An Alcohol Brief Intervention (ABI) for male remand prisoners: an MRC complex intervention framework development and feasibility study
Lead Research Organisation:
University of Edinburgh
Department Name: Sch of Health in Social Science
Abstract
There are just over 90,000 prisoners in UK prisons with 20% accounting for those on remand. Those who have or are at risk of offending frequently suffer from multiple and complex health issues, including mental and physical health problems, learning difficulties, substance misuse and increased risk of premature mortality. The impact of harmful alcohol use impacts significantly not only in relation to individual health, but also to the wider community and society as a whole. The cost of alcohol to the NHS is estimated at £3.5 billion per year. Alcohol-related crime costs £11 billion per year and as many as 70% of prisoners have admitted to having been under the influence of alcohol when committing the crime for which led to their imprisonment. We know that a large number of prisoners have a high rate of alcohol problems when compared with the general population, with an even higher rate amongst remand prisoners. Remand prisoners are those who are both unconvicted and convicted and unsentenced. They spend on average of 9 weeks held in custody awaiting trial and/or sentencing. This makes it difficult for them to access regular prison based alcohol services and receive interventions or treatment. We also know that brief alcohol advice in the form of an Alcohol Brief Intervention can be effective in achieving a reduction in alcohol consumption when delivered by nurses in certain health care settings. Prison therefore offers an opportunity for nurses to identify, respond and/or refer to treatment those remand prisoners who are consuming alcohol above recommended levels. There is however, limited evidence for the effectiveness, optimum timing of delivery, recommended length, content, implementation and economic benefit of Alcohol Brief Interventions in the prison setting for remand prisoners.
The proposed research wishes to develop an Alcohol Brief Intervention that is acceptable for delivery by prison nurses to male remand prisoners who have been identified as drinking alcohol at a level that is or has caused them harm. The study will also measure how feasible it is to deliver this intervention in the prison setting to male remand prisoners.
We will undertake the development of the Alcohol Brief Intervention through in-depth interviews and surveys with male remand prisoners and prison nurses in one large prison in England and one large prison in Scotland. From the data collected we will refine and develop an acceptable Alcohol Brief Intervention that is feasible to deliver and is based on sound behavioural change concepts.
The work is of importance to fill existing gaps in this area. We currently don't know what 'type' of Alcohol Brief Intervention is needed or is acceptable to the remand prisoner population. We are also unsure as to the issues surrounding the feasibility of delivering such an intervention by prison nurses. This study will address these issues. The development of an acceptable Alcohol Brief Intervention will then enable us to undertake a future pilot study, followed by a definitive Randomised Controlled Trial (RCT) evaluating its effectiveness and cost-effectiveness and ultimately an implementation study.
The proposed research wishes to develop an Alcohol Brief Intervention that is acceptable for delivery by prison nurses to male remand prisoners who have been identified as drinking alcohol at a level that is or has caused them harm. The study will also measure how feasible it is to deliver this intervention in the prison setting to male remand prisoners.
We will undertake the development of the Alcohol Brief Intervention through in-depth interviews and surveys with male remand prisoners and prison nurses in one large prison in England and one large prison in Scotland. From the data collected we will refine and develop an acceptable Alcohol Brief Intervention that is feasible to deliver and is based on sound behavioural change concepts.
The work is of importance to fill existing gaps in this area. We currently don't know what 'type' of Alcohol Brief Intervention is needed or is acceptable to the remand prisoner population. We are also unsure as to the issues surrounding the feasibility of delivering such an intervention by prison nurses. This study will address these issues. The development of an acceptable Alcohol Brief Intervention will then enable us to undertake a future pilot study, followed by a definitive Randomised Controlled Trial (RCT) evaluating its effectiveness and cost-effectiveness and ultimately an implementation study.
