Abstract

PROBATION IN England and Wales is managed by the National Probation Service – a public sector service working with high-risk offenders – and 21 ‘community rehabilitation companies’, which are a mixture of private and voluntary sector agencies working with medium and low-risk offenders. Collectively, these agencies supervise more than 200,000 people (Ministry of Justice 2014), while clinical commissioning groups (CCGs) are responsible for commissioning health care for this group (NHS Commissioning Board 2013). To commission patient-centred care, CCGs need a good understanding of offenders’ healthcare needs and of any barriers to service access that they experience. Assessments of their healthcare needs and research could help to identify ways of ensuring services are accessible and meet offenders’ needs, providing more patient-centred care and reducing health inequalities.

Researchers consider offenders on probation to be ‘hard to reach’ because probation is a ‘closed setting’ (permission is required to access it) (Hayes et al 2010) and engaging offenders in research can be problematic as the result of issues such as return to custody and the lifestyles that some lead (Mair and May 1997, National Offender Management Service in Wales 2015). Offenders also constitute a ‘vulnerable group’, because they may experience reduced autonomy because of health problems, such as substance misuse and mental illness (Mair and May 1997, Social Exclusion Unit 2002, Brooker et al 2009, 2011, 2012, Sirdifield 2012, Lang et al 2014); power differentials between them, researchers and healthcare professionals; social exclusion; and stigma (Moore and Miller 1999, Social Exclusion Unit 2002, Bond Sutton et al 2003, Peternelj-Taylor 2005). This can make research with this population problematic.

A review of research into strategies for improving the representation of socially disadvantaged groups in health and medical research identified 116 papers offering advice on recruitment (Bonevski et al 2014). None of these papers – 31 of which included were literature reviews – appeared to focus on the probation population. This highlights a paucity of literature about engaging probation populations in health research.