Background
Methods
Objectives
Data sources
Study selection
Eligibility criteria
Data extraction
Validity assessment
Data synthesis
Results
Study | Country | Study design | Health topics | Nature of intervention/scheme | Population/setting | Individual outcomes | Service, delivery or organisation outcomes | Validity score* |
---|---|---|---|---|---|---|---|---|
Ashton 2010 [75] | Canada | Qualitative | HIV/AIDS and HCV (& other infectious diseases) | Peer support | “Healing Lodge” – a small (28 bed) minimum/medium security prison for Aboriginal women, incorporating Aboriginal healing practices, meaningfulness and cultural-connection. Most women are serving sentences of 3 years or less. | Strengths of programme listed. | Not reported | 3b |
Staff perceptions. | ||||||||
Betts-Symond 2011 [76] | Ireland | Qualitative | Health, hygiene and cleanliness | Peer education | 700 prisoners in Wheatfield prison, Dublin Ireland (medium-high security male prison) and their immediate family members | Personal development and changed outlook of the volunteers; results presented under 6 themes: Environment, behaviours, capabilities, beliefs and values, identity & goals. | Relationship between operational health services and inmate IRC volunteers. | 3c |
Blanchette 1998 [58] | Canada | Mixed Qualitative& Quantitative | General emotional/ mental health, psychological support and counselling | Peer support | Women resident in one of four small prisons in Canada: Nova Institution; Etablissement Joliette; Grand Valley Institution; Edmonton Institution. | Self-esteem; | Staff and prisoners’ awareness and perceptions of the role and functioning of the PST (surveys); | 2b |
Sociometric tests for understanding personal and group dynamics; | ||||||||
Perceptions of the prison environment (correctional environment status inventory); | ||||||||
Staff and prisoners’ views, feelings and ideas about PST (interviews). | ||||||||
Boothby 2011 [53] | UK | Qualitative | General health/ support | Peer support | Male prison in the UK. | Insiders perceptions of role and themselves. | Numbers of prison staff | 1a |
The scheme supports prisoners who are new to the prison system. | prisoners’ mood; suicide rates | |||||||
Boyce 2009 [59] | UK | Mixed | Housing/resettlement | Peer advisors | Serving prisoners in: | skills and self-confidence, work ethic, | Effects on ‘professional’ time. | 2a |
3 category B prisons (male), 1 Youth Offending Institution (male) | sense of control over their lives, work experience and qualifications. | Staff concerns: potential for bullying or intimidation and breaches of confidentiality. | ||||||
Brooker & Sirdifield 2007 [54] | UK | Mixed Qualitative & Quantitative | Multiple health issues | Health Trainers | Serving prisoners in 4 adult prison, one Young Offenders Institution and one probation setting | Perceptions of tutors of the Health Trainers re. confidence; knowledge of services; communication skills; ability to assess someone’s readiness to change; self-esteem; self-worth. | Perceptions of prison-based trainees re. their role. | 1a |
Perceptions of health trainers re. knowledge of health issues and attitude; confidence in sign-posting individuals to services; changing own behaviour. | Perceptions of stakeholders re: | |||||||
Perceptions of health trainer clients; issues discussed; services referred on to. | -workload for prison PE departments | |||||||
-training sessions | ||||||||
-Raising risk issues | ||||||||
- engagement with health services | ||||||||
-Change of focus for the gym | ||||||||
-Highlighting a lack of health services in some areas | ||||||||
-Raising staff awareness of health issues and/ or services available | ||||||||
Bryan 2006 [60] | USA | Quantitative Pre-test post-test design (one group only). | HIV prevention | Peer education | 196 serving prisoners in maximum and minimum security prisons. 90% male, mean age 30.4y. | Knowledge; Perceived risk; Condom attitudes; Condom norms; Condom self-efficacy; Condom intentions; Attitudes for not sharing needles; Norms for not sharing needles; Self-efficacy for not sharing needles; Intentions to not share needles; Peer education attitudes; Peer education norms; Peer education self-efficacy; Peer education intentions; Peer education behaviour. | Not reported | 2b |
Chen 2006 [29] | Israel | Quantitative Pre & Post | General emotional/ mental health, psychological support and counselling | Peer counselling | 93 male repeat offenders in three prisons in Israel. (Two maximum security and one minimum security). | Sense of coherence; Meaning in life; | Not reported | 2b |
Mean age 36 years (SD = 6.35). | Anxiety; Depression; Hostility: | |||||||
Cichowlas & Chen 2010 [77] | USA | Qualitative | General health/ support | Prison hospice volunteers | Ill/dying prisoners at Dixon Hospice in Illinois | Perceptions of peer deliverers | Not reported | 3c |
Collica 2007 [78] | USA | Quantitative & Qualitative | HIV/AIDS and HCV (& other infectious diseases) | Peer education | All prisoners in USA were covered by the survey. | Facilities were asked to report on: | Not reported | 3c |
1. Number of HIV positive inmates in their custody; | ||||||||
