The Acceptability of a Smartphone App (BlueIce) for University Students Who Self-harm

Figures & data

Table 1. Participant demographic information.

Demographic	N (%)
Age
18–20	16 (64%)
21–23	6 (24%)
24+	3 (12%)
Gender identity
Female	20 (80%)
Male	4 (16%)
Non-binary	1 (4%)
Year of study
1	10 (40%)
2	10 (40%)
3	2 (8%)
4	2 (8%)
Degree type
Undergraduate	21 (84%)
Post-graduate	4 (16%)
Ethnicity
White	20 (80%)
Asian/Asian British	4 (16%)
Mixed	1 (4%)
Sexuality
Heterosexual	14 (56%)
Bisexual	9 (36%)
Gay/Lesbian	1 (4%)
Queer	1 (4%)
Self-harm status
Past self-harm	20 (80%)
Current self-harm	5 (20%)

Table

Code	Code title	Description	Examples
Distract	BlueIce as a useful distraction tool	BlueIce is a useful distraction tool to help the person stop thinking about/disengage from thoughts about self-harm.	“It’s got everything you might need to sort of, disengage yourself from those thoughts”
Therapeutic techniques	BlueIce gives you access to therapeutic techniques and coping strategies	BlueIce helps to distribute skills and techniques typically found in therapy and other support from mental health professionals. It also helps individuals learn/practice coping strategies and skills. This code can also include the individuals rating a therapeutic component of the app as positive, e.g., self-harm alternatives or mindfulness.	“I think like if you’ve already had DBT or CBT, or your sort of in the process of getting those, all these things kind of interlink to those like activities that you would do in those therapies and stuff” “Make it easier to access your other coping strategies is super good”
Not useful	Students thinking that BlueIce wouldn’t be used or useful	The individual wouldn’t use BlueIce for any reason, e.g., thinking it wouldn’t help or forgetting to. This could be in the moment or more generally.	“When you’re thinking about something and your head’s going crazy, I wouldn’t go on my app and log the thing”
Usefulness/impact	BlueIce as a useful tool	BlueIce is useful as it can provide support in moments of distress or of crisis, where the person is at risk of self-harming or is greatly troubled by thoughts of self-harm. It can also include more general references to students saying they would use this, or that it would be helpful for other students. This also includes references to the potential impact of BlueIce and it being useful for the university.	“That would be really useful for in the moment” “It would definitely be one of those things that people remember and think to come back to if they do need help.” “I think this has the potential to help a lot of people”
Appropriate	BlueIce’s appropriateness (or lack of) for university students	Individuals discussing whether they think BlueIce would be helpful for university students as a specific population, i.e., whether they think it will be helpful or not. This can also include references to its age appropriateness or whether it can offer tools that would be particularly helpful for students.	“All of those things are really important for any age group”
Accessible	BlueIce is accessible	This includes discussions of the ease of access/use of BlueIce, as well as its ability to reach a wider audience due to no limits to its access (e.g., no limit to downloads).	“Everyone has a phone nowadays, and has their phone in front of them, so I think it’s a good idea.”
Good feature	Specific feature highlighted positively	As above, this might need breaking down further to specify certain features, but at the moment it includes any reference to a specific element of BlueIce that people perceived positively (e.g., mood tracker, helplines)	“I think that the mood tracker is quite good”
Design	Design or layout praised	Participants not necessarily mentioning a specific feature, but commenting more generally on liking the way the BlueIce is laid out, the colors, the design, it being simple or straightforward	“It’s very ordered, it’s very simple and clear, and it’s like, really organized which I really like”
No negatives	No negatives	People saying that there’s nothing they dislike about the app.	“I think it all looks good to be honest. I think it’s all fine.” “There’s nothing I don’t like really”
Safe	BlueIce is safe to use/would do no harm	People specifically mentioning that they think BlueIce is safe for students to use, and/or that it would do no harm.	“BC: Do you think there’s any possibility that this could do any harm rather than good? 25: Umm, I don’t think so”
Autonomy	BlueIce promotes autonomy and self-help	Participants discussing how BlueIce is good because it allows them to practice self-help and allows them autonomy.	“It’s like building your own self soothing”
Gap filled	BlueIce fills gaps from other support that is hard to access	References to BlueIce providing things that other interventions cannot, including references to long waiting lists for services, difficult application processes, and other inconveniences. May overlap with accessibility.	“Something you can use in the meantime while you’re on waiting lists and stuff like that” “I know there’s quite long waiting times to get face to face support, and of course if you’re like meeting someone like once a week for an appointment, obviously then there’s a bit of a wider time frame for when stuff might be happening” “It provides you with something quite immediate which is really good that you can access straight away without having to wait around for your next session with student services and stuff like that”
