COLLEGE OF NURSING

PERCEIVED HEALTH STATUS AND SERVICES PROVIDED TO PERSONS

DEPRIVED OF LIBERTY IN SANTIAGO CITY JAIL – MALE DORMITORY
ACCESSIBILITY AND QUALITY OF HEALTH CARE SERVICES
PROVIDED TO PERSONS DEPRIVED OF LIBERTY
IN SANTIAGO CITY JAIL – MALE DORMITORY

A Thesis Proposal
Presented to
The Faculty of the College of Nursing
Northeastern College, Santiago City

In Partial Fulfillment of
The Requirements for the Degree in
Bachelor of Science in Nursing

By:

Tricia Anissa G. Ammoya

Valerie Grace B. Bakakeo
Lyka Nicole P. Baltazar
Princess Yasmin T. Bantilan
Ashley M. Caser

First Semester
S.Y. 2024-2025

December 2025
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APPROVAL SHEET

In partial fulfillment of the requirements for the requirements for the

Degree Bachelor of Science in Nursing this thesis entitled “Perceived Health

Status amd Services Provided to PDL’s” ACCESSIBILITY AND QUALITY OF

HEALTH CARE SERVICES PROVIDED TO PERSONS DEPRIVED OF

LIBERTY IN SANTIAGO CITY JAIL – MALE DORMITORY prepared and

submitted by Tricia Anissa G. Ammoya, Valerie Grace B. Bakakeo, Lyka

Nicole P. Baltazar, Princess Yasmin T. Bantilan, Ashley M. Caser is hereby

recommended for approval.

MARIA REBECCA CORAZON A. MANIPON, RN, MAN

Adviser

Approved by the Committee on Oral Examination with a grade of

___________.

NELIA B. PEREZ, RN, PhD, DNS

Chairperson

MARIA REBECCA CORAZON A. MANIPON, RN, MAN JUDITH LUTRIANA, RN, LPT, MAN, MAED
Member Member

Accepted as partial fulfillment of the requirements for the degree

Bachelor of Science in Nursing

JUDITH LUTRIANA, RN, LPT, MAN, MAED

Dean
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ACKNOWLEDGEMENT

The researchers would like to extend their sincere thanks and gratitude

to the following persons who have contributed and supported them in the

fulfilment of this study:

Dean Judith B. Lutrania, RN, LPT, MAN, MAED, College of Nursing, for

her support in encouraging and motivating the researchers in making this

study possible;

Mr. Mark Angelo Ubaldo, LPT, researcher, College of Nursing, whose

expert in research has made this study more satisfying and scholarly by his

insightful guidance and recommendation;

Ms. Maria Rebecca Corazon A. Manipon, RN, MAN, for her kind words,

encouragement, and consistent support in undertaking of this research, as

well as the patience and time spent checking or reviewing the manuscript,

providing recommendations/suggestion and constructive criticisms all of which

contributed significantly to the completion of this study.

(Insert for the panel)

Lastly the researchers would like to extend their heartfelt thanks to their

family and friends for their unwavering support throughout this process. Their

encouragement and belief helped us to stay focused and motivated, even

during challenging times. We are grateful for their love and support, which

made this research possible.

The Researchers
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DEDICATION

We sincerely dedicate this study to the entire faculty of Northeastern

College, College of Nursing, for fostering academic excellence within the

institution and to our beloved research instructors for the knowledge and

instruction we have received from the beginning, fosters us and has optimism

about our ability to succeed academically, and taught us everything we

needed to know in a compassionate and understanding manner so that we

could succeed and complete this excellent study.

To the highly motivating parents of the researchers, who never cease

encouraging us to complete our responsibilities while supporting us with

continuous physiological, financial, and emotional support. To everyone who

generously helped us in accomplishing this study, who shared their

knowledge with us, and who sacrificed up some of their time in order for us to

attain this goal.

Finally, we offer this accomplishment to our All-Powerful God, our

foundation of wisdom and strength, to whom we commit the effort of this

activity.

The

Researchers
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TABLE OF CONTENTS

Title Page 1
Approval Sheet 2
Acknowledgement 3
Dedication 5
Table of Contents 6
Chapters
I. THE PROBLEM AND ITS BACKGROUND
Introduction ……………………………………………………. 1
Statement of the Problem ……………………………………. 3
Theoretical Framework …………………………………… 4
Conceptual Framework ……………………………………. 6
Significance of the Study ……………………………………. 8
Scope and Limitations ……………………………………. 10
Definitions of Terms ……………………………………. 11
II. REVIEW OF RELATED LITERATURE AND STUDIES
Review of Literature and Studies ………………………. 17
III. RESEARCH METHODOLOGY
Research Design …………………………………………….. 22
Respondents of the Study …………………………………….. 22
Locale of the Study ……………………………………………. 23
Research Instrument/s ……………………………………. 24
Data Gathering Procedure …………………………………….. 24
Ethical Considerations ………………………………………… 26
Statistical Tools / Data Analysis …………………………….. 26
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Chapter I

THE PROBLEM AND ITS BACKGROUND

Introduction

The health status of populations in confinement is one of the global

public health concerns. The health status of populations in confinement,

including those in jails, refugee camps, or institutionalized settings, is a

significant global public health concern that demands immediate attention.

Confinement can significantly impact both physical and mental health. Factors

such as overcrowding, restricted access to healthcare services, poor nutrition,

and increased risk of infectious diseases contribute to this decline. The recent

COVID-19 pandemic has highlighted these vulnerabilities, showing how

confinement can worsen health disparities and negatively impact the well-

being of marginalized groups. Furthermore, the psychological effects of

confinement, such as heightened levels of anxiety, depression, and post-

traumatic stress disorder, pose considerable challenges that require thorough

public health strategies. Tackling these issues is crucial for upholding the

rights and dignity of those impacted. It also plays a vital role in advancing

health equity and enhancing the effectiveness of public health initiatives

worldwide.

