Acceptability of a Brief Web-Based Theory-Based Intervention to Prevent and Reduce Self-harm: Mixed Methods Evaluation

Abstract

Background The volitional help sheet (VHS) for self-harm equips people with a means of responding automatically to triggers for self-harm with coping strategies. Although there is some evidence of its efficacy, improving acceptability and making the intervention available in a web-based format may be crucial to increasing effectiveness and reach. Objective This study aims to use the Theoretical Framework of Acceptability (TFA) to explore the acceptability of the VHS, examine for whom and under what circumstances this intervention is more or less acceptable, and develop a series of recommendations for how the VHS can be used to support people in reducing repeat self-harm. Methods We explored acceptability in two phases. First, our patient and public involvement partners evaluated the original VHS from a lived experience perspective, which was subsequently translated into a web-based format. Second, a representative sample of adults in the United Kingdom 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 TFA, namely, affective attitude, burden, perceived effectiveness, ethicality, intervention coherence, opportunity costs, and self-efficacy. Data were analyzed using descriptive statistics, one-tailed t tests, and binary logistic regression. A directed content analysis approach was used to analyze qualitative data. Results Participants in the web-based survey rated the VHS as positive (affective attitude; t457=4.72; P<.001); were confident using it (self-efficacy; t457=9.54; P<.001); felt they did not have to give up any benefits, profits, or values when using it (opportunity costs; t439=−15.51; P<.001); understood it and how it worked (intervention coherence; t464=11.90; P<.001); and were confident that it would achieve its purpose (perceived effectiveness; t466=2.04; P=.04). 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 existing ones (ethicality), and clearer instructions and further detail about the purpose of the VHS (intervention coherence). Conclusions Our findings show high levels of acceptability among some people who have previously self-harmed, particularly among younger adults, people of White ethnic backgrounds, and people without long-term health conditions. Future research should aim to improve acceptability among older adults, people from minority ethnic groups, and people with long-term health conditions.

Clinician acceptability of an antibiotic prescribing knowledge support system for primary care: a mixed-method evaluation of features and context

“…Acceptability and intention to use the KS were rated using an online survey (Qualtrics XM, Utah, USA v062021; see Supplementary le 3) using the seven domains of the Theoretical Framework of Acceptability (35,37) TFA; on a scale from 0-10 with optional open text comments. To examine convergent validity, ratings for intention, expectation and desire to use the KS (38) were also captured (0 = very negative, to 10 = very positive).…”

“…As TFA scale cut-offs are still becoming established interpretation of ratings scores in the current study were conservative, interpreting high acceptability score as 7.00 or more. Previous studies have used 5.00 or more (37) but the e cacy of this cut point will only become apparent with more wide spread use of the framework. Future evaluations of the system would bene t from a wireframe or test system to help give participants a more coherent understanding of the intervention and gather views from users who may initially be less receptive to the intervention.…”

Feasibility, acceptability and effects of a group pelvic floor muscle telerehabilitation program to treat urinary incontinence in older women

“…To measure the acceptability of the teleGROUP program, physiotherapists evaluating the participants will answer a survey based on the Theoretical Framework of Acceptability (TFA), 59 using similar questions to those used in literature, adapted to the context of the study (see Appendix 2). 60 , 61 …”

Development of a theory-informed questionnaire to assess the acceptability of healthcare interventions

“…To assess whether other researchers had developed a TFA-based acceptability questionnaire, we completed a forward citation search in Google scholar (October 2021), and identified two articles that report using quantitative measures of the TFA constructs [ 17 , 18 ]. Neither article reported using an established method to develop their questionnaire, and neither questionnaire included an item assessing overall acceptability.…”

“…Neither article reported using an established method to develop their questionnaire, and neither questionnaire included an item assessing overall acceptability. Keyworth et al [ 18 ] describe useful methods for analysing data from Likert scale responses to TFA items but reported problems with the wording of the Opportunity Costs item and potential issues with the response format of this item and the Self-Efficacy item. Renko et al’s [ 17 ] questionnaire contained several examples where the item wording did not accurately reflect the TFA definitions or items that conflated multiple TFA constructs.…”