Abstract
In response to the increasing numbers of individuals accessing online child sexual exploitation material, Circles UK developed Circles ReBoot, a strength-based programme aimed to support attendees to pursue an offence-free lifestyle. This feasibility study of Circles ReBoot, which was based on the RE-AIM principles, highlighted positive outcomes across all domains, with the strongest evidence for Reach and Adoption. Effectiveness and Implementation were achieved and generated specific suggestions for further development. Maintenance was limited due to the timeframe of this study but showed promise. A common suggestion was the need for unstructured elements in the programme. The evaluation also highlighted different views on the integration and/or focus of the participants’ offending behaviour. Findings from this feasibility study informed a set of recommendations to the intervention provider and are discussed here with regards to evaluation research in forensic settings.
Introduction
Circles of Support and Accountability are targeted at individuals with convictions for a sexual offence and who are considered at risk of engaging in further sexual offending behavior. A Circle consists of a group of Volunteers (of four to six people) from a local community who support the individual (Core Member) in developing a positive and non-offending lifestyle and reintegrating safely into the community. Each Circle is coordinated by a regional Coordinator and supported through partnership with police, probation services, and other agencies. Empirical studies have shown the effectiveness of Circles to reduce risk-relevant factors and increase protective attributes for Core Members (Bates et al, 2014; Kitson-Boyce, 2018; Wilson et al., 2009).
Offending trends have highlighted the significant increase of online sex offending behavior, predominantly possession, distribution, and production of Child Sexual Exploitation Material (CSEM; Internet Watch Foundation [IWF], 2022). Previous research has shown that individuals with a CSEM offending history are less likely than those with contact offences to have previous convictions (Eke et al., 2018), and display fewer antisocial traits and greater victim empathy (Babchishin et al., 2015).
Research generally suggests that CSEM offenders cannot be treated like moderate or high-risk contact sex offenders. Research indicates that most CSEM users do not commit offline sexual offences against children (Houtepen et al., 2014), that interventions and treatments designed for contact sexual offending can be counterproductive or ineffective for CSEM users (Hanson & Yates, 2013; Mews et al., 2017), and they appear more likely to respond better to lower treatment dosage (Babchishin et al., 2018). Research further suggests the risk of (detected) CSEM recidivism is low, with a recent meta-analysis reporting a 5.5% recidivism rate within a 5-year reference. For men with exclusive CSEM-related sex offences, sexual recidivism rates were 3.9% on average; 4.8% relating to CSEM reoffending behavior and 1.4% relating to a contact sex offence (Helmus, 2023). As a result, individuals convicted of CSEM are more likely to be managed in the community (Beech et al., 2008).
CSEM users have been found to have specific criminogenic needs, which can be targeted to reduce risk of reoffending. These criminogenic needs include poor sexual self-regulation, relationship difficulties, loneliness, low self-esteem, issues around mental health (i.e., depression and anxiety), and substance abuse (Babchishin et al., 2015; Christensen & Tsagaris, 2020; Seto et al., 2012).
In addition, individuals managed in the community experience changes to their social circumstances, such as limited / lack of access to their own children and changes to their employment, living situation, and/or social support groups. Reoffending risk presents an interaction between factors located within the individual (i.e., motivation and sense of agency) and those located in the environment. LeBel et al. (2008), on a sample of property offenders post-release, identified that the subjective state of the individual appears to drive the direct (i.e., desistance behavior) and indirect effects (e.g., finding employment) required for successful reintegration. However, as Healy and O’Donnell’s (2008) highlighted, initial aspirations post-release are often focused on the individual’s immediate circumstances and basic needs; they postulated that achieving these immediate goals may support a developing a sense of agency, which may then lead to more altruistic goal setting.
In response to the identified criminogenic needs of CSEM users, the evidence base surrounding community interventions for individuals who have committed sexual offences (Clarke et al., 2015; Duwe, 2018), and the increased likelihood of an individual with a CSEM offending history receiving a noncustodial sentence (Beech et al., 2008) and the related considerations of developing a sense of direction and agency to support community reintegration, Circles UK developed Circles ReBoot, a Circle format targeted specifically at individuals with a history of CSEM offending behavior.
