A critical realist analysis of digital health screening for older people in prison

The growing cohort of older people (50+) in Australian prisons have high rates of physical, psychosocial and cognitive conditions, with evidence that many of these remain underdiagnosed or undetected. It is necessary to better identify the priority health and social needs of older people in prison to ensure a safe, equitable and cost-effective prison health system. Increased digital health screening in prison is seen as one promising approach to achieve this end. This study aims to explore the factors that are likely to impact future adoption of digital health screening tools for older people in prison. This is a qualitative analysis underpinned by a critical realist philosophy and explanatory model of science. Primary data were collected through seven focus groups in prisons across New South Wales, Australia. Participants included a diverse sample of older people in prison (n = 20), as well as nurses and psychologists working in justice healthcare and the correctional system (n = 13). Two global themes were generated from our analysis - constraint and conflict. Constraint, focusing on structural factors, reveals that limited system capacity and competing service priorities create organisational barriers towards the implementation of additional digital health screening. The second theme, conflict, examines individual barriers to help-seeking for older people in prison. These are caused, in part, by past traumatic life experiences as well as current pressures to conform to prevailing social norms within the prison environment. These structural and individual factors, and their interplay, require further attention before widespread digital health screening can be successfully implemented in Australian prisons.