Interrogating intervention delivery and participants' emotional states to improve engagement and implementation: A realist informed multiple case study evaluation of Engager
'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 und...
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| Veröffentlicht in: | PloS one 2022-07, Vol.17 (7), p.e0270691 |
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| creator | 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 |
| description | '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.
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.
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'.
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 pr |
| doi_str_mv | 10.1371/journal.pone.0270691 |
| format | Article |
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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.
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'.
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.
ISRCTN11707331, Wales Research Ethics Committee, Registered 02-04-2016-Retrospectively registered https://doi.org/10.1186/ISRCTN11707331.</description><identifier>ISSN: 1932-6203</identifier><identifier>EISSN: 1932-6203</identifier><identifier>DOI: 10.1371/journal.pone.0270691</identifier><identifier>PMID: 35834470</identifier><language>eng</language><publisher>United States: Public Library of Science</publisher><subject>Adaptation, Psychological ; Biology and Life Sciences ; Case reports ; Case studies ; Collaboration ; Computer and Information Sciences ; Datasets ; Drug use ; Emotions ; Evaluation ; Health problems ; Health risks ; Humans ; Intervention ; Intervention (Civil procedure) ; Male ; Mathematical analysis ; Medical research ; Medicine and Health Sciences ; Mental disorders ; Mental health ; Methods ; Prisons ; Qualitative Research ; Research and Analysis Methods ; Research ethics ; Social Sciences ; Wales</subject><ispartof>PloS one, 2022-07, Vol.17 (7), p.e0270691</ispartof><rights>COPYRIGHT 2022 Public Library of Science</rights><rights>2022 Weston et al. This is an open access article distributed under the terms of the Creative Commons Attribution License: http://creativecommons.org/licenses/by/4.0/ (the “License”), which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited. Notwithstanding the ProQuest Terms and Conditions, you may use this content in accordance with the terms of the License.</rights><rights>2022 Weston et al 2022 Weston et al</rights><lds50>peer_reviewed</lds50><oa>free_for_read</oa><woscitedreferencessubscribed>false</woscitedreferencessubscribed><citedby>FETCH-LOGICAL-c692t-c7c181d611359c493fa2dfd22a530a4091f4772a86d88a906c3723cf1bfa7a2b3</citedby><cites>FETCH-LOGICAL-c692t-c7c181d611359c493fa2dfd22a530a4091f4772a86d88a906c3723cf1bfa7a2b3</cites><orcidid>0000-0002-3845-3289 ; 0000-0002-3523-8559 ; 0000-0001-8735-2292</orcidid></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><linktopdf>$$Uhttps://www.ncbi.nlm.nih.gov/pmc/articles/PMC9282559/pdf/$$EPDF$$P50$$Gpubmedcentral$$Hfree_for_read</linktopdf><linktohtml>$$Uhttps://www.ncbi.nlm.nih.gov/pmc/articles/PMC9282559/$$EHTML$$P50$$Gpubmedcentral$$Hfree_for_read</linktohtml><link.rule.ids>230,315,729,782,786,866,887,2106,2932,23875,27933,27934,53800,53802</link.rule.ids><backlink>$$Uhttps://www.ncbi.nlm.nih.gov/pubmed/35834470$$D View this record in MEDLINE/PubMed$$Hfree_for_read</backlink></links><search><contributor>Mordaunt, Dylan A.</contributor><creatorcontrib>Weston, Lauren</creatorcontrib><creatorcontrib>Rybczynska-Bunt, Sarah</creatorcontrib><creatorcontrib>Quinn, Cath</creatorcontrib><creatorcontrib>Lennox, Charlotte</creatorcontrib><creatorcontrib>Maguire, Mike</creatorcontrib><creatorcontrib>Pearson, Mark</creatorcontrib><creatorcontrib>Stirzaker, Alex</creatorcontrib><creatorcontrib>Durcan, Graham</creatorcontrib><creatorcontrib>Stevenson, Caroline</creatorcontrib><creatorcontrib>Graham, Jonathan</creatorcontrib><creatorcontrib>Carroll, Lauren</creatorcontrib><creatorcontrib>Greer, Rebecca</creatorcontrib><creatorcontrib>Haddad, Mark</creatorcontrib><creatorcontrib>Hunter, Rachael</creatorcontrib><creatorcontrib>Anderson, Rob</creatorcontrib><creatorcontrib>Todd, Roxanne</creatorcontrib><creatorcontrib>Goodier, Sara</creatorcontrib><creatorcontrib>Brand, Sarah</creatorcontrib><creatorcontrib>Michie, Susan</creatorcontrib><creatorcontrib>Kirkpatrick, Tim</creatorcontrib><creatorcontrib>Leonard, Sarah</creatorcontrib><creatorcontrib>Harris, Tirril</creatorcontrib><creatorcontrib>Henley, William</creatorcontrib><creatorcontrib>Shaw, Jenny</creatorcontrib><creatorcontrib>Owens, Christabel</creatorcontrib><creatorcontrib>Byng, Richard</creatorcontrib><title>Interrogating intervention delivery and participants' emotional states to improve engagement and implementation: A realist informed multiple case study evaluation of Engager</title><title>PloS one</title><addtitle>PLoS One</addtitle><description>'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.
