JMIR Publications

ABSTRACT

Background:

Difficulties with emotion regulation (ER) have widely been associated with the development and persistence of poor mental health, such as depression, anxiety, self-harmful thoughts, behaviours, and suicide attempts. Despite the importance of ER as a transdiagnostic risk factor, few interventions directly target ER. The impact of one such intervention, Purrble (a socially assistive robot), was recently evaluated when compared to treatment-as-usual within a randomised controlled trial (RCT) with sexual orientation and gender identity minorities (LGBTQ+) youth who had self-harm experiences (Williams et al., 2026). However, while RCTs are well suited to evaluating effectiveness, they offer limited insight into how participants engage with, integrate, and perceive the value of interventions, like Purrble, in their everyday lives. Consequently, complementary qualitative process evaluation is needed to fully understand participants’ experiences and contextualise trial outcomes.

Objective:

Process evaluation interviews were used to explore and understand the engagement with and integration of the Purrble intervention, considering its perceived influence on ER, mental health, and self-harm experiences.

Methods:

Following their participation in the Purrble RCT, 40 LGBTQ+ young people (16-25 years) with current self-harm ideation took part in this qualitative process evaluation using semi-structured online interviews. Interviews explored participant expectations of the RCT and Purrble; engagement and appropriation of Purrble; and perceived impact to mental health and self-harm. Thematic analysis was used to develop a thematic framework.

Results:

Four overarching themes were developed from the data. The first theme describes how participants used Purrble to ground themselves and manage distress, often preventing escalation to self-harm thoughts or behaviours. The second theme captures how Purrble was perceived as a companion or source of comfort, supporting self-soothing and self-care. The third theme highlights the role of accessibility and proximity, how the availability and location of Purrble during moments of distress influenced its perceived usefulness. The final theme examines circumstances in which participants chose not to engage with Purrble, offering insights into barriers to use and individual differences in engagement.

Conclusions:

This process evaluation demonstrates how Purrble can be a helpful intervention for those LGBTQ+ young people with experience of self-harm thoughts and behaviours. This evaluation also clarifies when Purrble may not be helpful. These qualitative findings offer important insights supporting the quantitative results of the related RCT.