Table 1.

Included Studies

Study	Country	Study design	Health topics	Nature of intervention/scheme	Population/setting	Individual outcomes	Service, delivery or organisation outcomes	Validity score*
Ashton 2010 [75]	Canada	Qualitative	HIV/AIDS and HCV (& other infectious diseases)	Peer support	“Healing Lodge” – a small (28 bed) minimum/medium security prison for Aboriginal women, incorporating Aboriginal healing practices, meaningfulness and cultural-connection. Most women are serving sentences of 3 years or less.	Strengths of programme listed.	Not reported	3b
						Staff perceptions.
Betts-Symond 2011 [76]	Ireland	Qualitative	Health, hygiene and cleanliness	Peer education	700 prisoners in Wheatfield prison, Dublin Ireland (medium-high security male prison) and their immediate family members	Personal development and changed outlook of the volunteers; results presented under 6 themes: Environment, behaviours, capabilities, beliefs and values, identity & goals.	Relationship between operational health services and inmate IRC volunteers.	3c
Blanchette 1998 [58]	Canada	Mixed Qualitative& Quantitative	General emotional/ mental health, psychological support and counselling	Peer support	Women resident in one of four small prisons in Canada: Nova Institution; Etablissement Joliette; Grand Valley Institution; Edmonton Institution.	Self-esteem;	Staff and prisoners’ awareness and perceptions of the role and functioning of the PST (surveys);	2b
						Sociometric tests for understanding personal and group dynamics;
						Perceptions of the prison environment (correctional environment status inventory);
						Staff and prisoners’ views, feelings and ideas about PST (interviews).
Boothby 2011 [53]	UK	Qualitative	General health/ support	Peer support	Male prison in the UK.	Insiders perceptions of role and themselves.	Numbers of prison staff	1a
					The scheme supports prisoners who are new to the prison system.	prisoners’ mood; suicide rates
Boyce 2009 [59]	UK	Mixed	Housing/resettlement	Peer advisors	Serving prisoners in:	skills and self-confidence, work ethic,	Effects on ‘professional’ time.	2a
					3 category B prisons (male), 1 Youth Offending Institution (male)	sense of control over their lives, work experience and qualifications.	Staff concerns: potential for bullying or intimidation and breaches of confidentiality.
Brooker & Sirdifield 2007 [54]	UK	Mixed Qualitative & Quantitative	Multiple health issues	Health Trainers	Serving prisoners in 4 adult prison, one Young Offenders Institution and one probation setting	Perceptions of tutors of the Health Trainers re. confidence; knowledge of services; communication skills; ability to assess someone’s readiness to change; self-esteem; self-worth.	Perceptions of prison-based trainees re. their role.	1a
						Perceptions of health trainers re. knowledge of health issues and attitude; confidence in sign-posting individuals to services; changing own behaviour.	Perceptions of stakeholders re:
						Perceptions of health trainer clients; issues discussed; services referred on to.	-workload for prison PE departments
							-training sessions
							-Raising risk issues
							- engagement with health services
							-Change of focus for the gym
							-Highlighting a lack of health services in some areas
							-Raising staff awareness of health issues and/ or services available
Bryan 2006 [60]	USA	Quantitative Pre-test post-test design (one group only).	HIV prevention	Peer education	196 serving prisoners in maximum and minimum security prisons. 90% male, mean age 30.4y.	Knowledge; Perceived risk; Condom attitudes; Condom norms; Condom self-efficacy; Condom intentions; Attitudes for not sharing needles; Norms for not sharing needles; Self-efficacy for not sharing needles; Intentions to not share needles; Peer education attitudes; Peer education norms; Peer education self-efficacy; Peer education intentions; Peer education behaviour.	Not reported	2b
Chen 2006 [29]	Israel	Quantitative Pre & Post	General emotional/ mental health, psychological support and counselling	Peer counselling	93 male repeat offenders in three prisons in Israel. (Two maximum security and one minimum security).	Sense of coherence; Meaning in life;	Not reported	2b
					Mean age 36 years (SD = 6.35).	Anxiety; Depression; Hostility:
Cichowlas & Chen 2010 [77]	USA	Qualitative	General health/ support	Prison hospice volunteers	Ill/dying prisoners at Dixon Hospice in Illinois	Perceptions of peer deliverers	Not reported	3c
Collica 2007 [78]	USA	Quantitative & Qualitative	HIV/AIDS and HCV (& other infectious diseases)	Peer education	All prisoners in USA were covered by the survey.	Facilities were asked to report on:	Not reported	3c
						1. Number of HIV positive inmates in their custody;
						2. If they mandated HIV testing;
						3. If they provided prison-based peer programming on HIV.
						If answer to Q3 was YES:
						Extent of HIV peer education, and other services.
