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There is a strong political imperative to regard the prison as a key social setting for health promotion, but evidence indicates that drug misuse continues to be a significant issue for many prisoners. This paper aims to examine the social and environmental factors within the setting that influence individuals' drug taking.

Focus groups and interviews were conducted with prisoners and staff in three male training prisons in England. The sampling approach endeavoured to gain “maximum variation” so that a broad based understanding of the prison setting could be gathered. The data were analysed in accordance with Attride‐Stirling's thematic network approach.

The findings suggest a myriad of social and environmental factors influencing drug use. While staff recognised the scale of the drugs problem, they struggled to cope with creative inmates who were not perturbed by taking risks to gain their supplies. Fellow prisoners played a major role in individuals' decision making, as did the boredom of institutional life and Mandatory Drug Testing (MDT) policies within the institutions.

Drug treatment is an essential component of prison healthcare, but it only forms a small part of creating a health‐promoting setting. If the health‐promoting prison is to be fully realised, a more radical, upstream and holistic outlook is required.

The settings approach is an important theoretical and practical approach in health promotion. In comparison to other settings (such as schools), however, there has been limited research on the prison as a health‐promoting environment.

In the context of current prison safety and reform, the purpose of this paper is to discuss findings of an impact evaluation of a horticultural programme delivered in 12 prisons in North West England.

The programme was evaluated using quantitative and qualitative methods, including Green Gym© questionnaires, the Warwick Edinburgh Mental Wellbeing Scale (WEMWBS) and Biographic-Narrative Interpretive Method interviews.

Against a backdrop of high rates of suicide, self-harm and poor mental health, the horticultural programme studied proved beneficial to prisoner participants, the most marked effect was on mental health and wellbeing. In addition to data related to the original mental health outcome indicators, the study revealed multiple layers of “added value” related to mental health arising from horticultural work in a prison setting.

The main research limitations were the limited completion of follow-on questionnaires due to prisoners being released and the inability to conduct longitudinal data collection post-release. There was also concern about response bias and lack of resource to compare with the experience of prisoners not participating in the programme.

Positive impacts on prisoners’ mental health and wellbeing included increased confidence, social interactions with staff and other prisoners and gaining skills and qualifications and work experience, increasing potential for post-release employment.

Benefits of horticulture work on health are well established. However, to date, there is little research concerning the effects this work may have on mental wellbeing of prisoners both within prisons and more so upon their release back into the community.

There is interest in promoting health in prison from governmental levels, but, to date, understanding how best to do this is unclear. This paper argues that nuanced understanding of context is required to understand health promotion in prison. The purpose of the paper is to examine the potential for empowerment, a cornerstone of health promotion practice, in high-security prison establishments.

Independent prison inspections, conducted by Her Majesty’s Inspectorate of Prisons for England and Wales, form a critical element in how prisons are assessed. Documentary analysis was undertaken on all eight high-security prison reports using framework analysis.

Analysis revealed elements of prison life which were disempowering and antithetical to health promotion. While security imperatives were paramount, there were examples where this was disproportionate and disempowered individuals. The data show examples where, even in these high-security contexts, empowerment can be fostered. These were exemplified in relation to peer approaches designed to improve health and where prisoners felt part of democratic processes where they could influence change.

Both in the UK and internationally, there is a growing rhetoric for delivering effective health promotion interventions in prison, but limited understanding about how to operationalise this. This paper gives insight into how this could be done in a high-security prison environment.

This is the first paper which looks at the potential for health promotion to be embedded in high-security prisons. It demonstrates features of prison life which act to disempower and also support individuals to take greater control over their health.

Developing interventions in challenging contexts should imply proper discussion from its theoretical framework to implementation details. The purpose of this paper is to examine health promotion in prison settings as a mean of improving inmates’ rights concerning physical/emotional well-being, empowering inmates both to reclusion and re-entry challenges.

The development of a health promotion program, implemented in a prison setting with an initial group of 11 inmates, is described. The program design followed professionals’ and inmates’ inputs and previous similar interventions taking a peer education, community-based and participative approach.

