Access point analysis on the state of health care services in South African prisons: A qualitative exploration of correctional health care workers' and inmates' perspectives in Kwazulu-Natal and Mpumalanga

Maastricht University, Maestricht, Limburg, Netherlands
Social Science & Medicine (Impact Factor: 2.89). 12/2006; 63(9):2301-9. DOI: 10.1016/j.socscimed.2006.06.010
Source: PubMed


This paper explores inmates and prison health care workers perceptions of the state of health care services in four correctional facilities in South Africa. Structural and organisational issues are explored in terms of how they impact the delivery and provision of health care to inmates within correctional facilities. Additionally, the study forms an access point analysis of prisons as a health care setting as part of the development and testing of a STI/HIV health education intervention for soon to be released inmates. Focus group discussions (6-8 participants per group) were conducted with male inmates in four facilities in KwaZulu-Natal and Mpumalanga provinces. Individual face-to-face interviews were conducted with eight health personnel to get a view from both providers and end users of health care in correctional settings. Data were analysed thematically. We found strong evidence of prison being a strategic point to increase access to health services for offenders. Curative services within prisons were well established and running despite the presence of certain challenges varying across institutions. Prevention programmes emerged as an area that requires stronger emphasis to facilitate imparting skills and promoting safer practices for inmates upon release. Peer-led education programmes emerged as a key aspect of preparation for release and community reintegration amongst inmates.

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Available from: Torrance T Stephens, Aug 29, 2014
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    • "Prior studies have not examined health-related experiences, medical and mental health needs, and risk perceptions from the perspective of former inmates in the high-risk immediate post-release period. Prior studies of former inmates occurred outside the United States (Bereswill, 2004; Burgess-Allen, Langlois, & Whittaker, 2006; Hosser, Windzio, & Greve, 2008; Howerton et al., 2007; Sifunda et al., 2006; Vandevelde, Palmans, Broekaert, Rousseau, & Vanderstraeten, 2006), addressed juveniles rather than adults (Bereswill, 2004; Hanrahan, Gibbs, & Zimmerman, 2005), did not focus on health (Cooke, 2004), excluded women (Cooke, 2004; Hanrahan et al., 2005; Hosser et al., 2008; Howerton et al., 2007; Seal, Eldrige, Kacanek, Binson, & MacGowan, 2007), were disease-specific (Fontana & Beckerman, 2007; Harzke, Ross, & Scott, 2006; Inciardi et al., 2007; Thomas, Levandowski, Isler, Torrone, & Wilson, 2008), or did not report qualitative findings (Harzke et al., 2006). Thus, this study was designed to describe the health-related experiences, mental and physical health care issues, and perceptions of health risks of male and female former prison inmates after release from prison. "
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    ABSTRACT: In many states, budget constraints are prompting earlier release of prison inmates. Prior studies have demonstrated elevated mortality rates in the post-release period but little is known about the health experiences of former inmates in the transition from prison to the community. The objective of this study was to understand the health-seeking experiences, perceptions of risk, and medical and mental health needs of former prisoners in the first two months after release from prison. Participants consisted of 29 former inmates within the first two months after their release from prison to the Denver, Colorado area. Using qualitative methods, trained interviewers conducted individual, in-person, semi-structured interviews exploring participants' experiences with health, mental health, and health care since release. Interview transcripts were coded and analyzed utilizing a team-based approach to inductive analysis. We found that health-related behavior occurred in the context of a complex life experience, with logistical problems exacerbated by emotional distress. Major themes included 1) transitional challenges; 2) cognitive responses including perceptions about personal risk, knowledge and priorities; 3) emotional responses including pronounced stress, fear, anxiety, disappointment; and 4) health behaviors. Former inmates reported multiple challenges, poor transitional preparation preceding release, and inadequate or absent continuity of mental and physical health care in the context of significant emotional distress and anxiety. Improved release planning, coordination between the medical, mental health and criminal justice systems may reduce the risk of poor health outcomes for this population.
    Full-text · Article · Jul 2011 · International Journal of Law and Psychiatry
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    • "Aquestionnairewasdesignedbasedonexistingapproachestostudyingsubstanceuse amongstprisonpopulations(Braithwaiteetal.,2004),aswellasinformationobtained throughfocusgroupsconductedduringapreliminaryqualitativestudyinfourprisonsasa situationalanalysisoftheSouthAfricanprisonhealthsystem(seeSifundaetal.,2006a)and thesocialconstructionandculturalmeaningsofSTIandHIV/AIDSrelatedterminology (seeSifundaetal.,2006b).Usingdemographicvariablessuchasprovince,age,ethnicity, levelsofeducation,employmenthistoryandmaritalstatus,thequestionnairemeasured,by meansofself-reporting,pastriskysexualbehaviourandalcoholandotherdrugusepriorto incarceration.Furthermore,beliefsontheimpactofalcoholandmarijuanauseon participants'engagementinriskysexualbehaviourwasmeasuredusing22items.The questionnairewaspreparedinEnglishandtranslatedintoisiZulu.Toensuretheaccuracyof thetranslations,theZuluversionofthequestionnairewasback-translatedtoEnglishbya teamofresearchassistantswhowereinvolvedintheprojectasdatacollectorsandhealth educators.Thefirstauthor,whoisafirstlanguageisiZuluspeaker,recheckedallthe translations.Thequestionnairewasinterviewer-administered,asmostprisoninmateshad verylowliteracylevels. "
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    ABSTRACT: To examine a possible link between substance use and risky sexual behaviour, a cross-sectional study was conducted among 357 inmates across four South African prisons involved in a pre-release intervention programme for parolees. About 93% of the participants reported using alcohol and 52% used marijuana prior to imprisonment, while 56% reported previous occurrence of sexually transmitted infections (STIs). Logistic regression analyses explored the impact of substance use on intention to reduce risky sexual behaviour. Age and inconsistent use of condoms were positively associated with having an STI prior to incarceration, while reported alcohol and marijuana intake had no effect. Never using condoms before was highly associated with lower intention to engage in preventive behaviours upon release. It can be concluded that inmates demonstrate high levels of substance use and engagement in risky sexual behaviours. Targeted pre-release substance abuse interventions are essential to reduce the burden of disease amongst offenders.
    Full-text · Article · Mar 2007 · International Journal of Prisoner Health
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    • "Rich et al. (2001) demonstrate that harm reduction techniques are helpful to ex-offenders and that it is feasible to launch an effective HIV intervention to prison inmates. The information that is imparted to and received by the offenders is not only helpful to them, but to their community of family and friends, to whom they can impart important life skills and knowledge (Sifunda et al., 2006). "

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