Date of Award

January 2015

Document Type

Open Access Thesis

Degree Name

Medical Doctor (MD)

Department

Medicine

First Advisor

Emily A. Wang

Subject Area(s)

Medicine, Public health, Social research

Abstract

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 (CVR-RF) to mitigate this risk.

We conducted in-depth interviews with men and women with CVD-RF and who had been recently released from prison (n=26). Using a grounded theory approach and applying the constant comparative method, we inductively generated themes about CVD- RF care in prison. Data collection and analysis occurred iteratively to refine and unify emerging themes.

Four themes emerged from patient perspectives: (1) Access to care for chronic conditions is present, yet complicated in prisons. (2) Patient-provider partnerships can be undermined by providers' competing correctional and medical roles. (3) Informal support systems can improve self-management education and skills development. (4) The trade- off between prisoner security and patient autonomy influences opportunities for self- management.

Correctional policies pervaded patients' CVD-RF management, which undermined care delivered by providers and the development of critical self-management skills. Our findings support interventions to engage peers, providers, and care delivery systems in routine care to cultivate effective self-management strategies unique to prison.

Comments

This is an Open Access Thesis.

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