JMIR Publications

ABSTRACT

Background:

Self-harm is a significant global concern with multiple negative outcomes. Self-harm research tools typically focus on single risk factors meaning the temporal interplay between factors and their impact on self-harm is unknown. The card sort task for self-harm (CaTS) addressed these deficits by using 117 cards to examine multiple self-harm factors. In-person research is time-consuming, costly, and limits participation opportunities. Developing an electronic version of CaTS (CaTS-E) is necessary to address these issues, capture large datasets, and provide a stronger evidence base. Since CaTS’ inception, understanding of self-harm has evolved, including increasing awareness LGBTQIA+ people are at high-risk. Updating CaTS is essential to ensure its relevant to both LGBTQIA+ and cisgender-heterosexual self-harm.

Objective:

We present results from two studies. Study 1 is a pilot study assessing the feasibility of CaTS-E. Study 2. utilised qualitative interviews to identify additions or amendments to CaTS to increase its relevance as understanding of self-harm evolves.

Methods:

Study 1 recruited thirteen UK residents (aged 18-30) with lived self-harm experience. Feasibility and acceptability of CaTS-E were assessed using the Systems Usability Scale (SUS) and visual analogue scale (VAS). Study 2 recruited UK residents (n=13; LGBTQIA+ n=9; cisgender-heterosexual n=4; 21-29 years) with lived self-harm experience to one-on-one interviews.

Results:

Study 1 found CaTS-E to be a feasible web-app for use in self-harm research. VAS data showed no significant difference between pre- and post-study mood. In Study 2, thematic analysis resulted in 13 additional cards (e.g., ‘Before 6-months'; ‘I don’t feel comfortable in my body’; ‘I was bullied on social media’; ‘Self-harm gave me a feeling of control’). Cards were worded clearly, but minor amendments to wording on cards to increase LGBTQIA+ inclusivity were identified (i.e., changing ‘boyfriend/girlfriend’ to ‘partner’). While participants felt selective additions were necessary, too many may overwhelm participants. Therefore, future additions should be carefully considered.

Conclusions:

Pilot testing shows CaTS-E is a usable, feasible web-app to examine self-harm and capture large datasets. Importantly, completing CaTS-E does not negatively impact participants’ mood. Updates and key additions were made to CaTS from consultation with people with lived self-harm experiences. These increase the relevance of CaTS and ensure LGBTQIA+ inclusivity.