Partnering to Address Health Inequities among Incarcerated Populations: Prisons, Jails, and COVID-19 Vaccination.

BACKGROUND: Incarcerated people have been disproportionately affected by the COVID-19 pandemic and face significant challenges to COVID-19 vaccine confidence. OBJECTIVES: (1) Describe our partnerships with community members directly impacted by incarceration, (2) discuss the partnership's process for co-developing and implementing project interventions to increase COVID-19 vaccine confidence, and (3) share lessons learned from this unique community-engaged partnership. METHODS: An advisory board of 14 formerly incarcerated community members participated in this project. Their wisdom and experience led to the development and implementation of interventions to increase confidence in COVID-19 vaccines among incarcerated people. LESSONS LEARNED: Valuable lessons learned were centering community, leaning into trusted sources of information, acknowledging historical and present harms, and investing in community-engaged work. CONCLUSIONS: Centering lived experiences of those directly impacted by incarceration has been crucial to increasing vaccine confidence among this population. Doing so reinforced the importance of long-term investments in community-based collaborations with communities impacted by incarceration.

A model of care for Aboriginal and Torres Strait Islander prisoner health and wellbeing in South Australia.

PURPOSE: Aboriginal and Torres Strait Islander (Aboriginal) people are overrepresented in Australian prisons, where they experience complex health needs. A model of care was designed to respond to the broad needs of the Aboriginal prisoner population within the nine adult prisons across South Australia. The purpose of this paper is to describe the methods and findings of the Model of Care for Aboriginal and Torres Strait Islander Prisoner Health and Wellbeing for South Australia. DESIGN/METHODOLOGY/APPROACH: The project used a qualitative mixed-method approach, including a rapid review of relevant literature, stakeholder consultations and key stakeholder workshop. The project was overseen by a Stakeholder Reference Group, which met monthly to ensure that the specific needs of project partners, stakeholders and Aboriginal communities were appropriately incorporated into the planning and management of the project and to facilitate access to relevant information and key informants. FINDINGS: The model of care for Aboriginal prisoner health and wellbeing is designed to be holistic, person-centred and underpinned by the provision of culturally appropriate care. It recognises that Aboriginal prisoners are members of communities both inside and outside of prison. It notes the unique needs of remanded and sentenced prisoners and differing needs by gender. SOCIAL IMPLICATIONS: Supporting the health and wellbeing of Indigenous prison populations can improve health outcomes, community health and reduce recidivism. ORIGINALITY/VALUE: Only one other model of care for Aboriginal prisoner health exists in Australia, an Aboriginal Community Controlled Health Organisation-initiated in-reach model of care in one prison in one jurisdiction. The South Australian model of care presents principles that are applicable across all jurisdictions and provides a framework that could be adapted to support Indigenous peoples in diverse prison settings.

Mental Health, Drug Use, and Programming: Applying a Needs Assessment Framework in Arkansas' Largest Jail.

Jail programming is rarely informed by site-specific health needs, diagnostic-specific screening tools that are validated, or the input of incarcerated individuals. Using the community needs assessment (CNA) framework, we aimed to fill these gaps among people incarcerated in the Pulaski County Regional Detention Facility (PCRDF), Arkansas' largest jail. Participants were 179 adults at the PCRDF who completed surveys and open-ended questions focused on (a) their mental and behavioral health and (b) programming needs at the facility. Using a concurrent transformative mixed-methods design, we descriptively analyzed surveys and conducted content analysis of the open-ended questions. Over half of participants reported clinically significant anxiety (62.6%), post-traumatic stress disorder (53.1%), and/or depression (50.3%) symptoms; positive substance use disorder screening was especially common (91.7%). Nearly all (97%) individuals queried desired more programming, with the most desired being mental health and substance use programs. Other desired programs included physical health, education, community reintegration, family support, recreation, nutrition, religious/spiritual services, and meditation. Our CNA ensured the input of those directly impacted during program-focused decision making and identified strategies to effectively implement and sustain jail-based programs. Such assessments can be a potential mechanism for addressing the burden of mental and behavioral health problems in jail populations.

Mitigating COVID-19 Burden in People Experiencing Incarceration: A Systematic Review.

