Talking About History of Incarceration: Engaging Patients & Healthcare Providers in Communication (THInc)

Scientific Abstract

Background: Exposure to incarceration is associated with chronic disease and barriers to healthcare in the community; however, providers receive limited education about incarceration and health. We examined healthcare providers’ self-reported education and confidence in caring for patients with a history of incarceration.

Methods: An anonymous, online survey was emailed to a random sample (N=400) of nurse practitioners (NP), physician assistants (PA), and physicians (MD) at Brigham and Women’s Hospital (Department of Medicine). Participants self-reported demographics, incarceration-specific training, and confidence in interviewing and understanding the health implications of incarceration. Levels of confidence/agreement on a 5-point Likert scale were categorized as low, moderate, or high. Frequencies and relative frequencies were calculated.

Results: The overall response rate was 29% (n=115; PA=41%, NP=32%, MD=26%). Only 12% received training for currently or formerly incarcerated patients, but 50% considered it “highly” important. Most agreed that incarceration was associated with poor health (76%) and healthcare barriers (54%). Despite 74% reported caring for formerly incarcerated patients, only 19% routinely asked. Providers reported low confidence in asking about incarceration history (60%) and meeting patients’ unique needs (64%).

Conclusion: Providers reported limited education and low confidence in addressing formerly incarcerated patients’ needs; thus, further education may be needed.

Lay Abstract

Incarceration has been linked to chronic disease, but healthcare providers lack training about incarceration and health. We aimed to understand healthcare providers’ education and confidence in caring for incarcerated patients.

An anonymous, online survey was emailed to a random sample (N=400) of nurse practitioners (NP), physician assistants (PA), and physicians (MD) at Brigham and Women’s Hospital. Participants self-reported demographics, incarceration-specific training, and confidence in interviewing and understanding the health implications of incarceration. Respondents rated their confidence/agreement to statements using a 5-point scale. Counts and percentages were calculated.

Overall, 29% of providers responded (N=115; PA=41%, NP=32%, MD=26%). Only 12% received training in caring for currently or formerly incarcerated patients, but 50% felt it was “highly” important. Most agreed that incarceration was associated with poor health (76%) and healthcare barriers (54%). Even though 74% reported that they cared for formerly incarcerated patients, only 19% routinely asked about history of incarceration. Providers also reported low confidence in asking patients about their incarceration history (60%) and meeting their unique needs (64%).

In conclusion, healthcare providers reported limited education and low confidence in addressing formerly incarcerated patients’ needs. Our findings support the need for further training to better care for formerly incarcerated patients’ health.

Clinical Implications

Our findings suggest that healthcare providers require further education to understand the implications of incarceration on health. Training on how to discuss history of incarceration and how to address unique population-specific needs would support efforts towards achieving equitable healthcare.

Talking About History of Incarceration: Engaging Patients & Healthcare Providers in Communication (THInc)

Scientific Abstract

Lay Abstract

Clinical Implications

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