Application of the theoretical framework of acceptability in a surgical setting: Theoretical and methodological insights

The Swedish theoretical framework of acceptability questionnaire: translation, cultural adaptation, and descriptive pilot evaluation

BACKGROUND

Successful complex healthcare interventions require evaluations of acceptability. Acceptability is suggested to impact intervention implementation, uptake, adherence, intended outcomes, and overall effectiveness. Namely, interventions that are not acceptable to those delivering or receiving them may hinder the key components from being delivered as intended or the recipients from engaging with the interventions as required. However, no validated questionnaire that evaluates acceptability was found in Swedish.

METHODS

We translated the generic Theoretical Framework of Acceptability questionnaire into Swedish, culturally adapted it, and conducted a descriptive pilot evaluation of its psychometric properties. The process involved iterative translation and cultural adaptation following the COSMIN checklist. The questionnaire underwent a forward-backwards translation and an evaluation of face and content validity by an expert panel of researchers. Thereafter, the face validity and comprehensibility of the translated version were evaluated using cognitive interviews and the think-aloud technique; this process was carried out in two rounds of interviews, each with a lay panel of healthcare professionals comprising intervention deliverers and receivers. Lastly, the Swedish version was piloted on 16 Swedish healthcare professionals who had received an educational intervention.

RESULTS

The evaluations of face validity, comprehensibility, and the descriptive pilot evaluation indicate a successful translation, cultural adoption, and usability of the Theoretical Framework of Acceptability questionnaire. The evaluation of content validity showed some problems with the validity of the scale and 7 out of 10 items was below threshold values.

CONCLUSIONS

Overall, the Swedish Theoretical Framework of Acceptability questionnaire seems like a useful brief screening tool for the acceptability of healthcare interventions. The translation process revealed unresolved issues with content validity, possibly explained by the previously reported lack of consensus on the meaning of 'acceptability'. Complementing free text answers or interviews could strengthen the understanding of any unclear questionnaire elements. Our findings support the generic Theoretical Framework of Acceptability questionnaire developers' recommendations of continued cognitive interviewing and psychometric evaluations in any new setting. In addition, we recommend cross-measure validation between the existing acceptability questionnaires to help further refining the measurement of acceptability.

Acceptability of a physiotherapy-led intensive prone positioning service in intensive care: A qualitative study with multidisciplinary clinicians

BACKGROUND

The coronavirus disease 2019 (COVID-19) pandemic resulted in an increased number of patients with COVID-19-related respiratory failure requiring prone positioning. To reduce pressure on nursing and medical staff in the intensive care unit (ICU), a physiotherapy-led intensive prone positioning (PhLIP) service was implemented.

OBJECTIVES

The aim of this study was to explore the acceptability of the PhLIP service from the perspective of nurses and doctors working in the ICU and the physiotherapists who delivered the service.

METHODS

A qualitative evaluation was conducted using semistructured interviews and focus groups, guided by the theoretical framework of acceptability (TFA). Participants included doctors, nurses, and physiotherapists who interacted with or delivered the PhLIP service.

RESULTS

A total of 19 interviews (eight doctors and 11 physiotherapists) and four focus groups (13 nurses) were conducted. Eleven themes were identified within the eight domains of the TFA. Overall, the PhLIP team was highly valued and appreciated (TFA: affective attitude); enabled high-quality care and improved ICU efficiency (TFA: perceived effectiveness); reduced risks to patients and staff (TFA: perceived safety and risk); and was empowering for the clinicians involved (TFA: self-efficacy). Being in the PhLIP team was physically and mentally exhausting, and the service put strain on the physiotherapy department due to reallocation of staff (TFA: burden). Having trust in the physiotherapists leading the prone positioning service was a key influence on nursing and medical acceptance of the service.

CONCLUSION

The PhLIP team delivered an acceptable service that improved clinical care and efficiency during the COVID-19 pandemic. Other ICUs should consider the availability, skills, and confidence in the team selected to implement an intensive prone positioning service, should the need arise again. Researchers using the TFA to explore acceptability of healthcare innovations should also consider the recipients' trust in those delivering the intervention.

Acceptability of implementing a communication board for mechanically ventilated patients in intensive care units: A cross-sectional substudy of the intervention arm of a pilot randomised controlled trial

BACKGROUND

Communication boards are a low-technology tool used to facilitate interactions with mechanically ventilated patients in intensive care units (ICUs). Research on the acceptability of communication boards in resource-limited intensive care settings is lacking.