Although some prison settings present major constraints to interventions’ development, the authors were able to perform the program and reinforced the idea that prisons can and should be health-promoting contexts. The authors found several specific needs that must be addressed when people are under custody, if we want imprisonment to be developmental instead of detrimental experiences.

As a single-year-funded program, its replication and valid evaluation were enabled. Being external to the system also complicated the process agility, and conditioned inmates’ selection and compliance.

This paper promotes a best-practices forum in this issue; it addresses prison health agents’ training, who may assume an institutional essential role; it concerns inmates’ rehabilitation and ultimately, community health and safety.

The use of a peer education approach in these contexts is an innovative feature, since it has been developed in other institutional contexts and social groups. Nevertheless, the authors maintain the strong adequacy of this methodology to work with inmates and inside prison settings.

The purpose of this paper is to assess the health promotion needs of vulnerable young prisoners and the existing health promotion activities in custodial settings in seven European Union (EU) Member States.

The research comprised two components: the first involved identifying existing health promotion practices. The second involved mapping out young offenders’ health promotion needs by carrying out a needs assessment. Both quantitative and qualitative methods were adopted. The quantitative element comprised surveys among young prisoners and prison staff and focused on the availability and perceived importance of health promotion activities in prison. The qualitative element comprised focus groups with young offenders and individual interviews with prison staff, field experts and NGO members.

The findings from the research have identified a number of similar, but also some diverse areas of unmet need for health promotion activities in prison settings across these diverse seven EU countries. There is no consistency of approach within and between countries regarding health promotion policy, guidance, resources and programmes for young prisoners. In order to improve the health of young prisoners and to establish and increase sustainability of existing health promotion programmes, there is a need for the establishment of National and EU standards.

Providing health promotion activities for young prisoners while in custodial settings is key to addressing their unmet health and well-being needs and to facilitate their reintegration back into the community. Despite the barriers identified by this research, health promotion is to some extent being delivered in the partner countries and provides a foundation upon which further implementation of health promotion activities can be built especially when the benefits of health promotion activities, like dealing with the common problems of alcohol and drug addiction, mental health and communicable diseases are linked to successful reintegration.

This paper aims to explore how the TECH Model (testing for and treating infectious diseases and vaccination; environmental modification to prevent disease transmission; chronic disease identification and treatment; and health maintenance and education) can be used for assessing and achieving healthy prisons.

This paper explores the concepts of “health in prison” and “healthy prisons” in the context of recent research and guidance. The paper then considers the TECH Model as an approach to achieving healthy prisons.

Under each of the four TECH Model domains are tasks to achieve a healthy prison. For prisons with poor or no resources, each domain contains steps that will improve prison health and move towards a healthy prison for both prisoners and staff. Implementation can thus be “low‐TECH” or “high‐TECH” depending on the setting and the available resources and the model is specifically designed to provide options for resource‐poor as well as resource‐rich correctional settings.

The TECH Model is a first step in characterizing the components of a healthy prison and the processes to achieve this. This Model could be implemented in all levels of prisons internationally.

The purpose of this paper is to identify the factors which influence male prisoners’ motivation for, and engagement in, exercise and subsequent healthy behaviours.

The first authors conducted 20 semi-structured interviews with male prisoners inside an English medium-security male prison. Interviews were recorded and transcribed, themes were identified using thematic analysis and a critical realist perspective applied to understand objective processes behind prisoners’ experiences and shared meanings of exercise and engaging in healthy behaviours in prison.

Emerging themes indicate that in the context of healthy behaviours male prisoners aspired to a masculine ideal that was characterised by a culture of either adaptive behaviours, or maladaptive behaviours. The former fostered an adaptive exercise culture which promoted psychological well-being through an autonomy-supportive environment, consequently internalising motivation and minimising perceived barriers to engaging in healthy behaviours. Conversely, a culture of maladaptive behaviours fostered a maladaptive exercise culture which led to negative psychological well-being, underpinned by external forms of motivation which emphasised barriers to engaging in healthy behaviours.

