Application of a theoretical framework to assess intervention acceptability: a semi-structured interview study

Background: The importance of considering acceptability of healthcare interventions has been recognised. However there is little guidance on how to assess acceptability. Previous research has treated acceptability as a simple construct, assessed uni-dimensionally. Such an approach restricts the potential to identify variation, and to discriminate between interventions with high versus low levels of acceptability. The purpose of this study was to compare the use of a multi-construct theoretical framework with a more general approach, to investigate acceptability. Methods: Eleven healthcare professionals (HCPs) completed semi-structured interviews about the acceptability of two interventions. The first was an audit-and-feedback intervention (i.e. summary of clinical performance provided to HCPs) relating to blood transfusion practice. The second was an online toolkit to support hospital staff to respond to the feedback (e.g. by prompting action planning). Questions within the topic guide framed acceptability as 1) a global construct (i.e. one question about acceptability in general); 2) a multi-component construct (seven questions about acceptability), based on a recently-developed theoretical framework of acceptability (TFA). Transcripts were analysed using framework analysis. Findings: When answering the global question, participants (a) spontaneously referred to several constructs in the TFA, and (b) reported that both interventions were acceptable. Based on responses to the set of questions based on the TFA, participants reported more varied assessments of acceptability. Discussion: Investigating acceptability as a multi-component construct resulted in greater level of discrimination between levels of acceptability. The TFA could be applied to explore acceptability of healthcare interventions more widely.