A systematic review of the effectiveness and cost-effectiveness of peer education and peer support in prisons

Abstract

BackgroundPrisoners experience significantly worse health than the general population. This review examines the effectiveness and cost-effectiveness of peer interventions in prison settings.MethodsA 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:Population: Prisoners resident in adult prisons and children resident in Young Offender Institutions (YOIs).Intervention: Peer-based interventions.Comparators: Review questions 3 and 4 compared peer and professionally led approaches.Outcomes: Prisoner health or determinants of health; organisational/process outcomes; views of prison populations.Study designs: Quantitative, qualitative and mixed method evaluations.ResultsFifty-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.ConclusionsThere 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.Systematic review registrationPROSPERO ref: CRD42012002349.

Promoting health and well-being in prisons: an analysis of one year’s prison inspection reports

“…Peer support processes continue to be a popular intervention within the prison setting, and recent evidence derived from a systematic review has demonstrated the value of this in relation to a spectrum of health and social issues (Bagnall et al, 2015). Our analysis suggested that only 41% of prisoners were utilising peer support approaches for health and well-being.…”

“Imagine if I'm not here, what they're going to do?”—Health‐care access and culturally and linguistically diverse women in prison

“…It is apparent that peer interpreters in prison may take on informal roles that are in keeping with peer support workers. Prison peer support programmes are an emerging approach to bridge health service gaps; the research suggests benefits exist, but evidence is generally limited . These programmes utilize prisoners who are formally trained and employed in either paid or unpaid roles and include peer support and health education activities .…”

“…Prison peer support programmes are an emerging approach to bridge health service gaps; the research suggests benefits exist, but evidence is generally limited . These programmes utilize prisoners who are formally trained and employed in either paid or unpaid roles and include peer support and health education activities . They have the potential to reduce barriers to health care and empower CALD women through advocacy and support, while promoting cohesion within the prison community and supporting its rehabilitative function .…”

“…Benefits for the peer support workers in prisons include positive personal growth, satisfaction and improved physical and emotional health; however, benefits are less well defined for recipients of the support . It should be noted that the trust and power inherent in peer support worker roles in prison may incur additional security risks, such as distribution of contraband by the peer support worker . Further research is needed.…”

Peer social support training in UK prisons

“…It is known that a wide range of peer support schemes and interventions are undertaken in UK prison settings (Fletcher and Batty, 2012, South et al, 2014, Bagnall et al, 2015 Majesty's Inspectorate of Prisons HMIP, 2016), and that specific prisoner support roles are carried out in a range of informal and formal ways, (Stewart, 2011, Loeb, 2013. It is known that schemes focusing on developing prisoner peer workers are well developed in the United States of America (USA), particularly in relation to the escalating cost of caring for prisoners with dementia (Belluck, 2012) and prisoners nearing the end of their life (Stone et al, 2011).…”