Technical Summary
Background: In the UK it is known that a significant number of male remand prisoners have a high rate of alcohol problems when compared with non-remand prisoners and the general population. There is an association between alcohol and violent crimes with a rising number of offenders citing alcohol as a contributory factor of their offending. Alcohol Brief Interventions (ABIs) based on enhancing self-efficacy (a main causal determinant of behaviour) are an effective component of a population-level approach to harmful and hazardous drinking, assisting in reducing the aggregate level of alcohol consumed and therefore lowering the whole population's risk of alcohol-related harm. However, there is no evidence as to the effectiveness of a self-efficacy enhancing ABI in male remand prisoners. The development of such an intervention is of public health importance and is therefore warranted.
Aim: The aim of this early phase study is to adapt and define a self-efficacy enhancing ABI intervention to enhance Drinking Refusal Self-efficacy (DRSE) that will be acceptable to male remand prisoners. Methods: The methods draw on the MRC framework for early phase work, focusing on development and feasibility using mixed methods. We will undertake in-depth interviews with male remand prisoners (n~24) and 2 focus groups with prison nurses (n~6-8 in each group) in 2 large prisons accommodating male remand prisoners (1 Scotland; 1 England). A random cross-sectional survey of male remand prisoners (n~400) will then be undertaken to assess acceptability and feasibility of delivery. Data gathered will then be used to inform the refinement of an acceptable intervention that is feasible to deliver through formal Intervention Mapping. Future research: This intervention will be utilised in a subsequent pilot study. Ultimately a definitive Randomised Controlled Trial (RCT) will be conducted evaluating intervention effectiveness and cost-effectiveness, followed by an implementation study.
Aim: The aim of this early phase study is to adapt and define a self-efficacy enhancing ABI intervention to enhance Drinking Refusal Self-efficacy (DRSE) that will be acceptable to male remand prisoners. Methods: The methods draw on the MRC framework for early phase work, focusing on development and feasibility using mixed methods. We will undertake in-depth interviews with male remand prisoners (n~24) and 2 focus groups with prison nurses (n~6-8 in each group) in 2 large prisons accommodating male remand prisoners (1 Scotland; 1 England). A random cross-sectional survey of male remand prisoners (n~400) will then be undertaken to assess acceptability and feasibility of delivery. Data gathered will then be used to inform the refinement of an acceptable intervention that is feasible to deliver through formal Intervention Mapping. Future research: This intervention will be utilised in a subsequent pilot study. Ultimately a definitive Randomised Controlled Trial (RCT) will be conducted evaluating intervention effectiveness and cost-effectiveness, followed by an implementation study.
Publications
Holloway A
(2019)
Alcohol brief interventions for male remand prisoners: a mixed-methods feasibility and acceptability study
in The Lancet
Holloway A
(2017)
Proceedings of the 14th annual conference of INEBRIA New York, NY, USA, September 14-15, 2017
in Addiction Science & Clinical Practice
Description | Written Evidence to Inquiry on Prisoner Health submitted to Health and Sport Committee, Scottish Parliament (Invited to submit evidence and give oral evidence) |
Geographic Reach | National |
Policy Influence Type | Contribution to a national consultation/review |
Description | ESRC IAA Impact Grant |
Amount | £10,000 (GBP) |
Organisation | University of Edinburgh |
Sector | Academic/University |
Country | United Kingdom |
Start | 08/2018 |
End | 03/2019 |
Description | Knowledge Exchange & Impact |
Amount | £3,000 (GBP) |
Organisation | University of Edinburgh |
Sector | Academic/University |
Country | United Kingdom |
Start | 03/2018 |
End | 06/2019 |
Description | NIHR-PH |
Amount | £375,946 (GBP) |
Funding ID | PHR/17/44/11 |
Organisation | Public Heath Research (PHR) Progrmame |
Sector | Charity/Non Profit |
Country | United Kingdom |
Start | 12/2018 |
End | 04/2021 |
Description | Collaboration and partnership with NHS Lothian |
Organisation | NHS Lothian |
Country | United Kingdom |
Sector | Public |
PI Contribution | I was invited by the Chief Research Nurse for NHS Lothian and the Executive Director, Nursing, Midwifery and AHP's, Executive Lead REAS and Prison Healthcare to work with them on a health needs assessment in one of the prisons that they provide health care for. We have started the initial scoping work for this and are now discussing seeking funding to undertake some work in areas that are identified as high priority for health care provision. We have also submitted written evidence to the Inquiry on Prisoner Health being undertaken by the Health & Sport Committee at Scottish Parliament on the work we have undertaken. |
