Meaningful Involvement Research Articles

BIOETHICS AND PATIENT INVOLVEMENT IN MEDICAL DECISION-MAKING: CHALLENGES AND ETHICAL IMPLICATIONS IN CLINICAL PRACTICE

Background Patient involvement in medical decision-making has become an integral element in contemporary healthcare, affirming the rights and autonomy of patients in their care processes. This review presents an in-depth study concerning the issue of patient involvement in medical decision-making from a bioethical perspective, as well as exploring the challenges and ethical implications that arise in clinical practice. Methods A literature review method is used in this study, encompassing various literary sources that detail bioethical principles such as patient autonomy, justice, beneficence, and non-maleficence in the context of medical decision-making. Additionally, this study seeks a profound understanding of how clinical practices and health policies influence patient involvement and present specific ethical challenges. Result The findings of this literature review highlight the crucial role of bioethics in shaping more ethical practices in medical decision-making and identify key issues that need attention, such as inequality in access and information, value conflicts between patients and healthcare providers, and the need to focus on the best interests of the patient. Conclusion By understanding these ethical challenges and implications, we can better develop guidelines and policies that support meaningful and ethical patient involvement in clinical practice. Thus, this research contributes to the development of healthcare that respects bioethical values as well as the rights and needs of patients.

Meaningful community engagement and involvement in global health and research: 'Changing mindsets with a million conversations' in Sierra Leone.

Meaningful community engagement and involvement in global health and research: 'Changing mindsets with a million conversations' in Sierra Leone.

Involvement of Lay Assessors in the Inspection and Regulation of Public Services: A Systematic Review

Public services have increasingly sought to use lay assessors (often known as “experts by experience”) as members of inspection teams in health, social care, and education settings. This involvement has been credited as giving more influence to users over how services ought to run. Yet, little is known about the process or outcome of engaging with lay assessors. We conducted a systematic review to understand the benefits and challenges of involving lay assessors in the inspection of public services. Following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines, we searched the literature in English using five bibliographic databases with the date of publication limited to 2000 onward. Across 27 eligible studies, results suggest that including diverse views and perspectives is a strength, yet little consideration is given to issues of “representativeness” of lay assessors or the power differentials within mixed groups that can shape which perspectives gain dominance. Despite a frequent rehearsal of the many benefits of involving lay assessors in inspections as a potential force to drive up the quality of inspections and inspected services, the impact of including lay assessors in inspections in terms of improving services was hard to determine. When designing training for lay assessors, services needed to carefully consider the tension between maintaining the assessor’s “naive eye” versus becoming “professionalised.” It was also apparent that expectations are often not clearly shared over how lay perspectives could be included in final inspection reports, thus risking disengagement. Involving lay assessors is still a fairly novel, yet rich and meaningful way to improve services, yet a lack of clear expectations, and typical exclusion of lay assessors in setting standards for regulation, can still act as barriers to meaningful involvement, preventing lay views from being heard and acted upon.

Integrating Framing Approaches as a Tool for Managing Complex Transitioning to Renewable Energy (TRE) Projects: The Yatir Wind Farm Case Study

Transitioning to renewable energy is an urgent global goal. Wind energy is a promising renewable source with contentious obstacles. Using the Yatir Wind Farm project in Israel as a case study, we explore the potential of framing in identifying and mitigating obstacles in a wind farm project. The cognitive and strategic frames employed by stakeholders were elicited through 18 semi-structured interviews and more than 100 documents. This analysis highlights three conflicting issues: potential or perceived harm to neighboring residents, protecting birds and bats, and adapting to changing regulations throughout the process. Regarding residents’ opposition to feared harm from the project, initial cautious curiosity was followed by distrust and deep disappointment due to a lack of transparency and a sense of abandonment facing perceived existential threats to their health and homes. This led residents to conduct legal battles, which resulted in their claims being rejected. It also led to the breakdown of relationships among neighbors opposing and promoting the wind farms. In the case of bird and bat protection, stakeholders initially framed concerns emotionally until the dialogue shifted to scientific discourse, resulting in the successful refinement of mutually agreed upon regulatory guidelines. The structural appeal mechanisms effectively addressed evolving regulations, overcoming the lack of mutual understanding and resulting in the adoption of the majority of the new regulatory requirements. The analysis underscores the importance of understanding stakeholders’ frames for effectively working through the complex and transdisciplinary nature of sustainability transitions and achieving successful outcomes. It also reveals the need for formal mechanisms to validate stakeholder needs and integrate them into decision-making processes. Recommendations include early and meaningful public involvement, process improvement for stakeholder engagement, and enhanced transparency in decision-making processes.

