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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

Lauren Weston

Sarah Rybczynska-Bunt

Cath Quinn

Charlotte Lennox

Mike Maguire

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 Mar 29, 2024
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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Publisher Licence URL
http://creativecommons.org/licenses/by/4.0

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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