Conditional funding

It was originally intended to use multiple service providers to deliver the intervention. This was not possible for the following reasons. We considered it likely that the delivery at scale of a manualised intervention by volunteers would need the stable base offered by formal training and monitoring by experienced volunteer co-ordinators. For this, it was essential to secure funding. The funding was secured from a national charity on condition that we would use the money to deliver the intervention through one or more of its local branches only; we were unable to use other organisations to deliver the intervention. We looked at the viability of recruiting other branches of the charity to deliver the intervention. Other branches did express an interest but were unable to provide the intervention to participants recruited in the urban centre where the study was ongoing. Each branch of the charity was restricted through its constitution to serve the needs of its (bounded) local population. No branch could provide volunteers to work outside its geographical area. The research team was not adequately resourced to work in other geographical areas, which, in participant recruitment terms, was unnecessary in a conurbation with an estimated population of over half a million people.

An overview of the funding made available by the national charity is provided in Table 3. Detailed breakdowns follow of the resource for (1) the service provider, the local branch of the national charity, to recruit, train and mentor volunteer befriending facilitators (Table 4) and (2) a specialist trainer in group facilitation to support the manualisation of the intervention, provide advice on assessing its fidelity and train the volunteer facilitators (Table 5).

TABLE 3

Overall cost specification for the research intervention

TABLE 4

Detailed breakdown of the service provider’s costs

TABLE 5

Detailed breakdown of group facilitation trainer’s costs

The contract with the service provider

Contractual negotiations with the service provider ran between 20 October 2011 and 14 June 2012 when the contract was signed. The service provider was contracted to:

1. Identify and recruit suitable volunteers for the role of volunteer/facilitator for the delivery of the PLINY research intervention, including carrying out Criminal Records Bureau (CRB) checks.
2. Ensure that volunteers are oriented to working with older people and willing to deliver telephone befriending, are trained to carry out one-to-one calls in line with the PLINY research intervention and are ready to receive training in telephone befriending facilitation (to be delivered by a third party) in the numbers and by the dates shown in Table 6.
3. Ensure that volunteers take responsibility for scheduling and (subject to participant adherence) delivery of up to six one-to-one and 12 group telephone sessions for each person recruited to the PLINY research study and randomised to the TF group.
4. Ensure that there are sufficient volunteers to provide cover in the event of volunteer facilitator absence or discontinuation.
5. Provide ongoing ‘mentoring’ to volunteers, in line with the service provider’s policies and procedures and the PLINY research intervention, to ensure a point of contact and support.
6. Provide regular (at least monthly) updates to the research team on levels of volunteer recruitment and retention and feed back information, including the one-to-one and group call registers, to inform the research.
7. Alert the research team at the earliest opportunity if a participant wishes to withdraw or is unable to participate in the intervention (TF groups), with reasons recorded (if provided by the participant).

TABLE 6

Contract-specified deliverables for the service provider

Item (3), the delegation of first contact and scheduling of calls, might not be considered best practice for sustaining a volunteer befriending service. For instance, a Delphi survey of volunteer co-ordinators managing befriending services found general agreement that they should be managed either by a full-time or a part-time project co-ordinator.²⁵ The volunteer co-ordinators also agreed that it was essential to have a monitoring system in place (p. 51).²⁴ We were unable to broker such an arrangement within the available finances.

Marketing

Activity by the service provider to promote the volunteer opportunity included its website (news archive, 25 September 2012; accessed 10 May 2013), the Northern Community Assembly website (field note, 21 November 2012), the local Wellbeing Consortium (field note, 20 November 2012), a local newspaper and a range of community and voluntary networks and organisations available in the locality, which we have not named to preserve the anonymity of the service provider (field note, 14 June 2012; TMG, 15 November 2013). The service provider reported that potential volunteers referred to them by other agencies (e.g. Jobcentre Plus) were often not suitable for the facilitator role (TMG, 19 September 2012).

Suggestions for additional strategies to promote the volunteer role in the locality were made by the study team (e.g. TMG, 15 November 2013).

Training

Training sessions for the group intervention required a minimum of four volunteers for the training group to be feasible. The service provider identified an initial group of six volunteers early in the project (TMG, 20 February 2012) and scheduled one-to-one training for them in March 2012. The charity reported a number of implementation issues including matching the availability of volunteers to training dates (TMG, 20 February 2012). They also found that retaining volunteers between recruitment and training was difficult and required more resources than anticipated (TMG, 20 August 2012). It should be noted that the first group of volunteers (n = 4 in two groups) received induction and one-to-one calls training from the service provider in March 2012, 2 months before the scheduled start of participant recruitment. In fact, participant recruitment did not commence until June 2012, 1 month late, because of delays in contracting. A lower than anticipated response to the initial recruitment strategy (direct mail out to participants of a population cohort) meant a further delay before the research team had recruited and randomised the six intervention-arm participants needed for a group. According to the service provider, this delay caused the attrition of several existing volunteers (see Figure 1). At a time when the rate of participant recruitment was starting to increase, the service provider advised the study team that it was not actively recruiting volunteers (TMG, 19 September 2012) because there was an insufficient number of randomised participants. Instead, the service provider was waiting for candidate volunteers to approach them in response to advertisements.

