A report of a major empirical study relevant to health psychology
Instructions:-
Very Important Additional information TO CONSIDER-The research report should Analyse and evaluate the research findings and evaluate the impact of this psychological research.
-The research report is a major empirical study at a level congruent with the Quality Assurance Agency (QAA) descriptor for Doctoral (D) level qualifications and at a level congruent with the Scottish Level 12 descriptors within the Scottish Credit and Qualifications Framework.
-This evidence must demonstrate an understanding of a substantial body of knowledge within the field of health psychology, and to create and interpret new knowledge through original research.
-Both of this evidence report shall be written to a standard acceptable for publication in peer-reviewed academic journals relevant to health psychology at the time of submission. This standard shall apply to both the content and presentation of the work. Note that the word limits do not include references, tables or appendices.
The word limit is 15,000. I have 4,500 words that will be edited to match what will be written.RESEARCH DOCUMENT (The area of Health Psychology Doctorial level)
(1). Title of research report: Training health professionals in the application of Theory of Planned Behaviour (TPB) in managing health behaviour change for young offenders in Bulgaria.
(2). Brief about the research conducted- 50 Health Professionals (20- health trainers),(10- psychologists), (10-social workers) and (10-juvenile caseworkers) were trained in the application of The Theory of Planned Behaviour (TPB) to facilitate health behaviours of young offenders in Bulgaria
(3). Prior to designing the (quantitative) training based on The Theory of Planned Behaviour (TPB), the Likert Scale based on a five- point scale (from 4-0) was used to measure importance of series of questions, and so tapping into the cognitive and affective components of attitudes.
(4). Health professionals were divided into groups of 3.
-1st group had 18 participants (received 2 days training)
-2nd group had 17 participants (received 2 days training)
-3rd group had 17 participants (received 2 days training)Research Objectives for the Current Study
• To train health professionals in Bulgaria to manage health behaviours of young offenders
• To use a theory in health psychology such as (The Theory of Planned Behaviour ) for development, implementation and evaluation of young offenders’ health behaviours in relation to subjective wellbeing to include three components: positive emotion, lack of negative emotion and a general sense of satisfaction in life
• Young offenders health behaviours in relation to subjective wellbeing to focuses on: smoking, alcohol and drug abuse and inactive lifestyle).Headings must be written under the following:Content Page No.-Abstract
-Background
-Research conceptualisation (Literature review of health behaviour sof young offenders in Bulgaria) Theory of planned behaviour in managing health behaviours of young offenders
-Current research study
-Research Objectives of the Current Study
-Sampling (Health professionals)
-Implementation
-Research philosophy
-Research approach
-Data Collection
-Primary Data Collection
-Interview
-Secondary Data Collection
-Data Analysis
-Quantitative Approach
-Qualitative Approach
-The evaluation methods (Results)
-Questionnaire analysis
-The discussion of implications of the data in contributing to the development of new ideas and techniques, in relation to managing health behaviours of young offenders in Bulgaria and the relationship of data to previously published research (Discussion)
-Conclusion
-Recommendations
-References (APA Style)
Solution
A report of a major empirical study relevant to health psychology
Table of Contents
Overview of the TPB and Application in Managing Health Behaviour Change. 8
Current Policy and Practice. 14
Health Behaviour Needs of Young Offenders in Bulgaria. 16
Substance Abuse among Young Offenders. 17
Lack of Facilities for Young Offenders and their Current Status. 19
Juvenile offenders at Higher Risk of Behavioural Health Problems in Bulgaria. 20
Application of TPB in the Face of Exclusion of Young Offenders. 21
Behaviour Health Problems and Antisocial Behaviour in Young Offenders. 23
Summary of the Methodology. 32
Importance of Different Options in Managing Health Behaviour Change. 34
Critical Skills and Training. 36
Assessment of the Health Behaviours of the Young Offenders. 37
Training – Primary Concerns. 39
Addressing Health Inequalities via Improving Health Behaviours. 40
Significance of Training on Health Behaviour Change. 42
Challenges Facing Health Professionals. 44
Influence of Training on the Interventions. 45
Understanding Health Behaviour Change through Training. 46
Sustaining Training on Health Behaviour Change. 48
Importance of Different Options in Managing Health Behaviour Change. 50
Skills and Training for Managing the Health Behaviours of Young Offenders. 52
Importance of Assessing Health Behaviours of Young Offenders. 53
Primary Concerns in Training and Addressing Health Inequalities. 54
Role of Training in Influencing Interventions and Understanding of Health Behaviours. 57
CONCLUSION AND RECOMMENDATIONS.. 59
Young offenders in Bulgaria face punishment and incarceration in accordance with the country’s Penal Code, the Juvenile Delinquency Act, the Penal Procedure Code and other legal procedures covered by the legal framework. The measures have proven ineffective in managing health behaviour change and thus the need to improve support for health behaviour change. Training health professionals to apply the Theory of Planned Behaviour (TPB) is an active approach to managing health behaviour change and addressing the needs of young offenders in Bulgaria with behavioural health problems. The application of the theory allows the consideration of behavioural, normative and control beliefs, which influence perceptions and the attitudes people, have towards certain behaviours. This research focuses on identifying the importance of training health professionals (including psychologists, social workers, health trainers, and juvenile care workers) to integrate the behavioural health change model in addressing and meeting the health needs of young offenders and managing their health behaviour change. The research employs an efficient research methodology involving the training of 50 health professionals and using a workshop evaluation questionnaire that focuses on the different parts of the training, its impact and influence, and possible contribution towards the management of behaviour health change.
The
research findings show the importance of training health professionals in
applying the TPB for the improvement of the current measures and practice in managing
health behaviour change of young offenders. Currently, the correctional
measures seem inadequate in managing health behaviour change owing to the high
re-offending rates and plateauing levels of offending by young Bulgarians. The
study identifies the health needs of juvenile delinquents, the need for the
application of TPB in addressing and managing behaviours, and the need for
subjective well-being in dealing with behavioural problems such as smoking,
sedentary lifestyle, substance abuse, alcoholism, and mental issues such as
addiction. In conclusion, this study recommends a
collaborative/interdisciplinary training of professionals on the application of
the theory, the creation of effective interventions, and a focus on the
subjective well-being in managing the behaviours of the offenders. The
recommendations call for the formulation of policy to improve the
community-based and correctional facilities to address the health needs of the
juvenile delinquents and manage the health behaviour change adequately.
Additionally, the research supports the creation of programs such as seminars,
training workshops, and practice to ensure that health professionals sustain
the skills acquired during training.
Bulgaria records numerous behavioural health issues that affect the young population. According to Campbell, Abbott, and Simpson (2014) and the Directorate-General Justice, Freedom and Security (2016), some of the problems include conduct behaviour, mental illness, emotional disorders, depression, substance abuse, psychotic disorders, anxiety disorders, and oppositional defiant disorder among others. Moreover, Popov (2016) and Tomov, Mladenova, Lazarova, Sotirov, and Okoliyski (2004) identify smoking, sedentary lifestyle, substance abuse, and alcoholism as other highly prevalent behavioural health problems among young offenders in Bulgaria. While these behavioural health problems are manifest across the globe, the cognitive behavioural therapy, motivational interviewing, and reality therapy are used for the treatment of the health problems (Maragakis & O’Donohue, 2016; Schubert & Mulvey, 2014). Despite the use of these interventions, there is an increasing trend of behavioural health problems (Maragakis & O’Donohue, 2016). This research argues for the integration of the Theory of Planned Behaviour into the intervention measures to enhance the treatment process especially for young offenders (Seyal & Rahman, 2017). The application of the TPB model allows the self-analysis of behaviours, possible effects, and the impact of change thus enabling the young offenders to seek behavioural change or modification (Wang & Wang, 2015; Athamneh, Essien, Sansgiry, & Abughosh, 2017; Ates, Eyuboglu, Ates, & Zerenay, 2017). Equipping professionals with the necessary skills and capacity to help young offenders in Bulgaria through behavioural health change will improve the effectiveness of the approaches used to address the behavioural health problems. According to Popov (2016) and Chitsabesan, et al. (2006), the health and well-being of offenders carry significant weight in any community. There is a need to create health structures and implement programs that focus on fixing the care concerns and health problems affecting young offenders in Bulgaria.
According to the United Nations (2016) data, Bulgaria has a population of approximately 7.098 million people. The population comprises mainly of the adult population with the median age of 43.7 years with only 14.54% and 9.73% of the population lying between 0-14 and 15-24 years respectively. The population older than 25 is over 75 percent (CIA World Factbook, 2017). The largest population of Bulgarians are urban dwellers (UN Data, 2016). As the criminal justice system (CJS) focuses on the enforcement of the law and the prevention of crime and the protection of the rights of every individual and their property, it holds offenders found culpable liable for their offences. The five elements of the CJS include the Prison Service, the Police, Courts, the Prosecution Office, and the Probation Service work under the Ministry of the Interior, the Ministry of Justice, the Parliament, and the Government. As of 2010, Bulgaria had about 10,500 prisoners with a population of 148 per every 100,000 people (Home Office, 2010). Seventy four and 240 of the prisoners were juveniles and female respectively, while most of the population was between 30 and 39 (Directorate-General Justice, Freedom and Security, 2016; Seyal & Rahman, 2017). However, the percentage of young offenders, juveniles and young adults below 35 years is significant.
