PhD Research

To address these inequities, PhD candidate Scott Gill is part of a team leading a comprehensive program of research focused on strengthening health literacy within the NSW prison system. His work aims to develop health literacy informed interventions that are practical, meaningful, and grounded in the lived experiences of people in prison.

Understanding Health Literacy in the Prison Context

Initial studies and reviews have highlighted that the Australian prison population faces significant health challenges, yet interventions designed to address these issues often lack methodological rigour and rarely incorporate a health literacy focus. Scott’s research seeks to change this by applying a structured and evidence-based approach.

Central to this work is the Health Literacy Questionnaire (HLQ), a tool widely used to understand individuals’ and communities’ health literacy strengths and challenges. Scott systematically examined the utility of the HLQ in the prison context using an argument based validity framework, generating evidence on:

• response processes
• content relevance
• internal structure

This validation work supported the use of the HLQ as a needs assessment tool within NSW prisons.

Co Designing Solutions through the Ophelia Process

Scott’s research applied the Ophelia (Optimising Health Literacy and Access) process, a codesign methodology that brings community voices to the forefront. Using HLQ data, the process identifies key health literacy needs and then cocreates practical strategies with the people most affected.

Across the NSW prison system:

• 471 HLQ responses from the general prison population and 97 responses from people identifying as Aboriginal were analysed using hierarchical cluster analysis.
• This revealed 14 distinct health literacy profiles across the broader sample and 9 profiles among Aboriginal participants.
• 23 data driven vignettes—short stories illustrating typical individuals within each profile—were developed through interviews with people in prison.

These vignettes were presented for 21 idea generation workshops, including:

• 18 workshops with people in prison and correctional or health staff
• 3 yarning circles with Aboriginal participants
• Engagement totals: 54 people in prison and 53 staff

The workshops generated 260 unique health literacy action ideas across 17 strategies and 7 action areas, reflecting the diversity of needs and lived experiences.

Prioritising Action for System Wide Impact

To identify the most feasible and impactful strategies:

• 65 staff members rated each action idea on importance, feasibility, and current implementation status.
• 43 senior leaders from Justice Health and Corrective Services NSW then prioritised 109 action ideas across seven key priority areas.

This structured prioritisation ensures that the resulting interventions are both evidence based and grounded in operational realities.

Impact

Scott Gill’s doctoral program is set to produce:

1. A comprehensive validity argument, demonstrating the utility and appropriateness of the HLQ for identifying health literacy needs in NSW prisons.
2. A program theory for systemwide application - Providing a framework for understanding how health literacy development can be embedded across the NSW criminal justice system.
3. Evidence informed and codesigned interventions.

Actionable strategies that have the potential to:

• improve health outcomes
• strengthen equity
• reduce health disparities
• inform policy and practice across prison health services

Ultimately, this research contributes important knowledge on how to meaningfully engage people in prison in the design of interventions that affect their health, wellbeing, and access to care.