"Equipping and enabling" health literacy during a "time of change": understanding health literacy and organisational health literacy responsiveness for people leaving prison in later life.

Background: This qualitative study investigated experiences and understandings of health literacy for those released from prison in later life. The global rise in older incarcerated individuals-defined as those aged 50 and above-poses significant public health and health equity challenges. With up to one in four prisoners being categorized as "older," their complex health needs often exceed those of younger inmates and the general community. An important but under-investigated challenge for this older population is navigating health care systems and self-management of health after release. Research evidence, albeit limited, has consistently identified health literacy deficits in this this population, complicating their health outcomes and reintegration more generally. This study fills a gap in the experience of health literacy for older people leaving prison, thus contributing to conceptual understandings and guiding targeted intervention development for this marginalised population.

Results: Fifteen people with lived experience of release from prison in older age (mean age = 57) and thirteen staff or stakeholders with relevant professional experience from Australia participated in workshops and interviews exploring health literacy during the post-release period. An abductive thematic analysis was applied to the data, guided by the concept of health literacy and organisational health literacy responsiveness. The analysis produced two global themes ("Change" and "Equipped and Enabled") and seven subthemes ("A demanding time of change", "Braving a new world", "Leaving prison care", "I can only do what I can", "Help me help myself", "Others are key", "Everybody's problem, nobody's job"). Together, these themes indicated these individuals are the subject of complex and overlapping life circumstances, with limited resources and support currently available for health literacy both during and after release.

Conclusion: This population are mostly passive health care and information 'receivers' as a result of their imprisonment, who must be equipped and enabled to become more active health literacy 'doers'. This can be achieved through interventions that prepare the person better for life in community, and improve positive self-concept. Health and custodial organisations have an important role to play, with opportunities for improvement apparent across areas such as communication, focused health literacy policies, and collaboration with community partners.