2. If they mandated HIV testing; | ||||||||
3. If they provided prison-based peer programming on HIV. | ||||||||
If answer to Q3 was YES: | ||||||||
Extent of HIV peer education, and other services. | ||||||||
If answer to Q3 was NO: | ||||||||
How HIV education was provided and why inmate peers were not used. | ||||||||
Collica 2010 [55] | USA | Qualitative | HIV/AIDS and HCV (& other infectious diseases) | Peer education | Aimed at women in prison with HIV/AIDS. | Role of peers | Not reported | 1b |
One maximum and one medium security prison for women | ||||||||
Correctional Service of Canada 2009 [79] | Canada |
Quantitative & Qualitative
| General emotional/ mental health, psychological support and counselling | Peer Support | Women prisoners “in distress” | From interviews: predominant mental health issues of women prisoners; how these are addressed in training sessions; benefits to trained peer counsellors | Trust between staff and prisoners | 3c quant/3b qual |
From survey: whether prisoners value the PST; reasons for asking to see a peer counsellor; benefits to service recipients; helpfulness of peer counsellors; recommendations for improvements | Staff becoming part of peer support team | |||||||
Recommendations for improvements. | ||||||||
Daigle 2007 [24] | Canada | Not applicable | Suicide/Self harm | Peer support | Canadian prisons (no further details reported). | Not reported | Concerns about recruitment, security and responsibility | N/A |
Davies 1994 [32] | UK | Qualitative | Suicide/Self harm | Listeners | HMP Swansea (adult prison) | Attempted suicide rate. | staff time. | 2b |
use of the strip cell or care room. | Prison atmosphere. | |||||||
Listeners’ perceptions (benefits to Listeners) | ||||||||
Delveaux & Blanchette 2000 [80] | Canada |
Quantitative & Qualitative
| General emotional/ mental health, psychological support and counselling | Peer support | Small women’s prison.Women prisoners, all serving sentences of two or more years and classified as minimum or medium security. | Self esteem; Sociometric tests for understanding personal and group dynamics; Perceptions of the prison environment (correctional environment status inventory) | Staff and prisoners’ awareness and perceptions of the role and functioning of the PST (surveys) | 3c |
Staff and prisoners’ views, feelings and ideas about PST (interviews). | ||||||||
Dhaliwal & Harrower 2009 [61] | UK | Qualitative | Suicide/Self harm | Listeners | Vulnerable or distressed prisoners, or those at risk of suicide. | Listeners’ own experiences, the impact on them as individuals, skills and/or benefits acquired. | Presents findings in relation to what the prison service can do to support the scheme. | 2b |
Dolan 2004 [27] | Russia | Quantitative: pre and post | HIV/AIDS and HCV (& other infectious diseases) | Peer education | Male colony for drug-dependent prisoners in Siberia. Mean age 24 (range 18–30), 63% first time in prison, mean years served 1.2 (SD 0.7), 66% imprisoned for drug related offence. | Whether seen the program booklet? | Access to bleach and condoms | 3c |
Whether participated in peer training education? | ||||||||
Demographic characteristics; Knowledge of HIV transmission; STI and BBVI status; Drug use; Sexual activity; Tattooing; Access to bleach and condoms. | ||||||||
Eamon 2012 [81] | Canada |
Quantitative & Qualitative
| General emotional/mental health, psychological support and counselling | Peer Support | Edmonton Institution for Women population = 65 | Satisfaction with/ performance of PST; | Suggestions for improvement to number of sessions | 3b |
Hours per week of support provided by PST members; Time to response to inmate calls for peer response; Level of trust in PST members; Suggestions for improvement; Improving relationships. | ||||||||
Edgar 2011 [23] | UK |
Quantitative & Qualitative:
| Multiple health issues | Peer support/ Listeners | Not stated | Various, including Listeners and other peer roles. | Diverting workload away from staff. | 2b |
Farrin (undated) [82] | Australia | Review | Multiple health issues | Peer support | At-risk prisoner in 8 state prisons | Changes in responsibility, accountability and self-esteem (Syed & Blanchette 2000) | Reports the results from Devilly et al., 2003 on changing attitudes and behaviours; Offender preference | 3c |
Foster 2011 [56] | UK | Qualitative | Suicide/Self harm | Listeners | Adult category-B local male prison. Operational capacity 1103 | Effect on Listeners’ personal development; Self-esteem; well-being; relationships. | Prison environment, burden on prison staff and health care professionals. | 1a |
Numbers of potential suicides and incidents of self harm. | ||||||||
Goldstein 2009 [83] | USA | Quantitative | Mental health/Substance abuse | Peer mentoring | 2 correctional facilities. Incarcerated women with current or history of behavioural issues and/ or substance abuse. | Adherence to outpatient psychiatric treatment, including medication management; Medication compliance, sobriety & symptom reduction; Re-offending; Abstinence in the use of alcohol or illegal drugs or misuse of prescription drugs; Employment or enrolment in an educational program or completion of the application process for disability benefits; Secure treatment, transitional housing or a permanent place to live. | Nor reported | 3c |