Predictors of Parental Home Involvement in Low-Income Families in Tanzania

Understanding factors influencing parents' involvement in education activities is essential in tailoring strategies to encourage and maximize their participation. This study assessed predictors of parental home involvement in low-income families in four regions of Northern Tanzania. The questionnaires assessed 1176 parents of grade two children from 55 primary schools invited to teacher-parent meetings. The hierarchical multiple regression analyses showed that parents' perception of general school invitation, specific teacher invitation, specific child invitation, parents' knowledge and skills, parents' level of education, and marriage conditions were the strongest predictors of parental home involvement. However, parents' past school experience (valence) did not predict their present involvement at home. This study underscores the pivotal role of teachers and schools in instigating and fostering parental involvement at home. Teachers can create a collaborative learning environment beyond the classroom by implementing activities designed to arouse parents' interest and stimulate their desire to participate actively in their children's learning. The study recommends the interconnectedness of the educational ecosystem, where the efforts of schools and teachers serve as catalysts for meaningful parental involvement at home.

How to Keep Balance between Interaction and Automation? Toward User Overall Positive Experience of IoT-Based Smart Home Design

Advances in Internet of Things (IoT) technologies have had a profound impact on the experiential tasks of the smart home, particularly automated tasks supported by sensors, embedded systems, and communication devices that are capable of autonomously performing a range of tasks previously performed by humans. However, the improvement in the level of smart home automation has not necessarily promoted more meaningful, relaxing, and positive experiences for users. This is largely due to the fact that it often overlooks the meaningful involvement of humans in the process. This paper proposes a conceptual design model for a smart home through two studies that aim to maintain the benefits of automation while ensuring positive experiences with user engagement tasks. Study 1 involved qualitative data using semi-structured interviews to understand what tasks lead to positive user experiences (P-UX) during the use of the smart home and what kind of factors influence these positive experiences. Study 2, using an online questionnaire, quantitatively investigated the varying impact of these factors on positive experiences in both automation and human–machine interactions. The results of both studies show that there are nine factors that influence positive user experience in the smart home, with instrumentality, convenience, and flexibility playing an important role in the positive experience of automation, aesthetics, immersion, association, and memory, having a greater effect on the positive experience of user engagement in interactions, and customization and emotion contributing to both paradigms. In future smart home design, this model will help designers rationally allocate tasks between automation and human–machine interaction as a way to enhance the overall positive user experience.

Patient engagement in designing and publishing research in prostate cancer: a scoping review.

Patients with cancer have the unique ability of being able to offer valuable insights into how cancer therapeutics may impact the overall patient experience and improve clinical outcomes. Patient engagement could therefore contribute to tailoring treatment strategies and research design according to patient needs. This study evaluated patient engagement in prostate cancer research by identifying patient input in the prostate cancer literature. We performed a keyword cluster analysis of articles from multiple databases and congresses in which patients provided input on disease management or were involved in study design, manuscript authorship or presentation of results (patient voice). In total, 112 studies were included. Patients were involved in the design of 11studies and were credited as authors in four studies. This review suggests a lack of meaningful patient involvement in prostate cancer research and publications.

People of the sun: Local resistance and solar energy (in)justice in southern Portugal

This paper explores a public controversy surrounding a large solar power plant planned for the village of Cercal, in Alentejo, southern Portugal, mobilizing energy justice literature to shed light on the contradictions and injustices (re)produced by hegemonic energy transitions. Drawing on qualitative data from interviews, fieldwork and document analysis, this controversy is unpacked through three main tenets of energy justice: distributional, procedural and recognition, contributing to current research on solar energy justice.Our empirical findings indicate that the local population and environmental movements are concerned that Cercal might become a “green sacrifice zone” for the sake of the hegemonic energy transition. Procedural injustices were of particular concern, with interviewees claiming that the public consultation process failed to involve the local community, indicating that the State and corporate actors do not recognize residents as legitimate stakeholders, disregarding protest and active discord as legitimate forms of political participation.This original case study, unfolding in a country currently experiencing a significant lithium mining controversy, is a flagship example of how top-down and corporate energy transitions are major drivers of energy injustices, enforcing green grabbing and the enactment of green sacrifice zones under the aegis of carbon reductionism. In order to address these contradictions, a radical shift in the socioeconomic and political dynamics underlying the hegemonic energy transition is urgently needed, alongside the meaningful involvement of local communities in decision-making processes directly affecting their territories and livelihoods.

