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Motor neuron disease (MND) is a progressive, fatal, neurodegenerative condition that affects motor neurons in the brain and spinal cord, resulting in loss of the ability to move, speak, swallow and breathe. Acceptance and commitment therapy (ACT) is an acceptance-based behavioural therapy that may be particularly beneficial for people living with MND (plwMND). This qualitative study aimed to explore plwMND’s experiences of receiving adapted ACT, tailored to their specific needs, and therapists’ experiences of delivering it.
Method:
Semi-structured qualitative interviews were conducted with plwMND who had received up to eight 1:1 sessions of adapted ACT and therapists who had delivered it within an uncontrolled feasibility study. Interviews explored experiences of ACT and how it could be optimised for plwMND. Interviews were audio recorded, transcribed and analysed using framework analysis.
Results:
Participants were 14 plwMND and 11 therapists. Data were coded into four over-arching themes: (i) an appropriate tool to navigate the disease course; (ii) the value of therapy outweighing the challenges; (iii) relevance to the individual; and (iv) involving others. These themes highlighted that ACT was perceived to be acceptable by plwMND and therapists, and many participants reported or anticipated beneficial outcomes in the future, despite some therapeutic challenges. They also highlighted how individual factors can influence experiences of ACT, and the potential benefit of involving others in therapy.
Conclusions:
Qualitative data supported the acceptability of ACT for plwMND. Future research and clinical practice should address expectations and personal relevance of ACT to optimise its delivery to plwMND.
Key learning aims
(1) To understand the views of people living with motor neuron disease (plwMND) and therapists on acceptance and commitment therapy (ACT) for people living with this condition.
(2) To understand the facilitators of and barriers to ACT for plwMND.
(3) To learn whether ACT that has been tailored to meet the specific needs of plwMND needs to be further adapted to potentially increase its acceptability to this population.
Children with Severe Acute Malnutrition (SAM) are at risk of developmental problems. Psychosocial stimulation can improve the developmental outcomes of hospitalised children with SAM. However, the intervention has remained underutilised in health facilities in resource-poor settings. Moreover, there is limited evidence on the acceptability and feasibility of the intervention. We conducted a qualitative study to explore the acceptability and feasibility of integrating psychosocial stimulation interventions in the inpatient care of children with SAM in selected areas in the Silti Zone, Central Ethiopia. Nine focus group discussions and 15 key informant interviews were conducted with parents, health workers, and other stakeholders. The data were transcribed, translated, and analysed using a thematic approach. Caregivers and health workers had positive attitudes toward the intervention and perceived it beneficial for the children’s development, recovery, and bonding with the mothers. Health workers reported barriers such as lack of materials, time, and space, capacity building training, and supervision for the effective implementation of the intervention. At the household level, gendered factors such as the housework burden of mothers and the inadequate engagement of fathers in childcare were the main challenges to the implementation of the intervention. Overall, psychosocial stimulation intervention was found to be acceptable and feasible for routine implementation with inpatient care provided for children with SAM. The study recommends supporting health facilities, health workers, and partners with the necessary resources and skills to promote the implementation of stimulation interventions along with the existing care provided in health facilities in resource-poor settings.
At the broadest level, conceptions of the Islamic Republic’s political legitimacy are guided by one of three assumptions. The first assumption is that legitimacy is divinely bestowed, with the velayat-e faqih installed by God as someone who has the wisdom necessary to guide his people. There is no need for popular vote for the system to become legitimate, although there is no harm in it either. This popular vote is valid only when it has the leader’s approval. A second perspective assumes that God has given people the right and the ability to determine their own destiny and their affairs. Therefore, according to the shari‘ah, legitimacy rests with the people. A third outlook bridges these two perspectives, maintaining that while legitimacy is exclusively divine in genesis, it is practically irrelevant without acceptability, which makes the system functional when people participate in it. Legitimacy comes only from God, while it is the people who give the system the acceptance it needs by deciding what is in their interests. Moreover, acceptance has the added benefit of drawing people closer to the political system.
