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social workers, self-harm, looked after children, children in care, NICE guidelines, mixed methods, protocol, implementation
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Lever G, Dowding D, Jeyasingham D and Armitage C. Protocol for a mixed methods study to examine social workers' implementation of national guidelines with children in care who self-harm [version 1; peer review: awaiting peer review]. NIHR Open Res 2026, 6:15 (https://doi.org/10.3310/nihropenres.14109.1)
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Study Protocol
Protocol for a mixed methods study to examine social workers' implementation of national guidelines with children in care who self-harm
[version 1; peer review: awaiting peer review]
PUBLISHED 16 Feb 2026
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Abstract
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Corresponding author:
Gill Lever
Competing interests:
No competing interests were disclosed.
Grant information:
This project is funded by the National Institute for Health Research (NIHR) under [GM-PSRC and ARC-GM (Grant Reference Number R128571*BE02, R123859 GA0701)].
The views expressed are those of the author(s) and not necessarily those of the NIHR or the Department of Health and Social Care.
The funders had no role in study design, data collection and analysis, decision to publish, or preparation of the manuscript.
Copyright:
© 2026 Lever G et al.
This is an open access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.
How to cite: Lever G, Dowding D, Jeyasingham D and Armitage C. Protocol for a mixed methods study to examine social workers' implementation of national guidelines with children in care who self-harm [version 1; peer review: awaiting peer review]. NIHR Open Res 2026, 6:15 (https://doi.org/10.3310/nihropenres.14109.1)
First published: 16 Feb 2026, 6:15 (https://doi.org/10.3310/nihropenres.14109.1)
Latest published: 16 Feb 2026, 6:15 (https://doi.org/10.3310/nihropenres.14109.1)
The views expressed are those of the author(s) and not necessarily those of the NIHR or the Department of Health and Social Care.
The funders had no role in study design, data collection and analysis, decision to publish, or preparation of the manuscript.
Introduction
Child self-harm, involving intentional self-poisoning or injury, irrespective of motivation (NICE, 2022a), in young people under the age of 18, is an increasing problem globally (Cairns et al., 2019; Griffin et al., 2018; McManus et al., 2019; Morgan et al., 2017). Care-experienced children, defined as children who have been in the care of the local authority for more than 24 hours (NSPCC, 2024) are at greater risk of self-harm (Stanley et al., 2005), with risk rates between two and four-fold higher than the general population (Evans et al., 2017; Hjern et al., 2004; Katz et al., 2011; Pilowsky & Wu, 2006; Stanley et al., 2005; Vinnerljung et al., 2006). Despite the evidence of elevated self-harm and suicide in care-experienced children, the assessment and management of self-harm in children in care is an under-researched area (Johnson et al., 2017).
The National Institute for Health and Care Excellence (NICE) guidelines on self-harm: assessment, management, and preventing recurrence (NICE, 2022a) aim to improve the quality and care of individuals who self-harm in all services and settings, including children in care. Although the guidelines are advisory and are not intended to supersede other national or local processes and procedures involved in safeguarding and decision-making, they should be fully considered when making professional judgments and in consultation with individuals, their families, and carers.
Most of the guidelines' recommendations reinforce best practices and do not require additional resources to implement if previous guidance has been followed (NICE, 2022a). NICE previously published guidance on self-harm in 2004 on the short-term management and prevention of recurrence (CG16) and long-term management (CG133) in 2011. The 2022 guidance, self-harm: assessment, management and preventing recurrence (NG225), updates and replaces the earlier versions.
A recent rapid review of the literature, conducted by this researcher, revealed an absence of research on if and how social workers are implementing the guidelines (Lever et al., 2025). Whilst NICE guidelines purport to be evidence-based, much of the evidence derives from clinical studies and may not be generalisable to other areas (Scullard et al., 2011), such as residential children's homes. This study addresses several gaps in the literature. Adherence to NICE guidelines on self-harm is an under-researched area, and to date, no studies on awareness/implementation rates of NICE (2022a) guidance on self-harm: assessment, management, and preventing recurrence (NG225) have been identified in the literature. This study investigates adherence to the NICE (2022b) guidelines: Self-harm: assessment, management, and preventing recurrence, which replaced the 2004 guidelines. Previous research has focused on adult self-harm and the implementation of the guidelines from health professionals.
