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Behavioural Activation (BA) is a mental health treatment that encourages a person to develop or re-engage in activities that are pleasurable and meaningful to them. It is important to consider the ways such interventions can be made accessible and acceptable to individuals with communication disabilities like aphasia after stroke. Digital technologies may provide a scalable approach to increasing dissemination of BA to this population. The aim of this study was to examine the communicative accessibility and prospective acceptability of a digital BA intervention developed for this population. A qualitative research design was used, involving semi-structured interviews with 11 people with aphasia caused by stroke. Data were subject to qualitative content analysis. The results suggest that participants found the developed intervention to be both overall accessible and acceptable. Participants suggested improvements that highlighted the importance of considering how an individual's psychosocial and cognitive experience of stroke aphasia may influence their preferences for intervention layout and content. Results of our study reiterated the importance of a user-centred design process to ensure the accessibility and acceptability of digital interventions. This work provides the foundation for ongoing design of the intervention. The continued development may also provide a framework for future development of accessible and acceptable digital interventions not only for those living with aphasia after stroke but others living with acquired language or cognitive disabilities. [ABSTRACT FROM AUTHOR]

Assistance and companion dogs have numerous positive effects for family of autistic children, such as supporting their rehabilitation and improving their quality of life. To date, very few studies have compared the effects of both types of dogs. This comparison, considering the limited access to assistance dogs, could be helpful for families wanting to adopt a dog. An explanatory sequential design with a mixed-method approach was used. First, 85 parents (nassistance dogs = 57; ncompanion dogs = 28) of children aged between 3 and 17 years old (M = 10.73, SD = 3.67) completed an online questionnaire including sociodemographic questions and the Treatment Acceptability Rating Form-Revised (TARF-R). Then, 17 of these participants (nassistance dogs = 14; ncompanion dogs = 3) completed a semi-structured interview. The quantitative data analyses showed that parents with assistance dogs were significantly more satisfied: t (83) = −2.12, p =.037, d = 0.49. Significant associations between some sociodemographic variables (e.g., number of children, comorbid condition, reasons for acquiring a dog) and acceptability/satisfaction (TARF-R total scores) were found. The qualitative analysis revealed that families with both dog types observed positive effects. In brief, having an assistance dog constitutes a significant added value; nevertheless, both types of dogs are appreciated. Parents of children on the autism spectrum show significantly higher levels of satisfaction with having an assistance dog to assist the rehabilitation of their child on the autism spectrum when compared to a companion dog. Assistance and companion dogs are both perceived as beneficial by parents and as an important source of support for the rehabilitation of children on the autism spectrum and other members of their family. Companion dogs trained specifically to assist the rehabilitation of children on the autism spectrum should be offered to families in the context of limited access to assistance dogs. [ABSTRACT FROM AUTHOR]

Peer mediated intervention (PMI) is an evidence-based approach to supporting social and communication development for children on the autism spectrum. For PMI to be integrated into everyday practice, it needs to be acceptable to stakeholders. This article engaged with autistic individuals, early childhood educators, parents, and speech and language pathologists on the prospective acceptability of implementing PMI with minimally speaking preschoolers in inclusive preschool settings. Focus groups and semi-structured interviews were conducted. The transcriptions were analyzed qualitatively using reflexive thematic analysis. Stakeholders described PMI as an acceptable intervention approach for this population and provided valuable insights to inform the development and implementation of PMIs. Attention needs to be paid to how to support preschools to adopt a PMI-friendly philosophy. [ABSTRACT FROM AUTHOR]

Introduction: Telemonitoring has been proposed as an effective method to support integrated care for older people with hypertension and type 2 diabetes. This paper examines acceptability of telemontioring, its role in supporting integrated care, and identifies scale-up barriers. Methods: A concurrent triangulation mixed-methods study, including in-depth interviews (n = 29) and quantitative acceptability tool (n = 55) was conducted among individuals who underwent a 12-month telemonitoring routine. The research was guided by the Theoretical Framework of Acceptability. Interviews were analysed using template content analysis (TCA). Results: TCA identified seven domains of acceptability, with twenty-one subthemes influencing it positively or negatively. In the quantitative survey, acceptability was high across all seven domains with an overall score of 4.4 out of 5. Urban regions showed higher acceptability than rural regions (4.5 vs. 4.3), with rural participants perceiving initial training and participation effort as significantly more burdensome than their urban counterparts. Discussion: Patients described several instances where telemonitoring supported self-management, education, treatment, and identification elements of the integrated care package. However, there were barriers that may limit its further scale-up. Conclusion: For further scale-up, it is important to screen patients for monitoring eligibility, adapt telemonitoring devices to elderly needs, combine telemonitoring with health education, involve family members, and establish follow-up programmes. [ABSTRACT FROM AUTHOR]