						If answer to Q3 was NO:
						How HIV education was provided and why inmate peers were not used.
Collica 2010 [55]	USA	Qualitative	HIV/AIDS and HCV (& other infectious diseases)	Peer education	Aimed at women in prison with HIV/AIDS.	Role of peers	Not reported	1b
					One maximum and one medium security prison for women
Correctional Service of Canada 2009 [79]	Canada	Quantitative & Qualitative	General emotional/ mental health, psychological support and counselling	Peer Support	Women prisoners “in distress”	From interviews: predominant mental health issues of women prisoners; how these are addressed in training sessions; benefits to trained peer counsellors	Trust between staff and prisoners	3c quant/3b qual
						From survey: whether prisoners value the PST; reasons for asking to see a peer counsellor; benefits to service recipients; helpfulness of peer counsellors; recommendations for improvements	Staff becoming part of peer support team
							Recommendations for improvements.
Daigle 2007 [24]	Canada	Not applicable	Suicide/Self harm	Peer support	Canadian prisons (no further details reported).	Not reported	Concerns about recruitment, security and responsibility	N/A
Davies 1994 [32]	UK	Qualitative	Suicide/Self harm	Listeners	HMP Swansea (adult prison)	Attempted suicide rate.	staff time.	2b
						use of the strip cell or care room.	Prison atmosphere.
						Listeners’ perceptions (benefits to Listeners)
Delveaux & Blanchette 2000 [80]	Canada	Quantitative & Qualitative	General emotional/ mental health, psychological support and counselling	Peer support	Small women’s prison.Women prisoners, all serving sentences of two or more years and classified as minimum or medium security.	Self esteem; Sociometric tests for understanding personal and group dynamics; Perceptions of the prison environment (correctional environment status inventory)	Staff and prisoners’ awareness and perceptions of the role and functioning of the PST (surveys)	3c
						Staff and prisoners’ views, feelings and ideas about PST (interviews).
Dhaliwal & Harrower 2009 [61]	UK	Qualitative	Suicide/Self harm	Listeners	Vulnerable or distressed prisoners, or those at risk of suicide.	Listeners’ own experiences, the impact on them as individuals, skills and/or benefits acquired.	Presents findings in relation to what the prison service can do to support the scheme.	2b
Dolan 2004 [27]	Russia	Quantitative: pre and post	HIV/AIDS and HCV (& other infectious diseases)	Peer education	Male colony for drug-dependent prisoners in Siberia. Mean age 24 (range 18–30), 63% first time in prison, mean years served 1.2 (SD 0.7), 66% imprisoned for drug related offence.	Whether seen the program booklet?	Access to bleach and condoms	3c
						Whether participated in peer training education?
						Demographic characteristics; Knowledge of HIV transmission; STI and BBVI status; Drug use; Sexual activity; Tattooing; Access to bleach and condoms.
Eamon 2012 [81]	Canada	Quantitative & Qualitative	General emotional/mental health, psychological support and counselling	Peer Support	Edmonton Institution for Women population = 65	Satisfaction with/ performance of PST;	Suggestions for improvement to number of sessions	3b
						Hours per week of support provided by PST members; Time to response to inmate calls for peer response; Level of trust in PST members; Suggestions for improvement; Improving relationships.
Edgar 2011 [23]	UK	Quantitative & Qualitative:	Multiple health issues	Peer support/ Listeners	Not stated	Various, including Listeners and other peer roles.	Diverting workload away from staff.	2b
Farrin (undated) [82]	Australia	Review	Multiple health issues	Peer support	At-risk prisoner in 8 state prisons	Changes in responsibility, accountability and self-esteem (Syed & Blanchette 2000)	Reports the results from Devilly et al., 2003 on changing attitudes and behaviours; Offender preference	3c
Foster 2011 [56]	UK	Qualitative	Suicide/Self harm	Listeners	Adult category-B local male prison. Operational capacity 1103	Effect on Listeners’ personal development; Self-esteem; well-being; relationships.	Prison environment, burden on prison staff and health care professionals.	1a
						Numbers of potential suicides and incidents of self harm.