Lanzano et al. (2023) carried out a study in Italy, and their findings

were quite alarming on the perceived health status and satisfaction with

healthcare services for the detained population. Their research emphasizes

the need for comprehensive health care systems within jails since people in
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confinement often suffer from higher rates of physical and mental health

issues than those in the general population. A similar pattern is seen globally

where the overcrowded and under-resource jail systems create more health

problems, hence the high morbidity and mortality levels among the Persons

Deprived of Liberty (PDL). According to the WHO (year), jail health is part of

public health, and hence health care in jails needs improvement to address

issues peculiar to PDL. Studies show that the PDL experienced untreated

chronic conditions and mental health disorders at rates much higher than

those in the community (Guadamor et al., 2019).

Recent initiatives in the Philippines aim to improve healthcare access

for PDL, though challenges remain due to overcrowded and substandard

facilities. Leonor (2023) also emphasizes community-based rehabilitation,

which is a method of achieving local health outcomes by collaboration

between the community and correctional facilities, as demonstrated by the

Iriga District Jail. It goes further to implement policies that were initiated by the

Department of Health with the goal of fostering a healthy environment within

the centers of detention by addressing the physical, mental, and social

aspects of health. It advocates for the implementation of such policies, as the

majority of PDL are unable to access specific health services as a result of

bureaucratic constraints within correctional agencies. For instance, local

studies conducted by Guadamor et al. (2019) offer a specific perspective on

the health requirements and characteristics of PDL in facilities such as the

Ilagan City District Jail. These studies demonstrate that a significant number

of PDL experience a variety of health issues that are exacerbated by

inadequate living conditions and inadequate healthcare services. In this

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regard, there are emerging innovative solutions, such as telemedicine

programs, which allow detained individuals to consult with healthcare

providers located at a distance.

Legal frameworks forming the basis of this research focus on the right

to health of PDL in the Philippines. In fact, the 1987 Philippine Constitution

declares that the right to health is a basic human right. The government is

mandated to provide necessary healthcare services even for those deprived

of liberty. More recent DOH policies strengthen this by calling for an

environment that safeguards health and includes PDL in all national health

insurance programs like PhilHealth (BusinessWorld Online, 2024). In addition,

BJMP is required to implement necessary medical service and attend to

issues emanating from overcrowding, which could compromise effective

delivery of healthcare service (BJMP Data Statistics, 2020). Despite these

legal provisions, some system challenges still remain; they include

overcrowding and limited resources that impact on service quality and

accessibility among the PDL throughout different regions in the country.

Improving the bases for these legal provisions requires enhancing health

outcomes and making healthcare services offered to PDL comparable to

those offered within the broader community.

Conditions encountered by PDL in jails in the Philippines usually

consist of both satisfactory and unsatisfactory aspects regarding their health

care access and overall conditions. Eusebio's (2019) research conducted at

different district jails revealed that, although some initiatives were taken to

give the basic medical care, there were still many problems for the PDL such
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as lack of sufficient medical staff and poor infrastructures. For example,

according to Martinez (2019), this improvement in access to health care for

the PDL in Cabagan District Jail has not eradicated overcrowding as a deadly

threat to both physical and mental well-being. To add, Guadamor & Eusebio

(2019) argue that unhealthy conditions of living provoke widespread

communicable diseases in PDL and further deteriorate their fragile health

conditions. Contrary to this, engagement with the community has seen

positive changes in rehabilitation programs in jail institutions, among them

Iriga District Jail, as shown by Leonor in 2023, that teamwork can upgrade

service delivery and meet needs for PDL concerning health care services.

These are, however, often outweighed by some of the persistent challenges

facing PDL, which include lack of adequate nutrition, absence of mental

health support, and inadequate access to specialized medical care-issues that

remain critical to ensuring the overall well-being of PDL in the Philippines.

There is also a big gap within the literature concerning the detailed

analysis of perceived health status and satisfaction with health care service

among Persons Deprived of Liberty in the Philippines. Previous researches

conducted by Eusebio (2019) and Martinez (2019) has documented specific

issues like overcrowding and lack of access to health care; however, there is

a notable dearth of holistic studies on these factors in multiple detention

facilities. The study of Eusebio and Martinez is informative of the situation in

each particular jail but does not present a more general view on how these

problems generally influence the health perceptions and healthcare

satisfaction of PDL. It tries to fill this gap with a systematic review of

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experiences of PDL across different correctional facilities toward further

contribution to the total understanding of their health needs.

This study intends to find out the accessibility and quality of health care

services provided to persons deprived of liberty in Santiago City Jail – Male

Dormitory. It will give a much-needed holistic view that lacks in most previous

studies.

Statement of the Problem

The research aimed to investigate the relationship between perceived

health status and the healthcare services provided to Persons Deprived

of Liberty (PDL) accessibility and quality of health care services

provided to persons deprived of liberty in Santiago City Jail – Male

Dormitory .

Specifically, it seeks to answer the following questions:

1. What is the socio demographic profile of the respondents in terms

of:

a. Age;

b. Civil Status;

c. Educational attainment;

d. Religion;

2. What are the respondents perceived factors that affect the health

care delivery in terms of:

a. Availability;
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b. Affordability;

c. Accessibility;

d. Accommodation; and

e. Acceptability

3. What are the health care services being provided among PDL of

Santiago City Jail – Male Dormitory in terms of:

a. Counselling and support services;

b. Health promotion services;

c. Medical and nursing services; and

d. Dental health

4. What is the quality of health care services being rendered in terms

of:

a. Effectiveness;

b. Safety;

c. People-centered;

d. Timeliness;

e. Equitability;

f. Integrated; and

g. Efficiency

h. Communication;

i. Health Teaching;

j. Time Management;

k. Equitability
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5. Is there a significant relationship between the respondents

perceived factors in the delivery of healthcare services when group

according to their demographic profile?