This mixed methods study will provide insights into the management and prevention of self-harm in children in care. At present, it is unclear whether social workers of children in care, are aware of and implement the NICE guidelines on self-harm. Exploration of the barriers and facilitators to implementing the guidance with children in care by social workers offers a unique contribution to the knowledge base whilst addressing key limitations of the lack of diverse populations and sectors in the literature.
Methods
Here, we outline a protocol to explore social workers' knowledge of the NICE guidelines on self-harm and barriers and facilitators to implementation with children in care, using a mixed methods design. The research programme consists of two phases:
First, a large-scale survey of social workers’ awareness and implementation of the NICE guidelines on self-harm will be conducted. It is hypothesised that social workers will exhibit low levels of awareness and implementation rates of the NICE guidelines on self-harm. This is based on findings from the rapid review of the literature, which found that health professionals’ awareness and implementation of NICE guidelines on self-harm is low, a finding supported by the wider research literature demonstrating poor professional awareness of government policies and guidelines (Keyworth et al., 2018).
Analysis of the findings will inform the second phase of research. Rich, detailed data will be collated through semi-structured interviews and analysed using a framework for behaviour change.
Study design
This research involves a mixed methods study investigating children’s social workers' implementation of NICE guidelines on self-harm with children in care. Data from social workers who have worked with children in care who have actively self-harmed will be collated to gain a deep, multifaceted understanding of views and experiences and highlight potential barriers to NICE guideline implementation in this group.
Trauma-Informed approach
A trauma-informed approach to research takes account of the impact trauma has had on people's lives (Dowding, 2021). Social workers are at elevated risk of both primary and vicarious trauma. The helping professions generally attract people with significant life adversities (Newcomb et al., 2015), and "the negative effects of caring about and caring for others" (Perlman & Maclan, 1995, p.31) are well documented in the social work profession (Dykes, 2016; Esaki & Larkin, 2013; Peart, 2023; Sellers & Hunter, 2005; Thomas, 2016). The key principles of trauma-informed practice: safety, trust and transparency, choice, collaboration, and empowerment (Fallot & Harris, 2009) inform the research design, implementation, data analysis, and dissemination of the research findings.
Theoretical Domains Framework (TDF)
The TDF (Cane et al., 2012; Michie et al., 2005) integrates 33 theories of behaviour, incorporating 84 theoretical constructs of behaviour change and culminating in 14 distinct theoretical domains (1. knowledge, 2. skills, 3. social/professional role and identity, 4. beliefs about capabilities, 5. optimism, 6. beliefs about consequences, 7. reinforcement, 8. intentions, 9. goals, 10. memory, attention, and decision processes, 11. environmental context and resources, 12. social influences, 13. emotion, and 14. behavioural regulation). Its theoretical basis promotes the elicitation of beliefs in data collection (Dyson et al., 2011) and the identification of behaviour determinants that are instrumental in behaviour change interventions (Michie et al., 2005). The TDF is recommended as a framework for interviews to identify factors influencing behaviour (Michie et al., 2014).
Capability, Opportunity, and Motivation (COM-B) model of behaviour
The COM-B model consists of three interacting factors - capability, opportunity, and motivation - which must be present to generate behaviour (Michie et al., 2011). Factors influence one another, and a behaviour occurrence can result in changes to capability, motivation, and opportunity. The three key domains are further divided into six subdomains: physical and psychological capability, physical and social opportunity, and reflective and automatic motivation. The COM-B model is purposefully designed to be broad and flexible whilst being rooted in the scientific theory of behaviour implementation, ensuring its methodological rigour. The COM-B model of behaviour is widely used in public health and policy to identify which factors need to be targeted for a behaviour change intervention to be effective (West & Michie, 2020). Although the COM-B model is a distinct framework from TDF (Tomas et al., 2023), it is complementary (Fahim et al., 2020; Ojo et al., 2019), enabling the TDF to be condensed into its three key domains: capability, opportunity, and motivation. The TDF domains of knowledge, skills, memory, attention, decision processes, and behavioural regulation map onto capability. Environmental context, resources and social influences map onto opportunity, while intentions, goals, beliefs about capabilities, optimism, beliefs about consequences, reinforcement, social/professional role, and identity, and emotion map onto motivation.
