Acceptability of healthcare interventions: an overview of reviews and development of a theoretical framework

Mandeep Sekhon, Martin Cartwright, Jill J Francis, Mandeep Sekhon, Martin Cartwright, Jill J Francis

Abstract

Background: It is increasingly acknowledged that 'acceptability' should be considered when designing, evaluating and implementing healthcare interventions. However, the published literature offers little guidance on how to define or assess acceptability. The purpose of this study was to develop a multi-construct theoretical framework of acceptability of healthcare interventions that can be applied to assess prospective (i.e. anticipated) and retrospective (i.e. experienced) acceptability from the perspective of intervention delivers and recipients.

Methods: Two methods were used to select the component constructs of acceptability. 1) An overview of reviews was conducted to identify systematic reviews that claim to define, theorise or measure acceptability of healthcare interventions. 2) Principles of inductive and deductive reasoning were applied to theorise the concept of acceptability and develop a theoretical framework. Steps included (1) defining acceptability; (2) describing its properties and scope and (3) identifying component constructs and empirical indicators.

Results: From the 43 reviews included in the overview, none explicitly theorised or defined acceptability. Measures used to assess acceptability focused on behaviour (e.g. dropout rates) (23 reviews), affect (i.e. feelings) (5 reviews), cognition (i.e. perceptions) (7 reviews) or a combination of these (8 reviews). From the methods described above we propose a definition: Acceptability is a multi-faceted construct that reflects the extent to which people delivering or receiving a healthcare intervention consider it to be appropriate, based on anticipated or experienced cognitive and emotional responses to the intervention. The theoretical framework of acceptability (TFA) consists of seven component constructs: affective attitude, burden, perceived effectiveness, ethicality, intervention coherence, opportunity costs, and self-efficacy.

Conclusion: Despite frequent claims that healthcare interventions have assessed acceptability, it is evident that acceptability research could be more robust. The proposed definition of acceptability and the TFA can inform assessment tools and evaluations of the acceptability of new or existing interventions.

Keywords: Acceptability; Complex intervention; Defining constructs; Healthcare intervention; Theory development.

Figures

Fig. 1
Fig. 1
The theoretical framework of acceptability (v1). Note: In bold font are the labels we assigned to represent the examples of the variables applied to operationalise and assess acceptability based on the results from the overview (italic font). Note* Addition of the two control constructs emerging deductively from existing theoretical models
Fig. 2
Fig. 2
PRISMA diagram of included papers for searches completed in February 2014 and 2016
Fig. 3
Fig. 3
The theoretical framework of acceptability (v2) comprising seven component constructs. Note: The seven component constructs are presented alphabetically with their anticipated definitions. The extent to which they may cluster or influence each of the temporal assessments of acceptability is an empirical question

