Co-designing a novel intervention for prison staff affected by moral injury: a protocol

<b>Background:</b> Exposure to potentially morally injurious events (PMIEs) can contribute towards serious mental disorders. Prisons are uniquely challenging environments where staff must fulfil competing roles of security, care, and rehabilitation. Currently no manualised intervention for moral injury-related distress exists for prison staff. Here we describe the 'Co-designing a program for Addressing staff wellbeing and Reducing moral injury Experiences' (CARE) study protocol, which aims to co-develop an intervention to prevent and respond to moral injury-related ill health.<b>Methods:</b> Data will be collected from current and ex-prison staff. Current staff will be recruited from at least three prisons across the UK. We will survey a cross-section of prison staff exploring the prevalence of PMIEs and the impact of exposure on wellbeing, before carrying out qualitative interviews to explore the lived experiences staff moral injury. In addition, we will conduct interviews with ex-prison staff to understand the impact of PMIEs on wellbeing. These data will feed into the co-design of an intervention programme, designed to reduce distress among staff with PMIEs. Further feedback on the programme protocol will be sought from interview participants to ensure the co-developed programme is acceptable, and feasible to implement in future.<b>Results:</b> Quantitative staff survey data will be cross-sectional and will be analysed using multilevel regression models to explore associations between relevant factors. Qualitative data will be analysed using thematic analysis.<b>Conclusions:</b> Dissemination will include presentations at conferences, publication in academic journals, and free training events. By providing information about prison staff experiences, findings will not only inform the development of an evidence-based approach for staff in prison settings affected by moral injury but may also help inform broader approaches to providing support to other high-risk occupational groups.