Age range: 19 to 59 y (mean = 35 y). 15 out of the 32 participants had 5 or more prior incarcerations. | ||||||||
Grinstead 1997 [84] | USA | Quantitative: RCT | HIV | Peer education | Male inmates at large (n = approx. 5600) medium-security state prison. . 45% had history of injection drug use, more than 75% of these reported having shared equipment. | HIV Knowledge; Preference for teacher; | Not reported | 3b |
Condom use intention; Bleach use intention; HIV antibody use intention; | ||||||||
Interested in taking test now. | ||||||||
Grinstead 1999 [25] | USA | Quantitative. RCT | HIV prevention | Peer education | Large state prison for men. Mean age 35y, spent more than 9y of life in prison. 90% had just completed a sentence of less than 5y and <10% were imprisoned for the first time. | Risky behaviour at follow up: | Not reported | 3c |
used a condom the first time they had sex since release; used drugs since release; injected drugs since release; shared needles | ||||||||
Hall & Gabor 2004 [36] | Canada | Mixed quantitative and qualitative. | Suicide prevention | Listeners | Medium security prison with capacity 585. Inmates have committed serious crimes. | personal growth, knowledge of suicide, self-esteem, communication skills, and sense of purpose; support; general program operation; impact of training; personal development | Findings are reported related to program implementation | 3c |
modal age category 18-29y, followed by 30-39y. Length of sentence ranged from 2 years to life. | ||||||||
Hoover & Jurgens 2009 [85] | Moldova | Qualitative | HIV/AIDS and HCV (& other infectious diseases) | Peer outreach | 7 prisons (6male prisons and 1 female prisons) | Not reported | Decline in HIV cases | 3c |
Hunter & Boyce 2009 [57] | UK | Qualitative | Housing/resettlement | Peer advisors | Prisoners requiring housing advice in 5 prisons in SE England (Three Category B prisons (male), one young offender institution (male) and one female open prison.) | social interaction with others; experience and qualifications to assist post-release; self-confidence. | Views of prisoners and staff re. staff workload and prisoners’ use of their time in prison. | 1a |
Jacobson & Edgar (undated) [62] | UK | Qualitative | General health/ support | Peer support | New arrivals at HMP Edinburgh | Effects on prisoners | Use of staff time | 2c |
Junker 2005 [86] | USA | Quantitative | Suicide/Self harm | Peer Observers | Those prisoners judged to be suicidal | Not reported. | Number of hours individuals spent on suicide watch post-IOP compared to pre-IOP (i.e. using staff for observations): | 3b |
Levenson & Farrant 2002 [19] | UK | Quantitative & Qualitative | Multiple health issues | Peer support/ Listeners. | Not stated | Perceptions of role ( peer supporters) | Not reported | 3b quant/2b qual |
Self-esteem. | ||||||||
finding accommodation and small amounts of money after release | ||||||||
Martin 2008 [63] | USA | Quantitative. | HIV/ HCV prevention | Peer education | 3 sites: Delaware, Kentucky and Virginia. | The only outcome reported is condom use during sex. | Not reported | 2b |
RCT. | ||||||||
N = 343. Mean age 34y. 86% male. | ||||||||
Maull 1991 [64] | USA | Study design unclear | General health/support | Prison hospice volunteers | Ill prisoners at U.S. Medical Centre for Federal Prisoners in Springfield, Missouri | Effects on volunteers; | Retention/attrition of volunteers | 2b |
Effects on prisoners | ||||||||
McGowan 2006 [87] | USA | Qualitative | HIV counselling | Peer education | Male prisoners in state prisons in California, Mississippi, Rhode Island and Wisconsin. aged between 18 and 29y, incarcerated for at least 90 days, classified as minimum or medium security level, scheduled for release within 14 to 60 days. | Effect son HIV testing: mandatory testing at intake, voluntary testing at medical intake, and voluntary testing during a peer health orientation class. | Not reported | 3c |
Mentor 2 work [73] | UK | Study design unclear | Unclear | Peer mentoring | Prisoners with mental health problems at HMP Liverpool. | Self-esteem, confidence and motivation; Self-worth; Communication skills, reasoning and reflection skills; Mental health and treatment. | Numbers of volunteers and prisoners being mentored; effects after release. | 3c |
Munoz-Plaza 2005 [65] | USA | Qualitative | HIV/ AIDS and HCV (& other infectious diseases) | Peer education | A state correctional facility in California. Drug treatment program is located on a medium security prison yard that houses male inmates. age range 20–50 years | Not reported | Not reported | 2b |
O’Hagan 2011 [88] | UK | Quantitative | Literacy | Peer education | Serving Young Offenderss at 5 YOIs | Literacy: | Not reported | 3c |
Impact on learners; | ||||||||
Impact on mentors | ||||||||
Peek 2011 [89] | UK | Quantitative | Infectious disease prevention: screening and vaccination. | Peer education | Male prisoners at HMP High Down Category B male local prison. | Hep B and Hep C awareness and vaccination uptake. | signposting to healthcare, | 3c |
