Enduring Inequality in Diabetes and Hypertension Management in Thai Prisons: A Qualitative Study.

Abstract

For individuals in prisons, the management of diabetes and hypertension is resource-intensive and presents substantial challenges. This qualitative descriptive study explored the experiences of incarcerated individuals in accessing health-care resources for these conditions. In total, 60 participants (mean age = 44.3 ± 12.6 years), including 30 individuals at risk for and 30 diagnosed with diabetes and hypertension, were purposively enrolled by prison nurses. Data were collected through 12 focus group discussions and nonparticipatory observations conducted in 6 prisons in Thailand between September and December 2023. The data were analyzed using Braun and Clarke's thematic analysis framework. The findings revealed 3 key themes: "resource constraints," reflecting struggles with inadequate provisions (such as dietary ones); "neglect," reflecting inequalities in diabetes and hypertension screening and limited clinical monitoring; and "self-reliance," reflecting how participants coped with stress and managed life-threatening situations on their own. In conclusion, the study highlights substantial inequalities in diabetes and hypertension management in prisons. Targeted strategies are urgently needed to improve chronic disease management in prison settings.