Hypothesis of the Study

Ho: There is no significant relationship between perceived health status and

satisfaction with healthcare services provided to Persons Deprived of

Liberty (PDL) in the Philippines.

Theoretical Framework

Figure 1: Social Determinants of Health (SDH) framework

SDH framework Marmot (2005) and Wilkinson & Pickett (2009)

emphasizes that health outcomes depend not only on individual behavior and

biological factors but on the wider social, economic, and environmental

contexts within which individuals live. According to it, income, education,

employment, community safety, and other determinants affect health and

well-being. The SDH framework then helps in recognizing the interplay

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between societal conditions and the resultant health outcomes, such that

health is not purely the result of personal decisions but is rather highly

impacted by structural inequalities.

The paradigm of Social Determinants of Health incorporates two broad

categories: structural determinants and intermediary determinants. Structural

determinants include socioeconomic status, community context, and systemic

issues that lead to health inequities. These all influence the extent to which

people have access to a set of resources and opportunities that support good

health. Intermediary determinants are those related to the living conditions

and immediate surroundings that influence health outcomes and include

housing quality, health care services, and social support networks. These

determinants operate synergistically to shape health perceptions and

experience among individuals.

Conceptual Framework

Based on the theories and reviewed literature and studies, the

conceptual framework of the study is presented below:

INPUT PROCESS OUTPUT

-Physical health -Survey Questionnaire Proposed

-Mental health interventions or
-Quality of life Statistical tool,
policy changes based
-Access to healthcare on the findings to
-Accessibility
improve healthcare
_Quality of care
-Timeliness of service delivery for PDL.
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The present study explores the relationship between perceived health

status and services offered to PDL. This will respond to several critical

questions guiding the focus of the research. The questions include the extent

to which PDL perceive their health status, in dimensions of physical health,

mental health, quality of life, and access to healthcare. Understanding these

dimensions can help in the identification of precise health needs in this group

of people. The study focuses on the degree of satisfaction associated with the

health services given to PDL. This ranges from analyzing dimensions such as

accessibility, quality of care, and service delivery time. Evaluation in these

areas will give insights into areas where healthcare service delivery might not

meet standards and, therefore, improve. This will try to find out whether

perceived health status has a strong association with satisfaction with

healthcare services for PDL. Such an inquiry is necessary for establishing

how perceptions of health can influence levels of satisfaction and vice versa.

Finally, this study will try to recommend certain outputs or recommendations

as findings. These outputs may include practical ways to improve the delivery

of health care in jails with a view to better welfare for PDL.

Scope, Limitation and Delimitation

This research study includes the perceived health status and

satisfaction with health services by Persons Deprived of Liberty (PDL) in the

selected detention facilities across the Philippines. It will study the various

dimensions of health, which include physical health, mental health, quality of

life, and access to health services. This research will be conducted on various

detention centers to understand in-depth healthcare experiences of PDL.

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This study recognizes several limitations that might impact the

interpretation of its findings. One of the most important is the reliance on self-

reported data from PDL, which could be biased or inaccurate for reasons such

as social desirability or fear of repercussions. The cross-sectional nature of

the study also gathers information at a point in time that may not ideally

represent changes in health status or service satisfaction over time. Resource

constraints would limit the sample size and, thus, the diversity of the detention

facilities covered by the study, hence possibly influencing the generalisability

of the results to all PDL in the Philippines. Moreover, external factors that

might include corrections in health care reform as well as different facility

management practices might have an impact but cannot be controlled during

this research.

The delimitations of this study define the boundaries and clarify

what is not included in the research. This study will only focus on adult male

and female PDL in selected detention facilities, thereby excluding juvenile

detainees and people held in other types of custodial settings, such as

rehabilitation centers or mental health institutions. The research will focus on

specific aspects of healthcare services, such as accessibility, quality of care,

and timeliness, while excluding broader systemic issues that are related to jail

management or legal frameworks that are not directly related to health

services.

Significance of the Study

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The results of this study could help determine the current state of

perceived health status and satisfaction with healthcare services among

Persons Deprived of Liberty (PDL) in the Philippines.

Specifically, it would be beneficial to the following:

Policy Makers: The results can inform government officials and health

authorities about the particular health needs and service gaps experienced by

PDL, guiding the development of targeted policies and interventions that can

improve healthcare access and quality within correctional facilities.

Advocacy Groups: Organizations that are human rights groups and

jail reform groups may use the findings to lobby for improved health care in

jails for PDL, highlighting the need for health disparities in corrections as part

of the larger struggle for social justice.

Academic Community: There will be further related study from the

findings. More and more literature would focus on the importance of the health

status of people detained in jail and its relevance for public health.

Community Health Initiatives: The study may also help community

organizations develop programs to support PDL when they are released, thus

maintaining continuity of care and managing potential health issues that may

occur after release.

BJMP (Bureau of Jail Management and Penology): the BJMP

manages jail services and operations in the country; it may find improvements

for its policies and health service programs aimed at reducing morbidity in

health for PDL based on the study's results, with the specific understanding of

its own health concerns and satisfactory levels.

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Philippine National Police (PNP): The PNP would also benefit from

understanding health status in relation to how PDL behave in jails. Such

knowledge can result in better management that ensures a healthier

environment inside the jails.

