Individual health trainers to support health and well-being for people under community supervision in the criminal justice system: the STRENGTHEN pilot RCT

Abstract

Background Little is known about the effectiveness or cost-effectiveness of interventions, such as health trainer support, to improve the health and well-being of people recently released from prison or serving a community sentence, because of the challenges in recruiting participants and following them up. Objectives This pilot trial aimed to assess the acceptability and feasibility of the trial methods and intervention (and associated costs) for a randomised trial to assess the effectiveness and cost-effectiveness of health trainer support versus usual care. Design This trial involved a pilot multicentre, parallel, two-group randomised controlled trial recruiting 120 participants with 1 : 1 individual allocation to receive support from a health trainer and usual care or usual care alone, with a mixed-methods process evaluation, in 2017–18. Setting Participants were identified, screened and recruited in Community Rehabilitation Companies in Plymouth and Manchester or the National Probation Service in Plymouth. The intervention was delivered in the community. Participants Those who had been out of prison for at least 2 months (to allow community stabilisation), with at least 7 months of a community sentence remaining, were invited to participate; those who may have posed an unacceptable risk to the researchers and health trainers and those who were not interested in the trial or intervention support were excluded. Interventions The intervention group received, in addition to usual care, our person-centred health trainer support in one-to-one sessions for up to 14 weeks, either in person or via telephone. Health trainers aimed to empower participants to make healthy lifestyle changes (particularly in alcohol use, smoking, diet and physical activity) and take on the Five Ways to Well-being [Foresight Projects. Mental Capital and Wellbeing: Final Project Report. 2008. URL: www.gov.uk/government/publications/mental-capital-and-wellbeing-making-the-most-of-ourselves-in-the-21st-century (accessed 24 January 2019).], and also signposted to other options for support. The control group received treatment as usual, defined by available community and public service options for improving health and well-being. Main outcome measures The main outcomes included the Warwick–Edinburgh Mental Well-being Scale scores, alcohol use, smoking behaviour, dietary behaviour, physical activity, substance use, resource use, quality of life, intervention costs, intervention engagement and feasibility and acceptability of trial methods and the intervention. Results A great deal about recruitment was learned and the target of 120 participants was achieved. The minimum trial retention target at 6 months (60%) was met. Among those offered health trainer support, 62% had at least two sessions. The mixed-methods process evaluation generally supported the trial methods and intervention acceptability and feasibility. The proposed primary outcome, the Warwick–Edinburgh Mental Well-being Scale scores, provided us with valuable data to estimate the sample size for a full trial in which to test the effectiveness and cost-effectiveness of the intervention. Conclusions Based on the findings from this pilot trial, a full trial (with some modifications) seems justified, with a sample size of around 900 participants to detect between-group differences in the Warwick-Edinburgh Mental Well-being Scale scores at a 6-month follow-up. Future work A number of recruitment, trial retention, intervention engagement and blinding issues were identified in this pilot and recommendations are made in preparation of and within a full trial. Trial registration Current Controlled Trials ISRCTN80475744. Funding This project was funded by the National Institute for Health Research Public Health Research programme and will be published in full in Public Health Research; Vol. 7, No. 20. See the National Institute for Health Research Journals Library website for further project information.

Can Social Prescribing Foster Individual and Community Well-Being? A Systematic Review of the Evidence

“…The reported increased changes illustrate the potential for improvements in public health. Yet we find that only five studies at the individual level [ 27 , 57 , 60 , 79 , 81 ], two studies at the system level [ 60 , 79 ], and two studies at the community level [ 27 , 79 ] provide evidence to support claims that the observed change is due to a particular social prescribing programme. Given this small number of studies that establish causality, conclusions regarding the impact of social prescribing are tentative, at best.…”

“…Thirty-six studies employ a pre/post design [ 26 , 27 , 37 , 38 , 39 , 44 , 55 , 57 , 58 , 59 , 60 , 61 , 62 , 63 , 64 , 65 , 66 , 67 , 68 , 69 , 70 , 71 , 72 , 73 , 74 , 75 , 76 , 77 , 78 , 79 , 80 , 81 , 82 , 83 , 84 , 85 ], 8 report case studies with evidence taken at one point in time [ 26 , 42 , 70 , 74 , 78 , 83 , 85 , 86 ], 16 studies conduct surveys [ 27 , 37 , 55 , 57 , 58 , 60 , 62 , 63 , 68 , 72 , 77 …”

“…Forty-two of the studies are concerned with well-being. While 14 studies rely on either the long [ 26 , 38 , 42 , 59 , 63 , 66 , 67 , 70 , 71 , 73 , 77 , 81 ] or short [ 80 , 83 ] version of the Warwick–Edinburgh Mental Well-being Scale (WEMWBS), others employ measures such as the UK Office for National Statistics 4-question (ONS4) measure [ 68 , 76 ]; the University College London (UCL) Museum well-being measure [ 82 , 85 ]; interview and survey questions designed for the purposes of a particular programme [ 64 , 65 , 69 , 75 , 78 ]; the Kessler Psychological Distress Scale (K10) and the World Health Organisation Quality of Life score (QoL) [ 37 ]; self-determination theory [ 44 ]; psychological measures of depression and anxiety [ 60 ]; the Medical outcome profile (MYMOP) [ 61 ]; the Investigating Choice Experiments for the Preferences of Older People Capability Measure for Adults (ICECAP-A) capability-based measure [ 57 ]; or tests for components of well-being, such as self-confidence, strength, resilience, joy, and vitality [ 27 , 28 , 33 , 37 , 72 ]. Nine studies do not provide details of how well-being is assessed [ 36 , 47 , 53 , 57 , 62 , 68 , 70 , 82 , 87 ].…”

“…Table 1 summarises the information offered regarding individual-level impact, providing a list of measures used to assess impact and the number of studies using each measure. The third column of Table 1 identifies the studies that provide evidence of change in loneliness [ 27 , 37 , 79 , 80 , 85 ], social isolation [ 60 , 66 , 76 ], well-being [ 26 , 37 , 38 , 44 , 55 , 57 , 59 , 60 , 61 , 63 , 64 , 65 , 66 , 67 , 68 , 69 , 70 , 71 , 73 , 75 , 76 , 77 , 78 , 80 , 81 , 82 , 83 , 85 ], and connectedness [ 27 , 79 , 82 ]. This column contains studies that provide clearly defined, verifiable, standardised measures of the concepts and outcomes of interest and an assessment of change such as pre- and post-programme comparisons.…”

“…Though evidence of individual-level change in the outcomes of interest is generally robust, evidence that a social prescribing programme caused the change in outcomes is rare. In the fourth column of Table 1 , we identify only five studies that can claim a causal link between a social prescribing intervention and changes in key outcomes through robust means such as control group comparisons, randomisation, or statistical methods for causal inference such as mediation analysis or propensity score matching [ 27 , 57 , 60 , 79 , 81 ]. Due to the lack of robust causal evidence, we cannot conduct a meta-analysis of the effects of social prescribing, and we are limited in the conclusions we can draw regarding the impact of social prescribing on individual outcomes.…”