Agency and Access: Re-Designing the Prison Health Request Process
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 offenses, 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.
Agency
QUT Design Lab
Practice Area
Client
Queensland Health’s Office for Prisoner Health and Wellbeing, Capricornia Correctional Centre & Health Consumers Queensland
Industry
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 culture.
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 Challenge
The current prison health request system is focused on a paper-based Health Services Request Form: 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.
Project Vision
The vision of this project was to improve timely access to healthcare for prisoners, through the visual co-design and re-design of the heath request process.
Redesigned prison health services request form, with icons and pictograms to (1) provide
access to those with low literacy levels and (2) be more suitable for future digital applications.
Existing health request form – before our redesign
Re-designed health request notification form
Design + Execution
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.
A3 poster explaining the new system, to be displayed in common areas as part of an
onboarding experience.
Illustration of prisoner completing the new process. Note: photography in prisons in banned, so we have created this illustration.
Illustration of prisoner reading about the new health request process. Note: photography in
prisons in banned, so we have created this illustration.
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. Subsequently, the graphics have gone through 2 rounds of co-design evaluation and changes, based on feedback from prisoners, healthcare staff and prison management. While COVID-19 has delayed deployment and testing, this re-designed form will help improve timely access to healthcare for prisoners.
Project Details
Design Team
QUT Design Lab; Lisa Scharoun (graphic artist), Evonne Miller (project manager)
Collaborators
Queensland Health’s Office for Prisoner Health and Wellbeing: Graham Kraak, Capricornia Correctional Centre: Darren Holzberger, Health Consumers Queensland: Anne Curtis, Clinical Excellence Queensland: Linda McCormack
Photo Credits
Lisa Scharoun (QUT Design Lab)
Open Date
April 2022