There are a number of limitations inherent within this work that should be outlined and acknowledged. The majority of these limitations are due to methodological adaptations required due to the Covid-19 pandemic which was ongoing at the time of data collection (October 2021 – March 2022). At this time, stakeholders, and in particular prison-based NHS staff, were coping with particularly high workloads which impacted on their ability to fully engage with the project. As such, the interviewed sample contained fewer prison-based primary health care staff than we would have wished.
Further, face-to-face interviews with people residing in prison were not possible on account of Scottish Government guidelines that were in place during the timeframe of the project. Virtual interviews with people in prison were considered, but were not possible, given the tight timeframe of the project and the aforementioned workloads of those that would be required to support facilitating interviews.
To ensure a voice to those with lived experience of prison, people with recent experience of prison and family members of people in prison were instead invited to contribute to the project. Despite the team's best efforts, and the support of several relevant organisations, the numbers of people with experience of prison and family members of people in prison were lower than originally planned. It is recognised that such limitations will have inevitably impacted on the breadth of data collected in respect of health care provision within Scotland's prisons.
All interviews were conducted utilising remote technology. Whilst this method might, it could be argued, have increased the likelihood of some participants engaging with the project, it might also have created a barrier to some potential participants, for example those with limited access to the required technology and/or wifi connectivity or mobile data. It is likely that these barriers will have disproportionately impacted individuals with lived experience. In recognition of this, potential participants were given the choice of a telephone or virtual (e.g. MS Teams) meeting and had the option to turn the camera off should they opt for the latter.
Finally, and in respect of the quantitative assessment of health care needs, the limited data available meant that it has not been possible to adjust the prevalence estimates to account for differences in sex, age or other relevant characteristics to allow for more direct comparisons with the general (non-prison) Scottish population. As such, any differences in prevalence rates between Scotland's prison population and the general Scottish public must be interpreted cautiously.
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