All participants acknowledged that their prison sentence provided them with an opportunity to take stock of their health and address some of their health concerns. Prison had a detoxifying effect for many of the participants, ‘Prison has helped me, it’s cleansing my body.’ Moreover, for many participants prison was seen as a respite from their chaotic lives in the community where they were comparatively safe. One young man stated: ‘I feel kinda happy here as I’m away from my area. I know there’s no way I’ll get stabbed or shot in here. I think being here has affected my health in a positive way.’ All participants were therefore highly motivated to seek information and support to maintain and improve their health in the prison context since ‘everything in your life is related to your health.’ They tended to view peers as a suitable avenue to access certain information and support as well as provide an auxiliary healthcare service.
Access to Information and Support
Participants unanimously reported that the YOI currently did not provide enough health information and support and that access to prison healthcare was challenging. Peer-based approaches were welcomed as a response to redressing these gaps. For example, one respondent viewed prison health as ‘all about paracetamol (acetaminophen) and creams— that’s all,’ which was reactive and ineffective. They tended to view peer- based approaches as a potential way to increase access to broader health information when needed. Participants stated that they wanted more general health promotion information and support on a wide range of health topics including diet and nutrition, exercise, smoking cessation, personal hygiene, disease prevention and vaccinations, sexual health, mental health and coping, and primary care problems (such as sleep problems, pain management) whilst at the YOI. Many participants felt that peers could provide some of this information around key themes such as weight control, building muscle-mass, maintaining personal hygiene, preventing illnesses, and self-management tactics as well as more general information regarding accessing prison healthcare services and support for new prisoners when first entering the prison. A few participants also felt that peers could provide more information around disease prevention such as vaccinations. For example, one young man stated: ‘when I first came in, they just jabbed me but I had no idea what it was really.’ For others, the lack of information meant they refused vaccinations. One participant said: ‘I don’t know what’s in them and I don’t trust it.’ Thus for those who were distrustful of the system, peer-based approaches represented not only a convenient avenue for providing this type of health information and support, but also one which would be more credible, relevant, and meaningful for them.
In the current scheme, many viewed the information and support from the healthcare team as lacking relevance and empathy. For example, one young man stated:
I get that they are trying to help—like I know smoking isn’t good but they don’t really understand what we are going through in here. It’s boredom and stress really and it’s hard in here to deal with it all. They really don’t understand so when they say, ‘Oh stop smoking’ or do this and that, it’s not that easy.
Current health promotion posters and leaflets were considered mostly irrelevant, as one respondent stated, ‘no one reads a leaflet in here—you just think, “what do they know giving you this leaflet!” It’s pointless.’ Some participants felt that the lived experience of peers would mean that they were in a position to understand their concerns, in that ‘you can relate to other people in your position and they would be more approachable.’ Participants also thought they would likely receive the information and support from peers more positively as it comes from a more empa- thetic and relevant source.