Chlamydia awareness and screening. | Effects on nurses utilising their time in the prison. | |||||||
Effects on barriers between nursing staff and prisoners. | ||||||||
Prison atmosphere. | ||||||||
Changing role/perception of prisoners. | ||||||||
Penn State Erie 2001 [90] | USA | Mixed methods | Parenting | Peer education | Fathers in prison. State Correctional Institute at Albion (SCI Albion), in Erie county. A medium-security institution for men | contact with children per month/year; | Staff awareness and perceptions of programme | 3c |
Anger & Frustration; Knowledge about their child/children; Parental Locus of Control; ICAN Fathering Profile; Total Parenting score | ||||||||
Father’s Questionnaire: knowledge, | ||||||||
attitudes, skills, and behaviors. | ||||||||
Player & Martin 1996 [91] | UK | Study design unclear | Addictions/substance abuse | Peer counselling | Prisoners with addictions at HMP Downview | drug use; prisoner behaviour | Not reported | 3c |
Richman 2004 [92] | UK | Quantitative | General emotional/ mental health, psychological support and counselling | Listeners | HMP Manchester | Change in demeanour. | Effects on staff – peer worker relationship. | 3b |
Expected effects on release from prison (on Listeners) | ||||||||
Ross 2006 [66] | USA | Quantitative Pre & Post | HIV/ AIDS and HCV (& other infectious diseases) | Peer Education | 36 Texas State prison units. Peer educators and students were predominantly male, aged 34–43 y. | HIV–related knowledge; self–assessed educator skills among peer educators; Diffusion of HIV–related knowledge; | impact of the peer education program on HIV testing at participating units | 2b |
HIV–testing behavior and intentions | ||||||||
Schinkel & Whyte 2012 [67] | UK | Qualitative | Housing/resettlement | Peer mentoring | Based in Glasgow – prisons not stated. Prisoners serving sentences of between three months and four years. Service offered to eligible prisoners who are returning to Glasgow, Renfrewshire and North Lanarkshire. | Effects on prisoners | Staff perceptions of life coaches’ need for support. | 2b |
Schlapman & Cass 2000 [93] | USA | Quantitative – pre and post | HIV prevention | Peer education | Incarcerated adolescents in North central Indiana juvenile facility. | AIDS knowledge & self reported sexual behaviours. | Not reported | 3c |
Scott 2004 [68] | USA | Mixed quantitative (pre and post) and qualitative) | HIV prevention | Peer education | Prisoners at 5 Texas prison facilities. A diversity of facilities was selected (small and large, short and long term, male and female prisoners) | HIV related knowledge, attitudes and beliefs among peer educators and students. | Factors affecting implementation, maintenance and overall impact of the program from the perspective of program coordinators, wardens and peer educators. | 2b quant/2c qual |
South Africa | Quantitative Pre & Post | HIV/ AIDS and HCV (& other infectious diseases) | Peer education | 4 medium-sized correctional facilities (male) in South Africa. Number housed comparable in size to UK prison..N = 263. Mean age 27 y (range 17–55). Mean period of incarceration = 2 years (range 6 m – 17 y).65% were first time offenders. | Knowledge and beliefs; Attitudes; Sexual communication, social norms about gender relations and sexual violence; | Not reported | 2c | |
Self-efficacy; Intentions | ||||||||
Sirdifield 2006 [70] | UK | Qualitative | General health/ support | Health Trainer | All prisoners | Changes in Health Trainers’ attitudes and health behaviour. | demands placed on prison staff and health services as a result of the intervention. | 2b |
Recognising stress in other prisoners. | ||||||||
Snow 2002 [37] | UK | Quantitative | Suicide/ self harm | Listeners | 5 prisons having a Samaritan supported Listener scheme. All prisons were local type establishments and chosen because of the comparatively high rate of suicide. | Perceived benefit from using the scheme: | Not reported | 2b |
Approachability of listeners | ||||||||
Availability of listeners | ||||||||
Use of listener scheme in the future. | ||||||||
Reasons for not using the scheme | ||||||||
Ways to improve the scheme | ||||||||
Stewart 2011 [94] | UK | Quantitative & Qualitative | General health/ support | Peer support | 3 UK prisons. | Effects on prisoner-carers | communication between staff and prisoners. Training and supervision issues. | 3c |
Originally for older prisoners but to include those with learning disabilities, mental health problems and prisoners with physical and sensory disabilities. | Contribution to the health and social care services within the gaol. | |||||||
Syed & Blanchette 2000 [95] | Canada | Quantitative & Qualitative | General emotional/mental health, psychological support and counselling | Peer Support | Small women’s prison, n = 78 at time of study. All were serving sentences of minimum 2 years and were rated at ‘minimum’ or ‘medium’ security levels. | Self esteem; Sociometric tests for understanding personal and group dynamics; Perceptions of the prison environment (correctional environment status inventory); | Staff and prisoners’ awareness and perceptions of the role and functioning of the PST (surveys); | 3b quant/ 1c qual |
