A Systematic Review of Interventions to Improve Health Factors or Behaviors of the Cardiovascular Health of Prisoners During Incarceration.

BACKGROUND: Prisoners are disproportionately affected by cardiovascular disease and its risk factors. However, primary prevention of cardiovascular disease in correctional settings has been widely neglected, and there is little information on interventions to improve the cardiovascular health of prisoners while incarcerated. OBJECTIVE: The aim of this study was to systematically review published literature to identify interventions to improve the health factors or behaviors of the cardiovascular health of prisoners during incarceration. METHODS: Selected databases were searched using terms related to prisoners and cardiovascular disease. Studies were included if they had prisoners as participants and measured outcomes of cardiovascular health. Narrative synthesis was used to organize the evidence from the studies. RESULTS: Twelve articles detailing 11 studies were identified. Most of the studies involved only men. Interventions were classified into 4 types: structured physical activity, nutrition, mixed with physical activity and educational sessions, and smoking cessation. Most studies measured short-term outcomes relating to cardiovascular health such as changes in blood pressure and weight. Only 4 studies were of high quality. Structured physical activity interventions, nutrition interventions, and smoking cessation interventions delivered in a group setting had significant effects on at least 1 measured outcome. The effect of mixed interventions could not be determined. CONCLUSIONS: Structured physical activity interventions, nutrition interventions, and smoking cessation interventions delivered in a group setting can improve health factors or behaviors of the cardiovascular health of prisoners during incarceration. More high-quality research is needed to increase the evidence base on the effectiveness of these interventions in the correctional setting.

Knowledge and cardiovascular disease risk perception from the perspectives of prisoners and staff in a Scottish prison: a qualitative study.

PURPOSE: Prisoners have an increased risk of cardiovascular disease (CVD) compared to the general population. Knowledge and risk perception of CVD can influence engagement in preventative behaviours that lower an individual's CVD risk. This paper aims to explore prisoners' knowledge of CVD, and prisoners and staff's perceptions of prisoners' CVD risk. DESIGN/METHODOLOGY/APPROACH: This was a qualitative study in which semi-structured interviews were conducted with 16 prisoners and 11 prison and National Health Services staff in a Scottish prison. Data were analysed thematically using the framework method. FINDINGS: Most prisoners had limited knowledge of CVD as they could not describe it or could only identify one or two risk factors or cardiovascular events. Both prisoners and staff viewed prisoners' CVD risk as either pertaining to one individual, or pertaining to the general prisoner population. Unhealthy behaviours that were believed to increase CVD risk were linked to three perceived consequences of imprisonment: mental health problems, boredom and powerlessness. ORIGINALITY/VALUE: To the best of the authors' knowledge, this is the first study to explore the CVD knowledge of prisoners, and perceptions of CVD risk from the perspectives of prisoners and prison staff. Findings from this study indicate that CVD education needs to be a priority for prisoners, addressing knowledge of CVD, its risk and risk perceptions. Additionally, the findings indicate that individual and socio-environmental factors linked to prisoners' CVD risk need to be targeted to reduce this risk. Future research should focus on socio-environmental interventions that can lead to reducing the CVD risk of prisoners.