# Measuring Research Engagement among Previously Incarcerated Persons and Other Carceral Stakeholders while Implementing Wastewater-based Surveillance for SARS-CoV-2 in Jails: A Mixed-Methods Study

## TL;DR

This study explores how to better involve people with incarceration experience in improving jail health through wastewater testing for SARS-CoV-2.

## Contribution

The paper introduces a mixed-methods approach to assess engagement of incarcerated individuals and jail staff in implementing wastewater-based surveillance.

## Key findings

- Including PLE in decision-making improved over time when their feedback was shared.
- PLE felt the partnership should have been more equal, and their input was valued by jail staff.
- Medical leaders faced challenges in engaging staff due to hierarchical structures.

## Abstract

Engaging persons with lived experience of incarceration (PLE) in projects to improve carceral healthcare is recognized as important but is understudied. We leveraged an implementation project seeking to improve carceral infection control using SARS-CoV-2 wastewater-based surveillance (WBS) to study the engagement of diverse carceral stakeholders including PLE on implementation teams.

From April 2022 to December 2023, WBS Implementation teams were formed at four US jails. These included diverse carceral stakeholders: custodial and medical leadership, facilities management, and medical staff positions, along with PLE. Focus group discussions (n = 12) and key informant interviews (n = 6) facilitated internal and external collaboration between teams. The study team shared qualitative findings of PLE and carceral personnel between the two groups. We used Rapid Assessment Processes for qualitative thematic analysis to understand key themes related to dynamics of engagement. We used the Research Engagement Survey Tool (REST) to quantify the quality and quantity of stakeholder engagement.

Qualitative data demonstrate carceral personnel support for including PLE in decision-making improved over the project once PLE feedback was shared, although PLE expressed that the partnership ideally would have been on more equal footing. PLE perspectives were deemed useful to carceral personnel and the development of a sustainable system to incorporate resident feedback specific to mitigation efforts was a priority of both carceral personnel and PLE. Medical leaders identified barriers in engaging staff in WBS due to the hierarchal structure of decision-making. On a 1–5 Likert scale, REST scores aligned with qualitative data indicating lower engagement for PLE (mean 3.2 versus 3.9 for quality and 3.3 versus 4.1 for quantity of engagement). PLE had consistently lower REST scores than carceral personnel across all measured engagement principles.

This study brought disparate carceral stakeholders together to support the implementation of jail-based WBS and highlighted disparities in collecting and incorporating PLE feedback into jail infection control. Strengthening collaboration between the PLE and carceral personnel would ensure carceral health systems benefit from all perspectives.