References

    1. MRC U. Developing and evaluating complex interventions: new guidance. London: Medical Research Council; 2008.
    1. Say RE, Thomson R. The importance of patient preferences in treatment decisions—challenges for doctors. BMJ. 2003;327(7414):542–5. doi: 10.1136/bmj.327.7414.542.
    1. Torgerson D, Ryan M, Donaldson C. Effective Health Care bulletins: are they efficient? Qual Health Care. 1995;4(1):48. doi: 10.1136/qshc.4.1.48.
    1. Diepeveen S, Ling T, Suhrcke M, Roland M, Marteau TM. Public acceptability of government intervention to change health-related behaviours: a systematic review and narrative synthesis. BMC Public Health. 2013;13(1):756. doi: 10.1186/1471-2458-13-756.
    1. Stok FM, de Ridder DT, de Vet E, Nureeva L, Luszczynska A, Wardle J, Gaspar T, de Wit JB. Hungry for an intervention? Adolescents’ ratings of acceptability of eating-related intervention strategies. BMC Public Health. 2016;16(1):1.
    1. Fisher P, McCarney R, Hasford C, Vickers A. Evaluation of specific and non-specific effects in homeopathy: feasibility study for a randomised trial. Homeopathy. 2006;95(4):215–22. doi: 10.1016/j.homp.2006.07.006.
    1. Hommel KA, Hente E, Herzer M, Ingerski LM, Denson LA. Telehealth behavioral treatment for medication nonadherence: a pilot and feasibility study. Eur J Gastroenterol Hepatol. 2013;25(4):469. doi: 10.1097/MEG.0b013e32835c2a1b.
    1. Borrelli B, Sepinwall D, Ernst D, Bellg AJ, Czajkowski S, Breger R, DeFrancesco C, Levesque C, Sharp DL, Ogedegbe G. A new tool to assess treatment fidelity and evaluation of treatment fidelity across 10 years of health behavior research. J Consult Clin Psychol. 2005;73(5):852. doi: 10.1037/0022-006X.73.5.852.
    1. Proctor EK, Landsverk J, Aarons G, Chambers D, Glisson C, Mittman B. Implementation research in mental health services: an emerging science with conceptual, methodological, and training challenges. Adm Policy Ment Health Ment Health Serv Res. 2009;36(1):24–34. doi: 10.1007/s10488-008-0197-4.
    1. Medical Research Council (Great Britain) Health Services and Public Health Research Board Framework for design and evaluation of complex interventions to improve health. BMJ. 2000;321(7262):694–6. doi: 10.1136/bmj.321.7262.694.
    1. Craig P, Dieppe P, Macintyre S, Michie S, Nazareth I, Petticrew M. Developing and evaluating complex interventions: the new Medical Research Council guidance. BMJ. 2008;337:a1655. doi: 10.1136/bmj.a1655.
    1. Moore GF, Audrey S, Barker M, Bond L, Bonell C, Hardeman W, Moore L, O’Cathain A, Tinati T, Wight D. Process evaluation of complex interventions: Medical Research Council guidance. BMJ. 2015;350:h1258. doi: 10.1136/bmj.h1258.
    1. Becker CB, Darius E, Schaumberg K. An analog study of patient preferences for exposure versus alternative treatments for posttraumatic stress disorder. Behav Res Ther. 2007;45(12):2861–73. doi: 10.1016/j.brat.2007.05.006.
    1. Sidani S, Epstein DR, Bootzin RR, Moritz P, Miranda J. Assessment of preferences for treatment: validation of a measure. Res Nurs Health. 2009;32(4):419. doi: 10.1002/nur.20329.
    1. Tarrier N, Liversidge T, Gregg L. The acceptability and preference for the psychological treatment of PTSD. Behav Res Ther. 2006;44(11):1643–56. doi: 10.1016/j.brat.2005.11.012.
    1. Dillip A, Alba S, Mshana C, Hetzel MW, Lengeler C, Mayumana I, Schulze A, Mshinda H, Weiss MG, Obrist B. Acceptability–a neglected dimension of access to health care: findings from a study on childhood convulsions in rural Tanzania. BMC Health Serv Res. 2012;12(1):113. doi: 10.1186/1472-6963-12-113.
    1. DOLL R. Surveillance and monitoring. Int J Epidemiol. 1974;3(4):305–14. doi: 10.1093/ije/3.4.305.
    1. Staniszewska S, Crowe S, Badenoch D, Edwards C, Savage J, Norman W. The PRIME project: developing a patient evidence‐base. Health Expect. 2010;13(3):312–22.
    1. Andrykowski MA, Manne SL. Are psychological interventions effective and accepted by cancer patients? I. Standards and levels of evidence. Ann Behav Med. 2006;32(2):93–7. doi: 10.1207/s15324796abm3202_3.
    1. Bollen KA. Structural equations with latent variables. 1989.
    1. Campbell M, Egan M, Lorenc T, Bond L, Popham F, Fenton C, Benzeval M. Considering methodological options for reviews of theory: illustrated by a review of theories linking income and health. Syst Rev. 2014;3(1):1–11. doi: 10.1186/2046-4053-3-114.
    1. Davidoff F, Dixon-Woods M, Leviton L, Michie S. Demystifying theory and its use in improvement. BMJ Qual Saf. 2015;24(3):228–38. doi: 10.1136/bmjqs-2014-003627.
