Factors that determine the effectiveness of peer interventions in prisons in England and Wales

Epidemiological assessment of the prison population globally shows undeniable health need, with research evidence consistently demonstrating that the prevalence of ill health is higher than rates reported in the wider community. Since a meeting convened by the World Health Organisation in the mid-1990s, prisons have been regarded as legitimate settings for health promotion and a myriad of interventions have been adopted to address prisoners’ health and social need. Peer-based approaches have been a common health intervention used within the prison system, but despite their popularity little evidence exists on the approach. This paper presents findings from an expert symposium – part of a wider study which included a systematic review – designed to gather expert opinion on whether and how peer–based approaches work within prisons and if they can contribute to improving the health of prisoners. Experts were selected from various fields including the prison service, academic research and third sector organisations. Expert evidence suggested that the magnitude of success of peer interventions in prison settings is contingent on understanding the contextual environment and a recognition that peer interventions are co-constructed with prison staff at all levels of the organisation. Implications for developing peer-based interventions in prison are given which assist in developing the concept, theory and practice of the health promoting prison