Methodological challenges encountered in a study of co-payment policies and the health of women prisoners

Prison bureaucracies as well as the regulatory constraints of institutional review boards increase the difficulty and complexity of conducting research with prisoners. Although they are usually intended to serve as protection for prisoners, these circumstances, ultimately, can maintain the invisibility of prisoners and their health concerns from the general public and public health professionals. This paper analyzes the methodological challenges encountered in a qualitative, community-based participatory research project (CBPR) that explored the impact of co-payment policies on the health of women prisoners. The paper addresses: a) development the study using a community advisory board (CAB); b) inclusion of formerly incarcerated women, rather than prisoners, as participants; c) strategies used to maintain confidentiality, including a Certificate of Confidentiality from the National Institutes of Health; d) issues confronted during individual interviews and focus groups; e) concerns related to the dissemination of findings; and f) recommendations for future research. The intent of this CBPR project was to generate knowledge and promote a discourse about women prisoners' health without jeopardizing their extraordinary vulnerability.