    1. Giles EL, Sniehotta FF, McColl E, Adams J. Acceptability of financial incentives and penalties for encouraging uptake of healthy behaviours: focus groups. BMC Public Health. 2015;15(1):1. doi: 10.1186/s12889-015-1409-y.
    1. ICEBeRG . Designing theoretically-informed implementation interventions. 2006.
    1. Michie S, Prestwich A. Are interventions theory-based? Development of a theory coding scheme. Health Psychol. 2010;29(1):1. doi: 10.1037/a0016939.
    1. Rimer BK, Glanz K. Theory at a glance: a guide for health promotion practice. 2005.
    1. Berlim MT, McGirr A, Van den Eynde F, Fleck MPA, Giacobbe P. Effectiveness and acceptability of deep brain stimulation (DBS) of the subgenual cingulate cortex for treatment-resistant depression: a systematic review and exploratory meta-analysis. J Affect Disord. 2014;159:31–8. doi: 10.1016/j.jad.2014.02.016.
    1. Cipriani A, Furukawa TA, Salanti G, Geddes JR, Higgins JPT, Churchill R, Watanabe N, Nakagawa A, Omori IM, McGuire H, et al. Comparative efficacy and acceptability of 12 new-generation antidepressants: a multiple-treatments meta-analysis. Lancet. 2009;373:746–58. doi: 10.1016/S0140-6736(09)60046-5.
    1. Kedge EM. A systematic review to investigate the effectiveness and acceptability of interventions for moist desquamation in radiotherapy patients. Radiography. 2009;15:247–57. doi: 10.1016/j.radi.2008.08.002.
    1. Braun V, Clarke V. Using thematic analysis in psychology. Qual Res Psychol. 2006;3(2):77–101. doi: 10.1191/1478088706qp063oa.
    1. Carpiano RM, Daley DM. A guide and glossary on postpositivist theory building for population health. J Epidemiol Community Health. 2006;60(7):564–70. doi: 10.1136/jech.2004.031534.
    1. Epstein LH. Integrating theoretical approaches to promote physical activity. Am J Prev Med. 1998;15(4):257–65. doi: 10.1016/S0749-3797(98)00083-X.
    1. Hox JJ. From theoretical concept to survey question. 1997): Survey Measurement and Process Quality. New York ua: Wiley; 1997. pp. 45–69.
    1. Locke EA. Theory building, replication, and behavioral priming Where do we need to go from here? Perspect Psychol Sci. 2015;10(3):408–14. doi: 10.1177/1745691614567231.
    1. Thompson JD. On Building an Administrative Science. Adm Sci Q. 1956;1(1):102–11. doi: 10.2307/2390842.
    1. Weick KE. Drop Your Tools: An Allegory for Organizational Studies. Adm Sci Q. 1996;41(2):301–13. doi: 10.2307/2393722.
    1. Ajzen I. The theory of planned behavior. Organ Behav Hum Decis Process. 1991;50(2):179–211. doi: 10.1016/0749-5978(91)90020-T.
    1. Michie S, Johnston M, Abraham C, Lawton R, Parker D, Walker A. Making psychological theory useful for implementing evidence based practice: a consensus approach. Qual Saf Health Care. 2005;14(1):26–33. doi: 10.1136/qshc.2004.011155.
    1. Higgins JPT, Green SP, Wiley Online Library EBS, Cochrane C, Wiley I. Cochrane handbook for systematic reviews of interventions. Hoboken; Chichester: Wiley-Blackwell; 2008.
    1. Jadad AR, Moore RA, Carroll D, Jenkinson C, Reynolds DJM, Gavaghan DJ, McQuay HJ. Assessing the quality of reports of randomized clinical trials: is blinding necessary? Control Clin Trials. 1996;17(1):1–12. doi: 10.1016/0197-2456(95)00134-4.
    1. Moher D, Schulz KF, Altman DG, Group C. The CONSORT statement: revised recommendations for improving the quality of reports of parallel-group randomised trials. Lancet. 2001;357(9263):1191–4. doi: 10.1016/S0140-6736(00)04337-3.
    1. Atkins D, Eccles M, Flottorp S, Guyatt GH, Henry D, Hill S, Liberati A, O’Connell D, Oxman AD, Phillips B. Systems for grading the quality of evidence and the strength of recommendations I: critical appraisal of existing approaches The GRADE Working Group. BMC Health Serv Res. 2004;4(1):38. doi: 10.1186/1472-6963-4-38.
    1. Armijo‐Olivo S, Stiles CR, Hagen NA, Biondo PD, Cummings GG. Assessment of study quality for systematic reviews: a comparison of the Cochrane Collaboration Risk of Bias Tool and the Effective Public Health Practice Project Quality Assessment Tool: methodological research. J Eval Clin Pract. 2012;18(1):12–8. doi: 10.1111/j.1365-2753.2010.01516.x.
    1. Harris RP, Helfand M, Woolf SH, Lohr KN, Mulrow CD, Teutsch SM, Atkins D, Preventive MWGTU, Force ST. Current methods of the US Preventive Services Task Force: a review of the process. Am J Prev Med. 2001;20(3):21–35. doi: 10.1016/S0749-3797(01)00261-6.
    1. Andrews G, Cuijpers P, Craske MG, McEvoy P, Titov N. Computer therapy for the anxiety and depressive disorders is effective, acceptable and practical health care: a meta-analysis. PLoS One. 2010;5(10):e13196. doi: 10.1371/journal.pone.0013196.
