Being healthy in an unhealthy place: Health literacy and tactics in a young adult prison population

This thesis aimed to explore health promotion in a young adult prison population by examining the strengths and barriers of developing health literacy in the prison context. Health literacy describes the ‘cognitive and social skills which determine the motivation and ability of individuals to gain access to, understand and use information in ways which promote and maintain good health’ (WHO, 2009) where progressive levels of knowledge and skills supports greater autonomy in health in the context of everyday life (Nutbeam, 2008). The thesis consists of six studies, which include:

• Study 1: A qualitative study of the barriers to health literacy in the prison context
• Study 2: A qualitative study examining user-views of measures of health literacy and health outcomes
• Study 3 and 4: A cross-sectional survey of health literacy and the association with health outcomes
• Study 5: A qualitative study of the tactics for health used by young men in prison
• Study 6: Development and evaluation (through a clustered randomised controlled trial) of a leaflet to promote healthy tactics

The findings highlight the numerous barriers to health literacy, and the association of limitations with poorer health (particularly psychological health). Despite these barriers, young men adopt a range of health tactics to reclaim some control over their physical, mental, and emotional needs. In considering these tactics, a health leaflet was developed in participation with young men to develop relevant, authentic, and personalised health information. An evaluation of the health tactic leaflet highlights the impact on attitudes and uptake of tactics in the wider prison population. Overall, the findings confirm that prisons are challenging settings for health improvement where strengthening health literacy must consider individual and structural factors. Despite the challenges, the opportunities for public health are immense and require greater commitment at a practical and policy level.