Overall positive	BlueIce perceived positively	More vague reference to liking BlueIce as a whole, with no specific reason as to why, such as it being accessible, useful, appropriate, or any specific features mentioned.	“Yeah I think it looks good, I do think it looks good”
More support needed	Acknowledgement of importance of encouraging people to seek further support if necessary	Individuals saying that BlueIce would not be enough by itself for some people (e.g., people who self-harm “more severely” or who have been self-harming for a long time, and that it is not a replacement for other support so individuals should still seek professional help as well. Also includes references to people saying BlueIce should be used alongside other support, not by itself.	“Obviously also like make sure services are advertised” “I think like if it’s going on for a long time then obviously there’s a lot more going on and I think in that case like, probably seeking professional support is always the best way.”
More support needed: human contact	Human contact specifically is important	Participants mentioning that BlueIce is bad specifically because it lacks the element of human contact which they perceive as important.	“Not even face to face but just the availability of someone to talk to”
Individuality	Acknowledgement that different individuals want different support	References to there not being a “one size fits all approach” and that some things work for some people and not others. This is slightly different to the 2 codes above which focus more on whether BlueIce would be appropriate by itself, whereas this code is more about acknowledging that different people want different things out of interventions/acknowledging that different people may disagree with their point of view.	“You can’t have it perfect for everyone, some people like certain parts, some people won’t. You’ll never get everyone satisfied” “I can only speak for me personally”
Implementation: Strategy	Advertising/implementation strategy	Suggestions or ideas for how and where to advertise BlueIce, e.g., on the website, on campus, posters, etc.	“Around campus, or like, you know in student services and stuff like that, or in fresher dorms and things like that, people would see it” “The university website for that kind of support is really important”
Implementation: Trigger warning	Does BlueIce need a trigger warning	The participant discussing whether or not they think a trigger warning is needed for advertising BlueIce.	“But yeah I think having a trigger warning before writing about what it is um, you know, let’s say if it’s on the Instagram story for example to promote it, like having a trigger warning on the page before and then having it would be really helpful and I think it definitely would reach the people that it would need to reach.”
Implementation: Standalone	BlueIce working as a standalone intervention	Any reference to BlueIce being able to be used by itself, as a standalone intervention with no other support—and this being safe and appropriate to do.	“I think it would be really useful on its own.”
Implementation: 1st step	BlueIce as a first step/stepping stone to other support	BlueIce being perceived as something for individuals to use while on a waiting list, or while they are not yet able/willing to seek professional support. Also includes references to it helping people develop the confidence to seek other support. Also includes references to it perhaps being used by individuals with “lower level” self-harm or who have recently started self-harming.	“I think this is good for like a first step thing to get yourself to the place of actually being able to talk to a professional”
Implementation: Wider use	Wider application of BlueIce (e.g., not just for self-harm)	Participants discussing that BlueIce shouldn’t just be advertised as/limited to just helping self-harm, and that it may also be beneficial for people struggling with low mood, anxiety, etc.	“Even if there’s someone like, this is a really broad example but, someone does think that maybe they have a mood disorder or something without having been diagnosed, if this is something that helps them deal with those symptoms, then I think this would be useful”
Barrier	Barriers to using BlueIce/concerns around using BlueIce	Anything a participant discusses as a barrier to using BlueIce, including concerns around safety/security, stopping someone from seeking further support, mood tracker making things worse, not being motivated enough, etc.	“The possibility that people use it and not access the support that they really need” “I would say is that if you are feeling shit, how many times would you kind of go and kind of, log it?”
Changes	Suggestions for changes to the app	Participants suggesting features that could be added or things that could be changed to improve BlueIce	“One thing I think would be helpful, but I don’t know if this would work for other people, is um, if, you were able to specify what sort of behaviors you had engaged with so the app was almost tailored to your sort of, self-harm”