That every Bulgarian citizen, including offenders, has a right to basic health care requires the government to promote and protect the health of every offender (Bekaert, 2008; Chitsabesan P. K. et al., 2006; Carswell, Maughan, Davis, Davenport, & Goddard, 2004). Meeting the health needs of the offenders is essential for the assurance of their health. However, of greater importance, in consideration of the health problems and concerns arising from behaviours is the efficient management of health behaviour of the young offenders. It is important that the health professionals direct efforts to managing the health behaviour of the offenders to minimise the prevalence of healthcare problems and promote the health and well-being of every Bulgarian (Directorate-General Justice, Freedom and Security, 2016; Douglas & Plugge, 2008). The management of the health behaviour of the offenders demands the integration of specific measures and strategies that guarantee results. The application of the Theory of Planned Behaviour (TPB) model is important in managing health behaviour change for the offenders. However, the practical implementation of the model demands that health professionals have the skills, knowledge, and ability to execute and implement it effectively. This research focuses on providing an in-depth discussion of training health professionals such as social workers, psychologists, health trainers, and juvenile care workers among others within the context of managing health behaviour change of young offenders.
Overview of the TPB and Application in Managing Health Behaviour Change
The right to quality and efficient health care is preserved for every citizen yet health professionals continue to experience a great challenge in ensuring that young offenders enjoy this right (Anderson, Vostanis, & Spencer, 2004; Popov, 2016). There are numerous health challenges that offenders face that demand the help of well-trained health professionals from counsellors to psychologists, healthcare providers/workers, social workers, juvenile carers, and trainers among others (Underwood & Washington, 2016; Popov, 2016). To address the health problems of offenders, especially young ones, requires the application of different strategies and measures (Anderson, Vostanis, & Spencer, 2004). Training health professionals in the application of the TPB guarantees better outcomes when integrated into other treatment options such as the CBT, motivational interviewing, and reality therapy in addressing health problems by managing the health behaviours of the young offenders (Popov, 2016; Nicol et al., 2000). Training the professionals effectively will allow them to manage young offenders’ behaviours that threaten their well-being and health such as smoking, drug and substance abuse, binge drinking and alcoholism, and sedentary lifestyles among others (Anderson, Vostanis, & Spencer, 2004; Douglas & Plugge, 2008; Chitsabesan & Bailey, 2006). Outlining the TPB model and its possible implementation shed light on the theory and its application to actively encourage health and wellbeing of the young offenders.
According to Kiriakidis (2008), Forste, Clarke, and Bahr (2011), and Jalali, Shamsi, Roozbahani, and Kabir (2014), the integration of the Theory of Planned Behaviour in the management of health behaviours allows the efficient designing of interventions and implementation of programs that target and address specific behaviours. The application of the TPB requires the consideration of the behavioural, control, and normative beliefs that influence human behaviour (Jalali, Shamsi, Roozbahani, & Kabir, 2014; Koh & Mackert, 2016). Behavioural beliefs influence the attitude an individual holds towards certain behaviours and guide the considerations of different outcomes, whether positive or negative. The behavioural beliefs include questioning the possible outcomes, benefits of certain decisions, and the potential negative consequences (Wang & Wang, 2015; Seyal & Rahman, 2017). According to Seyal and Rahman (2017) and Athamneh, Essien, Sansgiry, and Abughosh (2017), the application of the TPB should consider the normative beliefs, which include the perception and influence of the society. The expectations of the society regarding a person’s behaviours and actions and the possibility of support or ridicule by society members inform behaviour. Wang and Wang (2015) and Hasking and Schofield (2015) argue for the importance of considering the normative and behavioural beliefs and combining them with the control beliefs (that include the capacity to make certain decisions) to allow the formation of intention. Embedded in the application of TPB, is the importance of understanding the beliefs and intentions to influencing behaviour change.
(Source: http://people.umass.edu/aizen/tpb.diag.html)
As Ajzen (1991) states, “Intentions to perform behaviours of different kinds can be predicted with high accuracy from attitudes toward the behaviour, subjective norms, and perceived behavioural control; and these intentions, together with perceptions of behavioural control, account for considerable variance in actual behaviour.” Attitudes outline the degree to which an individual favours a behaviour of interest or to which he/she finds such a behaviour unfavourable (Rosval, 2013). An individual considers the outcome of performing the specific behaviour and uses that to evaluate the favourability of the behaviour. If a person believes that a behaviour is likely to result in a positive behaviour then he/she is likely to perform it and vice versa. According to Ajzen, the attitude towards a behaviour is determined by access to behavioural beliefs (which links behaviour of interest to possible outcomes). If a person evaluates and finds a certain behaviour likely to bring forth positive outcomes, s/he forms intention, which mostly causes behaviour (Lange, Kruglanski, & Higgins, 2013).
Normative beliefs and control beliefs influence subjective norm and perceived behavioural control respectively, thus contributing to intention and shaping behaviour. Normative beliefs comprise of the perceived behavioural expectations of people held as important such as family members, friends, partners, and professionals among others (Ajzen, 2006). People’s motivations are likely to comply with the behavioural expectations of the important people in their lives (LaMorte, 2016). The normative beliefs, therefore, influence or determine the subjective norm. According to Lange, Kruglanski, and Higgins (2013), subjective norm is the social pressure that push people to behave in a certain way. Access to the normative beliefs, which set people to behave in ways as expected by their loved ones, close friends, and society members, creates a perceived social pressure (subjective norm) that influences behaviour. The control beliefs result in intention and consequently the performance of a behaviour. The TPB model describes behaviour as a product of the compatibility of intentions and perceptions of behavioural control (Wang & Wang, 2015).
The presence of factors that influence a person’s decision to perform a behaviour create the control beliefs. Control beliefs, according to Ajzen (1991), are a set of the beliefs resulting from factors that influence perception towards a behaviour. The perceived behavioural control comprise of the combination of the perceived power of different control factors. The presence of a factor that controls an individual’s perception of performing a behaviour determines whether the person behaves in a certain way or not. The perceived behavioural control refers to a person’s perception of his or her ability to perform a certain behaviour (Jalali, Shamsi, Roozbahani, & Kabir, 2014). If a person believes that they can perform a particular behaviour they are likely to form the intention of performing that behaviour. The intention shows an individual’s readiness to engage in a behaviour and often results in the performance of the behaviour.
In training the health professionals to apply the TPB model, understanding these basic tenets of the theory is essential for the establishment of the most impactful approaches when dealing with young offenders (Powell, Pattison, & Francis, 2016). The professionals must acquire knowledge and skills on how to integrate the model into the management of the young persons’ health behaviours for change.
- What degree is the possible influence of the TPB model in the context of managing the health behaviour change of the young offenders?
- To find out the effectiveness of integrating the Theory of Planned Behaviour into treatment interventions used in managing health behaviour change among young offenders in Bulgaria.
The
choice and use of the research method depends greatly on the type of study.
Qualitative, quantitative, literature-based, or mixed-method research methods
are applicable depending on the kind of data and information the researcher
wants to collect for the development of a well-researched paper. In studying
the application of the TPB model in managing the behavioural health needs of
young offenders in Bulgaria, the quantitative research method proves effective
in respect to training and collecting data from the professionals. It will
require the collection of data to for the discussion and sufficient data to
build on the research objectives. The literature review part will offer a
comprehensive discussion of the topic of research. The review uses only
credible scholarly materials including peer-reviewed journal articles, books,
and institutional websites. The journal articles identified by searching
specific phrases on different databases such as EBSCOhost, Google Scholar,
ProQuest, Medline, PsycINFO, and the Cochrane Library while the books were
accessed mainly through Google Books. Some of the phrases used include behavioural health problems, health needs in
Bulgaria, young offenders and behavioural health problem, the theory of planned
behaviour, treatment options for behavioural health management among
others. The website articles and reports were obtained from institutional websites. Moreover, the study employs quantitative research
techniques and research paradigms and philosophy to develop an elaborate
research. The data collection techniques include interviews and surveys.
Numerous authors have extensively discussed the health needs and behaviours of young offenders and the current policy and practice in addressing the issues (Nicol, et al., 2000; Bekaert, 2008; Carswell, Maughan, Davis, Davenport, & Goddard, 2004; Booth, 2002; Chitsabesan & Bailey, 2006; Douglas & Plugge, 2008; Anderson, Vostanis, & Spencer, 2004; Athamneh, Essien, Sansgiry, & Abughosh, 2017; Ates, Eyuboglu, Ates, & Zerenay, 2017; Jalali, Shamsi, Roozbahani, & Kabir, 2014). The literature review will place emphasis on the current policy and practice, the Theory of Planned Behaviour, and the behavioural health needs of offenders. The review of the literature on the current practice and policy offers insight on the effectiveness of the measures and strategies adopted and implemented for the management of the health behaviours of young offenders in Bulgaria. Moreover, discussing the health needs and the behaviours of the young offenders sheds light on the topic and outlines the importance of training health professionals to apply the TPB for the management of the health behaviours of the offenders.
The current measures do not address behavioural health problems among the young offenders effectively. A greater percentage of the youth with mental health problems do not have access to community-based services or residential settings (Schubert & Mulvey, 2014; Directorate-General Justice, Freedom and Security, 2016). As the quality of healthcare in the country improves, there is a need for further improvements in the delivery of acceptable, accessible, and quality health services for young offenders to ensure the efficient management of their health behaviours. The implementation of the TPB, according to Hasking and Schofield (2015), provides the reduction of the risk of engagement in antisocial and criminal activities. Using the TPB model would promote the effectiveness of the health professionals in addressing the health needs of the offenders (Wang & Wang, 2015; Young, Wells, & Gudjonsson, 2011; Jalali, Shamsi, Roozbahani, & Kabir, 2014).