Findings emphasise the need for prisons to promote an internal perceived locus of control for male prisoners when engaging in healthy behaviours.

The authors adopt a rare interdisciplinary approach combining a psychological theory of motivation and criminological perspectives of prison culture to understand how best to minimise the impact of prisons as an institution on the psychological well-being of male prisoners.

Those in prison have expert knowledge of issues affecting their health and wellbeing. The purpose of this paper is to report on work undertaken with male prisoners. This paper presents learning and findings from the process of engaging imprisoned men as peer researchers.

The peer researcher approach offers an emic perspective to understand the experience of being in prison. The authors established the peer research role as an educational initiative at a long-stay prison in Wales, UK to determine the feasibility of engaging imprisoned men as peer researchers. Focus groups, interviews and questionnaires were used by the peer researchers to identify the health and wellbeing concerns of men in prison.

The project positively demonstrated the feasibility of engaging imprisoned men as peer researchers. Four recurring themes affecting health and wellbeing for men in a prison vulnerable persons unit were identified: communication, safety, respect and emotional needs. Themes were inextricably linked demonstrating the complex relationships between prison and health.

This was the first prison peer-research project to take place in Wales, UK. It demonstrates the value men in prison can play in developing the evidence base around health and wellbeing in prison, contributing to changes within the prison to improve health and wellbeing for all.

The purpose of this study was to capture the experience of people after completing their period of COVID-19 14-day isolation in prison. This study used in-depth interviews to assess the impact of the restricted regime.

This was a cross-sectional qualitative study using an adapted regional survey to record people’s experiences of COVID-19 isolation on entry into prison. This study began in April 2020 and continued to run over eight months. A weekly capture of people’s stories was conducted using a convenience sample. A total of 168 people participated in the study, with in-depth interviews conducted by the health-care team. Content conceptual analysis was used to quantify and analyse the themes of impact of COVID-19 isolation. This information was then used to shape iterative health-care service development.

A number of key themes have emerged from the experiences of COVID-19 isolation, including connection, communication and support. Stories highlighted how isolation had exacerbated depression, anxiety or feelings of self-harm. This was amplified by the uncertainty of the pandemic and lack of information about accessing services in the altered prison regime. A priority for people in COVID-19 isolation was contact with family. Telephone calls and virtual visits were cited as mitigating the mental health impact of social isolation. People who felt supported by health-care or prison staff reported coping with their time in isolation better. Timely, accessible information was pivotal in support, leading to development of Engagement Lead check-ins on the isolation landings. It is crucial that a public health approach is core to the COVID-19 response in prisons. The thematic analysis of the experiences has enabled a focused understanding of the impact of COVID-19 isolation and an accountability of care provision through organisational collaboration and iterative improvements to service delivery.

There is a paucity of real-time evidence of the impact of restricted regimes in prison owing to COVID-19. This study gives an important insight.

Women in prison throughout the world experience higher rates of mental and physical illness compared with the general population and compared with men in prison. The paper finds no published studies that report on men or women in prison engaging in participatory health research to address their concerns about nutrition and fitness. The purpose of this paper is to describe a pilot nutrition and fitness program, which resulted from a unique prison participatory health research project.

Women in prison designed, led, and evaluated a six-week pilot fitness program in a minimum/medium security women's prison. Pre- and post-program assessments included a self-administered questionnaire and body measures. Open-ended questionnaire responses illuminated the quantitative findings.

Sixteen women in prison completed the program evaluation. Weight, body mass index, waist-to-hip ratio, and chest measurements decreased, and energy, sleep, and stress levels improved by the end of the program.

As a component of a participatory research project, incarcerated women designed and led a nutrition and fitness program, which resulted in improved body measures and self-reported health benefits.

Incarceration provides opportunities to engage women in designing their own health programs with consequent potential long-term “healing” benefits.