Definition of Terms - Alphabetize, hanging indent

For further understanding, the following terms are operationally and

conceptually defined:

Perceived Health Status: This pertains to self-rating by a patient of the

condition of health, cutting across different aspects, including physical health

and mental health, quality of life, and access to the services available in the

hospital. In this regard, it manifests how PDL rate their general health relative

to their incarceration.

Physical Health: refers to the general condition of the body, including

absence of disease or illness and capacity to execute daily activities. In PDL,

it can include assessment for chronic conditions, general fitness, and health-

related complaints.

Mental Health. This refers to emotional, psychological, and social well-being.

It influences the way an individual thinks, feels, and acts. Mental health is very

significant in explaining how individuals can handle stress, relate to others,

and make choices. Confined conditions and social support can affect PDL's

mental health.

Quality of life includes well-being, satisfaction of a person regarding life, or

one's experience of life through different dimensions including physical,

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mental, social, and environmental aspects. This can easily influence the life of

PDL in various ways, specifically depending on their jail condition and

healthcare provided.

Access to Care: It describes the ability of patients to access necessary

healthcare. These include, among others, access to healthcare providers,

service costs, transportation to the provider, and limitations that may prohibit

PDL from accessing care in a timely manner.

Satisfaction with Health Care Services: This concept refers to how

individuals assess their experience with health care services that they receive

while in jail. It involves several aspects such as accessibility (ease of access

to services), quality of care (the effectiveness and appropriateness of

treatment), and timeliness of service (timeliness in receiving care).

Accessibility: This is the extent to which health care services are accessible

and accessible to PDL. It encompasses issues such as the physical distance

to the health facilities within the jail system and the availability of medical staff.

Quality of Care: It is the measure of quality services offered by medical

professionals within correctional settings. This may include the medical

personnel's competence, sufficiency of the treatment protocols offered, and

patient-centered care.

Time to Service: It refers to the time within which services are offered to PDL

after their request or need for the same. This delay in accessing healthcare

impacts health outcome and patient satisfaction.

Persons Deprived of Liberty (PDL)

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CHAPTER II
REVIEW OF RELATED LITERATURES AND STUDIES
This chapter aims to contextualize the current research, identify gaps in the

existing body of knowledge, and underscore the importance of addressing

health disparities and service delivery challenges in detention facilities.

Through this, the study seeks to contribute to the growing discourse on

improving health outcomes and service quality for PDL.

Perceived Health Status Among PDL

A thorough study of the health status of people behind bars in the United

States conducted by Dyer et al. (2020) showed that these people suffer from

a different physical health profile than the general population. Chronic

conditions such as hypertension and asthma are common, often left untreated

or under-treated because preventive care is not readily available. Correctional

facilities were identified as environments that compounded health risks,

mainly because of systemic shortcomings in healthcare delivery and lack of

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emphasis on preventive measures. The research highlighted the cyclical

nature of health issues within these settings, where poor management of

chronic diseases could lead to severe complications over time, thus

exacerbating health inequities upon PDL' release. It can thus be argued that

systemic corrections- facilities-level healthcare reforms are necessary:

comprehensive medical care and preventative methods shall be integrated.

Such healthcare reform would not only address instant inequalities in health

but also work as the basis for continuity of treatment after release from jail-

that is, reducing recidivism and improving public health conditions. The study

emphasized the ethical duty of ensuring that quality health services be

delivered to PDL in view of more comprehensive public health and human

rights considerations. Further calls for public health systems' cooperation with

correctional healthcare service providers were made toward establishing more

balanced and sustainable health interventions specifically suitable to the

needs of PDL.

Rivera et al. (2022) analyzed the health condition of Persons Deprived of

Liberty (PDL) in regional detention centers across the Philippines, finding

serious health problems that indicate structural failures in jail healthcare.

Malnutrition and communicable diseases, specifically tuberculosis, were the

most common health issues found in PDL. Detention center overcrowding

was also a main factor in the exacerbation of these health problems, which

would also create a breeding ground for infectious diseases to spread easily

and where nutrition and medical services could not be effectively

administered. According to Rivera et al., there were several detention centers

that did not have any infrastructure, medical staff, and funding for PDL' health
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care. This often led to late or inadequate treatment that further deteriorated

their health and created a cycle of preventable problems. The authors called

for reforms in policy to enhance systems in jail healthcare facilities by urging

enhanced investment from the government and strengthening linkages with

public health institutions. They also suggested periodic health check-ups and

strategic interventions aimed at the specific risks that the health of PDL faces.

In this light, the study could argue that tackling these systemic barriers would

improve the general health and well-being of imprisoned populations and

make detention centers act as places where basic human rights are met and

contribute toward public health.

Jones et al. (2021) presented a detailed analysis of the prevalence of chronic

health conditions among PDL in the United States, revealing significant health

disparities that are often overlooked in public discourse. The study found high

rates of chronic diseases, including diabetes and heart disease, which were

associated with the limited lifestyles and healthcare resources available in

correctional facilities. Poor nutrition, exercise, and access to health care

characterized the worsening health of most PDL. The authors explained that

correctionalism, primarily focused on incarceration, had neglected the

demand for overall health monitoring with proactive healthcare interventions.

Jones et al. recommended the formation of a robust health monitoring

program in corrections facilities to deal with chronic diseases. They

recommended incorporating evidence-based best practices in jail health care

structures, emphasizing routine screenings, treatment plans that are

individualized to each inmate, and education on health for the PDL. The

research contended that addressing chronic health issues in jails is both a

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matter of moral imperative and strategic public health intervention in the

interest of long-term savings on health care costs and improved reintegration

outcomes among former PDL. By prioritizing health equity within the

correctional system, concluded the authors, it would be possible to mitigate

the negative impact of incarceration on health and contribute to broader

societal well-being.