Health professionals and policymakers have made considerable efforts in the past few years to identify and address the needs of the offenders for the management of their health behaviour. The current policy focuses on systematic screening of offenders in juvenile prisons to identify their health needs and address them adequately. According to (Schubert & Mulvey, 2014), the approach has changed from judgmental to a more sympathetic and realistic view of the offenders as troubled young people who require guidance and professional assistance. However, according to (Bekaert, 2008) and (Seyal & Rahman, 2017), the approach used does not address the main issues affecting the young offenders, which explains the increased prevalence of juvenile delinquents. Anderson, Vostanis, and Spencer (2004), Carswell, Maughan, Davis, Davenport, and Goddard, (2004) and Schubert and Mulvey (2014) state that young offenders with behavioural health problems experience more troublesome life outcomes.
Despite the numerous measures implemented to meet the health needs of young offenders, the current policy and practice do not address the health needs of young offenders adequately (Directorate-General Justice, Freedom and Security, 2016; Chitsabesan & Bailey, 2006; Kinner et al., 2014). There is a need to improve the capacity of the health professionals of Bulgaria to equip them sufficiently with the ability to address the concerns and ensure the promotion and improvement of the health and well-being of young Bulgarian offenders. According to Campbell, Abbott, and Simpson (2014), the current practice makes it difficult for the juvenile delinquents to develop the trust of the staff thus making it even harder to open up and accept behavioural change. Campbell, Abbott, and Simpson (2014) and Underwood and Washington (2016) found that staff who show concern, respect, and empathy towards offenders with health behaviour problems are likely to manage the health behaviour change of their patients effectively. The application of the TPB model in the management of the health behaviour change of the young offenders will improve the acceptability of the services that health professionals offer to the offenders since it involves the integration of the values of respect, non-judgmental intervention, and empathy (Koh & Mackert, 2016; LaMorte, 2016). According to Carswell, Maughan, Davis, Davenport, and Goddard (2004), Hasking and Schofield (2015), Koh and Mackert (2016), young people are likely to accept help, seek advice, or avoid confrontation when they feel respected and if the professionals show genuine concern. Most importantly, the application of the TPB model allows the self-analysis of behaviours, possible effects, and the impact of change thus enabling the young offenders to seek behavioural change or modification (Wang & Wang, 2015; Athamneh, Essien, Sansgiry, & Abughosh, 2017; Ates, Eyuboglu, Ates, & Zerenay, 2017).
Health Behaviour Needs of Young Offenders in Bulgaria
Young people are at the stage of exploration and testing, and the attitudes and behaviours adopted during this time continue into adulthood. Healthcare providers who offer care for young people can influence their knowledge, behaviours, and attitudes by giving them accurate information (Vieira, Skilling, & Peterson-Badali, 2009). Young people also view health practitioners as credible sources of their health information. However, the providers do not engage the offenders adequately in discussing health behaviour change. Therefore, in most cases, their behavioural health problems are not adequately addressed (Kinner, Degenhardt, Coffey, Sawyer, Hearps, & Patton, 2014). Given the high levels of health behaviour needs among young offenders in Bulgaria, it is imperative for healthcare practitioners to conduct careful screening to improve their recognition of behavioural health needs. Moreover, for this need to be addressed, youth healthcare institutions will need to be adequately resourced and developed.
Young people aged between 10 and 20 make up about 15% of the population in Bulgaria along with other countries in Europe (Kinner et al., 2014). Young offenders are believed to be the most vulnerable group with complex behavioural health needs. Health outcomes in the later stages of life include mental health problems and drug and substance dependence. Some studies of young offenders have shown high rates of behavioural health problems and mental disorders. In Bulgaria, psychiatric disorders have been recognised in some cultural groups while drug and substance abuse have established the higher risk of co-occurring behavioural health problems (Madjarov, 2006). Studies of young offenders in Young Offenders Institutions determined that their lifestyle, health concerns, and social exclusions are different from the general population but comparable to homeless teenagers or those living under the care of Local Authority (Townsend et al., 2010). These findings show that young offenders seek behavioural health services in times of need. Most of the studies on juvenile offender’s behavioural health problems have in the past been based on psychiatric diagnosis to determine their level of need.
Substance Abuse among Young Offenders
Many studies have tried to examine substance use among juvenile delinquents. A large part of literature has helped to explain the prevalence of substance abuse among young offenders including their risk factors to help identify those more likely to continue substance use and to offend in adulthood (Eisner, 2002). The prevalence of substance abuse is higher in young offenders compared to the general population (Young, Dembo, & Henderson, 2007). The factors attributable to the early onset of drug and substance use and involvement in young offenders coincide significantly, and experiences of drug use and offending among young people may be two-way reinforcing. Other researchers have attempted to establish the association between early onset of drug and substance use and the possibility of continuing drug problems in adulthood (Young, Dembo, & Henderson, 2007). According to these authors, young offenders are at higher risk of developing drug problems in adulthood. Other researchers suggest that juvenile delinquents who have a history of persistent offending are more likely to engage in problematic drug and substance abuse than their peers (Young, Wells, & Gudjonsson, 2011).
Contact with young offending institutions provides a significant opportunity for early intervention with juvenile offenders with problematic substance use to prevent them from drug problems that might continue in their later lives and antisocial behaviour. Throughout this process, healthcare providers in contact with young offenders should demonstrate vigilance to the possibility of drug and substance use and be ready to intervene when necessary. For instance, those engaged in arrest referral centres should demonstrate vigilance as it is possible for young offenders to participate in drug use and should be ready to refer them on for assessment. Alternatively, the precautionary measures in addition to deferred cautioning scheme provide a significant opportunity to refer young offenders for assistance. The Bulgarian government has in place anti-drugs strategy that emphasises on action to ensure that offenders at severe risk of developing problematic drug use receive proper and targeted interventions (Madzharov, Karaganova, & Simeonova, 2008). This category is most characteristic of young offenders and appropriate drug intervention programs, therefore, need to be part of the action intended to help youth resist drugs to achieve their full potential in the society.
Drug and substance abuse among juvenile offenders is believed to contribute to inactive lifestyles. A sedentary lifestyle has been associated with anti-social behaviour among young delinquents. Through effective correctional facilities for juvenile offenders, the communities can be protected from anti-social and drug-related behaviours and enabling young people with problematic drug and substance use to overcome these problems and live healthily and never to offend. Many researchers believe that when examining the needs of juvenile offenders concerning drug and substance abuse, the interventions, and services developed for them should be separate and different from those developed for adults (Townsend et al., 2010). Most drug intervention programs support this view. The experience working with adult offenders is not the same as that of young offenders engaged in drug and substance use especially considering the complexities and variations of working within the young offender’s institutions.
Lack of Facilities for Young Offenders and their Current Status
Bulgaria has recorded the lowest youth crime rates in two decades, but still, hundreds of thousands of adolescents are detained every year in the country’s detention facilities. These facilities are meant to temporarily lock away youths who pose a high risk of re-offending or those who are likely to escape their trial (Vieira, Skilling, & Peterson-Badali, 2009). Despite the nation’s lowest rates of youth crimes in two decades, its use of detention facilities is steadily rising with the majority being young people who even do not pose the perceived high risk. Over 50% of juvenile offenders are detained for nonviolent crimes (Madzharov, Karaganova, & Simeonova, 2008). The current state of the facilities for juvenile delinquents exposes them to an environment that virtually resembles adult prisons than the kind of family and community-based interventions that has been proven to be most effective.
Detained young offenders who are awaiting trial or sometimes awaiting placement in a community-based program or another facility can spend some days or months in detention centres. In most cases, detained youths are socially and emotionally detached from families and societies who are most concerned with their recovery and success (Madzharov, Karaganova, & Simeonova, 2008). The current facilities for young offenders are overcrowded and understaffed creating an environment that promotes violence and the feeling of abandonment. Studies show that facilities for juvenile delinquents have a negative effect on their behavioural, mental health, education, and employment (Townsend et al., 2010). Psychologists have also found that the experience young people go through in detention facilities may increase the possibility of them to engage in criminal behaviour and re-offend thereby threatening the safety of the public.
Juvenile offenders at Higher Risk of Behavioural Health Problems in Bulgaria
The proportion of young offenders with health behaviour problems increases with age and are most prevalent in boys than girls. For instance, between the age of 10 and 15 years, about 14% of boys and 10% of girls have behavioural health problems (Huw Williams, Cordan, Mewse, Tonks, & Burgess, 2010). As they approach adolescence, the proportion rises but remains higher in boys than girls (Huw Williams, Cordan, Mewse, Tonks, & Burgess, 2010). Some researchers have associated behavioural health problems with some specific genes, but others have yet to confirm these findings. Studies also show that incidence of behavioural health problems for young offenders ranges from 20 to 80% and highest for those in custody. The prevalence of behavioural health problem has been reported to be almost three times greater for young offenders than the general population. The common problems for the population of juvenile delinquents are emotional disorders, concentration disorders as well as drug and substance abuse.
