Table 3.
Parent reflections on the acceptability of PiP-SP+, including feasibility and validity
| TFA construct: definition | Subtheme of TFA construct | Illustrative quote |
|---|---|---|
| Affective attitude (acceptability): ‘How an individual feels about the intervention’ | Positive feedback | ‘I was super impressed with it – like it’s awesome… I’m just so grateful that we had this opportunity to be a part of it.’ P5 |
| Challenging to provide feedback for improvement | ‘I’m just trying to think if there was anything negative… oh, I wish I could give you something, but I can’t.’ P7 | |
| Programme structure | ‘I really like the structure of the programme. I really enjoyed the fact that there was a tailoring aspect to it and [coach] … it felt quite very cohesive.’ P10 | |
| Confronting and emotionally challenging topic | ‘Suicide and attempts at suicide, and your kid, your son, whoever your child is, saying that they don’t want to be here… It [PiP-SP+] was good. It was beneficial. But yeah, still, still tough.’ P6 | |
| Perceived effectiveness (validity): ‘The extent to which the intervention is perceived as likely to achieve its purpose’ | Increased parental self-efficacy in responding to adolescent’s suicidal thoughts/behaviour | ‘I can see things escalating and step in before it gets to that really suicidal stage if that makes sense. And then yeah, if she gets, if it does escalate to that point where I feel that she might be thinking along those lines, then I can step in, and I’m confident that I can say the right things and discuss it with her. Whereas before I, you know, was never sure.’ P4 |
| Increased parental self-efficacy in responding to adolescent’s non-suicidal self-injury | ‘I was completely oblivious to self-harm and how it relates and so it [PiP-SP+] gave me a bit more confidence in terms of where is she at with it.’ P5 | |
| Noticeable changes in parenting | ‘The conversation that I then had with [adolescent], I run it so differently now… It was chalk and cheese to what would normally happen… it was amazing. At the end of the conversation [adolescent] was just like, ‘Oh, thanks Mum. That was really helpful”.’ P10 | |
| Noticeable changes in adolescent | ‘Self-harm has definitely been reduced a lot. … I find she’s more resilient at the moment, like just little things she’s done. I’m like, “okay, normally, she would have kind of fallen down in a situation like that“.’ P3 | |
| Increased parent’s hope for their adolescent’s recovery | ‘I felt like before I was always waiting for something bad to happen. And always being quite depressed about that… I’ve seen, you know, how I respond to things helps [adolescent] get over it and get, get over those crisis points, I do have a lot more hope now.’ P7 | |
| Helped parent implementation of knowledge | ‘I’ve heard a lot of stuff before. But I just wasn’t good at applying it at all, like, so I found it [the programme] was really good with my skill building.’ P8 | |
| ’Adolescent responses were unexpected and beyond parent’s control | ‘I do think I know what to do, but then it’s the response from [adolescent] that is what throws things off… I could do that [PiP-SP+ strategy], but my child would not answer me back that way. You know, like no matter what would be said.’ P11 | |
| Unable to attribute individual effects to PiP-SP | ‘I don’t know if it’s the programme, or just how things have eventuated - that things have gotten better while we’re doing the programme. Look, it’s probably a combination of both.’ P3 | |
| Intervention coherence (validity): ‘Extent to which the participant understands the intervention and how it works’ | Clear understanding of the intended effects of PiP-SP+ | ‘Everybody was always quite kind of clear on you know what it, what it was for and what it was going to be, and stuff like that.’ P2 |
| Parents were initially unsure of what to expect of programme | ‘I don’t know if I had any expectations, to be honest, I didn’t know what to expect.’ P3 | |
| Ethicality: ‘Extent to which the intervention has a good fit with an individual’s value system’ | Appropriate to parents | ‘Absolutely appropriate with regards to all of those things… my whole yeah attitude towards parenting it definitely did fit.’ P4 |
| Relatable to parents | ‘The content itself like there were a couple of times where it brought me to tears. I could really relate.’ P1 | |
| Tailored to parents’ individuality | ‘Sometimes I needed more time to stay with one area. But that was kind of something that we worked out between [coach] and I.’ P9 | |
