Barriers and Facilitators to Quality Healthcare for African Americans with Incarceration Histories.

Background: Prior research has shown that African American men and women are more likely to receive lower quality healthcare compared to their white counterparts, which is exacerbated in jail and prison healthcare systems.

Objective: The purpose of this study is to explore barriers and facilitators to quality healthcare among African American men and women released from Illinois State Prisons or Cook County Jail by examining their opinions and experiences with overall healthcare and cancer screening during and after incarceration.

Design: Four focus groups (n = 25 "co-researchers") were conducted to understand how formerly incarcerated African American men and women perceive and describe their experience of accessing, understanding, and utilizing healthcare during and after incarceration. Co-researchers' reports on healthcare during incarceration are retrospective.

Key Results: Multiple facilitators and barriers to accessing healthcare were described. Unique themes from during incarceration included lack of access to adequate and appropriate healthcare, lack of trustworthiness of healthcare systems, excessive and punitive co-pays for questionable and inadequate healthcare, responses to inappropriate or inadequate healthcare motivated by negative attitudes, and actions by correctional staff or healthcare professionals which dis-incentivized medical help-seeking, and gaps in knowledge and understanding about cancer screening and chronic health conditions. Post-release themes included strong motivations to access and routinely utilize healthcare systems, the ability to prioritize health, increased access to healthcare and healthcare systems (though this required structural assistance), good or better-quality healthcare, and on-going support, knowledge, and positive interactions with healthcare professionals.

Conclusions: This study highlights the need to address barriers to accessing healthcare during and after incarceration, particularly given racial disparities in healthcare treatment and outcomes.