• Anne-Marie Bagnall, Jane South, Claire Hulme, James Woodall, Karen Vinall-Collier, Gary Raine, Karina Kinsella, Rachael Dixey, Linda Harris, and Nat M J Wright.
• Centre for Health Promotion Research, Leeds Beckett University, Leeds, LS1 3HE, UK. a.bagnall@leedsbeckett.ac.uk.
• Bmc Public Health. 2015 Jan 1; 15: 290.

BackgroundPrisoners experience significantly worse health than the general population. This review examines the effectiveness and cost-effectiveness of peer interventions in prison settings.MethodsA mixed methods systematic review of effectiveness and cost-effectiveness studies, including qualitative and quantitative synthesis was conducted. In addition to grey literature identified and searches of websites, nineteen electronic databases were searched from 1985 to 2012. Study selection criteria were:PopulationPrisoners resident in adult prisons and children resident in Young Offender Institutions (YOIs).InterventionPeer-based interventions.ComparatorsReview questions 3 and 4 compared peer and professionally led approaches.OutcomesPrisoner health or determinants of health; organisational/process outcomes; views of prison populations.Study DesignsQuantitative, qualitative and mixed method evaluations.ResultsFifty-seven studies were included in the effectiveness review and one study in the cost-effectiveness review; most were of poor methodological quality. Evidence suggested that peer education interventions are effective at reducing risky behaviours, and that peer support services are acceptable within the prison environment and have a positive effect on recipients, practically or emotionally. Consistent evidence from many, predominantly qualitative, studies, suggested that being a peer deliverer was associated with positive effects. There was little evidence on cost-effectiveness of peer-based interventions.ConclusionsThere is consistent evidence from a large number of studies that being a peer worker is associated with positive health; peer support services are also an acceptable source of help within the prison environment and can have a positive effect on recipients. Research into cost-effectiveness is sparse.Systematic Review RegistrationPROSPERO ref: CRD42012002349.

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