Families’ moral distress when supporting military Veteran and public safety personnel mental health: Conceptual model

LAY SUMMARY Families offer vital mental health and well-being support to Veterans and public safety personnel. This study offers a model of how families can experience moral distress from service cultures that exclude them, leaving families stuck, exacerbating a sense of moral distress resulting from perceived organizational betrayal felt in the context of families’ help-seeking experiences. The model was informed by in-depth interviews conducted in Australia with 25 family members with experience seeking help and providing support to a family member who is a Veteran or public safety personnel. The interviews provided a detailed description of how embedded and aligned families were to a member’s service role, and their profound sense of betrayal and distress when attempts to support family members’ mental health were thwarted. Families may experience moral distress from identifying the problem and potential support solutions, but having nowhere to go to realize those supports for their family member. The implications for Veteran and public safety organizations as well as health professionals to promote more meaningful involvement of families is discussed.

THE CHILD’S RIGHT TO BE HEARD IN CIVIL PROCEEDINGS

Caring for the welfare of children is a continuous and ongoing process, the foundation of which is a legally sound system. Child-friendly proceedings are designed to ensure the meaningful involvement of children in the decision-making process, which, of course, is manifested in the proper realization of the child’s right to be heard. A child’s right to be heard in civil proceedings is a crucial aspect of child-centred justice, recognizing children as active participants in decision-making. The article studies the evolution of the child’s right to be heard in the international legal system, thus examining international conventions such as the United Nations Convention on the Rights of the Child and regional documents that recognize the children’s right to participate in decision-making processes related to them. The article analyzes the legal framework applicable in different jurisdictions, including challenges and best practices in exercising the right. In addition, the article discusses the importance of the child’s participation in civil proceedings, emphasizing its impact on the child’s development and well-being and, on the other hand, on the quality of court decisions. The article discusses the relationship between the child’s right to be heard and the standard of protection of the best interests. It emphasizes the need for a multidisciplinary approach when dealing with cases related to children. The article reviews the practical challenges and opportunities related to this issue and circumstances limiting the right, such as age and maturity. The legal ways necessary for better realization of the child’s right to be heard are proposed in the form of recommendations in the article.

Beyond community engagement: perspectives on the meaningful involvement of people with HIV and affected communities (MIPA) in HIV cure research in The Netherlands

Background Meaningful involvement of people with HIV and affected communities in HIV cure research is essential to ensuring that cure research efforts are conducted transparently, socially justly, and ethically. This study set out to investigate how people with HIV and affected communities are involved in cure research in the Netherlands and explore what can be done to optimize involvement and engagement. Methods Eighty-five semi-structured online, telephone, and face-to-face interviews were conducted with people with HIV (N = 30), key populations (N = 35), and key informants (KI; N = 20) in the field of HIV. The interviews were analyzed using reflexive thematic analysis. Results Awareness of the meaningful involvement of people with HIV (MIPA) efforts was low among people with HIV and key populations, which contrasted with KI, who exhibited greater awareness. People with HIV and KI emphasized the importance of MIPA in ensuring the representation of lived experiences in HIV cure research and fostering trust between communities and researchers. Practical implementations of MIPA were unclear, ultimately resulting in difficulties defining MIPA beyond clinical trial participation. People with HIV and key populations also doubted their skills and self-efficacy to make meaningful contributions when confronted with involvement beyond participating in research and clinical trials. Conclusions MIPA is crucial for improving the quality, transparency, and ethical conduct of HIV cure research. It emphasizes the need for increased awareness and funding, standardized guidelines to ensure meaningful involvement, and combat tokenism and misconceptions.