Research questions
The study asks four research questions based on the research objectives:
Research Question 1: What proportion of children’s social workers in England are aware of the NICE guidelines on self-harm?
Research Question 2: What proportion of children’s social workers in England are implementing NICE guidelines on self-harm?
Research Question 3: Is there variation in social workers' implementation of NICE guidelines on self-harm according to (i) specialism, (ii) professional experience, (iii) workplace, and (iv) region?
Research Question 4: What are the barriers and facilitators to social worker's implementation of NICE guidelines on self-harm with children in care?
The mixed methods study will be conducted with social worker participants in England from February 2025 to April 2026. The research programme involves two phases:
Phase 1: Quantitative study
Research questions 1, 2, and 3 will be addressed through an online survey, in which social workers' knowledge, views, and experiences will be ascertained. Ethical approval for this study has been obtained from the University of Manchester Research and Ethics Committee (Ref: 2025-20361-39290)
Sampling & sample size
Purposive sampling will be used to recruit social worker participants for the survey study in phase 1 of the research. Participants will be recruited between February and December 2025. The recruitment strategy is multi-modal, comprising letter drops, advertisement on social media platforms, and the British Association of Social Workers (BASW) e-bulletin, to yield a large sample size, mitigate the margin of error, and produce meaningful results. Eligibility criteria are broad and include all children's social workers (and students of social work) practising in England. It is challenging to calculate a sample size due to the lack of available data on the number of social workers who work with children in care and how many of those children self-harm. Therefore, the assumption has been made that 10% of the 33,119 child and family social workers (FTE) practising in England (Community Care, 2024) will have worked with a child in care who has self-harmed in the past 12 months. This provides an ideal sample size of 345 with a 95% confidence interval and 5% margin of error.
Inclusion and exclusion criteria
Inclusion criteria are occupation as a Children's Social Worker or student of social work, practising in England, and having worked with at least one child in care who has actively self-harmed, within the last 12 months. Exclusion criteria are social workers practising in the devolved nations and outside of the UK and children’s social workers who have not worked with a child in care who has actively self-harmed within the last 12 months.
Data collection
An online survey is an efficient data collection method with the advantage of being rapid, inexpensive, and wide-reaching, surpassing geographic boundaries. Providing the opportunity for participant anonymity, online surveys also minimise the effects of social desirability (Burruss & Johnson, 2021). However, they tend to generate low response rates, typically below 20% (Fricker et al., 2005). In this study, we address this by offering an incentive to participate for the chance to win a £50 gift voucher through a prize draw. To mitigate against participants answering the survey more than once, IP addresses will be checked, and any multiple IP addresses that contain the same demographic information will be deleted.
The survey will explore children's social workers' awareness and implementation rates of NICE guidelines on self-harm in England. Children's social workers practise in diverse settings (including local authorities, NHS, charities, and the private sector) and specialties (including child and adolescent mental health services (CAMHS), child protection, fostering and adoption teams, learning disability, refugee and asylum seeker support) and have varying levels of experience within the profession, as well as of supporting children in care who self-harm.
The survey consists of 19 questions (three screening questions (1-3), two assessing awareness and implementation levels (4-5), and six assessing opportunity, motivation, and capability to implement the NICE guidelines on self-harm, adapted from Keyworth et al., 2020 (6-11) based on the COM-B model (Michie et al., 2011); a free response question asking participants if anything has helped or hindered NICE guideline implementation with children in care who self-harm (12); seven questions addressing demographic information (13-19): area of social work specialism, number of years of experience, regional area of work, age, ethnicity, gender and disability status). Items 16-19 ask about personal information of protected characteristics, constructed using Diversity and Inclusion Survey (DAISY) guidance (EDIS & Wellcome, 2022) and Sex and Gender Equity in Research (SAGER) guidelines (Heidari et al., 2016). These questions contain an optional response of “prefer not to respond.” 18 of 19 items are forced-choice questions, requiring participants to insert a response, meaning items cannot be skipped. Item 12, the free response text item, is the exception. The forced response pattern is to minimise the risk of missing data. All survey items were reviewed by a trauma-informed expert and public contributors with lived experience of self-harm to ensure language sensitivity and acceptability.
