title: A systematic review of the effectiveness and cost-effectiveness of peer education and peer support in prisons.
abstract: BACKGROUND
  Prisoners experience significantly worse health than the general population. This review examines the effectiveness and cost-effectiveness of peer interventions in prison settings.
  
  
  METHODS
  A mixed methods systematic review of effectiveness and cost-effectiveness studies, including qualitative and quantitative synthesis was conducted. In addition to grey literature identified and searches of websites, nineteen electronic databases were searched from 1985 to 2012. Study selection criteria were:
  
  
  METHODS
  Prisoners resident in adult prisons and children resident in Young Offender Institutions (YOIs).
  
  
  METHODS
  Peer-based interventions.
  
  
  METHODS
  Review questions 3 and 4 compared peer and professionally led approaches.
  
  
  RESULTS
  Prisoner health or determinants of health; organisational/process outcomes; views of prison populations.
  
  
  METHODS
  Quantitative, qualitative and mixed method evaluations.
  
  
  RESULTS
  Fifty-seven studies were included in the effectiveness review and one study in the cost-effectiveness review; most were of poor methodological quality. Evidence suggested that peer education interventions are effective at reducing risky behaviours, and that peer support services are acceptable within the prison environment and have a positive effect on recipients, practically or emotionally. Consistent evidence from many, predominantly qualitative, studies, suggested that being a peer deliverer was associated with positive effects. There was little evidence on cost-effectiveness of peer-based interventions.
  
  
  CONCLUSIONS
  There is consistent evidence from a large number of studies that being a peer worker is associated with positive health; peer support services are also an acceptable source of help within the prison environment and can have a positive effect on recipients. Research into cost-effectiveness is sparse.
  
  
  BACKGROUND
  PROSPERO ref: CRD42012002349.
authors.affiliation: Centre for Health Promotion Research, Leeds Beckett University, Leeds, LS1 3HE, UK. a.bagnall@leedsbeckett.ac.uk.
authors.forename: Anne-Marie
authors.initials: AM
authors.lastname: Bagnall
authors.affiliation: Centre for Health Promotion Research, Leeds Beckett University, Leeds, LS1 3HE, UK. j.south@leedsbeckett.ac.uk.
authors.forename: Jane
authors.initials: J
authors.lastname: South
authors.affiliation: Academic Unit of Health Economics, Leeds Institute of Health Sciences, University of Leeds, LEEDS, LS2 9LJ, UK. C.T.Hulme@leeds.ac.uk.
authors.forename: Claire
authors.initials: C
authors.lastname: Hulme
authors.affiliation: Centre for Health Promotion Research, Leeds Beckett University, Leeds, LS1 3HE, UK. j.woodall@leedsbeckett.ac.uk.
authors.forename: James
authors.initials: J
authors.lastname: Woodall
authors.affiliation: Academic Unit of Health Economics, Leeds Institute of Health Sciences, University of Leeds, LEEDS, LS2 9LJ, UK. K.A.Vinall@leeds.ac.uk.
authors.forename: Karen
authors.initials: K
authors.lastname: Vinall-Collier
authors.affiliation: Centre for Health Promotion Research, Leeds Beckett University, Leeds, LS1 3HE, UK. g.raine@leedsbeckett.ac.uk.
authors.forename: Gary
authors.initials: G
authors.lastname: Raine
authors.affiliation: Centre for Health Promotion Research, Leeds Beckett University, Leeds, LS1 3HE, UK. k.kinsella@leedsbeckett.ac.uk.
authors.forename: Karina
authors.initials: K
authors.lastname: Kinsella
authors.affiliation: Centre for Health Promotion Research, Leeds Beckett University, Leeds, LS1 3HE, UK. r.dixey@leedsbeckett.ac.uk.
authors.forename: Rachael
authors.initials: R
authors.lastname: Dixey
authors.affiliation: Spectrum Community Health CIC, White Rose House, West Parade, Wakefield, WF1 1LT, UK. linda.harris@spectrum-cic.nhs.net.
authors.forename: Linda
authors.initials: L
authors.lastname: Harris
authors.affiliation: Leeds Community Healthcare HMP Leeds Healthcare Department, 2 Gloucester Terrace, Armley, Leeds, LS12 2TJ, UK. natwright@nhs.net.
authors.forename: Nat M J
authors.initials: NM
authors.lastname: Wright
mesh_terms: D000328:Adult; D002648:Child; D003362:Cost-Benefit Analysis; D003376:Counseling / Q000191:economics* / Q000706:statistics & numerical data; D006266:Health Education / Q000191:economics* / Q000706:statistics & numerical data; D006293:Health Promotion / Q000191:economics* / Q000706:statistics & numerical data; D006801:Humans; D008297:Male; D011329:Prisoners / Q000193:education* / Q000706:statistics & numerical data; D011330:Prisons / Q000191:economics / Q000458:organization & administration*; D012657:Self-Help Groups; D012944:Social Support