Need For Speed Most Wanted 2005 Trainer 1.3 Free Download
Berniece Leonhardt
Callaghan L, Thompson TP, Creanor S, et al. Individual health trainers to support health and well-being for people under community supervision in the criminal justice system: the STRENGTHEN pilot RCT. Southampton (UK): NIHR Journals Library; 2019 Dec. (Public Health Research, No. 7.20.)
This chapter focuses on the assessment of the acceptability and feasibility of the intervention, the trial methods and any potential adaptations indicated. We have included the perspectives of the participants (control and intervention), STRENGTHEN health trainers and the offender managers who worked with the researchers. The findings are presented for each method of data collection, brought together in a case study and then summarised with regard to our stated aims.
Delivery (treatment) fidelity70 was assessed in the trial to examine the extent to which the intervention was delivered as intended. This allows greater confidence that any changes in the dependent variables can be reasonably attributed to the intervention70 and allows planning for future improvements to intervention delivery by identifying areas that may have been delivered below an expected standard.
The health trainer training, manual and supervision were designed to equip the health trainers with the skills to effectively deliver and engage the participant in six core competencies across the duration of the intervention. In summary, the six core competencies were:
These core competencies were intended to be transient across sessions, with acknowledgement that not all of them may necessarily be applicable in every session (except for core competency 1, which was considered fundamental to the intervention in terms of being client-centred and building trust and rapport). All competencies were intended to be delivered in a client-centred approach drawing on motivational interviewing techniques and principles (see Appendix 1 for a detailed description).
Active participant involvement (core competency 1) scored highest, approaching the proficient level of delivery, whereas engaging social support and managing social influence (core competency 6) scored the lowest. All other items were rated as approaching the mid-point of the scale for competent delivery (Figure 3).
Active participant involvement scored notably higher than the other competencies; this is probably due to the importance placed on it during intervention development and health trainer training. The population was acknowledged as being potentially very distrustful of services; therefore, rapport- and trust-building (a key component in core competency 1) were key aims emphasised throughout training and supervision. They were particularly evident as aims of the first session, and through a function of the sampling procedure, more opportunity to demonstrate core competency 1 was observed because 50% of the sessions sampled being a first session.
Engaging social support and managing social influence (core competency 6) showed a trend of being the least well-delivered competence. Anecdotally, this may be due to the difficulties this population faces in feeling trapped by their social circles and influences, unable to relocate from a community of offending, and perceived barriers to what are considered new socially acceptable activities owing to their being labelled as an offender with the attached stigma. Conversely, some participants had consciously isolated themselves in attempt to move away from a culture of offending. Future training and intervention development would benefit from increased understanding of how the population perceive their social influences and identify acceptable ways to help participants to positively manage negative social influence and engage positive social support.
Although the other four competencies scored reasonably well, they were all slightly below the threshold for competent delivery. It is possible that this occurred as a result of over-emphasis on actively engaging the participant, which occurred at the expense of the other competencies; it also possibly occurred as a result of the sampling procedure. Additional scoring of sessions other than the first sessions may have uncovered more examples of proficient delivery of the other competencies. These issues should be considered in more detail in future research and health trainer training.
Eleven intervention and five control participants took part in one-to-one semistructured interviews with Lynne Callaghan (broken down by site in Table 32). Characteristics of interview participants are presented in Table 33.
Most interviews were conducted in person in CRC/NPS offices; one participant (from a CRC) chose to meet in a caf. Interviews were between 20 and 90 minutes; intervention participant interviews took longer. Interviews were guided by a semistructured interview schedule [see the project web page: www.journalslibrary.nihr.ac.uk/programmes/phr/145419/#/ (accessed 30 August 2019)] developed for control and intervention (engaged and disengaged) participants. Questions focused broadly on the acceptability of trial methods (both groups) and the intervention (intervention group).
All participants were asked about their experience of being approached to take part in the study, their motivation to participate, their understanding of randomisation and the acceptability of data collection methods. Control participants were asked about their experience of being allocated to the control group and any support that they had accessed to support change in any of the target health behaviours and well-being. Intervention participants were asked about their experience of being allocated to the intervention group, acceptability of the intervention, procedures and style of delivery, behaviour/well-being focus, experience of goal-setting, own behaviour change (single and multiple) and perceived benefits.
The research team worked closely with offender managers to ensure that participation was not counted towards an enforceable component of their order, although one participant thought that it did. Some offender managers allowed their clients to forgo a probation appointment if they attended a STRENGTHEN appointment. Participants in both groups found the initial introduction process acceptable, and found the study information sufficient to make a decision regarding participation.
Participants in both groups talked about making a contribution to research as their initial motivation for participation and clearly understood that this was a research study, not an offer simply to receive an intervention. Participants were keen to contribute to help people in a similar situation and building knowledge:
Intervention participants, in particular, spoke about wanting to make a change in their lives, although this was not always obviously linked to the target health behaviours, for example using the intervention to provide occupation to fill their day and support them in developing a routine.
Although there was some disappointment expressed by control participants interviewed that they were not allocated to the intervention group, it did not reduce their motivation to participate in the study and engage in follow-up appointments. Two of the control participants could not remember being told which group they were in, but it was not clear if this was due to difficulty of recollection or failure in communication. There was some confusion about whether the decision was random or based on their responses to outcome measures:
Participants were able to make changes to the frequency of sessions in accordance with their needs. Therefore, the intensity of health trainer support could be increased or reduced to support behaviour change goals, to allow for changes in circumstances or other commitments, or as participants took increased control over health and/or well-being and relied less on the support of the health trainer:
Participants described how health trainers also communicated with them via mobile phones to maintain contact between sessions. This extra communication enabled participants to receive information related to supporting their behaviour-change goals and reminders for intervention appointments. Participants found this to be acceptable:
Community Rehabilitation Company participants were given the opportunity to meet with their health trainer at an agreed public place following the initial meeting. This option was not available to NPS participants because of their higher category of risk. As both CRC offices were in busy city centres and in areas where parking charges were enforced, being able to meet in an area that was local to residences or work places facilitated attendance:
National Probation Service participants were aware of their assessed level of risk and understood that their health trainer sessions would be held in the probation service offices. One NPS participant stated that, although he would have preferred attend sessions in another location, the flexibility of delivery meant that he was able to arrange sessions to take place immediately after a mandated course. This flexibility, and further strategies for managing his anxiety when in the waiting room, meant that he could maintain his engagement.
Participants in both arms of the pilot trial found their participation in the research and, where relevant, the intervention, to be acceptable. Participants suggested potential improvements including:
The six health trainers (three in the north-west and three in the south-west) who delivered the intervention took part in one-to-one semistructured interviews with Lynne Callaghan in person (south-west) or by telephone (north-west). Interviews were guided by a semistructured interview schedule [see the project web page: www.journalslibrary.nihr.ac.uk/programmes/phr/145419/#/ (accessed 30 August 2019)] that covered questions relating to training; supervision; the intervention manual; their experience of delivery, including barriers to and facilitators of delivery; and motivational interviewing (MI) techniques.
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