Attending to cardiovascular disease risk factors after incarceration: A study of empowerment and structural barriers to care.

Incarceration in the United States is associated with high rates of cardiovascular disease (CVD) risk factors and elevated CVD risk continues into the immediate period following release from prison. One reason may be that people who are released from incarceration experience difficulties accessing healthcare and navigating the healthcare system. We use empowerment theory to describe the experiences of people after release from incarceration who have been diagnosed with or affected by risk factors for CVD, specifically focusing on ways in which they overcome barriers within the United States' medical system. We conducted a secondary analysis of qualitative data collected in Baltimore, MD in 2019. Qualitative data were collected through interviews and interactive discussion forums with 98 people who were previously incarcerated and 19 key informants. Data were analysed using qualitative thematic analysis guided by the theoretical constructs of powerlessness and empowerment. Individuals who were formerly incarcerated described feeling empowered primarily through personal motivation, maintaining a positive mindset and receiving support from within the system. They also listed a number of structural barriers they faced and repeatedly suggested a desire for improved access to healthcare and a greater understanding of the healthcare system. Efforts to develop a straightforward and easily accessible support system can promote empowerment and encourage a successful return to society and should be prioritised.