Abstract
BackgroundDespite greater risk of cardiovascular disease (CVD) mortality in patients with a history of incarceration, little is known about how prisons manage CVD risk factors (CVD-RF) to mitigate this risk.MethodsWe conducted in-depth interviews with individuals with CVD-RF who had been recently released from prison (n = 26). These individuals were recruited through community flyers and a primary care clinic in Connecticut. Using a grounded theory approach and the constant comparative method, we inductively generated themes about CVD-RF care in prisons. Data collection and analysis occurred iteratively to refine and unify emerging themes.ResultsFour themes emerged about care in prison: (1) Participants perceive that their CVD-RFs are managed through acute, rather than chronic, care processes; (2) Prison providers’ multiple correctional and medical roles can undermine patient-centered care; (3) Informal support systems can enhance CVD-RF self-management education and skills; and (4) The trade-off between prisoner security and patient autonomy influences opportunities for self-management.ConclusionsPatients develop self-management skills through complex processes that may be compromised by the influence of correctional policies on medical care. Our findings support interventions to engage peers, medical providers, care delivery systems, and correctional staff in cultivating effective self-management strategies tailored to prison settings.
Highlights
Despite greater risk of cardiovascular disease (CVD) mortality in patients with a history of incarceration, little is known about how prisons manage CVD risk factors (CVD-RF) to mitigate this risk
We sampled purposively to achieve a diverse range of perspectives about CVD-RF management in prison (Table 3)
Themes A number of themes about CVD-RF management in prison and upon release emerged in our study
Summary
Despite greater risk of cardiovascular disease (CVD) mortality in patients with a history of incarceration, little is known about how prisons manage CVD risk factors (CVD-RF) to mitigate this risk. The correctional health literature, suggests that patient centered care practices, like self-management, will be difficult to implement in prisons due to security constraints on patient autonomy (Condon et al 2007; Woodall et al 2014), poor access to care (Harner and Riley 2013a, 2013b), strained relationships with medical providers (Stoller 2003; Young 2000), and lack of education and programming (Loeb et al 2007). We elicited patients’ perspectives about their care for CVD-RF to explore how correctional systems support the development of patients’ knowledge and skills for CVD-RF self-management. These findings may guide future interventions to effectively tailor chronic care delivery in prison, given the security constraints inherent to this setting
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