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This paper aims to discuss some of the obstacles to implementing policy and strategy related to health promoting prisons. It focuses on the role of prison officers and raises issues concerning their conditions of service, training and organisational culture in a situation where the prison system faces security issues, overcrowding and high levels of ill health among prisoners.

This paper emerged as a result of significant overlapping themes between two separate studies conducted by the authors. The paper draws on the authors' qualitative data from these studies.

The findings demonstrate the ambiguities and tensions in changing organisational cultures and among prison staff. Alongside the qualitative data, the paper draws on theory regarding policy implementation at the micro‐level to show how staff can block or speed up that implementation.

Prison officers are an essential part of health promoting prisons, but have been relatively ignored in the discussion of how to create healthier prisons.

The contribution that prison staff make to creating health promoting prisons has been under‐explored, yet pertinent theory can show how they can be more effectively involved in making changes in organisational culture.

The existing evidence base and policy context of sports‐based prisoner health promotion is evaluated, and an original analysis of current provision and best practice in delivering sport to address physical, mental and substance misuse needs among prisoners across the secure estate in England and Wales is presented, with a focus on the variability of provision across different prison establishments.

Inspectorate reports published by Her Majesty's Inspectorate of Prisons (n=184) were analysed to assess the extent to which health promotion objectives are being implemented through physical education in prisons across England and Wales. Examples of innovative sport‐based health promoting programmes are drawn upon in order to illustrate principles of best practice.

Despite health promotion being engrained in existing policy, the degree to which physical, mental health and substance misuse needs are addressed through sport in prison remains highly variable and locally contingent across the secure estate, although examples of innovative practice are evident.

For sport to promote prisoner health most effectively, tailored sports provision should be embedded within multi‐modal interventions which draw on internal and external partnerships and promote opportunities for ongoing sporting participation. Further research is required to delineate principles of best practice applicable to discrete prisoner populations.

Sport can play a key role in addressing a multitude of prisoner health needs whilst contributing to achieving “healthy prison” objectives in practice. Sport and physical activity clearly offers a valuable way of motivating prisoners to engage in health promoting initiatives.

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.

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.

Investigates 1999/2000 health promotion activities in prisons in England and Wales and documents the range and quality of health promotion occurring in prisons, against which future activity might be measured. Finds that health promotion is under‐resourced and the concept and practice poorly understood. Health needs assessment tended to be analysis of and for health‐care services and, except in a minority of cases, did not include consultation with staff, prisoners or their families. Where responsibility was shared and the work based on multi‐disciplinary approaches, it seems more likely to have been reported accurately as health promotion activity. The official policy of a healthy settings/whole prison approach was not understood by many and its application was limited. The findings have informed the development of a new health promotion strategy for the prison service in England and Wales.

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.

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.

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.

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.

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.