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Actions and solutions informed by the health literacy strengths and challenges (ie, health literacy-informed interventions) of people in prison offer an opportunity to build fit-for-purpose and effective interventions in this unique context. This study aims to adapt and apply the three-phase Optimising Health Literacy and Access (Ophelia) process in a state-wide prison context to generate codesigned improvements in information, resources and services for people in prison.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods and analysis<\/jats:title>\n                    <jats:p>Health Literacy Questionnaire data from 471 people in prison will be analysed using descriptive and cluster analyses (Ophelia Phase 1). Clusters, with qualitative interview data, will then inform vignette development for use in ideas generation workshops and yarning circles with stakeholders to develop health literacy-informed interventions. Selection, prioritisation and testing of identified interventions will be undertaken (Phase 2), followed by implementation and evaluation (Phase 3). This project will advance intervention development in the prison context, enabling the voice of people in prison and service providers to be heard through codesign. The protocol will inform the development and implementation of interventions to systematically improve the delivery of information, services and resources for people in prison, which may be relevant to prison healthcare authorities globally.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Ethics and dissemination<\/jats:title>\n                    <jats:p>Ethical approval to undertake Phase 1 of the Ophelia process has been granted from the following Human Research Ethics Committees: Swinburne University of Technology (Ref: 20236977\u201315461), Justice Health NSW (Ref: 2022\/ETH01433), Aboriginal Health and Medical Research Council (Ref: 2007\/22) and the Corrective Services Ethics Committee (Ref: D2022\/1452326). Dissemination of the study findings will be the Justice Health NSW codesign process and ownership of the project through authentic engagement with people with lived experience and health and corrective staff. It will also be disseminated through publication in a PhD thesis, peer-reviewed research papers and conference presentations.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1136\/bmjopen-2024-092128","type":"journal-article","created":{"date-parts":[[2025,4,7]],"date-time":"2025-04-07T21:42:32Z","timestamp":1744062152000},"page":"e092128","update-policy":"https:\/\/doi.org\/10.1136\/crossmarkpolicy","source":"Crossref","is-referenced-by-count":4,"title":["Applying co-design health literacy development in Australian prisons: protocol for system-wide application of the Optimising Health Literacy and Access (Ophelia) process"],"prefix":"10.1136","volume":"15","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-0427-1639","authenticated-orcid":false,"given":"Scott W","family":"Gill","sequence":"first","affiliation":[{"name":"Centre for Global Health and Equity, School of Health Sciences, Swinburne University of Technology, Hawthorn, Victoria, Australia"},{"name":"Justice Health and Forensic Mental Health Network, Matraville, New South Wales, Australia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Julia","family":"Bowman","sequence":"additional","affiliation":[{"name":"Justice Health and Forensic Mental Health Network, Matraville, New South Wales, Australia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-8950-7689","authenticated-orcid":false,"given":"Christina","family":"Cheng","sequence":"additional","affiliation":[{"name":"Centre for Global Health and Equity, School of Health Sciences, Swinburne University of Technology, Hawthorn, Victoria, Australia"},{"name":"Justice Health and Forensic Mental Health Network, Matraville, New South Wales, Australia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Caron","family":"Shaw","sequence":"additional","affiliation":[{"name":"Clinical Excellence Commission, Sydney, New South Wales, Australia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Stephen","family":"Hampton","sequence":"additional","affiliation":[{"name":"Justice Health and Forensic Mental Health Network, Matraville, New South Wales, Australia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Wendy","family":"Hoey","sequence":"additional","affiliation":[{"name":"Justice Health and Forensic Mental Health Network, Matraville, New South Wales, Australia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Richard H","family":"Osborne","sequence":"additional","affiliation":[{"name":"Centre for Global Health and Equity, School of Health Sciences, Swinburne University of Technology, Hawthorn, Victoria, Australia"},{"name":"Justice Health and Forensic Mental Health Network, Matraville, New South Wales, Australia"},{"name":"Department of Public Health, University of Copenhagen, Kobenhavn, Region Hovedstaden, Denmark"},{"name":"NOVA University of Lisbon, Lisboa, Portugal"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"239","published-online":{"date-parts":[[2025,4,7]]},"reference":[{"key":"2025121602233915000_15.4.e092128.1","doi-asserted-by":"publisher","DOI":"10.1111\/j.1467-9566.2007.00474.x"},{"key":"2025121602233915000_15.4.e092128.2","doi-asserted-by":"crossref","first-page":"407","DOI":"10.1146\/annurev-publhealth-071521-034016","article-title":"Public Health and Prisons: Priorities in the Age of Mass Incarceration","volume":"44","author":"Cloud","year":"2023","journal-title":"Annu Rev Public Health"},{"key":"2025121602233915000_15.4.e092128.3","doi-asserted-by":"crossref","first-page":"8S","DOI":"10.1177\/0033354919826563","article-title":"Linkages Between Incarceration and Health","volume":"134","author":"Massoglia","year":"2019","journal-title":"Public Health Rep"},{"key":"2025121602233915000_15.4.e092128.4","unstructured":"Lin B , Delahunty B , Clancey G . 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