Abstract
Background: Self-harm is highly prevalent among university students, but very few students receive professional support for it. People who self-harm face several barriers to accessing support, such as stigma and long waiting lists. To help overcome these barriers and provide more students with support for self-harm, alternative options must be explored. Research has shown that apps can be effective and acceptable for students struggling with various mental health issues, such as anxiety, depression or stress, but this was yet to be investigated for self-harm specifically. This thesis outlines four sequential studies that wereundertaken to assess the feasibility and acceptability of a self-help smartphone app for students who self-harm.
Methods: Through the lens of pragmatism, multiple and mixed methods were used in this project to address the research objective, with each study informing the next. The first study was a scoping review of mHealth interventions for self-harm to identify the most appropriate app to evaluate with a university population. This review unveiled BlueIce as the most appropriate option. In the second study, 25 students were interviewed about their opinions towards interventions and support for self-harm, including digital interventions, and they were also shown screenshots of BlueIce to gauge initial acceptability. In study
three, the safety and acceptability of BlueIce were evaluated with 15 students attending student services, where it was provided alongside treatment as usual. Pre and post measures and follow-up interviews were used for the purposes of triangulation. Finally, to explore the feasibility of delivering BlueIce within the general university population and to explore whether it could be helpful for students, BlueIce was made available to any student at the university to download anonymously via an online platform. 88 students downloaded BlueIce, and 27 completed baseline and follow-up measures.
Results: The scoping review found no apps for students who self-harm, but BlueIce was highlighted as the most appropriate app to trial. Students interviewed in the second study corroborated findings that they do struggle accessing professional support. They were also enthusiastic about BlueIce and thought it would be appropriate for students. When BlueIce was trialled in the third study, participants further endorsed the perceived acceptability of BlueIce. Moreover, BlueIce was determined to be safe for students as there were no adverse events or increase in symptom scores on mental health measures, and students reported that it had no negative impact on their wellbeing. In the final study, scores on participants’ measures of anxiety, depression and self-harm urges significantly decreased, and coping self-efficacy and positive coping strategies significantly increased, indicating the app could feasibly be a helpful source of support for students.
Conclusion: No previous research had evaluated an app for students who self-harm. This project found that students struggle to access professional support for numerous reasons and, consequently, digital interventions are appealing due to their anonymity and convenience. BlueIce specifically was typically perceived by students to be helpful for learning ways of coping with difficult emotions and managing distress. BlueIce was also found to help improve symptoms of anxiety and depression, as well as reducing self-harm urges. However, some students were not motivated to use it and preferred other types of support such as professional services. Overall, BlueIce can be a valuable tool for some students and should be offered as well as other types of support and resources.
| Date of Award | 24 May 2023 |
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| Original language | English |
| Awarding Institution |
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| Supervisor | Paul Stallard (Supervisor) & Emma Rich (Supervisor) |