Goldstein 2009 [83]	USA	Quantitative	Mental health/Substance abuse	Peer mentoring	2 correctional facilities. Incarcerated women with current or history of behavioural issues and/ or substance abuse.	Adherence to outpatient psychiatric treatment, including medication management; Medication compliance, sobriety & symptom reduction; Re-offending; Abstinence in the use of alcohol or illegal drugs or misuse of prescription drugs; Employment or enrolment in an educational program or completion of the application process for disability benefits; Secure treatment, transitional housing or a permanent place to live.	Nor reported	3c
					Age range: 19 to 59 y (mean = 35 y). 15 out of the 32 participants had 5 or more prior incarcerations.
Grinstead 1997 [84]	USA	Quantitative: RCT	HIV	Peer education	Male inmates at large (n = approx. 5600) medium-security state prison. . 45% had history of injection drug use, more than 75% of these reported having shared equipment.	HIV Knowledge; Preference for teacher;	Not reported	3b
						Condom use intention; Bleach use intention; HIV antibody use intention;
						Interested in taking test now.
Grinstead 1999 [25]	USA	Quantitative. RCT	HIV prevention	Peer education	Large state prison for men. Mean age 35y, spent more than 9y of life in prison. 90% had just completed a sentence of less than 5y and <10% were imprisoned for the first time.	Risky behaviour at follow up:	Not reported	3c
						used a condom the first time they had sex since release; used drugs since release; injected drugs since release; shared needles
Hall & Gabor 2004 [36]	Canada	Mixed quantitative and qualitative.	Suicide prevention	Listeners	Medium security prison with capacity 585. Inmates have committed serious crimes.	personal growth, knowledge of suicide, self-esteem, communication skills, and sense of purpose; support; general program operation; impact of training; personal development	Findings are reported related to program implementation	3c
					modal age category 18-29y, followed by 30-39y. Length of sentence ranged from 2 years to life.
Hoover & Jurgens 2009 [85]	Moldova	Qualitative	HIV/AIDS and HCV (& other infectious diseases)	Peer outreach	7 prisons (6male prisons and 1 female prisons)	Not reported	Decline in HIV cases	3c
Hunter & Boyce 2009 [57]	UK	Qualitative	Housing/resettlement	Peer advisors	Prisoners requiring housing advice in 5 prisons in SE England (Three Category B prisons (male), one young offender institution (male) and one female open prison.)	social interaction with others; experience and qualifications to assist post-release; self-confidence.	Views of prisoners and staff re. staff workload and prisoners’ use of their time in prison.	1a
Jacobson & Edgar (undated) [62]	UK	Qualitative	General health/ support	Peer support	New arrivals at HMP Edinburgh	Effects on prisoners	Use of staff time	2c
Junker 2005 [86]	USA	Quantitative	Suicide/Self harm	Peer Observers	Those prisoners judged to be suicidal	Not reported.	Number of hours individuals spent on suicide watch post-IOP compared to pre-IOP (i.e. using staff for observations):	3b
Levenson & Farrant 2002 [19]	UK	Quantitative & Qualitative	Multiple health issues	Peer support/ Listeners.	Not stated	Perceptions of role ( peer supporters)	Not reported	3b quant/2b qual
						Self-esteem.
						finding accommodation and small amounts of money after release
Martin 2008 [63]	USA	Quantitative.	HIV/ HCV prevention	Peer education	3 sites: Delaware, Kentucky and Virginia.	The only outcome reported is condom use during sex.	Not reported	2b
		RCT.
					N = 343. Mean age 34y. 86% male.
Maull 1991 [64]	USA	Study design unclear	General health/support	Prison hospice volunteers	Ill prisoners at U.S. Medical Centre for Federal Prisoners in Springfield, Missouri	Effects on volunteers;	Retention/attrition of volunteers	2b
						Effects on prisoners
McGowan 2006 [87]	USA	Qualitative	HIV counselling	Peer education	Male prisoners in state prisons in California, Mississippi, Rhode Island and Wisconsin. aged between 18 and 29y, incarcerated for at least 90 days, classified as minimum or medium security level, scheduled for release within 14 to 60 days.	Effect son HIV testing: mandatory testing at intake, voluntary testing at medical intake, and voluntary testing during a peer health orientation class.	Not reported	3c
Mentor 2 work [73]	UK	Study design unclear	Unclear	Peer mentoring	Prisoners with mental health problems at HMP Liverpool.	Self-esteem, confidence and motivation; Self-worth; Communication skills, reasoning and reflection skills; Mental health and treatment.	Numbers of volunteers and prisoners being mentored; effects after release.	3c
Munoz-Plaza 2005 [65]	USA	Qualitative	HIV/ AIDS and HCV (& other infectious diseases)	Peer education	A state correctional facility in California. Drug treatment program is located on a medium security prison yard that houses male inmates. age range 20–50 years	Not reported	Not reported	2b
O’Hagan 2011 [88]	UK	Quantitative	Literacy	Peer education	Serving Young Offenderss at 5 YOIs	Literacy:	Not reported	3c
						Impact on learners;
						Impact on mentors
Peek 2011 [89]	UK	Quantitative	Infectious disease prevention: screening and vaccination.	Peer education	Male prisoners at HMP High Down Category B male local prison.	Hep B and Hep C awareness and vaccination uptake.	signposting to healthcare,	3c
						Chlamydia awareness and screening.	Effects on nurses utilising their time in the prison.