Alvarado et al. (2023) conducted a study on the physical health of Persons

Deprived of Liberty (PDL) in Cebu, Philippines, with a particular focus on the

prevalence of communicable diseases such as tuberculosis. The research

highlighted that poor ventilation and inadequate hygiene conditions in

detention facilities were significant contributing factors to the spread of these

diseases. The study noted that overcrowding and insufficient healthcare

resources further exacerbated the situation. The authors therefore suggested

improvement in infrastructure such as improved ventilation systems and

hygiene practices. They further advocated for health screening regularly and

for early medical intervention to prevent communicable diseases from

spreading among the PDL. The findings have therefore emphasized

improving living conditions in detention centers for better health and wellbeing

of detainees in the Philippines. These measures could reduce the burden of

preventable diseases in such high-risk environments.

Quality of Life and Mental Health of PDL

Smith and Johnson (2021) conducted an in-depth investigation into the mental

health of incarcerated populations in Canada, focusing on the high prevalence

of untreated mental health issues such as depression and anxiety. Their study

revealed that a significant portion of PDL were struggling with these

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conditions without adequate treatment or support. The research indicated

systemic issues within the correctional system, such as resource deficiencies

and the unavailability of mental health services targeted towards PDL. The

study suggested that untreated mental health issues typically result in poor

outcomes, including higher rates of self-harm and suicide ideation. Based on

their findings, they called for a comprehensive approach to mental health care

in corrections facilities, emphasizing the integration of mental health

professionals with healthcare teams in such institutions. In addition, they

called for the establishment of holistic mental health services for PDL that

would involve early intervention, preventive care, and long-term support for

PDL to address the mental health crisis in Canadian jails and enhance the

well-being of PDL.

Luna and Santos (2019) conducted a study in the PDL in Metro Manila,

Philippines on the mental health impacts of jail conditions, indicating

overcrowding and limited mental health services as the key factors negatively

affecting their mental well-being. Their findings showed that the living

circumstances in the jails, due to the insufficient provision of psychological

care, have increased stress conditions and the general decline of PDL' quality

of living. Among these, the crowding was said to be a major contributor

because it causes overcrowding, few personal spaces, limited privatization,

and poor sanitation and hygiene. The lack of enough qualified professional

mental health care specialists within the jail system contributed to the

dilemma, leaving most PDL unassisted. This would improve the mental health

services system in place within the jails by instituting comprehensive psych

services and additional jail staff training that allow for them to identify mental
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disorder conditions or problems. They also advocated for policies that would

reduce overcrowding, improve living conditions, and ensure that PDL receive

the mental health care they need to improve their well-being while

incarcerated.

Parker and Green (2020) analyzed the mental health issues among jail PDL in

the United Kingdom and reported that depression and PTSD are the most

common mental disorders. They found that addressing these problems in the

correctional system is important since mental health issues that remain

untreated tend to worsen complications such as behavioral problems and

exacerbation of psychological distress. The study also revealed that many of

the PDL had had some form of trauma before their incarceration, which only

added to their mental health issues. They stressed the need for therapeutic

interventions to be integrated into the standard treatment packages in UK

jails. They urged that therapy sessions and other mental health treatments be

part of the standard package of jail healthcare rather than optional or ad hoc

services. Their suggestions also included enhancing the training of staff to

recognize and respond to mental health needs, and to establish environments

that encourage rehabilitation rather than punishment. According to Parker and

Green (2020), by integrating therapy and mental health support more

holistically, the UK could do much better in addressing the psychological

needs of those incarcerated and reducing the long-term adverse effects of

incarceration on mental health.

Villanueva and Cruz (2022) surveyed the mental health of PDL in Davao City,

Philippines to determine the impact of protracted detention on psychological

well-being. The study found that it is isolation and overcrowding which causes
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mental health deterioration most especially in detention facilities. Long-term

imprisonment also meant feelings of hopelessness, depression, and anxiety.

Most PDL experienced significant psychological distress because of a lack of

social interaction and limited mental health care. The authors have identified

that these conditions are highly prevalent in overcrowded facilities. Most PDL

spend extended periods in confined spaces with little or no personal privacy.

This report advised detention facilities to enhance the care of their inmate

populations by integrating mental health interventions into the detention

center. Recommendations included conducting scheduled mental health

screenings, availing psychological counseling, and including PDL in

rehabilitation programs created to help detainees' mental health recoveries

and diminish the harmful side effects caused by extended incarceration

periods. The study sought to enhance the total well-being of PDL in Davao

City and other similar settings by addressing mental health proactively.

Access to Healthcare Services in Correctional Facilities

Nguyen et al. (2023) conducted an in-depth review of the challenges to

access to healthcare in Australian jails, highlighting several key issues that

have challenged the delivery of appropriate care to those in jail. Of these

challenges, the study reported that understaffing within healthcare teams was

responsible for delays in delivering necessary medical services, and long

waits for routine and emergency care. There was also a lack of specialized

medical care, especially for those PDL with more complicated health

conditions. The study pointed out the necessity for an integrated approach by

proposing that correctional healthcare systems be connected to the public

health systems in general to enhance access and continuity of care. This way,
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the study argued, PDL would benefit from better comprehensive, timely, and

high-quality healthcare services. Nguyen et al. (2023) called for systemic

reforms and better resource allocation to address these healthcare access

challenges within Australian jails.

Delos Santos (2021) analyzed the status of healthcare access in provincial

jails in the Philippines and revealed significant gaps in the delivery of medical

services. Inadequate funding and a shortage of medical personnel were found

to be the primary challenges faced by provincial jails in the Philippines,

resulting in limited access to needed health care. Many PDL, especially those

in remote locations, found it difficult to get proper medical attention because of

these systemic shortcomings. The study also cited the reason as the lack of

well-equipped medical facilities in the jails, which hinders their ability to meet

urgent as well as long-term health needs. According to Delos Santos (2021),

the resource gap between the local government and healthcare providers

must be bridged through stronger collaboration. The study argued that access

to healthcare might be improved significantly among the country's

incarcerated for the simple reason that there is a need to increase funding for

healthcare in provincial jails as well as adequately train and deploy medical

staff.

