n = 521) and when looking for health information (n = 669). Health care providers were second to the internet for both questions (n = 333 and n = 579, respectively). Other types of information sources, such as friends, magazines, and pharmacists, were cited far less frequently.

Expectedly, those with some college education or a degree were more likely to consult almost all of the sources listed compared with their less educated peers, including spouses (p = .004), family members (p = .002), friends (p = .033), magazines/TV/newspaper (p = .024), the library (p = .003), the internet (p < .001), health information website (p < .001), pharmacist (p < .001), and doctor/health care provider (p < .001). Similarly, females more frequently searched the internet (p < .001) and health information websites (p = .001) for health information. In addition, females were also more likely than males to consult health care providers (p = .003) and pharmacists (p < .001).

White respondents were more likely than non-White respondents to seek information from the library (p = .011), the internet (p = .002), and pharmacists (p = .045). Those who identified as LGBTQ were significantly more likely to consult a family member or neighbor (p = .015), the internet (p = .002), or a pharmacist (p = .004) than those who identified as straight. No significant relationships were observed between senior and nonsenior status, nor between Hispanic and non-Hispanic, and the types of sources used.

Health Topics of Interest

To help determine the most salient health topics for this population and, thereby, the topics to include on the Edovo tablets, participants in this needs assessment were asked about their interest in 12 health topics previously identified as relevant to the incarcerated population (Table 3). Almost all participants reported interest in at least one or more health topics, with the overwhelming majority (98%) indicating interest in three or more topics. The three most popular topics included how to take better care of myself (n = 1,107), how to sign up for insurance (n = 1,094), and how to improve eating habits (n = 936). By far, the topic with the least interest was how to understand the labels on medicine bottles (n = 320).

Table 3.

Health Topics of Interest

Question   Frequency (n) of those indicating interest, valid %
Interest in health insurance topics? How to understand words about health insurance 865, 45.8%
How to calculate what I have to pay for insurance 911, 48.3%
How to sign up for health insurance 1,094, 57.9%
Interest in general health topics? How to understand medicine bottle labels 320, 16.9%
How to talk to a doctor or nurse 565, 29.9%
How to get mental health help 696, 36.9%
How to find a doctor or nurse 745, 39.5%
How to get help for addiction 769, 40.7%
How to understand results from laboratory tests 866, 45.9%
Interest in preventative health topics? How to prevent or manage infectious diseases 713, 37.8%
How to find help to prevent health problems 844, 44.7%
How to learn more about community-based services 883, 46.8%
How to improve eating habits 936, 49.6%
How to take better care of myself 1,107, 58.6%
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Compared with males, females reported greater interest in a number of topics, including how to get help for addiction problems (p = .032), how to get help for mental health problems (p < .001), and how to learn more about community-based health services (p = .008). LGBTQ status was associated with greater interest in two health topics: how to get help with mental health issues (p = .007) and how to take better care of myself (p = .001). LGTBQ individuals reported lower interest in how to sign up for health insurance (p = .006).

Somewhat surprisingly, senior status was associated with lower interest in multiple health topics, including how to sign up for health insurance (p = .005), how to get help for addiction problems (p = .005), how to get help for mental health problems (p = .032), how to take better care of myself (p = .017), how to improve eating habits and nutrition (p = .001), and how to prevent or manage infectious diseases (p = .002).

Hispanic respondents reported significantly higher interest than non-Hispanics in how to get help with mental health problems (p = .008). White participants showed greater interest than non-White participants in how to get help for addiction problems (p < .001) and how to learn more about community-based health services (p = .002).

Those with only some high school education demonstrated lower interest than their more educated peers in several topics: how to understand words about health insurance (p = .007), how to calculate what I have to pay for health insurance (p = .002), how to find a doctor or nurse (p = .035), how to talk to a doctor or nurse (p = .049), how to understand the label on a medicine bottle (p = .027), how to understand laboratory results (p = .001), how to improve eating habits (p = .025), and how to learn more about community-based services (p = .001).

In contrast, those with some college or a college degree expressed greater interest in how to calculate what I have to pay for health insurance (p = .031), how to understand laboratory results (p = .019), and how to learn more about community-based services (p < .001). High school graduates expressed greater interest in learning how to talk to a doctor or nurse (p = .044) than either nonhigh school graduates or those with some college or a degree.