Behavioural treatments are recommended first-line for insomnia, but long-term benzodiazepine receptor agonist (BZRA) use remains common and engaging patients in a deprescribing consultation is challenging. Few deprescribing interventions directly target patients. Prescribers’ support of patient-targeted interventions may facilitate their uptake. Recently assessed in the Your Answers When Needing Sleep in New Brunswick (YAWNS NB) study, Sleepwell (mysleepwell.ca) was developed as a direct-to-patient behaviour change intervention promoting BZRA deprescribing and non-pharmacological insomnia management. BZRA prescribers of YAWNS NB participants were invited to complete an online survey assessing the acceptability of Sleepwell as a direct-to-patient intervention. The survey was developed using the seven construct components of the theoretical framework of acceptability (TFA) framework. Respondents (40/250, 17.2%) indicated high acceptability, with positive responses per TFA construct averaging 32.3/40 (80.7%). Perceived as an ethical, credible, and useful tool, Sleepwell also promoted prescriber–patient BZRA deprescribing engagements (11/19, 58%). Prescribers were accepting of Sleepwell and supported its application as a direct-to-patient intervention.
FoodRx is a 12-month healthy food prescription incentive program for people with type 2 diabetes (T2DM) and experiences of household food insecurity. In this study, we aimed to explore potential users’ prospective acceptability (acceptability prior to program use) of the design and delivery of the FoodRx incentive and identify factors influencing prospective acceptability.
Design:
We used a qualitative descriptive approach and purposive sampling to recruit individuals who were interested or uninterested in using the FoodRx incentive. Semi-structured interviews were guided by the theoretical framework of acceptability, and corresponding interview transcripts were analysed using differential qualitative analysis guided by the socioecological model.
Setting:
Individuals living in Alberta, Canada.
Participants:
In total, fifteen adults with T2DM and experiences of household food insecurity.
Results:
People who were interested in using the FoodRx incentive (n 10) perceived it to be more acceptable than those who were uninterested (n 5). We identified four themes that captured factors that influenced users’ prospective acceptability: (i) participants’ confidence, views and beliefs of FoodRx design and delivery and its future use (intrapersonal), (ii) the shopping routines and roles of individuals in participants’ social networks (interpersonal), (iii) access to and experience with food retail outlets (community), and (iv) income and food access support to cope with the cost of living (policy).
Conclusion:
Future healthy food prescription programs should consider how factors at all levels of the socioecological model influence program acceptability and use these data to inform program design and delivery.
This research paper addresses the hypotheses that Kluyveromyces marxianus can be cultured with good alcohol production on different whey-derived matrices, and that the fermented product can be used in order to develop alcoholic beverages with acceptable sensory characteristics by mixtures with yeast-fermented fruit-based matrices. Growth and fermentative characteristics of Kluyveromyces marxianus LFIQK1 in different whey-derived matrices were explored by culturing (24 h, 30°C) on reconstituted whey, demineralized whey, heat-treated whey and milk permeate media. High lactose consumption, ethanol production and yield were observed. Reconstituted whey matrix was selected for mixing with orange or strawberry juices fermented using Saccharomyces cerevisiae to obtain alcoholic beverages (W-OR and W-ST, respectively). Consumer evaluation of beverages was performed using acceptability and Check-All-That-Apply (CATA) questions. Good acceptance was observed, significantly higher for W-ST than for W-OR. CATA questions gave information about organoleptic characteristics of beverages. Penalty analysis showed W-R and W-ST were positively associated with smooth/refreshing and fruity/natural, respectively. Liking was represented, accordingly with penalty analysis, by natural/refreshing. A novel alternative for utilization of whey and whey-related matrices by alcoholic beverages production with natural ingredients is presented.