							Effects on barriers between nursing staff and prisoners.
							Prison atmosphere.
							Changing role/perception of prisoners.
Penn State Erie 2001 [90]	USA	Mixed methods	Parenting	Peer education	Fathers in prison. State Correctional Institute at Albion (SCI Albion), in Erie county. A medium-security institution for men	contact with children per month/year;	Staff awareness and perceptions of programme	3c
						Anger & Frustration; Knowledge about their child/children; Parental Locus of Control; ICAN Fathering Profile; Total Parenting score
						Father’s Questionnaire: knowledge,
						attitudes, skills, and behaviors.
Player & Martin 1996 [91]	UK	Study design unclear	Addictions/substance abuse	Peer counselling	Prisoners with addictions at HMP Downview	drug use; prisoner behaviour	Not reported	3c
Richman 2004 [92]	UK	Quantitative	General emotional/ mental health, psychological support and counselling	Listeners	HMP Manchester	Change in demeanour.	Effects on staff – peer worker relationship.	3b
						Expected effects on release from prison (on Listeners)
Ross 2006 [66]	USA	Quantitative Pre & Post	HIV/ AIDS and HCV (& other infectious diseases)	Peer Education	36 Texas State prison units. Peer educators and students were predominantly male, aged 34–43 y.	HIV–related knowledge; self–assessed educator skills among peer educators; Diffusion of HIV–related knowledge;	impact of the peer education program on HIV testing at participating units	2b
						HIV–testing behavior and intentions
Schinkel & Whyte 2012 [67]	UK	Qualitative	Housing/resettlement	Peer mentoring	Based in Glasgow – prisons not stated. Prisoners serving sentences of between three months and four years. Service offered to eligible prisoners who are returning to Glasgow, Renfrewshire and North Lanarkshire.	Effects on prisoners	Staff perceptions of life coaches’ need for support.	2b
Schlapman & Cass 2000 [93]	USA	Quantitative – pre and post	HIV prevention	Peer education	Incarcerated adolescents in North central Indiana juvenile facility.	AIDS knowledge & self reported sexual behaviours.	Not reported	3c
Scott 2004 [68]	USA	Mixed quantitative (pre and post) and qualitative)	HIV prevention	Peer education	Prisoners at 5 Texas prison facilities. A diversity of facilities was selected (small and large, short and long term, male and female prisoners)	HIV related knowledge, attitudes and beliefs among peer educators and students.	Factors affecting implementation, maintenance and overall impact of the program from the perspective of program coordinators, wardens and peer educators.	2b quant/2c qual
Sifunda 2008 [69,101]	South Africa	Quantitative Pre & Post	HIV/ AIDS and HCV (& other infectious diseases)	Peer education	4 medium-sized correctional facilities (male) in South Africa. Number housed comparable in size to UK prison..N = 263. Mean age 27 y (range 17–55). Mean period of incarceration = 2 years (range 6 m – 17 y).65% were first time offenders.	Knowledge and beliefs; Attitudes; Sexual communication, social norms about gender relations and sexual violence;	Not reported	2c
						Self-efficacy; Intentions
Sirdifield 2006 [70]	UK	Qualitative	General health/ support	Health Trainer	All prisoners	Changes in Health Trainers’ attitudes and health behaviour.	demands placed on prison staff and health services as a result of the intervention.	2b
						Recognising stress in other prisoners.
Snow 2002 [37]	UK	Quantitative	Suicide/ self harm	Listeners	5 prisons having a Samaritan supported Listener scheme. All prisons were local type establishments and chosen because of the comparatively high rate of suicide.	Perceived benefit from using the scheme:	Not reported	2b
						Approachability of listeners
						Availability of listeners
						Use of listener scheme in the future.
