Professor James Woodall

Background. In the United Kingdom, local government is well-placed to conduct and apply research about the wider determinants of health. However, local authorities often lack sufficient research infrastructure to support research capacity, capability and culture. Since 2022, the UK National Institute for Health and Care Research has funded 30 Health Determinants Research Collaborations (HDRCs) to develop this infrastructure. HDRCs are hosted by local authorities collaborating with universities and other partners to strengthen a culture of evidence-informed decision making. HDRCs are conducting local evaluations, including baseline assessments of local authority research capacity, capability and culture. Methods. A national peer-support group was formed to support shared learning among teams evaluating HDRCs. Here, as embedded evaluators from 10 HDRCs, we present reflections on the planning, delivery, and interpretation of baseline assessments. Reflections were gathered via group discussions and written submissions. All 10 HDRC baseline assessments explored local authority research capacity, capability and culture, and two also studied early HDRC team collaboration. Results. Competing priorities during early HDRC implementation called for pragmatic and timely baseline assessment methods. Most HDRCs developed baseline surveys, though interviews and focus groups were conducted by some. Despite similar aims, methods varied substantially according to local contexts. Evaluators often adapted existing validated survey tools, e.g., from health settings, as none were identified for use across local government. Definitions of research also ranged from academic definitions to broader notions of evidence. Useful insights were gathered across diverse samples to aid implementation locally, however low response rates were received to all-staff surveys and heterogenous approaches limited comparison across HDRCs. Findings contributed to recommendations for evaluating and developing HDRC activities (e.g., communications and training provisions) appropriate for local authorities with stretched resources. Where measured, collaborations were functioning well, with recommendations to enhance communication. Conclusions. The early contexts and challenges of HDRCs influenced pragmatic baseline assessments. Methods were often chosen to capture baseline contexts rapidly, and they will be refined and complemented by additional evaluation methods as HDRCs progress. Developing new validated measures and an agreed definition of research for local authorities may strengthen understanding of research capacity, capability and culture across local government.

Health, a universal human value and a fundamental human right, is a contested and elusive concept. Lay meanings of health are among the different dimensions of the understanding of health, and they have been of great interest to researchers because they help people to understand themselves and their world and influence their health choices and practices. They are subject to change with changing circumstances across the lifespan. The purpose of this study was the exploration of the meanings of health among individuals living with comorbid type 2 diabetes (T2DM) and hypertension (HTN) in The Gambia which, to our knowledge, was hitherto unexplored. The study design was interpretivist and data were collected through thirty-two qualitative interviews with eighteen participants, most of whom participated in two separate interviews, from November 2018 to July 2019. Data were analysed using Braun and Clarke’s reflexive thematic analysis. Three main themes were generated to capture the meanings of health: (1) health: embodiment of corporeal experiences; (2) health: freedom; and (3) health: reward for virtue. The findings highlight the complexity of lay meanings and underscore the need for their incorporation into health promotion policy and practice to promote equality, participation and empowerment and bring the public back into public health.

The incidence and prevalence of type 2 diabetes mellitus (T2DM) and hypertension (and their comorbidity) have been increasing in sub-Saharan Africa, including The Gambia. Diet is a critical driver of these public health problems, and diet-related health education is a major strategy employed for their prevention and management. The aim of this paper is to explore the lived experiences of diet-related health education among individuals with comorbid type 2 diabetes and hypertension in Serrekunda, The Gambia, a subject hitherto unexplored in the country. The study employed a qualitative (interpretivist) methodology. Thirty-two interviews were conducted with 18 participants, with most participating in two interviews at separate time-points between November 2018 and July 2019. In addition to participant validation, the two points in time interviews elicited more depth and provided rich data. The data were analysed using Braun and Clarke’s six-phased approach to Thematic Analysis. Four main themes were generated in relation to the experiences: (i) one-off blanket dietary advice (ii) education in a vacuum (iii) diabetes-hypertension diet dichotomy and (iv) imbalanced power relationship. The study underscores the need for a reconfiguration of diet-related health education in The Gambia to include lived experiences as critical components of health promotion in tackling T2DM and hypertension. This requires an ecological approach, critical health education, regulations on unhealthy foods, and active participation of individuals as equal partners in health education.

Two decades since the World Health Organization Regional Office for Europe published a report on health promotion in prison that stimulated further debate on the concept of the “health-promoting prison,” this article discusses the extent to which the concept has translated to the United States. One predicted indicator of success for the health-promoting prison movement was the expansion of activity beyond European borders; yet 2 decades since the European model was put forward, there has been very limited activity in the United States. This “Critical Issues and Trends” article suggests reasons why this translation has failed to occur.

Background: The protective effects of exclusive breastfeeding (EBF) to the health of infants and mothers alike have been well documented. The rates of EBF remain low in spite of the recognized benefits and the persistent global call for infants to be breastfed exclusively on breast milk for the first six months of life. Health education has been widely suggested as one of the key intervention strategies for increasing the duration of EBF in low income countries. Objective: To conduct a systematic review to assess the effectiveness of health education interventions in increasing the duration of EBF in low income countries. A secondary objective of the review was to identify the theoretical bases of both effective/non-effective interventions and also to identify the educational methods that were utilized. Methods: Systematic review of experimental and quasi-experimental studies of health education interventions that evaluated exclusive breastfeeding outcome. Studies not published in English language and studies not reporting exclusive breastfeeding outcome were excluded. A narrative synthesis was used. Data Sources: Studies dating from 1980 – 2013 in English language were searched in the following databases: Cochrane Central Register of Controlled Trials, MEDLINE, Academic Search Complete. ScienceDirect and Google Scholar search engine. Results: Twelve (12) studies were identified. Five were randomized controlled trials and additional three were before-after studies with control groups. The remaining four were non-randomized controlled trial. Only one study applied a theoretical framework in developing and implementing the intervention. EBF rate was significantly higher in the intervention groups compared with the control groups in ten (10) of the studies. The remaining two (2) studies reported no difference in EBF rates between the intervention groups and the control groups. Most of the studies reviewed had important methodological limitations. Conclusion: Because of the methodological limitations of most of the included studies, firm conclusion on the effectiveness of health education interventions in increasing the duration of exclusive breastfeeding in low income countries cannot be made. Nonetheless there is a potential for this to be achieved if more methodologically rigorous health education interventions are developed and evaluated in low income countries.

The role of health promoters and educators in the current and future response to COVID-19 is critical, but, to date, under explored. This opinion paper offers a number of important contributions that this professional group may offer both in the immediate and future strategy of global public health. While the importance of a medical model of health cannot be underplayed, the social model of health suggests that some groups in society are being more disproportionately impacted than others. Health promotion has been committed to reducing inequalities and therefore offers ‘a voice’ to those most marginalised. The paper suggests that bottom-up approaches focusing on building individual and community control is essential and, moreover, the concepts of a settings approach in health promotion, the fostering of critical health literacy and ‘salutogenesis’ may be worthy of further debate and discussion.

The role of health promoters and educators in the current and future response to COVID-19 is critical, but, to date, under explored. This opinion paper offers a number of important contributions that this professional group may offer both in the immediate and future strategy of global public health. While the importance of a medical model of health cannot be underplayed, the social model of health suggests that some groups in society are being more disproportionately impacted than others. Health promotion has been committed to reducing inequalities and therefore offers ‘a voice’ to those most marginalised. The paper suggests that bottom-up approaches focusing on building individual and community control is essential and, moreover, the concepts of a settings approach in health promotion, the fostering of critical health literacy and ‘salutogenesis’ may be worthy of further debate and discussion.

Prison is a home to some people and a workplace for others. It is a setting with significant interaction with the wider community through family and legal visits, and service provision. Prisoners tend to come from marginalised and socially disadvantaged sections of society, exhibiting a disproportionately high incidence of ill health. Prison is therefore a key setting to intervene for both individual and wider public health benefit. This chapter seeks to explore prisons as settings for health. It outlines the historical developments of the health-promoting prison concept and discusses how the idea has developed over the past number of years. The chapter also highlights some of the challenges and tensions that have faced policy and practice in this environment, including the challenges of translating the strategy into practical action. The chapter provides a case study illustrating the health and well-being benefits of whole-system working, before concluding with a discussion of the future role of prisons as settings for health.

Purpose: 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 in order to understand health promotion in prison and examines the potential for empowerment, a cornerstone of health promotion practice, in high-security prison establishments. Design/methodology/approach: Independent prison inspections, conducted by Her Majesty’s Inspectorate of Prisons for England and Wales (HMIP), form a critical element in how prisons are assessed. Documentary analysis was undertaken on all eight high-security prison reports using framework analysis. Findings: 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 shows 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. Practical implications: 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. Originality/value: 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.

In this commentary, we propose using laws in implementing the Healthy Prisons Agenda. We evaluate the efficacy of laws in tackling health inequalities in prisons, provide recommendations on how states can uphold their international commitments that safeguard prisoners’ right to healthcare, and frame prisons as health-promoting settings. We also assess the challenges that can thwart this proposal, such as the non-binding nature of international obligations, global prison overcrowding and the dependency on prison governors and staff for implementation of the Agenda. The commentary concludes by recommending further evaluation of our proposal and testing its potential generalisability to other health-promotion agendas.

This paper explores prisoner and staff views of the current smoking policy in English and Welsh prisons (a partial ban permitting smoking in prison cells) and gauges perceptions of the implications of the forthcoming policy change which will see a total smoking ban within all parts of the institution. Five focus group discussions in one medium security male prison in England were undertaken. Three focus groups were undertaken with prisoners (both smokers and non-smokers) and two focus groups with staff. The findings suggest that smoking is embedded in the fabric of prison life and serves several functions, including alleviating anxiety in prisoners. The current smoking policy was perceived as being a fair policy that both supported smoking and non-smoking prisoners. There were concerns, however, that a total smoking ban would have adverse outcomes for prisoners and staff, including deleterious effects on mental health and the potential for violence. The paper concludes by suggesting that the incoming policy, which sees a total smoking ban in prisons, is laudable, but this research suggests that without careful implementation there may be adverse health and organisational outcomes.

Objective: To explore the barriers to positive mental health in a group of young offenders. Design A qualitative approach was used to provide insight into the ways in which mental health for young offenders is experienced and managed. Setting A Young Offenders Institute (YOI) accommodating males aged between 18 and 21 years. Method: Participants were recruited voluntarily using posters. Twelve offenders participated in focus groups and an additional three interviews were carried out with individuals who felt uncomfortable in the focus group situation. Results: Participants stressed that feelings in a YOI could not be shared due to the masculine ethos that had been created on the wings. Listener services were reported to be ineffective for support because using them would show weakness and vulnerability to other prisoners. Visiting time was the main highlight in the routine for most young offenders; however, leaving family and friends was difficult. In dealing with these emotions young offenders would use coping mechanisms, including acts of aggression to vent built-up frustrations. The issue of prison staff and their effect on mental health was raised by all offenders involved in the research. Unanimously, it was suggested that there are both excellent prison officers who engage with the prisoners, and staff who abuse their power and treat prisoners disrespectfully. Conclusion: Promoting mental health is not the principle business of a YOI. However, this research has generated some issues for consideration for governors and those working within this setting.