AIM

The aim of this study was to assess patients' and nurses' experienced acceptability of implementing a communication board in Sri Lankan ICUs.

DESIGN

This was a cross-sectional substudy of the intervention group patients and nurses who participated in a pilot randomised controlled trial that assessed the feasibility of implementing a communication board in two ICUs in one Sri Lankan hospital.

METHODS

In the parent trial conscious, ventilated adult ICU patients were recruited. This substudy included all patients in the intervention group in the parent trial and ICU nurses who used the communication board. Sekhon's generic acceptability questionnaire, adapted and translated into Sinhala, was administered to both patients and nurses. The questionnaire comprised eight items; seven items represented the seven constructs of the framework (possible scores ranging from 7 to 35), and a single item measured general acceptability. Descriptive and inferential statistics were used to analyse the data. Additionally, nurses were asked three open-ended questions regarding their views on using the communication board, and data were analysed using content analysis.

RESULTS

Of the 123 patients screened in the parent trial, 60 met the inclusion criteria and were randomised, with 30 randomly allocated to the intervention group. In total, 30 patients and 50 nurses completed the survey (response rate: 100%). Both patients and nurses rated all items positively except "burden". Patient and nurse total mean scores for the seven items, excluding the single-item general acceptability, were 27.5 (standard deviation: 2.6) and 27.2 (standard deviation: 2.2), respectively. Patients and nurses both scored high on the single-item general acceptability, with a median (interquartile range) of 4.0 (4.0-5.0) and 4.0 (4.0-4.0), respectively. Two patient items and five nurse items significantly correlated with the single-item general acceptability. Two categories, (i) drivers for using the communication board and (ii) obstacles to communication board use, were found through content analysis.

CONCLUSION

This substudy demonstrated that the communication board was acceptable to both patients and nurses despite its perceived "burden".

Addressing scabies among street children in Ethiopia: an ethnographic study of acceptable interventions by prospective recipients and deliverers

Introduction

Scabies is a neglected tropical disease that affects the physical, socioeconomic, and psychological wellbeing of patients. Street children, due to poor living conditions and social marginalization, are at increased risk of infestation and face significant barriers to access healthcare services. Various interventions to control scabies have been suggested and implemented, but few have been based on the needs and viewpoints of the street children themselves. Drawing on the theoretical framework of acceptability (TFA), this article explores the interventions that street children, parents, and other key informants perceived to be appropriate to control scabies among street children.

Methods

An ethnographic approach was adopted to collect qualitative data from purposively selected street children, parents/caregivers, and key informants representing NGOs and the health and social sectors in Addis Ababa, Hawassa, and Adama. Rich data were gathered using FGDs, in-depth interviews, key informant interviews and drawing exercises, enhancing children's engagement in the study. Interviews were conducted in participants' preferred languages, recorded, transcribed verbatim, and translated into English for analysis. Data were coded by the two researchers who had collected them, and themes and sub-themes were identified.

Results

Living in overcrowded conditions, lack of access to sanitation materials and health services were among the priority needs and lived experiences of the street children. Providing peer-led health education, educating and mobilizing existing healthcare providers, preventing child streetism, raising the awareness of the community children migrate from, and providing sanitation facilities were among the proposed interventions that were considered appropriate to control scabies among street children.

Conclusion

Collaborative and participatory interventions that align with the lived experiences of street children and other stakeholders are likely to increase participation and enhance the feasibility and impact of scabies control and elimination efforts.

Nucleus accumbens deep brain stimulation in adult patients suffering from severe and enduring anorexia nervosa (STIMARS): protocol for a pilot study

Background

Affecting adolescent and young adults, anorexia nervosa (AN) has the highest death rate of all mental disorders. Effective treatment options are lacking and a significant proportion of patients develop severe and chronic forms of the disease with long-lasting functional impairment. Neurobiology of AN implicates the nucleus accumbens as a core structure of the ventral striatum highly connected to the prefrontal cortex, the insula and the limbic system. Several studies reported promising results of deep brain stimulation for treatment-resistant AN. The aim of this study was to investigate the safety and efficacy of bilateral nucleus accumbens deep brain stimulation in severe and enduring AN.

