Prisoners’ experience and perceptions of health care in Australian prisons: a qualitative study

Abstract

Purpose Patient-centred care is a key approach used in Australia for the delivery of quality health care, and understanding experiences and perceptions is a key part to this. This paper aims to explore prisoners’ experiences and perceptions of health-care service provision in New South Wales, Australia. Design/methodology/approach In February and March 2017, 24 focus groups, consisting of 128 participants, were undertaken using semi-structured interviews that explored experiences of health care in prison. Findings A conceptualisation of the prisoners’ health-care experience around the core category of access to health care emerged from the data. Enablers or barriers to this access were driven by three categories: a prison construct – how the prisoners “see” the prison system influencing access to health care; a health-care system construct – how the prisoners “see” the prison health-care system and the pathways to navigate it; and personal factors. Communication was the category with the greatest number of relational connections. Research limitations/implications This study takes a pragmatic approach to the analysis of data, the findings forming the basis for a future quantitative study. The findings identify communication as a key issue for access to health care. Originality/value This study provides first-hand accounts of enablers and barriers to accessing health-care services in the prison environment. To the best of the authors’ knowledge, this study is the first of its kind to identify access to health care as a core category and is of value to health workers and researchers that work with the prison population.

Prisoners' perceptions of the healthcare service: A qualitative study

“…The staff have greater power in decision-making than the prisoners. This is the same as the findings in the New South Wales, Australia study (Capon et al, 2020). Therefore, telehealth is urgently needed at the studied prison because telehealth provides a format where the prisoners can meet with specialists and ask health questions directly without being under the control of the prison staff, which is their right under Thai law.…”

COVID-19 and incarcerated older adults: a commentary on risk, care and early release in Australia

“…There is international evidence that prisoners who perceive themselves to be ill or need medical attention avoid seeking health care for a number of reasons. Some of these barriers relate specifically to the incarcerated person and their relationship with the health staff, such as trust, previous negative experiences, knowledge of available health services and the person's health literacy, while others refer more to policy and practice issues, such as poor quality health care, extended wait times and gatekeeping by staff (Ahmed et al, 2016;Bowen et al, 2009;Capon et al, 2020;Feron et al, 2008;Sullivan et al, 2016).…”

“…One small study from an English and Welsh prison estate focused specifically on older male prisoners' (N = 27) experiences of accessing medication on entry to prison, and reported generally negative experiences, with key themes being: "delays in confirming medicines; changes to medication; communication difficulties; and enforced helplessness" (Sullivan et al, 2016). A recent qualitative investigation was conducted across 12 prisons in NSW to explore incarcerated persons' experiences and opinions regarding health care (Capon et al, 2020). A complex network was identified which, like extant studies, spanned individual prisoner factors and health-care systems issues.…”

Exploring the challenges to safer prescribing and medication monitoring in prisons: A qualitative study with health care staff

“…The need to focus on the quality of care provided to prisoners has been emphasised in recent years in the United Kingdom (UK) following high levels of self-harm, suicide rates, substance abuse, violence and deaths in custody or shortly after release [ 12 ]. Overcrowding [ 13 ], diversion of prescribed medication for illicit use, inappropriate polypharmacy (where multiple medications are prescribed and not optimised) [ 14 ], inadequate staff levels [ 15 ], reduced access to healthcare [ 9 ] and organisational culture [ 16 ] have been identified as challenges to the quality of care. Much of the harm resulting from adverse events (an unwanted/unintended health care event which may arise due to medication error, poor safety culture, poor transfer of information or inadequate staff training) in prison is thought to be preventable [ 17 ].…”

“…Research from China and the US [1], indicates that prisoners typically experience greater morbidity and health needs than the general population [2] including a higher prevalence of mental health problems, infectious diseases including COVID-19, and other long term conditions [3][4][5][6]. Despite these needs, studies in Europe, the US, UK, Australia and Canada suggest prisoners may suffer health inequalities such as reduced access to, and suboptimal treatment for mental health support, psycho-social interventions and over the counter medicines [7][8][9][10]. The prison population has been documented as having higher levels of socio-economic deprivation; in particular poorer levels of education, more likely to have been in foster care and more likely to have a history of substance misuse [11].…”