Purrble Use Among LGBTQ+ Young People With Self-Harm Experiences: Findings From a Qualitative Process Evaluation of a...

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, behaviors, 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; developed by Sproutel and Committee for Children), was recently evaluated when compared to treatment-as-usual (TAU) within a randomized controlled trial (RCT) with sexual orientation and gender identity minorities, that is, lesbian, gay, bisexual, transgender, queer, or questioning (LGBTQ+) youth, who had self-harm experiences. 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 contextualize trial outcomes.

This study aimed to explore and understand the engagement with and integration of the Purrble intervention using process evaluation interviews, considering its perceived influence on ER, mental health, and self-harm experiences.

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 semistructured online interviews. Interviews explored participant expectations of the RCT and Purrble; engagement and appropriation of Purrble; and perceived impact on mental health and self-harm. Thematic analysis was used to develop a thematic framework.

Four overarching themes were developed from the data. The first theme describes how participants used Purrble to ground themselves and manage distress, with participants suggesting de-escalation of their self-harm thoughts or behaviors. 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.

This process evaluation helps to contextualize how Purrble could be a helpful intervention for those LGBTQ+ young people with experience of self-harm thoughts and behaviors. This evaluation also clarifies when Purrble may not be helpful. These qualitative findings offer important contextual insights alongside the quantitative results of the related RCT.