Methods and analysis

This is a prospective, multicentre, single-arm, open-label, non-randomized pilot trial of bilateral nucleus accumbens deep brain stimulation for severe and enduring AN. Patients will be followed up for 24 months after deep brain stimulation. The main objective of this study is to measure the safety and feasibility of nucleus accumbens deep brain stimulation in this population. The recruitment rate will be collected prospectively. Potential deep brain stimulation efficacy will be monitored by changes in: 1) health-related quality of life; 2) weight; 3) eating disorder symptomatology; 4) neuropsychological changes of cognitive flexibility, habits formation, emotional processing and central coherence; 5) psychiatric comorbidities (anxiety, depression, obsession). Local field potential recordings during an exposure task will be proposed to the patients. Additionally, caregiver quality of life will be assessed.

Discussion

We present the design and rationale for a pilot study investigating the safety of nucleus accumbens deep brain stimulation for treatment resistant anorexia nervosa. This trial will provide an estimated effect size of nucleus accumbens deep brain stimulation for treatment-resistant anorexia nervosa to support future larger-scale clinical trials.

A qualitative pilot study exploring the acceptability of a peer provider delivered substance use brief intervention from the perspective of youth in Kenya

BACKGROUND

Substance use disorders are prevalent among youth in sub-Saharan Africa (SSA), yet treatment resources are scarce. Peer provider delivered brief interventions (BIs) represent an affordable and potentially scalable strategy for addressing youth substance use disorders. The goal of this study is to assess the acceptability of a peer provider delivered substance use BI from the perspective of youth in Kenya.

METHODS

We conducted qualitative semi-structured interviews with youth participants (n = 25) to explore acceptability of a substance use BI. Youth were participants in a two-arm mixed-methods pilot randomized controlled trial (RCT) investigating the feasibility of a peer provider delivered single-session substance use BI for youth aged 15-24 years with moderate-risk substance use. The semi-structured interviews were conducted three months after the BI was delivered and were guided by the Theoretical Framework of Acceptability (TFA). Qualitative data were analyzed through thematic analysis.

RESULTS

We interviewed 25 of 38 participants in the BI arm, 18 males and 7 females; 15 were ages 18-24 years, and 10 ages 15-17 years. Affective attitude: Most youth reported that they enjoyed the session content and enjoyed interacting with the peer provider. Burden: Most youth felt that it was easy to understand the session and participate in it. Perceived effectiveness: Most of the youth perceived the intervention to be effective in helping them reduce substance use and improve their well-being. Ethicality: All youth perceived that the counselling session fit in with their goals and values. Intervention coherence: Most youth understood the overall goal of the intervention. They reported that the goal of the intervention was to help youth stop substance use, and to bring about behavior change. Opportunity costs: Some youth reported that they had to forgo other activities to attend the session, such as work, school, sports, gaming, visiting family, or house chores. Self-efficacy: Most youth felt confident about being able to cut down or stop using substances following the intervention.

CONCLUSION AND RECOMMENDATIONS

Our findings indicate that the peer provider delivered single-session substance use BI was acceptable to youth. The youth recommended that follow-up sessions be provided to ensure sustained behavior change. This study supports the utility of the TFA in exploring acceptability of a substance use intervention from the perspective of young people.

TRIAL REGISTRATION

NCT05545904 Registration date 16/09/2022 Registry ClinicalTrials.gov https//clinicaltrials.gov/study/NCT05545904.

The acceptability of a novel seismocardiography device for measuring VO2 max in a workplace setting: a mixed methods approach

BACKGROUND

Workplace health screening rarely includes measures of cardiorespiratory fitness, despite it being a greater predictor of cardiovascular disease and all-cause mortality than other routinely measured risk factors. This study aimed to determine the comparative acceptability of using a novel seismocardiography device to measure cardiorespiratory fitness via VO2 max during a workplace health check.

METHODS

Participants were invited to participate in workplace health screening sessions where VO2 max was assessed by both seismocardiography at rest and sub-maximal exercise testing, in order for acceptability of both to be compared across multiple domains. Questionnaires and focus group guides for participants and practitioners were developed based on the Theoretical Framework of Acceptability. Data were analysed using t-tests and deductive thematic analysis.

RESULTS

There was a significant difference in the acceptability domain of 'affective attitude' between the novel SCG device (M = 9.06 ± 1.14) and the sub-maximal exercise testing (M = 7.94 ± 1.79); t = 3.296, p = .001, d = 0.50, and in the domain of 'burden' between the novel SCG device (M = 9.16, ± 0.55) and the sub-maximal exercise testing (M = 7.41 ± 1.45); t = 7.033, p = < 0.001, d = 1.45. Practitioners and employees highlighted the potential of seismocardiography to create a more inclusive and accessible workplace offer, allowing those with restricted mobility or those with differing physical or emotional needs to participate in wellness testing; yet there was a lack of understanding in both groups around intervention effectiveness and coherence.