Application of TPB in the Face of Exclusion of Young Offenders
As the health professionals in Bulgaria focus on the application of the TPB model in managing the health behaviours of young offenders in the country, Popov (2016) and Jacomy-Vité (2011) cite a significant challenge of exclusion of the offenders. Juvenile delinquents in the country experience different types of exclusion. The biggest challenges facing healthcare professionals might be the inability of the offenders to seek behavioural change due to the normative beliefs. ridicule, discrimination, and exclusion of offenders from social interactions and participations make it difficult for the offenders to consider a change. However, according to Anderson, Vostanis, and Spencer (2004) and Kiriakidis (2008), guiding the offenders to see the necessity of change regarding the behavioural beliefs is essential for making the stride of change. The implementers must show offenders the benefits of change and include the normative beliefs in the process so that they understand what the society expects of them. Leading the offenders through the transition through guidance and empowerment programs is essential to firmly establish the confidence that the offenders require making the change.
In the discussion of the exclusion of offenders, Jacomy-Vité (2011) cites social marginalisation, school exclusion, low academic attainment, and dissociation from families as key concerns that influence the behaviour of offenders significantly. The author argues that the marginalisation of the group is affected by the low social and economic statuses of their families and poor livelihoods (Jacomy-Vité, 2011). While supporting Jacomy-Vité (2011), (Clement, 2012) argues that school exclusion of offenders and poor performance or dropping out of school contribute significantly to shaping their behaviours. Juvenile delinquents’ behaviours are viewed as disruptive resulting in their exclusion, which makes it difficult to perform or achieve their academic goals. The cases of exclusion and poor performance often lead to dropping out of school. Additionally, separation from their families contributes to the development of certain behaviours. The adoption and implementation of the TPB model should incorporate the challenges that offenders face and adopt measures that guide them to understanding the influence of certain behaviours on their lives and the society (Hasking & Schofield, 2015; Popov, 2016). The process would outline the importance of changing behaviour and developing socially acceptable behaviours.
Training health professional to address the health needs of the young offenders and their health behaviours is essential in the promotion of public health. The health professionals must have the capacity to identify the different health needs and adopt effective measures for the improvement of health and change of health behaviours. According to Jacomy-Vité (2011), addressing the concern of exclusion of the young offenders in Bulgaria is a major step towards the achievement of success in promoting the health and wellbeing of the group. Exclusion makes it difficult for the juvenile delinquents to access or receive quality care or benefit from health behaviour programs. The integration of the TPB model into the health care programs that target young offenders and their needs would improve the efficacy in providing healthcare for the needs (Forste, Clarke, & Bahr, 2011; Kiriakidis, 2008). However, training the health professionals to undertake the different roles within the scope of their practice is important. Training psychologists, social workers, health trainers and juvenile caseworkers are important since it equips the professionals with the necessary knowledge to handle and guide the offenders through behavioural change.
Behaviour Health Problems and Antisocial Behaviour in Young Offenders
Juvenile offenders often face complex problems in their lives such as social exclusion, deprivation, poor parenting, and drug and substance abuse. Most juvenile offenders experience chaotic lifestyles and tend to display impulsive behaviours (Young, Wells, & Gudjonsson, 2011). A study of behavioural health problems and antisocial behaviour among young offenders tend to focus on their disruptive behaviour. Some studies are keen to point out that behavioural health concerns do not necessarily lead to anti-social behaviour; rather it is young offenders who already have antisocial tendencies, which are more likely to adopt antisocial behaviours (Tremblay, Colley, Sanders, Healy, & Owen, 2010). Studies show that conduct disorders are the most common behavioural health problems in young offenders. These disorders are associated with persistent patterns of antisocial behaviour, and they are the most common reasons for young people being referred to Young Offenders’ Institutions (Tremblay, Colley, Sanders, Healy, & Owen, 2010).
Most
juvenile offenders who show antisocial behaviour make up a relatively complex
group about the social factors influencing their behavioural health and
subsequent outcomes. Psychologists have tried to extend the aspect of a
psychopath, which has previously been associated with adults to young people to
examine the association among their behavioural health problems and antisocial
behaviour (Mulvey et al., 2004). However, there are some controversies
regarding the full application of the concept to young people. That has been
because the psychopath is considered a biological trait, which is untreatable.
However, behavioural health problems and antisocial behaviours in juvenile
offenders can be treated using appropriate facilities and under vigilant
healthcare practitioners. Often, juvenile delinquents who have behavioural
health problems and antisocial behaviours develop these traits from their
social environments, and appropriate intervention programs can help fix these
problems and prevent the problems from developing in future (Townsend et al.,
2010).
This chapter discusses the methodology comprehensively, tackling parts such as the research philosophy, design, data collection and analysis, the limitation of the study, and research ethics. The study involved the training of 50 health professionals who were later administered with questionnaires to highlight or point out the importance of different options in applying the TPB model, the concerns therein, and other critical aspects as will be shown in the results section.
The choice of a suitable research philosophy influences researches significantly. According to Kuada (2012), the type of the research determines the selection of the philosophy, which then defines the strategies applicable. This research focuses on the application of the TPB model in managing health behaviour changes of young offenders in Bulgaria. Understanding the different ways of training health professionals on the application of the model in the management of the behaviours of the offenders requires a deeper analysis of the problems and the health challenges they face. Information regarding the psychological research was collected systematically and was concerned with a particular type of problem that needed the attention of the researcher (Cho, 2006). In this particular case, the onion process was employed to undertake the scientific research problem and to collect the information needed.
Figure 1 Onion Process (Handfield & Blackhurst, 2011)
The research mainly has two particular options in this case; interpretivism and positivism. These approaches are primarily utilised in combination where a researcher is utilising both the quantitative and qualitative methods.
In this particular research, the positivism approach was utilised because of the quantitative approach to the research. The application of the quantitative research method will ensure the integration of numerical data and the integration of other techniques such as the positivism approach allowing the effective analysis and discussion. According to Creswell (2014), the quantitative research method places focus on objective measurements and numerical, statistical, and mathematical analysis of the data collected, in this case through surveys/questionnaires. Further, as Check and Schutt (2011) assert, the method allows the generalisation of the data gathered across populations to explain phenomena and shed light on the issues under research. The objectivity aspect and the focus of the quantitative research approach in understanding the phenomena make it possible to integrate the positivist approach in the research effectively. Creswell (2014) states that the choice of the approach or philosophy in a research plays a major role in influencing its credibility and validity. The positivist paradigm in this research will play a major role in shaping the research by influencing an understanding of the data. Bazeley (2013) states that the positivist research approach emphasises gaining knowledge objectively using scientific techniques of enquiry. This study is a quantitative research and makes the application of the paradigm effective since it works better with the inclusion of experiments and surveys.
The integration of an efficient research design is critical for the development of a comprehensive and well-researched study. According to Bazeley (2013), the integration of an effective research design into the philosophy and the research strategy influences the process and contributes positively towards the development of the study. The research design covers the entire strategy used in the course of the study. The choice of the strategy of design is informed by the research problem and objectives. The researcher must choose techniques that work efficiently and coherently, building on each other to address the problem and the objectives of the study (Kuada, 2012). In the discussion of the application of the TPB model in understanding and addressing the health behaviour concerns facing young Bulgarian offenders and influencing the change of their behaviour, this research identifies the quantitative research method, uses surveys/questionnaires to collect data, and applies numerical data analysis to make sense of the data. The non-probability sampling technique was used to determine the participants (health professionals) within the healthcare setting (Creswell, 2014). The participants were trained and later given questionnaires with ten questions each with five options to highlight the options they found most important in relation to the questions.
The sampling technique applied allowed the identification of the fifty participants for the research. According to Khan (2012) and Rubin and Babbie (2011), using the non-probability sampling technique allows the choice of the most suitable persons for the research. Considering that the study of the health behaviours and problems facing young offenders is an issue that requires expert contribution and engagement, the application of the technique in this research allowed the involvement of professional workers including health trainers, psychologists, juvenile caseworkers, and social workers. The participants were identified through a partnership network in Bulgaria about the management of young offender’s health behaviour change and recruited via email. 50 health professionals were divided into two groups of 25, and each group were trained for three days for 3 hours per training session. However, one of the participants dropped out citing unavoidable circumstances and a need to deal with emergent personal commitments. The training integrated the Theory of Planned Behaviour in managing health behaviour change for young offenders in Bulgaria. All health professionals were from Bulgaria and included 20 health trainers, ten psychologists, ten social workers, and ten juvenile caseworkers. The participants were presented with questionnaires or survey questions to contribute towards the research.
The research approach was based on the onion process, and it includes two methods deductive and inductive approach. The inductive approach can be mainly noted as the approach in which the researcher has first to collect the data and then have to explore it to look into various issues (Creswell, 2014). Inductive approach is mainly known as the process of building the theories that also involves the establishment of various observation and general information regarding the study subject. On the other hand, the deductive approach works upon the hypothesis and provides results based on the collected hypothesis. On the other hand, the inductive methods work upon the research questions. In this particular research, the deductive approach has been utilised along with the qualitative studies. With the use of deductive approach, this particular study moved from a general perspective to the specific perspective (Creswell, 2014; Wickramasinghe, 2016). The deductive approach applied in the research blends effectively with the quantitative research method and positivist paradigm. The quantitative research generalises data to understand certain phenomena in the society. The integration of the deductive reasoning in applying the TPB will allow narrowing the generalised findings to specifics thus enabling the researcher to create clear arguments and recommendations.
The processes of collecting and analysing data play critical roles in defining the accuracy and precision of the findings. The effectiveness of the method of data collection relies greatly on the definitiveness of the sampling and the techniques of research administration (Creswell, 2014). The effective analysis of the data gathered paves the way for the discussion and development of impactful recommendations. The data collection is such a procedure in which a researcher has to decide that if both the primary and secondary methods of data collection should be utilised for the research or not. The integration arguments from different authors as secondary research play a major role in affirming creating precedence and discussing the data.
