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

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.

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

10.2196/preprints.28349 ◽

2021 ◽

Author(s):

Chris Keyworth ◽

Rory O'Connor ◽

Leah Quinlivan ◽

Christopher J Armitage

Keyword(s):

Self Efficacy ◽

Health Conditions ◽

Opportunity Costs ◽

Perceived Effectiveness ◽

Younger Adults ◽

Web Based ◽

Affective Attitude ◽

Self Harm ◽

White Ethnic

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.

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P105 Therapists acceptability of delivering a psychologically informed gait rehabilitation intervention in early rheumatoid arthritis (GREAT): a qualitative interview study

Rheumatology ◽

10.1093/rheumatology/keaa111.103 ◽

2020 ◽

Vol 59 (Supplement_2) ◽

Author(s):

Mandeep Sekhon ◽

Emma Godfrey ◽

Gordon Hendry ◽

Nadine E Foster ◽

Samantha Hider ◽

...

Keyword(s):

Rheumatoid Arthritis ◽

Feasibility Study ◽

Early Rheumatoid Arthritis ◽

Self Efficacy ◽

Gait Rehabilitation ◽

Opportunity Costs ◽

Perceived Effectiveness ◽

Structured Interviews ◽

Intervention Delivery ◽

Affective Attitude

Abstract Background Great Strides is a brief psychologically informed gait rehabilitation intervention (two compulsory face-to-face sessions and up to four optional sessions delivered over 3 months) aimed at improving lower limb function for adults with early rheumatoid arthritis (RA). As part of the Gait Rehabilitation in Early Arthritis Trial (GREAT) feasibility study, physiotherapists and podiatrists received two days of bespoke training delivered by psychologists, physiotherapists and podiatrists on i) the gait rehabilitation exercise programme (six walking exercises) ii) aspects of motivational interviewing (MI) and iii) delivery of key behaviour change techniques (BCTs) to facilitate motivation and adherence to the Great Strides intervention. The training was supported by a bespoke therapist manual and session checklists. The aim of this study was to explore therapists’ acceptability of: (1) the bespoke training received and (2) delivering the intervention within the GREAT feasibility study. Methods All 10 therapists who received training were invited to complete semi-structured interviews. The topic guide was informed by the Theoretical Framework of Acceptability (TFA). Interviews were audio recorded, professionally transcribed and a deductive thematic analysis was applied. Data were coded into six TFA constructs (Affective Attitude; Burden; Intervention Coherence; Opportunity Costs; Perceived Effectiveness; Self-efficacy). Results Nine out of ten therapists (four physiotherapists, five podiatrists) participated in the semi-structured interviews. Five therapists (four physiotherapists, one podiatrist) delivered the Great Strides intervention. Key barriers and enablers with regards to the acceptability of the bespoke training and intervention delivery were identified. Training: Therapists liked the supportive training environment (affective attitude), understood the purpose of the training sessions (intervention coherence), reported that the role play exercises aided their confidence in applying MI and BCTs (self-efficacy) and found that the training sessions were vital preparation for delivering the intervention (perceived effectiveness). Aspects of training which were considered unacceptable included the lack of time to attend the training sessions (opportunity costs). Delivery: All therapists enjoyed applying MI and BCTs to encourage participants to complete the gait exercises (affective attitude) and valued the opportunity to provide individualised care (intervention coherence). Barriers associated with acceptability included the use of trial-related materials (e.g. checklist) during intervention delivery (burden), interference of intervention delivery with routine clinical workload (opportunity costs) and the time delay between receiving training and initial intervention delivery (perceived effectiveness). Conclusion Both GREAT intervention training and delivery were considered acceptable to most therapists. The results have guided key refinements for training and intervention delivery for the GREAT internal pilot and full trial (e.g. remote access to training, timing of training in relation to intervention delivery). These refinements have the potential to improve the bespoke training and enhance the delivery of the Great Strides intervention maximising efficiency and potential for effectiveness. Disclosures M. Sekhon None. E. Godfrey None. G. Hendry None. N.E. Foster None. S. Hider None. M. van der Leeden None. H. Mason None. A. McConnachie None. I. McInnes None. A. Patience None. C. Sackley None. M. Steultjens None. A. Williams None. J. Woodburn None. L. Bearne None.

