Connell, Catriona (2019) Increasing occupational participation for people with a personality disorder and an offending history: an intervention development study. PhD thesis, University of Warwick.

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Abstract

Background
Personality disorder is highly prevalent among people in contact with criminal justice and forensic mental health services. People with an offending history and a personality disorder (personality disordered offenders; PDOs) experience poor health and reoffending outcomes. This impacts the individual concerned, victims of offending, public health and public services. Occupational participation describes undertaking personally meaningful and socially valued activities and roles. It is integral to health and associated with lower risk of reoffending. It is therefore an important outcome for PDOs in the community.

Aim and research questions
This research aimed to address gaps in the literature to inform development of an intervention to increase occupational participation for PDOs in the community. It answered three questions. For this population:

• What factors influence occupational participation?
• What are the required components of an intervention to increase occupational participation, and what should these components include?
• How can a new intervention be implemented in a natural context for a feasibility study and pilot evaluation?

Methods
The research consisted of four work packages informed by Medical Research Council guidelines for developing and evaluating complex interventions. It was underpinned by a critical realist philosophy. Patient and Pubic Involvement was integrated throughout, along with an established theory of occupational participation and its associated model, the Model of Human Occupation.

Work Package One involved two systematic reviews to establish what is already known about i) the factors that influence occupational participation for PDOs in the community, and ii) the effectiveness of interventions to increase it. The lack of evidence informed the remaining work packages. Work Package Two used a convergent parallel mixed-methods design to identify factors that influence occupational participation. Quantitative and qualitative data collected from interviews with 18 PDOs were analysed separately in three parallel sub-studies. This was followed by a structured integration process.

Work Package Three utilised a three-round multi-disciplinary Delphi survey to establish consensus on the content of an intervention. In round one, participants rated the importance and modifiability of the factors, and described best practice to modify these. Responses were converted into statements about the potential effectiveness of different aspects of intervention. Participants rated their agreement in rounds two and three. When 75% of participants agreed with a statement, it was used to specify intervention content.

Work Package Four involved specifying the intervention and modelling its outcomes and processes. Established processes to develop a manual, model the intervention, and produce a logic model were applied using the data collected in the previous work packages and additional literature searches.

Results and findings
Twenty-eight factors influence occupational participation for PDOs in the community. Some factors were not described by the Model of Human Occupation. The same factors influenced occupational participation in activities and roles valued by dominant society (prosocial occupations) and those considered deviant, criminal or harmful (antisocial occupations). Elaboration of the Model would increase its explanatory power with this population. The data supported the use of occupational adaptation to inform intervention development.

Delphi participants reached consensus on 121 statements. They rated all 28 factors as above 5/10 for importance, but only eight above 5/10 for modifiability. Consensus was not reached on the integration of digital/internet technology.

An intervention manual and a logic model were produced, both suitable for a feasibility study and pilot evaluation. The modelling process generated further questions and indicated that a process evaluation would be a beneficial addition in future research.

Conclusions
This research established the factors that influence occupational participation for PDOs in the community. It produced consensus on intervention content that is likely to effect change. These results make a unique contribution to knowledge.

A complex intervention was developed to increase occupational participation for PDOs in the community. An intervention manual and logic model of the intervention provide a basis for further intervention development and evaluation. These outputs show the aim of the research was achieved

Item Type:	Thesis (PhD)
Subjects:	G Geography. Anthropology. Recreation > GT Manners and customs H Social Sciences > HV Social pathology. Social and public welfare R Medicine > RC Internal medicine
Library of Congress Subject Headings (LCSH):	Personality disorders, Mental health, Criminals, Victims of crimes
Official Date:	January 2019
Dates:	Date Event January 2019 Published
Institution:	University of Warwick
Theses Department:	Warwick Medical School
Thesis Type:	PhD
Publication Status:	Unpublished
Supervisor(s)/Advisor:	Furtado, Vivek ; McKay, Elizabeth ; Singh, Swaran
Format of File:	pdf
Extent:	xvi, 470 leaves: illustrations, charts
Language:	eng

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