Applying effective data collection methods is necessary for the development of an elaborate research. Primary data is mainly collected by the researcher, that is his/her opinion and is supported by the experiment and surveys conducted from a sufficient sample population. The primary data collection methods are mainly questionnaires that are both open and closed-ended, interviews, and sampling. The methods utilised for this research were close-ended questionnaire (Bazeley, 2013). The close-ended questionnaires allow greater participation since participants do not have to take much time addressing the questions, giving their thoughts or opinions. The application of these kinds of issues in the survey allows the professionals to take minimal time in answering the questions thus encourages even those with tight schedules to participate. Check and Schutt (2011) argue that the application of close-ended questions in quantitative research is necessary since it allows the comparison of results, engagement of many participants, and careful measurement of the results.
The research integrates information from different journal databases such as Medline, PsycINFO, The Cochrane Library, EBSCOhost and others such as Google Scholar and Google Books. The inclusion of various arguments from the numerous sources used help in creating a comprehensive, articulate, and credible research.
Data analysis is a particular method that is utilised for the changing or modification of the research to attain a supposed outcome against particular research questions or research problems (Skipper & Hanna, 2009). These analyses are carried out through various quantitative and qualitative tools to elaborate the results effectively with validity and reliability. These tools also help the researcher to attain the desired outcome of the research (Christine, 2010). Data analysis is noted as the most significant part of the research from the researcher’s viewpoint (Romano, 2012). The researcher chooses the data analysis techniques depending on the techniques of data collection applied in the course of the study. For a study that applies the quantitative research method and data collection techniques such as surveys, the application of the numerical data analysis and content analysis are essential for delivering quality data and results analysis. This research will use the numerical data analysis method to interpret the data and discuss the results/findings.
The application of the Theory of Planned Behaviour in studying the behavioural changes and managing the behaviours of young offenders offers a critical challenge. The wide range of applicability of the TPB model makes it a useful approach to studying and managing the behaviours of the group. However, its limitations create a challenge in its implementation by health professionals thus questioning its ability to produce superior outcomes. Ates, Eyuboglu, Ates, and Zerenay (2017) and LaMorte (2016) point out the assumptions made by the TPB model as some of the limitations influencing its implementation. The assumption that people acquire opportunities and resources for successful behaviour change regardless of the intentions, and its inability to account for different variables that influence behavioural motivation/intention poses limitations in applying the model. Additionally, perceiving and taking behaviour as a product of linear decision-making portrays behaviour as incapable of changing over time. The consideration of the different limitations of the TPB model outlines the limitation of this research (LaMorte, 2016).
The conduction of this research followed the outlined research principles and ethics to avoid unethical conduct, infringement on the participant’s rights, disrespect or disregard of their dignity, and possible legal liability following misconduct. The researcher abides by ethical guidelines of research such as ensuring respect for intellectual property, giving credit for contributions of other persons involved who contributed directly towards the development of the study, citing materials used throughout the work, and informing willing participants the essence of the research (Datt & Datt, 2016). The participants were briefed on the research goals and availed with a choice of participation. No one who participated in the conduction of the research was compelled, coerced, or influenced/manipulated in any way to take part. Additionally, confidentiality and privacy are maintained throughout the research for participants who wish to remain anonymous. Further, according to Hoonaard and Hamilton (2016), ethical consideration in research allows the inclusion and production of factual knowledge and originality, the avoidance of error, the promotion of accountability, and the production of quality work. In the course of the production of this work, the research built on the social and moral values of social responsibility, public health, and human rights. Additionally, there was a need for the avoidance of error by avoiding the falsification, misrepresentation or fabrication of data (Datt & Datt, 2016). The integration of the different ethical consideration made it possible to develop research that upholds the general ethical principles and guidelines.
Training of the health professionals was used as one of the key methods of determining its effectiveness and applicability in the management of the health behaviours of young offenders in Bulgaria. This particular part of the research will provide the results of the questionnaire, which was conducted with 50 health professionals who were randomly chosen from a pool of health professionals. The 50 health professionals, were trained to manage health behaviours of young offenders about subjective wellbeing considering three components: positive emotion, lack of negative emotion and a general sense of satisfaction in life. The results of the questionnaire will be presented in the form of tables and graphs.
The effective choice of a method influences
the credibility, validity, accuracy, and dependability of research. This
research applies a research methodology that enables the conduction of a
well-thought and comprehensive research. The study applies an articulate
research philosophy and design, which allows efficiency in the collection of
data for inclusion in the research. The participants were administered with
questionnaires after training to evaluate the importance of different in
applying the TPB model. Moreover, the integration of the philosophies and
paradigms of research such as the elements of positivism enables the final data
gathering and analysis. Most importantly, the choice of the data analysis
techniques substantiates effectiveness in the process, translating to precision
and accuracy. The study acknowledges the various limitations posed by the
challenges of the TPB model and its implementation and the possibility of
erroneous information from some participants and works towards ensuring the
credibility of the research. Moreover, the researcher upholds ethical
guidelines and principles to ensure that it meets the academic requirements
while maintaining professionalism and aspects of diligence, credibility, and
validity.
After the training, the participants were presented with questionnaires that used the Likert Scale. Each questionnaire comprised of five options. The participants were required to tick the option they viewed as the most important to determine the most important experiences in the context of applying the TPB model. The frequency per every option was recorded and will be used to plot graphs to help elaborate the results. The Likert Scale was as follows: Value of “4” – Absolutely important, Value of “3” -Very Important, Value of “2”- Of Average, Importance, Value of “1” – Of little importance, Value of “0”- Not important at all.
Importance of Different Options in Managing Health Behaviour Change
1st research question with five options: 49 health professionals
| Question 1. How would you rate the importance of any of the options in managing health behaviour change for young offenders? | ||||
| Managing lifestyle changes that focus on substance and drugs misuse, alcohol, smoking and poor diet | Focusing on assessment and guidance of juvenile delinquents behaviour change | Addressing the challenges facing the delivery of behaviour change for your offenders | Reducing Health-related problems of young offenders | Allowing juvenile offenders actually to change their behaviour through correctional methods |
| Value of “4” – Absolutely important (28 respondents) | Value of “3” -Very Important (7 respondents) | Value of “2”- Of Average Importance (5 respondents) | Value of “1” – Of little importance (4) respondents) | Value of “0”- Not important at all (5) respondents |
When asked to rate the importance of certain options in the management of health behaviour change for young Bulgarian offenders, the professional participants offered responses whose application in this study will guide the development of the most effective recommendations. In the case of the importance of the management of lifestyle changes that focus on substance use and drug abuse, alcohol, smoking, and poor diet, a majority of the participants stated that they held the management option that focused on substance abuse, smoking, drugs use, and poor diet as of great importance. 28, 7, 5, 4, and 5 respondents respectively viewed the different options as absolutely important, very important, of average importance, of little importance, and of no importance in that order. In managing health behaviour change for young offenders, therefore, managing lifestyle changes that focus on substance and drugs misuse, alcohol, smoking and poor diet was viewed by the most respondents (28) as the most important approach. The graphical representation of the data shows the level of importance as perceived by the participants after the training. The representation of the data requires the grouping of the data as shown below. The graph appears as shown; representing the options of absolute importance to the last option which is not important at all.
A, B, C, D, and E represent the different questions as they appear in the table. The up/down bars ease the identification of the rating of each number as per the question and number of respondents.
2nd research question with five options: 50 health professionals
| Question 2. What skills and training would be useful for you in managing health behaviours of young offenders if any? | ||||
| Training based on behaviour lifestyle changes in the context of “subjective well-being and life satisfaction.” | Training based on social activities and social skills to guide young offenders | Training based on medical conditions of young offenders | Skills-based on preventing juvenile offenders from engaging in damaging health behaviours | Training based on repetitive intergenerational lifestyles factors of young offenders |
| Value of “4” – Absolutely important (40 respondents) | Value of “3” -Very Important (10 respondents) | Value of “2”- Of Average Importance (0 respondents) | Value of “1” – Of little importance (0 respondents) | Value of “0”- Not important at all (0 respondents) |
The participants responded to the second option about what specific skills and training would be useful for the management of health behaviours of young offenders. 40 of the 50 respondents stated that training health professionals based on the behaviour and lifestyle changes in the context of subjective well-being and life satisfaction is important for promoting health and influencing the behavioural change of young offenders in the country. The high number showed the option as absolutely important in managing health behaviour problems. When asked the usefulness of training based on social activities and skills to guide the offenders towards behavioural change, 10 of the respondents gave an affirmative, pointing it out as very important. The rest of the questions on skills, competencies and training were viewed as unimportant in influencing behavioural change following the integration of the TPB model into the management of young offenders’ behaviour change. The health/medical condition of the offenders, skills on the prevention of the offenders from engagement on damaging behaviours, and skills developed from training based on repetitive intergenerational lifestyles was seen as not necessary in the implementation of the TPB in managing the health behaviours of young offenders.
The following graph represents the results of the skills and training question and the level of importance for the different set of skills/training.