						Reasons for not using the scheme
						Ways to improve the scheme
Stewart 2011 [94]	UK	Quantitative & Qualitative	General health/ support	Peer support	3 UK prisons.	Effects on prisoner-carers	communication between staff and prisoners. Training and supervision issues.	3c
					Originally for older prisoners but to include those with learning disabilities, mental health problems and prisoners with physical and sensory disabilities.		Contribution to the health and social care services within the gaol.
Syed & Blanchette 2000 [95]	Canada	Quantitative & Qualitative	General emotional/mental health, psychological support and counselling	Peer Support	Small women’s prison, n = 78 at time of study. All were serving sentences of minimum 2 years and were rated at ‘minimum’ or ‘medium’ security levels.	Self esteem; Sociometric tests for understanding personal and group dynamics; Perceptions of the prison environment (correctional environment status inventory);	Staff and prisoners’ awareness and perceptions of the role and functioning of the PST (surveys);	3b quant/ 1c qual
					Survey respondents, average age 34.5y (sd = 9.07, range 21–58). Average sentence length 4.39y (range 2 to 15y). Average time spent at Grand Valley = 9 months (SD = 0.62, range = 2 weeks to 2 years).	Staff and prisoners’ views, feelings and ideas about PST (interviews).
Syed & Blanchette 2000 [96]	Canada	Quantitative & Qualitative	General emotional/ mental health, psychological support and counselling	Peer Support	women’s prison in Canada. N = 56 at time of study. All were serving sentences of minimum 2 years and were rated at ‘minimum’ or ‘medium’ security levels.	Self esteem; Sociometric tests for understanding personal and group dynamics; Perceptions of the prison environment (correctional environment status inventory);	Staff and prisoners’ awareness and perceptions of the role and functioning of the PST (surveys)	3b quant/ 2b qual
					All women, average age 35.1y (SD = 11.3, range = 21 to 62). Average sentence length 4.7 years (range 2y to life). Mean time served at Joliette = 13.3 m (range 2 m to 2.5y).	Staff and prisoners’ views, feelings and ideas about PST (interviews).
Taylor 1994 [97]	Australia	Quantitative and Qualitative: Pre-post	HIV prevention	Peer education	New South Wales Correctional Centres. 90% of inmates had been in other correctional centres.	Knowledge; attitudes	Awareness of the peer education scheme.	3b
The Learning Ladder Ltd. (undated) [74]	UK	Qualitative.	Mentoring for education/to improve qualifications	Peer mentoring	HM Young Offenders Institution Reading – a small prison holding prisoners between the ages of 18 and 21y.	self-esteem; confidence; attitude to offending behaviour.	Success of scheme.	3c
Vaz 1996 [28]	Mozambique	Quantitative, pre-post	HIV/ STD prevention	Peer education	Largest prison in Mozambique (1900 prisoners incarcerated at time of study). 300 inmates sentenced to 1 year or longer, selected on entry. Mean age 26y.	knowledge around HIV/AIDS ; relationship between knowledge of HIV/AIDS and educational attainment of participants.	Not reported	3b
Walrath 2001 [71]	USA	Quantitative Pre & Post	Violence	Peer training.	Medium all-male security corrections facility in Maryland, USA, housing inmates serving sentences of 3 months or longer.	Anger; Self esteem; Optimism; Locus of Control; Behaviour	Not reported	2b
					Age range: 18 to 51 y, mean age 30 y. Average sentence 20y, ranging from less than 1 year to life.
Wright & Bronstein 2007 [72,102] 2 papers	USA	Mixed Qualitative & Quantitative	General health/ support	Prison hospice volunteers	Dying prisoners in 14 prison hospices in the USA	Not reported	Impact of having a hospice (& implicitly, using prisoner volunteers) on prison environment & climate.	2c
Zack 2001 [21]	USA	Quantitative	HIV/AIDS and HCV (& other infectious diseases)	Peer education	Medium-security prison housing approximately 6000 men who stay at the prison for an average of less than two years. Men arriving at and leaving the prison, and women visitors.	Intentions to use condoms and be tested for HIV; Knowledge; HIV/AIDS testing; behaviour	Resistance from staff	3b
							Institutional lockdowns
		RCT
Zucker 2006 [98]	USA	Quantitative. One-group pretest - posttest.	Hepatitis C prevention	Peer education	Massachusetts county jail . 25 men who spoke and wrote in English.	Changes in self-reported behaviour, knowledge, relationship with teacher .	Not reported	3c

NOTE: Validity score: 1 = good internal validity, 2 = moderate internal validityand 3 = poor internal validity; a = highly relevant, b = of some relevance, and c = not very relevant.