Survey respondents, average age 34.5y (sd = 9.07, range 21–58). Average sentence length 4.39y (range 2 to 15y). Average time spent at Grand Valley = 9 months (SD = 0.62, range = 2 weeks to 2 years). | Staff and prisoners’ views, feelings and ideas about PST (interviews). | |||||||
Syed & Blanchette 2000 [96] | Canada | Quantitative & Qualitative | General emotional/ mental health, psychological support and counselling | Peer Support | women’s prison in Canada. N = 56 at time of study. All were serving sentences of minimum 2 years and were rated at ‘minimum’ or ‘medium’ security levels. | Self esteem; Sociometric tests for understanding personal and group dynamics; Perceptions of the prison environment (correctional environment status inventory); | Staff and prisoners’ awareness and perceptions of the role and functioning of the PST (surveys) | 3b quant/ 2b qual |
All women, average age 35.1y (SD = 11.3, range = 21 to 62). Average sentence length 4.7 years (range 2y to life). Mean time served at Joliette = 13.3 m (range 2 m to 2.5y). | Staff and prisoners’ views, feelings and ideas about PST (interviews). | |||||||
Taylor 1994 [97] | Australia | Quantitative and Qualitative: Pre-post | HIV prevention | Peer education | New South Wales Correctional Centres. 90% of inmates had been in other correctional centres. | Knowledge; attitudes | Awareness of the peer education scheme. | 3b |
The Learning Ladder Ltd. (undated) [74] | UK | Qualitative. | Mentoring for education/to improve qualifications | Peer mentoring | HM Young Offenders Institution Reading – a small prison holding prisoners between the ages of 18 and 21y. | self-esteem; confidence; attitude to offending behaviour. | Success of scheme. | 3c |
Vaz 1996 [28] | Mozambique | Quantitative, pre-post | HIV/ STD prevention | Peer education | Largest prison in Mozambique (1900 prisoners incarcerated at time of study). 300 inmates sentenced to 1 year or longer, selected on entry. Mean age 26y. | knowledge around HIV/AIDS ; relationship between knowledge of HIV/AIDS and educational attainment of participants. | Not reported | 3b |
Walrath 2001 [71] | USA | Quantitative Pre & Post | Violence | Peer training. | Medium all-male security corrections facility in Maryland, USA, housing inmates serving sentences of 3 months or longer. | Anger; Self esteem; Optimism; Locus of Control; Behaviour | Not reported | 2b |
Age range: 18 to 51 y, mean age 30 y. Average sentence 20y, ranging from less than 1 year to life. | ||||||||
USA | Mixed Qualitative & Quantitative | General health/ support | Prison hospice volunteers | Dying prisoners in 14 prison hospices in the USA | Not reported | Impact of having a hospice (& implicitly, using prisoner volunteers) on prison environment & climate. | 2c | |
Zack 2001 [21] | USA | Quantitative | HIV/AIDS and HCV (& other infectious diseases) | Peer education | Medium-security prison housing approximately 6000 men who stay at the prison for an average of less than two years. Men arriving at and leaving the prison, and women visitors. | Intentions to use condoms and be tested for HIV; Knowledge; HIV/AIDS testing; behaviour | Resistance from staff | 3b |
Institutional lockdowns | ||||||||
RCT | ||||||||
Zucker 2006 [98] | USA | Quantitative. One-group pretest - posttest. | Hepatitis C prevention | Peer education | Massachusetts county jail . 25 men who spoke and wrote in English. | Changes in self-reported behaviour, knowledge, relationship with teacher . | Not reported | 3c |
Country | Number of studies |
---|---|
USA | 20 |
UK | 20 |
Canada | 9 |
Australia | 2 |
Ireland | 1 |
Israel | 1 |
Moldova | 1 |
Russia | 1 |
Mozambique | 1 |
South Africa | 1 |
Intervention mode | Number of studies |
---|---|
Peer education | 21 |
Peer support | 14 |
Listeners | 6 |
Peer mentoring | 4 |
Prison hospice volunteers | 3 |
Peer advisors | 2 |
Health trainers | 2 |
Peer counselling | 2 |
Peer outreach | 1 |
Peer observers | 1 |
Peer training | 1 |
Health topic | Number of studies |
---|---|
HIV/AIDS/HCV/BBV prevention | 20 |
General health, hygiene | 12 |
Emotional support | 8 |
Suicide/self harm prevention | 7 |
Employment/housing post release | 4 |
Mental health/substance abuse | 2 |
Improving educational skills | 2 |
Parenting | 1 |
Violence reduction | 1 |
Type of peer intervention | Working definition |
---|---|
Peer education
| Peer education involves the teaching and communication of health information, values and behaviours between individuals who are of equal social status, or share similar characteristics, or have common experiences [103,104]. Peer education has been widely applied in the prison setting, particularly in relation to HIV prevention and risk reduction. Peer educators typically undertake formal training to equip them with the knowledge and skills to undertake the role. |
Peer support