Purpose Given epidemiological data highlighting poor health outcomes for prison staff and correctional workers, this systematic review aims to understand what health promotion interventions, delivered in prison settings, are effective for prison staff health. Design/methodology/approach A systematic review was undertaken, with search parameters encompassing papers published over a ten-year period (2013–2023). Health promotion programmes; well-being programmes; and occupational health interventions to support prison staff health as part of a targeted approach or as part of a whole-prison approach were included in the review. Findings The review identified 354 studies, of which 157 were duplicates and 187 did not meet the inclusion criteria. This left ten studies in the review from five countries. Reducing the impact of tobacco smoke was the commonly cited intervention, with four studies focusing on smoke-free prison legislation, but other studies focused on stress reduction for staff and supporting holistic health. The papers were of poor methodological quality, with the exception of three included studies that had robust designs. Most studies showed limited or no impact of interventions to support prison staff health, the exception being policy interventions to reduce second-hand smoke exposure. Originality/value Prison staff have poor health outcomes and yet limited attention has been paid to interventions to support their health. This review suggests a number of considerations for future policy and practice and direction for further research to improve prison staff health.

Inequalities in people's health due to economic or social circumstances remain a persistent challenge in the UK, with people from disadvantaged communities disproportionately likely to die earlier and experience more health issues than the general population. Health promotion has a vital role in reversing health inequalities and requires a focus on structural and political-level determinants of health, rather than individuals' lifestyle choices. However, while health promotion is a significant aspect of nurse education curricula, individual nurses may experience role confusion regarding the application of health promotion in their practice. Therefore, a shift is required in nurse education and training on health promotion, as well as its practical implementation. This article suggests some approaches that could be taken to reconfigure the role of nurses in health promotion.

The role of health promoters and educators in the current and future response to COVID-19 is critical, but, to date, under explored. This opinion paper offers a number of important contributions that this professional group may offer both in the immediate and future strategy of global public health. While the importance of a medical model of health cannot be underplayed, the social model of health suggests that some groups in society are being more disproportionately impacted than others. Health promotion has been committed to reducing inequalities and therefore offers “a voice” to those most marginalised. The paper suggests that bottom-up approaches focusing on building individual and community control is essential and, moreover, the concepts of a settings approach in health promotion, the fostering of critical health literacy and “salutogenesis” may be worthy of further debate and discussion.

Health inequalities remain persistent and challenging. In some instances, health inequalities are growing within society with some communities disproportionately likely to die sooner and experience more ill health. At the core of addressing health inequalities is a need to focus on structural and political level determinants, rather than individual choices and lifestyles which are often a manifestation of broader economic and social issues. Health promotion is a key discipline in reversing health inequalities and it is laudable that the nursing curricula focuses substantially on promoting health. However this paper argues that without reconfiguration of training and practice, the nurse workforce will consistently fall short in meaningfully addressing health inequalities. A shift is needed in the training; conceptual understanding; and practical execution of health promotion by those within the nursing sector. The paper suggests some tangible ways forward to redefine the health-promoting potential of the nurse workforce.

Purpose The paper offers commissioners and practitioners insights into how a gender and culturally sensitive Covid-19 vaccination clinic was set up in a local area that was experiencing lower uptake rates. Design/methodology/approach This paper seeks to examine and share a city-wide approach to improve vaccine uptake in a large metropolitan city in the UK. Findings In mitigating inequalities and ensuring underserved populations have access to the Covid-19 vaccine, there is a need to work with communities to develop vaccine clinics that provide a local, convenient and trusted offer that meets the needs of residents. Originality/value Developing a local Covid vaccine offer that meets cultural needs focusing on an area of low uptake in a large metropolitan city.

The notion that prisons should become more ‘health promoting’ is a policy agenda that is gaining increasing momentum, particularly in England and Wales1 , Scotland2 and across other European nations. The political strides made in this regard have been recognised globally, especially in the United States, where penal health reformers are attempting to replicate successful policy initiatives in Europe3 . Despite the favourable rhetoric, the extent to which the concept of a ‘health promoting prison’ is fully understood and implemented ‘on the ground’ by prison staff and managers in England varies4 . The primary aim of this article, therefore, is to open up and stimulate discussion on the World Health Organisation’s (WHO) concept of a health promoting prison, as the extent to which this idea has been critically considered and debated is minimal. To encourage this wider discussion, the paper has three primary aims. It will first seek to introduce the origins and principles underpinning the health promoting prison; it will then set the health promoting prison within a political context. The paper will go on to explore some drawbacks to the approach, including the underlying conceptual and practical challenges.

This paper sought to explore how hospitals can be reconfigured to adopting more ‘health-promoting’ approaches and values. Specifically, the paper focuses on the role of hospital chaplaincy and argues that spiritual care should be considered alongside other health domains. Using semi-structured interviews, the aim of the paper is to explore the experiences of patients who accepted (n=10) and declined (n=10) hospital chaplaincy services. Data were analysed drawing on principles of Interpretative Phenomenological Analysis (IPA). The findings suggested that participants who accessed chaplaincy services reported using the chaplains for pastoral, religious and spiritual care which contributed positively to their sense of well being. This included religious rituals and supportive conversations. The majority of these participants had existing links with a faith institution. Participants who declined chaplaincy services reported having personal religious or spiritual beliefs. Other reasons cited, included: that the offer was made close to discharge; they had different support mechanisms; and were unaware of what the chaplaincy service offered. Participants identified a number of skills and attributes they associated with chaplains. They perceived them as being religious but available to all, somebody to talk to who was perceived as impartial with a shared knowledge and understanding. The paper concludes by highlighting the important role of chaplaincy as part of a holistic health-promoting hospital. This has implications not only for the design, delivery and promotion of chaplaincy services but also for health promotion more broadly to consider spiritual needs.

Lay understandings of health and illness have a well established track record and a plethora of research now exists which has examined these issues. However, there is a dearth of research which has examined the perspectives of those who are imprisoned. This paper attempts to address this research gap. The paper is timely given that calls have been made to examine lay perspectives in different geographical locations and a need to re-examine health promotion approaches in prison settings. Qualitative data from thirty-six male sentenced prisoners from three prisons in England were collected. The data was analysed in accordance with Attride-Stirling's (2001) thematic network approach. Although the men's perceptions of health were broadly similar to the general population, some interesting findings emerged which were directly related to prison life and its associated structures. These included access to the outdoors and time out of their prison cell, as well as maintaining relationships with family members through visits. The paper proposes that prisoners' lay views should be given higher priority given that prison health has traditionally been associated with medical treatment and the bio-medical paradigm more generally. It also suggests that in order to fulfil the World Health Organization's (WHO) vision of viewing prisons as health promoting settings, lay views should be recognised to shape future health promotion policy and practice.

This chapter reinforces the principle that research can be about working with and alongside, not ‘on’, people and communities. Despite widespread support for this from those working in health research (Green et al., Health promotion. Planning and strategies, Sage, 2019), there has been reluctance for the translation of these ideas into prison contexts—this, it could be surmised, is for several reasons, including: security concerns and a predominance historically for more quantitative approaches in prison health research. This chapter seeks to outline what participatory research means in prison and moreover to exemplify this using contemporary examples. The added value of participatory methods within prison research will be discussed before the challenges, and ways in which they can be managed, are outlined.

This chapter aims to provide practitioners with practical ideas on how to promote mental health in prisons and Young Offenders Institutions, providing some working principles for practitioners and drawing on lessons learned from research and existing examples of good practice. Men in prison are a vulnerable group in society, with many having been subjected to a lifetime of social exclusion. The importance of promoting positive mental health in prisons and not just promoting the absence of mental illness is crucially important. While it may be difficult to imagine positive mental health among prisoners, prison should provide an opportunity for individuals to be helped towards a sense of personal development without harming themselves or others. Mental health promotion is a key agenda for prisons, highlighted in the Prison Service Order for health promotion and by the World Health Organization. Contact with family and friends is an important source of support and should be promoted to encourage positive mental health.

Prisons are seen as a (temporary) home and community for offenders, yet they also have a dual role as a workplace for prison staff. This article explores how the "healthy settings" philosophy, commonly used in schools, applies in the prison environment. The article explores the concept of the health-promoting prison from the perspective of prison staff using semistructured interviews in three English prisons. Data were analyzed using Attride-Stirling's thematic network approach. The findings indicate that working in a prison can be highly stressful and can have a negative impact on physical and mental health. Staff perceived that the focus of health promotion efforts was in many cases exclusively focused on prisoners, and many suggested that prison staff needs were being overlooked. The article argues that the theory and practice of a health-promoting prison have developed rapidly in recent years but still lag behind developments in other organizations. The article suggests that health promotion policy and practice in prison settings may need to be reconfigured to ensure that the needs of all those who live and work there are recognized.

Purpose – 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. Design/methodology/approach – 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. Findings – 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. Practical implications – 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. Originality/value – 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 introduction we give an overview of the main issues and innovations emerging from a very diverse and wide-ranging set of twelve chapters. In particular, the introduction addresses issues of ethical health research within prison settings within the context of the abolitionist/reformist debate relating to prisons. Cumulatively the chapters provide an insight into prison health research within various prison jurisdictions across the UK.

Two decades since the WHO Regional Office for Europe outlined and published a report on health promotion in prison, which stimulated further debate on the concept of the ‘health promoting prison’, this paper discusses the extent to which the concept has translated into practice and the extent to which success has been achieved. This paper primarily focuses on why there has been a gap between the strategic philosophy of health promotion in prison and practical implementation, suggesting that factors such as ‘lifestyle drift’ and public and political opinion have played a part. A further argument is made in relation to the overall commitment of European countries and more broadly WHO in their support of settings-based health promotion in this context. It is proposed that there has been a weakening of commitment over time with a worrying ‘negative trajectory’ of support for health promoting prisons. The paper argues that despite these challenges, the opportunities and potential to address the needs of those who are often most vulnerable and excluded is colossal and acting to tackle this should be a greater priority.

A number of claims have been made regarding the importance of prisoners staying in touch with their family through prison visits, firstly from a humanitarian perspective of enabling family members to see each other, but also regarding the impact of maintaining family ties for successful rehabilitation, reintegration into society and reduced re-offending. This growing evidence base has resulted in increased support by the Prison Service for encouraging the family unit to remain intact during a prisoner’s incarceration. Despite its importance however, there has been a distinct lack of research examining the dynamics of families visiting relatives in prison. This paper explores perceptions of the same event – the visit – from the families’, prisoners’ and prison staffs' viewpoints in a category-B local prison in England. Qualitative data was collected with 30 prisoners’ families, 16 prisoners and 14 prison staff, as part of a broader evaluation of the visitors’ centre. The findings suggest that the three parties frame their perspective of visiting very differently. Prisoners’ families often see visits as an emotional minefield fraught with practical difficulties. Prisoners can view the visit as the highlight of their time in prison and often have many complaints about how visits are handled. Finally, prison staff see visits as potential security breaches and a major organisational operation. The paper addresses the current gap in our understanding of the prison visit and has implications for the Prison Service and wider social policy.

In the introduction we give an overview of the main issues and innovations emerging from a very diverse and wide-ranging set of twelve chapters. In particular, the introduction addresses issues of ethical health research within prison settings within the context of the abolitionist/reformist debate relating to prisons. Cumulatively the chapters provide an insight into prison health research within various prison jurisdictions across the UK.

Purpose: This paper explores the conditions that create a ‘good’ prison visit, focusing on the role that a dedicated third-sector run prison visitors’ centre plays in creating a supportive environment. Design: This paper draws on a synthesis of empirical data gathering conducted over a decade at a voluntary sector managed prison visitors’ centre based at a male prison in Northern England. The paper draws specifically on qualitative data gathered through four independent evaluations of the centre over a ten-year period. Findings: An important point to emerge from the research is the unwavering importance of the prison visit in the life, well-being and regime of a prisoner. Prison visitors’ centre are shown to be an important part of creating positive visits experiences offering a space for composure and for support for families. Originality: Many voluntary sector organisations are unable to commission large research and evaluation studies, but are often able to fund smaller pieces of work. Pooling qualitative evidence from smaller studies is a viable way to potentially strengthen commissioning decisions in this sector.