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Effectiveness of a Web-Based SUpport PRogram (SUPR) for Hearing Aid Users Aged 50+: Two-Arm, Cluster Randomized Controlled Trial (Preprint)

10.2196/preprints.17927 ◽

2020 ◽

Author(s):

Janine FJ Meijerink ◽

Marieke Pronk ◽

Birgit I Lissenberg-Witte ◽

Vera Jansen ◽

Sophia E Kramer

Keyword(s):

Hearing Loss ◽

Hearing Aids ◽

Self Efficacy ◽

Primary Outcome ◽

Strategy Use ◽

Communication Strategy ◽

Support Program ◽

Self Management ◽

Web Based

BACKGROUND Hearing aid (HA) use is known to improve health outcomes for people with hearing loss. Despite that, HA use is suboptimal, and communication issues and hearing-related activity limitations and participation restrictions often remain. Web-based self-management communication programs may support people with hearing loss to effectively self-manage the impact of hearing loss in their daily lives. OBJECTIVE The goal of the research is to examine the short- and long-term effects of a web-based self-management SUpport PRogram (SUPR) on communication strategy use (primary outcome) and a range of secondary outcomes for HA users aged 50 years and older. METHODS Clients of 36 HA dispensing practices were randomized to SUPR (SUPR recipients; n=180 HA users) and 34 to care as usual (controls; n=163 HA users). SUPR recipients received a practical support booklet and online materials delivered via email over the course of their 6-month HA rehabilitation trajectory. They were encouraged to appoint a communication partner and were offered optional email contact with the HA dispensing practice. The online materials included 3 instruction videos on HA handling, 5 videos on communication strategies, and 3 testimonial videos. Care as usual included a HA fitting rehabilitation trajectory only. Measurements were carried out at baseline, immediately postintervention, 6 months postintervention, and 12 months postintervention. The primary outcome measure was self-reported use of communication strategies (3 subscales of the Communication Profile for the Hearing Impaired [CPHI]). Secondary outcome measures included self-reported personal adjustment to hearing loss (CPHI); use, satisfaction and benefit of HAs and SUPR (use questionnaire; International Outcome Inventory for Hearing Aids [IOI-HA], Alternative Interventions [IOI-AI]); recommendation of HA dispensing services; self-efficacy for HA handling (Measure of Audiologic Rehabilitation Self-Efficacy for Hearing Aids [MARS-HA]); readiness to act on hearing loss (University of Rhode Island Change Assessment adapted for hearing loss [URICA-HL]); and hearing disability (Amsterdam Inventory for Auditory Disability and Handicap [AIADH]). RESULTS Linear mixed model analyses (intention to treat) showed no significant differences between the SUPR and control group in the course of communication strategy use (CPHI). Immediately postintervention, SUPR recipients showed significantly higher self-efficacy for advanced HA handling than the controls, which was sustained at 12 months (MARS-HA; mean difference immediately postintervention: 5.3, 95% CI 0.3 to 10.4; P=.04). Also, SUPR recipients showed significantly greater HA satisfaction than controls immediately postintervention (IOI-HA; 0.3, 95% CI 0.09 to 0.5; P=.006), which was sustained at 12 months, and significantly greater HA use than the controls immediately postintervention (IOI-HA; 0.3, 95% CI 0.02 to 0.5; P=.03), which was not sustained at 12 months. CONCLUSIONS This study provides ground to recommend adding SUPR to standard HA dispensing care, as long-term, modest improvements in HA outcomes were observed. Further research is needed to evaluate what adjustments to SUPR are needed to establish long-term effectiveness on outcomes in the psychosocial domain. CLINICALTRIAL ISRCTN77340339; http://www.isrctn.com/ISRCTN77340339 INTERNATIONAL REGISTERED REPORT RR2-10.1136/bmjopen-2016-015012

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Self-harm in older people: a clear need for specialist assessment and care

