School of Public Health, University of the Western Cape, Cape Town, South Africa; Department of Social Policy and Intervention, University of Oxford, Barnett House, Oxford, United Kingdom.
School of Public Health, University of the Western Cape, Cape Town, South Africa.
Soc Sci Med. 2023 Jun;326:115899. doi: 10.1016/j.socscimed.2023.115899. Epub 2023 Apr 10.
Intervention acceptability has become an increasingly key consideration in the development, evaluation and implementation of health and social interventions. However, to date this area of investigation has been constrained by the absence of a consistent definition of acceptability, comprehensive conceptual frameworks disaggregating its components, and few reliable assessment measures. This paper aims to contribute to this gap, by proposing a conceptual framework and exploratory model for acceptability with a specific priority population for health and developmental interventions: adolescents and youth in Africa. We document our multi-staged approach to model development, comprising both inductive and deductive components, and both systematic and interpretative review methods. This included thematic analyses of respective acceptability definitions and findings, from 55 studies assessing acceptability of 60 interventions conducted with young people aged 10-24 in (mainly Southern and Eastern) Africa over a decade; a consideration of these findings in relation to Sekhon et al.'s Theoretical Framework of Acceptability (TFA); a cross-disciplinary review of acceptability definitions and models; a review of key health behavioural change models; and expert consultation with interdisciplinary researchers. Our proposed framework incorporates nine component constructs: affective attitude, intervention understanding, perceived positive effects, relevance, perceived social acceptability, burden, ethicality, perceived negative effects and self-efficacy. We discuss the rationale for the inclusion and definition of each component, highlighting key behavioural models that adopt similar constructs. We then extend this framework to develop an exploratory model for acceptability with young people, that links the framework components to each other and to intervention engagement. Acceptability is represented as an emergent property of a complex, adaptive system of interacting components, which can influence user engagement directly and indirectly, and in turn be influenced by user engagement. We discuss opportunities for applying and further refining or developing these models, and their value as a point of reference for the development of acceptability assessment tools.
可接受性已成为健康和社会干预措施的开发、评估和实施中越来越重要的考虑因素。然而，迄今为止，这一研究领域受到缺乏一致的可接受性定义、分解其组成部分的综合概念框架以及缺乏可靠评估措施的限制。本文旨在通过为健康和发展干预措施的特定优先人群——非洲的青少年和青年提出一个概念框架和探索性模型来填补这一空白。我们记录了我们模型开发的多阶段方法，包括归纳和演绎成分，以及系统和解释性审查方法。这包括对 55 项研究的各自可接受性定义和发现进行主题分析，这些研究评估了十年来在（主要是南部和东部）非洲进行的 60 项针对年轻人（年龄在 10-24 岁之间）的干预措施的可接受性；考虑这些发现与 Sekhon 等人的可接受性理论框架（TFA）之间的关系；对可接受性定义和模型的跨学科审查；对关键健康行为改变模型的审查；以及与跨学科研究人员的专家咨询。我们提出的框架包含九个组成部分：情感态度、干预理解、感知积极影响、相关性、感知社会可接受性、负担、道德性、感知负面影响和自我效能感。我们讨论了包含每个组件的理由及其定义，突出了采用类似结构的关键行为模型。然后，我们扩展这个框架，为年轻人开发一个可接受性的探索性模型，将框架组件相互连接，并与干预参与联系起来。可接受性被表示为一个复杂的自适应系统的涌现属性，该系统可以直接和间接影响用户参与，反过来也可以受到用户参与的影响。我们讨论了应用和进一步细化或开发这些模型的机会，以及它们作为可接受性评估工具开发的参考点的价值。