Rationale, Structure, and Content of Circles ReBoot
In line with the Risk Need Responsivity principles (Bonta & Andrews, 2007) and based on a strength-based desistance approach (e.g., Marshall & Marshall, 2012), Circles ReBoot is (a) shorter than a “traditional” Circle (i.e., 12 sessions over a 6-month period) and (b) offers a more structured format for the sessions, focused on building strengths, achieving goals, and fostering skills development. This is delivered through Keys for Change, which involves the Core Member following an iteration of identifying, achieving, maintaining, and developing goals. The final session is used to reflect on and conclude the Circle and to formulate a long-term plan, identifying external support networks and inner strengths for future use. As with a “traditional” Circle, Circles ReBoot is formed of a Core Member, supported by Volunteers, and overseen by a Coordinator whose role it is to recruit the Core Member, work with the Volunteers, and liaise with key agencies.
Current Study
The first stage of the Circles ReBoot roll-out consisted of an initial pilot, aimed to answer the following questions: (a) Can the programme attract referrals and be delivered? (b) To what extent does Circles ReBoot deliver its stated goals? (c) What factors (personal, interpersonal, systemic, and situational) are associated with success? These questions formed the basis of a feasibility design.
Feasibility studies are a useful tool to assess how well an intervention has done, whether the intervention should continue, and if so, how, and if any changes are necessary (National Institute for Health and Research, 2021). Generally, they are used to evaluate the adequacy of current methods and procedures (Polit & Beck, 2017) and increase the likelihood that the intervention will be successful (Van Teijingen & Hundley, 2001).
The RE-AIM model (Glasgow et al., 1999; Kessler et al., 2013) is a widely used feasibility framework, to test the quality, pace, and impact of interventions in health professions. Typically used in studies which focus on changing individual behaviors (King et al., 2010), RE-AIM has been used in the planning and evaluation of health-related practices in various clinical and community programs, such as chronic pain management (Ball et al., 2020), physical activity interventions (Bopp et al., 2007), and positive psychology interventions (Hone et al., 2015), with some application in forensic populations (Merdian, Perkins, Dustagheer, et al., 2020). RE-AIM consists of a systematic exploration of five key areas of intervention: (a) Reach, (b) Effectiveness, (c) Adoption, (d) Implementation, and (e) Maintenance (a full breakdown of these terms is described in Results).
Whilst widely utilized across different sectors, there are limitations relating to the administration and/or reporting of the RE-AIM framework. These include inconsistencies in the reporting of the dimensions (Effectiveness and Implementation are most widely reported; Gaglio et al., 2013), a lack of qualitative contributions (Holtrop et al., 2018), and difficulties in applying the framework in non-research settings (Ory et al., 2015). However, its practicality and applicability in real-world settings, with its focus on population impact, feasibility, and acceptability, has been identified as a key tenet of the RE-AIM framework (Kwan et al., 2019). The current study therefore employed the RE-AIM framework to assess the feasibility of Circles ReBoot, including an initial outcome evaluation, to inform future developments and the efficacy and sustainability of the programme. Further, this study was designed to overcome some of the limitations identified in evaluations of the RE-AIM framework, including the consideration of all RE-AIM domains, consideration of qualitative contributions, and exploring delivery of the intervention in a practice setting.
Method
Recruitment and Sample Size
Overall, 12 ReBoot Circles were offered as part of the pilot roll-out, including one that dropped out due to logistical and practical issues on the part of the provider. Across the remaining 11 Circles, there were 11 Core Members (CMs), 40 Volunteers (Vs), and 7 Coordinators (COs).
The inclusion criteria for CMs, as defined by Circles UK, were: men aged 18 years or above, with a conviction for possessing indecent images of children, and an assessed capacity to participate in the Circles ReBoot programme, which requires a moderate level of use of English. Exclusion criteria were: convictions for contact sexual, or violent, offending, significant current mental disorder or significant current substance misuse, or a currently chaotic lifestyle that would by incompatible with consistent participation. Final inclusion was dependent on the CO’s assessment.
The V inclusion criteria were: men or women aged 18 years or above, selected through the Circles UK volunteer recruitment process (standard recruitment, vetting and attendance at 16hrs core Circle training). This pool of general Circles Vs was offered the opportunity to be trained for and deliver Circles ReBoot. They attended a 4–5 hr online training event delivered by local COs. There was an expectation that at least one Circle member had previously delivered a Circle.
RE-AIM Evaluation Plan
Based on the RE-AIM framework, for each domain, a key question and associated assessment queries were formulated and mapped against the data sources (see Table 1).
Circles ReBoot Evaluation Plan: Data Sources and Key Findings.