Kumar et al. (2023) assessed the challenges of accessing health care among

PDL in Indian jails, particularly identifying low numbers of staff and resource

gaps as major barriers to proper health care provision. According to the

findings, most correctional facilities lacked adequate healthcare structures,

with low medical personnel availability compared to the incarcerated

population. This shortage was accompanied by suboptimal availability of

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medicines and antiquated equipment to further restrict care delivery

capabilities. The researchers highlighted collaboration between public health

institutions and correctional facilities, which needed to be addressed in

delivering quality services. According to Kumar et al. (2023), a partnership

may eventually bridge resource and expertise differences, further enhancing

healthcare delivery to PDL. The study argued that public health institutions

could play a pivotal role in ensuring that the individuals incarcerated would

receive timely and appropriate healthcare through the facilitation of exchange

of medical knowledge and resources.

Soriano (2021) assessed the health services available in northern Luzon

provincial jails in the Philippines. She based her evaluation on the availability

of medicines and healthcare workers considering the constraints brought by

limited budget allotments. The researcher discovered that inadequate budget

allocations to healthcare not only prevented these facilities from implementing

essential medical services but gave many PDL poor-quality care. With limited

financial inputs, provincial jails could not ensure that there was a constant

stock of medical equipment, medicines, and other critical healthcare needs.

Furthermore, the lack of medical professionals worsened the situation, for

there were not enough healthcare providers to attend to the healthcare needs

of the PDL. Soriano (2021) emphasized the need to raise budgetary

allocations for jail healthcare to ensure that PDL get the necessary care. By

securing more funding, the study argued, provincial jails could improve the

quality of healthcare services, ultimately enhancing the well-being of

incarcerated individuals in Northern Luzon.

Satisfaction with Healthcare Services Among PDL

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The survey conducted by Harris et al. (2020) assessed the UK detainees'

satisfaction regarding the healthcare services they received and determined

that it was moderately satisfactory for the overall care received. Detainees

reported general satisfaction with their basic health care, but the concerns

were mainly on the responsiveness of the care and patients' lack of dignity.

Most detainees complained of long waiting periods before being attended to;

this led to frustration and feelings of neglect. Furthermore, the communication

between healthcare providers and PDL was often complained about; some

felt that their issues were not being taken seriously. In response to these

problems, he suggested the incorporation of regular feedback mechanisms to

better understand the needs of the PDL and align the health services with the

expectations of the PDL. The UK jail system may better deliver healthcare

and improve the services provided to PDL by frequently gathering and acting

on patient feedback, the study suggested.

Gomez and Reyes (2022) examined the satisfaction level of persons deprived

of liberty (PDL) in healthcare services about their needs in the Visayas,

Philippines. The findings revealed that PDL generally welcomed the provision

of basic healthcare services, like regular medical check-ups and emergency

care. However, many expressed dissatisfaction with the delays in receiving

treatment and the lack of access to specialized care, such as mental health

support or treatment for chronic conditions. These delays were particularly

problematic for PDL with urgent medical needs, who often had to wait

extended periods before being seen by a doctor or referred for further

treatment. They recommended that the hospitals increase the number of

hospital staff within the facilities because this would help to reduce existing
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pressure on the available health resources. They also opined that improving

healthcare to make service delivery easier and make access to general and

specific care timely would improve general inmate satisfaction significantly.

Anderson et al. (2022) surveyed PDL in Norway to determine their satisfaction

with healthcare services in correctional facilities. The study showed that while

the basic medical needs, including emergency care and common ailments,

were generally met, there were significant concerns about the availability and

timeliness of specialized care. PDL also shared their frustration of delay in

referral to specialist care. Some of them indicated having to wait for a long

time before being referred for specialist treatment. They suggested that a

better referral system and coordination between the general healthcare

providers and the specialists could reduce delays. In addition, the study

suggested that health staff be offered continuous training to help them better

manage specialized care requests. Improving the referral process and training

of health professionals, the study reasoned, would enable Norway to enhance

overall PDL satisfaction with health services in jails.

Padilla and Gonzales (2020) explored the health satisfaction of PDL in

Laguna, Philippines. Their study indicated considerable dissatisfaction with

treatment delay and inadequate health programs. The majority of PDL

experienced a waiting period of hours before getting treated for minor to

severe medical concerns, leading to frustration and concern for their well-

being. The study also observed that the healthcare services provided were

usually elementary care, and there were inadequate resources to deal with

complex or chronic health issues. They recommended the implementation of

regular feedback mechanisms, such as surveys or interviews, to capture PDL'

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concerns and suggestions for improvement. Incorporating inmate feedback in

the formulation of healthcare services could lead facilities to align medical

care better with the needs of PDL, as suggested by the study. The other key

steps for the enhancement of service delivery in the provincial jails of Laguna

included increased funding for comprehensive health programs and training of

health staff to increase efficiency.

Health Status and Healthcare Satisfaction

Chen et al. (2021) investigated the associations between perceived health

status and healthcare service satisfaction among PDL in Chinese correctional

facilities. There was an above-average positive correlation between perceived

health and PDL' healthcare service satisfaction. PDL reporting better health

were more likely to say that they were more satisfied with the medical care

received. Health outcomes would seem, therefore, to have a crucial role in

shaping PDL' perceptions of care quality. In this context, the research

underlined the importance of individualized care plans and emphasized how

tailoring the medical intervention to the particular health needs of each inmate

might improve the health outcome and satisfaction levels. They recommended

that correctional healthcare systems prioritize personalized healthcare

strategies, offering more targeted treatments and support. By addressing

individual health concerns in a more personalized manner, correctional

facilities could potentially enhance both the health and satisfaction of

incarcerated individuals, leading to better overall well-being.