CONCLUSIONS

Seismocardiography may offer an acceptable route to cardiorespiratory fitness testing in the workplace, due to the low effort requirement and simplicity of administration. This study suggests that practitioners delivering such services have a critical role to play in acceptability of health interventions at work, as employees will be heavily influenced by practitioner beliefs around coherence and effectiveness. Comprehensive delivery training is important for the adoption of new health-related technologies such as seismocardiography into workplace health screening.

Evaluating Ovarian Cancer Risk-Reducing Salpingectomy Acceptance: A Survey

SIGNIFICANCE

This study found that many participants were willing to consider RRS to prevent ovarian cancer. Further research on RRS should be undertaken to understand how this can be best used for ovarian cancer prevention.

Acceptability of single-dose HPV vaccination schedule among health-care professionals in Kenya: a mixed-methods study

BACKGROUND

The World Health Organization recommends a single-dose human papillomavirus (HPV) vaccination schedule for girls and boys to accelerate progress toward cervical cancer elimination. We applied the Theoretical Framework of Acceptability (TFA) within the context of HPV vaccination to assess the acceptability of a single-dose schedule among health-care professionals in Kenya.

METHODS

A REDCap survey was developed using relevant Theoretical Framework of Acceptability domains and validated with health-care professionals. Descriptive analyses and multivariate Poisson regression were conducted to assess factors associated with increased acceptability. Free-text responses were analyzed using a rapid qualitative approach, and findings were presented using a joint display.

RESULTS

Among 385 responses, 74.2% of health-care professionals were female and 48.6% were nurses. On average, respondents had been in their position for 60 months, and one-third (33.2%) were based at level-4 facilities. The majority (75.84%) thought that giving a single-dose of the HPV vaccine to adolescent girls and young women was either acceptable or very acceptable. Qualitative findings highlighted that lack of information was the underlying reason for health-care professionals who were resistant, and most clinicians thought that a singled-dose schedule was less burdensome to clinicians and patients. Hospital directors had a non-statistically significantly lower acceptability likelihood than nurses (incident rate ratio = 0.93, 95% confidence interval = 0.45 to 1.71) and health-care professionals at urban facilities had a non-statistically significantly lower acceptability likelihood than clinicians in rural facilities (incident rate ratio = 0.97, 95% confidence interval = 0.83 to 1.13).

CONCLUSION

Although not statistically significant, predictors of increased acceptability provide information to tailor strategies to increase HPV vaccination coverage and accelerate progress toward cervical cancer elimination.

Examining the measurement of severity of intimate partner violence and its association to mental health outcomes: a narrative synthesis

Introduction

The aims of this synthesis were to investigate the relationship between IPV severity and mental health outcomes and shed light to gaps and limitations in existing methodologies used to assess IPV severity and its association with mental health outcomes.

Methods

We conducted a two-stage narrative synthesis of 76 studies. First, we identified IPV measures used in at least five studies, focusing on their variations and severity score calculation. Then, we analyzed findings of studies correlating IPV severity with mental health outcomes, identifying features of measures and statistical methods influencing result consistency.

Results

Measures of intimate partner violence were often modified from their original, potentially impact on the reliability and validity of these measures. The operationalization of violence severity varied across studies, leading to inconsistencies in scoring whereby compromising the consistency of severity levels across studies. We found lack of consistency in applying validated methods for scoring instruments to determine abuse severity. In this review, we consistently found that the severity of IPV and its various subtypes were linked to different mental health outcomes across multiple studies. We discovered evidence suggesting that experiencing more types of IPV was associated with worse mental health outcomes. Generally, higher levels of overall IPV severity and its specific subtypes were correlated with poorer mental health outcomes. However, our analyses did not reveal consistent patterns that would allow for a definitive determination of how individual IPV subtypes differently affect mental health outcomes. Nevertheless, we observed that increasing severity of physical IPV tended to have a notable impact on post-traumatic stress disorder (PTSD). Conversely, increasing severity of psychological IPV was consistently associated with depression. While sexual IPV severity was explored in fewer studies, the evidence regarding its impact on various mental health outcomes was less conclusive.

Discussion

To achieve a comprehensive understanding of the mechanism by which IPV severity is related to mental health it may be time to take an alternative approach to measuring IPV severity. No IPV measures assessed the acceptability of the content to people who have experienced IPV. This is an important omission with significant consequences for the validity of the evidence base.