| Consider adaptation to underserved parents | ‘Somebody who is vision impaired how would they engage? Someone who is hearing impaired, how would they engage? … I can imagine that parents with a disability just have, you know, one more layer of complexity in their life.’ P1 | |
| Burden (feasibility): ‘Perceived amount of effort that is required to participate in the intervention’ | Effort was reasonable and worthwhile | ‘It’s like anything that’s worth it. It takes an effort, but it’s worth it… It’s like a drop in the ocean compared to what benefits it can do - save your kid’s life. So, the effort, it is fine.’ P8 |
| Programme was flexible to parents’ needs | ‘I thought the programme was very flexible. I didn’t sort of spend my time doing things that weren’t really relevant to me.’ P1 | |
| At times challenging to complete with competing life demands | ‘It wasn’t something that I wasn’t looking forward to and didn’t want to do or that it was arduous for me to do. It was just I just hadn’t found time in my week to do it.’ P5 | |
| Opportunity costs (feasibility): ‘Extent to which benefits, profits or values must be given up to engage in the intervention’ | No opportunity costs, only benefits | ‘It was opposite. You know I got from it rather than it took.’ P7 |
| Interfered with parents’ work commitments | ‘What was very difficult for me was not being able to engage with the programme outside of work hours. I don’t know how a kind of person who works at the intensity that I work… to take time away from work on top of everything else.’ P1 | |
| If a financial cost was associated, this would be challenging | ‘If, you know, somebody had to pay to do this programme… Counselling, you know, privately is expensive enough. But if you want to try and help your family as well… I think if there was a cost involved, it probably might be difficult.’ P6 | |
| Confidence in completing programme a (feasibility): ‘Participant’s confidence that they can perform the behaviour required to participate in the intervention’ | Confidence in completing programme requirements | ‘I was confident. I thought it would be fine. And I did complete it [PiP-SP+].’ P11 |
| May benefit from further opportunities for behaviour implementation | ‘What came out was sometimes I needed more time to stay with one area… when you look at it for the time that you had to learn… have a coaching session about it, making goals, and then having the week to see how you can implement it… a week can go really fast. And you think “you know what? I haven’t really even tried to do that” or “I didn’t take any opportunities to do that”.’ P9 | |
| Additional acceptability subthemes | Parent’s hope for wider implementation of PiP-SP+ | ‘I would love to see this rolled out everywhere, to anyone who shows up in an emergency department with a teenager who is going through this crisis… Because, as I said, we got nothing when we went to the emergency department… It was really hard, and we were just floundering and not knowing what to do and where to go… I just wish that everyone who was going through the horrible time that we went through could have the same result.’ P5 |
| Parents could benefit from a follow-up booster session | ‘A check-in would be something that would be really helpful… just tap in to go, “how are you going? Have you, have you been giving any new ones a go, or is there any questions you want to ask?” That might kind of just remind you to keep on track.’ P9 | |
| Consider the inclusion of a secondary caregiver | ‘There’s two parents, and it’s just one parent going to the programme. Getting the buy in from the other parent to go along with that goal sometimes can be difficult.’ P7 | |
| Parents’ increased sense of advocacy and peer support | ‘Doing that [the programme] also raises the awareness amongst the people I talk to as… It’s taboo when you start talking to people about it. But having done this programme, it enabled me to be up to talk about it with them.’ P7 |
TFA, Theoretical Framework of Acceptability; PiP-SP+, Partners in Parenting Plus – Suicide Prevention.
a.
The construct ‘confidence in completing the programme’ was originally called ‘self-efficacy’ in the TFA. 31 It was renamed here to clearly distinguish between parental self-efficacy in responding to their adolescent’s suicidal thoughts and behaviours and their self-efficacy in completing programme requirements.