The survey will be implemented on the online Qualtrics system, which offers a range of accessible survey types and patterns. The Qualtrics platform provides easy-to-scan QR codes, facilitating instant access to the participant information, consent form and then survey from the advertisement (Burruss & Johnson, 2021). Qualtrics features an interactive interface so that responses to an item require completion before the delivery of the next item on the screen. This controls for skipping items and enables participant suspension and resumption of survey completion, which helps to reduce attrition rates (Couper et al., 2001; Wright, 2005). We have tried to reduce the burden on respondents, using a concise check-box fixed response survey to prevent the high attrition levels of long and time-consuming surveys (Burruss & Johnson, 2021). This design also eliminates blank and out-of-range responses (Couper et al., 2001). Another feature of Qualtrics that aids data validity is that it clarifies words and terms via pop-up information when the participant clicks on them (Burruss & Johnson, 2021). Skip patterns are also utilised in the survey design, so only questions applicable to each participant are displayed, and irrelevant items are automatically bypassed to reduce survey length and completion time. Furthermore, partial completion is minimised by using progress indicators, which enable participants to ascertain how much more of the survey remains (Burruss & Johnson, 2021; Couper et al., 2001). Information regarding partial survey completion also enables analysis of any trends at which survey abandonment occurs that could indicate a particular survey item being problematic (Couper et al., 2001). Patterns of participants' response times will also be analysed to identify items that may be unclear, as well as exceptionally rapid responses (Burruss & Johnson, 2021) that could be indicative of bots and undermine data validity.
Quantitative data analysis
Data from the large-scale survey will be analysed using IBM SPSS Statistics (V.25). Data will be exported from the Qualtrics platform into SPSS (V.25) for data cleaning and statistical analysis. Multiple responses from the same participant will be identified using the deduplication procedure for online surveys, as described by Konstan et al., 2005. This involves screening all completed surveys for duplicate internet service provider (ISP) entries and eliminating any surveys that contain identical ISP and demographic data (region, social work specialism, etc.). All data, including from partial survey completion will be included in the analysis. A descriptive analysis of participant characteristics will be generated from the survey data to summarise participants’ self-reported awareness and implementation of the NICE guidelines on self-harm. The sample's representativeness to the base population will be cross-checked against Social Work England data, and a chi-square will be performed to assess sample representativeness. The analysis will adjust for potential demographic confounders (region, etc.). Subgroup analyses (comparing social work specialism, etc.) will be performed to identify differences between groups in reported opportunities, capabilities, and motivations to implement the guidelines. This will be assessed using analysis of variance (ANOVA) or Kruskal-Wallis (if the assumptions of ANOVA are not met). We intend to perform multiple regression analysis to examine the association of COM-B variables with NICE guideline implementation.
Phase 2: Qualitative study
The data obtained from the survey of children's social workers with experience working with children in care who have actively self-harmed in the past 12 months will be used to inform the second study. Phase 2 of the research addresses research question 4, exploring the barriers and facilitators to social worker's implementation of NICE guidelines on self-harm with children in care, using semi-structured interviews.
Questions have been developed based on previous study semi-structured interview questions of health professionals (Leather, 2022; Leather et al., 2022; Leather et al., 2023). The semi-structured interviews comprising social work participants will be recruited during phase 1 of the research, whereby survey respondents will be asked if they are interested in taking part in a semi-structured interview. Eligible and interested participants will be contacted in January–February 2026. The sample size is determined according to Francis et al.’s framework for theoretically rooted interviewing. This framework sets an a priori minimum sample size of 10 and ceases data collection at the point when three interviews do not identify new themes (Francis et al., 2010).
