Heart, soul, and recovery: a real-time modified Delphi study on an integrated mental health, substance use and cardiovascular care intervention for justice-involved Black/African American men

Criminal legal system involvement is strongly associated with poorer cardiovascular health, the leading cause of death among incarcerated individuals, with Black/African American men disproportionately affected. Co-occurring substance use and mental health disorders (COD) further compound risks for this population. Despite the urgent need to address these risk factors and disparities, few culturally tailored, integrated cardiovascular disease risk and COD interventions exist for this population. The purpose of this study was to combine current research evidence with the experience of people with lived experience (PWLE) and people with professional experience (PWPE) to inform the core components of a new intervention for system-involved Black/African American men with co-occurring substance use, mental health, and cardiovascular disease risks. We conducted a real-time modified Delphi study with people with lived experience (PWLE; n = 14) and professional experience (PWPE; n = 11) in the criminal legal system, COD, and CVD. Informed by a focused literature review and initial stakeholder input, 102 statements addressing intervention priorities were generated and then rated using a Likert scale. Statements meeting ≥ 80% agreement were retained. Percent consensus was calculated, and thematic analysis of qualitative responses was conducted. Experts reached consensus on 76 of 102 items (74.5%), identifying strong agreement on target population, intervention type, setting, and cultural tailoring. They endorsed developing a transdiagnostic, culturally tailored intervention for Black/African American men with any co-occurring substance use and mental health disorder and any level of criminal legal system involvement preferring in-person or hybrid formats over digital-only approaches. Experts prioritized addressing key CVD risk factors, particularly smoking, hypertension, diabetes and high cholesterol through direct, in-program strategies and emphasized trust, flexibility, and co-creation as an essential component to engagement and impact. Findings provide foundational insight into components of an optimal culturally responsive, integrated intervention to address CVD and COD among justice-involved Black/African American men and can further inform public health strategies to reduce health disparities and guide behavioral, carceral, and public health system improvements.