Ideally, comprehensible second language (L2) speech would be seen as acceptable speech. However, the association between these dimensions is underexplored. To investigate the relationship between comprehensibility and “academic acceptability,” defined here as how well a speaker could meet the demands of a given role in an academic setting, 204 university stakeholders judged L2 speech samples elicited from a standardized English test used for university admissions. Four tasks from 100 speakers were coded for 13 speech stream characteristics. Judgments for comprehensibility and acceptability correlated strongly (r = .93). Linear mixed-effects models, used to examine judgments across all tasks and separately for each task, indicated that while random intercepts (i.e., speaker ability, listener severity) explained a substantial amount of total variation (32–44%) in listener judgments compared to speech characteristic fixed effects (8–21%), fixed effects did account for variation in speaker random effects (reducing variation compared to intercept-only models by 50–90%). Despite some minimal differences across task types, the influence of speech characteristics across both judgments was mostly similar. While providing evidence that comprehensible speech can indeed be perceived as acceptable, this study also provides evidence that speakers demonstrate both consistent and less consistent performance, in reference to speech stream production, across performances.
There are high levels of nutritional and metabolic, cardiovascular, and respiratory tract diseases among people diagnosed with serious mental illness (SMI). Consequently, we developed a pragmatic, affordable nutritional and exercise intervention: Choices4Health. Due to the COVID-19 pandemic, we modified this intervention so it could be delivered online. The aim of this study was to explore the experience of participating in online Choices4Health, in a real-world clinical setting, from the perspectives of service users with SMI.
Methods:
The study aim was addressed using thematic analysis. Service users who had attended online Choices4Health, received a SMI diagnosis (defined as a schizophrenia spectrum disorder or an affective disorder), and resided in a South Dublin catchment were invited to participate. Nine participants were purposefully sampled. Semi-structured interviews were conducted by telephone. Data analysis was guided by thematic analysis procedures.
Results:
Six themes were generated: Being ready and not overburdened (Engagement); Gaining knowledge and implementing it (Learning and doing); Viewing the intervention as appropriate and effective (Targeted impact); Being at home with others online (Belonging); Having a positive affective attitude towards the intervention (Feeling); and Perceiving problems with intervention delivery (Recommended change).
Conclusions:
Findings suggest that online Choices4Health is, broadly speaking, acceptable from a service user perspective, but that further refinement is required to address specific issues participants identified. These relate to follow-up or programme extension, technology access, in-person contact preference, and participant inclusion criteria. Further research is required into online Choices4Health efficacy, innovations to reduce digital exclusion, and managing group dynamics in telehealth interventions.
This mixed-methods complementarity study explored family members’, friends’, and health care providers’ perspectives of acceptability of group leisure activities as an intervention for loneliness experienced by older adults living with dementia. A sample of 25 family members, friends, and health care providers of people living with dementia in ON rated the acceptability of group leisure activities (adapted Treatment Perception and Preference questionnaire) and discussed their ratings in an interview. Quantitative (descriptive statistics) and qualitative (conventional content analysis) results were integrated to understand acceptability. Participants viewed group leisure activities as effective, logical, and suitable for use with people living with dementia. Participants described the need for flexible programs, careful facilitation, and attention to activity selection. Group leisure activities were seen as low risk, but stigmas related to dementia could prevent participation. The findings inform the design of acceptable group leisure activities, promoting their use to address loneliness in people living with dementia.
Efficacy studies show early nutrition interventions improving infant nutrition status, but understanding caregiver acceptability is required for implementation of such interventions. This systematic review examines caregivers’ perceptions of nutrition interventions in young children.
Design:
We searched the Cochrane Central Register of Controlled Trials, MEDLINE, Embase, CINAHL and PsychINFO from date of online journal inception through December 2020. Interventions included oral (powder/liquid/tablet) and/or intravenous supplementation, food fortification and nutrition counselling. Inclusion criteria included primary research, data presented on caregiver perception and studies published in English. Quality assessment was performed using the Critical Appraisal Skills Programme tool. Studies underwent narrative synthesis using inductive thematic analysis.
Setting:
No restriction.
Participants:
Caregivers of children under 24 months of age.
