Acceptability of a Chinese version of volitional help sheet to prevent self-harm repetition: a qualitative study

Background: Individuals who self-harm have increased suicide rates. Brief interventions are associated with reduced repeated suicide attempts. However, very few previous studies investigated the acceptability of brief interventions before implementing new trials.

Aim: We aimed to explore the perceptions of individuals who self-harm towards a brief intervention, i.e., the Chinese version of the volitional help sheet (VHS-C), which encourages people to link a critical situation with an appropriate response.

Method: Fourteen participants who presented to hospitals with self-harm were interviewed about their perspectives regarding the acceptability of the paper- and web-based VHS-C. Data were analyzed using the framework method.

Results: The participants could understand the intended goal of the VHS-C by reading the written instructions but indicated that having verbal instructions would also help. They shared the reasons why they felt the VHS-C helpful (e.g., relatable contents, useful coping strategies, and appropriate instructions that made them feel understood) or unhelpful (e.g., being not specific enough, not useful during the crisis, and triggering negative emotional responses). Some indicated that the VHS-C might not be applicable to people experiencing ongoing distress in emergency departments. Most participants preferred the web-based to the paper-based VHS-C and suggested that the format and frequency of follow-up reminders could leave the users to decide.

Conclusions: The contents of the VHS-C were acceptable for people who presented to hospitals with self-harm. The VHS-C may be more helpful before individuals encounter suicidal thoughts than when they have an ongoing crisis.