People experiencing incarceration (PEI) have poorer COVID-19 clinical outcomes compared with the general population. Many interventions were implemented in incarceration facilities to mitigate the burden of COVID-19. This systematic review seeks to analyze the effectiveness of these interventions. Twenty-two studies were included. Reduction of the incarcerated population/interfacility transfers, cohorting of new and infectious incarcerated people, mass asymptomatic testing (despite often low uptake), hygiene measures, and prioritization of PEI in vaccine policy had some evidence of effectiveness at reducing transmission and risk of COVID-19 in incarceration facilities. Visitation suspension had conflicting evidence of effectiveness. Studies were of low or medium quality. Inadequate control of confounding variables limited the reliability and validity of conclusions drawn. Many studies relied on retrospective, third-party data. Higher quality research is required.

Supporting Older, Frail, and Vulnerable Adult Prisoners Through Peer Care: Observations, Reflections, and Recommendations Based on a UK/U.S. Researcher Exchange Visit.

This article describes key findings from a UK/U.S. prison health researcher exchange in September 2023. The aims were to increase familiarity with the research context and to observe the roles of peer caregivers in U.S. prison settings. The researchers identified several differences and similarities in peer caregiving between UK and U.S. sites and detail six recommendations related to policy and practice concerning both sides of the Atlantic. It is believed that the adoption of such recommendations will contribute to improved care and, thereby, the health and well-being of vulnerable people incarcerated in prison.

Using Linkage-enhancement Strategies to Bridge Treatment Gap among Inmates and Former Inmates in Correctional Settings with Inadequate Mental Health Care.

Service linkage and skill enhancement strategies were devised in Nigerian prisons with inadequate mental health resources to support the provision of psycho-legal services, including the assessments, identification, and care of inmates and former inmates with mental illness. Over the study period, 74 individuals, consisting of 64 (86.5%) males with a mean age of 33.25 (SD=11.2) years received care or psycho-legal services through these strategies. Clinically, 49% of the participants were diagnosed with schizophrenia (International Classification of Diseases, Tenth Revision (ICD-10) diagnosis code: F20.0-9), 66.7% had first formal clinical diagnosis of mental illness, and as many as 56.1% of the participants endorsed using psychoactive substances. Most participants (73.0%) were assessed and treated within the prison's general medical services with support from a multidisciplinary team from a regional psychiatric hospital. Of the 50 psycho-legal assessments conducted, eight (10.8%) and 12 (16.2%) participants were not criminally responsible and unfit to stand trial, respectively. We included an action-plan to support the implementation of collaborative care, skill-enhancement, and linkage of services as viable strategies in correctional settings with inadequate mental health care.

Programa de vacunación en prisiones: impacto del virus SARS-CoV-2 y retos de futuro / Prison vaccination programmes: the impact of the SARS-CoV-2 virus and future challenges

La vacunación ha sido tradicionalmente una de las actividades de prevención primaria a la que mayor esfuerzo se ha dedicado en las instituciones penitenciarias españolas. Una vez más, la pandemia de coronavirus de tipo 2 causante del síndrome respiratorio agudo severo (SARS-CoV-2) ha puesto de manifiesto la importancia de la vacunación en el control de las enfermedades inmunoprevenibles. Tras superar la emergencia sanitaria provocada por la enfermedad del coronavirus de 2019 (COVID-19), tenemos por delante el reto de recuperar las coberturas vacunales que teníamos antes de la pandemia, además de aumentar las de otras vacunas con menor implantación en nuestro medio. Entre las estrategias de mejora que se deben implementar, estaría la optimización de la transmisión de la información sanitaria entre centros penitenciarios dependientes de diferentes administraciones. También sería deseable poder acceder a los sistemas de información sobre vacunas de las diferentes comunidades autónomas, tanto para conocer el estado vacunal de los pacientes como para notificar las dosis administradas durante el periodo de internamiento, así como mejorar las estadísticas vacunales disponibles en prisión.(AU)

