Record-breaking recruitment for prison study

A study funded by NIHR CLAHRC East Midlands into the cardiovascular (CVD) health of prisoners has become the largest piece of research to take place in prison in Europe after recruiting 1,200 inmates.

Prisoners have high levels of morbidity, with more than 30% of all deaths in custody occurring due to CVD. However, preventative approaches to reduce avoidable mortality in these settings are poorly researched.

Community CVD risk assessment programmes have been rolled out in prisons with limited success and crucially evidence is unavailable on whether high levels of anxiety and depression in prisoners may further challenge uptake of effective health interventions.

In response, this research, a non-cohort, prevalence study,has been collecting healthcheck data, including assessments of anxiety and depression, in a bid to:

• Describe a systematic profile of the distribution of CVD and metabolic risk factors in defined prison populations of 35-74 year-old males and identify current patterns of uptake of CVD risk measurement (Healthchecks) in those populations against the overall CVD risk profile. 
• Track well-defined mental health measures of anxiety and depression and analyse relationships to CVD risk profiles at individual level and uptake of subsequent risk reduction interventions.     
• Explore barriers to current implementation in those defined populations and explore how systematic understandings of the distribution of CVD risks and anxiety and depression may offer opportunities to test and improve effective intervention in those populations. 

The study is titled ‘Describing patterns of cardiovascular disease (CVD) risk profiles in prisoners and exploring implications on implementation of the national primary care CVD Healthchecks Programme in prison populations’.

Recruitment has closed, with participants taking part from six prisons, HMP Nottingham, Lincoln, Gartree, Lowdham, Whatton and Ranby. The 1,200 recruitment target was met in January 2019.

As per programme guidance, those excluded were prisoners with established cardiovascular disease, following standard practise for all NHS Healthchecks in the community. All eligible prisoners were invited to take part, despite the sentence length, and included remand prisoners.

Focus groups were also run at prison sites, inviting groups of prisoners to discuss the NHS Healthchecks. Two types of prisoner groups were run: those who had agreed to have an NHS Healthcheck and those who declined to have one. Focus groups were also conducted with healthcare staff and separate focus groups with non-healthcare staff. Additionally, there was one focus group conducted with ex-prisoners.

The analysis will identify patterns of high risk in individuals and groups based on age and ethnicity, including any groupings of physical CVD risk factors, and with anxiety or depression, to help inform multiple risk factor interventions. 

Picture credit: Matthew Ansley