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Marti C.1,2, Peterhans B.3, Rau B.4
1University of Basel, Basel, Switzerland, 2Swiss Tropical and Public Health Institute, Basel, Switzerland, 3Swiss Tropical and Public Health Institute, Education and Training, Basel, Switzerland, 4International Committee of the Red Cross (ICRC), Health Unit, Geneva, Switzerland
Background: Prisoners represent a particularly vulnerable part of the population (WHO, 2014). Addressing the health of prisoners can be an opportunity to improve public health (Fazel and Baillargeon, 2011). Because health care in Swiss prisons is aligned with the principle of equivalence (SAMW, 2002), prisons should ensure adequate healthcare including physiotherapy, which is equivalent to that in the community. Although physiotherapy is part of basic health care it is not yet provided in all Swiss prisons.
Purpose: The aim of this study was to explore the current situation of physiotherapy provision in Swiss prisons in order to address the factors that need to be considered so that equivalent physiotherapy can be provided in prisons of Switzerland and elsewhere.
Methods: The approach chosen was both quantitative and qualitative. First a cross-sectional survey was conducted by doing telephone questionnaires with 110 Swiss prisons (all except those attached to a University Hospital). Descriptive statistics and logistic regression (the association between the number of inmates per institution and the provision of PT) were done to analyse the data.
Secondly semi-structured individual interviews with decision-makers, doctors and physiotherapists working in five different Swiss prisons were undertaken. 12 participants were selected purposively at the basis of their profession, the place and type of institution they work for and the model of physiotherapy provision the institution uses. The data was analysed using the Framework Method (Gale et al., 2013).
Results: 94 out of 110 (85.5%) institutions have participated in the survey. Out of these 85.1% provide access to physiotherapy. The proportion of detainees having access to physiotherapy in Swiss prisons is 97%. In addition 63.8% (60/94) institutions provide physiotherapy on-site and 21.3% (20/94) send their inmates outside for physiotherapy. Furthermore there is a significant association between the number of inmates per institution and physiotherapy provision (p=0.001).
Results from 11 interviews revealed that aspects of the Swiss penal and health system levels, the institutional level as well as personal opinions influence and hinder equivalent access to physiotherapy in Swiss prisons.
Conclusion(s): This is the first study in the field of physiotherapy in Swiss prisons. Results from the survey imply that access to physiotherapy is almost equivalent in prisons compared to the community. Furthermore the chance that physiotherapy is provided is significantly higher in prisons with a high number of inmates. However, in regard to the qualitative results we can conclude that access to physiotherapy is not yet equivalent to access of non-prisoners. In order to ensure equivalent physiotherapy provision in Swiss prisons, laws and decrees regulating prison health care on the national and cantonal level need to include physiotherapy provision.
Implications: This study considers a new area in the field of physiotherapy and can serve as basis for discussion on prison physiotherapy in many countries worldwide and where public health needs are immense. Findings can also promote discussion about involving prison physiotherapy in projects of organisations such as the ICRC, who work in places of detention.
Funding acknowledgements: None
Topic: Globalisation: health systems, policies & strategies
Ethics approval: The study was approved by the board of the Swiss Tropical and Public Health Institute of Basel, Switzerland.
All authors, affiliations and abstracts have been published as submitted.