Vaccination has traditionally been one of the primary prevention activities to which most effort has been devoted in Spanish penitentiary institutions. Once again, the type 2 coronavirus pandemic causing severe acute respiratory syndrome (SARS-CoV-2) pandemic has highlighted the importance of vaccination in the control of immunopreventable diseases.After overcoming the health emergency caused by the coronavirus disease 2019 (COVID-19), we face the challenge of recovering the vaccination coverage we had before the pandemic, in addition to increasing the coverage of other vaccines with lesser implantation in our environment. Among the improvement strategies to be implemented would be the optimization of the transmission of health information between penitentiary centers dependent on different administrations. It would also be desirable to be able to access the vaccine information systems of the different autonomous communities, both to know the vaccination status of patients and to report the doses administered during the period of internment, as well as to improve the vaccine statistics available in prison.(AU)

Barriers and advocacy needs for hepatitis C services in prisons: Informing the prisons hepatitis C advocacy toolkit.

BACKGROUND: Carceral settings are a key focus of the 2030 WHO global hepatitis C virus (HCV) elimination goals. Despite this, access to HCV testing and treatment services in prisons remains low globally, limiting opportunities to achieve these goals. Advocacy efforts are needed to address service inequities and mobilise support for enhanced HCV programs in prisons globally. INHSU Prisons, a special interest group of the International Network on Health and Hepatitis in Substance Users (INHSU) is developing a Prisons HCV Advocacy Toolkit to address this need. Here we present findings of a mixed study to inform the development of the Toolkit. METHODS: The aim of this study was to inform the development of the Toolkit, including understanding barriers for scaling up prison-based HCV services globally and advocacy needs to address these. An online survey (n = 181) and in-depth interviews (n = 25) were conducted with key stakeholders from countries of different economic status globally. Quantitative data were statistically analysed using R Studio and qualitative data were analysed thematically. The data sets were merged using a convergent design. RESULTS: Key barriers for enhanced prison-based HCV services included lack of political will and action, lack of prison-based healthcare resources, and poor awareness about HCV and the importance of prison-based HCV services. These findings underscore how advocacy efforts are needed to motivate policymakers to prioritise HCV healthcare in prisons and ensure funds are available for services (including diagnostic tools and treatment, healthcare teams to implement services, and systems to measure their success). Advocacy resources to raise the awareness of policy makers, people working in the prison sector, and incarcerated populations were also identified as key to increasing HCV service uptake. CONCLUSION: The Toolkit has the potential to support advocacy efforts for reaching HCV elimination targets. By understanding the advocacy needs of potential Toolkit end-users, the findings can inform its development and increase its accessibility, acceptability, and uptake for a globally diverse audience.

A Survey of State Correctional Health Care Providers on Advance Care Planning: Opportunity for Collaboration With Corrections.

Prison populations are rapidly aging. Persons in prison age quicker and suffer more chronic illness and disability than their nonincarcerated peers, posing challenges to caring for prisoners who are chronically ill and dying. The goal of our study was to describe state prisons' practices and policies addressing persons in prison with advanced chronic and life limiting illness through a national web-based survey of state-level prison health care professionals. In particular, we focused on advanced care planning, use of health care directives, decision-making about goals of care, including life sustaining treatments, The response rate was 22% for a sample size 152 completed surveys. The average age of respondent was 52 years; majority were female and Caucasian, and had worked in corrections more than 8 years. Nearly half were registered nurses. Most reported their prison did not have a dedicated end-of-life care program and only 11% offered a peer-care program. However, two-thirds indicated their facility provided the opportunity to designate a health care agent with physicians most likely responsible for facilitating completion of a health care directive. It is evident the care of persons aging and dying in prison is complex and requires further investigation addressing staff and prison population education, ethics guidelines for care, compassionate release, and advance care planning. This study suggests that hospice and palliative care professionals could collaborate with corrections professionals and national organizations to provide innovative education and support to enhance the humane care of this vulnerable population.