Objective: The health of the prison population has become an increasing concern, given the disproportionate rates of ill health in this population. Moreover, the challenges faced by prisoners’ families and their children are also becoming more apparent, with prisoners’ children being more likely than other children to experience mental and emotional health problems and more likely to go to prison themselves. Prison visits are an integral part of institutional structures and are a key way by which families stay in contact and mitigate against the negative effects of family separation. This paper focuses particularly on the impact of prison play visits as an alternative to ‘standard’ visiting procedures. Design: Cross-sectional qualitative study. Setting: A male prison in Northern England. Method: Telephone interviews with six prison visitors who had regularly participated in a play visit, plus a focus group with five prisoners. Results: The paper identifies play visits as a useful way to maintain family well-being as they ‘mimic’, albeit temporarily, domestic life. This is reported to be beneficial for future family outcomes and in enabling children to adjust to parental incarceration. Play visits improve levels of intimacy, which is beneficial for the mental and emotional health both of prisoners and their children. Conclusion: The paper argues for a more holistic notion of prisoner health that sees family connections as a key part of supporting health and well-being.

Since the inception of the prison as a ‘setting’ for health promotion, there has been a focus on how the health of those men and women who spend ‘time inside’ can at least be maintained and if possible, enhanced, during their prison sentence. This paper presents findings from a mainly qualitative evaluation of a prison visitors' centre in the UK. It reports experiences of prisoners' families, prisoners, prison staff, the local community and the ways in which the visitors' centre has contributed positively to their health and well-being. In addition, key stakeholders were interviewed to ascertain the role this visitors' centre has in policy frameworks related to re-offending. The findings from this evaluation underscore how the visitors' centre improved the quality of visits, and contributed towards the maintenance of family ties through the help and support it provides for families and prisoners. The paper concludes by suggesting that visitors' centres are an essential part of a modern prison service helping to address the government's health inequalities agenda.

Purpose – 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. Design/methodology/approach – 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. Findings – 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. Practical implications – Prison officers are an essential part of health promoting prisons, but have been relatively ignored in the discussion of how to create healthier prisons. Originality/value – 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.

A number of claims have been made regarding the importance of prisoners staying in touch with their family through prison visits, firstly from a humanitarian perspective of enabling family members to see each other, but also regarding the impact of maintaining family ties for successful rehabilitation, reintegration into society and reduced re-offending. This growing evidence base has resulted in increased support by the Prison Service for encouraging the family unit to remain intact during a prisoner’s incarceration. Despite its importance however, there has been a distinct lack of research examining the dynamics of families visiting relatives in prison. This paper explores perceptions of the same event – the visit – from the families’, prisoners’ and prison staffs' viewpoints in a category-B local prison in England. Qualitative data was collected with 30 prisoners’ families, 16 prisoners and 14 prison staff, as part of a broader evaluation of the visitors’ centre. The findings suggest that the three parties frame their perspective of visiting very differently. Prisoners’ families often see visits as an emotional minefield fraught with practical difficulties. Prisoners can view the visit as the highlight of their time in prison and often have many complaints about how visits are handled. Finally, prison staff see visits as potential security breaches and a major organisational operation. The paper addresses the current gap in our understanding of the prison visit and has implications for the Prison Service and wider social policy.

Children can find the process of visiting a prison traumatic and as a result of parental incarceration may experience a range of adverse outcomes. When children stay in contact with their imprisoned parent through prison visiting, however, this seems to be a protective factor. This paper reports on a play visits service based at Her Majesty's Prison Leeds, UK. The service provides supervised play work provision for children visiting their father. Data were derived from prisoners and prisoners' families and were triangulated as a means of achieving a level of validity. The findings reveal that play visits do produce positive outcomes for children and play visits are effective in maintaining and strengthening family ties. These effects may be stronger when compared to standard prison visits, but further research is needed to confirm this.

The global prison population has grown exponentially in all five continents and consistent analysis shows that many diseases, illnesses and long-term conditions are over-represented in the prison population. Despite the myriad of health challenges in the population, the concept and practice of health promotion is both contested and underdeveloped with significant variation in its application in prison systems globally. The purpose of this commentary paper is twofold. The first is to provide a short overview of the health-promoting prison concept which we argue, at present, is a largely Eurocentric idea which has not been adopted on a global scale. Second, the paper makes a case for more global action on prison health promotion and invites further dialogue and discussion amongst the health promotion community.

Research has shown that prison visits have the potential to improve prisoners’ mental wellbeing, increase social support and reduce the inmate perceived stresses associated with imprisonment. Identifying effective ways to promote the health and well-being of prisoners is important because although they are not a homogeneous group, they often have unhealthy lifestyles and poorer health compared to the wider population. Fazel and Baillargeon suggest that prisoners bear a ‘substantial burden of physical and psychiatric disorders relative to the general population’. In particular, evidence suggests that prisoners experience higher rates of mental health issues including suicide. Improving the health of individuals in the criminal justice system is recognised to be a key element of the reducing reoffending and health inequalities agendas. The determinants of offending are similar to the determinants of health; poor housing, low levels of social capital, stress, substance misuse, low educational attainment. By adopting a social rather than medical model of health, it could be argued that increasing the health of an individual could also potentially be beneficial in terms of reducing re-offending and lead to better rehabilitation outcomes.

This summary presents the main findings of a thematic evaluation on the community health champion role and empowerment, based on data collected from projects being delivered as part of the Altogether Better programme. The aim of this thematic evaluation was to understand how the Altogether Better projects involve community health champions to improve health and to provide robust evidence to inform the development of practice. This summary sets out the main findings from the thematic evaluation and concludes with some implications for policy and practice.

Strategies to reduce the burden of persistent pain in society are rooted in a biomedical paradigm. These strategies are located downstream, managing persistent pain once it has become a problem. Upstream activities that create social conditions to promote health and wellbeing are likely to help, yet health promotion discourse and research is lacking in pain literature. In this article we argue that the subjective nature of pain has not sat comfortably with the objective nature of medical practice. We argue that the dominance of the biomedical paradigm, with a simplistic ‘bottom-up’ model of pain being an inevitable consequence of tissue damage, has been detrimental to the health and well-being of people living with persistent pain. Evidence from neuroscience suggests that bodily pain emerges as perceptual inference based on a wide variety of contextual inputs to the brain. We argue that this supports community, societal and environmental solutions to facilitate whole-person care. We call for more salutogenic orientations to understand how people living with persistent pain can continue to flourish and function with good health. We suggest a need for ‘upstream’ solutions using communitybased approaches to address cultural, environmental, economic, and social determinants of health, guided by principles of equity, civil society, and social justice. As a starting point, we recommend appraising the ways human society appreciates the aetiology, actions, and solutions towards alleviating persistent pain.

Employment is a key determinant of health and is consistent with a range of positive health, social and economic outcomes for individuals and communities. This paper focuses on an innovative skills and employment project undertaken in Leeds, a large metropolitan city in the United Kingdom. It sought to create an employment pathway from the community into hospital-based employment, mirroring theoretical aspects of the health-promoting hospital philosophy, or more broadly a settings approach to health promotion which seeks greater levels of social justice. Using qualitative methodology with key constituents of the programme, the research identified an approach to connecting local communities with paid employment roles in a local hospital. The research focussed on the conception, design and delivery of the programme and has showed the elements required to increase the likelihood of success. This includes providing a bespoke support and tailored intervention package for individuals and strong partnership working between delivery partners and strategic groups. While the focus of the research is not on outcomes, there are examples of instances where individuals had gained employment and skills; increases in confidence; and evidence of the programme raising aspirations for themselves and others.

Background: The voluntary sector has long been recognised as making an important contribution to individual and community health. In the UK, however, the links between primary health care services and the voluntary and community sector are often underdeveloped. Social prescribing is an innovative approach, which aims to promote the use of the voluntary sector within primary health care. Social prescribing involves the creation of referral pathways that allow primary health care patients with non-clinical needs to be directed to local voluntary services and community groups. Such schemes typically use community development workers with local knowledge who are linked to primary health care settings. Social prescribing therefore has the potential to assist individual patients presenting with social needs to access health resources and social support outside of the National Health Service. Aim: The aim of this paper is to explore the concept of social prescribing and discuss its value as a public health initiative embedded within general practice. Methods: The rationale for social prescribing and existing evidence are briefly reviewed. The paper draws on a case study of a pilot social prescribing scheme based in general practice. Data collected during the development, implementation and evaluation of the scheme are used to illustrate the opportunities and limitations for development in UK primary health care. Findings: The potential for social prescribing to provide a mediating mechanism between different sectors and address social need is discussed. The paper argues that social prescribing can successfully extend the boundaries of traditional general practice through bridging the gap between primary health care and the voluntary sector. The potential for wider health gain is critically examined. The paper concludes that social prescribing not only provides a means to alternative support but also acts as a mechanism to strengthen community–professional partnerships. More research is needed on the benefits to patients and professionals.

Objective: This paper reports on a programme which sought to engage individuals and groups who are underrepresented in the UK labour market. The programme aimed to improve access to employment opportunities and provide practical support in job applications. The focus was on encouraging people to seek employment in the health and social care sectors and on tackling health inequalities in the region. Design: Qualitative inquiry. Setting: Leeds, UK. Method: Using focus groups and interviews, the paper explores key learning from the programme and the experience of programme delivery, both from the perspective of the professionals working on the programme and the individuals participating. Results: A co-ordinated strategic partnership where key agencies share common purpose is critical. The value of a localised strategy to engage communities was an important mechanism for success. Targeting schools and businesses provided opportunities to reach individuals who might usually find employment services difficult to access. The programme sought to put people’s aspirations at the heart of delivery, offering choice and tailored opportunities to develop their careers. This could include developing specific skills or raising awareness of potential careers. The programme promoted opportunities by removing barriers in the job application process. A range of positive health outcomes were reported for participants engaging in the programme that require further exploration. Conclusion: Meaningful employment is an important health determinant, but some communities face barriers to employment and consequently find the labour market difficult to access. Findings suggest a range of ways to engage people in meaningful employment and support.

Structural approaches to promoting health focus on policies and practices affecting health at the community level and concentrate on systems and forces of society, including distribution of power, that foster disadvantage and diminish health and well-being. In this paper we advocate consideration of structural approaches to explore macro level influences on the burden of persistent pain on society. We argue that health promotion is an appropriate discipline to ameliorate painogenic environments and that a "settings approach" offers a crucial vehicle to do this. We encourage consideration of socio-ecological frameworks to explore factors affecting human development at individual, interpersonal, organizational, societal, and environmental levels because persistent pain is multifaceted and complex and unlikely to be understood from a single level of analysis. We acknowledge criticisms that the structural approach may appear unachievable due to its heavy reliance on inter-sectoral collaboration. We argue that a settings approach may offer solutions because it straddles "practical" and cross-sectorial forces impacting on the health of people. A healthy settings approach invests in social systems where health is not the primary remit and utilises synergistic action between settings to promote greater health gains. We offer the example of obesogenic environments being a useful concept to develop strategies to tackle childhood obesity in school-settings, community-settings, shops, and sports clubs; and that this settings approach has been more effective than one organisation tackling the issue in isolation. We argue that a settings approach should prove useful for understanding painogenic environments and tackling the burden of persistent pain.

