Application of co-design to develop and prioritise health literacy-informed action ideas for implementation across prisons in New South Wales, Australia

The value of considering health literacy in informing intervention development for diverse populations is well-recognised. People in prison frequently experience vulnerabilities and poor health, making prisons an important health-promoting environment. This study applied the Ophelia (Optimising Health Literacy and Access) process in New South Wales (NSW) prisons in Australia to co-design and prioritise health literacy-informed action ideas (i.e., suggested ideas with the potential to improve the health and equity for individuals or groups of people). In 2024, ideas generation workshops and yarning circles were held across six sites, where participants discussed vignettes and were asked to suggest action ideas to support the persona depicted. Staff then rated identified action ideas on their importance, current implementation and feasibility. Senior leaders then participated in a workshop to prioritise the action ideas. A total of 107 participants (people in prison = 54; staff = 53) discussed 23 diverse vignettes in eighteen ideas generation workshops and three yarning circles. From over one thousand suggestions, 260 action ideas were identified and inductively analysed, resulting in 17 strategies and seven action areas. Sixty-five staff rated the action ideas, informing the prioritisation workshop (attended by 43 senior leaders), where 109 action ideas were prioritised into seven priority areas for intervention development, testing and evaluation. This bottom-up and top-down co-design approach lays a strong foundation for service redesign, quality improvement and future research. Prioritised action ideas will now be developed into interventions and trialled in NSW prisons, which have the potential to improve the equity and well-being of people in prison globally.