Participants were also able to voice interest in health care topics by using an open-text field. The top three topics mentioned by participants included sexually transmitted infectious diseases and treatment (n = 105), mental health (n = 92), and physical activity (n = 60). Although many of the 905 written entries can be classified under a listed health care topic (such as substance use and addiction treatment [n = 47]), many participants used the open-text field to specify topics of interest. For example, participants expressed a desire to learn more about certain health diseases, including cancer (n = 35), diabetes (n = 28), and dental health (n = 26). Write-in topics were not included in the analysis of the listed health topics.

Discussion

This survey yielded some important insights, both expected and unexpected. Prior research has established a positive relationship between gender and health-seeking behavior, which is confirmed by this article (Thompson et al., 2016). Compared with the sampled males, females were not only more likely to seek health care information from multiple sources, but also expressed greater interest in self-help health care topics, including how to get help for mental health care and addiction problems. Females are known to seek mental health care more often than males, in part because of more favorable and open psychological attitudes (Mackenzie et al., 2006).

This openness to help seeking may also explain why female respondents were more interested than male respondents in learning about addiction problems (McHugh et al., 2018). This finding may also be the result of higher rates of addiction problems among justice-involved females, as prior research indicates that females have addiction rates comparable with and, in some cases, greater than justice-involved males (Fazel et al., 2017). In addition, addiction issues among justice-involved females are more likely to be accompanied by co-occurring mental health conditions and a history of trauma and physical and/or sexual abuse (Langan & Pelissier, 2001; Peters et al., 1997).

LGBTQ individuals also expressed greater interest in how to get help for mental health care, another observation seen across prior studies (Cochran et al., 2003; Tjepkema, 2008). LGBTQ individuals may be more likely to seek care because of minority stress, the additional stress experienced by minority groups that results from hostile social environments created by stigma, prejudice, and discrimination (Meyer, 2003). It has also been suggested that the LGBTQ community, specifically lesbian and bisexual subgroups, has a positive norm of seeking mental health care (Cochran & Mays, 2000).

Curiously, respondents with only some high school education were significantly less interested in eight of the health topics compared with their more educated peers. The positive relationship between education and health has been long established, yet the relationship between education and interest in learning more about health is not so clear.

Using the Health Information National Trends Survey, researchers have observed that low rates of health information-seeking behavior are correlated with low socioeconomic status and lack of education (Richardson et al., 2012). One underlying reason for this observation may be low confidence in personal ability to obtain information, or low self-efficacy (Richardson et al., 2012). For example, learning how to calculate insurance costs requires confidence in mathematic ability, or at least enough mathematic knowledge to attempt a calculation. Without a high school education, certain skills become exponentially harder to learn, perhaps to the point where participants felt that the skills are not worth the effort.

Given that over 50% of respondents with less than a high school education were also non-White or Hispanic, mistrust in the health care system may be another reason why this group was less likely to want to find a doctor or learn how to talk to a nurse. Racial and ethnic minority groups have higher rates of mistrust in the health care system, one consequence of the United States' history of unethical research on these populations (Carroll, 2011; Hodge, 2012; Stein, 2017).

Minority individuals are more likely than their White peers to experience negative treatment from health care providers and to face language or cultural barriers that impede patient–provider communication (Machado, 2014). Thus, both low self-efficacy and mistrust in the medical community may have contributed to the less educated respondents' lower interest in learning about the listed health topics.

Finally, senior respondents were less likely than nonseniors to indicate interest in six of the listed health topics. Because seniors generally seek health information at greater rates than nonseniors (a trend also confirmed by this article), this finding is particularly unexpected. One prior study observed that high self-efficacy in older justice-involved males is correlated with increased health-promoting behavior (Loeb & Steffensmeier, 2006). If self-efficacy is related to health-promoting behavior, such as learning more about health topics, it is plausible our sample has low self-efficacy. Alternatively, although more unlikely, this disinterest could indicate very high self-efficacy, such that older respondents are satisfied with their health knowledge and do not feel the need to learn health skills that would be helpful upon release.

