190 Chapter 7 networks, social support, and social participation, were tailored to the individual needs (chapter 3, 4, and 5). Although the intervention was modified in several ways to facilitate implementation in addition to forensic psychiatric care, we showed that the implementation was generally challenging (chapter 4 and 5). In line with previous research, we found a substantial amount of intervention dropout in forensic patients (Olver et al., 2011; Pettus-Davis et al., 2015; Priebe et al., 2020; Siette et al., 2017). Implementation challenges of social network interventions have been reported previously in research, which were related to the organization (e.g., care institutes are not advocating social network enhancement), community (e.g., stigma and availability of volunteers), patients and their personal social network (e.g., patients can be resistant to enhance their network due to negative experiences with people or lack necessary social skills), and caregivers (e.g., lack of training) (Biegel et al., 1994, 1995). Our research confirmed several barriers on patient-, community-, and caregiver-level, which should be considered to guide future implementation (chapter 4 and 6). Regarding patient-level barriers, we found that the majority of patients were open to contact with a volunteer coach yet, were unable or unwilling to actively improve their social network during the intervention. In particular, avoidant and passive attitude of patients and a timing issue due to various problems and responsibilities negatively influenced patient compliance. It is possible that past and current negative social experiences, such as perceived discrimination and stigmatization, which may have reduced patients’ self-esteem, were underlying reasons for avoidant attitudes toward volunteers (Link et al., 2001; Webber et al., 2014; Yanos, Roe, & Lysaker, 2010). Patients’ attitudes might also be explained by a lack of social skills to develop and maintain a relationship with volunteers (Biegel et al., 1994, 1995). Furthermore, patients in our sample were challenged with multiple problems, for example, complex and chronic psychiatric problems as well as socio-environmental problems. Therefore, the timing of the intervention may have been unfortunate; patients reported being overloaded with personal problems that required their attention and professional care. However, it should be noted that these patient-level barriers probably fluctuated over time, as all patients initially agreed to participate in the intervention and also expressed social network-related needs (Priebe et al., 2020). The variety and sustainable availability of community volunteers could be an important community-level barrier (chapter 5). Although in our research, we were able to recruit sufficient volunteer coaches, one-on-one matching of volunteers to patients is an
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