Enfermeiros no atendimento de urgência em presídios: explorando razões do chamado e local da assistência / Enfermeras en atención de urgencia en cárceles: explorando razones de la llamada y local de la asistencia / Nurses in urgent care in prisons: exploring reasons for the call and place of assistance

RESUMO Objetivo: analisar as percepções dos enfermeiros do Serviço de Atendimento Móvel de Urgência (SAMU) em atendimentos realizados em penitenciárias perante as razões das demandas e o local da assistência. Método: trata-se de um estudo exploratório e descritivo de abordagem qualitativa. Realizaram-se entrevistas nos meses de agosto a dezembro de 2017, individuais e audiogravadas, seguindo roteiro semiestruturado com 91 enfermeiros que atuavam no SAMU de cidades do estado da Paraíba, Brasil. Aplicou-se o referencial metodológico da Análise de Conteúdo proposta por Bardin para categorização dos dados obtidos. Resultados: das análises das falas dos participantes emergiu a presença de dificuldades como demandas não pertinentes ao serviço, local inadequado para assistência, falta de privacidade durante os atendimentos e de escolta para transporte quando necessário. Considerações finais: os problemas relatados evidenciam a necessidade do estabelecimento de estratégias para melhorar as condições da assistência potencializando a capacidade de resolutividade do serviço e para problemas que não podem ser resolvidos em uma única visita de profissionais do SAMU no ambiente prisional, que seja garantido a continuidade da assistência em outros serviços articulados a ele e para isso são necessários fortes laços intersetoriais.

RESUMEN Objetivo: analizar las percepciones de los enfermeros del Servicio de Atención Móvil de Urgencia (SAMU) en atenciones realizadas en prisiones ante las razones de las demandas y el lugar de la asistencia. Método: se trata de un estudio exploratorio y descriptivo de enfoque cualitativo. Se realizaron entrevistas en los meses de agosto a diciembre de 2017, individuales y audiograbadas, siguiendo guion semiestructurado con 91 enfermeros que actuaban en el SAMU de ciudades del estado de Paraíba, Brasil. Se aplicó el referencial metodológico del Análisis de Contenido propuesto por Bardin para categorización de los datos obtenidos. Resultados: de los análisis de los relatos de los participantes surgió la presencia de dificultades como demandas no pertinentes al servicio, local inadecuado para asistencia, falta de privacidad durante las atenciones y de escolta para transporte cuando necesario. Consideraciones finales: los problemas relatados evidencian la necesidad de que se establezcan estrategias para mejorar las condiciones de la asistencia, perfeccionando la capacidad de resolución del servicio y para problemas que no pueden ser resueltos en una sola visita de profesionales del SAMU en el ambiente carcelario, que se garantice la continuidad de la asistencia en otros servicios articulados a él y para ello son necesarios fuertes lazos intersectoriales.

ABSTRACT Objective: to analyze the perceptions of nurses from the Mobile Emergency Care Service (SAMU) in care provided in penitentiaries regarding the reasons for the calls and the place where care is provided. Method: this is an exploratory and descriptive study with a qualitative approach. Individual and audio-recorded interviews were carried out from August to December 2017 following a semi-structured script with 91 nurses who worked in the SAMU in cities in the state of Paraíba, Brazil. The methodological framework of Content Analysis proposed by Bardin was applied to categorize the data obtained. Results: the presence of difficulties emerged from the analysis of the speeches of the participants. They included calls for reasons not relevant to the service, inadequate place for assistance, lack of privacy during consultations, and lack of escort for transport when necessary. Final considerations: the reported problems highlight the need to establish strategies to improve the conditions of care provision so as to enhance the service's ability to solve problems that cannot be solved in a single visit by SAMU professionals in the prison environment, which guarantees the continuity of assistance in other services articulated to it, making strong intersectoral links necessary.

Evaluation of a national smoke-free prisons policy using medication dispensing: an interrupted time-series analysis.