There is a growing policy discourse and empirical evidence which suggests a need for a shift in the way that care is delivered for people with long-term conditions – moving from an expert-driven consultation to one based on collaboration and partnership. Year of Care is an approach to managing long-term conditions, focused on personalised care planning whereby patients work together with the clinician using a collaborative process of shared decision-making to agree goals, identify support needs, develop and implement action plans, and monitor progress. This paper reports the learning from implementing Year of Care in Leeds where nine ‘early adopter’ sites rolled-out the programme. Process and delivery issues are highlighted in the paper, including the challenge of navigating cultural change in General Practice and training and support issues. It is anticipated that this learning and insight will have utility beyond Leeds to other areas adopting greater patient centred care models.

Abstract

This chapter concludes Part VII, with a focus on salutogenesis in prisons. In this chapter, the authors present and debate how prison health rhetoric, policy and practice are influenced by a pathogenic view of prisoner “health.” The authors comment that there is a growing recognition of a salutogenic approach to prison health policy and practice, to help tackle the root causes of health, criminality and inequality. This chapter emphasises that while the health of prisoners is influenced by material and social factors beyond their control, a salutogenic approach offers an alternative way of delivering public health and health promotion in prisons. The chapter concludes noting that the application of salutogenesis in prisons is in its infancy. They call for research, policy and practice framed by a salutogenic orientation, leading to sustained and effective measures to improve the health of people in criminal justice settings, and reducing health inequalities in prisons.

This paper draws from a study, which explored paternal absence through imprisonment and the impact of this on infant emotional wellbeing and mental health. Little evidence exists to demonstrate the impact of a father’s imprisonment on infant involvement, attachment relationships and the consequences of such separation for both infant and father. A scoping study, synthesising literature gathered from a range of academic sources, allowed for exploration of key concepts and clarification of pertinent themes in this relatively under-studied area. Findings suggest that maintaining father involvement whilst in prison is vital in promoting and maintaining positive infant mental health and that the health visitor is well placed to play a pivotal role in supporting the families of those within the criminal justice system.

The definitive text on health promotion, this book covers both the knowledge-base and the process of planning, implementing and evaluating successful health promotion programmes.

There is renewed optimism about the development of policy and practices related to promoting health in prison settings, driven by the epidemiological data which suggests that the health of people in prison remains very poor. In England and Wales, the focus of this paper, independent prison inspections, conducted by Her Majesty’s Inspectorate of Prisons for England and Wales (HMIP), form a critical element in how prisons are assessed. This includes efforts within prisons to promote health and well-being. This paper, using content and thematic analysis, analyses one year (2018) of inspection reports in 38 male prisons. Analysis demonstrates that a ‘whole-prison approach’ to promoting health and well-being is poorly understood, with only 41% of prisons showing characteristics of this approach. Of the male prisons inspected in 2018, there was good availability of disease prevention activities and screening programmes (88%) and smoking cessation support (94%). The provision of peer support mechanisms, access to condoms and access to health information was highly-variable across prisons. The paper makes several conclusions about the state of health promotion in prison and moreover the current criteria adopted by HMIP to assess health and well-being which seems to offer a very narrow biomedical perspective.

This paper seeks to critically discuss the current state of health promotion, arguing that ambiguity remains in its conceptual foundation, practice and education which is contributing to its decline in several parts of the world. Drawing on relevant literature, the paper re-examines the status of health promotion as a specialist discipline in its own right and suggests that the reaffirmation of this status can move health promotion from the margins to the mainstream of public health policy and practice. The paper briefly rehearses some common conceptualisations of health promotion before suggesting four tensions which, if resolved, could offer greater conceptual clarity and galvanise the contribution of the discipline in addressing individual and community health across the globe.

Aims: Local authorities in England are responsible for public health and health promotion. This article sought to explore how research and decision-making co-exist in a local authority in England. Methods: An Embedded Researcher was based within the local authority and used qualitative methodology to address the research aim. Interviews and focus groups were employed to ascertain a range of stakeholder views in the local authority. All transcripts were coded on NVivo 12 by the Embedded Researcher and two members of the research team cross-checked a sample for coding accuracy. Data were analysed using framework analysis. Results: The data suggest several barriers to using research to inform decision-making in health promotion and public health. The study shows that research is valued in local authorities, but not always privileged – this is due to cultural factors and practical political reasons which often means that decisions need to be made expediently. Participants outlined a juxtaposition between academic credibility; timeliness to complete the research and the financial cost associated with it; against the independence and credibility that independent academics could bring. Conclusion: Policy formulation and delivery is an integral aspect of health promotion and critical to achieving improved population health and reductions in health inequalities. However, there exists tensions between gathering research evidence and making research-informed decisions. The article concludes by advocating the use of Embedded Researchers to fully understand how research is gathered and used to support public health and health promotion policymaking.

Background Local government has become a key constituent for addressing health inequalities and influencing the health of individuals and communities in England. Lauded as an effective approach to tackle the multiple determinants of health, there are concerns that generating and utilising research evidence to inform decision-making and action is a challenge. This research was conducted in a local authority situated in the north of England and addressed the research question – ‘What is the capacity to collaborate and deliver research?’. The study explored the assets that exist to foster a stronger research culture, identified barriers and opportunities for developing research capacity, and how a sustainable research system could be developed to impact on local residents’ health and reduce health inequalities. Methods This was a qualitative study utilising semi-structured interviews and focus groups. The study used an embedded researcher (ER) who was digitally embedded within the local authority for four months to conduct the data collection. Senior Managers were purposively sampled from across the local authority to take part in interviews. Three focus groups included representation from across the local authority. Framework analysis was conducted to develop the themes which were informed by the Research Capacity Development framework. Results Tensions between research led decision making and the political and cultural context of local government were identified as a barrier to developing research which addressed health inequalities. Research was not prioritised through an organisational strategy and was led sporadically by research active employees. A recognition across leaders that a culture shift to an organisation which used research evidence to develop policy and commission services was needed. Building relationships and infrastructure across local government, place-based collaborators and academic institutions was required. The embedded researcher approach is one method of developing these relationships. The study identifies the strengths and assets that are embedded in the organisational make-up and the potential areas for development. Conclusion Research leadership is required in local government to create a culture of evidence-based principles and policy. The embedded research model has high utility in gaining depth of information and recognising contextual and local factors which would support research capacity development.

Objectives: Gambling is a public health concern, given the multiplicity of harms for individuals, families and communities. This paper reports on the commissioning and delivery of a problem gambling treatment service in a metropolitan area in England where the concentration of problem gambling is often higher than the national average. Study design: A cross-sectional study, using purposively sampled ‘experts’ and stakeholders involved in the conception and set-up of the service. Methods: Individual semi-structured interviews were used to ascertain the depth of information required to fully appreciate the nuances and complexities of the service. Eight participants took part in the interviews with an additional respondent providing written comments in relation to the interview schedule as a workaround to accommodate the organisational impacts of Covid-19. Results: The paper identifies several factors contributing to the successful delivery of the service. Well-managed collaborative provision with expertise from across sectors is critical, but this needs to be balanced against the challenges faced by bridging cultural variances in practice and language. Adopting evidence-based models of delivery was central to practice and moreover geographical location is a key consideration to encourage access for those facing gambling problems and discourage feelings of stigma. Conclusions: This paper offers a unique contribution to understanding more about the provision of gambling treatment services. This is crucial given that greater numbers of people face challenges as a consequence of gambling harms and such services should be seen part of forming a coherent public health response.

Background: The Scottish Prison Service (SPS) has been long regarded for its progressive policy approach to health promotion in prison. It is one of the few countries with a strategic plan for health promotion implementation. Given the paucity of understanding in relation to the concept of a health promoting prison, this study assessed routinely collected prison inspection data to understand and distil learning in regard the practical implementation of health-promoting prisons. Methods: Her Majesty's Chief Inspector of Prisons for Scotland (HMIPS) oversees the independent inspection of all prisons. This desk-based study analysed openly accessible inspection reports from a public repository. The sample was limited to inspection reports using the 2018 revised Standards to ensure comparability between reports. Eight unique inspection reports meeting this criterion were downloaded between January and October 2020. The prisons had their inspections undertaken between May 2018 and January 2020. Data from the reports which focused on ‘health and wellbeing’ were inductively coded using NVivo 12 to support thematic analysis. Results: Results are presented against the values and principles outlined in the SPS’ own framework for promoting health in prison. All of the institution reports contained evidence of fairness and justice in their prison and understandings of health inequalities were recognised by staff. There were also examples of mutual (peer) support between people in prison; good relationships between staff and prisoners; and strong health promotion leadership. Conversely, some environmental conditions hindered the development of health promotion – this included staffing shortages and some practices fostering health inequity. Even where a prison was reported as having health promotion activities in place these were focused on a narrow range of individual risk factors such as smoking cessation or substance misuse. Far less attention was paid to wider health determinants. Conclusions: Scotland has been at the forefront of attempts to embed a health promoting prison philosophy in their justice system. Inspection data focusing on ‘health and wellbeing’ were analysed, but the analysis suggests that more could be done to ensure a health promoting setting. The way prisons inspectors are assessing health and wellbeing in particular areas is very narrow, with the focus exclusively on healthcare without a wider appreciation of how other areas of prison life can impact.

The second edition of this popular introductory textbook has been fully revised to provide a totally up-to-date guide to the practical aspects of promoting health. Focusing on the range of skills needed to become an effective practitioner, it takes readers step-by-step through the different settings in which health promotion takes place, and the various tools they might employ. The book offers accessible and comprehensive coverage of all the key topics in contemporary health promotion, including chapters on health promotion through the lifespan, one-to-one communication, working with groups, using the media and digital technologies, advocacy, and planning and management. As well as incorporating the most recent government policies and initiatives in public health, the new edition draws on the very latest literature and statistics. In particular, there is new and expanded material on issues such as: community initiatives and social capital; novel resources offered by digital technologies; health literacy; health in the media; stress in the workplace, and much more. Throughout the text there are activities to develop students’ understanding and encourage reflective practice. Each chapter opens with a list of the central issues and learning objectives, and key terms highlighted in the text are clearly explained. Carefully chosen figures and photographs enliven and reinforce the text, while a well-designed website (www.politybooks.com/healthpromotion) offers up-to-date online resources to test and extend students’ learning. The new edition of Practical Health Promotion will continue to be the ideal and indispensable practical guide to health promotion for students at all levels. It will inspire anyone involved with health care to find practical ways of promoting positive change.

Objectives Although local politicians (councillors) in England are key decision-makers in relation to local services, little is known about how they use evidence in making decisions pertaining to the wider determinants of health. The setting-up of 30 Health Determinants Research Collaborations (HDRCs), commissioned to increase the capability and capacity of local authorities to use research and other evidence, provides an opportunity to plug this knowledge gap. Study design A qualitative reflection on our initial experiences of working with councillors in one HDRC. Methods We critically reflect on these interactions to extract wider learning that will be of interest to researchers and practitioners in local authorities and potentially research funders. We develop a continuum of interactions with councillors in the HDRC based on our experiences. Results Organisational positionality plays a crucial role in shaping research interactions and outcomes. By focusing on existing practices, preferences, and strengths, researchers can move beyond the deficit models that often dominate academic discourse. Engaging with councillors is rarely a linear process; it demands parallel approaches and a high degree of adaptability. Researchers must also remain attentive to both the challenges and opportunities presented by organisational structures and electoral cycles. In this context, mixed-methods research demonstrates resilience, accommodating the varied levels of engagement and involvement among councillors. Conclusions We conclude from these experiences that research with councillors and building their capability to use research evidence in their work requires sustained, flexible, and relational approaches that are responsive to the political and organisational realities of local government.

Recent evidence suggests that school nurses are best placed to raise awareness and support families affected by paternal imprisonment. Less emphasis has been placed on health visitor practice in working with and supporting families with children under the age of five involved in the criminal justice system and yet professionals working in the area offer a potential in addressing the needs of these families. Through presenting findings from a review of the literature undertaken to explore the impact of father imprisonment on infant mental health, this paper seeks to discuss emerging findings from the current evidence-base.