Development of a Health Impact Assessment Implementation Model: Enhancing Intersectoral Approaches in Tackling Health Inequalities- A Mixed Methods Study Protocol

Public health research presents compelling evidence that health is socially determined. To address structural inequalities and inequities in health, public policies require intersectoral development and implementation. Health Impact Assessment (HIA) is an established approach for analysing potentially detrimental health impacts of policies, programmes, and projects, as well as potentially positive impacts and opportunities. National public health policy, Healthy Ireland (2013–2025), endorses an intersectoral whole-of-system approach to ensure that health is a central part of all relevant policy areas. HIA is endorsed in this policy as one way to drive this agenda. Synergising with this policy commitment for HIA, the all-island Institute of Public Health Ireland produced revised HIA guidance in 2021. Two HIAs will be carried out as part of this project, including one at a local policy level, addressing the Cork City Development Plan (2022–2028), and the second HIA at a national policy level, addressing the Irish Government’s Climate Action Plan (2024). The updated HIA guidance will be used in the conduct of these HIAs. This research project involves a co-creation of a Health Impact Assessment Implementation Model by employing an action research approach with implementation science frameworks to the conduct of the two HIAs. Therefore, the process of doing the HIAs will form the basis for the research study. In order to enhance meaningful community involvement in HIA in Ireland, the project will co-create a Community Engagement Toolkit for HIA. This Model will strengthen researcher, policy actor, practitioner, community, and voluntary sector capacity to collaboratively develop and implement intersectoral and equitable policy responses to major population health issues.

It takes it out of the textbook: Benefits of and barriers to expert by experience involvement in pre-registration mental health nursing education.

Nurse academics teaching mental health nursing have generally favourable views about the importance of expert by experience involvement. Nurse academics experience significant barriers in supporting the implementation of academic positions for experts by experience, particularly in obtaining funding. The experts by experience could contribute to mental health nursing education does not appear to be clearly understood by nurse academics. WHAT ARE THE IMPLICATIONS FOR PRACTICE?: Mental health services aspire to adopt a recovery-oriented approach to practice. Involving experts by experience in mental health nursing education can facilitate increased understanding and appreciation of recovery-oriented practice. Nurse academics could play an important role in supporting the implementation of experts by experience positions in nursing academia. To do so, they require an understanding of the benefits of EBE involvement in academia and the barriers that can be encountered when attempting to facilitate the implementation of such positions. Experts by experience contribute unique expertise, essential to the development of quality mental health services. Conveying this expertise through the educating the future nursing workforce in mental health is essential. INTRODUCTION: Involving service users in mental health nursing education is ad hoc and minimal, despite growing evidence of its benefits. Insights and experiences of nurse academics teaching mental health to pre-registration students have been underrepresented in the research to date. To seek insights and experiences of nurse academics involved in designing and delivering pre-registration mental health nursing education in Australian universities regarding involving service users in mental health nursing education. A descriptive qualitative study involving 19 nurse academics from 13 Australian universities, involved in pre-registration mental health nursing education. Data were analysed thematically. Participants reported minimal service user involvement. Most sought an increase and identified barriers. Data analysis resulted in five identified themes: (1) value-rich, (2) resource-poor, (3) imperfect processes, (4) 'part, but not all' and (5) unrecognised worth. Increasing meaningful involvement of service-users in mental health nursing education requires support and investment from multiple stakeholders. Nurse academics are crucial stakeholders in understanding the unique expertise service users bring. Service users being central to all aspects of mental health services requires their active participation in the education of health professionals. Nurse academics have an important role in realising this goal.

Advancing HIV cure research in low- and middle-income countries requires empowerment of the next generation of scientists

While low- and middle-income countries (LMICs), especially in Southern and Eastern Africa, bear the largest burden of the HIV globally, investigators working on the front lines in these regions are leading a limited number of research efforts, particularly related to HIV cure. Conducting HIV cure research in high-burden HIV LIMCs provides an unparalleled opportunity to formulate innovative research strategies, design trials tailored to the local context, evaluate clinical outcomes within key and vulnerable populations, meaningful involvement of stakeholders, and to shape policies in areas where HIV prevention and cure interventions can yield the most significant impact. Further, the high prevalence of infection, with varied HIV strains affecting large diverse populations, creates a unique environment for studies that would not be feasible in any other part of the world. This underscores the critical importance of addressing obstacles to unlock the full potential of research efforts in these regions. In this viewpoint, we identify significant challenges facing early career investigators in LMICs, particularly in Africa, that hinder their full engagement in HIV cure research. Drawing examples from the International AIDS Society's Research-for-Cure Academy, we provide practical recommendations to overcome barriers that include limited access to funding, effective mentors, educational and career development opportunities, coupled with inadequate investment in infrastructure that contribute towards the limited number of investigators from high-burden HIV LIMCs who are spearheading cutting-edge cure research. Addressing these challenges is crucial to empower investigators who possess unique insights and expertise, and who are well positioned to lead HIV cure-related research efforts. We acknowledge and welcome initiatives that promote capacity building and knowledge exchange between early-career investigators in LMICs and their peers and scientific leaders from high-income countries (HICs). Prioritizing investment in global collaboration and partnership will play a pivotal role in empowering the next generation of African scientists and clinicians. To expedite advancements of cure-related strategies that will be effective in high-burden HIV LMICs, we endorse the sustainable expansion of these pivotal initiatives in these regions, to enhance their effectiveness and hasten progress in the pursuit of a global HIV cure.