Inclusion and exclusion criteria
Inclusion criteria are participants from phase 1 of the research (social workers, including students of social work) practising in England who have experience of working with children in care in the past 12 months, who have actively self-harmed in this time, who consented to being contacted about participating in the semi-structured interviews and audio-visual recording. Participants will be purposively selected to enable the spectrum of awareness and implementation rates to be systematically explored. Exclusion criteria are social workers who did not participate in phase 1 of the research, participants who did not provide consent to be contacted about participating in semi-structured interviews in research phase 2, and participants who did not consent to audio-visual recording.
Informed consent
Participants who match the inclusion criteria will be sent an email with the participant information sheet inviting them to participate in semi-structured interviews. Participants will be given at least seven days to consider the information and provide informed written consent to participate in audio-visual recorded interviews via Microsoft Teams.
Data collection
Semi-structured interviews are an effective methodology for collecting data on attitudes, perspectives, and experiences (DeJonckheere & Vaughn, 2019). They have the advantage of generating comparable data, whilst affording flexibility to probe further insights from individual responses (Knox & Burkard, 2009). The use of online semi-structured interviews has increased in recent years (Lobe et al., 2022), and lessons have been taken from some of the challenges encountered. As unfamiliar technology can present a challenge for both participants and researchers (Lobe & Morgan, 2021), we shall conduct interviews using the platform Microsoft Teams, which Local Authorities, the NHS, and the third sector widely use. Thus, participants are expected to be familiar with this platform. However, we take the precaution of offering a 5–10-minute pre-session with all participants to address technical issues and ethical considerations, as well as the provision of a software guide.
Whilst the flexibility of online interviews enables participants to be interviewed in their home environment, this risks greater distraction and third-party influence/compromised confidentiality (Rahman et al., 2021; Saarijarvi & Bratt, 2021). We mitigate this challenge by following the recommendations for online interviewing described by Saarijarvi and Bratt (2021) by sending participant information a week in advance and resending it the day before the scheduled interview. This will contain the interview questions (provided in advance, in accordance with a trauma-informed and neuro-affirmative approach), a digital link to the interview, and interview preparation advice (to enable video-camera on a computer/smartphone; ensure stable wi-fi connection; ensure there is a private, quiet, and calm environment for the duration of the interview). All participants will be encouraged to wear headsets to reduce background noise and enhance audio quality, whilst also promoting privacy and confidentiality. At the start of the interview, the researcher will check with participants that they are in a safe and quiet environment with minimum distractions.
Online interviews have several advantages, eliminating travel time and costs for both the researcher and participants and enabling a widely dispersed sample for inclusion (Keen et al., 2022; Lobe et al., 2022; Saarijarvi & Bratt, 2021), as well as better access for participants with disabilities (Williams et al., 2018) and caring responsibilities (Henderson & Moreau, 2020; Horrell et al., 2015). Participants also have choice over their environment, promoting psychological safety. As semi-structured interviews have time-sensitive components, the timings of each item can be effectively monitored on screen, more discreetly than in person, reducing the risk of appearing distracted (Keen et al., 2022).
The duration of the semi-structured interview is 45–60 minutes. With participants’ written consent, the semi-structured interview will be audio-visually recorded. Participants are explicitly informed in advance and at the beginning of the semi-structured interviews that there are no right or wrong answers. The confidentiality statement will be read out at the beginning of the semi-structured interview and repeated at the end. Participants will be reminded of their right to withdraw at any time without needing to provide a reason. Whilst the researcher will be vigilant for signs of participant distress and will offer breaks, emotional support, and the option to cease the interview, it is acknowledged that it can be more difficult to detect and respond appropriately to signs of participant distress in the online forum (Lobe et al., 2022). However, cues can be drawn from intonation and facial expression (Saarijarvi & Bratt, 2021), and participants have more agency to withdraw than they would in physical face-to-face interviews, where there can be greater implicit demand to continue, by terminating the interview with the click of a button (Lobe et al., 2022; Thunberg & Arnell, 2021).
