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.