PROJECT SUMMARY/ABSTRACT
Incarcerated individuals have higher rates of chronic disease than the general population, and disease
burden will likely increase as the prison population continues to age. Despite this, health care services in prison
primarily focus on infectious diseases, mental illness, and substance abuse, largely neglecting chronic physical
health conditions. The Chronic Disease Self-Management Program (CDSMP) is an evidence-based program
developed to support self-management for people with chronic illnesses. At least 10 randomized trials conducted
in non-correctional settings have linked CDSMP to disease-related improvements and reduced healthcare
expenditures. CDSMP has been used in state corrections systems via 3 approaches: 1) bringing community
agency CDSMP leaders into the correctional setting to lead the program, 2) training correctional staff as program
leaders, and 3) training incarcerated individuals to serve as peer leaders. To date, however, there has been little
research into efficient and effective strategies for scaling up the intervention within state corrections systems
using any of these approaches. Scale-up (i.e. deliberate efforts to increase the impact of successfully tested
health innovations to benefit more people and promote sustainability) is an understudied concept in
implementation science, with few existing empirical studies that explicitly focus on the process of scale-up.
Assessing scalability, however, is crucial for ensuring sustainability of complex interventions within resource-
poor settings. The research objective of this K01 is to evaluate and maximize the scalability of CDSMP among
older adults in state correctional systems. Guided by the Scaling up Management Framework, we will use a
mixed methods research approach to query community agency leaders, staff, and incarcerated individuals about
ways to maximize the scalability of CDSMP within state correctional settings and develop and refine CDSMP
scale-up strategies for these settings. Our goal is to develop scale-up strategies to be evaluated in a subsequent
randomized implementation trial. The training objectives of this K01 will add expertise in implementation science
and justice-involved research to my existing knowledge base in biopsychosocial models of disease, social
gerontology, health disparities, quantitative analysis, and chronic disease management, to reach my goal of
becoming an independent researcher who uses implementation science approaches to improve health outcomes
among justice-involved populations. As the prison population continues to age, the burden of chronic disease
within correctional systems will continue to increase, which contributes to skyrocketing correctional costs.
Understanding how to expand evidence-based chronic disease programs within correctional systems is crucial
for reducing disease-related morbidity and mortality among incarcerated individuals and for reducing costs. This
line of research will identify and test scale-up strategies for chronic disease management in prisons.