| Peer support is the support provided and received by those who share similar attributes or types of experience. Peer support can be an informal process between individuals and/or can be provided through formalised interventions where peer supporters seek to promote health and/or build people’s resilience to different stressors [104]. There is a range of different peer support interventions reported in the prison literature. In the UK, the Listeners scheme is a specific peer support intervention focused on prevention of suicide and self-harm. |
Prison hospice volunteers
| Prison hospice volunteers provide companionship, practical assistance and social support to terminally ill patients. They may be involved in a range of activities as requested by patients including letter writing, reading, accompanying patients to religious services and other parts of prison and sometimes maintain a bedside vigil with dying patients [102]. |
Mentoring
| Mentoring describes the development of a relationship between two individuals where the mentee is able to learn from the mentor, model positive behaviour and gain experience, knowledge or skills [105,106]. Peer mentors, as defined by Finnegan et al., have a similar background or experiences to their mentee ([106]:6). There are a number of peer mentoring schemes in UK prisons focused on education and training, such as The Learning Ladder [74], and on resettlement and prevention of reoffending. |
Health trainers
| Health trainers are lay public health workers who use a client-centred approach to support individuals around health behaviour change and/or to signpost them to other services, some of which are also free at the point of delivery (Health Trainers England). Prison health trainers receive the standardised training on health promotion, healthy lifestyles and mental health, but adapted for the prison setting and client group. |
Review Question 1: What are the effects of peer-based interventions on prisoner health?
Intervention type: | |||||||
---|---|---|---|---|---|---|---|
Peer Education | Peer support | Listeners | Prison hospice volunteers | Peer mentoring | Health trainers | Other | |
Knowledge
| Two qualitative studies showed increased knowledge on a variety of topics, including: drugs, sexual health, nutrition, alcohol and mental health issues [54]. | ||||||
Statistically significantly higher proportion of correct answers to 22/ 43 questions asked in peer education vs control group. RR 0.43 (95% CI: 0.33, 0.56, 1 study n = 949) to 3.06 (95% CI: 1.91, 4.91, 1 study, n = 200). | Improvements were seen in the mean knowledge scores in all areas in one study [54], but it was not possible to ascertain whether these improvements were statistically significant. | ||||||
Knowledge scores: mean difference 0.46 (95% CI: 0.36, 0.56, 2 studies, n = 2494, I2 = 94%). | Both health trainers and Health Trainer tutors reported that Health Trainers had developed effective communication and listening skills as well as fostering attributes essential for team working and future employment after release from prison [54]. | ||||||
In the study on literacy [88], > 90% of learners agreed that their reading and communication skills had improved. | |||||||
Intentions
| In one study [37] 61% of those surveyed said they could talk to a Listener about anything that was worrying them. 74% had no problems contacting a Listener when they had requested help. | ||||||
One RCT [84] reported improvements in: interest in taking HIV test for the first time (RR 1.49, 95% CI: 1.12, 1.97); | 57% of users thought they would seek the help of a Listener if they faced a similar problem in the future. | ||||||
interest in taking HIV test now (RR 1.82, 95% CI: 1.33, 2.49); condom use intention (RR 1.15, 95% C I: 1.08, 1.22); | |||||||
intention to never use condoms (RR 0.59, 95% CI: 0.48, 0.72). | |||||||
No improvement in intention to use bleach with drug injecting equipment (RR 1.06, 95% CI: 0.97, 1.16). | |||||||
No improvement [67] in intention to take a HIV test (RR 1.24, 95 CI: 0.75, 2.05) and a negative effect on peer educators’ intentions (RR 0.62, 95% CI: 0.41, 0.95). | |||||||
A study in South Africa [69] did not show any evidence of a commitment to change their behaviours, X2(10, N = 69) = 10.934, p = .36. | |||||||
Attitudes/ Beliefs
| One study [91] showed that a drug treatment intervention that included the support of trained prison counsellors caused changes in prisoners’ reported attitudes to drugs and alcohol. This translated to a self-reported reduction in drug and alcohol use. The one-to-one sessions with trained peer counsellors was regarded as the most “helpful aspect” of the recovery process. | ||||||
In one study [54], more than 50% of health trainers stated that their attitude had changed in the areas of: healthy eating/ diet; sexual health issues; smoking cessation; exercise; mental health issues. 75% of HTs stated that they would like to get a job as a HT when they are released from prison | |||||||
“HIV positive inmates should be separated” (RR 2.55, 95% CI: 1.94, 3.33); | |||||||
“I feel safe in the same wing as an inmate who is HIV positive” (RR 0.74, 95% CI: 0.68, 0.84); | |||||||
“I know enough to protect myself from catching HIV/AIDS” (RR 0.54, 95% C: 0.50, 0.59). | |||||||
Behaviour