BACKGROUND: Internationally, smoking prevalence among people in prison custody (ie, people on remand awaiting trial, awaiting sentencing, or serving a custodial sentence) is high. In Scotland, all prisons implemented a comprehensive smoke-free policy in 2018 after a 16-month anticipatory period. In this study, we aimed to use data on medication dispensing to assess the impact of this policy on cessation support, health outcomes, and potential unintended consequences among people in prison custody. METHODS: We did an interrupted time-series analysis using dispensing data for 44 660 individuals incarcerated in 14 closed prisons in Scotland between March 30, 2014, and Nov 30, 2019. We estimated changes in dispensing rates associated with the policy announcement (July 17, 2017) and full implementation (Nov 30, 2018) using seasonal autoregressive integrated moving average models. Medication categories of primary interest were treatments for nicotine dependence (as an indicator of smoking cessation or abstinence attempts), acute smoking-associated illnesses, and mental health (antidepressants). We included antiepileptic medications as a negative control. FINDINGS: A 44% step increase in dispensing of treatments for nicotine dependence was observed at implementation (2250 items per 1000 people in custody per fortnight, 95% CI 1875 to 2624) due primarily to a 42% increase in dispensing of nicotine replacement therapy (2109 items per 1000 people in custody per fortnight, 1701 to 2516). A 9% step decrease in dispensing for smoking-related illnesses was observed at implementation, largely accounted for by respiratory medications (-646 items per 1000 people in custody per fortnight, -1111 to -181). No changes associated with announcement or implementation were observed for mental health dispensing or antiepileptic medications (control). INTERPRETATION: Smoke-free prison policies might improve respiratory health among people in custody and encourage smoking abstinence or cessation without apparent short-term adverse effects on mental health dispensing. FUNDING: National Institute of Health Research Public Health Research programme, Scottish Government Chief Scientist Office, and UK Medical Research Council.

Effectiveness of psychological interventions in prison to reduce recidivism: a systematic review and meta-analysis of randomised controlled trials.

BACKGROUND: Repeat offending, also known as criminal recidivism, in people released from prison has remained high over many decades. To address this, psychological treatments have been increasingly used in criminal justice settings; however, there is little evidence about their effectiveness. We aimed to evaluate the effectiveness of interventions in prison to reduce recidivism after release. METHODS: For this systematic review and meta-analysis, we searched the Cochrane Central Register of Controlled Trials, Embase, Global Health, MEDLINE, PsycINFO, and Google Scholar for articles published from database inception to Feb 17, 2021, without any language restrictions. We searched for randomised controlled trials (RCTs) that evaluated the effect of psychological interventions, delivered to adolescents and adults during incarceration, on recidivism outcomes after release. We excluded studies of solely pharmacological interventions and of participants in secure psychiatric hospitals or special residential units, or attending therapies mainly delivered outside of the prison setting. We extracted summary estimates from eligible RCTs. Data were extracted and appraised according to a prespecified protocol, with effect sizes converted to odds ratios. We used a standardised form to extract the effects of interventions on recidivism and estimated risk of bias for each RCT. Planned sensitivity analyses were done by removing studies with fewer than 50 participants. Our primary outcome was recidivism. Data from individual RCTs were combined in a random-effects meta-analysis as pooled odds ratios (ORs) and we explored sources of heterogeneity by comparing effect sizes by study size, control group, and intervention type. The protocol was pre-registered with PROSPERO, CRD42020167228. FINDINGS: Of 6345 articles retrieved, 29 RCTs (9443 participants, 1104 [11·7%] females, 8111 [85·9%] males, and 228 [2·4%] unknown) met the inclusion criteria for the primary outcome. Mean ages were 31·4 years (SD 4·9, range 24·5-41·5) for adult participants and 17·5 years (SD 1·9; range 14·6-20·2) for adolescent participants. Race or ethnicity data were not sufficiently reported to be aggregated. If including all 29 RCTs, psychological interventions were associated with reduced reoffending outcomes (OR 0·72, 95% CI 0·56-0·92). However, after excluding smaller studies (<50 participants in the intervention group), there was no significant reduction in recidivism (OR 0.87, 95% CI 0·68-1·11). Based on two studies, therapeutic communities were associated with decreased rates of recidivism (OR 0·64, 95% CI 0·46-0·91). These risk estimates did not significantly differ by type of control group and other study characteristics. INTERPRETATION: Widely implemented psychological interventions for people in prison to reduce offending after release need improvement. Publication bias and small-study effects appear to have overestimated the reported modest effects of such interventions, which were no longer present when only larger studies were included in analyses. Findings suggest that therapeutic communities and interventions that ensure continuity of care in community settings should be prioritised for future research. Developing new treatments should focus on addressing modifiable risk factors for reoffending. FUNDING: Wellcome Trust, Fonds de recherche du Québec - Santé.

