Lauren Weston
Interrogating intervention delivery and participants’ emotional states to improve engagement and implementation: A realist informed multiple case study evaluation of Engager
Weston, Lauren; Rybczynska-Bunt, Sarah; Quinn, Cath; Lennox, Charlotte; Maguire, Mike; Pearson, Mark; Stirzaker, Alex; Durcan, Graham; Stevenson, Caroline; Graham, Jonathan; Carroll, Lauren; Greer, Rebecca; Haddad, Mark; Hunter, Rachael; Anderson, Rob; Todd, Roxanne; Goodier, Sara; Brand, Sarah; Michie, Susan; Kirkpatrick, Tim; Leonard, Sarah; Harris, Tirril; Henley, William; Shaw, Jenny; Owens, Christabel; Byng, Richard
Authors
Sarah Rybczynska-Bunt
Cath Quinn
Charlotte Lennox
Mike Maguire
Dr Mark Pearson Mark.Pearson@hull.ac.uk
Reader in Implementation Science
Alex Stirzaker
Graham Durcan
Caroline Stevenson
Jonathan Graham
Lauren Carroll
Rebecca Greer
Mark Haddad
Rachael Hunter
Rob Anderson
Roxanne Todd
Sara Goodier
Sarah Brand
Susan Michie
Tim Kirkpatrick
Sarah Leonard
Tirril Harris
William Henley
Jenny Shaw
Christabel Owens
Richard Byng
Abstract
Background ‘Engager’ is an innovative ‘through-the-gate’ complex care intervention for male prison-leavers with common mental health problems. In parallel to the randomised-controlled trial of Engager (Trial registration number: ISRCTN11707331), a set of process evaluation analyses were undertaken. This paper reports on the depth multiple case study analysis part of the process evaluation, exploring how a sub-sample of prison-leavers engaged and responded to the intervention offer of one-to-one support during their re-integration into the community. Methods To understand intervention delivery and what response it elicited in individuals, we used a realist-informed qualitative multiple ‘case’ studies approach. We scrutinised how intervention component delivery lead to outcomes by examining underlying causal pathways or ‘mechanisms’ that promoted or hindered progress towards personal outcomes. ‘Cases’ (n = 24) were prison-leavers from the intervention arm of the trial. We collected practitioner activity logs and conducted semi-structured interviews with prison-leavers and Engager/ other service practitioners. We mapped data for each case against the intervention logic model and then used Bhaskar’s (2016) ‘DREIC’ analytic process to categorise cases according to extent of intervention delivery, outcomes evidenced, and contributing factors behind engagement or disengagement and progress achieved. Results There were variations in the dose and session focus of the intervention delivery, and how different participants responded. Participants sustaining long-term engagement and sustained change reached a state of ‘crises but coping’. We found evidence that several components of the intervention were key to achieving this: trusting relationships, therapeutic work delivered well and over time; and an in-depth shared understanding of needs, concerns, and goals between the practitioner and participants. Those who disengaged were in one of the following states: ‘Crises and chaos’, ‘Resigned acceptance’, ‘Honeymoon’ or ‘Wilful withdrawal’. Conclusions We demonstrate that the ‘implementability’ of an intervention can be explained by examining the delivery of core intervention components in relation to the responses elicited in the participants. Core delivery mechanisms often had to be ‘triggered’ numerous times to produce sustained change. The improvements achieved, sustained, and valued by participants were not always reflected in the quantitative measures recorded in the RCT. The compatibility between the practitioner, participant and setting were continually at risk of being undermined by implementation failure as well as changing external circumstances and participants’ own weaknesses.
Citation
Weston, L., Rybczynska-Bunt, S., Quinn, C., Lennox, C., Maguire, M., Pearson, M., …Byng, R. (2022). Interrogating intervention delivery and participants’ emotional states to improve engagement and implementation: A realist informed multiple case study evaluation of Engager. PLoS ONE, 17(7 July), Article e0270691. https://doi.org/10.1371/journal.pone.0270691
Journal Article Type | Article |
---|---|
Acceptance Date | Jun 15, 2022 |
Online Publication Date | Jul 14, 2022 |
Publication Date | Jul 1, 2022 |
Deposit Date | Aug 21, 2022 |
Publicly Available Date | Aug 22, 2022 |
Journal | PLoS ONE |
Print ISSN | 1932-6203 |
Electronic ISSN | 1932-6203 |
Publisher | Public Library of Science |
Peer Reviewed | Peer Reviewed |
Volume | 17 |
Issue | 7 July |
Article Number | e0270691 |
DOI | https://doi.org/10.1371/journal.pone.0270691 |
Public URL | https://hull-repository.worktribe.com/output/4041475 |
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Copyright Statement
Copyright: © 2022 Weston et al. This is an open access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.
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