Developing gender-specific evidence-based standards to improve the health and wellbeing of women in prison in England: a literature review and modified eDelphi survey

Lucy J. McCann*, Jo Peden, Emily-Rose Phipps, Emma Plugge, Eamonn J. O’Moore

*Corresponding author for this work

Research output: Contribution to journalArticlepeer-review

2 Citations (Scopus)


Purpose: There are significant health inequalities experienced by women in prison. They face distinct challenges and have particular and complex needs, specifically with regard to their physical and mental health. The purpose of this paper is to describe the approach taken to develop a set of health and wellbeing standards for the women’s prison estate in England, which can be applied elsewhere. 

Design/methodology/approach: A structured literature review of standard healthcare databases and grey literature was used to inform development of suggested standards. A multidisciplinary expert panel provided consensus on the standards through an online survey and women with a history of contact with the criminal justice system were consulted through consensus groups. 

Findings: A total of 549 papers were included in the final review. From this, 127 standards were identified for inclusion in the Delphi process. Consensus was achieved on all standards; this, combined with the analysis of qualitative feedback provided by both the survey and the consensus groups, resulted in the development of 6 overarching principles and 122 standards, across ten topic areas. 

Originality/value: These standards are the most extensive that are known to exist for health and wellbeing of women in prison and the first to be developed in England. The process used ensures the standards have high validity, acceptability and feasibility and can be used to support those developing similar methodologies. There are few papers which document the development of standards to improve health and to the authors knowledge, only one other paper has been published detailing the development of health standards in prison settings specifically.

Original languageEnglish
Pages (from-to)17-28
Number of pages12
JournalInternational Journal of Prisoner Health
Issue number1
Early online date30 Aug 2019
Publication statusPublished - 10 Feb 2020

Bibliographical note

Funding Information: Members of the project team: Lucy McCann (LM), Specialty Registrar in Public Health, South West England; Jo Peden (JP), Consultant in Public Health, Public Health England; Emily Phipps (EPh), Specialty Registrar in Public Health, Oxford School of Public Health; Emma Plugge (EPl), Senior Fellow in Public Health, Public Health England; Éamonn O’Moore (EO’M), National Lead for Health and Justice, Public Health England and Director of the UK Collaborating Centre for WHO Health in Prisons, European Region.

Project team responsibilities: EO’M and JP initiated the idea for the study. LM and JP led the development of the project protocol; EPh led development of the modified eDelphi protocol and LM led development of the literature search protocol. EPl provided academic oversight of the project and input into the literature search protocol. LM conducted the literature search and LM, JP and EPh reviewed the literature. LM, JP and EPh developed the initial draft of standards, which were reviewed by EO’M. LM produced the online questionnaire for the eDelphi process. LM and JP reviewed the feedback from the questionnaire and consensus groups and made relevant changes to the standards. JP, EO’M and EPl finalised the standards for publication. LM wrote the initial draft of the paper to which all the authors contributed. All authors read and approved the final manuscript.

No additional funding was sought for this study. The study was approved by the Research Ethics and Governance Group (REGG) at Public Health England and the National Research Committee at Her Majesty’s Prison and Probation Service. The authors are grateful to the members of the expert panel who contributed to the modified eDelphi, to the women with experience of prison who took part in the consensus groups and to Revolving Doors Agency who carried out the consensus groups. They would also like to thank Public Health England colleagues in the Health and Justice Team, the Nutrition and Obesity team and the Drugs and Alcohol team, who provided feedback during the process.

Open Access: No Open Access licence

Publisher Copyright: © 2019, Emerald Publishing Limited.

Citation: McCann, L.J., Peden, J., Phipps, E., Plugge, E. and O’Moore, E.J. (2020), "Developing gender-specific evidence-based standards to improve the health and wellbeing of women in prison in England: a literature review and modified eDelphi survey", International Journal of Prisoner Health, Vol. 16 No. 1, pp. 17-28.



  • Health
  • Public health
  • Standards
  • Wellbeing
  • Women prisoners
  • Women’s health


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