Note. CM = Core Member; CO = Coordinator; V = Volunteer; MFM = Monthly Forum Meeting minutes; MAML: Assessment “My Assessment, My Life”
Data Sources and Materials
The evaluation considered three different types of data sources:
- the CSEM Pathways Tool (CPT; Merdian, Perkins, McCashin, et al., 2020), completed prior to the start of Circles ReBoot with the CO of their Circle. The CPT enables a systematic exploration of aetiological elements in an individual’s offending pathway, based on offence-related vulnerabilities, offending environment, permission-giving thoughts, sexual arousal, personal situation, evaluation of consequences for the individual, and protective factors. - Meeting Minutes. Meeting minutes were available from the sessions of each Circle and from the Monthly Forum Meetings between COs and Circles UK leadership. Minutes were available from 11 out of 11 Circles (100%), although the degree of completeness varied. In total, there were 137 records of meeting minutes. On average, there were 12.45 meeting minutes per Circle, ranging from 11 to 17. The average length of a Circle meeting was 63.58 min, ranging from 60 to 120 min. - Worksheets: Three assessment worksheets, completed as part of Circles ReBoot, were included in this evaluation: ◦ Exploring Strengths (Session 2). CMs were asked to identify their strengths from a given list (e.g., curiosity, resilience) and/or identify additional strengths. ◦ Goal Setting Form (Session 3). CMs were asked to identify a goal, identify the next steps and what they will do to the next session to achieve this. ◦ My Assessment, My Life (MAML; Sessions 4 and 12). MAML was designed by to get a sense of the needs of the CM and if change can be observed at the end of Circles ReBoot. MAML assesses seven domains (28 items): (1) Practical (e.g., “My finances are in control”), (2) Setting goals (e.g., “I deal with daily problems well”), (3) Relationships (e.g., “I get on with other people”), (4) Wellbeing (e.g., “I feel positive about myself”), (5) Purpose (e.g., “I have enough variety in my daily life”), (6) Change (e.g., “My regular habits are healthy ones”), and (7) Resilience (e.g., “I can cope with obstacles”). The first domain (Practical) is rated on a 4 point Likert scale, “Not at all” (0), “Partially” (1), “Mostly” (2), and “Completely” (3). All other domains are rated on a 5 point Likert scale, “None of the time” (0), “Rarely” (1), “Most of the time” (2), “Often” (3), and “All of the time” (4).
Method of Analysis
Quantitative data was analyzed descriptively (specific method of analysis for each data source is presented in the description of findings) while qualitative data was analyzed in two ways. Meeting minutes were screened for negative events, implementation obstacles, and untoward incidents. Interviews were transcribed and anonymized, and analyzed using Coding Reliability, a form of positivist Thematic Analysis (Braun & Clarke, 2019; Guest, 2012; Stemler, 2001) where resulting themes are understood to be content categories derived from the pre-set interview questions. A set of initial codes was defined by the second author, which provided the initial coding framework. Using this framework, a selection of interviews was independently coded by the first author; any discrepancies were discussed, and the coding framework was updated accordingly. Reliability of the updated coding framework was tested based on a second selection of interviews, and subsequently applied to the whole sample. The resulting codes were summarized into themes; theme names, theme description, and relevant quotes were defined by consensus between the first and second author, and each theme was written up. In the final step of the analysis, the third author independently reviewed these summaries. No further changes were implemented at this stage.
Project Registration and Ethical Approval
This project was fully reviewed by the Ethics Committee of Royal Holloway University of London.
Results
The findings are set out according to the RE-AIM framework; a summarized version of key findings is included in the Evaluation Plan (Table 1).
Reach
Reach in the RE-AIM framework is concerned with who is likely to benefit from the programme, and how the target population can be best reached. Typically, Reach also looks to ascertain whether the participants are representative of the target population (King et al., 2010). Overall, the current study showed Reach as achieved. Sufficient and suitable participants were identified through the referral process. CMs were able to identify personal strengths; the top six current strengths identified were: kindness, honestly, humor, open-mindedness, empathy, and being detail-oriented; strengths aligned with the Circle ethos as part of developing a more satisfying and offence-free life.
There was only one referral drop-out, which was potentially indicative of a lack of engagement by the potential CM. COs consequently added that stability in a person’s life should be considered as an additional suitability criterion. According to COs, police and probation staff appeared enthusiastic about Circles ReBoot despite some indications of possible referral reluctance due to the perceived low risks of potential candidates and the potentially restrictive specificity of the referral criteria.