A provisional semi-structured interview schedule is derived from the COM-B, to assess key determinants of behaviour and is informed by questions used in previous research exploring health professionals' implementation of NICE guidelines on self-harm (Leather et al., 2022; Leather et al., 2023). The interview schedule includes a range of open-ended questions to encourage social work participants to provide detailed accounts of barriers and facilitators, affecting their knowledge of, and implementation of the NICE guidelines on self-harm with children in care. As non-verbal cues are more limited in the online forum (Lobe et al., 2022), we anticipate increased use of verbal prompts. Prompts related to TDF domains have been developed, as Michie et al. (2014) recommended, which will support fluidity and aid engagement. To support the spontaneity of interaction in the online environment, participants will be instructed not to use the mute function unless they are experiencing background noise (Van Voort et al., 2023).
The semi-structed interview consists of ten questions, relating to the COM-B constructs. Questions are framed in relevant language, as Atkins et al. (2017) recommended, and items are purposefully structured to facilitate logical and continuous fluidity, emulating typical conversation (Rubin & Rubin, 2005). Questions and prompts were reviewed by a trauma-informed expert and public contributors with lived experience of self-harm to ensure language sensitivity and minimise the risk of re-traumatisation. We incorporate an open final interview question, asking, “Is there anything that we have not covered that you feel is important/relevant?” to mitigate the risk of issues that are important to the participant being neglected (McGowan et al., 2020). Field notes will be made during and following the semi-structured interviews, as well as during data analysis. These are for debrief and reflexivity purposes and will not be included in the data analysis. Additional supervision will be set up during the data collection phase to reflect on and discuss researcher perceptions, experiences and reactions, to support impartiality (Holloway & Galvin, 2017) and researcher resilience (Dowding, 2021; Silverio et al., 2022).
Qualitative data analysis: Framework analysis
Data from the semi-structured interviews, in phase 2 of the research, will be audio-visually recorded and transcribed verbatim and analysed using framework analysis (Ritchie & Spencer, 1994) in the computer-assisted qualitative analysis software, Nvivo v.14. Participant names will be replaced with pseudonyms to protect identities.
Framework analysis is a versatile method that can be adapted for use with many qualitative approaches (Gale et al., 2013). It offers a systematic and transparent approach to data analysis, encapsulating thematic analysis and describing data patterns (Ritchie & Lewis, 2003). Framework analysis identifies data similarities and differences and relationships between data, enabling both descriptive and explanatory conclusions to be drawn (Klingberg et al., 2023). The coding framework for analysis is developed using the TDF, as advised by Atkins et al. (2017).
Framework analysis will facilitate the interpretation of diverse views and experiences and enable systematic identification of areas of similarities and differences within and between children's social workers, encountering children in care who self-harm. Rich insights into the influence of personal and organisational factors on the management of self-harm in children in care and its impact will be drawn. Framework analysis is well suited to semi-structured interviews since its matrix output provides a structure for analysis by participants and code. In this way, the views of each participant are connected within the matrix, and the context of individual views, patterns, and nuances is apparent (Klingberg et al., 2023).
The semi-structured interview data will be analysed according to the five stages of framework analysis adapted from Gale et al., 2013, to systematically identify facilitators and barriers to NICE guideline implementation.
Stage 1: Data Immersion Audio-visual recordings and verbatim transcriptions of the semi-structured interviews will be observed repeatedly for data immersion.
Stage 2: Familiarisation Initial thoughts and impressions will be recorded on the transcripts.
Stage 3: Coding & Indexing Predefined codes, based on the TDF, will be applied to describe interpretations of the data.
Stage 4: Charting Data into the Framework Matrix Data will be charted by summarising it by category into the matrix. Illustrative quotations will be tagged in Nvivo v.14 onto the chart.