Collaborator Contribution | They have provided resources for the initial piece of work and data retrieval. |
Impact | We have also submitted written evidence to the Inquiry on Prisoner Health being undertaken by the Health & Sport Committee at Scottish Parliament on the work we have undertaken. |
Start Year | 2016 |
Description | Podcast PRISM-A podcast |
Form Of Engagement Activity | A broadcast e.g. TV/radio/film/podcast (other than news/press) |
Part Of Official Scheme? | No |
Geographic Reach | International |
Primary Audience | Professional Practitioners |
Results and Impact | Podcast was made and link was sent to both study settings who had participated for dissemination to staff and third sector organisations providing alcohol services in prisons. The podcast was also sent to Scottish Prison Service and Her Majesty's probation and prison service. This was well received and contributed to further discussions with prison services around the next steps required with the programme of research i.e. submission to NIHR-PH for pilot feasibility and their support to facilitate if funded which we received. |
Year(s) Of Engagement Activity | 2017 |
URL | http://edin.ac/2xjS45d |
Description | Research on health in prison settings in Scotland - a colloquium |
Form Of Engagement Activity | Participation in an activity, workshop or similar |
Part Of Official Scheme? | No |
Geographic Reach | National |
Primary Audience | Policymakers/politicians |
Results and Impact | At this event, attended by academics and stakeholders, Aileen Campbell MSP, Scottish Public Health Minister also attended and gave an address, announced a new £100 000 fund to support local partnership projects in prisons, involving NHS boards and the Scottish Prison Service (SPS) to improve wellbeing in prisons and took questions. The health of people in prison is significantly poorer than that of the general population and with the majority of sentenced people returning to the community, improving the health of this population is important from a wider public health perspective. Since 2011, prison healthcare services in Scotland are managed by the National Health Service (NHS), whereas it previously was managed by the Scottish Prison Service (SPS). The transfer followed on from recommendations from the Prison Healthcare Advisory Board (PHAB), set up by Scottish Ministers, which was established in 2007. However, five years on the Royal College of Nursing (RCN) assessed the progress of the transfer and concluded that several areas need further improvement. The RCN report prompted an inquiry by the Scottish Parliamentary Health and Sport Committee (SPHSC), which led to the establishment of the Health and Social Care in Prisons Programme Board, with the aim of improving prison healthcare. On the backdrop of the inquiry, an event was held on 4 June 2018, with key stakeholders in the area of prison health to explore recent and current research in Scotland. The aim of this event was to gain a better understanding of current research activities and to facilitate discussion around future research priorities. The event was attended by academics, representatives from NHS and SPS, third sector organisations, freelance researchers, government officials, and the Public Health Minister. This report provides a brief overview of health in prison settings; the policy context in Scotland; a summary of the content of the event, emerging issues, feedback of participants; and next steps in further developing prison health research in Scotland. This project was funded through the University of Edinburgh College of Arts, Humanities and Social Sciences Knowledge Exchange and Impact Grant. |
Year(s) Of Engagement Activity | 2018 |
URL | https://www.research.ed.ac.uk/portal/en/publications/research-on-health-in-prison-settings-in-scotla... |
Description | Webinar |
Form Of Engagement Activity | A broadcast e.g. TV/radio/film/podcast (other than news/press) |
Part Of Official Scheme? | No |
Geographic Reach | International |
Primary Audience | Other audiences |
Results and Impact | A live webinar was hosted that provided an overview of the study and an opportunity for those who took part to engage with Aisha Holloway and Dorothy Newbury-Birch ask questions. This resulted in practitioners who were working in the prison setting who took part in the webinar, following on with further discussion and questions afterwards and we were able to link them to further resources, services and contacts to help them deliver ABIs in the prison setting. |
Year(s) Of Engagement Activity | 2017 |
URL | https://media.ed.ac.uk/media/HOLLOWAY+Aisha_webinar/1_vyw3zd0n |