Assessment of the Health Behaviours of the Young Offenders
3rd research question with four options: 50 health professionals
| Question 3. How often do you think it is necessary to assess health behaviours of young offenders if at all? | ||||
| On quarterly basis through appointments with health professionals to assess readiness to change behaviour | On regular basis through effective consultations with young offenders | On monthly basis through hospital appointments with Doctors | On monthly basis through psychiatric appointments | On daily basis to examine lifestyle choices of young offenders |
| Value of “4” – Absolutely important (25) | Value of “3” -Very Important (10) | Value of “2”- Of Average Importance (8) | Value of “1” – Of little importance (4) | Value of “0”- Not important at all (3) |
The assessment of health behaviours of young offenders is a major issue of concern in the management of their health behaviour changes. People have different opinions on the effectiveness of the assessment of the behaviours of the users. The presentation of the various options concerning the evaluation of the health behaviours of the offenders to the professionals helped to highlight the most important aspects of the process. How to assess the offenders’ health behaviours was central to this question. 25 of the 50 health professionals agreed that it was necessary to evaluate the offenders often. They termed the quarterly basis through appointments with the health professionals as absolutely relevant for determining the health behaviours of the offenders. Additionally, 10 and eight respondents respectively stated that it was imperative and of average importance to assess the behaviours of the juvenile delinquents on a regular basis through effective consultations with the young offenders and on a monthly through hospital appointments with doctors respectively.
Moreover, there was a call by some professionals to initiate and implement programs that ensure monthly psychiatric assessment or a daily examination of the lifestyle choices of the young offenders. Four respondents gave the process of assessing the offenders monthly under the guidance of psychiatric assistance. This indicated little importance in connection with the implementation of the TPB model and the examining the focus on the management of changing behaviour goals. Additionally, three of the respondents found it necessary for the examination of the of the lifestyle choice of the young offenders every day. However, this only placed the issue of the consideration of lifestyles of the offenders at the value of 0 on the Likert Scale. The graphical representation of the information obtained on the matter of assessment appears as shown in the following chart.
4th research question with five options: 50 health professionals
| Question 4. What are your primary concerns regarding training required in managing health behaviours of young offenders if any? | ||||
| Access to psychological training wellbeing strategies to manage behaviour change | Training based on young offenders motivation and readiness for change | Training in guidance of behaviour change for young offenders | Training in the use of effective questions to raise awareness and provide supportive behaviour change | Training in active listening skills and how to build trust and rapport with young offenders |
| Value of “4” – Absolutely important (30) | Value of “3” -Very Important (10) | Value of “2”- Of Average Importance (8) | Value of “1” – Of little importance (2) | Value of “0”- Not important at all (0) |
The research sought to understand the concerns by requesting the professionals to respond to questions regarding their primary concerns during the training process. 30 of the respondents cited access to psychological training and wellbeing strategies in the management of behavioural change as a major concern thus showing its significant importance. The 30 placed the concern as absolutely important on the Likert Scale. Further, the survey sought to categorise the concern of training based on the young offender’s motivation and readiness for the behavioural health change. Ten of the health professional participants pointed the concern as primary regarding training for the management of health behaviours of young offenders. Additionally, other concerns included the training guidance of behavioural change for the offenders, training in the use of effective questions to raise awareness and provide supportive change, and training in active listening skills and how to build trust/rapport with the young offenders, which were supported by eight, two and zero respondents respectively. The three concerns were identified as of average, little or no importance at all in that order.
The following graphical representation of the primary concerns shows their importance and possible impact in training health professionals for preparedness to apply the TPB in managing the health behaviour changes of young offenders.
Addressing Health Inequalities via Improving Health Behaviours
5th research question with five options: 50 health professionals
| Question 5. How will improving health behaviours of juvenile delinquents address health inequalities if any? | ||||
| Lowering the frequency of risky behaviours such as smoking also, reducing vulnerability | Promoting positive experiences to mitigate adversity later on in life | Promoting participation of young offenders’ focus of early intervention and consequent prevention | Bridging the gap and helping to improve the overall well-being of young offenders | Increasing access to a better chance in life with credibility with peers |
| Value of “4” – Absolutely important (20) | Value of “3” -Very Important (10) | Value of “2”- Of Average Importance (10) | Value of “1” – Of little importance (5) | Value of “0”- Not important at all (5) |
The need for reducing the frequency of the risky behaviours such as smoking and drinking among others to lower their vulnerability was found to be of absolute importance. 20 of the 50 respondents stated pointed out that the move was significant giving it a score of four on the Scale. Promoting positive experiences was seen as very important ion the mitigation of adversity later on the offenders’ lives and, therefore, critical for alleviating inequality in health. 10 respondents gave it the 3rd score terming it very necessary. The same score was given to the influence of promoting participation of the offenders on early intervention and prevention by ten health professionals. Bridging the gap and focusing on the improvement of the overall wellbeing of the juvenile delinquents and increasing accessibility to a better chance with peers were viewed as of little importance and not important by five respondents each. The graph below depicts the information thus enhancing its understanding.
Significance of Training on Health Behaviour Change
6th research question with five options: 50 health professionals
| Question 6. What measure of significance has training on health behaviour change provided for you if any? | ||||
| To better understand the underlying predictors of behaviour with the aim of reducing this behaviour in offender populations | Interventions will be designed to match the abilities, strengths, learning style, and motivation for change for young offenders | Interventions will be more effective if attention is given to variables that can have an impact on learning | Offenders will gain more from an intervention focused on simple behavioural strategies rather than complex cognitive processes | Interventions can typically target inappropriate thoughts and inappropriate behaviours simultaneously |
| Value of “4” – Absolutely important (25) | Value of “3” -Very Important (15) | Value of “2”- Of Average Importance (7) | Value of “1” – Of little importance (3) | Value of “0”- Not important at all (0) |
The measure of the importance of the training is important to determine its possible impact in promoting the health and wellbeing of young offenders. Trained health professionals stand an elevated chance of effectively addressing the concerns of the young persons. Most of the professionals involved in the training program agreed that it was necessary for improving their capacity to address and help the juvenile offenders through their process of changing health behaviours. 25 of the health professionals decided that it was important to understand the underlying predictors better through training. Moreover, 15 identified training as critical in designing interventions to match the strengths, abilities, style and motivation for the change of the young offenders as very important scoring a three on the Likert Scale. Whe
n posed with the question, seven respondents (a score of 2) pointed out that the effectiveness of interventions increases when attention to the learning variables is prioritised. Moreover, three respondents stated that the offenders are likely to gain more from interventions that integrate simple behavioural strategy instead of complex cognitive process. The last aspect of the question received no response giving it a score of zero and making the inclusion of interventions in targeting inappropriate behaviours/thoughts unnecessary during training.
Challenges Facing Health Professionals
7th research question with five options: 50 health professional
| Question 7. How significant are the unique challenges faced by health professionals in managing health behaviours of young offenders if any? | ||||
| Lack of provision of training in managing health behaviours of young offenders | Juvenile delinquents have little or no knowledge about behavioural health issues | Juvenile offenders are both physically and mentally impaired and are not part of their management | Difficulty in understanding risk-taking behaviours and social influences that affect a young offender | Understanding resistance from juvenile offenders about managing health behaviour issues |
| Value of “4” – Absolutely important (32) | Value of “3” -Very Important (10) | Value of “2”- Of Average Importance (5) | Value of “1” – Of little importance (3) | Value of “0”- Not important at all (0) |
The challenges facing the health professionals in their delivery of services especially when dealing with young offenders influence the quality of the services and the process of managing their health behaviours. One of the options availed in the survey was the lack of provision of the training which received a score of four on the Likert Scale as a fundamental challenge that the professionals face. Additionally, the possession of little knowledge about health and behaviour, physical and mental impairment of the offenders, difficulties in undertaking risks, and understanding the resistance of the offenders were four unique challenges identified as a key through the survey. They received scores of three, five, three and zero respectively showing that they are significant, of average importance, little importance, and of no importance at all, in that order. The representation of the survey answers following the scores and the number of respondents per option appears as seen in the following graph.
Influence of Training on the Interventions
8th research question with five options: 50 health professionals
| Question 8. How vital will the training affect the designing of effective behaviour change interventions for young offenders if any? | ||||
| Training will increase the use of evidence of what works in designing and delivering services for young offenders | Training will provide early intervention approaches in improving risky behaviour outcomes for young offenders | The training will provide practical evidence about how interventions are implemented | Interventions can be delivered in the context of young offenders service system | Training will offer robust intervention on health behaviour outcomes |
| Value of “4” – Absolutely important (25) | Value of “3” -Very Important (15) | Value of “2”- Of Average Importance (8) | Value of “1” – Of little importance (2) | Value of “0”- Not important at all (0) |
The importance of the training sessions was put to question through a survey of the health professionals asking them its influence on designing effective behaviour change interventions. The application of evidence of the most efficient approaches requires training. 25 respondents found this remarkable, scoring a four on the Likert Scale. The training also enables early intervention as 15 respondents asserted, by terming training as very important in the process. Further, when asked whether training was vital to providing practical evidence about the implementation of interventions, 8 of the respondents affirmed the importance of the training for the achievement of the purpose. This number gave it a score of 2 on the Likert Scale. On whether the delivery of the interventions can happen in the context of the offender’s service system and whether the training offers robust intervention on health behaviour outcomes, two respondents affirmed the first question, but none of the participants found the latter important. The representation of the information about the importance of training in influencing the design of effective interventions for managing the health behaviours of young offenders is presented in the following graph. The number of respondents is matched against the score on the Likert Scale.