| In one study [92], 64% of 22 prisoners claimed that friends and family had noticed a difference in their demeanour, finding them more relaxed, responsible, optimistic, able to speak more and more able to listen. 73% agreed that their new responsibilities would allow them to ‘adjust better’ on release, and 55% agreed that the ‘prison authorities’ appreciated their work. 77% said there was a difference in how immediate staff interacted with them: being trusted more, staff talking more to them, staff being grateful for the work they do. 86% said that fellow prisoners behaved differently towards them. | In one study [83] At 3 months, 38/44 participants (86%) were receiving outpatient psychiatric services and 40/44 (91%) successfully managing their medications. | Peer training: One study [71] reported a statistically significantly reduced rate of confrontation post-intervention at 0.432 (CI: 0.319, 0.583, p < 0.0005). | ||||
Positive effects seen: | At 6 months, 36/44 participants (82%) were medication compliant, and 35/44 (80%) demonstrated symptom reduction. 12/44 (27%) had not maintained sobriety at 6 month time point. 17/22 (77%) participants released for at least 12 months had not been rearrested. 16/22 participants who had been released for at least 12 months (73%) were abstinent in use of alcohol or illegal drugs or misuse of prescription drugs. | ||||||
Not using a condom at first intercourse after release from prison (RR 0.73, 95% CI: 0.61, 0.88, 2 studies, n = 400); | |||||||
injecting drugs after release from prison (RR 0.66, 95% CI: 0.53, 0.82, 2 studies, n = 400); | |||||||
injected in past 4 weeks (RR 0.11, 95% CI: 0.01, 0.85, 1 study, n = 241); | |||||||
sharing injection equipment after release from prison (RR 0.33, 95% CI: 0.20, 0.54, 2 studies, n = 400); | |||||||
peer educators never having had an HIV test (RR 0.31, 95% CI: 0.12, 0.78, 1 study, n = 847). | |||||||
In one Russian study [27] the prevalence of tattooing in prison significantly decreased (42% vs 19%, p = 0.03) and of those who were tattooed the proportion using a new needle increased from 23% to 50%. | |||||||
HIV tests in prison [87] was associated with having attended a HIV prevention programme in prison (OR = 2.81, 95% CI: 1.09, 7.24). | |||||||
Chlamydia screening in the under-25 s rose from 13 to 83 in a 6 month period after beginning a peer education intervention, similarly hepatitis C screening increased from 9 to 46, and numbers were also increased for HIV screening and hepatitis B vaccinations [89]. | |||||||
In a study on parenting skills [90] statistically significant improvements in self-reported father/ child contact were seen (mean difference 41.3, 95% CI: 6.47, 76.13). | |||||||
Confidence
| One study [69] reported no significant differences. | Volunteers experience increases in self-esteem and self-worth as a result of the service they provide to others [72,102]. Evidence also suggests prisoners gain an enhanced sense of compassion for other people [72,102] and being prison hospice volunteers allows individuals ‘to give something back’ [77]. | Health trainers seemed most confident in signposting to exercise, smoking cessation and drugs services and least confident in signposting to self-harm, immunisation and dental services [54]. | Peer training: One study [71] reported s mall but statistically significant negative effects of the intervention on self- esteem (MD −2.15, 95% CI: −4.20, −0.10), measured with the Rosenberg self-esteem scale, and optimism (MD 1.30, 95% CI: −0.83, 3.43), measured with the life orientation text. | |||
Qualitative evidence suggested improvements in the peer deliverers’ self-esteem, self-worth and confidence as a result of the role [53,58,79-81,96].The sense of being trusted by the prison authorities to counsel and support prisoners in distress was reported to enable peer deliverers to regain their self-respect [23,79].The notion that peers became more empowered consequentially was alluded to [58,79,80,95,96]. | Qualitative research [54] found that training as a health trainer had been a huge boost to prisoners’ confidence, self-esteem and self-worth, reported by key staff. There was also evidence of health trainers bolstering other prisoners’ reported self-esteem and confidence through listening and supporting individuals [54]. | Peer outreach: Qualitative evidence suggested that peer volunteers felt that their role was worthwhile and that they were making a difference to the health of the prison population [85]. | |||||
Peer advisers: Two studies reported increased self-esteem and self-confidence, coupled with peer deliverers reporting that they were building a work ethic and a sense of control over their lives [57,59]. The role was perceived by the volunteers to be worthwhile and purposeful as well as enabling social interaction with others and offering ‘structure’ to the prison day [57] | |||||||
Mental health