Results:
Of 11 798 records identified, thirty-seven publications were included. Interventions included oral supplementation, food fortification and nutrition counselling. Caregivers included mothers (83 %), fathers, grandparents and aunts. Perceptions were gathered through individual interviews, focus group discussions, questionnaires, surveys and ratings. Totally, 89 % of studies noted high acceptability (n 33 most notably increased appetite (n 17). In total, 57 % of studies (n 21) cited low acceptability, commonly from side effects (n 13) such as gastrointestinal issues, appetite loss and stained teeth.
Conclusions:
Positive perceptions and enthusiasm for interventions were frequently reported. Key to implementation was the increased appetite noted by caregivers. A substantial proportion of studies reported negative perceptions, mainly due to side effects. In future interventions, mitigation and education around common side effects are crucial for acceptability. Understanding both positive and negative caregiver perceptions is important for informing future nutrition interventions and strengthening sustainability and implementation.
Individuals who self-harm have increased suicide rates. Brief interventions are associated with reduced repeated suicide attempts. However, very few previous studies investigated the acceptability of brief interventions before implementing new trials.
Aims
We aimed to explore the perceptions of individuals who self-harm toward a brief intervention, the Chinese version of the volitional help sheet (VHS-C), which encourages people to link a critical situation with an appropriate response.
Method
Fourteen participants who presented to hospitals with self-harm were interviewed about their perspectives regarding the acceptability of the paper- and web-based VHS-C. Data were analysed with the framework method.
Results
The participants could understand the intended goal of the VHS-C by reading the written instructions, but indicated that having verbal instructions would also help. They shared the reasons why they felt the VHS-C was helpful (e.g. relatable contents, useful coping strategies and appropriate instructions that made them feel understood) or unhelpful (e.g., being not specific enough, not useful during the crisis and triggering negative emotional responses). Some indicated that the VHS-C might not be applicable to people experiencing ongoing distress in emergency departments. Most participants preferred the web-based to the paper-based VHS-C, and suggested that the format and frequency of follow-up reminders could leave the patient to decide.
Conclusions
The contents of the VHS-C were acceptable for people who presented to hospitals with self-harm. The VHS-C may be more helpful before individuals encounter suicidal thoughts than when they have an ongoing crisis.
Naturalistic online grocery stores could provide a novel setting for evaluating nutrition interventions. In 2021–2022, we recruited US adults (n 144, 59% low-income) to complete two weekly study visits: one in a naturalistic (‘mock’) online grocery store developed for research and one in a real online grocery store. Participants selected groceries and responded to survey questions. Analyses examined survey responses and expenditures on fifteen food categories (e.g., bread, sugar-sweetened beverages). Nearly all enrolled participants completed both visits (98% retention). Moreover, nearly participants all reported that their selections in the naturalistic store were similar to their usual purchases (95%) and that the naturalistic store felt like a real store (92%). Participants’ spending on food categories in the naturalistic store were moderately-to-strongly correlated with their spending in the real store (range of correlation coefficients: 0⋅36–0⋅67, all P-values < 0⋅001). Naturalistic online grocery stores may offer a promising platform for conducting nutrition research.
Mood problems are common after stroke, and screening is recommended. Training may support staff knowledge and implementation of screening, but the feasibility of training programmes in the Australian healthcare system has not been formally established. This study aimed to assess the feasibility of a mood screening training for a multidisciplinary team (MDT) of stroke clinicians working in a post-acute inpatient rehabilitation service.
Twelve staff from a rehabilitation service at a major hospital in Sydney, Australia participated in a 3-h interactive training session. The feasibility of running the course, assessment of knowledge gained via a consolidation exercise and quiz and acceptability of the training were assessed via focus groups.
The in-person modality of the training hindered recruitment and assessment of participants’ knowledge, though the actual measures themselves appeared appropriate. Nine participants provided feedback in two focus groups. Thematic analysis identified positive reactions to the training. However, low self-efficacy persisted and organisational/socio-cultural barriers to implementation emerged. Following training, the medical officers of the MDT had successfully implemented routine screening.
Overall, the training appeared acceptable and to foster knowledge in staff. However, limitations to recruitment and administering evaluations were identified. The development of flexible online training may improve future evaluations of screening training programmes/pathways.