Understanding Health Behaviour Change through Training
9th Research Question with five options: 50 health professionals
| Question 9. How will the training contribute to your understanding of health behaviour change for young offenders if any? | ||||
| Enhance an understanding of the research and theory with an in-depth knowledge | Know what resources are available and the constraints and challenges that will be faced | Knowledge and skills that will be needed to deliver health behaviour intervention | Knowledge of functional and adaptable set of skills | Enhance an existing skills set |
| Value of “4” – Absolutely important (40) | Value of “3” -Very Important (5) | Value of “2”- Of Average Importance (4) | Value of “1” – Of little importance (1) | Value of “0”- Not important at all (0) |
The effectiveness of the training will influence the ability of the health professionals to perform their roles in managing the health behaviours of young Bulgarian offenders. The research focused on identifying the contribution the training will make towards the understanding of the professionals about the health behaviour change for the target population. The 50 participants were presented with different options to determine how training contributes to their understanding of the health behaviour changes and management. When asked whether the training contributed to the enhancement of their knowledge of the research and theory with in-depth knowledge, 40 of the 50 respondents affirmed, giving the option a score of 4 on the Likert Scale. According to five of the respondents, training contributes to understanding about the resources, constraints and challenges that face professionals in the promotion of behavioural health change of the offenders. Additionally, four and one respondents affirmed the position that training was essential for enhancing the knowledge and skills required for delivering the services and the knowledge of the functional and adaptable set of skills respectively. As to whether training enhanced existing skill set, the survey received zero response.
The following is a graphical representation of the frequency of response and the Likert Score for each option.
Sustaining Training on Health Behaviour Change
10th research question with five options: 50 health professionals
| Question 10. How important is it for you to maintain the training you receive in health behaviour change for young offenders? | ||||
| To keep up to date with my skills and knowledge | To maintain up to date with using evidence-based procedures wherever available | To stay up to date with demands for health behaviour change | Fostering a good working alliance with other health professionals | To sustain my interest and motivation |
| Value of “4” – Absolutely important (50) | Value of “3” -Very Important (0) | Value of “2”- Of Average Importance (0) | Value of “1” – Of little importance (0) | Value of “0”- Not important at all (0) |
After the training, the participants were presented with five options on how important is for them as health professionals to sustain the training they received in the management of health behaviours of young offenders. All the respondents pointed out that sustaining the training was important to keep up to date with their knowledge and skills. The first option, therefore, was said by the 50 respondents as absolutely outstanding while the other options of the survey received zero response.
This part focuses on offering a comprehensive discussion of the findings focusing mainly on the implications of the results in contributing to the development of new ideas and techniques in managing the health behaviours of young offenders. The findings were a response from the health professionals trained during the conduction of the research. The discussion offers insight on the topic by enabling a better understanding and paving the way for integration in the conclusion and recommendations part. The following elements integrate existing research with the findings of this research to outline the possible impact and contribution of the results in improving the effectiveness of the health professionals in addressing the needs of the Young Bulgarian offenders and the management of their health behaviours.
Importance of Different Options in Managing Health Behaviour Change
The findings of the research identify the direction of the lifestyle changes of the young offenders as essential in the process of managing the health behaviour change of the juvenile delinquents. The findings correspond to the arguments presented by Castellana, Barros, Serafim, and Busatto Filho (2014) and Ellwand (2016) that cite lifestyle changes as crucial in addressing the needs of young offenders with behavioural health problems and mental health issues such as addiction, substance abuse, alcoholism and alcohol use, and smoking. The management of the lifestyles of young offenders facing these matters is a major step towards the achievement of success in managing the health behaviours of the offenders. Eisenbarth, Osterheider, Nedopil, and Stadtland (2012) support the finding by stating that the success of a health professional in guiding a young person through lifestyle change including poor diet and sedentary lifestyles depends greatly on the effectiveness of the approaches adopted to manage their way of life. According to (Olver, Stockdale, & Wong, 2012), the adoption and implementation of the TPB model allow the efficient management of lifestyle change through the involvement or engagement of the young person in the process.
According to the findings of the research, other critical elements in the management of the health behaviours changes of juvenile offenders include the assessment of the guidance of the juvenile delinquents behaviour change, addressing the challenges that limit effectiveness in the delivery of the professional services, reducing health-related problems, and involving the offenders and facilitating self-change through correctional methods. These options received a low response from the health professionals but are equally important in contributing to the effectiveness of the overall health strategy for managing the change of health behaviours among the young offenders. Assessing and guiding juvenile delinquents through the process of change is necessary for the achievement of the positive outcomes (Wu & Chen, 2005; Ellwand, 2016; Castellana, Barros, Serafim, & Busatto Filho, 2014). While supporting the argument, Northey (1999) and Zlodre, Yiend, Burns, and Fazel (2016) posit that some of the offenders have experienced traumatic emotional experiences and require emotional and psychological support and guidance for meaningful behavioural change. Additionally, addressing the challenges that limit the delivery of professional services to the young offenders and the reduction of the health-related problems promotes efficacy in delivering the services thus improving the possibility of change. Most importantly, there is a need, according to Ellwand (2016), to help the young offenders to self-realisation of the importance of behavioural change. The TPB model focuses on the behavioural, normative, and control beliefs thus influencing attitudes, subjective norms, and perceptions leading to an understanding of intentions and actual behavioural change. The integration of the TPB model in addressing the health needs of young offenders and their behavioural change allows juvenile offenders to change.
Skills and Training for Managing the Health Behaviours of Young Offenders
Health professionals require a broad range of competencies to effectively deliver quality services in dealing with juvenile delinquents with behavioural health problems. Equipping the professionals with the necessary skills for managing the health behaviour change of the young offenders is crucial for success in the process. According to the research, the professionals admitted that training based on the behaviour lifestyle change of the offenders in the context of subjective well-being and life satisfaction was necessary. Biddle (2015) and Yazdani, Lloyd, and Ganvir (2011) support the finding by stating that the integration of health strategies that target the subjective well-being and life satisfaction of the young person would assist effectiveness in addressing the behavioural health problems. The health professionals, therefore, require sufficient training to ensure efficacy in meeting the needs of the young offenders for impactful health behaviour change. Most of the respondents found the training essential for successful delivery services. Training based on the social skills and activities is vital for equipping the health professionals with the necessary social skills to deal with the young offenders. According to Schubert and Mulvey (2014), most offenders depict antisocial behaviours that place them at crossroads with other members of the society. Developing the social skills required to address the social, psychological, and emotional problems depicted by the offenders would be important in enhancing effectiveness in the management of the health behaviours of the offenders.
The findings of the research show that training based on the medical conditions, for the prevention of the young offenders from engagement in damaging behaviours, and on intergenerational lifestyle factors that are repetitive are not important in the process of managing the health behaviours of the offenders. According to Schubert and Mulvey (2014), juvenile delinquents face diverse medical conditions that differ significantly from one to another. Training depending on the medical condition of one offender would limit the effectiveness of the health professional in dealing with the concerns of other delinquents. Additionally, Athamneh, Essien, Sansgiry, and Abughosh (2017) and Olver, Stockdale, and Wong (2012) question the effectiveness of forcing change on offenders terming it inefficient and unnecessary especially when dealing with young delinquents. This argument makes it unnecessary for health professionals to acquire skills for compelling the offenders to change or preventing them from certain damaging behaviours. Training should focus on equipping the health professionals with the most impactful skills for superior outcomes in the management of health behaviour change of the group.
Importance of Assessing Health Behaviours of Young Offenders
The assessment the health behaviours of the juvenile delinquents is critical in ensuring the effectiveness of the approach applied in the management process. The respondents termed the quarterly basis of assessment relevance in determining the influence of the method on the offender. Using this finding in the direction of the health behaviours of young offenders in Bulgaria will help health professionals achieve better outcomes about changing the health behaviours of the juvenile offenders. Regular and monthly assessments were viewed as of some level of importance in the management. In the improvement of the effectiveness of the approaches implemented by health professionals in Bulgaria, there is a need to emphasise that the experts consider the quarterly assessment of the offenders to assess their readiness for behavioural change. When dealing with young people with behavioural health problems, the professionals must focus on adequate assessment to ensure positive outcomes. Discouraging the continuous evaluation of the offenders is important to give them a chance to reflect. The integration of the findings into the management of the health behaviours of young offenders will attach effectiveness to the TPB model thus improving the quality of the services translating to positive behavioural change.
Primary Concerns in Training and Addressing Health Inequalities
The research found numerous concerns in the training process whose integration in the implementation of the TPB model and new approach to the management of the health behaviours of young offenders will be critical. Access to psychological training and wellbeing strategies for equipping the health professionals with the psychological capability to address the need of the offenders and influence their behavioural change was identified as a major primary concern (Yager, Waitzkin, Parker, & Duran, 2007). The consideration of the problem will be necessary for the development of an impactful approach. Additionally, training based on the offender’s motivation and readiness for change, in the guidance of behaviour change and training in the use of effective questions to raise awareness and facilitate supportive behaviour change were considered as primary concerns. Training the health professionals in Bulgaria will have to consider these concerns for the achievement of successful management of the health behaviours of the offenders. Lapidos, Christiansen, Rothschild, and Halstead (2002), Power (2000), and Schubert and Mulvey (2014) state the importance of outlining the challenges that the health professionals face and addressing them adequately to minimise their negative impact on the professionals’ delivery of healthcare services.
