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A new web-based intervention to help reduce and prevent repeat self-harm has been designed by researchers alongside those with lived experience. The intervention was tested by a national sample of 514 people who had self-harmed to find out what they thought of it and whether they believed it could help them.
The research, which has been published today in the Journal of Medical Internet Research, reveals that the intervention, which has previously been found to be effective, is liked by those with lived experience of self-harm. Therefore, it is likely to be accepted and used widely, researchers believe.
The study, “Acceptability of a Brief Web-Based Theory-Based Intervention to Prevent and Reduce Self-harm: Mixed Methods Evaluation,” is funded by the National Institute for Health Research Greater Manchester Patient Safety Translational Research Centre (NIHR GM PSTRC). The Centre is a partnership between The University of Manchester and Salford Royal National Health Service (NHS) Foundation Trust.
The new web-based intervention is based on a paper version used in hospitals that was found to be effective in previous research.
Dr Chris Keyworth, Lecturer in Psychology at the University of Leeds and lead for this study at the GM PSTRC, said, “We know that self-harm is happening more often across the UK, and there’s a challenge to develop preventative strategies that work and are considered acceptable by those who self-harm”.
“One important thing to consider is the amount of effort required to engage with a new intervention. We could develop an intervention that’s effective, but if those who use it think too much effort is involved, it won’t make the difference it’s designed to, and outcomes may be limited. So, an important part of our research was to uncover whether our new intervention was acceptable for people who have self-harmed.”
The intervention is rooted in more than a decade of research on “volitional help sheets,” which have been used effectively to improve outcomes for people who have self-harmed. This new, web-based volitional help sheet contains a list of situations that may act as triggers for someone with a history of self-harm. It also contains a list of responses to select that are designed to reduce the urge to self-harm.
Researchers worked with a patient and public involvement and engagement (PPIE) group with lived experience of self-harm to ensure the intervention is as acceptable as possible with the lowest level of effort. This involved ensuring that all the situations listed were relevant and the language was appropriate for those who self-harm. In total, the intervention includes 13 situations and 13 solutions. Once the intervention was agreed upon by researchers and PPIE group members, it was tested by those with a history of self-harm through a web-based survey.
Dr Chris Keyworth continued, “This research shows that the modifications made to our intervention have been judged as acceptable by people with lived experience of self-harm, which means it has more chance of making a difference. It has the potential to work well alongside patient health care, such as by GPs [general practitioners] when helping to support people to reduce repeat self-harm, as well as people on their own at home.”
The research also identified how the intervention could be further improved to increase its impact. For example, the findings suggest it is harder for people to engage with the intervention when they have harmed themselves in the last year. If the intervention can be made easier to engage with for this group of people, it could prove to be useful as part of long-term support strategies, such as when the urge to self-harm may not be at its peak.
Professor Chris Armitage, behavioral science lead for the GM PSTRC and senior researcher on the project, said, “There are very few interventions available to health care professionals who want to intervene to prevent self-harm, and this research provides them with an option that, on the face of it, is simple to administer, but is in fact underpinned by decades of behavioral science research.”
Mette Isaksen, Senior Research and Evidence Manager at Samaritans, said, “Samaritans research found that people who have self-harmed want support to learn different coping strategies and reminders of what’s worked for them in the past. However, this type of support was hard to come by. We welcome this research, which worked directly with people who have self-harmed to develop a new support intervention focused on exactly this. Much more needs to be done to ensure people who self-harm have ready access to a range of support options that are right for them.”
Mary Vingoe—Communications Manager
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About the NIHR GM PSTRC: The NIHR GM PSTRC is a partnership between The University of Manchester and Salford Royal NHS Foundation Trust in collaboration with The University of Nottingham that aims to make health care safer in primary care and transitions of care. It is funded by the NIHR for 5 years, from 2017 until 2022, and is one of three PSTRCs in England. The GM PSTRC is responsible for research across four themes: Safety Informatics, Medication Safety, Safer Care Systems and Transitions, and Safety in Marginalized Groups.
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Keyworth C, O’Connor R, Quinlivan L, Armitage CJ. Acceptability of a Brief Web-Based Theory-Based Intervention to Prevent and Reduce Self-harm: Mixed Methods Evaluation. J Med Internet Res 2021;23(9):e28349.