The aim of this evidence review is to capture the impact that community health champion work, and that of those in similar roles, has for older people. This includes older people who become community health champions and older people in communities (programme beneficiaries) who are supported by community health champions. The evidence for older people working in lay public health roles presented in this report is derived from three primary sources: *A rapid review of the evidence in relation to older people and lay public health roles; *A summary of key themes emerging from the data collected with older people during a thematic evaluation of community health champions in Yorkshire and Humberside produced for Altogether Better; *Analysis and synthesis of monitoring and evaluation data produced by Altogether Better’s older people’s projects.

Through qualitative exploration with soon-to-be released men in three prisons in England, this article examines the difficulties that prisoners envisage on returning back to community settings, entering other settings such as workplaces, and the implications the transition may have for their health. Interviews and focus groups were conducted with 36 prisoners, some of whom were convicted of sexual offences and based on a vulnerable prisoner unit. While not all prisoners offered the information, approximately two-thirds of the sample had offended previously. The transition that individuals make from the prison setting to the community can be potentially complex and often detrimental to health. Accommodation issues were forecast as a major concern for those men without family ties. Temporarily residing with friends or living in hostel residences were viable options for many prisoners, but both had drawbacks which could increase the probability of engaging in substance misuse. Resettlement issues were perceived to be more difficult for sex-offenders; their ‘identity’ provided an additional burden which created further reintegration difficulties. Employment opportunities, for example, were predicted to be drastically reduced as the men had signed the sex-offenders’ register. This article suggests that opportunities for successful transition could be enhanced by a more ‘joined-up’ settings perspective and proposes that a settings-based approach to health promotion, which emphasises the synergy between social settings and addressing wider determinants of health, should be applied to prisons to reduce, rather than exacerbate, inequalities.

The 'health-promoting prison' has been informed by a broader settings-based philosophy to health promotion which conceptualizes health as the responsibility for all social settings. Though in its relative infancy, the notion of a health-promoting prison has gained political backing from international organizations like the World Health Organization, but the implementation of the policy rhetoric has not translated across all prison environments. The aim of this paper is to consider how key elements of health promotion discourse-choice, control and implicitly, empowerment-can apply in the context of imprisonment. These concepts were examined in three category-C (secure) prisons in England, through interviews with 36 male prisoners and 19 prison staff conducted by the first author. Analysis showed that prisoners negotiated the norms, structures and strictures of prison life by both relinquishing control and also by taking control, showing resistance and exercising some element of choice. The paradox is that, as most prisoners are expected to be released at some point they need to exercise some agency, control and choice, but these learning experiences may be constrained whilst 'inside'. The paper argues that if a settings approach in prison is truly to move forward, both conceptually and practically, then health promoters should seek to embed the key values of health promotion within the prison setting.

The majority of prisoners are drawn from deprived circumstances with a range of health and social needs. The current focus within ‘prison health’ does not, and cannot, given its predominant medical model, adequately address the current health and well-being needs of offenders. Adopting a social model of health is more likely to address the wide range of health issues faced by offenders and thus lead to better rehabilitation outcomes. At the same time, broader action at governmental level is required to address the social determinants of health (poverty, unemployment and educational attainment) that marginalise populations and increase the likelihood of criminal activities. Within prison, there is more that can be done to promote prisoners’ health if a move away from a solely curative, medical model is facilitated, towards a preventive perspective designed to promote positive health. Here, we use the Ottawa Charter for health promotion to frame public health and health promotion within prisons and to set out a challenging agenda that would make health a priority for everyone, not just ‘health’ staff, within the prison setting. A series of outcomes under each of the five action areas of the Charter offers a plan of action, showing how each can improve health. We also go further than the Ottawa Charter, to comment on how the values of emancipatory health promotion need to permeate prison health discourse, along with the concept of salutogenesis.

The health needs of women in sub-Saharan African prisons are both neglected and poorly understood. Outside South Africa, little research exists on African prison health; what is available tends to be gender-blind and concerned with disease prevention rather than with health promotion. While Vetten (2008) has raised this concern previously, a comprehensive overview of women’s health and health promotion in African jails is clearly absent. Available evidence shows that the conditions in African prisons are harmful to health, justifying a need for a health promoting prisons agenda rooted in the needs of sub-Saharan Africa. Women prisoners have significant mental and physical health needs, and international conventions on health care are not being respected globally. The health promoting prison concept has considerable attention in the Global North, with a commitment to equivalence of health care, gender sensitivity and to prisoners’ social as well as health needs. This article provides an opportunity for critical reflection on women’s health in prison, shows the lack of research in this area, questions the suitability of the health promoting prisons’ agenda for sub-Saharan Africa, draws on our limited experience of the women’s prison in Lusaka, Zambia, and produces recommendations to tackle women’s health and wellbeing needs within the criminal justice systems of sub-Saharan Africa.

Objectives: There has been an increased focus in policy discourse on individuals with severe, multiple and complex needs. This paper seeks to understand how best to enable these individuals to take greater control of their health. Design: Qualitative, user-led, peer research Setting: Large urban UK city. Method: Trained peer researchers with previous experience of severe and multiple disadvantage gathered data using a snowball sampling approach from 21 individuals engaged in a service specifically designed to provide for their needs. Results: The study identified enabling factors that create conditions for individuals with severe and multiple disadvantage to take greater control of factors impacting on their health and social situations. These included working holistically with individuals, understanding the interconnected issues impacting on health, developing trusting relationships with professionals and working within a positive framework that fosters self-belief and is focused on salutogenesis rather than pathogenesis. Conclusion: There exists a set of enabling factors that may support individuals facing particular challenges in their lives. While derived from within a specific geographical context, findings have relevance to other settings in relation to ways of working. Peer research demonstrates itself to be a research approach well suited to understanding lived experiences.

Peer interventions delivered for prisoners by prisoners offer a means to improve health and reduce risk factors for this population. The variety of peer programs poses challenges for synthesizing evidence. This paper presents a typology developed as part of a systematic review of peer interventions in prison settings. Peer interventions are grouped into four modes: peer education, peer support, peer mentoring and bridging roles, with the addition of a number of specific interventions identified through the review process. The paper discusses the different modes of peer delivery with reference to a wider health promotion literature on the value of social influence and support. In conclusion, the typology offers a framework for developing the evidence base across a diverse field of practice in correctional health care.

Empowerment is core to health promotion however, there is a lack of consensus in the wider literature as to how to define it and at what level it may occur. Definitional inconsistency inevitably leads to challenges in measuring empowerment yet, if it is as important as is claimed this must be addressed. This paper discusses the complexities of measuring empowerment and puts forward a number of recommendations for researchers and policy makers as to how this can be achieved noting some of the tensions that may arise between theoretical considerations, research and practice. We argue that empowerment is a culturally and socially defined construct and that this should be taken into account in attempts to measure it. Finally we conclude that, in order to build up the evidence base for empowerment, there is a need for research clearly defining what it is and how it is being measured.

Background: Evidence of the effectiveness of social prescribing is inconclusive causing commissioning challenges. This research focusses on a social prescribing scheme in Northern England which deploys ‘Wellbeing Coordinators’ who offer support to individuals, providing advice on local groups and services in their community. The research sought to understand the outcomes of the service and, in addition, the processes which supported delivery. Methods: Quantitative data was gathered from service users at the point they entered the service and also at the point they exited. Qualitative interviews were also undertaken with service users to gather further understanding of the service and any positive or negative outcomes achieved. In addition, a focus group discussion was also conducted with members of social prescribing staff to ascertain their perspectives of the service both from an operational and strategic perspective. Results: In total, 342 participants provided complete wellbeing data at baseline and post stage and 26 semi-structured qualitative interviews were carried out. Improvements in participants’ well-being, and perceived levels of health and social connectedness as well as reductions in anxiety was demonstrated. In many cases, the social prescribing service had enabled individuals to have a more positive and optimistic view of their life often through offering opportunities to engage in a range of hobbies and activities in the local community. The data on reductions in future access to primary care was inconclusive. Some evidence was found to show that men may have greater benefit from social prescribing than women. Some of the processes which increased the likelihood of success on the social prescribing scheme included the sustained and flexible relationship between the service user and the Wellbeing Coordinator and a strong and vibrant voluntary and community sector. Conclusions: Social prescribing has the potential to address the health and social needs of individuals and communities. This research has shown a range of positive outcomes as a result of service users engaging with the service. Social prescribing should be conceptualised as one way to support primary care and tackle unmet needs.

In this perspective article we advocate community-based system change for people living with persistent pain. Our view is that greater use of the voluntary and community sector, in partnership with the clinical sector, creates the conditions for a “whole person” approach to pain management, leading to greater personalised care for adults living with long-term pain whilst having the potential to ease some of the pressures on General Practitioners and other clinical services. We advocate pain care that is socially connected, meaningful within socio-cultural contexts and aligned with the principles of salutogenesis. We provide an example of a UK National Health Service (NHS) commissioned pain service called “Rethinking Pain” that operationalises this perspective. Led by the voluntary and community sector, Rethinking Pain works in partnership with the clinical sector to provide a central holistic pathway of care for people experiencing persistent pain. This is the first time that this model of care has been commissioned for persistent pain in this area of England. The Rethinking Pain service is underpinned by core values to work with people to manage their pain holistically. The Rethinking Pain team proactively engage with people in the community, actively approaching and engaging those who experience the biggest health inequalities. In this article we provide an overview of the context of pain services in the UK, the rationale and supporting evidence for community-based system change, and the context, pathway, values, goals, and aspirations of the Rethinking Pain service.

Health Promotion Ethics: A Framework for Social Justice critically considers the ethical dimensions of promoting health with individuals and communities, encouraging a nuanced understanding of health promotion in the context of fairness, empowerment and social justice. The concept of social justice, indeed, is central. The book explores how health promotion should be considered in relation to moral, social and legal issues, from individual responsibility to government intervention, as well as the possibility that existing practice maintains rather than alleviates existing health inequalities by stigmatising certain groups. It also questions the 'rights' of those who promote health to use particular strategies, for example using fear to encourage behaviour change. The ethics of health promotion practice and research are considered, introducing several important debates. Case studies, international material and opportunities to reflect on practice are used throughout to bring the important issues under discussion to life, engaging both students and practitioners alike. The book provides a fascinating route to reflect on what it really means to promote health for all in a more equitable way.

AIMS: The contribution that lay people can make to the public health agenda is being increasingly recognised in research and policy literature. This paper examines the role of lay workers (referred to as 'community health champions') involved in community projects delivered by Altogether Better across Yorkshire and Humber. The aim of the paper is to describe key features of the community health champion approach and to examine the evidence that this type of intervention can have an impact on health. METHODS: A qualitative approach was taken to the evaluation, with two strands to gathering evidence: interviews conducted with different stakeholder groups including project leads, key partners from community and statutory sectors and community workers, plus two participatory workshops to gather the views of community health champions. Seven projects (from a possible 12) were identified to be involved in the evaluation. Those projects that allowed the evaluation team to explore fully the champion role (training, infrastructure, etc.) and how that works in practice as a mechanism for empowerment were selected. In total, 29 semi-structured interviews were conducted with project staff and partners, and 30 champions, varying in terms of age, gender, ethnicity and disability, took part in the workshops. RESULTS: Becoming a community health champion has health benefits such as increased self-esteem and confidence and improved well-being. For some champions, this was the start of a journey to other opportunities such as education or paid employment. There were many examples of the influence of champions extending to the wider community of family, friends and neighbours, including helping to support people to take part in community life. Champions recognised the value of connecting people through social networks, group activities, and linking people into services and the impact that that had on health and well-being. Project staff and partners also recognised that champions were promoting social cohesiveness and helping to integrate people into their community. CONCLUSIONS: The recent public health White Paper suggested that the Altogether Better programme is improving individual and community health as well as increasing social capital, voluntary activity and wider civic participation. This evaluation supports this statement and suggests that the community health champion role can be a catalyst for change for both individuals and communities.

