The volitional help sheet (VHS) for self-harm equips people with the means of responding automatically to triggers for self-harm with coping strategies. Although there is some evidence of efficacy, improving acceptability and making the intervention available in an online format may be crucial to increasing effectiveness and reach.
The aims were to: (1) use the Theoretical Framework of Acceptability (TFA) to explore the acceptability of the intervention, (2) examine for whom and under what circumstances the VHS is more or less acceptable, and (3) develop a series of recommendations for how the VHS can be used to support people to reduce repeat self-harm.
We explored acceptability in two phases. First, our patient/public involvement partners evaluated the original VHS from a lived experience perspective, which was subsequently translated to an online format. Second, a representative sample of UK adults who had previously self-harmed were recruited via a YouGov survey (N = 514) and were asked to rate the acceptability of the VHS based on the seven constructs of the Theoretical Framework of Acceptability, namely: affective attitude, burden, perceived effectiveness, ethicality, intervention coherence, opportunity costs, and self-efficacy. Data were analysed using descriptive statistics, one-sample t‐tests, and binary logistic regression. A directed content analysis approach was used to analyse the qualitative data.
Participants in the online survey rated the VHS: positively (affective attitude), t(457) = 4.72, p < .001; were confident using it (self-efficacy), t(457) = 9.54, p < .001; felt they did not have to give up any benefits, profits or values when using it (opportunity costs) t(439) = -15.51 p < .001; understood it and how it worked (intervention coherence) t(464) = 11.90, p < .001; and were confident that it would achieve its purpose (perceived effectiveness) t(466) = 2.04, p < .05. The TFA domain ‘Burden’ appeared to be an important indicator of acceptability. Lower levels of perceived burden when using the VHS tool were more prevalent among younger adults aged 18-24 years (OR=3.63, 95%CI 1.50-8.78), people of white ethnic background (OR=3.02, 95%CI 1.06-8.613), and people without a long-term health condition (OR=1.53, 95%CI 1.01-2.30). Perceived modifications to further improve acceptability included: improved formatting (burden), the feature to add new situations and responses or amend/edit existing ones (ethicality), and (c) clearer instructions and further detail about the purpose of the volitional help sheet (intervention coherence).
Our findings show high levels of acceptability among some people who have previously self-harmed, particularly among younger adults, people of white ethnic background, and people without long-term health conditions. Future research should aim to improve acceptability among older adults, people from minority ethnic groups, and among people with long-term health conditions.