Effectiveness of the Training Program for Prison Health Volunteers in Caring for Prisoners with Diabetes and Hypertension

Abstract

Introduction Non-communicable diseases (NCDs), particularly diabetes and hypertension, represent major health challenges within correctional facilities, with prevalence rates continuing to rise. The increasing incidence of NCDs among incarcerated populations mirrors the upward trend observed in the general population outside prisons, thereby intensifying the demand for healthcare services. However, the limited number of medical personnel available in correctional institutions poses significant constraints. Reliance solely on healthcare professionals is insufficient to ensure comprehensive and continuous care for the growing number of inmates affected by chronic conditions. To address this issue, the Department of Corrections has implemented a policy to strengthen the prison healthcare system through the training of Prison Health Volunteers (PHVs). These trained volunteers are equipped to assist health staff in providing basic healthcare services to fellow prisoners, particularly those living with diabetes and hypertension. Their role includes supporting self-care practices, promoting appropriate health behaviors, and reducing the risk of complications. Consequently, PHVs play a vital role in advancing sustainable health promotion within prisons, despite the limitations in healthcare resources.

Objective This study aims to examine the effectiveness of the Prison Health Volunteer (PHV) training program in supporting the care of inmates with diabetes and hypertension. The specific objective is to compare participants’ disease-related knowledge, skills, values and attitudes toward the role of PHVs in caring for prisoners with diabetes and hypertension, both before and after the training program.

Design This quasi-experimental study employed a one-group pretest–posttest design. The researchers developed a training curriculum for Prison Health Volunteers (PHVs) in accordance with correctional facility regulations. The curriculum was grounded in Kolb’s experiential learning model, which emphasizes knowledge construction through prior experience, reflective observation, conceptualization, and application. In addition, the program integrated and adapted elements from the existing Village Health Volunteer (VHVs) training framework to suit the prison context. The training program comprised a total of 75 hours, including 15 hours of theoretical instruction and 60 hours of practical training. It was structured around four core activities: 1) Sharing Experience, 2) F rom Awareness to Understanding, 3) S ummarizing for Meaningful Practice, and 4) P racticing for Skill Development.

Methodology The study sample consisted of 27 prisoners who completed the Prison Health Volunteer (PHV) training program between 2020 and 2023 at a correctional facility located in northeastern Thailand. The sample size was calculated using the G*Power software, and participants were selected through stratified random sampling based on their PHV responsibilities in providing healthcare services across different prison zones. Data collection was conducted between March and April 2025. Two sets of research instruments were employed: 1) A training instrument, specifically the PHV training curriculum for the care of inmates with diabetes and hypertension, and 2) Data collection instruments: (1) A knowledge assessment on diabetes, hypertension, and health communication, (2) A skills assessment for inmate care related to diabetes and hypertension, and (3) An evaluation of values and attitudes toward the PHV role in caring for prisoners with diabetes and hypertension. The quality of the instruments was examined by experts. The content validity index (CVI) of the training curriculum was 1.00, while the CVI for the knowledge, skills, and values/attitudes assessments was .97. Reliability testing indicated that the knowledge assessment had a Kuder–Richardson Formula 20 (KR-20) coefficient of .76, whereas the skills and values/attitudes assessments demonstrated Cronbach’s alpha coefficients of .89 and .71, respectively. Data were analyzed using descriptive statistics and Paired t-test.

Results The majority of participants were male (92.6%), with a mean age of 35 years (SD = 6.81). Most had attained secondary-level education (77.7%). Regarding their experience as Prison Health Volunteers (PHVs), more than half had served for at least two years (55.6%). Only 37% had previously received training in the care of people with diabetes and hypertension, while the majority (66.7%) reported prior experience in caring for patients with these conditions before incarceration. After the training program, participants demonstrated statistically significantly higher scores across all measured domains. The mean knowledge score increased from 13.48 (SD = 2.20) before training to 17.85 (SD = 1.40) after training (t = -9.034, p < .001). Similarly, the mean skills score rose from 13.07 (SD = 1.54) to 17.66 (SD = 1.70) (t = -10.339, p < .001). In addition, the mean score for values and attitudes toward the PHV role increased from 3.04 (SD = 0.39) to 3.54 (SD = 0.28), with statistical significance (t = -5.105, p < .001).

Recommendation The findings indicate that this training program can serve as a model for developing Prison Health Volunteers (PHVs), enhancing their competencies in the care of prisoners with diabetes and hypertension. The program strengthens both proactive health promotion roles and supportive functions for medical personnel, particularly in correctional facilities with similar contexts and organizational structures.