Using the socioecological model to guide service delivery improvements to the prison needle exchange program in Canada: insights from multi-level stakeholders.

BACKGROUND

In 2018-2019, Canada introduced a Prison Needle Exchange Program (PNEP) across nine federal facilities to mitigate the harms associated with drug injection among incarcerated people. However, program uptake has been limited. We explored the barriers and facilitators to improving PNEP services among key stakeholders in prison.

METHODS

Stakeholders in nine federal prisons with active PNEP participated in focus groups using nominal group technique to achieve rapid consensus. Responses were generated, rank-ordered, and prioritized by each stakeholder group (correctional officers, healthcare workers, and people in prison). We identified the highest-ranking responses to questions about barriers and solutions to PNEP uptake and described them using the five levels of the Socioecological Model: individual, interpersonal, organizational, system, and structural/policy.

RESULTS

Between September 2023 and February 2024, 34 focus groups were conducted with 215 participants (n = 51 correctional officers (24%); n = 67 healthcare workers (31%); n = 97 people in prison (45%)). Key barriers identified were lack of confidentiality and privacy across all levels and fear of repercussions from drug use and fear of being targeted at the individual-interpersonal levels. Preferred solutions included comprehensive education across all levels, and establishment of supervised/safe injection sites and external program management, potentially involving peers, at the structural level.

CONCLUSIONS

Several multi-level modifiable barriers to improving PNEP uptake in Canadian federal prisons were shared among key stakeholders. Structural changes to PNEP delivery, including supervised/safe injecting sites and peer-led programs, were proposed as solution-driven enablers to increasing PNEP uptake among incarcerated people who inject drugs. These data will inform Canadian efforts to expand PNEP provision.