Communicating evidence that a policy is effective can increase public support although the effects are small. In the context of policies to increase healthier eating in out-of-home restaurants, we investigate two ways of presenting evidence for a policy's effectiveness: (i) visualising and (ii) re-expressing evidence into a more interpretable form. We conducted an online experiment in which participants were randomly allocated to one of five groups. We used a 2 (text only vs visualisation) × 2 (no re-expression vs re-expression) design with one control group. Participants (n = 4500) representative of the English population were recruited. The primary outcome was perceived effectiveness and the secondary outcome was public support. Evidence of effectiveness increased perceptions of effectiveness (d = 0.14, p < 0.001). There was no evidence that visualising, or re-expressing, changed perceptions of effectiveness (respectively, d = 0.02, p = 0.605; d = −0.02, p = 0.507). Policy support increased with evidence but this was not statistically significant after Bonferroni adjustment (d = 0.08, p = 0.034, α = 0.006). In conclusion, communicating evidence of policy effectiveness increased perceptions that the policy was effective. Neither visualising nor re-expressing evidence increased perceived effectiveness of policies more than merely stating in text that the policy was effective.
Indian adolescents experience body dissatisfaction. However, empirically supported interventions are lacking, particularly in lower socio-economic regions of India. This paper describes the acceptability testing of a six-session teacher-led comics-based intervention, aiming to improve body image and related outcomes among adolescents in Indian Hindi medium schools.
Methods
Thirty-five students (50% girls; Mage, girls = 12.3 years; Mage, boys = 13 years) and nine teachers (11% women) from Hindi medium schools in Rajasthan, India, completed a quantitative acceptability questionnaire regarding comics that target body dissatisfaction and associated risk factors. They also participated in online or telephone semi-structured interviews to share in-depth feedback, with teachers providing additional feedback on an accompanying teacher guide. The quantitative data were analysed descriptively, with the interviews analysed using qualitative codebook thematic analysis.
Results
Quantitative analyses revealed that 73% of students felt the comics made them feel good about themselves. Qualitative analyses revealed four themes: (1) body dissatisfaction is a concern; (2) the comics are powerful; (3) increasing ease of understanding; (4) a teacher guide to aid delivery.
Conclusion
This study demonstrates acceptability of a novel teacher-led comics-based body image intervention for adolescents in Indian Hindi medium schools from lower socio-economic settings. These findings are currently informing intervention optimizations, which will be evaluated in a randomized controlled effectiveness trial. If found to be effective, this intervention will be disseminated across eight Indian states by UNICEF. Trial registration. This trial has been registered with ClinicalTrials.gov; a database of privately and publicly funded studies conducted around the world. Registration date: 2nd May 2020; Registration ID: (NCT04317755). https://clinicaltrials.gov/ct2/show/NCT04317755?term=NCT04317755&draw=2&rank=1.
To increase access to support, an online psychosocial support tool for adults with visible differences was adapted for use without referral or supervision. This intervention combines a cognitive behavioural and social skills model of support. This study aimed to assess the usability and acceptability of Face IT@home as a self-help intervention. Eighty-one participants were recruited (32 with visible differences). Stage 1 included 14 participants (11 female, all with visible differences) who viewed two sessions of Face IT@home and undertook a semi-structured telephone interview. Stage 2 consisted of 14 think-aloud sessions (13 female, none with visible differences) with participants, supervised by researchers. Stage 3 employed 53 participants (47 female; 19 with visible differences), to view one session of Face IT@home and complete an online survey to evaluate usability and acceptability. User interviews, think-aloud studies and questionnaires identified usability and acceptability factors of Face IT@home that make it fit for purpose as a self-help tool. Participants suggested some changes to the Face IT@home program to improve usability. Participants reported that Face IT@home was a useful tool for people with visible differences and could be effective. The CBT-based model was considered a useful approach to addressing psychosocial concerns. The online self-help format will increase access to psychological support for adults with visible differences.
Key learning aims
(1) The paper outlines an important cognitive behavioural framework for supporting adults with visible differences.