The British Journal of Psychiatry ◽

10.1192/bjp.bp.111.104109 ◽

2012 ◽

Vol 200 (5) ◽

pp. 356-358 ◽

Cited By ~ 7

Author(s):

Michael S. Dennis ◽

David W. Owens

Keyword(s):

Older Adults ◽

Older People ◽

Evidence Based ◽

Short Term ◽

Younger Adults ◽

Suicide Rates ◽

Self Harm ◽

Evidence Based Care

SummarySuicide rates are generally elevated after episodes of non-fatal self-harm, especially among older adults. Evidence suggests that non-fatal and fatal self-harm are more closely related in older than in younger adults. Older people who have self-harmed need specialist assessment followed by good short-term and long-term evidence-based care.

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Effectiveness of a Web-Based SUpport PRogram (SUPR) for Hearing Aid Users Aged 50+: Two-Arm, Cluster Randomized Controlled Trial

Journal of Medical Internet Research ◽

10.2196/17927 ◽

2020 ◽

Vol 22 (9) ◽

pp. e17927

Author(s):

Janine FJ Meijerink ◽

Marieke Pronk ◽

Birgit I Lissenberg-Witte ◽

Vera Jansen ◽

Sophia E Kramer

Keyword(s):

Hearing Loss ◽

Hearing Aids ◽

Self Efficacy ◽

Primary Outcome ◽

Strategy Use ◽

Communication Strategy ◽

Support Program ◽

Self Management ◽

Web Based

Background Hearing aid (HA) use is known to improve health outcomes for people with hearing loss. Despite that, HA use is suboptimal, and communication issues and hearing-related activity limitations and participation restrictions often remain. Web-based self-management communication programs may support people with hearing loss to effectively self-manage the impact of hearing loss in their daily lives. Objective The goal of the research is to examine the short- and long-term effects of a web-based self-management SUpport PRogram (SUPR) on communication strategy use (primary outcome) and a range of secondary outcomes for HA users aged 50 years and older. Methods Clients of 36 HA dispensing practices were randomized to SUPR (SUPR recipients; n=180 HA users) and 34 to care as usual (controls; n=163 HA users). SUPR recipients received a practical support booklet and online materials delivered via email over the course of their 6-month HA rehabilitation trajectory. They were encouraged to appoint a communication partner and were offered optional email contact with the HA dispensing practice. The online materials included 3 instruction videos on HA handling, 5 videos on communication strategies, and 3 testimonial videos. Care as usual included a HA fitting rehabilitation trajectory only. Measurements were carried out at baseline, immediately postintervention, 6 months postintervention, and 12 months postintervention. The primary outcome measure was self-reported use of communication strategies (3 subscales of the Communication Profile for the Hearing Impaired [CPHI]). Secondary outcome measures included self-reported personal adjustment to hearing loss (CPHI); use, satisfaction and benefit of HAs and SUPR (use questionnaire; International Outcome Inventory for Hearing Aids [IOI-HA], Alternative Interventions [IOI-AI]); recommendation of HA dispensing services; self-efficacy for HA handling (Measure of Audiologic Rehabilitation Self-Efficacy for Hearing Aids [MARS-HA]); readiness to act on hearing loss (University of Rhode Island Change Assessment adapted for hearing loss [URICA-HL]); and hearing disability (Amsterdam Inventory for Auditory Disability and Handicap [AIADH]). Results Linear mixed model analyses (intention to treat) showed no significant differences between the SUPR and control group in the course of communication strategy use (CPHI). Immediately postintervention, SUPR recipients showed significantly higher self-efficacy for advanced HA handling than the controls, which was sustained at 12 months (MARS-HA; mean difference immediately postintervention: 5.3, 95% CI 0.3 to 10.4; P=.04). Also, SUPR recipients showed significantly greater HA satisfaction than controls immediately postintervention (IOI-HA; 0.3, 95% CI 0.09 to 0.5; P=.006), which was sustained at 12 months, and significantly greater HA use than the controls immediately postintervention (IOI-HA; 0.3, 95% CI 0.02 to 0.5; P=.03), which was not sustained at 12 months. Conclusions This study provides ground to recommend adding SUPR to standard HA dispensing care, as long-term, modest improvements in HA outcomes were observed. Further research is needed to evaluate what adjustments to SUPR are needed to establish long-term effectiveness on outcomes in the psychosocial domain. Trial Registration ISRCTN77340339; http://www.isrctn.com/ISRCTN77340339 International Registered Report Identifier (IRRID) RR2-10.1136/bmjopen-2016-015012