Effectiveness
Effectiveness in the RE-AIM framework looks to measure the effects of an intervention, including the positive, negative, and unintended consequences of the programme, attrition and adherence to outcome measures, and its acceptability, obstacles, and barriers. From the 12 initially recruited Circles, there was one drop-out. The Circle ended prematurely with the mutual agreement of the CM and all parties, and data from this Circle was excluded from the analysis.
Of the remaining 11 Circles, the programme showed very good adherence with regards to provision of evaluation data; but only eight of the 11 CMs participated in the interview. Of the remaining three, two did not respond to requests for interviews and one could not be scheduled in the required time frame. However, no distinguishable difference was identified between interview completers and non-completers with regards to the selection variables, their MAML assessments or evaluations forms. For each Circle, there was at least one representative (CM, Vs, or CO) included in the interviews.
Overall, effectiveness was assessed as positive: (a) participants were able to identify the aims of Circles ReBoot, defined as skills development, implementing positive changes, focusing on strengths, providing space for reflection, preventing reoffending, and redirecting offending behavior; (b) the CMs deployed their identified strengths into meeting prosocial goals whilst reducing harmful behaviors, such as social isolation and substance use; (c) the CMs reportedly improved their coping mechanisms for possible future challenges; (d) CMs reflected on how to change their lifestyles in ways that would lead to a more satisfying and offence free future; and CMs sought positive opportunities for change, such as engagement in hobbies, employment, and relationship development. CM needs, for example associated with autistic traits, presented additional challenges. As anticipated, a key mechanism of change was CMs’ relationships with the Vs, especially where CMs were willing and open in their engagement; indeed, lack of engagement was frequently raised as a barrier to effectiveness. All CMs described their experience of Circles ReBoot as being exclusively positive, and specifically referred to increases in self-awareness, confidence, seeking positive opportunities and reduction in harmful behaviors. On balance, participants experienced the structure of Circles ReBoot as facilitative. While CMs experienced challenging emotions throughout Circles ReBoot, for example, feeling unaccomplished or unwanted negative emotions, no unintended negative consequences were identified or recorded elsewhere.
With regards to the MAML assessment, of the seven domains, Practical had the lowest pre-rating and Relationships had the highest pre-rating (average score per item; see Table 2). However, average scores should be treated with caution given the small sample size. Table 2 also outlines how CM changed over time; overall, most deterioration was reported for Resilience (n = 3). The domains with the highest no-change score were Purpose and Relationships (both n = 4), and Setting Goals and Change showed the strongest improvement (n = 9 each).
Change Across MAML Domains.
Note. Practical is rated on a 4 point Likert scale, “Not at all” (0), “Partially” (1), “Mostly” (2), and “Completely” (3). All other domains are rated on a 5 point Likert scale, “None of the time” (0), “Rarely” (1), “Most of the time” (2), “Often” (3), and “All of the time” (4).
As part of the analysis, we also identified seven items where more than half of the CMs scored particularly low pre-Circle (defined as “Areas of Need”; see Table 3). Three from the original seven items remained an Area of Need post-Circle. It is noteworthy that these items all belong to the Practical domain, highlighting education and employment as an area of need post-Circles ReBoot.
MAML - Areas of Need.
Note. Practical is rated on a 4 point Likert scale, “Not at all” (0), “Partially” (1), “Mostly” (2), and “Completely” (3). All other domains are rated on a 5 point Likert scale, “None of the time” (0), “Rarely” (1), “Most of the time” (2), “Often” (3), and “All of the time” (4).
Area of Need: participants with score below 2 on any item.
Regarding CMs’ ratings on the Evaluation Forms (Table 4), of the 14 items, those relating to the environment of Circles received the highest average score (Items 1 and 2) while personal confidence (Item 10) and present focus (Item 14) received the lowest average scores. As before, average scores should be treated with caution given the small sample size. Item 10 (“I am more confident.”), Item 12 (“I have learnt how to handle new situations.”), and Item 14 (“I am better able to focus on the present moment.”) had the highest number of CMs who provided a particularly low rating, with n = 3 low scorers each.
Core Members’ Evaluation Forms – Analysis.
Note. Items are rated on a 4 point Likert scale, “Not at all” (1), “Partially” (2), “Mostly” (3), and “Completely” (4). Data was available from 8 of the 11 Circles.
Low score: number of participants with score below 3 on any item.