| No effect on anger or frustration in the parenting skills study [92], either immediately post-intervention (MD 0.20, 95% CI: −1.42, 1.82) or at longer follow-up (MD 1.40, −0.03, 2.83). | Peer support was reported to have helped prisoners either practically, emotionally, or both [58] and in one study it was demonstrated that this type of intervention could be particularly beneficial for prisoners during the early part of their sentence [62]. Those who had used peer support reported using it as an avenue to vent and to overcome feelings of anxiety, loneliness, depression and self-injury [58,79,96] and there were indications that this may be potentially beneficial in preventing suicides in prison [53]. | Three studies [32,36,56] reported an impact in reducing depression and anxiety in distressed prisoners and improving their mental state. There is anecdotal evidence that suicide and self-harm is reduced as a result of the support offered by peers acting in this role. A fourth study [37] found 44% of users of the Listener scheme reported that they always felt better after confiding in a Listener, while 52% felt better at least 'sometimes'. 84% said they had always found the experience helpful. | In one study, prison volunteers described life enrichment, growth, and coming to terms with their own mortality as a result of their involvement [64]. Moreover, the recipients of one of the programmes suggested how the volunteers had supported them and enabled them to overcome states of depression [64]. | Peer training: One study [71] found no statistically significant effect of the intervention on anger (mean difference −4.01, 95% CI: −9.40, 1.38), measured with the anger expression scale. | ||
Four studies [32,56,61,92] related the emotional burden of listening to other prisoners’ problems and issues. Discussions relating to suicidal intentions and other distressing topics could be particularly burdensome for peer deliverers to manage. There were also reports of peer deliverers experiencing ‘burnout’ and mental exhaustion as a result of the demands placed on their time by other prisoners [56,92] | Peer support and counseling: One study [29] looked at the effects of peer support (Narcotics Anonymous meetings) and counselling (12 step programme), compared to peer support alone (NA meetings only) on mental health, namely coherence, meaning in life, anxiety, depression and hostility. Improvements with the combined interventions were seen in all outcomes: coherence (mean difference −0.31, 95% CI: −0.48, −0.14), meaning in life (MD −0.42, 95% CI: −0.65, −0.19), anxiety (MD −0.42, 95% CI: −0.66, −0.18 ), depression (MD −0.35, 95% CI: −0.52, −0.18 ), hostility (MD −0.11, 95% CI: −0.18, −0.04). | ||||||
Preference
| In an American HIV RCT [84], 68% preferred to be taught by an inmate with HIV versus 11% who preferred a HIV/ AIDS educator. | ||||||
Additional themes
| Qualitative evidence suggested that peer deliverers found the experience personally rewarding, giving their time in prison meaning and purpose [55,68]. In one study, this included improved listening and communication skills as a result of their participation [90]. Other [55research suggested that being a peer educator also enabled the difficulties of prison life to be off-set through the supportive network of other trained peer educators. | 16/22 (73%) participants released for at least 12 months were employed, enrolled in an educational program or had completed the application process for disability benefits. | Prisoner outcomes: Issues most likely to be discussed with health trainers were reported in one study [54] to be exercise, weight and healthy eating. | Peer observers: One controlled study [86] found a statistically significant decrease (t(71.55) = 2.14, p = 0.036) in the mean number of hours on watch following the implementation of the Inmate Observer Programme. | |||
18/22 (82%) participants who had been released for at least 12 months had secured treatment, transitional housing or a permanent place to live. | Onward referrals: Health trainers in one study [54] were most likely to refer clients to gym staff or healthcare staff. Referrals were also made to Counselling, Assessment, Referral, Advice, and Throughcare services (CARATS), counsellor, dentist and optician. | ||||||
Staff reported that PST members were effective in handling crisis interventions, providing services to inmates and serving as role models. | |||||||
In one study [81] PST members estimated that they provided support to others of 3–5 hours per week on average. | |||||||
In several studies [23,58,79,80,96], there was indication of peer deliverers gaining better self-awareness and perspective on their life as well developing the skills to deal with their own health and offending issues. There was limited information on the impact that the role would have on future re-offending. Only in one study [23] was it suggested that the experiences of being a peer support worker would be beneficial in reducing the likelihood of re-offending. | |||||||
The demands placed on peer support worker/counsellors by other prisoners gave individuals a sense of purpose in prison [23,53,94] and this was beneficial for combatting boredom while serving the prison sentence [23,53].However, there were indications that the role could be challenging and onerous and the burden of care of supporting many prisoners could be problematic [53]. |