Background Despite literature recognising the huge potential of co-production as a positive approach to evidence creation, there is a dearth of evidence about how co-production principles can problematise knowledge exchange, specifically in evaluation work. Aims To critically examine 3 evaluation projects commissioned by voluntary sector stakeholders to illustrate challenges in knowledge exchange linked to the co-production of evidence exchange. Methods We critically compare the challenges experienced in co-producing evidence across 3 evaluations, reflecting on power dynamics, co-productive ways of working and emotions, which all impact upon successful knowledge exchange. Findings In project 1, internal monitoring data required for reporting was not shared. In project 2, the commissioners’ need to evidence success resulted in limited knowledge sharing, with valuable learning about partnership issues and service delivery held internally. In project 3, evidence demonstrating the failure of a local authority model of area management for community members was partially discredited by statutory stakeholders (state actors). Discussion and conclusions Bias in evaluation reporting and academic publication can arise from current knowledge exchange processes, including co-production. Voluntary sector funding is problematic as stakeholders delivering programmes also commission evaluations. Knowledge exchange is influenced by vested interests arising from the political context in which data is gathered. Evaluators can face aggression, challenge and unfair treatment resulting in damaged relationships, and failures in knowledge exchange. The emotional elements of knowledge exchange remain under-reported. Varying and shifting power dynamics also limit knowledge exchange. Changing research practice, to support power sharing needs further exploration to facilitate improved knowledge exchange.

Purpose: A proportion of the working age population in the UK experience mental health conditions, with this group often facing significant challenges to retain their employment. As part of a broader political commitment to health and well-being at work, the use of job retention services have become part of a suite of interventions designed to support both employers and employees. While rigorous assessment of job retention programmes are lacking, this paper examines the success of, and distils learning from, a job retention service in England. Design/methodology/approach A qualitative methodology was adopted for this research with semi-structured interviews considered an appropriate method to illuminate key issues. Twenty eight individuals were interviewed, including current and former service users, referrers, employers and job retention staff. Findings Without the support of the job retention service, employees with mental health conditions were reported to have been unlikely to have maintained their employment status. Additional benefits were also reported, including improved mental health outcomes and impacts on individuals’ personal life. Employers also reported positive benefits in engaging with the job retention service, including feeling better able to offer appropriate solutions that were mutually accepted to the employee and the organisation. Originality/value Job retention programmes are under researched and little is known about their effectiveness and the mechanisms that support individuals at work with mental health conditions. This study adds to the existing evidence and suggests that such interventions are promising in supporting employees and employers.

Background: Local authorities in England are ideally placed to address the social determinants of health in the communities they serve. An evidence-led approach to developing programmes and policies to tackle determinants of health is critical to ensuring outcomes are attained and resources are used appropriately. Previous studies though suggest that local authorities do not always use evidence consistently in their decision-making processes. This paper seeks therefore to explore perceived research capability and capacity across one local authority in northern England to understand how research influences policy and practice. Methods: A qualitative exploration of 29 leaders and managers across the local authority, representing the four directorates of the organisation, was obtained to gain an overall understanding of research capacity and capability. Data were analysed thematically with eight overarching thematic categories derived. Results: The capacity and capability for research across the local authority directorates varied. Some participants described departments within directorates as being research active where research was part of their core business. Conversely, some departments were engaged in front-line service delivery where research was not prioritised. In these areas there was a disconnect between daily working practices and research. Staff in these departments generally lacked skills and training in research, whereas those in research active areas often had professional training where research was incorporated. There was rarely a shared definition of research by participants and ambiguity in what constituted research was common. The local authority was perceived to gather lots of data, but this was often used very functionally to fulfil reporting obligations. Curiosity to explore data was often minimised due to work pressures. Links from local authority staff to democratically elected officials varied and research and evidence was not always routinely presented. The majority of participants recognised that reforming ways of working and developing a clear training offer around research would be beneficial to addressing health outcomes. Conclusions: Data demonstrated variance between research practice, partnerships and culture in departments where space for intellectual curiosity was tempered by service demands. There were exceptions to this, where departmental views of research were positive and leaders valued the research-informed culture.

Background Women in prison have comparatively greater health needs than men, often compounded by structures and policies within the prison system. The notion of a ‘health-promoting’ prison is a concept which has been put forward to address health inequalities and health deterioration in prisons. It has, however, not been fully discussed in relation to women in prison. The paper aims to distil the learning and evidence in relation to health promotion in female prisons using prison inspection reports of women’s prisons in England and Wales. Methods Prison inspection reports are one way of ascertaining the contemporary situation in prisons. Prison inspections are often unannounced and use a myriad of methods to draw conclusions around various aspects of prison life. Thirteen prison inspection reports were analysed thematically focusing on health promotion within the institutions. Two analysts conducted the work using NVivo 12. Results Five core thematic areas were identified during the analysis of the reports. Saliently, a joined-up approach to health promotion was not a common feature in the prisons and indeed the focus tended to be on screening and ‘lifestyle issues’ rather than a concern for the underlying determinants of health. There was often an absence of a strategic approach to health promotion. There were some good examples of the democratic inclusion of women in prison in shaping services, but this was not widespread and often tokenistic. There were some examples of inequity and the inspection reports from a small number of institutions, illustrated that the health needs of some women remained unmet. Conclusions The paper suggests that there is potentially some work before conditions in women’s prisons could be described as ‘health-promoting’, although there are some examples of individual prisons demonstrating good practice. The health promoting prison movement has, implicitly at least, focused on the needs of men in prison and this has been to the exclusion of the female prison population. This does lead to several challenges and the potential for exacerbating health challenges faced by an already marginalised and vulnerable group. Greater focus on the health promotion needs of women in prison is required.

This study contributes to ongoing reflections and debate on the legacy of the Ottawa Charter by illustrating how contemporary forms of intersectoral collaboration can be mobilised to address persistent health inequalities. Collaborations involving organisations from diverse sectors are often viewed as well-positioned to tackle complex health challenges, yet they frequently encounter political, organisational and cultural barriers that hinder their effectiveness. This paper uses a longitudinal approach to explore issues in relation to the formation and sustainability of a multi-sector collaboration in one geographic area in the UK, working under the banner of the Health Determinants Research Collaboration (HDRC) – a programme which seeks to further understand health determinants and to improve health outcomes in communities. Through qualitative interviews at two time points – 12 months apart – with constituents of the collaboration, the data demonstrated a clear and shared vision for the collaboration and a neat ‘dovetailing’ of skill-sets related to community brokerage; academic rigour; and statutory legitimacy. While the collaboration under focus here was in its infancy, cultural and practical tensions in ways of working; trust issues; pace of working; and philosophy were predicted to, and indeed did, emerge and required careful monitoring to ensure intended outcomes were not derailed.

Although there is existing evidence on what works to treat burnout and work-related stress, there is less on what works to prevent it from occurring in the first place. This report provides an overview of literature covering how to prevent burnout and work-related stress in individuals and within organisations.

Background Peer interventions involving prisoners in delivering peer education and peer support in a prison setting can address health need and add capacity for health services operating in this setting. This paper reports on a qualitative synthesis conducted as part of a systematic review of prison-based peer interventions. One of the review questions aimed to investigate the positive and negative impacts of delivering peer interventions within prison settings. This covered organisational and process issues relating to peer interventions, including prisoner and staff views. Methods A qualitative synthesis of qualitative and mixed method studies was undertaken. The overall study design comprised a systematic review involving searching, study selection, data extraction and validity assessment. Studies reporting interventions with prisoners or ex-prisoners delivering education or support to prisoners resident in any type of prison or young offender institution, all ages, male and female, were included. A thematic synthesis was undertaken with a subset of studies reporting qualitative data (n=33). This involved free coding of text reporting qualitative findings to develop a set of codes, which were then grouped into thematic categories and mapped back to the review question. Results Themes on process issues and wider impacts were grouped into four thematic categories: peer recruitment training and support; organisational support; prisoner relationships; prison life. There was consistent qualitative evidence on the need for organisational support within the prison to ensure smooth implementation and on managing security risks when prisoners were involved in service delivery. A suite of factors affecting the delivery of peer interventions and the wider organisation of prison life were identified. Alongside reported benefits of peer delivery, some reasons for non-utilisation of services by other prisoners were found. There was weak qualitative evidence on wider impacts on the prison system, including better communication between staff and prisoners. Gaps in evidence were identified. Conclusions The quality of included studies limited the strength of the conclusions. The main conclusion is that peer interventions cannot be seen as independent of prison life and health services need to work in partnership with prison services to deliver peer interventions. More research is needed on long-term impacts.

Purpose: Formalised support services for prisoners that rely on peer methods of delivery show promising health and social outcomes but there is also conjecture that negative effects, both at an individual and organisational level, can occur. Design/methodology/approach: Individuals with recognised professional expertise from various sectors (including ex-prisoners) were invited to contribute to an expert symposium to share their perceptions of the positive and negative effects of peer interventions in prison. Discussions and debate were audio recorded with the consent of all delegates and verbatim transcripts were analysed using Framework Analysis. Findings: According to the participants, peer interventions in the prison setting created both positive and negative impacts. It was clear from the evidence gathered that peer interventions in prisons can impact positively on health outcomes, but these effects were perceived to be more well-defined for peer deliverers. The notion that peer deliverers can be subjected to ‘burnout’ suggests that supervisory processes for peer workers need to be considered carefully in order to avoid the intervention from being counter-productive. Organizationally, one of the salient issues was the adverse effects that peer interventions cause to the security of the prison. Originality/value: To our knowledge, this is the first time an expert symposium has been conducted to specifically examine peer interventions in prison and to consider the effects, both positive and negative, of such schemes.

Purpose: This paper assesses the effectiveness of a toothbrushing intervention delivered in primary schools in Yorkshire and the Humber, a Northern district of England. The toothbrushing intervention was designed with the intention of improving the oral health of young children. The paper reports the effectiveness of the intervention and explores process issues related to its co-ordination and delivery. Design/methodology/approach: The evaluation had three data gathering approaches. These were: in-depth case studies of three selected schools participating in the toothbrushing programme; interviews with oral health programme leads; and a small scale questionnaire based survey which was sent to the 18 schools participating in the intervention. Findings: The intervention was accepted by children and they enjoyed participating in the toothbrushing scheme. Moreover, children had often become more knowledgeable about toothbrusing and the consequences of not regularly cleaning their teeth. The scheme was contingent on key staff in the school and the programme was more successful where school’s embraced, rather than rejected the notion of improving children’s health alongside educational attainment. Whether the intervention made differences to brushing in the home requires further investigation, but there is a possibility that children can act as positive ‘change agents’ with siblings and other family members. Practical implications: This paper suggests that schools can be an effective setting for implementing toothbrushing interventions. Originality/value: Toothbrushing in schools programmes are a relatively new initiative that have not been fully explored, especially using qualitative approaches or focussing on the views of children. This paper makes a particular contribution to understanding the process and delivery of toothbrushing interventions delivered in primary schools. The implications for programmes outside of the UK context are discussed.