Outbreaks of COVID-19 variants in US prisons: a mathematical modelling analysis of vaccination and reopening policies.

BACKGROUND: Residents of prisons have experienced disproportionate COVID-19-related health harms. To control outbreaks, many prisons in the USA restricted in-person activities, which are now resuming even as viral variants proliferate. This study aims to use mathematical modelling to assess the risks and harms of COVID-19 outbreaks in prisons under a range of policies, including resumption of activities. METHODS: We obtained daily resident-level data for all California state prisons from Jan 1, 2020, to May 15, 2021, describing prison layouts, housing status, sociodemographic and health characteristics, participation in activities, and COVID-19 testing, infection, and vaccination status. We developed a transmission-dynamic stochastic microsimulation parameterised by the California data and published literature. After an initial infection is introduced to a prison, the model evaluates the effect of various policy scenarios on infections and hospitalisations over 200 days. Scenarios vary by vaccine coverage, baseline immunity (0%, 25%, or 50%), resumption of activities, and use of non-pharmaceutical interventions (NPIs) that reduce transmission by 75%. We simulated five prison types that differ by residential layout and demographics, and estimated outcomes with and without repeated infection introductions over the 200 days. FINDINGS: If a viral variant is introduced into a prison that has resumed pre-2020 contact levels, has moderate vaccine coverage (ranging from 36% to 76% among residents, dependent on age, with 40% coverage for staff), and has no baseline immunity, 23-74% of residents are expected to be infected over 200 days. High vaccination coverage (90%) coupled with NPIs reduces cumulative infections to 2-54%. Even in prisons with low room occupancies (ie, no more than two occupants) and low levels of cumulative infections (ie, <10%), hospitalisation risks are substantial when these prisons house medically vulnerable populations. Risks of large outbreaks (>20% of residents infected) are substantially higher if infections are repeatedly introduced. INTERPRETATION: Balancing benefits of resuming activities against risks of outbreaks presents challenging trade-offs. After achieving high vaccine coverage, prisons with mostly one-to-two-person cells that have higher baseline immunity from previous outbreaks can resume in-person activities with low risk of a widespread new outbreak, provided they maintain widespread NPIs, continue testing, and take measures to protect the medically vulnerable. FUNDING: Horowitz Family Foundation, National Institute on Drug Abuse, Centers for Disease Control and Prevention, National Science Foundation, Open Society Foundation, Advanced Micro Devices.

Characteristics of Deaths Among Individuals in US Immigration and Customs Enforcement Detention Facilities, 2011-2018.

Importance: Concerns have been raised that substandard medical care has contributed to deaths in US Immigration and Customs Enforcement (ICE) detention facilities. After each in-custody death, ICE produces detainee death reviews, which describe the circumstances of the death and determine whether ICE Performance-Based National Detention Standards (PBNDS) were violated. Objective: To describe factors associated with deaths in ICE detention facilities. Design, Setting, and Participants: This case series used data extracted from detainee death reviews of deaths among individuals detained in ICE facilities for whom these reviews were available from January 2011 to December 2018. Exposures: All individuals were in the custody of ICE at the time of death. Main Outcomes and Measures: Data including demographic information, medical histories, recorded medical data, and reported violations of PBNDS were systematically extracted and summarized. Results: Among 71 individuals who died in an ICE detention facility during the study period, detainee death reviews were available for 55 (77.5%). Most were male (47 [85.5%]), and the mean (SD) age at death was 42.7 (11.5) years. Individuals resided in the US for a mean (SD) of 15.8 (13.2) years before detention and were in ICE custody for a median of 39 days (interquartile range, 9-76 days) before death. Most had low burdens of preexisting disease, with 18 (32.7%) having a Charlson Comorbidity Index score of 0 and 15 (27.3%) having a score of 1 or 2. A total of 47 deaths (85.5%) were attributed to medical causes and 8 (14.5%) to suicide. Markedly abnormal vital signs were documented in the death reviews before 29 of 47 deaths from medical causes (61.7%), and 21 of these 29 deaths (72.4%) were preceded by abnormal vital signs during 2 or more encounters with ICE personnel before death or terminal hospital transfer. Overall, 43 detainee death reviews (78.2%) identified PBNDS violations related to medical care, with a mean (SD) of 3.2 (3.0) deficiencies per detainee death review. Conclusions and Relevance: In this case series, deaths in ICE detention facilities from 2011 to 2018 occurred primarily among young men with low burdens of preexisting disease. Markedly abnormal vital signs preceded death or hospital transfer for most nonsuicide deaths. The PBNDS were violated in most detainee death reviews. These results suggest that additional oversight and external evaluation of practices related to medical and psychiatric care within ICE facilities are needed.