Stage 5: Interpreting Researchers will journal ideas, insights, and early interpretations and discuss these regularly. Analytic memos will be used to stimulate discussion, as described by Charmaz (2006). A collaborative approach to the analysis will be endorsed. Two researchers will analyse the transcripts independently. Any disagreement will be resolved by discussion with the wider research team. Codes and themes will be documented in key domains. In this final stage, commonalities and differences will be identified, connections between categories mapped, and descriptive and/or explanatory interpretations will be generated. If the data is rich enough, predictions can be made about the extent to which the guidelines are likely to be implemented in distinct conditions.
Gale et al. (2013) caution that the final phase of framework analysis, interpreting the data, is time-consuming, often taking longer than expected. Accordingly, additional sessions are set aside should they be needed for sufficient data interpretation. Researchers will be flexible and adaptive to enable the generation of rich and nuanced insights. Critical reflection is a core feature throughout the research process in recognition that how qualitative research is conducted and analysed is inevitably influenced by researcher characteristics. The researcher will keep a journal to record reflections, insights, ideas, impressions, and early interpretations about the research and analysis, as Gale et al. (2013) recommended. Academic supervision and examination of journals/field notes documenting the researcher’s perceptions of the interview process and their emotional responses will promote objectivity and help to minimise the risk of researcher bias, influencing data interpretation (Cowles, 1988) as well as supporting researcher resilience and wellbeing (Dowding, 2021).
We are mindful that qualitative explorations of behavioural determinants, influences, and experiences should be flexible and open to identifying all emergent ideas and themes (Layder, 1993; McGowan et al., 2020). Although we use a predominantly deductive approach, whereby data is coded into TDF domains, inductive content analysis will be applied to emergent sub-themes within each TDF domain as per guidance from Atkins et al. (2017). We will apply the coding, as described in Arden et al. (2019), whereby two researchers independently code under the TDF domain that best matches the data, and instances where data relates strongly to multiple TDF domains will be coded in all that apply. As the evidence indicates that some TDF domains measure an amalgamation of factors rather than distinct behaviour (Huijg et al., 2014), double coding should enhance the identification of related themes and domains. Data under each domain will then be subjected to inductive content analysis to create sub-themes, identified according to the procedure outlined by Atkins et al. (2017) when: mentioned by several participants; participants report conflicting beliefs and experiences; or there is strong importance expressed that may affect the target behaviour. Any discrepancies in coding will be discussed and resolved using the wider research team.
Patient and Public Involvement
A Social Worker Advisory Panel (SWAP) comprising three children and family social workers was formed to guide the research process. They reviewed the research materials, provided feedback on the recruitment strategy, advised on trauma-informed practices, and promoted the study within their networks. Public Contributors with lived experience of self-harm at the National Institute of Health and Care Research (NIHR) Patient Safety Research Collaboration (PSRC) Greater Manchester (GM) provided feedback on the equality impact assessment, reviewed the research materials, and advised on trauma-informed processes.
Ethics and dissemination
Ethical approval for the online survey study was granted by the University of Manchester Research Ethics Committee on 29 January 2025 (Ref: 2025-20361-39290). Participants provide implied consent. Participants are required to provide full, informed written consent to data collection for the semi-structured interviews. Initial approval from the Research Ethics Committee (REC) is currently being sought. Manuscripts with the results of the survey and semi-structured interviews will be submitted for publication in peer-reviewed journals. Findings will also be showcased at conferences and public engagement events.
Conclusion
This mixed methods study of social workers’ implementation of the NICE guidelines on self-harm with children in care will provide information about the proportion of social workers who are presently aware of and/or implementing the guidelines, as well as insights into social workers’ opportunities, capabilities, and motivation for doing so. The findings will add to the evidence base on NICE guidance on self-harm implementation, extending knowledge to the social care sector and vulnerable groups. The results of this study will inform the development of interventions aimed at improving the quality of care and support of children in care who self-harm.
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Lever G, Dowding D, Jeyasingham D and Armitage C. Protocol for a mixed methods study to examine social workers' implementation of national guidelines with children in care who self-harm [version 1; peer review: awaiting peer review]. NIHR Open Res 2026, 6:15 (https://doi.org/10.3310/nihropenres.14109.1)
NOTE: If applicable, it is important to ensure the information in square brackets after the title is included in all citations of this article.
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