Program design, implementation and evaluation of women's prison health outreach services delivered by peer educators

In 2004, the Woman-to-Woman curriculum program was developed as a peer-driven health education program for the women in the Texas Department of Criminal Justice (TDCJ) correctional systems. There are 11,791 incarcerated females in this system and as of January 2007, 60 classes had delivered programming to 1,518 women.

In 2006, a qualitative retrospective evaluation focused on data from staff, peer educators and participants, with non-participants as a control. Personal interviews were conducted with 12 peer educators and 3 staff. Focus groups collected data from participants and non-participants.

For peer educators, the program improved presentation and communication skills, thus increasing self-esteem and accountability. They were viewed as role models as well as health resources for those around them. On average, each peer educator talked to 12 people a week outside of a class setting about a health related topic. This approximates 18,700 teachable moments during a year, factored on an existing corps of 30 peer educators.

For peer educators and participants, the primary change in behavior was greater attendance to annual health exams and Pap smears. Everyone in the participant/intervention group reported getting an annual exam compared to 47% of the non-participant/control group. Participants were also more likely to agree to a Pap. After the class, more women were doing self-breast exams compared to non-participants. Women reported anecdotal changes in behavior based upon information from the class, including changes in diet, increased awareness of Hepatitis exposure threats and more attention to body changes and fluctuations.

Perhaps one of the most important findings was about communicating with healthcare providers and the importance of self-advocacy for health concerns. Through the role-plays, the peer educators learned how to frame their health questions in a manner that fostered support from the medical providers. They reported better communication with their providers, resulting in their perceptions of better health care. This information was thus shared with students during the classes.

From a systems perspective, the peer education program proved so successful that the activities resulted in job code designation for peer educators. It was a cost effective way to deliver programming and formed the foundation for a peer-driven Prison Rape Elimination Act initiative. Woman-to-Woman was an efficient and cost effective way to deliver programming to the female offender population. It was also a very popular program and viewed as a positive effort for women on the part of TDCJ.