An exploration of knowledge and risk perceptions of cardiovascular disease from the perspectives of prisoners and stakeholders to guide the development of a cardiovascular risk reduction intervention

Abstract

Background: Cardiovascular disease (CVD) is an important health concern in prison populations as they have an increased risk of the disease compared to the general population. However, there is a lack of interventions to reduce prisoners’ cardiovascular risk, and little is known about the knowledge and risk perceptions of the disease in prison. This study aims to explore the knowledge and risk perceptions of CVD from the perspectives of prisoners and staff to guide the development of a cardiovascular risk reduction intervention for prisoners. Methods: This was a qualitative, exploratory study. Semi-structured interviews were conducted with 16 prisoners and 11 staff, who were purposively recruited from a private prison in Scotland. Framework analysis was used to analyse the data. Findings: The prisoners and staff had limited, non-expert knowledge of CVD. Common behavioural risk factors and cardiovascular events were identified, but gaps in knowledge were evidenced. There were similarities and differences in perceptions of prisoners’ risk of the disease; risk was primarily assessed by judgements about the prisoners’ current health status rather than their risk factor status. Prisoners’ risk of CVD was attributed to negative health behaviours such as smoking and physical inactivity, and these were influenced by multiple factors that interacted across three levels of influence. Individual factors included self-efficacy and mental health problems, social factors included the prison culture and social interactions, and institutional factors included the prison regime and healthcare barriers. An ecological framework was designed to guide a cardiovascular risk reduction intervention that focuses on the multi-level influences of prisoners’ cardiovascular risk. Conclusion: Prisoners have limited knowledge and misconceptions of CVD, and engage in several risky behaviours. There are multi-level influences on prisoners’ CVD risk and cardiovascular health. An ecological approach is recommended to address these influences to reduce the prisoners’ risk of CVD.