The Opposite of a “Killer App:” Nurse Researcher Hopes Program Will Help Former Inmates With Diabetes

The Opposite of a “Killer App:” Nurse Researcher Hopes Program Will Help Former Inmates With Diabetes

Oftentimes, social or economic disadvantages prevent a person from living their healthiest life. Last year, the American Diabetes Association (ADA) announced grant funding  to support projects that focus on the impact of such health disparities on those with diabetes.

Louise Reagan, MS, APRN, ANP-BC, an assistant professor at the University of Connecticut School of Nursing, received one of those grants — called the Health Disparities and Diabetes Innovative Clinical or Transitional Science Award — as her research focuses on people with diabetes who are reentering society from prison.

Reagan says her team has found that people living with diabetes in prison lack critical knowledge and skills regarding managing their diabetes. As these individuals transition to the community, they are required to self-manage diabetes independently and are not prepared to do so.

Diabetes survival and self-management skills include knowing what foods to eat, how to control blood glucose (sugar), when to take insulin, how to manage sick days, and how to access health care. These skills are critical for incarcerated individuals, as their rate of diabetes diagnosis is almost 50% higher than the general population.

“I wanted to figure out what we could do to reach persons with diabetes at this critical transition period when they’re just getting out of prison and into the community, and how we could help them self-manage their illness,” Reagan says. “The Connecticut Department of Correction (CDOC), a community collaborator and advocate for the needs of persons transitioning from prison to the community, and my team don’t want citizens returning to the community from prison to end up in the emergency room being treated for hypoglycemia or dangerously low blood glucose when it can be prevented.”

Reagan worked as an advanced practice registered nurse in Hartford for 16 years, treating underserved populations with multiple comorbid diseases, including diabetes. This clinical work exposed her to the challenges that people released from prison or living in supervised community housing post-prison release face in self-managing their illness when reentering the community, and inspired her research.

She says many social barriers prevent patients from adequately caring for their own health. It can be challenging to provide diabetes education to recently released patients due to their multiple housing locations, desire for anonymity, and limited access to clinical care.

Additionally, she says, the priorities of people recently released from prison are often to avoid reentering prison, to find a job, and reestablish social and family relationships rather than manage their diabetes and other aspects of their health.

“Patients have many other competing needs when integrating into their societal roles,” Reagan says. “The Diabetes LIVE JustICE research provides an opportunity to help them with their health.”

Her study — called Diabetes Learning in Virtual Environments Just in Time for Community reEntry (Diabetes LIVE JustICE) — examines the feasibility and acceptability of a mobile app that provides diabetes education, support, and other resources in a virtual environment to people recently released from prison living in supervised community housing or on parole. Reagan’s goal is to improve health outcomes and reduce health inequities for this vulnerable population.

Reagan’s app, called LIVE Outside, contains live sessions with diabetes educators and instructive games to inform users about self-care.

Over the course of 12 weeks, Reagan will be measuring users’ diabetes knowledge, stress, and self-care after using LIVE Outside and comparing it to typical diabetes care education.

The mobile app is a culmination of projects Reagan has been working on since completing her postdoctoral fellowship at New York University. There, she served as a project director for an R01 study using a personal computer-based virtual environment called Diabetes LIVE, which promoted diabetes education to community-dwelling individuals.

Reagan’s proceeding research project with the CDOC, Diabetes Survival Skills (DSS), was an in-person intervention run within CDOC-managed correctional facilities. However, this project experienced attrition as individuals reentered society and could no longer participate, she says.

With collaboration and support from the Connecticut Department of Correction, Reagan anticipated taking in-person DSS interventions beyond prisons to supervised housing facilities to reach recently released individuals. This intervention, however, was put on hold due to the COVID-19 pandemic.

This forced Reagan to get creative with her work, leading to her innovation and the ADA grant.

“I was thinking about my work, and I wondered, ‘what if we use a virtual environment and adapt it to a mobile environment?’ ” Reagan says. “We could adapt the virtual app, use my program from the Diabetes Survival Skills, and blend them into a mobile app.”

