What this article is about
In brief
Eleven adults interviewed after self-harm in Hong Kong described limited awareness of nearby social services, mixed experiences with follow-up, and the importance of counselling skill and trust. They suggested longer opening hours and services tailored to needs such as gambling and financial strain.
For nursing students
Study summary
Leung and colleagues interviewed 11 adults who had attended hospital after self-harm to understand how they viewed community health and social services in Hong Kong. The participants were 24 to 58 years old; two were men and nine were women. Interviews were conducted in a private meeting room and analysed by coding transcripts into themes.
The analysis organized service experiences around availability, accessibility, affordability, and acceptability. Six participants did not know which community services were available, and six did not know about services near their homes. People who had used services reported both helpful and discouraging experiences. Regular contact with a nurse or social worker and telephone support were valued, while some accounts described long waits, limited information, brief appointments, or interactions that lacked empathy.
Cost was not reported as a barrier to reaching nearby services in this sample. Participants placed greater emphasis on knowing where to seek help, attending during suitable hours, and trusting the person providing support. Suggestions included longer opening hours, more nursing involvement, combined health and social services, and focused help for gambling and financial strain.
These interviews describe experiences in one Hong Kong district rather than showing which service changes are effective. The small, predominantly female sample and possible interview and coding bias limit transfer to other populations.
Original publication
Source abstract and study details
Read the source abstract
Objective: This study aimed at exploring the attempters’ perception of community social services included any barriers to seeking help and services. Method: The participants were patients with self-harming behavior aged 15 years or above. A set of guiding questions were designed to explore the general barriers and accessibility to community social services. A voice recording was made, which was later converted into a text transcript and then preceded for content analysis with co-occurrence and similarity matrix interpretation. Two males and nine females with a history of self-harm aged between 24 and 58 years were recruited for the interviews. Result: The participants had diverse experiences and backgrounds, and attitudes toward community social services. However, there was a shared perception of the need to enhance community social services. There were four main themes and 12 sub themes identified. The main theme included the service availability, service accessibility, affordability and acceptability. For details, participants were unaware of the available types of care/social services in the community, and were unaware about the nearby social services. They also suggested extending service hours and focused services should be offered to help people with different backgrounds and needs. Actually, those with experience of service utilization had both positive and negative perspectives and they gave suggestions for service delivery, mainly extending service hours and offering focused services such as for gambling control and financial planning. In view of interaction with service providers, counseling skills and trust were highly appreciated by the participants. Conclusion: The results identified common circumstances of falling into financial hardship (gambling) and social fragmentation (divorce, poor family relationships, and poor marital relationships), which also suggested to enhance services on center location, service arrangement, and skill of caregivers. Keywords: Cognition, Community health services, Patients, Self mutilation
Reviewed findings
Main findings
- Six of 11 participants were unaware of the types of community care or social services available, and six were unaware of nearby services.
- Participants who had used services described both supportive contact and problems including long waits, insufficient information, short appointments, and interactions perceived as lacking empathy.
- All participants reported no financial implications in reaching nearby services; three reported private psychiatric follow-up.
- Participants suggested longer opening hours, services tailored to particular needs, more nursing support, and closer coordination of health and social services.
Using the findings
Practice considerations
- At discharge, clinicians can check whether a person knows which local service to contact and how to reach it; this addresses an information gap without assuming referral prevents recurrence.
- Service teams can use the accounts to review opening hours, waiting times, continuity of contact, and how options are explained.
- Counselling rapport and trust were valued by five participants, making the paper suitable for reflection rather than proof of an effective communication intervention.
For educators
Teaching and appraisal notes
This Hong Kong qualitative study offers a compact case for appraising service-user evidence after self-harm. Eleven adults completed semi-structured interviews, and the researchers used coded content, co-occurrence, and similarity analyses to organize perceptions into availability, accessibility, affordability, and acceptability.
A useful distinction is frequency versus importance. Six participants lacked awareness of service types or nearby services, five discussed staff skill and trust, and two raised specific concerns about the local centre’s accessibility. These counts describe interview coding; they do not rank causal barriers or predict service use.
Appraisal should focus on the guiding questions’ influence on themes, possible subjectivity in phrase-level coding, the small gender-imbalanced sample, and transfer from one urban district. Participant suggestions are not interventions proven to prevent repeat self-harm.
Critical appraisal
Limitations
- Eleven participants from one Hong Kong district provide a narrow account, and only two participants were men.
- The authors noted that semi-structured guiding questions could shape responses and leave important experiences unexplored.
- Coding phrases into categories may introduce subjective interpretation; the study did not evaluate whether suggested changes improve outcomes.
Classroom use
Discussion Questions
- How does not knowing a service exists differ from being unable or unwilling to use it?
- Which participant suggestions would require outcome testing before implementation?
- What information would you need before transferring these findings to a Canadian service?
- How might the interview guide and phrase-coding method have shaped the four themes?
Source-based questions
Frequently asked questions
Did participants describe cost as a barrier?
No. The authors reported inexpensive nearby transport, and three participants had attended private psychiatric services. That finding should not be generalized to other populations.