(2) The paper demonstrates the importance of user testing and client involvement in developing intervention models.
(3) The studies highlight one approach to the process of user testing that can produce a robust online intervention.
Substance misuse among adolescents is a public health problem because of its prevalence and consequences.
Objectives
i) To develop a culturally adapted version of the Unplugged program in Chile, renamed as “Yo Sé Lo Que Quiero (YSLQQ)”, for substance use prevention; ii) To evaluate the acceptability and feasibility of its implementation.
Methods
Pilot study, with randomized controlled trial design, with two arms (Intervention Group, IG; and Control Group, CG). The sample consisted of 1,556 students from 6th to 8th grade from six schools (1:1 ratio) in Santiago, Chile. The IG received the 12 sessions of the YSLQQ program and the CG the usual substance use prevention activities. Acceptability was assessed through a student questionnaire, and feasibility through teacher self-report.
Results
More than half of the students reported that they liked the sessions. 61.3% were satisfied with the duration of the program and 61.7% with the activities. 68% of students agreed that the program helped them to have more refusal skills towards tobacco, alcohol, and drug use in the future. On the other hand, concerning feasibility and fidelity, 88.9% of the teachers remained faithful to the manual, and 91.6% of the activities were fulfilled according to the manual.
Conclusions
The present study demonstrated that “Yo Sé Lo Que Quiero” program is acceptable and feasible for future implementation in adolescents.
Language for all is a method developed in the Netherlands for providing information in such a way that as many intended readers as possible both comprehend and accept this information. Readers include people with a large variety of reading abilities including people with low literacy skills. Language for all can be characterized as a more accessible variant of plain language with some characteristics of easy language.
In three studies the comprehension and acceptance of and preference for texts written in Language for all was evaluated, comparing original texts with a version in Language for all.
Information written in Language for all was significantly better understood and accepted, and was preferable to the original version.
In conclusion, Language for all is a promising effective, inclusive, and comprehensive method to provide information to people with and without low literacy skills. Further research is recommended.
Cognitive behaviour therapy (CBT) is considered to be the most empirically supported treatment in the Western world. However, many authors emphasize the need for cultural adaptations of CBT for patients in a non-Western context. Before considering such adaptations, it is important to investigate the reasons and the degree to which this type of treatment should be adapted. One important factor is the acceptability of CBT by local health care consumers in non-Western countries, for which there is only very limited empirical evidence. This explorative study aimed to investigate the acceptability of CBT’s principles and specific interventions in Indonesia. Lectures and video clips were developed, demonstrating various mainstream CBT principles and procedures. These were presented to 32 out-patients and mental health volunteers from various Indonesian community health centres (Puskesmas), who were asked to rate to what extent they considered the presented materials to be acceptable in accordance with their personal, family, cultural and religious values. Acceptance in all four value domains was rated as very high for the general features of CBT, as well as for the content of the video clips. There were no significant differences in acceptability between the value domains. The presented study suggests that mainstream CBT applications, which are slightly culturally adapted in terms of language, therapist–patient interaction and presentation, might resonate well with consumers in community health centres in Indonesia.
Key learning aims
(1) Adapting CBT to non-Western patients should be based on empirical evidence.
(2) The potential need for adaptation of CBT might depend on the acceptability of unadapted CBT.
(3) Acceptability is assumed to be related to patients’ values.
The aim of this article is to better understand how judgements about nudge acceptability are formed and whether they can be manipulated. We conducted a randomized experiment with N = 171 participants to test whether acceptability judgements could be (1) more favourable when the decision to implement the nudges was made following a consultation with the targeted population and (2) influenced by the joint framing of the nudge's purpose and effectiveness (in terms of an increase in desirable behaviour versus decrease in undesirable behaviour). We tested these hypotheses on various nudge scenarios and obtained mixed results that do not clearly support our hypotheses for all nudge scenarios. A surprising result that calls for further work is that by mentioning that a nudge had been implemented through a consultation with the targeted population its acceptability could be lowered.