Given the need for diabetes self-management education during the critical transition from prison to the community, the CDOC was excited to work with Reagan again to develop a remote mobile option for the people with diabetes under their care. Reagan then collaborated with her colleagues from Diabetes LIVE — Constance Johnson (UTHealth Houston), Allison Vorderstrasse (University of Massachusetts Amherst), and Stephen Walsh (UConn School of Nursing) — to combine DSS and Diabetes LIVE into a mobile app.

Diabetes LIVE JustICE was created and Reagan applied for the ADA grant to propel her innovation forward.

“My team and I had been talking about making this app mobile,” Reagan says. “The grant allows us to put all our work together to collaborate on this new idea.”

Reagan says she is grateful to have received this grant and for the strong collaboration with and involvement of the CDOC.

“When I received notice that the project was going to be funded, it was just an unbelievable feeling,” she says. “For me, this grant meant I had the opportunity to help underserved populations with their health, and I am so grateful for that. I feel so thankful that we can offer something to these people that sometimes don’t have anything.”

This research is supported by an American Diabetes Association grant #11-21-ICTSHD-05 Health Disparities and Diabetes Innovative Clinical or Translational Science Award. To learn more about the grant program, visit professional.diabetes.org. To learn more about the UConn School of Nursing, visit nursing.uconn.edu and follow the School on FacebookInstagramTwitter, or LinkedIn.

Nurses Making a Difference: Ph.D. Student Takes Aim at Correctional Health Care Inequities

Nurses Making a Difference: Ph.D. Student Takes Aim at Correctional Health Care Inequities

When you think of being a nurse, do you envision yourself wearing scrubs and treating patients in a hospital? Perhaps you think of taking patients’ vitals and administering medications, or moving between beds to care for the sick. While nursing often involves this discipline of bedside care, you might not have imagined working in a prison, despite the vital role nurses have in this field.

UConn School of Nursing Ph.D. student Anne Reeder, BSN, MPH is gaining expertise in this nontraditional area because she says she wants to help reduce inequities in the correctional health care system.

“I worked in a mid-sized jail in Colorado from 2011 to 2015, which was one of the most challenging, yet rewarding, experiences,” Reeder says. “I started asking questions about some of the inequities I saw and realized I wanted to study this topic formally and structurally.”

Reeder has a background in both nursing and public health. She earned her Bachelor of Science in Nursing in 2010 from Michigan State University, and then went on to earn her Master of Public Health in 2014 from the Colorado School of Public Health. Now, she is advancing her studies in both nursing and American Studies through UConn’s School of Nursing and The Graduate School, respectively.

“One of my primary goals is to elevate the voices of people who are incarcerated.”

Reeder’s research focuses on correctional health care, specifically mental health care, health services administration, and quality of care. She says there are often barriers when people who are incarcerated attempt to access health care inside correctional facilities. There is a lack of both physical and human resources, which makes high-quality, community-equivalent health care difficult, she says.

“One of the myriad reasons for the lack of access and quality disparity is the Medicaid Inmate Exclusion Policy, which significantly limits the use of Medicaid dollars for people who are incarcerated,” Reeder says. “Another reason is the stigma and social bias associated with incarceration.”

Reeder’s research aims to expose and decrease inequities in the correctional health care system by centering the material and social needs of people who are incarcerated.

“I am currently working on an integrative review that examines reentry programs for people with mental illness who are leaving U.S. jails,” Reeder says.

She has made two preliminary findings from the integrative review: there is a lack of conclusive evidence regarding the efficacy of existing jail reentry programs for people with mental illness and there is a disconnect between existing reentry models and the implementation research needed to demonstrate model efficacy.

As she continues to study the U.S. correctional health care system, Reeder hopes to implement research-based programs aimed at improving the quality of care for incarcerated individuals within its institutions.

“One of my primary goals is to elevate the voices of people who are incarcerated,” Reeder says, “so that they may more meaningfully direct their health care in correctional facilities.”