# Co-Developing Content Updates for the Card Sort Task for Self-Harm–Digital (CaTS-D) With People With Lived Self-Harm Experiences: Pilot Study and Thematic Analysis

## TL;DR

Researchers developed and tested a digital version of a self-harm research tool, making it more inclusive and accessible.

## Contribution

A digital self-harm research tool (CaTS-D) was developed and validated with input from people with lived self-harm experiences, including LGBTQIA+ inclusivity updates.

## Key findings

- CaTS-D was found to be a feasible and usable web application for self-harm research.
- Thematic analysis identified 13 new cards to enhance the tool's relevance and inclusivity.
- Minor wording changes improved LGBTQIA+ inclusivity without overwhelming participants.

## Abstract

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 (Card Sort Task for Self-harm—digital; CaTS-D) 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 that lesbian, gay, bisexual, transgender, queer, intersex, asexual, and other minoritized gender and sexual identities (LGBTQIA+) people are at high risk. Updating CaTS is essential to ensure its relevance to both LGBTQIA+ and cisgender-heterosexual self-harm.

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

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

Study 1 found CaTS-D to be a feasible web application for use in self-harm research. VAS data showed no significant difference between pre- and poststudy mood (t9=1.59; P=.15). In Study 2, thematic analysis resulted in 13 additional cards (eg, “Before 6 mo;” “I don’t feel comfortable in my body;” “I was bullied on social media;” and “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 (ie, changing “boyfriend/girlfriend” to “partner”). While participants felt selective additions were necessary, too many may overwhelm participants. Therefore, future additions should be carefully considered.

Pilot-testing shows CaTS-D is a usable, feasible web application to examine self-harm and capture large datasets. Importantly, completing CaTS-D 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.