Presentation exploring the p-FFIT prison health programme

1. MRC/CSO Social and Public Health Sciences Unit, University of Glasgow.
The acceptability of a football-based healthy
lifestyle programme delivered to
inmates in two Scottish prisons
Matt Maycock, Cindy Gray*, Alice MacLean & Kate Hunt
MRC|CSO Social and Public Health Sciences Unit,
University of Glasgow
*Institute for Health and Wellbeing, University of Glasgow
8th Academic and Health Policy Conference
20th March 2015,
Boston

2. MRC/CSO Social and Public Health Sciences Unit, University of Glasgow.
Introduction
When delivered in a community setting (Scotland’s top
professional football clubs), the Football Fans in Training (FFIT)
programme attracted overweight and obese men and helped
them:
• Lose weight
• Improve their diet
• Become more active (Hunt et al 2014)
This presentation outlines our experience of testing the feasibility
of delivering an adapted version of FFIT to men in two secure
institutional settings in Scotland.

3. MRC/CSO Social and Public Health Sciences Unit, University of Glasgow.
Health in UK/Scottish prisons
• Men living within prisons experience many context-specific
challenges to their mental and physical well-being, often
compounded by lifetime disadvantage.
• The prevalence of overweight/obesity among male prisoners in the
UK is ‘unacceptably high’ (Herbert K et al (2012).
• Despite being given opportunities to eat healthily and take part in
PA, many prisoners choose not to do so (ibid).
• Prisoners in the UK are less likely to achieve recommended
minimum PA guidelines than non-incarcerated men (ibid).
• National recommendations suggest using prison settings to
promote PA, healthy eating and wellbeing (Scottish Prison Service
(2002))

4. MRC/CSO Social and Public Health Sciences Unit, University of Glasgow.
The p-FFIT Programme - Aims
Aim 1: To adapt FFIT for delivery to prisoners in a secure
institutions.
Aim 2: To assess the feasibility of collecting baseline, post-
programme, 6-month, 9-month and 12-month health-related
outcome data and process evaluation data from the
target population.
Aim 3: To assess the likelihood of a range of health benefits and
hence the outcomes and sample size for a future randomised
controlled trial.

5. MRC/CSO Social and Public Health Sciences Unit, University of Glasgow.
Prison A
State run, high
security, all male
Adult short & long
term prisoners
Three deliveries
completed, led by
prison gym staff
(PEIs) with local
football club
coaches at 2
sessions
Prison B
Privately run, high
security, all male
Adult short & long
term prisoners
Two deliveries
completed, led by
local football club
club coaches
supported by PEIs &
other prison staff
Prison
A
Phase 1
Phase 2
Phase 3
Prison
B
Phase 1
Phase 3

6. MRC/CSO Social and Public Health Sciences Unit, University of Glasgow.
Methods
Prison A (Phase two) Prison B (Phase one)
Delivered to 17 prisoners in total
by prison Physical Education
Instructors (PEIs)
Data collection
• Observations of 9 sessions
• Interviews with participants
who completed programme
(n=7)
• Interviews with participants
who did not complete (n=5)
• Informal conversations with
PEIs
Delivered to 17 prisoners by
community coaches from a
professional football club and
Physical Education Instructors
(PEIs)
Data collection
• Observations of 6 sessions
• Interviews with participants
who completed programme
(n=9)
• Interviews with PEIs and staff
(n=1)

7. MRC/CSO Social and Public Health Sciences Unit, University of Glasgow.
p-FFIT Results - Observations
• Generally speaking the fidelity [what was outlined in the delivery notes
being comprehensively delivered] of the sessions was high
• Towards the end of the programme fidelity declined noticeably
• There was a sense of the group supporting and encouraging one
another as the programme progressed
• PEIs and football club coaches were committed, enthusiastic and well
prepared
• Prison management seem engaged with and supportive of, the p-FFIT
programme

8. MRC/CSO Social and Public Health Sciences Unit, University of Glasgow.
Well I got a lot o’ knowledge and
understand aboot the portion
sizes an’ healthy eating an’ healthy
living… an’ good knowledge aboot
daein’ the steps an’ the cell
workoots an’ that. Gottae meet new
people (P2)
I benefited from losing weight, getting
fit, achieving something I probably
would never ever do outside. It’s all
helpful information. When I first
started, I couldn't get up those stairs
without having breathing problems. So
my level of fitness has increased quite
(P1)
Well I got a lot of knowledge and
understanding about the portion
sizes and healthy eating and healthy
living… and good knowledge about
doing the steps and the cell
workouts and that. I got to meet
new people (P2)
p-FFIT Results Participant Perspectives – Positive

9. MRC/CSO Social and Public Health Sciences Unit, University of Glasgow.
There is barriers in prison. The food
obviously number one, eh? But
you could ask the prison all day long
tae change it – they won’t change it.
Yeah, but very expensive. (P5)
You’ve got somebody else in the cell
with you. Mind you, the co-pilot I’m in
with now he does cell workouts, know
what I mean? Well, as I say, if you've
got money you can buy things off
the sundries like fruit and things, so
that's probably the biggest barrier for
people would be… Aye. That's probably
the biggest barrier for most people
would be motivation.It was for me
anyway. (P7)
There are barriers in prison. The
food is obviously number one. But
you could ask the prison all day long
to change it – they won’t change it.
Yeah, but very expensive. (P5)
p-FFIT Results Participant Perspectives - barriers

10. MRC/CSO Social and Public Health Sciences Unit, University of Glasgow.
p-FFIT Conclusions
This presentation has illustrated that:
• FFIT has the potential to be successfully adapted for secure settings
• The p-FFIT programme was successful in HELPING SOME men MAKE
positive lifestyle change with a secure setting, but there are important
barriers to making and sustaining change in this context.
• Delivering a gender and context sensitised health promotion intervention in
a secure setting has the potential to facilitate engagement with a cohort of
hard to reach and disadvantaged men
• There were issues of participant retention with p-FFIT that were more
significant within the prison context than in the community deliveries of
FFIT
• Further development work needs to be done on adapting FFIT for secure
settings

11. MRC/CSO Social and Public Health Sciences Unit, University of Glasgow.
Acknowledgments
Thanks to Participants, SPFL coaches, MRC/CSO SPHSU Survey Office, Sally
Wyke, Nanette Mutrie, Bill Mullen
Collaborators Alice MacLean, Cindy Gray, Kate Hunt
Programme Delivery Scottish Prison Service Physical Education Instructors,
Coaches from SPFL clubs
Programme Funding Scottish Prison Service, NHS Ayrshire and Arran
Research Funding This research was funded by CSO grant - CZH-4-886 and
Gender and Health Programme core funding

12. MRC/CSO Social and Public Health Sciences Unit, University of Glasgow.
matthew.maycock@glasgow.ac.uk
www.matthewmaycock.com
Thanks