title: Patients' experiences managing cardiovascular disease and risk factors in prison.
abstract: BACKGROUND
  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.
  
  
  METHODS
  We 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.
  
  
  RESULTS
  Four 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.
  
  
  CONCLUSIONS
  Patients 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.
authors.affiliation: Department of Internal Medicine, University of California - San Francisco, San Francisco General Hospital, 1001 Potrero Avenue, Building 10, 3rd Floor, Ward 13, San Francisco, CA 94110 USA.
authors.forename: Emily H
authors.initials: EH
authors.lastname: Thomas
authors.affiliation: Department of Internal Medicine, Yale University School of Medicine, P.O. Box 208056, 333 Cedar Street, New Haven, CT 06520 USA.
authors.forename: Emily A
authors.initials: EA
authors.lastname: Wang
authors.affiliation: Department of Health Policy and Administration, Yale School of Public Health, P.O. Box 208034, 60 College Street, New Haven, CT 06520 USA.
authors.forename: Leslie A
authors.initials: LA
authors.lastname: Curry
authors.affiliation: RAND Corporation, 1776 Main Street, Santa Monica, CA 90407 USA.
authors.forename: Peggy G
authors.initials: PG
authors.lastname: Chen
keywords: Cardiovascular disease; Chronic disease management; Incarceration; Prison; Self-care; Self-management support