Modelo participativo de comunicación en salud: el caso del Centro Penitenciario Álava / Participatory health communication model: the case of Alava Penitentiary Centre

Mejorar el estado de salud de la población general no es tarea fácil. Hacerlo en el caso de colectivos desfavorecidos es aún más complicado. Presentamos una intervención inédita de educación para la salud desarrollada en el Centro Penitenciario Araba/Álava mediante una estrategia de comunicación altamente eficaz y eficiente. Con acciones informativas sencillas, vehiculizadas por un canal de comunicación existente, se ha conseguido mejorar la adherencia a la medicación de la población reclusa. El Programa «Tu medicación te aporta un plus», desarrollado en un contexto de escasez de recursos y dirigido a un target de población con necesidades complejas, se ha retroalimentado a través de la participación de las personas reclusas y está plenamente implantado, con una trayectoria de más de 3 años. Detallamos su puesta en marcha y los resultados obtenidos, especialmente el impacto en la salud mental y calidad de vida de la población reclusa. Aportamos una estrategia de comunicación y educación en salud de bajo coste, que promueve el empoderamiento individual y colectivo, y es válido y aplicable tanto en el ámbito penitenciario como en otros contextos comunitarios: centros educativos, sociales y sanitarios. El objetivo del estudio es mejorar la salud y la calidad de vida de las personas reclusas a través de un programa de intervención adaptado a sus características y necesidades

Improving the health of the general population is not an easy task. In the case of disadvantaged groups it is even more complicated. We report an unprecedented health education intervention carried out at Araba/Álava Prison Centre by means of a highly effective and efficient communication strategy. With simple explanatory actions, conveyed by an existing communication channel, it was possible to improve the prison population's medication adherence. "Your medication gives you a plus" Programme, carried out against a backdrop of scarcity of resources and targeted at a population with complex needs, has been fed back through the participation of inmates and has been fully implemented over more than three years. We outline implementation of the programme and its results, especially the impact on mental health and quality of life of the prison population. We provide a low-cost health education and communication strategy, which promotes individual and group empowerment, and is valid and applicable both in the prison setting and in other community contexts: educational, social and health centres

Constructing a middle-range theory to explain the uptake of hepatitis C tests in prison.

BACKGROUND: Realist evaluation is increasingly used in healthcare research, and theories can provide plausible explanations of why interventions work or do not work in certain circumstances such as the effect of the opt-out hepatitis C virus (HCV) testing policy in English prisons. AIM: To present the process of constructing the middle-range theories (MRTs) developed as part of an evaluation of hepatitis C test uptake in an English prison as a resource for researchers using realist evaluation. DISCUSSION: MRTs are propositions that can explain a particular behaviour or outcome. In this evaluation, the MRTs emerged from a realist evaluation, a theory-driven approach for understanding what interventions work, in what circumstances and how. The mixed-methods data collected during the realist evaluation and the sociological theory of prisonisation were used to create the MRTs. Combining prisonisation with the qualitative data illustrates how healthcare interventions may be viewed by people in prison who may have adopted either the 'deprivation' or 'importation' processes of adaptation to cope with their incarceration. Their views may affect the acceptance of HCV tests. CONCLUSION: The development of MRTs is a creative and iterative process, requiring an in-depth understanding of the data collected and the subject area. MRTs permit us to see relationships among phenomena that might otherwise seem disconnected, thereby aiding the development of more efficacious interventions. IMPLICATIONS FOR PRACTICE: The MRT developed presents an evidence base for selecting interventions to increase the uptake of HCV tests in prisons. This paper explains how a MRT was developed and how HCV test uptake in prisons can be explained using a sociological theory.