Family Involvement Training for Staff and Family Caregivers: Case Report on Program Design and Mixed Methods Evaluation.

The COVID-19 pandemic underscored the imperative for meaningful family involvement in long-term care, aligning with policy and safety standards while enhancing outcomes for caregivers, residents, and staff. The objectives of this article are as follows: (1) a case study report on implementing a family involvement intervention designed to facilitate the formal and safe engagement of family caregivers in resident care and (2) the pilot evaluation of the intervention. We used Knapp's six-step implementation science model to guide and describe intervention development to provide insight for others planning family involvement projects. We employed sequential mixed methods, including surveys with quantitative and qualitative questions before and after program implementation for providers, and surveys and interviews with family caregivers a year after. We used the Mann-Whitney U test (p < 0.05) to assess differences in health providers' perceptions pre- and post-education. Families and staff perceived that the Family Involvement Program was important for improving the quality of care, residents' quality of life and family/staff relationships. Providers' perceptions of the program's positive impact on residents' quality of life (p = 0.020) and quality of care (p = 0.010), along with their satisfaction with working relationships with families (p = 0.039), improved significantly after the program. Qualitative data confirmed improvements in family-staff relationships. In conclusion, we documented the design of this family involvement initiative to encourage family caregivers and staff to work together in residents' care. Youville's Family Involvement Program gives families and family caregivers an explicit role as partners in long-term care. The mixed methods pilot evaluation documented improvements in staff and family relationships.

The Influence Of Communication And Organizational Climate On The Participation Of Parents In The Provision Of Education Kinderfield Elementary School In Indonesia

This research explores the impact of communication and organizational climate on parental engagement within Kinderfield Elementary School's educational provision in Indonesia. The study aims to investigate how effective communication between school stakeholders and a positive organizational environment influence parents' active participation in their children's education. By examining this relationship, we seek to provide valuable insights for enhancing collaborative efforts among all parties involved in fostering student success. Our findings will contribute to the existing body of knowledge regarding factors that promote meaningful involvement from parents in Indonesian schools.

What motivates public collaborators to become and stay involved in health research?

BackgroundPeople with lived experience of health and illness are increasingly being involved in research. Knowing what creates interest in becoming involved in health research may help identify appropriate ways of facilitating meaningful involvement. The study aimed to investigate why people became public collaborators in health research and what helped sustain their commitment to staying involved.MethodsSemistructured individual qualitative interviews were conducted with 11 Norwegian public collaborators recruited from patient organisations. To enhance the quality and relevance of this study, three public collaborators were involved in framing the study and in the data analysis. One of them is a coauthor of this paper. The interviews were analysed through reflexive thematic analysis, and two themes were generated.ResultsThe first theme, ‘research as a vehicle to impact’ showed how interest in becoming involved in research was founded on the possibility of impacting healthcare through research. Other inspiring factors were how they appraised the relevance of the research, in addition to the public collaborators’ own sense of moral duty to advocate for research related to their own as well as others, illnesses or diseases. The second theme, ‘‘Acknowledgement and accessibility’, framed how the participants perceived appreciation of experiential knowledge as crucial for maintaining motivation in their role as public collaborators. Other promoters of sustained involvement presented were training for both public collaborators and researchers, adequate allowance as a means for visualising and valuing PPI, and accessible language.ConclusionsThis study contributes to the understanding of how to facilitate meaningful and sustainable PPI, which requires a safe space for collaboration and attention to accessibility. Facilitating meaningful involvement may, in turn, increase the potential impact and sustainability of PPI.