Parent Education and Counseling (PairEd-C) Intervention to Improve Family-Centered Care: Protocol for a Prospective Acceptability Study Using the Theoretical Framework of Acceptability

BACKGROUND

Family-centered care (FCC) is an intervention approach based on a respectful relationship between family and health care providers (HCPs) to ensure the health and well-being of children and their families. Although HCPs have a better perception of FCC, the level of its implementation is low. Reasons for low implementation include limited understanding, lack of training, and lack of implementation guidelines and tools to support implementation. Thus, we developed the Parent Education and Counseling (PairEd-C) intervention to improve FCC in pediatric oncology settings and assess its acceptability.

OBJECTIVE

The objective of this study is to assess the prospective acceptability of the PairEd-C intervention using the theoretical framework of acceptability (TFA) in the pediatric oncology department in a tertiary hospital in Ethiopia.

METHODS

The study was conducted using an exploratory qualitative study design. We aimed to recruit 10 to 15 participants for the in-depth interview. The study participants were health service leaders working in child cancer, HCPs, social workers, and parents of children with cancer. The intervention was developed using the integration of the first phase of the Medical Research Council (MRC) framework for developing and testing complex interventions and the behavior change wheel (BCW) framework. The main PairEd-C intervention components align with the intervention functions of education, persuasion, training, environmental restructuring, modeling, and enablement, which were intended to improve FCC in the pediatric oncology unit by providing structured and comprehensive education and counseling of parents of children with cancer. The intervention was implemented by providing training for the health care team, facilitating discussion among HCPs and setting a shared plan, improving the commitment of the health care team, providing education for parents, improving parents' capacity to attend the intervention sessions, arranging discussion among parents of children with cancer, and provision of education and counseling on distress. The HCPs working in the unit received training on the designed intervention. The trained educators and the health care provider delivered the intervention. Data will be analyzed using deductive thematic coding with a framework analysis technique based on the 7 TFA constructs. Atlas ti. version 9 will be used for data analysis.

RESULTS

Funding was acquired in 2017, and ethical clearance for conducting the study was obtained. We conducted the interviews with the study participants from December 2023 to January 2024. As of the acceptance of this protocol (June 2024), 12 study participants were interviewed. The data analysis process was started subsequently, and the manuscript will be completed and submitted for publication in early 2025.

CONCLUSIONS

This acceptability study is expected to show that the designed intervention is acceptable to study participants, and the findings will be used to improve the intervention before progressing to the next step of our project.

INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID)

DERR1-10.2196/54914.

Facilitators, barriers and acceptability of implementing a communication board in Sri Lankan intensive care units: A qualitative descriptive study

OBJECTIVES

To explore patients' and nurses' views of potential facilitators, barriers, and prospective acceptability of implementing a communication board in Sri Lankan intensive care units.

DESIGN

A qualitative, descriptive study.

RESEARCH METHODOLOGY

Eight patients who received mechanical ventilation and nine nurses who worked in adult medical and surgical intensive care units were purposively selected. Data were collected via audio-taped, semi-structured, face-to-face interviews in January/February 2023. Interview guide questions were informed by the knowledge-to-action framework and the theoretical framework of acceptability. Data were analysed using inductive and deductive content analysis. The 32-item checklist of the consolidated criteria for reporting qualitative research (COREQ) was used to ensure the quality of reporting.

SETTING

A 3,000 bed Sri Lankan teaching hospital with 18 intensive care units.

FINDINGS

Four categories reflecting patients' and nurses' anticipated use of the board were found. The first category described patients' and nurses' 'readiness to use the communication board' and their positive attitudes towards it. The second category focused on the 'potential benefits of the communication board', while the third category emphasised the 'individual patient characteristics' that should be taken into consideration when implementing communication boards. The final category described practical aspects related to 'integrating communication boards into routine practice'.

CONCLUSION

This study demonstrates communication boards may improve communication between ventilated patients and nurses, and they are acceptable to end users. Adopting these tools may be a pivotal step to enhancing patient-centred care in demanding intensive care settings.

IMPLICATIONS FOR CLINICAL PRACTICE

An inability to communicate effectively with ventilated intensive care patients creates negative experiences for both patients and nurses. Communication boards may act as a medium to better understand patients' needs during mechanical ventilation.Understanding patients' and nurses' views is beneficial when designing patient-centred communication interventions in intensive care units.