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Multi-method findings of a participatory approach to developing preventative health tools for BC individuals with incarceration experience CPHA, Toronto 28 th May, 2014. Overview of CCPHE projects. P4H -Vancouver Foundation , January/11 – January/14

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Multi-method findings of a participatory approach to developing preventative health tools for BC individuals with incarceration experience

CPHA, Toronto

28th May, 2014

overview of ccphe projects
Overview of CCPHE projects

P4H -Vancouver Foundation, January/11 – January/14

  • Preventive health: Cancer, HIV/AIDS, Hepatitis C, Mental Health, Addiction
  • Men and women with incarceration experience enrolled in Greater Vancouver area.

P4C- Public Health Agency of Canada,April/12 – March/14

  • Prevention and screening of breast, cervicaland colon cancers
  • Men and women with incarceration experience enrolled in twogeographical locations: Greater Vancouver area and Nanaimo.
prison participatory preventive health project p4h
Prison Participatory Preventive Health Project (P4H)


  • Goal 1: To use participatory approaches to develop preventive health tools, and methods of evaluation, for men and women with incarceration experience
  • Goal 2: To pilot preventive health tools/programs, developed using participatory approaches, among men and women with incarceration experience.
  • Goal 3: To promote the uptake and evaluation by health and correctional organizations of successfully piloted preventive health tools/programs.
prison participatory cancer prevention project p4c
Prison Participatory Cancer Prevention Project (P4C)

OVERALL GOAL: Promote participation in cancer screening and early detection among individuals with incarceration experience (IIE) in BC.

  • Inclusive participation of individuals with incarceration experience (IIE) throughout the project’s entirety.
  • Increased trust between health care practitioners (HCP) and individuals with incarceration experience (IIE).
  • Acceptable, accessible and available self-advocacy, peer support and cancer screening tools for individuals with incarceration experience (IIE).
  • Increased knowledge of barriers to cancer screening for IIE, and increased knowledge of participatory action research processes.
  • Increased feasibility of uptake of self-advocacy, self-management, peer support and cancer screening programs nationally and with correctional institutions.
guiding values developed collaboratively by project advisory committee members
Guiding ValuesDeveloped collaboratively by Project Advisory Committee members


Equal participation of all relevant stakeholders


Encourage all people to share their opinions and ideas

Active Listening

Hear what others have to say


Acknowledge that everyone has something to offer

Reciprocal Learning

Learn from one another

Cultural Safety

No judgement


Honesty and accountability in all actions

what we did
What we did
  • Hired project coordinators
  • Hired project assistants with incarceration experience
  • UBC Research Ethics Board certificates
  • Enrolled and consented 183 participants with incarceration experience:
    • 107 Greater Vancouver
    • 76 Nanaimo
  • Participants invited to (develop), pilot and evaluate preventive health tools and workshops
multi method evaluation consensus all members of project team
Multi-Method Evaluationconsensus - all members of project team
  • Workshop evaluation
    • Number of workshops (&, numbers of participants)
    • Post-workshop satisfaction surveys (Likert scales)
    • Focus group discussions with workshop participants
      • Open ended questions (e.g. Tell us how you think this workshop would work inside prison?What aspects would you change?)
  • Pre- and post- project surveys
    • Changes in participant health knowledge, attitudes and practices over the duration of the project
additional evaluation
Additional Evaluation
  • Participant narratives
    • “Tell us about the experience of participating in this project”
  • Members of the Project Team, including the Project Advisory Committee (PAC)
    • Shared their reflections about their own learning processes
  • Health Care Practitioners
    • Pre- and post- Knowledge and Attitudes survey for documentary viewers
data collection and analysis
Data Collection and Analysis
  • Qualitative Data: Audio-recordings transcribed verbatim, identifiers removed. NVivoTM10 used to organize the data. Interpretative Descriptionanalysis approach (S. Thorne). Coded, placed into categories, generated overall themes.
    • Quotes selected to illuminate the major themes.
  • Quantitative Data: survey data entered into Fluid Survey software and exported to SASS. Descriptive statistics were used, with tests of association:
    • Categorical variables: Chi-square (or , Fisher's exact test if cell size <=5).
    • Ordinal variables: Wilcoxon's 2-sample test.
    • Continuous variables: t-test.

Tests results with p-value <0.05 statistically significant.

Test results with p-value 0.05 – 0.1 approach statistical significance

preventive health workshops
Preventive Health Workshops


Facebook Group

Cancer feedback session

Activity: barriers to being healthy

Reminder cards and poster

Marnie’s Health Tips


Navigating the Health Care System

Cancer Prevention


Finding Our Voices







Cancer Screening

Hepatitis C






Mental Health




Community Organization

Health Care Provider


Academic expert


Experiential Learning

Interactive theatre activity
















preventive health workshop evaluation
Preventive Health Workshop Evaluation

Satisfaction Likert Surveys

preventive health workshop evaluation1
Preventive Health Workshop Evaluation

Focus Group Findings

Cancer prevention workshop focus groups(n=41)

reported here.