Ethical challenges for children undergoing surgery: Evaluation of graduate nursing students' learning

Background&#x0D; Multiple barriers can impede the holistic care of children and their meaningful involvement in their healthcare in the context of surgery. These include lack of clinician knowledge of the ethical concerns impacting children and scarce educational resources. Our team created an open-access training module (https://childsxethics.net) to enhance clinicians’ understanding of ethical challenges for children undergoing surgery. Objective&#x0D; To evaluate the level of Bloom’s Taxonomy cognitive, affective, and psychomotor learning reached by graduate nursing students after completing the module. Methods&#x0D; A qualitative descriptive study was conducted. Data sources comprised of participants’ course assignments. Data were analysed inductively and deductively using Bloom’s Taxonomy and the Childhood Ethics Framework. Results&#x0D; Nineteen participants wrote online reflections and peer responses. Two subgroups completed group assignments. The module and associated class assignments successfully promoted high levels of cognitive and affective learning of ethical challenges impacting children undergoing surgery. The type of assignment influenced participants’ level of learning and achievement of learning objectives. Cognitive and affective learning processes were enhanced when integrating reflections and fostering dialogue/interaction among peer learners. Implications&#x0D; Study findings will be used to improve the module. Future iterations will include collaborations with international clinicians to enhance the global relevance of the module contents, which will be evaluated with other clinicians/trainees. Providing educational resources for clinicians on ethical challenges in children’s surgery will help facilitate the recognition of children as active moral agents and improve their surgical experiences by promoting holistic patient care.

An umbrella review of reviews on challenges to meaningful adolescent involvement in health research.

Less than 1% of studies on child and adolescent health report the involvement of adolescents in health research. This is attributed to barriers experienced by researchers and adolescents in the engagement process. To address this under-involvement of adolescents, we first need a better understanding of the factors that hinder adolescent involvement in health research. We conducted an umbrella review of reviews to consolidate the review-level evidence on the barriers to meaningful involvement of adolescents in health research. We preregistered this umbrella review of reviews with PROSPERO (CRD42021287467). We searched 11 databases; Google Scholar; and PROSPERO; supplemented by a hand search of the reference lists of eligible reviews, relevant journals, websites of 472 organisations, and input from experts. This resulted in the inclusion of 99 review articles exploring adolescent involvement in studies on adolescent physical or mental health, which were narratively synthesised. Adolescent coresearchers were engaged at all stages of the review. We found that adolescent involvement in health research is impeded by several challenges experienced by researchers and adolescents. Some challenges experienced by researchers were organisational issues which included limited resources, gatekeeping and paying adolescents. Some barriers were related to a lack of preparedness among researchers and included a lack of awareness of adolescent involvement, the need for training and guidance, and negative attitudes towards participatory research. There were also barriers around how adolescents can be involved, such as researchers finding it challenging to adapt to new methods, issues with recruitment and retention of adolescents, inclusiveness and accessibility. There were also challenges specific to adolescents, such as adolescents' skills and expertise, training, motivations and study goals. Finally, barriers related to the ethical involvement of adolescents included issues with power dynamics, confidentiality, safety and protection of adolescents. Some of the barriers reported by adolescents included tokenistic involvement, inaccessibility of adolescent involvement, and their competing demands. Researchers may find this review useful in understanding and planning for potential challenges of involving adolescents in research. Despite many identified barriers to adolescent engagement, few mitigation strategies were identified to address these barriers. There is a clear need to establish best practices for meaningful adolescent involvement in health research. Adolescents were involved at multiple stages of this umbrella review of reviews. They reviewed the protocol, screened 25% of the articles at title and abstract screening stage, screened 10% of full-text articles, and worked on data analysis. They also helped plan and conduct a participatory workshop with an adolescent advisory group to discuss the challenges experienced by adolescents in health research.

The parole dossier and its negative impacts on prisoner identity

This article suggests that the parole dossier may be working to damage prisoners’ sense of their identity through the creation of a carceral script which describes a person whom they do not recognise as themselves, and which leads to an increased narrative labour. Prisoners struggle, therefore, under that labour to form a post offence identity with which to navigate a complex process such as parole. As identity, and its repair, appear instrumental to desistance, elements of the process, such as the dossier, could be putting hopes of rehabilitation at risk. Using the analysis of 15 prisoner interviews, this article explores a parole process described as undermining agency. A process where risk assessment is perceived poorly and where ultimately the experience can lead to negative impacts on an already fragile self-identity. In conclusion, this article attempts to offer some solutions, to mitigate the negative effects, with a view to maximising the potential impact of the dossier process on future desistance, through the more meaningful involvement of the prisoner at its centre.