Once the research team had managed to increase the rate of participant recruitment through general practice mail-outs, the service provider experienced repeated difficulties identifying volunteers to fill facilitator training groups. As a result, the first two training sessions (May 2012) contained only two genuine volunteers; to make the training viable, the service provider’s staff and members of the study team – who did not intend to deliver the intervention – made up the places to make the training viable. A finite training budget meant that running sessions with insufficient numbers of genuine volunteers was not sustainable. As a result, we agreed that the four (ideally five) places on training sessions scheduled for some time in the future had to be filled by a certain date – the ‘book by’ date – or they would be cancelled. ‘Book by’ dates were arranged with the group facilitator trainer to assist the service provider as it reported (TMG, 14 June 2012) practical difficulties in co-ordinating volunteers at the times and pace required by (1) the trial, which had a window of 1 year to recruit 248 participants to test the effectiveness of a public health intervention, which had to be rolled out at scale, and (2) the group training (four 1-hour telephone sessions on different days). The service provider did not always confirm whether sufficient volunteers had been identified by the ‘book by’ date despite reminders from the trainer/study manager (e-mail and telephone, 16 November 2012).

The total number of volunteers group trained between 17 May 2012 and 22 October 2012 was 11, instead of the 20 who should have been trained. Two trained volunteers were not available to take on a group; one was on a student placement with the service provider and needed to return to full-time education and one was available for only 1 day per week, having assumed that they could make befriending calls in the evening. Three training sessions (during which 15 more volunteers should have been trained) were cancelled between August 2012 and January 2013 because of a lack of take-up. Three volunteers facilitated four groups (n = 24) to completion between September 2012 and May 2013 (with up to 6 weeks one-to-one befriending beforehand). One group received one-to-one befriending from a fourth volunteer facilitator who dropped out before the group stage. An existing volunteer took over for the group calls stage (see Monitoring volunteers). The number of days that volunteers ‘survived’ in the project (from completing group training to the day that they dropped out) ranged from 12 to 118 (mean 62 days).

Monitoring volunteers

Feedback from volunteers was collected by the service provider and reported to the TMG and, when relevant, to other volunteers delivering the service. The study team also captured implantation issues during set-up and recruitment in field notes.

The service provider was responsible for providing ongoing ‘mentoring’ to volunteers, in line with its existing policies and procedures relating to volunteers and the intervention protocol, to ensure a point of contact and support for the volunteers whilst they were delivering the TF service. The charity provided a summary of the project in its induction pack together with copies of the one-to-one training manual (field notes, 20 March 2012, 15 June 2012, 9 October 2012). Volunteers often contacted the study team with enquiries about what to do in certain circumstances, for instance if participants missed calls and the facilitator had been only able to contact one (of six) participants in the first week (field note, 30 October 2012), they were going on holiday (field note, 17 September 2012) or if they experienced technical difficulties with audio recording calls (field note, 29 September 12) (see also Boundaries between research and service delivery). The reasons why volunteers contacted the study team rather than the service provider are considered in Boundaries between research and service delivery and Chapter 5 (see Results of the volunteer interviews).

Volunteers reported difficulties in contacting participants to arrange the initial and subsequent one-to-one telephone calls (see Chapter 5, Results of the volunteer interviews). Volunteers reported that it would be better to make calls in the early evening and that some participants had also reported this. however, to safeguard participants using the service the provider did not permit volunteers to make calls before 0900 or after 1700 from Monday to Friday. This resulted in one volunteer dropping out (see Figure 1).

In reviewing volunteer identification and recruitment (field note, 5 December 2012), the service provider identified three issues that it felt were impacting on the recruitment and retention of volunteers: (1) existing volunteers found it difficult to contact participants for the one-to-one calls as they were ‘socially active’, resulting in the volunteers being reluctant to take on another group; (2) there was a time delay between volunteers being trained and actually delivering the service; and (3) there was a lack of introductions by the service provider between the volunteers and the ‘participants’. The service provider decided that volunteers would introduce themselves to study participants at the first contact (one-to-one call) and be responsible for scheduling one-to-one and group calls (field note, 22 March 2012). One of the volunteer co-ordinators stated that, for their face-to-face visiting service, volunteers often want to be introduced to clients by the service provider staff and felt that this may have contributed to the difficulty in recruiting or retaining volunteers (field note, 2 January 2012).

One volunteer (out of 10) who completed all training dropped out during intervention delivery (between completion of the one-to-one calls and the start of the group calls) because of ill-health. Attempts by the service provider to contact two trained volunteers failed and, because of the already limited pool of volunteers, the only facilitators available were those already running a friendship group. The service provider reported contacting participants of the group to let them know and asked the existing volunteers (n = 2) if they would be willing to take on the group (field note, 5 December 2012). One volunteer agreed but did not run the groups concurrently, which resulted in a delay in the group calls starting. Some participants were difficult to contact (field note, 14 February 2012) and at least one member of the group was not contacted (see Chapter 5, Results of volunteer interviews).

In accordance with the intervention design, the service provider asked volunteer facilitators to discuss with participants in their groups whether they would like to volunteer to run their own group when they had finished their own involvement, thereby contributing to the notion of older people helping other older people. Feedback on responses was not provided.

Boundaries between research and service delivery

Boundaries between the research and the service being investigated were blurred in some instances. Participants called the study team to advise that they would miss the week’s call; volunteers called the study team directly if they were unsure about what to do (see Monitoring volunteers). For instance, one volunteer enquired about what information participants had received about ‘how it all works’ (field note, 26 September 2012). Another enquired about how the group could exchange contact details so that members could meet up (field note, 25 March 2013). The service provider also referred volunteers to the study team for information, for example one volunteer enquired about the Christmas period (VF03, female, field note, 3 December 2012) and one volunteer (not interviewed, female) contacted the team because she lacked confidence in making the calls via the Community Network system (field note, 2 November 2013). Additional training was provided to this volunteer by the study team (field note, 8 November 2012).