Templeton Michelle, Kelly Carmel, Lohan Maria
Queen's University Belfast, School of Nursing and Midwifery, Belfast, United Kingdom.
JMIR Res Protoc. 2019 Apr 29;8(4):e11829. doi: 10.2196/11829.
The sexual health of young men in prisons is often among the poorest in any given country. They may have developed sexual behaviors that, from a public health perspective, are considered problematic and burdensome. These include poorer use of condoms and engaging in more frequent casual sex, resulting in higher rates of sexually transmitted infections, including HIV and viral hepatitis. Thus, young incarcerated men are a highly marginalized and socially excluded high-risk group, in greater need of sexual health education and services.
The aim of this study was to create an innovative sexual health promotion intervention, made for and with young men in prisons, to encourage them to avail of regular sexual health checkups. This included developing a Web-based animated-style sexual health promotion intervention (1.42 min) coupled with upskilling the prison nurses to offer a partnership approach to prison health care. This paper focuses on the development of the intervention and the importance of the underpinning rights-based (RB) participatory intervention design.
We employed an RB participatory approach and recruited 14 participants who attended 3 coproduction workshops held within a prison site in Northern Ireland, United Kingdom. A bespoke 3-day training for nurses beforehand, ensured they gained a deeper understanding of the determinants of poor sexual health. The coproduction team comprised young men, prison nurses, nurse sexual health consultant, media company representatives, and facilitator. Workshops focused on content, design, tone and medium of communication for a Web-based intervention that would be appealing and engaging for young incarcerated men.
A 1.42-min animation Dick loves Doot was created to promote a positive attitude toward sexual health checkups. The RB approach enabled the young men to participate, have their voices heard and see their stories reflected through the animation. The nurses' capacities to protect, fulfill, and respect the young men's rights to appropriate sexual health services and education was also enhanced. Evaluations confirmed that we successfully provided accurate sexual health information in a way that was engaging and accessible and that encouraged the young men to avail of the new prison sexual health services that were set up in the prison and now provided by nurses.
The RB participatory approach to health advanced in this study provided a means to (1) gain invaluable insider knowledge to understand the impact of structural determinants on health and health inequalities and strategies by which to target young incarcerated men (2) create inclusive opportunities for developing bespoke targeted interventions, and (3) galvanize collaborative partnerships to disrupt the structures and processes that lead to and encourage health inequities. To reduce future risk, effective treatment, coupled with coproduced interventions that transmit relevant health messages in a relevant and meaningful way, is key to success.
在任何一个国家，监狱中青年男性的性健康状况往往是最差的。他们可能形成了一些从公共卫生角度来看有问题且麻烦的性行为。这些行为包括避孕套使用率较低以及更频繁地进行随意性行为，从而导致包括艾滋病毒和病毒性肝炎在内的性传播感染率更高。因此，被监禁的青年男性是一个高度边缘化且被社会排斥的高危群体，他们更需要性健康教育和服务。
本研究的目的是为监狱中的青年男性创建一种创新的性健康促进干预措施，以鼓励他们定期进行性健康检查。这包括开发一个基于网络的动画形式的性健康促进干预措施（1.42分钟），同时提升监狱护士的技能，使其能采用合作方式提供监狱医疗保健服务。本文重点关注干预措施的开发以及基于权利的（RB）参与式干预设计的重要性。
我们采用基于权利的参与式方法，招募了14名参与者，他们参加了在英国北爱尔兰一个监狱场地内举办的3次联合制作研讨会。事先为护士们定制了为期3天的培训，以确保他们对性健康状况不佳的决定因素有更深入的理解。联合制作团队由青年男性、监狱护士、护士性健康顾问、媒体公司代表和协调人组成。研讨会聚焦于基于网络的干预措施的内容、设计、语气和传播媒介，该干预措施要对被监禁的青年男性有吸引力且能引起他们的兴趣。
制作了一部时长1.42分钟的动画《迪克爱杜特》，以促进对性健康检查持积极态度。基于权利的方法使青年男性能够参与其中，让他们的声音被听到，并在动画中看到自己的故事得到体现。护士们在保护、实现和尊重青年男性获得适当性健康服务和教育的权利方面的能力也得到了提升。评估证实，我们成功地以一种引人入胜且易于理解的方式提供了准确的性健康信息，并鼓励青年男性利用监狱新设立且现由护士提供的性健康服务。
本研究中推进的基于权利的参与式健康方法提供了一种手段，（1）获取宝贵的内部知识，以了解结构性决定因素对健康及健康不平等的影响以及针对被监禁青年男性的策略；（2）创造包容性机会来开发定制的针对性干预措施；（3）激发合作伙伴关系，以打破导致并助长健康不平等的结构和流程。为降低未来风险，有效的治疗，以及以相关且有意义方式传递相关健康信息的联合制作干预措施，是成功的关键。