Another possible explanation for the low rate of interest in health topics among seniors is that seniors are less likely to be released and, therefore, unlikely to need community-based health skills. In addition to increasing rates of entry into the penal system, older individuals often serve mandatory sentences or have committed violent crimes warranting lengthy sentences (Ollove, 2016). A probable consequence of extended incarceration is a recognized dependence on correctional health care for the foreseeable future. Particularly as the elderly population grows within and outside of the correctional system, further investigation into seniors' health interests and perceptions about their health is warranted.

Limitations

Limitations of this article include the survey design, which facilitated self-selected participation such that those with a higher level of education or greater interest in health may have been more likely to take the survey. Participants were allowed to skip questions, which resulted in a high percentage of respondents who elected not to report their demographic information. Limiting respondents to identify with only one racial or ethnic category may have led to oversimplification of the relationship between race and health care interest and access.

Although the tablet technology was designed to be user friendly, respondents unfamiliar with technology (i.e., older individuals) may have demonstrated less interest in certain health topics due to the unfamiliar format of the survey and subsequent short informational modules. In addition, although the survey questions were written to accommodate low literacy individuals, we cannot exclude the possibility that low literacy individuals may have struggled to read or respond to the survey questions.

Moreover, although our sample comprised individuals from 35 facilities across 17 states, findings of this article may not be generalizable to the overall justice-involved population because our sample did not include prisons. Further research is needed to evaluate the differences, if any, in the needs of those imprisoned in jails versus prisons.

Conclusion

This needs assessment provided important information to help determine how justice-involved individuals seek health care information, as well as identify specific health topics of interest to this population. Our findings provide insight into delivering health information to this hard-to-reach population and the importance of tailoring information to different demographic groups. Salient themes that emerged from this research include the relatively equal use of the internet and health care providers as resources for health information, the extensive interest in learning about multiple health care topics, and demographic variations in health information-seeking behaviors and health topics of interest.

Using the findings from this survey, we were able to provide short informational modules that corresponded with the health topics in which participants were interested. Participants were then able to access the modules on the Edovo tablets. Future articles will explore whether and how participants accessed the modules. To evaluate the effectiveness of the education module intervention, forthcoming articles will also examine changes in knowledge and confidence using pre- and postmodule training surveys.

Although the results indicate that certain demographic characteristics are associated with different rates of health information-seeking behaviors and interest in health topics, additional investigation is needed to not only confirm these findings but also further understand respondents' rationale behind their answers. This is particularly true for seniors and those without a high school diploma or GED. With this information and future studies, correctional health education initiatives may become more appealing to justice-involved individuals, resulting in better self-care management, reduced health care costs, and reduced recidivism (Seifert et al., 2012; Woods et al., 2013). The additional benefactors of a focused correctional health care education program include the individuals and families of the communities to which they return.

Finally, it should be noted that tablet-based health education modules alone cannot comprehensively address the multitude of physical and mental health problems seen in the justice-involved community. These education modules will prove most effective if used alongside other evidence-based health interventions. For example, programs with peer educators have been shown to be more successful in promoting behavior changes than those without (Bagnall et al., 2015).

Correctional staff, particularly case managers and health care providers, have the capacity to improve health within the correctional facility and upon release. Reentry planning must be done before release with a focus on connecting individuals to community health services, as well as fulfilling other nonmedical social needs, such as housing and employment (Woods et al., 2013). A holistic approach that supports justice-involved individuals throughout their incarceration and after release will prove most effective in improving health outcomes of these individuals.

Acknowledgments

We thank Shafer Tharrington and the Edovo team for research support.

Author Disclosure Statement

The authors disclosed no conflicts of interest with respect to the research, authorship, or publication of this article.

Funding Information

This article was funded by the National Library of Medicine and National Institutes of Health. The grant number is RFA-LM-17-002.

1

The topics of the 12 health modules were addiction and substance use disorders, advocacy and self-care, preventative care, dental health, health insurance, medications and reading laboratory results, insurance, mental health (depression), mental health (general), nutrition and physical activity, pain management, sexual and reproductive health/women's health, and smoking cessation. Patterns of use by participants will be examined in a future article.

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