Martinez and Cruz (2023) analyzed the relationship between the health status

of PDL and healthcare satisfaction in the case of Mindanao, Philippines. The

findings showed that there was a significant relationship: PDL who thought
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their health was in better condition more likely to report higher levels of

satisfaction with the services rendered through healthcare. This study brought

forward how the health perceptions among the PDL can have an extreme

influence on their perception of quality care. The study also revealed the fact

that when people feel they are healthier, they perceive that the care provided

will be better, even when healthcare services are limited and delayed. They

recommended implementation of periodic health assessments to review PDL'

physical and mental health according to their findings. They also

recommended specific interventions that target specific health needs, thereby

enhancing the overall well-being of PDL and raising their satisfaction with jail

health services in Mindanao.

Chow et al. (2021) examined the correlation between perceived health status

and satisfaction with healthcare services in Singaporean jails. According to

this study, PDL who perceived their health as better generally reported

greater satisfaction with the healthcare services available to them. The study

indicated that health perceptions are essential in determining overall

satisfaction with care because the PDL' beliefs about their health directly

influenced their attitudes toward the medical treatment they received. The

study emphasized the need for individualized health plans to optimize

satisfaction levels. They asserted that individualized medical care in

correctional facilities - where the care is tailored according to the inmate's

specific requirements - will result in higher health perception. Individualized

care, as a result, would improve the health condition of the PDL while

ensuring that the PDL' health satisfaction levels are improved due to

enhanced healthcare service in jails.

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Manalo and Reyes (2023) explored how the perceived health status of PDL

influences satisfaction with healthcare services for PDL in Iloilo, Philippines.

The results of the study indicated that PDL who reported better health were

more likely to be satisfied with the medical services received. This study

highlighted that health perceptions are crucial in determining the level of

satisfaction, as individuals who feel healthier are more confident about the

care received. The authors suggested that regular health monitoring systems

should be implemented to track and manage PDL' health more effectively. By

conducting regular health check-ups, medical staff would be better equipped

to address emerging health issues before they escalate, leading to better

health outcomes and higher satisfaction levels. Their study suggested that

routine health assessments should be integrated into correctional healthcare

systems to improve the overall quality of care and ensure that PDL' health

needs are constantly met, which will ultimately improve their satisfaction with

healthcare services.

Synthesis

The literature on health and healthcare experiences of Persons Deprived of

Liberty (PDL) highlights several interdependent themes. First, perceived

health status among PDL has consistently reflected inequalities regarding

physical health conditions due to systemic barriers. Foreign studies included

Dyer et al. (2020) and Jones et al. (2021), which found chronic diseases,

especially hypertension and diabetes, prevailing across correctional facilities

that remain poorly managed due to neglectful preventive care. Similarly, local

studies, such as those of Rivera et al. (2022) and Alvarado et al. (2023),
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highlighted problems, such as malnutrition and communicable diseases,

which were exacerbated by poor hygiene and overcrowding in Philippine jails.

Quality of life and mental health became a concern. Studies made in Canada

(Smith & Johnson, 2021) and the UK (Parker & Green, 2020) pointed to

untreated mental health problems that included depression and PTSD. For

the Philippines, Luna and Santos (2019) and Villanueva and Cruz (2022)

stated that overcrowding and confinement furthered psychological distress.

Improvements in mental health intervention and support systems remain in

need.

Access to healthcare services in correctional facilities further reveals

structural limitations. Nguyen et al. (2023) and Kumar et al. (2023) identified

barriers such as understaffing and resource shortages in Australia and India,

respectively. In the Philippines, Delos Santos (2021) and Soriano (2021)

similarly noted funding constraints and inadequate medical personnel as

major obstacles, advocating for stronger collaboration between local

governments and health providers to address these gaps.

Satisfaction with healthcare services is closely related to service quality and

timeliness. Harris et al. (2020) and Anderson et al. (2022) reported moderate

satisfaction in the UK and Norway, respectively, but delays and lack of

specialized care were issues for concern. In the Philippines, Gomez and

Reyes (2022) and Padilla and Gonzales (2020) indicated dissatisfaction with

delays in treatment and lack of overall programs, thus requiring feedback

mechanisms to improve service delivery.

Finally, and most consistently, perceived health status showed a relationship

with healthcare satisfaction. Chen et al. (2021) and Chow et al. (2021) found
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that better-perceived health outcomes positively influence satisfaction with

healthcare services. These findings were echoed locally by Martinez and Cruz

(2023) and Manalo and Reyes (2023), who recommended health

assessments and individualized care plans to improve both health outcomes

and satisfaction.

In a nutshell, these studies reveal the urgent need for systemic reforms,

targeted interventions, and collaborative efforts to tackle the health and

healthcare challenges faced by PDL.

Chapter III
Research Design
For the research entitled “Perceived Health Status and Services Provided to
PDL’s”, an ideal research design would be a descriptive cross-sectional
design, which collects data at a single point in time to describe and analyze
the current conditions of perceived health status and healthcare services
provided to PDL’s. Its primary aim is to assess and describe the research’s
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objective without attempting to determine casual relationships. The focus

would be on the understanding the prevalence of health issues, the types of
services available, and how PDL’s perceive the adequacy or quality of those
services.
Key aspects will follow such as population, variables, data collection and
analysis. Population would focus on a specific- group, in this case, persons
deprived of liberty. Variables will be based on perceived health status which
includes the self-reported assessments of physical and mental health; general
well-being or specific health conditions and services provided which includes
medical, psychological or rehabilitation services offered to PDL’s within the jail
or detention system. Data would be collected through surveys and interviews
conducted at a single point in time. Lastly, analysis, the research would
analyze the distribution of perceived health status and the availability or
quality of services, often descriptive statistics like frequencies, percentages
and averages.

