Background
Methods
Study context
Study rationale
Study phases
Phase one: Document analysis and naturalistic observation
Phase two: In-depth individual and focus group interviews
Description | # of people |
---|---|
In-Depth Individual Interviews | |
Stakeholdersa: ᅟ• Corrections system (n = 16); included 6 dietitians who work (current or previous) in corrections ᅟ• Reintegration (n = 13) | 29 |
Individuals with lived experience of incarceration | 11 |
Partners of individuals with lived experience of incarceration | 7 |
In-Depth Focus Group Interviews | |
Three focus groups that included: ᅟ• Individuals with lived experience of incarceration (n = 2) ᅟ• Partners of individuals with lived experience of incarceration (n = 3) ᅟ• Stakeholdersa (n = 11) within the corrections system (n = 3) and involved in societal reintegration (n = 8) | 16 |
Use of secondary data
Analysis
Scoping review
Thematic analysis
Results
Scoping review
Description of corrections-based health and nutrition Services in Canada
Results of scoping review
Thematic analysis of naturalistic observation and interview textual data
“As far as food..for many it’s all they got.” (Stakeholder Incarceration; SI#1).
“..food was a big deal. So to change things like taking pizza off the menu … could lead to riots. So you had to be really careful with some of the choices you made around the menu.” (Dietitian#6; RD#6)
“It is a challenging job … it’s a really difficult population to work with..I remember running into one inmate who had been in segregation for a really long time..he couldn’t remember how to follow recipes, he couldn’t remember how to cook foods anymore..and I had just started working..and I was like don’t worry all you have to do is Google simple recipes … he looked at me like I had no idea what I was talking about..Google..what? … ” (RD#1)
“Unfortunately these young ones that get in learn the hard way sometimes … It is not a job for the light hearted.” (RD#3)
“..it’s an interesting and unique clientele – I found it challenging and I loved it. In university there is a lot of discussion about disease states but not a lot of discussion about the different environments and how to deal with them and manage things.” (RD#6)
“The only time prisoners don’t eat in prison is due to segregation or if we have lock down … This year we’ve had three so far. (reference is to number of lock downs up to February)” (Stakeholder incarceration #16; SInc#16)
“It [the posting] has the duty for five years … they had a really hard time getting somebody long term … like for me personally … it’s kind of like I can’t do this job for that long if I don’t have some kind of outlet … ” (RD#1)
“ … you need to do a lot of self-directed stuff to work your way through it all … But really as far as keeping yourself up to date and really learning about the prison system we tend to look to the Americans … like the Correctional Foodservice and Nutrition Manual.” (RD#3)
In conjunction with overall health service access issues, delays in access to MNT occurred due to factors such as clinic space constraints. Although on-site health clinics are available, appointments for nutrition counseling, even if requested by an incarcerated person, required a referral by a nurse or physician. Furthermore, if on a given day there was a surplus of health providers in the clinic, MNT would be cancelled in order to provide space.“Access to health care is limited as it took a while before [incarcerated family member] was able to see the physician.” (Family Member #1; FM1)
1. Access | |
System gate keeping | • Medical model system used for access to MNT (e.g., requirement for referrals) • Service delays due to clinic cancellations • Attempts to fill MNT voids by other health professionals |
2. Visibility | |
Lack of awareness about services | • Limited awareness of MNT by staff and incarcerated individuals |
Misconceptions about services | • Tendency to view MNT as being about menu development |
3. Adequacy | |
Limited work time | • Low dietitian to incarcerated individuals ratio (e.g., one full-time equivalent dietitian to 2150 incarcerated individuals) • Services dispersed over many facilities with varying geographical proximities and diverse populations • Resource constraints (e.g., clinic space availability) creating delays in service |
Skills development and utilization | • Post-secondary and entry-level nutrition training does not include correctional facilities • Limited therapeutic standards specific to incarcerated individuals (e.g., nutrition risk screening, assessment) • Underutilization of clinical nutrition skills |
4. Environmental Barriers | |
Food availability | • Options available to incarcerated individual vary by facility |
“… we had just one female prison and I only went there once in the whole time [7 years].” (RD#2).
“You’re telling me there is someone who looks after diet stuff? I never saw or heard anything about this..” (Incarcerated Individual; from Field Notes Document #10; FN#10).
“There’s a doctor who comes. Sometimes physio. There is a nurse that works every day – does the meds. For other services like dietitian, orthotics, specialists they may need to go out.” (SInc8)
“It was hard to get anything really accomplished beyond 3 meals a day.” (RD#2)
“$35/week from CSC..allocated for food and beverages … and are not allowed to add more to it … can purchase [food] from the canteen from..own savings. [The Individual] had limited food skills..didn’t know a lot about how to prepare foods..wasn’t given any food skills training … .” (Family member: FM#1)
“It’s almost like they [inmates] see me as a service inside the institution only … when they get close to being released and getting out it’s like they don’t want to talk about diet anymore … They are more like ‘I am getting out of here, I will lose weight when I get out. I will control my blood sugar when I get out, everything will be fine when I get out’.” (RD#1)
Discussion
MNT systems strengthening
“ … I could leave notes for the physician, but they weren’t often in the institutions long … it was a different physician in different institutions … I would communicate through the health care chief.” (RD#2)
“..for example, in a grocery store where they place bags of chips how prominently they display it … how large of the percentage of the store is dedicated to certain types of foods … the cost of food … those choices as far as environment have impact both on habits … It’s the same in the prison system.. what’s available in the vending machines.. what’s available in the cafeteria..have long term impacts ..a second sort of factor is..motivation. We have certain motives for our food choices and I don’t think those motivations are in isolation … some people may make food choices based on their.. health goals – long range and short range – as well as what choices their friends and social peers are making and some of their ideology and beliefs … the environment that we create in the prison or outside the prison or the social circles and networks that are made are going to have major effects on the choices that are made.” (SInt#16)
“That is an excellent question, and I don’t know. Some of them have always had weight issues, and they have continued to have weight issues, a lot of them didn’t and then gained a lot of weight in the institution, but this is just based on my observations. I don’t have info on that..” (RD#1)
“I also think that what is interesting is the needs of men and women are very different and the way they are managed. For women many have children they are getting back to and that is a goal.” (RD#8)
Increasing sustainability of MNT
“There were like regular menus … other than that specific direction would have to be given for each individual [therapeutic] diet.” (RD#2)
“ … It was about managing the present situation and side effects and stuff like that … I might help with budgeting and helping them select foods from the stores … we didn’t really talk a lot about skills..” (RD#6)
“ … We were getting to the point where they were wanting to learn about bread making, and whole wheat pita … ”
“ … that’s why we do peer support. Because we are people that have gotten out and we are trying to teach them about getting out. And things that we have found that are going to being successful on getting out..” (SI#26 from focus group data)
“Any time we had an immigrant woman released from jail … They often taught the others [about cooking] and that worked out really well … ” (SI#31 from focus group data)
“Something should happen before release. It’s almost like a program you start three months before release that teaches life skills … How to grocery shop..How to cook..I think it’s hard when they are released they may have a place to go to but they don’t have money to get pots and pans … If you have acceptable housing I think there is potential to get some skills building after release … ” (RD#6)
“I think as dietitians these are not environments we are use to and I think it should be part of what we should learn.”(RD#6)