The feasibility of following up prisoners, with mental health problems, after release: a pilot trial employing an innovative system, for engagement and retention in research, with a harder-to-engage population

Abstract

BackgroundFollowing up released prisoners is demanding, particularly for those prisoners with mental health problems, for whom stigma and chaotic lifestyles are problematic. Measurement of mental health outcomes after release is challenging. To evaluate mental healthcare for offender populations, using high-quality randomised controlled trials, evidenced-based methods must be developed to engage them while in custody, to locate and re-interview them after release, and to collect potentially stigmatising mental health outcomes data.MethodsWe developed an initial theoretical model and operational procedures for collecting baseline and follow-up data informed by a literature search, focus groups, and case studies. Male prisoners from five prisons in two sites were invited to participate. The inclusion criteria included individuals who were above threshold on nine-item Patient Health Questionnaire, seven-item Generalized Anxiety Disorder, or post-traumatic stress disorder scales, or who had reported mental health problems in the past 2 years or had been assessed with a likely personality disorder. Potential participants were interviewed to generate baseline data and were re-contacted before their release. We then contacted them for a follow-up interview, which included repeating the earlier data collection measures 2–8 weeks after release. A qualitative formative process evaluation produced and refined a model procedure for the recruitment and retention of male prison leavers in trials, identified the mechanisms which promoted engagement and retention, and mapped these against a theoretical behaviour change model.ResultsWe developed a flexible procedure which was successful in recruiting male prison leavers to a pilot trial: 185/243 (76%, 95% confidence interval (CI) 70–81%) of those approached agreed to participate. We also retained 63% (95% CI 54–71%) of those eligible to participate in a follow-up interview 2–8 weeks after release. Mental health outcomes data was collected at both these time points.ConclusionsIt is possible to design acceptable procedures to achieve sustained engagement critical for delivering and evaluating interventions in prison and in the community and to collect mental health outcomes data. These procedures may reduce attrition bias in future randomised controlled trials of mental health interventions for prison leavers. This procedure has been replicated and successfully delivered in a subsequent pilot trial and a definitive randomised controlled trial.Electronic supplementary materialThe online version of this article (10.1186/s13063-018-2911-1) contains supplementary material, which is available to authorized users.

Retention in clinical trials after prison release: results from a clinical trial with incarcerated men with HIV and opioid dependence in Malaysia

“…Findings here suggest that in addition to reducing drug relapse and mortality, interventions to address infectious disease and substance use during reentry may also improve retention rates. 60 While receiving HHRP-M was associated with linkage to the study (completion of at least one study visit), only methadone was associated with study retention, both when defined as a repeated measure or as sustained retention to all visits. One explanation for the effect of HHRP-M on linkage is that HHRP-M participants were offered an optional individual "booster" session 4 weeks after prison release for which they received additional compensation.…”

“…61 Such characteristics of the HHRP-M intervention have been shown to improve retention in previous studies. 28,60,62 One explanation for the increased retention in the methadone arm is that methadone, which has been repeatedly demonstrated to improve HIV-related health outcomes, 63 including among prisoners, 64 and in supervised settings in Malaysia, 65 may have improved study retention by preventing drug relapse and improving social functioning. 66 Additionally, increased retention in the methadone arm could have been due to the proximity of interview sites to methadone treatment facilities or to increased ability of research staff to locate participants engaged in methadone therapy, both of which could bias treatment effect estimates.…”

Retaining participants in community-based health research: a case example on standardized planning and reporting

“…Planning is critical to retention and therefore is a valuable component of the research design process [41,42]. Adequate planning also enhances participants' ties with the researchers and the study [12,41]. For the BCHCP adapted ecological model, planning activities began prior to study launch, as the overall protocol was being Adapted with permission from [39] developed.…”

“…Yet researchers often fail to identify and address barriers to participation, leading to disadvantaged groups being characterized as "hard-to-reach" [6,[9][10][11]. Also, in Canada and elsewhere, policy-makers and practitioners have often struggled to reach, engage and retain populations who are experiencing socioeconomic disadvantage-with the aim of reducing health disparities and improving health outcomes [6,11,12]. Considerable disparities persist in health and social conditions and in the provision of public services [13,14].…”

“…Considerable disparities persist in health and social conditions and in the provision of public services [13,14]. A better understanding of how to reach, engage and maintain contact with these groups can inform health research, as well as the provision of health and social services, in turn contributing to reducing health inequities [10][11][12][13].…”