Abstract
Acceptability is a core concept in digital health. Available frameworks have not clearly articulated why and how researchers, practitioners and policy makers may wish to study the concept of acceptability. Here, we aim to discuss (i) the ways in which acceptability might differ from closely related concepts, including user engagement; (ii) the utility of the concept of acceptability in digital health research and practice; (iii) social and cultural norms that influence acceptability; and (iv) pragmatic means of measuring acceptability, within and beyond the research process. Our intention is not to offer solutions to these open questions but to initiate a debate within the digital health community. We conducted a narrative review of theoretical and empirical examples from the literature. First, we argue that acceptability may usefully be considered an emergent property of a complex, adaptive system of interacting components (e.g., affective attitude, beliefs), which in turn influences (and is influenced by) user engagement. Second, acceptability is important due to its ability to predict and explain key outcomes of interest, including user engagement and intervention effectiveness. Third, precisely what people find acceptable is deeply contextualized and interlinked with prevailing social and cultural norms. Understanding and designing for such norms (e.g., through drawing on principles of user centered design) is therefore key. Finally, there is a lack of standard acceptability measures and thresholds. Star ratings coupled with free-text responses may provide a pragmatic means of capturing acceptability. Acceptability is a multifaceted concept, which may usefully be studied with a complexity science lens.
Highlights
The extent to which interventions are perceived as “acceptable” to patients, family members, treatment providers, institutional review boards and policy makers is central to digital health research and practice [1]
Acceptability sits at the core of the widely deployed Technology Acceptance Model [2], which posits that perceived ease of use and perceived usefulness of a given technology positively influence usage intentions, which in turn drive the adoption of new technologies
Acceptability is related to the term “tolerability” in the medical setting, which has historically been used to indicate the extent to which a drug or procedure induces pain, discomfort, Implications Practice: Care should be taken to distinguish between acceptability of trial procedures and of the intervention itself
Summary
The extent to which interventions are perceived as “acceptable” to patients, family members, treatment providers, institutional review boards and policy makers is central to digital health research and practice [1]. Within our suggested dynamic model, upon learning about a new digital health intervention (e.g., a smartphone app, an implant, a wearable device), potential users consider whether the intervention fits with their value system (“ethicality”), whether it appears effortful to use (“burden”) and/or whether it appears likely to achieve its purpose (“perceived effectiveness”) [5] Such beliefs are themselves heavily influenced by the sociocultural context within which the individual resides (“perceived norms”). Potential users simultaneously form an impression (“affective attitude”) of how they feel about the intervention, which is positively or negatively valanced, which influences (and is influenced by) their motivation to change (“want/need”) The interaction of these components – cognitions and affect – gives rise to preuse acceptability (i.e. an emergent property of the complex, adaptive system), which is experienced as a gut reaction [8, 9]. The proposed dynamic model has been described here in relation to potential or actual users, it is intended to apply to family members, caregivers and healthcare professionals
Sign-in/Register to view highlights & summary Sign-in/Register to access full text options 
Talk to us
Join us for a 30 min session where you can share your feedback and ask us any queries you have
Schedule a call