Three themes emerged.

workshop logistics and structure
Workshop Logistics and Structure
  • Variety
    • “Switching it up a bit and having different people doing it in different ways helped to keep me paying attention ‘cause I’ll lose focus really quickly”

-Vancouver participant

  • Peer-led learning
    • “It’s not something you just learned out of a textbook alright. It’s actual life experiences that people are talking about.”

-Vancouver participant

  • Recommendations
    • More time for sharing information:

“I learn the most and digest the most information when there’s questions and discussions” -Vancouver participant

health outcomes
Health Outcomes
  • Control
    • “The biggest thing I learned is that I am in control of my own destiny…when it comes to your health and everything, that’s solely me.” –Vancouver participant
  • Information sharing
    • “just to remind your friends, especially if they’re getting into their like 50s that all the screening, whether for male issues or female issues, to go get the screens and you know, save their life type thing”

–Nanaimo participant

  • Goal-setting
    • “I’m going to be drinking less pop. I have high blood pressure, and it’s not good to have too much sugar for me.” –Nanaimo participant
    • “I could do more walking you know, and to start out with, cut back on my smoking till I do quit right.” –Vancouver participant
workshops inside prisons
Workshops Inside Prisons
  • Content
    • Most common suggestion was dietary information:

“People who are in and out of prison, on that revolving door, are being exposed to unhealthy food and that’s the kind of habits you pick up when you come out because, you don’t know any better, right?” -Vancouver participant

  • Relevance
    • “I think it’ll be really helpful to people inside, just to hear the same information that I just heard, cause it meant something to me and I have been in the same situation.” -Vancouver participant
  • Structure
    • Ideal to have combination of peer educators and professionals:

“Peer-based, peer-led is really important…when I was younger I wouldn’t listen to anybody seriously if it wasn’t somebody my age who had a similar experience” -Vancouver participant

“In a prison setting, they don’t always take their peers seriously, so it might help to have the professionals to back up what they are saying.”

-Vancouver participant


Pre- and Post- project

participant survey findings

(Canadian Community Health Survey items, when possible)

  • 6-item demographic survey (age, education, employment, gender, ethnicity, housing, etc.)
  • 70-item survey about preventive health
  • 25-item survey about diet and exercise
  • 11-item survey about experiences with HCP
  • 13-item survey about cervical cancer
  • 17-item survey about breast cancer
  • 19-item survey about colorectal cancer
participants who completed post project surveys
Participants who completed post- project surveys
  • A total of 58 (32%) participants completed post-project surveys (and, pre-project surveys)
  • Participants who resided in institutions/recovery houses/halfway houses at baseline were less likely to complete post-project surveys
  • Participants who completed post-project surveys:
    • older
    • out of custody for longer
    • more likely to be from Nanaimo
changes in hepatitis knowledge n 58
Changes in hepatitis knowledge (n=58)
  • Hepatitis consists of an inflammation of your liver. ‘True’ 74% -> 100% (p=0.0463)
  • Would you know where to go in your neighbourhood to see a health care professional regarding hepatitis related health issues? ‘Yes’ 79% -> 100% (p=0.1050)
changes in preventive health practices n 58
Changes in preventive health practices (n=58)
  • Not counting carrots, potatoes or salad, how often do you usually eat other vegetables? (p=0.0107)
  • How often do you usually eat potatoes, not including french fries, fried potatoes, or potato chips? (p=0.0581)
  • In a typical month over the past year, how often have you participated in mod/strenuous activity? (p=0.0445)
  • In a typical week in the past 3 months, how many hours did you usually spend walking to work, school or doing errands? (p=0.0713)
changes in knowledge and beliefs about cervical screening
Changes in knowledge and beliefs about cervical screening
  • All women who have ever been sexually active (touchingor intercourse) are at risk of cervical cancer? ‘True’ 20% -> 70% (p=0.0698)
  • You are more likely to develop cervical cancer if you have (or had) multiple partners or if you became sexually active at an early age. ‘True’ 20% -> 70% (p=0.0698)
changes in knowledge and beliefs about colorectal screening n 58
Changes in knowledge and beliefs about colorectal screening (n=58)
  • These tests (FOBT and FIT) are painful and take a long time. ‘False’ 29% -> 64% (p=0.0029)
  • If I don’t have symptoms, I do not need to have colorectal cancer screening done. ‘False’ 66% -> 92% (p=0.0093)
  • All men and women 50 to 74 years should be  screenedfor colorectal cancer regularly. ‘True’ 67% ->92% (p=0.0182)
  • People get colorectal cancer because they have lived a bad  life. ‘False’ 74% -> 92% (p=0.0632)

Thank you



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