# Including Prisoners in Research Design: Codevelopment of a Practical Guidance Toolkit to Support Intervention Delivery to Address the Physical and Mental Health of Older Prisoners (PAMHOP) Study

## TL;DR

This study created a toolkit to improve the physical and mental health of older prisoners by involving them in designing and testing activities.

## Contribution

The paper introduces a co-developed practical guidance toolkit for delivering health interventions to older prisoners.

## Key findings

- Common mental and physical health issues were identified, with engagement in activities improving mental health symptoms.
- Creative activities and peer support were key to engagement and sustainability of interventions.
- Intervention delivery costs were higher for male participants compared to female participants.

## Abstract

Over the last decade, the number of older people in custody with common mental and physical health problems has increased. Little is known about the effectiveness of interventions targeting this age group.

To codevelop a practical guidance toolkit(s) to support the delivery of interventions to benefit the common mental and physical health of older people in custody.

Twelve 3‐h workshops between March and April 2023 were conducted with 26 participants at two prison sites in the North of England. The six workshops in each site consisted of research‐based activities and interlinked taster sessions. The research data were collected by the research team to identify the causal links between common mental and physical health problems; activity preferences; the feasibility, acceptability and sustainability of delivering the activities and engagement barriers, which formed a bespoke questionnaire. The taster sessions (drugs and alcohol for males, chair yoga for females, books and crafting, and a historical session for both males and females) were delivered by the research team and prison staff. Feedback from the workshop participants was documented using an adapted questionnaire to record the experiences of those taking part. A micro‐costing framework was used to estimate the cost.

Similar common mental and physical health factors were listed by males and females. Symptoms of common mental health problems were improved by engaging with others of the same age, conducting activities outside and a consistent prison regime. Activity preferences (e.g., creative activities) were underpinned by a sense of purpose, learning new things, gaining and sharing skills. Engagement was supported by building good relationships and offering guidance through peer support, with activities led by staff of a similar age. Activities were more likely to be deemed feasible, acceptable and sustainable when aligned with the prison strategy and in conjunction with the regime. The average cost per participant for the intervention delivery was higher for males than females (£157 vs. £89).

Older people in custody report high levels of mental and physical health problems. Engagement with people in custody helps to support the development of interventions maximising possible health benefits. Further research is required to develop an evidence‐base for this group of people in custody.

People in custody were involved in the design and implementation of the workshops. The Project Advisory Group advised us on our research methodology and evaluated the feasibility, acceptability and sustainability of the activities using a questionnaire; they also provided practical advice about the project delivery.