Addressing health inequalities is key to promoting public health and protecting the well-being of every citizen. Bulgaria records high rates of health inequalities that affect people from the low social class significantly. Young offenders are greatly affected by the inequality. The focus of the research on this area identifies that improving the health behaviours of the juvenile delinquents will minimise the health inequalities. Improving the health behaviours of the offenders improves their ability to seek and accept healthcare services. A majority of the respondents agreed that improving the health behaviours lowers the risks and frequency of repeat offences and minimises engagement in unhealthy behaviours. Additionally, it promotes positive outcomes and participation of the offenders thus demanding the application of more efficient health interventions. Pushing for better interventions results in the development of better health facilities for offenders thus minimising the inequalities. The implementation of the research will contribute significantly towards the improvement of the health facilities of juvenile prisons and community-based institutions for addressing the behavioural health problems affecting young people in Bulgaria (Campbell, Abbott, & Simpson, 2014; Directorate-General Justice, Freedom and Security, 2016; Kinner et al., 2014).
Training health professionals equip them with the necessary skills and competencies for addressing the health problems facing their patients thus ensuring the satisfaction of the needs and the achievement of better outcomes. In determining the measure of the significance of the training for the professionals in the management of health behaviour change for the offenders, the research found that it allowed a better understanding of the predictors of behaviours, which placed them in a better position to address the health problems. Professionals with the necessary training can address the young people’s health problems, including health behaviour change. Additionally, training informs the professionals and make them stand a better chance to develop and implement interventions that address the problems effectively (Marsh & Todd 3rd, 2015; Peter, 2013). Bulgaria requires interventions that match the young offenders’ problems and work effectively to influence health behaviour changes. Therefore, the implementation of the findings of the research will be critical in the quest for the management of the health problems and health behaviour changes.
By focusing on the challenges faced by health professionals and their significance in training and the management of health behaviours, the research outlined critical issues necessary for the creation of better juvenile health management programs in Bulgaria. Health professionals dealing with young offenders need to overcome the unique challenges they face for efficacy in addressing the health needs of young offenders. The health officials must invest in more sufficiently equipped training facilities and programs to ensure the professionals receive quality training. Additionally, by citing the insufficient understanding of behavioural health issues by the offenders considering the challenge that comes with dealing with offenders with mental health problems or physical disabilities, the research shows the need for Bulgarian health professionals to acquire special skills. Implementing programs that educate juvenile delinquents on behavioural health issues and providing health facilities that also consider young offenders with special needs is important. The findings will contribute significantly towards the improvement of the healthcare facilities and system manly on sectors that address health care problems among young offenders.
Role of Training in Influencing Interventions and Understanding of Health Behaviours
The training of health professionals in the course of the research played a major role in changing the knowledge of the health problems and the design of interventions for the management of health behaviours changes among young offenders. Almost all respondents showed the need for training and acknowledged its importance in enhancing their understanding of the health behaviour problems and change. Training health professionals in Bulgaria will equip them with this knowledge and ensure the achievement of superior outcomes when addressing health behaviour problems among young persons (Marsh & Todd 3rd, 2015). The process will also ensure that the professionals have a good understanding of the available resources and how to utilise them effectively to achieve the set objectives. The in-depth knowledge that professionals receive in the course of training is necessary for the promotion of the health of the offenders by helping them to deal with their emotional, psychological, and behavioural problems (Marsh & Todd 3rd, 2015; Short, 2013). Moreover, the training will equip the health professionals with a functional and adaptable set of skills for application in the course of delivering health services to their patients.
The influence of training on the design and implementation of interventions is undeniable. Training health professionals equip them with a deeper and better understanding of the problems thus placing them at an elevated ground for the development of effective interventions. According to the findings, training increases the use of evidence of what works thus enhancing competence and the capability of the professional to design interventions that promote efficiency in the delivery of services for the improvement of the health of the young offenders. Professionals acquire the skills that allow them to identify and address the health problems depicted by juvenile delinquents thus minimising the risk of repeat offences and improving behaviour outcomes. Marsh and Todd 3rd,( 2015) support the importance of training and cites its significance in the enhancement of the health providers’ capacity in addressing different health problems and meeting the needs of the patients. Integrating the findings of the research in Bulgaria will be critical for the improvement of the health and wellbeing of the offenders.
The importance of
maintaining training in the healthcare setting is unquestionable. Short (2013) and Marsh and Todd (2015) put forward that there is a dire need for
health professionals to acquire the necessary skills for the provision of care
and continually improve those skills to match the emerging needs and ensure
continued quality improvement. The research found that it was critical for
health professionals to sustain the skills acquired from the training for the
efficient delivery of care services. Adopting and implementing programs and
measures that keep the knowledge, training and skills of the professionals up
to date is essential if Bulgaria will adequately address the health behaviour
changes of the young offenders in the health care system (Marsh & Todd 3rd, 2015).
CONCLUSION AND RECOMMENDATIONS
Majority of the population in Bulgaria is made up of youth, especially adolescents. Most visits to hospitals by youth increase during adolescence. There is a great need for the creation of programs that encourage the young people to seek and accept healthcare services especially in connection to behavioural health problems such as addiction, smoking, alcoholism and substance abuse. Additionally, it is important to encourage the youth to consider professional help in light of mental health issues and behavioural problems to alleviate antisocial behaviours and engagement in criminal activity. However, the consideration of the diverse health needs of this group shows the need for the health professionals to possess the critical skills and training required to address the young people’s health needs adequately. Health needs in juvenile offenders differ depending on their gender, family breakdown, sexual orientation, education levels, and social class among others.
There is a steady increase in crime over the years most of which are committed by young people. This has also seen an increase in the number of juvenile offenders convicted or cautioned for some crimes, which include drug offences, violence and theft. Juvenile delinquents being between the age of 18 and 25 form a fraction of between 40-45% of the prison’s population. However, the increasing cases of antisocial behaviours by young persons and high cases of substance abuse, alcohol use, smoking, and addiction to drugs draw concern and demand immediate attention. The current policy and practice do not address the concerns efficiently and thus the need for efficient and impactful approaches that guarantee better outcomes when addressing the behavioural health changes among young offenders.
Young prisoners are seen as a vulnerable group that have numerous physical and psychological health needs. If their health needs are not met adequately, it leads to health problems including tobacco and substance dependence, sexually transmitted disease, mental health illness and early pregnancies in females. The study shows that health problems among young offenders are not different from vulnerable teenagers. The high rate of accidents, alcohol and substance abuse and hospital admissions are a concern that requires effective interventions. The application of the Theory of Planned Behaviour promises superior outcomes in the management of behavioural problems among young offenders in Bulgarian.
More than half of the young offenders in custody have diagnosable mental health problems. Suicide in detention and correctional facilities is high than in the population. At times mental health services are either not provided or are of poor quality. Various factors hurt young offender’s mental health. In the prison setting, prisoners experience forced communication and conflicts, which usually affects the inmates negatively. Most inmates experience isolation from the outside world and relatives because some are restricted in closed, isolated prisons with a high degree of security. Contact with outside world is limited to media such as television. Suggestions have been put forward to help develop support networks some of which include more prison leaves and visits by relatives. However, this research finds that the implementation of effective interventions including training health professionals to integrate the TPB model in addressing the health needs of the offenders within the juvenile correctional facilities and within communities are important approaches
Effective training of health professionals will be impactful in addressing the health needs of young offenders in Bulgaria and the management of the health behaviour changes. The implementation of the intervention in Bulgaria will create an effective ground for the management of the health behaviour changes of young offenders by equipping the professionals sufficiently for efficacy in the process. Training the health professionals will make it possible for them to point out risky behaviours that threaten the health of the young Bulgarians such as smoking, drug and substance abuse, alcoholism, and sedentary lifestyles. The application of the TPB model will make it possible to create interventions that contribute towards effective and superior outcomes. Professionals who guide the offenders to understand the behavioural, control and normative beliefs through the TPB approach ascertain success in targeting specific behaviours and dealing with them conclusively. The different beliefs influence attitudes and perceptions and thus influence behaviour significantly.
The creation of interventions that focus on the management of lifestyles, specifically targeting substance abuse, drugs and alcohol use, alcoholism, smoking, poor diet and sedentary lifestyles is important. The interventions will make it possible for health professionals to address the needs of the young offenders leading to positive behaviours that minimise their risk of antisocial behaviours and engagement in crime. However, training should be central in the healthcare setting to equip the professionals with the skills and capacity to create the interventions. The approach, therefore, should start with a comprehensive training. A collaborative training of professionals is recommended to bring insights from different perspectives to guide and equip the professionals with a wider view and capability to address the diverse health needs that the young people depict.
Training based on subjective well-being and life satisfaction are necessary for the achievement of better outcomes in managing the health behaviour changes in juvenile delinquents. Training the health professionals to focus on the subjective well-being of the young offenders will facilitate efficient management of their behaviours. The focus should be directed towards positive outcomes including the health and longevity of the juvenile delinquents. Training the professionals to focus on guiding the young offenders to achieve optimism and happiness, build meaningful social relationships, and improve their productivity should be prioritised.
The assessment of the juvenile offenders’ readiness and willingness to change in the course of managing their health behaviours and exposing the professionals to psychological training are necessary processes. The assessment determines the readiness of the offenders to change while psychological training enables the professionals to deal with offenders with different health concerns, including mental illness, physical disabilities, and other issues such as stubbornness and antisocial behaviours. Focusing on improving the health behaviours of the offenders, directly and indirectly, addresses the issue of health inequalities.
Adopting and implementing programs that ensure that the health professionals sustain their training are necessary strategies. The health professionals need to continuously improve their skills and knowledge through training and sustaining what is acquired in the process. Education programs, seminars, and workshops that train and sharpen the skills of the professionals are necessary. Moreover, giving the professionals platforms to practice and engage young offenders in particular through community-based and correctional facilities will ensure that the health professionals in Bulgaria maintain their skills and apply them for the benefit of the society
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