Epidemiological assessment of the prison population globally shows undeniable health need, with research evidence consistently demonstrating that the prevalence of ill health is higher than rates reported in the wider community. Since a meeting convened by the World Health Organisation in the mid-1990s, prisons have been regarded as legitimate settings for health promotion and a myriad of interventions have been adopted to address prisoners’ health and social need. Peer-based approaches have been a common health intervention used within the prison system, but despite their popularity little evidence exists on the approach. This paper presents findings from an expert symposium – part of a wider study which included a systematic review – designed to gather expert opinion on whether and how peer–based approaches work within prisons and if they can contribute to improving the health of prisoners. Experts were selected from various fields including the prison service, academic research and third sector organisations. Expert evidence suggested that the magnitude of success of peer interventions in prison settings is contingent on understanding the contextual environment and a recognition that peer interventions are co-constructed with prison staff at all levels of the organisation. Implications for developing peer-based interventions in prison are given which assist in developing the concept, theory and practice of the health promoting prison.

This paper explores the qualitative perspectives of women about a community embedded fathers initiative in Northern England. Projects to improve the wellbeing of men and their children are less common within the landscape of parent and child support, with mothers more often being the target recipients. Asking women about their perceptions of an initiative for fathers then offers original insights from women who are positioned as ‘related outsiders’, in that they were ‘outside’ the project but ‘inside’ the family and community. Findings suggest that women are able to see the positive impact of such a project, identifying that it offers a shared space for men and children, time for mothers without their children and can help with shifting roles and attitudes around child care and emotional labour in the home. The initiative was also seen by the women as offering men more healthy means of coping, including men moving away from traditional hegemonic practices, which in turn shifted some women’s long held gendered beliefs about men as fathers. This research then offers a relational gendered backstory to a father’s initiative, demonstrating how such initiatives can potentially ‘undo’ gender and the positive implications this could have for families.

There have been concerns about the decline of health promotion as a practice and discipline and alongside this, calls for a clearer articulation of health promotion research and what, if anything, makes it distinct. This discussion paper, based on a review of the literature; the authors’ own experiences in the field; and a workshop delivered by two of the authors at the 8th Nordic Health Promotion Conference, seeks to state the reasons why health promotion research is distinctive. While by no means exhaustive, the paper suggests four distinctive features. The paper hopes to be a catalyst to enable health promotion researchers to be explicit in their practice and to begin the process of developing an agreed set of research principles.

Introduction Public Health England (PHE) carried out a consultation exercise with its People’s Panel, a group of approximately 1000 lay members who regularly participate in engagement exercises with the organisation. The aim of the consultation was to find out what members of the public think the public health system can do to put communities at the heart of public health. Method An online survey was designed by PHE. Questions covered demographics and five open questions. Members of the People’s Panel were invited to complete the survey. Data were coded and analysed thematically by Leeds Beckett University. Results In total, 342 respondents completed the survey (female, 70.5%; 55 years or over, 66.6%). Three quarters (75.7%) of respondents were members or part of social/ neighbourhood/ sports/ volunteer/ political/ faith-based/ community groups. Respondents reported that public sector organisations could best support communities and encourage involvement by: understanding local needs and priorities; raising awareness of existing provision as well as providing inclusive activities and better infrastructure. Factors considered to get in the way of or weaken community strengths and vitality included: austerity; disengagement; social isolation; political will; no ‘heart’ to the community; poor communication; and crime and anti-social behaviour. Suggestions for improvement were provided. Conclusion For the health system to put communities at the heart of public health, lay members feel more ‘local thinking’ surrounding co-production and shared decision making is needed. Improvements to communication/ information sharing within the health system as well as the promotion of the social model of health are suggested. Funders This work was funded by Public Health England

People struggle to tell their story of living with pain and when they do it is articulated in a way that may not be understood, heard or taken seriously. Unmasking Pain is an artist-led project that explored creative approaches to tell stories of life with pain. The project was led by a dance theatre company that specialises in storytelling and emotional experiences for players and audiences. The project involved artists and people living with ongoing pain co-creating activities and environments to curiously explore "oneself", through imagination and creative expression. This article discusses insights and perspectives emerging from the project. The project revealed the power of art to make-sense of oneself with or without pain, and how art facilitates expression of complex inner experience and personal stories. People described Unmasking Pain as "explorative joy despite pain", and "a new set of rules" that contrasts with those experienced during clinical encounters. We discuss how art has the potential to improve clinical encounters and promote health and well-being, and whether artist-led activities are an intervention, therapy, or something else. Pain rehabilitation specialists from the project described Unmasking Pain as "freeing-up thinking", allowing conceptual thought beyond the biopsychosocial model of pain. We conclude that art has the potential to shift people living with pain from "I can't do, I am not willing to do it" to "Perhaps I can, I'll give it a go, I enjoyed".

This evidence review looks at the evidence base for empowerment and health & wellbeing. It was commissioned as part of the evaluation of the Altogether Better programme, a five-year initiative funded through the BIG Lottery that aims to empower people across the Yorkshire and Humber region to lead healthier lives. The regional programme is made up of a learning network and 16 community and workplace projects, which are working to increase physical activity, improve healthy eating and promote better mental health & well-being. Altogether Better is based on a programme empowerment model. This model is based on three elements: building confidence, building capacity and system challenge.

Although under-researched and under-theorised compared to other settings, there is potential for the family setting to be harnessed to support the development of healthy children and societies and to reduce health inequalities. Within this setting, the role of fathers as health facilitators has yet to be fully understood and considered within health promotion. This paper draws on a two year evaluation of a community embedded intervention for fathers and children in an area of multiple deprivation in North West England. The evaluation integrated a variety of qualitative methods within a participatory evaluation framework to help understand the development and impact of a programme of work co-created by a social enterprise and fathers from within the community. Findings suggest that allowing fathers to define their own concerns, discover solutions to these and design locally appropriate ways to share these solutions can result in significant change for them, their children and the wider community. Key to this process is the provision of alternative spaces where fathers feel safe to share the substantial difficulties they are experiencing. This improved their confidence and had a positive impact on their relationships with their children and with significant others around them. However, this process required patience, and a commitment to trusting that communities of men can co-create their own solutions and generate sustainable success. We suggest that commissioning of services delivered ‘to’ people could be replaced, or supplemented, by commissioning appropriate organisations to work with communities to co-create solutions to needs they themselves have recognised.

Volunteer engagement is crucial to the effective delivery of mega-sporting events. While evidence points to reported motivations and wellbeing benefits for individual participants during and post event, there is less evidence on how this type of civic participation relates to the social context in which it occurs and the wider social determinants of health. This qualitative study sought to understand impacts on wellbeing and the determinants of health resulting from the experience of volunteering at the Glasgow 2014 Commonwealth Games. Focus groups and interviews were conducted one-year post-Games to gather the perspectives of 46 volunteers and 7 unsuccessful applicants on their experiences. Participants provided insight into the volunteer journey, contributions and associated outcomes. Wider social impacts were also reported including a renewed sense of pride in the city. The qualitative analysis suggested an important non-linear relationship between volunteer contributions, impacts and rewards, and the outcome of enhanced social connections. The emergent ‘people and place’ framework identifies some critical factors around city life and volunteer assets that planners could consider in developing and evaluating sustainable volunteering and its wider impacts beyond a mega-event.

Background The prisoner population has poorer health and worse health inequalities than the general population. Peer-based interventions may be an effective way of reaching this vulnerable group. Methods The systematic review aimed to answer the following questions: 1. What are the effects of peer interventions on prisoner health and its determinants? 2. What are the positive and negative impacts of delivering peer interventions on health services in prisons? 3. How do the effects of peer approaches compare to those of professionally led approaches? 4. What is the cost effectiveness of peer interventions in prisons? In addition to grey literature identified and searches of websites, 19 electronic databases were searched from 1985 to present. Quantitative, qualitative and mixed method evaluations were included. Results 57 studies were included in the effectiveness review; most were of poor methodological quality. Evidence suggested that peer education interventions are effective at reducing risky behaviours, and that peer support services are acceptable within the prison environment, have a positive effect on deliverers and recipients and can impact positively on the prison as an organisation. There was only one study on cost-effectiveness of peer-based interventions. Conclusions Being a peer worker is associated with positive health; peer support services are also an acceptable source of help within the prison environment and can have a positive effect on recipients, although research into cost-effectiveness is sparse. Peer-based interventions can be considered a valuable mechanism to maintain or improve health and wellbeing in the prison setting. Funding: NIHR HS&DR programme Project 10/2002/13

Background The prisoner population has a higher prevalence of poor health and health inequalities compared to the general population. Peer based interventions may be an effective way of reaching this vulnerable group. Methods Review questions: 1. What are the effects of peer interventions on prisoner health and its determinants? 2. What are the positive and negative impacts of delivering peer interventions on health services in prison settings? 3. How do the effects of peer approaches compare to those of professionally led approaches? 4. What is the cost effectiveness of peer interventions in prison settings? 19 electronic databases were searched from 1985 to present, plus relevant websites. Inclusion criteria: prisoners, or children in Young Offender Institutions; delivering or receiving peer-based interventions; outcomes relating to health or its determinants, organisational or process outcomes; Quantitative, qualitative and mixed method evaluations. Results 58 studies were included in the review; most were methodologically poor. Evidence suggested that peer education interventions are effective at reducing risky behaviours, and peer support services are acceptable within the prison environment, having a positive effect on recipients. Consistent evidence from many studies, suggested that being a peer deliverer was associated with positive effects. There was little evidence on cost-effectiveness of peer-based interventions. Conclusions There is consistent evidence from a large number of studies that being a peer worker is associated with positive health; peer support services are also an acceptable source of help within the prison environment and can have a positive effect on recipients. Research into cost-effectiveness is sparse.

Background The prisoner population has a higher prevalence of poor health and health inequalities compared to the general population. Peer based interventions may be an effective way of reaching this vulnerable group, but to date the evidence has not been systematically reviewed. Methods The systematic review aimed to answer the following questions: 1. What are the effects of peer interventions on prisoner health and its determinants? 2. What are the positive and negative impacts of delivering peer interventions on health services in prison settings? 3. How do the effects of peer approaches compare to those of professionally led approaches? 4. What is the cost effectiveness of peer interventions in prison settings? In addition to grey literature identified and searches of websites, 19 electronic databases were searched from 1985 to present. Two reviewers selected studies using the following criteria: prisoners resident in adult prisons or children resident in Young Offender Institutions; delivering or receiving peer-based interventions; outcomes relating to prisoner health or its determinants, organisational or process outcomes or views of prison populations. Quantitative, qualitative and mixed method evaluations were included. Results 57 studies were included in the effectiveness review and one study in the cost-effectiveness review; most were of poor methodological quality. Evidence suggested that peer education interventions are effective at reducing risky behaviours, and that peer support services are acceptable within the prison environment and have a positive effect on recipients. Consistent evidence from many, predominantly qualitative, studies, suggested that being a peer deliverer was associated with positive effects. There was little evidence on cost-effectiveness of peer-based interventions. Conclusions There is consistent evidence from a large number of studies that being a peer worker is associated with positive health; peer support services are also an acceptable source of help within the prison environment and can have a positive effect on recipients. Research into cost-effectiveness is sparse. Main messages This comprehensive systematic review of peer interventions in prisons found positive effects for peer deliverers and recipients, particularly in mental health and reducing risky behaviours.

