Re-designing how prisoners request and access health services

Why it matters

Globally, 10.74 million people are in prison – as pre-trial/remand prisoners or convicted and sentenced. A prison sentence protects the community, punishes the offender, and deters similar offences, with rehabilitation a critical component of the criminal justice system. As well as addressing the factors that contribute to re-offending, entering prison provides an opportunity to access healthcare and address health issues. However, the problems in prisoners’ lives are complicated. Compared to the general population, people in prison are often from economic and socially disadvantaged backgrounds, more likely to use illicit drugs, have lower levels of literacy and poorer physical and mental health.

Good health is key to successful rehabilitation – and prison can provide the space and time to address health needs. However, the delivery of healthcare in prison is also not straight forward, due to security regimes and differences between prison and healthcare systems and cultures.

Project Overview

Re-designing the Prison Health Request Form:

This Australian project, a collaboration between Queensland Health’s Office for Prisoner Health and Wellbeing, Capricornia Correctional Centre, Health Consumers Queensland and the QUT Design Lab, was designed to enhance access and communication by redesigning the health request form – to be trialled in one regional men’s prison and then rolled out. The project responded to a Queensland Offender Health Services Review identifying barriers to accessing timely health services, and the use of digital technologies in the Prison System. A key issue identified was the lack of agency that prisoners felt in procuring solutions to their health issues.

The current system is focused on a paper-based Health Services Request Form, in Figure 1: to access non-emergency healthcare, prisoners request this paper form (from a guard or health provider), write in their health concern, and submit it once a day, where it is processed, and they receive an appointment. Prisoners generally have limited literacy, yet this process is reliant on prisoners being able to convey key information about their health, in writing, which health staff then use to determine when they should be seen (a triaging process). Confidentiality issues also arise if prisoners request assistance to complete the form.

The Design Process and Solution:

The design team visited the case study prison for two days, co-designing with four groups of prisoners and one group of healthcare providers, refining outcomes with a prison health reference group. Giving prisoners access to digital technologies (e.g., iPads and screen-based applications) for procuring health services in the highly controlled prison environment is challenging. This requires a full re-design of the internal security system. Therefore, our team provided guidance on an immediate paper-based design intervention that could eventually be transitioned and scaled for digital application.

We chose to redesign the procurement form using icons and pictograms to (1) provide access to those with low literacy levels and (2) be more suitable for future digital applications as part of a screen-based icon-system. The modified form is purposely visual (to address lower literacy levels) and provides indicative wait time indications, so prisoners have a better understanding of when they might see the specific health practitioner. A key issue identified by prisoners was that they did not understand some of the services offered. The form uses a set of custom designed icons that visually describe these options. Prisoners also noted low-literacy levels limited their ability to describe pain points; thus, we provided a visual of the male figure to enable the user to pinpoint areas of pain and/or discomfort. As the form needs to be reproduced internally, we used simple line drawings that would transfer well and is set in an A4 template. Elements of the form can form a visual system that can be applied across a range of outputs, lending itself to future applications in a digital system. As a first iteration, this paper-based form enables prisoners to become used to the visual language and approach, with a A3 poster also explaining the new system as part of an onboarding experience. While COVID-19 has delayed deployment and testing, this re-designed form will help improve timely access to healthcare for prisoners.

Alongside the form request process, we are in the process of trialling a virtual, internal pop-up nurse clinic. As correctional centres often experience challenges that restrict offender movement, movement, the proposal is to use existing/additional technology in prison blocks so offenders can have a virtual consultation with nurses from the prison health centre. Potentially, not having to escort offenders to the clinic may save guard time and increase efficiency of the system, with these additional video consultations providing more timely access to health services.

Project Outcomes

Special Awards & Achievements:

“Agency and Access: Re-Designing the Prison Health Request Process” has been awarded a prestigious global design accolade, as a named finalist at the 2022 SEGD Global Design Awards in Portland, USA (June, 16-18). The organizational mission of SEGD – the Society for Experiential Graphic Design – is to “Educate, Connect and Inspire”, and we are delighted that our Australian project to re-design the prison request form and process was shortlisted!  The awards celebrate design that inspires and improves the human experience for individuals of all backgrounds and abilities – and you can see our project, with the other finalists and award winners, at the SEGD Project Gallery: segd.org.

In 2024, the project was recognised with an Iron A’ Design Award for Strategic Design.

Thank you to the broader project team – especially the prisoners and healthcare staff, and our partners: Queensland Health’s Office for Prisoner Health and Wellbeing (Graham Kraak), Capricornia Correctional Centre (Darren Holzberger), Health Consumers Queensland (Anne Curtis) and Clinical Excellence Queensland (Linda McCormack).

Project Team

• Professor Evonne Miller – Professor of Design Psychology and Director of the QUT Design Lab, Evonne is also co-Director of HEAL – the Healthcare Excellence Accelerator, a CEQ Queensland Health funded initiative putting designers (design thinking and doing) into healthcare. Her expertise is in design for health, and she has secured and managed over $3.9M in research grants, including two Australian Research Council grants on how best to redesign aged care.
• Professor Lisa Scharoun – Head of QUT’s School of Design, Lisa’s research centres on cross-cultural design, co-design methodologies and visual communication. Lisa is led editor of the book “Cross-Cultural Design for Healthy Ageing” (Intellect Books, 2020).
• Dr Ruari Elkington, Lecturer in Creative Industries, has expertise in visual communication and interaction design in the context of healthcare.
• Dr Shane Pike, Lecturer in Drama, is a practicing writer/director with an interest in rural men’s health, and expertise in designing augmented reality experiences.