    1. Blenkinsopp A, Hassey A. Effectiveness and acceptability of community pharmacy‐based interventions in type 2 diabetes: a critical review of intervention design, pharmacist and patient perspectives. Int J Pharm Pract. 2005;13(4):231–40. doi: 10.1211/ijpp.13.4.0001.
    1. Kulier R, Helmerhorst FM, Maitra N, Gülmezoglu AM. Effectiveness and acceptability of progestogens in combined oral contraceptives–a systematic review. Reprod Health. 2004;1(1):1. doi: 10.1186/1742-4755-1-1.
    1. Kaltenthaler E, Sutcliffe P, Parry G, Rees A, Ferriter M. The acceptability to patients of computerized cognitive behaviour therapy for depression: a systematic review. Psychol Med. 2008;38:1521–30. doi: 10.1017/S0033291707002607.
    1. Brooke-Sumner C, Petersen I, Asher L, Mall S, Egbe CO, Lund C. Systematic review of feasibility and acceptability of psychosocial interventions for schizophrenia in low and middle income countries. BMC Psychiatry. 2015;15:19. doi: 10.1186/s12888-015-0400-6.
    1. Muftin Z, Thompson AR. A systematic review of self-help for disfigurement: Effectiveness, usability, and acceptability. Body Image. 2013;10(4):442–50. doi: 10.1016/j.bodyim.2013.07.005.
    1. El-Den S, O’Reilly CL, Chen TF. A systematic review on the acceptability of perinatal depression screening. J Affect Disord. 2015;188:284–303. doi: 10.1016/j.jad.2015.06.015.
    1. Littlejohn C. Does socio-economic status influence the acceptability of, attendance for, and outcome of, screening and brief interventions for alcohol misuse: a review. Alcohol Alcohol. 2006;41:540–5. doi: 10.1093/alcalc/agl053.
    1. Figueroa C, Johnson C, Verster A, Baggaley R. Attitudes and acceptability on HIV self-testing among key populations: a literature review. AIDS Behav. 2015;19(11):1949–65. doi: 10.1007/s10461-015-1097-8.
    1. Botella C, Serrano B, Baños RM, Garcia-Palacios A. Virtual reality exposure-based therapy for the treatment of post-traumatic stress disorder: A review of its efficacy, the adequacy of the treatment protocol, and its acceptability. Neuropsychiatr Dis Treat. 2015;11:2533–45. doi: 10.2147/NDT.S89542.
    1. Rodriguez MI, Gordon-Maclean C. The safety, efficacy and acceptability of task sharing tubal sterilization to midlevel providers: a systematic review. Contraception. 2014;89(6):504–11. doi: 10.1016/j.contraception.2014.01.008.
    1. Moss-Morris R, Weinman J, Petrie K, Horne R, Cameron L, Buick D. The revised illness perception questionnaire (IPQ-R) Psychol Health. 2002;17(1):1–16. doi: 10.1080/08870440290001494.
    1. Bandura A. Self-efficacy: toward a unifying theory of behavioral change. Psychol Rev. 1977;84(2):191. doi: 10.1037/0033-295X.84.2.191.
    1. Lee C, Bobko P. Self-efficacy beliefs: comparison of five measures. J Appl Psychol. 1994;79(3):364. doi: 10.1037/0021-9010.79.3.364.
    1. Clement S. The self‐efficacy expectations and occupational preferences of females and males. J Occup Psychol. 1987;60(3):257–65. doi: 10.1111/j.2044-8325.1987.tb00258.x.
    1. Rixon L, Baron J, McGale N, Lorencatto F, Francis J, Davies A. Methods used to address fidelity of receipt in health intervention research: a citation analysis and systematic review. BMC Health Serv Res. 2016;16:1. doi: 10.1186/s12913-016-1904-6.
    1. Eborall HC, Stewart MCW, Cunningham-Burley S, Price JF, Fowkes FGR. Accrual and drop out in a primary prevention randomised controlled trial: qualitative study. Trials. 2011;12(1):7. doi: 10.1186/1745-6215-12-7.
    1. Sanders C, Rogers A, Bowen R, Bower P, Hirani SP, Cartwright M, Fitzpatrick R, Knapp M, Barlow J, Hendy J, et al. Exploring barriers to participation and adoption of telehealth and telecare within the Whole System Demonstrator trial: a qualitative study. 2012.
    1. Wickwar S, McBain H, Newman SP, Hirani SP, Hurt C, Dunlop N, Flood C, Ezra DG. Effectiveness and cost-effectiveness of a patient-initiated botulinum toxin treatment model for blepharospasm and hemifacial spasm compared to standard care: study protocol for a randomised controlled trial. Trials. 2016;17(1):1. doi: 10.1186/s13063-015-1128-9.
    1. Moher D, Liberati A, Tetzlaff J, Altman DG. Preferred reporting items for systematic reviews and meta-analyses: the PRISMA statement. The BMJ. 2009;339:b2535. doi: 10.1136/bmj.b2535.
    1. APA. Glossary of Psychological Terms. 2017 [online] Available at: . [Accessed 19 Jan 2017].
    1. Glanz K, Rimer BK, Viswanath K. Health behavior and health education: theory, research, and practice: John Wiley & Sons; 2008.

Source: PubMed

Sponsors en medewerkers

Medische omstandigheden

Geneesmiddelinterventies

3
Abonneren