Regarding obstacles to the interventions, participants listed issues relating to engagement, communication, and familiarity amongst the Circle members, specific issues concerning the Circles ReBoot content and material delivery, and practical issues, such as venue access; none of which highlighted any substantial concerns. In addition, the content of available Circle minutes was screened for any untoward events or obstacles which impacted the delivery of Circles ReBoot. A total of 26 events were identified, which fell into five categories: (a) CM behavior and engagement issues (e.g., CM reluctance to talk about certain topics), (b) Practical issues (e.g., difficulty finding venue), (c) Circles ReBoot material (e.g., specific worksheets lacked explanation), (d) External situations impacting goal delivery (e.g., COVID-19 made enhanced socializing difficult), and (e) Running out of time. All of these issues were also identified in the interviews.
Adoption
Adoption in the RE-AIM framework measures how well the programme can be adopted into the service. In this evaluation, based on the Vs’ and COs’ ratings of programme attributes as part of the evaluation forms (Table 5) and interview responses, Adoption was assessed as good, in that (a) the initial Circles Reboot training was regarded as useful and relevant, (b) CMs were able to successfully engage with the Circles ReBoot process and contents, and (c), to a lesser degree, all the sessions made sense and were easy to run.
Volunteers’ and Coordinators’ Ratings on Circles ReBoot Evaluation Forms – Programme Attributes.
Note. Response Scale “Strongly Disagree” (1), “Moderately Disagree” (2), “Slightly Disagree” (3), “Slightly Agree” (4), “Moderately Agree” (5), and “Strongly Agree” (6); M = Mean, SD = Standard Deviation.
Vs sometimes required more support than in a traditional Circle, and Vs and COs commented on the substantial administrative load of Circles ReBoot. Circles ReBoot showed generally good Volunteer attendance and only three volunteer dropouts were reported; one during training due to the structure of Circles ReBoot, one due to the required travel, and one following a session where the discussed content made them feel uneasy. Variable experiences were reported on the nature and intensity of training, supervision, and consultation with COs. CMs responses highlighted the non-judgemental, inclusive, and supportive space offered by the Vs as a crucial element of future Circles. The responses did not directly identify any obstacles.
Implementation
Implementation in the RE-AIM framework examines whether the intervention is delivered as intended and if there is a need for adaptations or adjustments. Overall, Implementation was achieved. There were some variations in delivery, based on the emerging needs of CMs and the Vs’ judgements and decisions in response to these. Whilst there was positive feedback on the structured approach to building upon CMs’ strengths and capacity to make positive changes in their lives, two main suggestions for improvement emerged: First, was the need for greater flexibility in the use of the structured program, in terms of the appropriateness of different sections for different CMs, the avoidance of unnecessary repetitiveness (e.g., on goal setting) and the need to incorporate more informal relationship building between CMs and Vs. Secondly, there was an identified need to enable offence and risk-related matters to be aired and worked upon as appropriate.
There were mostly negative views on the extent to which training prepared Vs for their involvement in Circles ReBoot, but this was counterbalanced by the general view that COs were generally readily available and offered useful feedback and guidance. Specific suggestions for improvement of the training were provided, including a reduced time lag between training and onset of a Circle, integration of observation or role-play activities, and improved preparation to respond to CMs’ engagement needs. For the content of Circles ReBoot, several sessions were positively received, particularly Goal setting and Different Points of View. With regards to areas of improvement, suggestions and feedback to specific sessions were provided.
Maintenance
Maintenance in the RE-AIM framework refers to the long-term consequences of participating in the programme, both at the individual (i.e., can the observed effects maintain over time?) and operational (i.e., can Circles ReBoot sustain the programme?) level (King et al., 2010). In this evaluation, Maintenance was assessed as promising.
For this evaluation, the extent to which clear and tangible outcomes could be achieved was limited by the opportunities CMs had to make significant changes within the timescales considered. Since Circles ReBoot was running in the latter stages of the Covid pandemic restriction, this was a real and understandable limitation to progress for some CMs. It was recognized that positive changes achieved through Circles ReBoot, including greater reflection and self-awareness, more confidence in social situations and more willingness to seek out positive opportunities for change, may be sustained but could be subject to various situational constraints, including opportunities for personal development, the reactions of other people, and the need for CMs to remain motivated and to effectively handle negative situations. Comments were made by CMs and Vs on the desirability of more gradually phasing out contact with the Vs and/or having a follow-up session to moderate feelings of a rapid and stark termination, as well as signposting to other support systems.
