Hooper Monique, Virdun Claudia, Phillips Jane L
School of Nursing, Faculty of Health Queensland University of Technology, QLD, Brisbane, Australia.
Palliative & End of Life Care, and Member, Flinders Research Centre for Palliative Care, Death, and Dying, College of Nursing and Health Sciences, Flinders University, Adelaide, Australia.
Int J Equity Health. 2025 Apr 29;24(1):115. doi: 10.1186/s12939-025-02462-x.
The United Nations (UN) 2015 'Mandela Rules' stipulates that people in prison will have access to equivalent healthcare to other community members. This expectation has challenged prisons in high-income countries to strengthen healthcare delivery to better meet the needs of the growing number of incarcerated First Nations and older, frailer people, many with complex healthcare needs. Yet little is known about correctional and justice health professionals' ('prison workforces') capacity to identify and support people in prisons with complex healthcare needs.
To identify the post-Mandela Rules strategies that have increased the prison workforce's capacity to provide evidence-based healthcare.
A systematic review. Three health and Criminal Justice databases were searched (2015-June 2024) to identify empirical data regarding the 'individual', 'organizational' and 'community' capacity-building strategies employed to improve the prison workforce's healthcare capabilities. Kirkpatrick's Model was used to assess the evaluation level, while Popay's narrative synthesis was applied to the extracted data. Findings are reported according to the PRISMA Statement.
Of the 20 included articles, the highest level of evidence (level III) was generated by a mixed methods study, with most (n = 17) generating low-level (Level IV) evidence. Ten studies evaluated mental health behavioral capacity-building strategies, with limited attention given to other chronic illnesses, ageing, palliative care, or cultural needs. More complex capacity-building strategies that included individual, organizational, and community-level elements generated the best outcomes. The best individual-level capacity-building outcomes were more frequent (> 5 occasions) interactive health-related education delivered in partnership with external experts. However, the commonly employed capacity-building strategies were short didactic education sessions, which were less effective.
If prisons are to meet the UN Mandela Rules' aspirations, more impactful individual, organizational and community-level capacity-building strategies are urgently required. Transitioning to co-designed, interactive, culturally sensitive, evidence-based approaches is crucial if the prison workforce is to better recognize and effectively respond to the needs of more culturally diverse and older, sicker populations with complex healthcare needs.
Prospero CRD42023410564.
联合国2015年的《曼德拉规则》规定，监狱中的人员应能获得与其他社区成员同等的医疗保健服务。这一要求促使高收入国家的监狱加强医疗服务提供，以更好地满足越来越多被监禁的原住民以及老年体弱人群的需求，其中许多人有着复杂的医疗需求。然而，对于惩教和司法卫生专业人员（“监狱工作人员”）识别和支持监狱中有着复杂医疗需求人员的能力，我们知之甚少。
确定《曼德拉规则》实施后提高监狱工作人员提供循证医疗保健服务能力的策略。
进行系统综述。检索了三个卫生与刑事司法数据库（2015年至2024年6月），以识别有关为提高监狱工作人员医疗保健能力而采用的“个人”“组织”和“社区”能力建设策略的实证数据。使用柯克帕特里克模型评估评估水平，同时将波佩的叙述性综合法应用于提取的数据。研究结果根据PRISMA声明报告。
在纳入的20篇文章中，最高证据水平（三级）来自一项混合方法研究，大多数文章（n = 17）产生的是低水平（四级）证据。十项研究评估了心理健康行为能力建设策略，对其他慢性病、老龄化、姑息治疗或文化需求的关注有限。包含个人、组织和社区层面要素的更复杂的能力建设策略产生了最佳效果。最佳的个人层面能力建设成果是与外部专家合作开展的更频繁（>5次）的互动式健康相关教育。然而，常用的能力建设策略是简短的说教式教育课程，效果较差。
如果监狱要实现联合国《曼德拉规则》的目标，迫切需要更具影响力的个人、组织和社区层面的能力建设策略。如果监狱工作人员要更好地识别并有效应对文化背景更多样、年龄更大、病情更重且有着复杂医疗需求人群的需求，向共同设计、互动式、文化敏感且基于证据的方法转变至关重要。
Prospero CRD42023410564。
