A qualitative synthesis of the positive and negative impacts related to delivery of peer-based health interventions in prison settings.
BACKGROUND
Peer interventions involving prisoners in delivering peer education and peer support in a prison setting can address health need and add capacity for health services operating in this setting. This paper reports on a qualitative synthesis conducted as part of a systematic review of prison-based peer interventions. One of the review questions aimed to investigate the positive and negative impacts of delivering peer interventions within prison settings. This covered organisational and process issues relating to peer interventions, including prisoner and staff views.


METHODS
A qualitative synthesis of qualitative and mixed method studies was undertaken. The overall study design comprised a systematic review involving searching, study selection, data extraction and validity assessment. Studies reporting interventions with prisoners or ex-prisoners delivering education or support to prisoners resident in any type of prison or young offender institution, all ages, male and female, were included. A thematic synthesis was undertaken with a subset of studies reporting qualitative data (n = 33). This involved free coding of text reporting qualitative findings to develop a set of codes, which were then grouped into thematic categories and mapped back to the review question.


RESULTS
Themes on process issues and wider impacts were grouped into four thematic categories: peer recruitment training and support; organisational support; prisoner relationships; prison life. There was consistent qualitative evidence on the need for organisational support within the prison to ensure smooth implementation and on managing security risks when prisoners were involved in service delivery. A suite of factors affecting the delivery of peer interventions and the wider organisation of prison life were identified. Alongside reported benefits of peer delivery, some reasons for non-utilisation of services by other prisoners were found. There was weak qualitative evidence on wider impacts on the prison system, including better communication between staff and prisoners. Gaps in evidence were identified.


CONCLUSIONS
The quality of included studies limited the strength of the conclusions. The main conclusion is that peer interventions cannot be seen as independent of prison life and health services need to work in partnership with prison services to deliver peer interventions. More research is needed on long-term impacts.


BACKGROUND
PROSPERO ref: CRD42012002349 .
Centre for Health Promotion Research, School of Health and Community Studies, Leeds Beckett University, CL 505, Calverley Building, City Campus, Leeds, LS1 3HE, UK. j.south@leedsbeckett.ac.uk.
Jane
J
South
Centre for Health Promotion Research, School of Health and Community Studies, Leeds Beckett University, Leeds, UK.
James
J
Woodall
Centre for Health Promotion Research, School of Health and Community Studies, Leeds Beckett University, Leeds, UK.
Karina
K
Kinsella
Centre for Health Promotion Research, School of Health and Community Studies, Leeds Beckett University, Leeds, UK.
Anne-Marie
AM
Bagnall
Health promotion; Implementation; Lay involvement; Offender health; Peer education; Peer support; Qualitative research; Systematic review
Ann Health Law. 2010;19(1 Spec No):127-32
21495560
Public Health. 2010 Feb;124(2):99-106
20167340
AIDS Educ Prev. 2006 Dec;18(6):504-17
17166077
Crisis. 2004;25(1):19-26
15384653
BMC Public Health. 2015 Mar 25;15:290
25880001
BMJ. 2004 Apr 24;328(7446):1010-2
15105329
Int J Prison Health. 2015;11(2):87-97
26062660
BMC Med Res Methodol. 2008 Jul 10;8:45
18616818
Ann Intern Med. 2009 Aug 18;151(4):W65-94
19622512
Crisis. 2007;28(3):122-30
17992825
Hosp J. 1991;7(3):43-55
1820303
J Correct Health Care. 2011 Jan;17(1):6-18
20810874