Research Instrument
For a study on the “Perceived Health Status and Services Provide to PDL’s”
with a descriptive cross sectional design, the research instrument includes
several sections to gather data’s. The first section collects demographic
information, including age, gender, civil status and pre-existing health
conditions. The second section assesses the perceived health status of
PDL’s, with questions addressing physical, mental, and emotional.
Respondents are asked about their general health, frequency of illness,
emotional well-being and access to medical and psychological services. The
third section measures PDL’s awareness of health services available in the
facility, asking about medical consultations, dental services, mental health
support, vaccinations and nutritional programs. The fourth section measures
the frequency of utilization, asking how often PDL’s access different health
services such as medical, dental , mental health and vaccination programs.
Additionally, this section explore barriers to accessing services such as lack of
awareness, limited availability of healthcare personnel. Finally, an open-
ended section invites respondents to provide feedback on the quality of health
services and suggest potential improvements. This instrument ensures a
comprehensive data to understand the PDL’s health perceptions and
experiences with the services provided.

Locale of the Study

The Bureau of Jail Management and Penology serves as the locale for
this study in Perceived Health Status and Services provided to PDL. Located
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in Batal, Santiago City, Isabela, BJMP plays a crucial role in establishing and
maintaining jails and providing basic needs for Persons Deprived of Liberty
(PDL). By focusing on the locale, this research aims to explore how
healthcare services are offered and provided to Persons deprived of Liberty
(PDL.)

Research Instrument
For a study on the “Perceived Health Status and Services Provide to PDL’s”
with a descriptive cross sectional design, the research instrument includes
several sections to gather data’s. The first section collects demographic
information, including age, gender, civil status and pre-existing health
conditions. The second section assesses the perceived health status of
PDL’s, with questions addressing physical, mental, and emotional.
Respondents are asked about their general health, frequency of illness,
emotional well-being and access to medical and psychological services. The
third section measures PDL’s awareness of health services available in the
facility, asking about medical consultations, dental services, mental health
support, vaccinations and nutritional programs. The fourth section measures
the frequency of utilization, asking how often PDL’s access different health
services such as medical, dental , mental health and vaccination programs.
Additionally, this section explore barriers to accessing services such as lack of
awareness, limited availability of healthcare personnel. Finally, an open-
ended section invites respondents to provide feedback on the quality of health
services and suggest potential improvements. This instrument ensures a
comprehensive data to understand the PDL’s health perceptions and
experiences with the services provided.

Data Gathering Procedure

Data collection for this study proceed in a systematic and carefully monitored
manner to ensure accuracy and consistency. The initial step involved
obtaining permission and approval from important authorities, including the
Bureau of Jail Management and Penology (BJMP), ethical review boards and
facility’s management. Following approval, designed and constructed
questionnaire or survey instrument to collect data on perceived health status
(physical, mental and emotional), awareness and utilization of health services
provided by the BJMP. Study population was then selected through sampling
to accurately represent the target demographic group. Ensure participants
understand the purpose, benefits, risks of the study and emphasize that
participation is voluntary and will not affect their standing in the facility.
Survey administration or data collection includes interviews about his
demographic information, perceived health status, awareness of services and
utilization of services in a private and secure environment. Input survey
 COLLEGE OF NURSING

responses into a database for analysis, cross data for completeness and
accuracy. Use descriptive statistics to summarize demographic data and
responses. Analyze trends and correlations in perceived health status and
service utilization . This data-gathering process ensures a comprehensive and
ethical approach on PDL’s health status and the services they receive.

Statistical Treatment of Data

The statistical treatment of data in this study is designed to ensure that the
analysis accurately reflects the relationships and patterns associated with the
perceived health status and services provided to PDL . Quantitative data
gathered from researcher made questionnaires will be analysed using
descriptive statistics such as means, medians, and standard deviations to
summarize respondents’ demographics and key variables related to
healthcare services provided to PDL. This initial analysis will provide an
overview of the sample characteristics and effectiveness, understanding of
the general landscape of healthcare provided within the study population.
For more in-depth analysis, inferential statistics will be employed, including t-
tests and ANOVA, to compare differences between groups (e.g., PDL vs.
Non-PDL) and assess the significance of relationships among variables (e.g.,
satisfaction level)

Ethical Considerations
Ethical considerations are paramount in conducting research involving
human subjects, particularly in sensitive field such as healthcare. This study
will adhere to established ethical guidelines, including obtaining informed
consent from all the participants before data collection. Participants will be
fully informed about the study’s purpose, procedures, potential risks, and
benefits, ensuring that they understand their rights to withdraw at any time
without any consequences. The consent process will also emphasize their
privacy and confidentiality of their responses, assuring them that their data will
be anonymized and securely stored.
Furthermore, the research will be conducted in accordance with the
principles of confidentiality, non-maleficence, privacy, and justice. By
prioritizing participants’ welfare and ensuring that their involvement does not
cause any harm, the study aims to contribute positively to the discourse on
the perceived health status and services provided to PDL while respecting
participants’ dignity and rights. Ethical approval will be sought from relevant
institutional review boards before the commencement of the study, ensuring
that all research activities align with ethical standards set forth by the
American Psychological Association (APA) and the World Health Organization
(WHO). This careful consideration of ethical implications underscores the
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commitment to conducting responsible and respectful research within the

healthcare context.

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