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Multicentred randomised controlled trial of an augmented exercise referral scheme using web-based behavioural support in individuals with metabolic, musculoskeletal and mental health conditions: protocol for the e-coachER trial

BMJ Open ◽

10.1136/bmjopen-2018-022382 ◽

2018 ◽

Vol 8 (9) ◽

pp. e022382 ◽

Cited By ~ 1

Author(s):

Wendy Ingram ◽

Douglas Webb ◽

Rod S Taylor ◽

Nana Anokye ◽

Lucy Yardley ◽

...

Keyword(s):

Mental Health ◽

Physical Activity ◽

Chronic Conditions ◽

Controlled Trial ◽

Health Conditions ◽

Web Based ◽

Behavioural Support ◽

Randomised Controlled ◽

Exercise Referral

IntroductionPhysical activity is recommended for improving health among people with common chronic conditions such as obesity, diabetes, hypertension, osteoarthritis and low mood. One approach to promote physical activity is via primary care exercise referral schemes (ERS). However, there is limited support for the effectiveness of ERS for increasing long-term physical activity and additional interventions are needed to help patients overcome barriers to ERS uptake and adherence.This study aims to determine whether augmenting usual ERS with web-based behavioural support, based on the LifeGuide platform, will increase long-term physical activity for patients with chronic physical and mental health conditions, and is cost-effective.Methods and analysisA multicentre parallel two-group randomised controlled trial with 1:1 individual allocation to usual ERS alone (control) or usual ERS plus web-based behavioural support (intervention) with parallel economic and mixed methods process evaluations. Participants are low active adults with obesity, diabetes, hypertension, osteoarthritis or a history of depression, referred to an ERS from primary care in the UK.The primary outcome measure is the number of minutes of moderate-to-vigorous physical activity (MVPA) in ≥10 min bouts measured by accelerometer over 1 week at 12 months.We plan to recruit 413 participants, with 88% power at a two-sided alpha of 5%, assuming 20% attrition, to demonstrate a between-group difference of 36–39 min of MVPA per week at 12 months. An improvement of this magnitude represents an important change in physical activity, particularly for inactive participants with chronic conditions.Ethics and disseminationApproved by North West Preston NHS Research Ethics Committee (15/NW/0347). Dissemination will include publication of findings for the stated outcomes, parallel process evaluation and economic evaluation in peer-reviewed journals.Results will be disseminated to ERS services, primary healthcare providers and trial participants.Trial registration numberISRCTN15644451; Pre-results.

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Regulation of Experienced and Anticipated Regret for Daily Decisions in Younger and Older Adults in a Swedish One-Week Diary Study

GeroPsych ◽

10.1024/1662-9647/a000102 ◽

2013 ◽

Vol 26 (4) ◽

pp. 233-241 ◽

Cited By ~ 7

Author(s):

Pär Bjälkebring ◽

Daniel Västfjäll ◽

Boo Johansson

Keyword(s):

Older Adults ◽

Diary Study ◽

Anticipated Regret ◽

Younger Adults ◽

Web Based ◽

Decision Regret ◽

Diary Method ◽

Regulation Strategies

Regret and regret regulation were studied using a weeklong web-based diary method. 108 participants aged 19 to 89 years reported regret for a decision made and a decision to be made. They also reported the extent to which they used strategies to prevent or regulate decision regret. Older adults reported both less experienced and anticipated regret compared to younger adults. The lower level of experienced regret in older adults was mediated by reappraisal of the decision. The lower level of anticipated regret was mediated by delaying the decision, and expecting regret in older adults. It is suggested that the lower level of regret observed in older adults is partly explained by regret prevention and regulation strategies.

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