As with the CMs, the Vs and COs generally experienced Circles ReBoot as a positive experience, from which they had gained professional knowledge and skills. Circles ReBoot was considered to have potential for longevity given its short delivery timeframe, its focus on the CM’s individual needs, but explored the option of a less structured and more informal approach, and the need for systematic follow-up evaluation.
Key Findings and Discussion
This pilot evaluation was aimed to explore the feasibility of Circles ReBoot, a structured, strengths-based and shorter format of Circles of Support and Accountability, aimed at individuals with a CSEM offending history. Based on the RE-AIM model as a framework for evaluating its feasibility, an evaluation plan was designed, identifying specific assessment areas and related data sources, including interviews and Circles ReBoot materials. Key findings from the evaluation indicated that:
Overall, the evaluation demonstrated positive outcomes for Circles ReBoot in all domains, with the strongest evidence for Reach and Adoption. Effectiveness and Implementation were achieved and generated specific and tangible suggestions for further development and improvement. Maintenance was limited due to the timeframe of this evaluation but showed promising findings.
Appropriate referrals were forthcoming from police and probation services using the Circles ReBoot inclusion and exclusion criteria.
Eleven of the 12 Circles ReBoot Circles ran to completion. The one drop-out appears not to be linked to the Circles ReBoot model.
CMs reported a range of positive experiences and did not identify any adverse consequences from their participation. Positive changes included increased sense of self-worth and self-efficacy, encouragement to seek positive opportunities and (re)connect socially, and greater reflection and self-awareness.
Use of the structured and semi-structured session plans was generally well received, with different CMs, and associated Vs, finding different sessions most helpful. The evaluation identified some needs-led variations in the programme delivery and some points where the structured format may be perceived as less facilitative.
A common feedback theme for some combinations of CMs and Vs was the need for them to spend more time getting to know each other before the structured work began.
At the end of Circles ReBoot, there was similar feedback from CMs and Vs about the ‘cliff edge’ ending, with associated suggestions of phasing out each Circle and/or to incorporate follow up sessions.
There was a need to enable the integration and/or focus of the CMs’ offending behaviour and its context into the programme, and differing views how this would best be done.
While the programme content and focus on goal setting was generally well-received, some specific issues were identified with corresponding suggestions for improving aspects of individual sessions, materials, or exercises.
Participants were cautiously optimistic about the potential long-term impacts of the positive changes achieved during Circles ReBoot but emphasized the impact of the strengths and needs of individual CMs, and the need for systematic follow-up evaluation.
As part of the evaluation, for each RE-AIM domain, the findings were translated into a series of recommendations to the provider of Circles Reboot.
During this evaluation, some limitations were identified that impact comparability and generalizability of the findings. These included:
Despite those limitations, on balance, it can be concluded that, with some adjustments as outlined here, Circles ReBoot shows promise as a strength-based, structured, and time-limited intervention for individuals with a CSEM offending history. The next steps should include an (a) evaluation of an updated version of Circles ReBoot, based on these findings; (b) a long-term follow up of intervention completers; (c) a controlled test of its effectiveness alongside appropriate control groups, moving toward a randomized control trial design. It would also be useful to integrate established measures of outcome variables to increase reliability and triangulation of findings.
The findings further show that the RE-AIM framework proved to be an appropriate feasibility framework for this type of evaluation and resulted in an informative and rich data pool based on specifically targeted questions being explored. The findings further add to the empirical literature highlighting that feasibility studies have merit in intervention research, particularly in forensic psychology, where practical and methodological limitations may not provide the conditions for randomized control trials, or as a precursor to a more controlled testing approach (e.g., Fromberger et al., 2018; Lo et al., 2020).
Footnotes
Acknowledgements
Not applicable
Data Availability
The data that support the findings of this study may be made available on request from the corresponding author. The data are not publicly available due to the sensitive nature of the data.
Declaration of Conflicting Interests
The author(s) declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article.
Funding
The author(s) disclosed receipt of the following financial support for the research, authorship, and/or publication of this article: The project was funded by Circles UK.
Ethical Considerations
This project was approved by the Research Ethics Committee of Royal Holloway University of London (REC Project ID: 2684).
Consent to Participate
Respondents received an information sheet detailing the study and provided written consent to participate.
Consent for Publication
As part of the study brief, participants were informed of the plans for publication. In order to maintain anonymity and confidentiality of all participants, any identifying features have been removed from this report and direct quotes have been de-identified where required.