Background: Offender health is deemed a priority issue by the Department of Health. Peer support is an established feature of prison life in England and Wales; however, more needs to be known about the effectiveness of peer-based interventions to maintain and improve health in prison settings. Objectives: The study aimed to synthesise the evidence on peer-based interventions in prison settings by carrying out a systematic review and holding an expert symposium. Review questions were (1) what are the effects of peer-based interventions on prisoner health and the determinants of prisoner health?, (2) what are the positive and negative impacts on health services within prison settings of delivering peer-based interventions?, (3) how do the effects of peer-based approaches compare with those of professionally led approaches? and (4) what are the costs and cost-effectiveness of peer-based interventions in prison settings? Data sources: For the systematic review, 20 electronic databases including MEDLINE, PsycINFO, the Cumulative Index to Nursing and Allied Health Literature and EMBASE were searched from 1985. Grey literature and relevant websites were also searched. To supplement the review findings 58 delegates, representing a variety of organisations, attended an expert symposium, which provided contextual information. Review methods: Two reviewers independently selected studies using the following inclusion criteria: population – prisoners resident in prisons and young offender institutions; intervention – peer-based interventions; comparators: review questions 3 and 4 compared peer-led and professionally led approaches; outcomes – prisoner health or determinants of health, organisational/process outcomes or views of prison populations; study design: quantitative, qualitative and mixed-methods evaluations. Two reviewers extracted data and assessed validity using piloted electronic forms and validity assessment criteria based on published checklists. Results from quantitative studies were combined using narrative summary and meta-analysis when appropriate; results from qualitative studies were combined using thematic synthesis. Results: A total of 15,320 potentially relevant papers were identified of which 57 studies were included in the effectiveness review and one study was included in the cost-effectiveness review; most were of poor methodological quality. A typology of peer-based interventions was developed. Evidence suggested that peer education interventions are effective at reducing risky behaviours and that peer support services provide an acceptable source of help within the prison environment and have a positive effect on recipients; the strongest evidence came from the Listener scheme. Consistent evidence from many predominantly qualitative studies suggested that being a peer deliverer was associated with positive effects across all intervention types. There was limited evidence about recruitment of peer deliverers. Recurring themes were the importance of prison managerial and staff support for schemes to operate successfully, and risk management. There was little evidence on the cost-effectiveness of peer-based interventions. An economic model, developed from the results of the effectiveness review, although based on data of variable quality and a number of assumptions, showed the cost-effectiveness of peer-led over professionally led education in prison for the prevention of human immunodeficiency virus (HIV) infection. Limitations: The 58 included studies were, on the whole, of poor methodological quality. Conclusions: There is consistent evidence from a large number of studies that being a peer worker is associated with positive health. Peer support services can also provide an acceptable source of help within the prison environment and can have a positive effect on recipients. This was confirmed by expert evidence. Research into cost-effectiveness is sparse but a limited HIV-specific economic model, although based on a number of assumptions and evidence of variable quality, showed that peer interventions were cost-effective compared with professionally led interventions. Well-designed intervention studies are needed to provide robust evidence including assessing outcomes for the target population, economic analysis of cost-effectiveness and impacts on prison health services. More research is needed to examine issues of reach, utilisation and acceptability from the perspective of recipients and those who choose not to receive peer support. Study registration: This study was registered as PROSPERO CRD42012002349. Funding: The National Institute for Health Research Health Services and Delivery Research programme.

BACKGROUND: Prisoners experience significantly worse health than the general population. This review examines the effectiveness and cost-effectiveness of peer interventions in prison settings. METHODS: A mixed methods systematic review of effectiveness and cost-effectiveness studies, including qualitative and quantitative synthesis was conducted. In addition to grey literature identified and searches of websites, nineteen electronic databases were searched from 1985 to 2012. Study selection criteria were: Population: Prisoners resident in adult prisons and children resident in Young Offender Institutions (YOIs). INTERVENTION: Peer-based interventions Comparators: Review questions 3 and 4 compared peer and professionally led approaches. OUTCOMES: Prisoner health or determinants of health; organisational/ process outcomes; views of prison populations. STUDY DESIGNS: Quantitative, qualitative and mixed method evaluations. RESULTS: Fifty-seven studies were included in the effectiveness review and one study in the cost-effectiveness review; most were of poor methodological quality. Evidence suggested that peer education interventions are effective at reducing risky behaviours, and that peer support services are acceptable within the prison environment and have a positive effect on recipients, practically or emotionally. Consistent evidence from many, predominantly qualitative, studies, suggested that being a peer deliverer was associated with positive effects. There was little evidence on cost-effectiveness of peer-based interventions. CONCLUSIONS: There is consistent evidence from a large number of studies that being a peer worker is associated with positive health; peer support services are also an acceptable source of help within the prison environment and can have a positive effect on recipients. Research into cost-effectiveness is sparse. SYSTEMATIC REVIEW REGISTRATION: PROSPERO ref: CRD42012002349 .

Health education has changed in numerous ways since the inception of this journal, with many developments moving the discipline forward in ways that perhaps were not envisaged 75 years ago. Whilst there have been reported concerns about the decline of the discipline of health promotion and therefore associated worries about education, the contemporary evidence base has grown (Woodall et al 2017 in press), which we argue supports the delivery of quality education and the development of capable, skilled practitioners. Pedagogy has further developed too, and technology now enables health education to have a broader global reach through online teaching, social media and open-access publications. Many global challenges remain, and the UK context is one in which both health education and indeed practice faces major trials despite the traditions and approaches to health education developed by those educated and trained in this setting over a period of many years. We argue that the broader UK policy environment remains a challenge to current health promotion education, research and practice.

BACKGROUND: Community-based volunteering supports outbreak management by extending reach into at-risk communities. This paper examines the application of a 'community champions' model in England, UK, during the COVID-19 pandemic. Evidence pre-pandemic shows that community champion interventions tap into social networks to strengthen connections with disadvantaged communities. During the pandemic, the UK government set up a COVID community champions funding award scheme for local authorities to develop local programmes that addressed emerging inequalities. The study aim was to identify transferable learning on community engagement in the pandemic by undertaking a secondary qualitative synthesis of practice-based case studies of local COVID community champion programmes. METHODS: A systematic staged approach for synthesis of practice-based case studies was used. In total, 16 COVID community champion case studies, which were written by practitioners involved in local programme implementation and published by the Local Government Association, were included. Case studies covered aims, programme development and delivery, examples of activities and a discussion of learning. Framework qualitative analysis methods were used to code and organise data prior to cross case analysis. The final stage produced an overarching thematic framework that best represented descriptive and interpretive themes. RESULTS: The results provide an overview of common features of COVID community champion programmes and emergent learning. All local programmes aimed to reduce health inequalities by involving at-risk communities in local prevention efforts, adapting the approach to local priorities. Two levels of community engagement were volunteer mobilisation and subsequent community-based outreach activities. Elements of capacity building, such as training and creation of networks, were common. The synthesis of practice-based learning found that stronger relationships with communities were regarded as a key mechanism to support more equitable prevention strategies. Other learning themes related to champion roles, community engagement strategies and programme implementation. CONCLUSIONS: By focusing on how community champion approaches were applied by local authorities in England during the COVID-19 pandemic, this study contributes to knowledge on volunteer mobilisation as a mechanism to improve public health communication and outreach. Notwithstanding the limitations of experiential evidence, the synthesis of practice-based learning highlights potentially transferable community engagement strategies for health protection and health improvement.

Health Champions are a growing component within the British public health workforce and their roles are now emphasised within the coalition’s Government’s public health strategy. However, there is the need for further exploration of the way in which Health Champions use interpersonal communication within their roles. This paper reports on the findings from a mixed method evaluation of one Health Champion programme in North East England. A key finding was the way in which Health Champions used circles of influence to communicate health knowledge and to try to achieve behaviour change, starting with themselves in the centre of their circle and then moving outwards to influence others such as family, friends and colleagues through their social networks. The paper argues that health champions act as healthy role models within their own circles of influence to successfully communicate health knowledge to those around them.

In 2012, I project managed a team of researchers who were commissioned to undertake an evaluation of the Sunderland Health Champions Programme. Evaluation is an activity that remains central to health promotion practice because it is concerned with assessing whether interventions are effective (Green and South 2006). Health Champions are a growing component within the British public health workforce and their roles are emphasised within the coalition’s Government’s public health strategy. However, there is the need for further exploration of the way in which Health Champions work and the effectiveness of programmes that use Health Champions as a mechanism to try to achieve positive health changes. Therefore Sunderland tPCT commissioned independent researchers, staff from the Centre for Health Promotion Research at Leeds Metropolitan University to evaluate their Health Champion Programme.

The Health and Social Care Volunteering Fund (HSCVF) is an innovative programme that was established in 2009 by the Department of Health (DH) to build organisational and community capacity for volunteering through a national and local grant scheme. The HSCVF has offered both funds and tailored support to health and social care projects delivered by Voluntary, Community and Social Enterprise (VCSE) organisations. The HSCVF is managed by a partnership led by Ecorys and with expertise from leading national voluntary sector organisations: Attend, Community Service Volunteers (CSV) and Primetimers. To date the HSCVF has funded a total of 157 local and national projects, of which 114 are currently live. This report presents findings from an evaluation of the HSCVF with a specific focus on the 2010/2011 national and local projects, conducted by a team from the Institute for Health & Wellbeing at Leeds Metropolitan University. It presents evidence on the extent to which, how and in what ways the HSCVF programme has built organisational and community capacity across the national and local HSCVF projects, as well as on the health and social outcomes that resulted.

Community champions (also known as health champions) are community members who volunteer to promote health and wellbeing or improve conditions in their local community. Champions use their social networks and life experience to address barriers to engagement and improve connections between services and disadvantaged communities. Findings from this rapid review show that community champion approaches have high relevance to reducing health inequalities, whether the context is one of an emergency, or of longer term prevention. Community champions can be key connectors in communities but these roles do not operate in isolation and need to be embedded in effective community engagement strategies. As public health interventions, community champion approaches can be applied flexibly dependent on local needs and community assets. This review identifies different models and ways of building champion programmes

The Centre for Health Promotion at Leeds Beckett University were commissioned to review existing literature on the impacts of mega-sporting event volunteering and to undertake a qualitative study to investigate the experiences of volunteers at the Glasgow 2014 Commonwealth Games (known as ‘clyde-siders’). The study also set out to explore the experiences of those who applied to be a clyde-sider but were not successful with their application (referred to as non-clyde-siders). The literature review identified process issues as significant factors in the delivery of a mega-sporting event that results in a positive experience for volunteers. The review also found that mega-sporting event volunteering yields health and social outcomes both for individual volunteers and the host community. The weight of evidence in this review suggests that the process of mega-sporting event volunteering is relatively well understood. However, gaps remain with regard to the longer-term outcomes of mega-sporting event volunteering for individual volunteers (and those who apply but do not go on to become volunteers) and for communities. Qualitative exploration with clyde-siders and non-clyde-siders identified important assets that they brought to the Glasgow 2014 Commonwealth Games. Existing skills and experiences from their professional life or other volunteering roles; a personal touch reflecting commitment and approachability; and local knowledge of the city were important attributes that were highlighted. The research highlighted that while volunteers added to the success of the Games and its delivery, they were also able to draw on the event for their own personal benefit. Positive outcomes included increased confidence and knowledge, and the development of skills for future employment. These outcomes were often more pronounced in clyde-siders than non-clyde-siders, but this was not always the case as some non-clyde-siders drew benefits from applying for the role. The development of friendships and the value that people placed on meeting new people was a particularly prominent finding for both clyde-sider and non-clyde-siders. This included ‘bridging’ with others across social and cultural boundaries. The link between place, participation and the social impacts of volunteering at the Glasgow 2014 Commonwealth Games is a distinctive finding from the research. For clyde-siders, benefits were derived from the formal volunteering role and from being part of the collective experience in the city during the Games. These benefits could not be solely attributed to being a volunteer, as non-clyde-siders also reported gaining from being part of the friendly atmosphere generated by hosting the Games. Implications for strategic planning for mega-sporting events are outlined in the report.