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.
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'.
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.
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Database</collection><collection>Materials Science Collection</collection><collection>Access via ProQuest (Open Access)</collection><collection>ProQuest One Academic Eastern Edition (DO NOT USE)</collection><collection>ProQuest One Academic</collection><collection>ProQuest One Academic UKI Edition</collection><collection>Engineering Collection</collection><collection>Environmental Science Collection</collection><collection>Genetics Abstracts</collection><collection>MEDLINE - Academic</collection><collection>PubMed Central (Full Participant titles)</collection><collection>DOAJ Directory of Open Access Journals</collection><jtitle>PloS one</jtitle></facets><delivery><delcategory>Remote Search Resource</delcategory><fulltext>fulltext</fulltext></delivery><addata><au>Weston, Lauren</au><au>Rybczynska-Bunt, Sarah</au><au>Quinn, Cath</au><au>Lennox, Charlotte</au><au>Maguire, Mike</au><au>Pearson, Mark</au><au>Stirzaker, Alex</au><au>Durcan, Graham</au><au>Stevenson, Caroline</au><au>Graham, Jonathan</au><au>Carroll, Lauren</au><au>Greer, Rebecca</au><au>Haddad, Mark</au><au>Hunter, Rachael</au><au>Anderson, Rob</au><au>Todd, Roxanne</au><au>Goodier, Sara</au><au>Brand, Sarah</au><au>Michie, Susan</au><au>Kirkpatrick, Tim</au><au>Leonard, Sarah</au><au>Harris, Tirril</au><au>Henley, William</au><au>Shaw, Jenny</au><au>Owens, Christabel</au><au>Byng, Richard</au><au>Mordaunt, Dylan A.</au><format>journal</format><genre>article</genre><ristype>JOUR</ristype><atitle>Interrogating intervention delivery and participants' emotional states to improve engagement and implementation: A realist informed multiple case study evaluation of Engager</atitle><jtitle>PloS one</jtitle><addtitle>PLoS One</addtitle><date>2022-07-14</date><risdate>2022</risdate><volume>17</volume><issue>7</issue><spage>e0270691</spage><pages>e0270691-</pages><issn>1932-6203</issn><eissn>1932-6203</eissn><abstract>'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.
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.
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'.
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.
ISRCTN11707331, Wales Research Ethics Committee, Registered 02-04-2016-Retrospectively registered https://doi.org/10.1186/ISRCTN11707331.</abstract><cop>United States</cop><pub>Public Library of Science</pub><pmid>35834470</pmid><doi>10.1371/journal.pone.0270691</doi><tpages>e0270691</tpages><orcidid>https://orcid.org/0000-0002-3845-3289</orcidid><orcidid>https://orcid.org/0000-0002-3523-8559</orcidid><orcidid>https://orcid.org/0000-0001-8735-2292</orcidid><oa>free_for_read</oa></addata></record> |
| fulltext | fulltext |
| identifier | ISSN: 1932-6203 |
| ispartof | PloS one, 2022-07, Vol.17 (7), p.e0270691 |
| issn | 1932-6203 1932-6203 |
| language | eng |
| recordid | cdi_plos_journals_2689600368 |
| source | MEDLINE; DOAJ Directory of Open Access Journals; Public Library of Science (PLoS) Journals Open Access; EZB-FREE-00999 freely available EZB journals; PubMed Central; Free Full-Text Journals in Chemistry |
| subjects | Adaptation, Psychological Biology and Life Sciences Case reports Case studies Collaboration Computer and Information Sciences Datasets Drug use Emotions Evaluation Health problems Health risks Humans Intervention Intervention (Civil procedure) Male Mathematical analysis Medical research Medicine and Health Sciences Mental disorders Mental health Methods Prisons Qualitative Research Research and Analysis Methods Research ethics Social Sciences Wales |
| title | Interrogating intervention delivery and participants' emotional states to improve engagement and implementation: A realist informed multiple case study evaluation of Engager |
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