Abstract
BACKGROUND
Prisoners experience significantly worse health than the general population. This review examines the effectiveness and cost-effectiveness of peer interventions in prison settings.
METHODS
A 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.
RESULTS
Fifty-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.
CONCLUSIONS
There 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 REGISTRATION
PROSPERO ref: CRD42012002349.
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