Background: The interdisciplinary realm of medical humanities explores narratives and experiences that can enhance medical education for physicians through perspective-taking and reflective practice. However, there is a gap in comprehension regarding its appropriateness at the postgraduate level, especially when utilising art therapists as faculty. This study aims to assess the acceptability of an innovative art therapy-focused educational initiative among junior doctors during a palliative care rotation, with the goal of cultivating empathy and promoting well-being. Methods: A qualitative research project was conducted at the Division of Supportive and Palliative Care (DSPC) in the National Cancer Centre Singapore (NCCS). The study involved the recruitment of junior doctors who had successfully completed a three-month palliative care rotation program, spanning from January 2020 to April 2021. In a single small-group session lasting 1.5 h, with 3 to 4 participants each time, the individuals participated in activities such as collage making, group reflection, and sharing of artistic creations. These sessions were facilitated by an accredited art therapist and a clinical psychologist, focusing on themes related to empathy and wellbeing. To assess the acceptability of the program, two individual interviews were conducted three months apart with each participant. An independent research assistant utilised a semi-structured question guide that considered affective attitude, burden, perceived effectiveness, coherence, and self-efficacy. Thematic analysis of the transcribed data was then employed to scrutinise the participants' experiences. Results: A total of 20 individual interviews were completed with 11 participants. The three themes identified were lack of pre-existing knowledge of the humanities, promotors, and barriers to program acceptability. Conclusions: The participants have mixed perceptions of the program's acceptability. While all completed the program in its entirety, the acceptability of the program is impeded by wider systemic factors such as service and manpower needs. It is vital to address these structural limitations as failing to do so risks skewing current ambivalence towards outright rejection of future endeavours to integrate humanities programs into medical education. [ABSTRACT FROM AUTHOR]

Self-directed bibliotherapy interventions can be effective means of psychological support for individuals with cancer, yet mixed findings as to the efficacy of these interventions indicate the need for further research. We investigated the experience of individuals with cancer after using a new self-help book, based on Acceptance and Commitment Therapy (ACT). Ten participants with cancer (nine females and one male, 40–89 years old) were given access to a bibliotherapy self-help ACT-based book and participated in post-intervention semi-structured interviews. Five themes were generated from reflexive thematic analysis: (1) The value of bibliotherapy (2) Timing is important (3) Resonating with cancer experiences (4) Tools of the book (5) ACT in action. The book was found to be acceptable (self-directed, accessible, understandable content, good responsiveness to exercises) and feasible (easy to use, ACT-consistent). Although not explicitly evaluated, participants' reports indicated defusion, present moment awareness, and consideration of values, as the ACT processes that contributed to adjustment, via helping them to regain control over their lives and become more present within the moment. Findings also indicate that the intervention may be best accessed following completion of initial medical treatment. [ABSTRACT FROM AUTHOR]

Doxycycline postexposure prophylaxis (doxy-PEP) reduces sexually transmitted infections (STIs) in men who have sex with men (MSM) and transgender women (TGW). In a clinical trial of doxy-PEP, we sought to assess acceptability, impact, and meaning of doxy-PEP use among MSM/TGW. We conducted semistructured, in-depth 1:1 interviews with MSM and TGW enrolled in the intervention arm of the Doxy-PEP study. We queried motivations for and meaning of use, attitudes, beliefs, adherence, effect on sexual behaviors, and partner, community, and structural factors related to use. We coded interview transcripts into content areas, followed by thematic analysis. We interviewed 44 participants (median age 38), 2% were TGW, 17% Black, 61% White, 30% Hispanic, and 45% persons with HIV. We identified three overarching themes. First, participants found doxy-PEP acceptable, and believed it was effective based on their history of STIs, easy to adhere to, and acceptable to sex partners. Second, doxy-PEP benefited their quality of life and mental health, offering "peace of mind" by reducing their anxiety about acquisition or unwitting transmission of STIs. Participants reported feeling more "in control" of preventing STIs, and positive about supporting their personal, partner, and community health. Third, impact on sexual behavior was variable, with most reporting no change or a brief initial change. Participants in a multi-site clinical trial of doxycycline for STI prevention perceived it to be efficacious, and that it provided quality-of-life benefits, including reduced anxiety and sense of control over sexual health. Doxy-PEP had limited impact on sexual behavior. Clinicaltrials.gov: NCT03980223. [ABSTRACT FROM AUTHOR]

Breastfeeding is a crucial public health approach that reduces infant morbidity and mortality by providing essential nutrients and antibodies, and breast milk is easily digested. Breastfeeding and donated milk serve as a preventative measure against necrotising enterocolitis. Additionally, they protect against viruses and nosocomial sepsis. When a birthing parent's own milk is unavailable, alternative enteral nutrition for preterm or low‐birth‐weight infants is either donor human milk (DHM) or artificial formula. This study aimed to understand mothers' acceptance of the donor human milk bank (DHMB) and DHM. A qualitative phenomenological study was conducted in Limpopo Province, South Africa. The study used purposive sampling to select 23 mothers in postnatal and neonatal wards. Data collection was via in‐depth interviews using a semistructured interview guide. Manual data analysis using an interpretative phenomenological analysis (IPA) framework was used to coding. Concepts were grouped to generate themes. Three themes and nine subthemes were generated: (1) DHMBs (2) cultural perspective of DHMB, and (3) health considerations of DHM. Participants were unaware of the DHMB. Hesitancy in accepting DHM due to fear of contracting HIV was observed. Cultural beliefs are an influencing factor for use, while donation was driven by altruistic reasons, preventing waste, helping others and having previously benefited from DHM. The study found that mothers are willing to donate human milk. Willingness to donate can be increased by raising awareness about DHMB and addressing culture and safety concerns at antenatal clinics. Key messages: The study emphasises the possible willingness to accept the concept of donating and utilising donor human milk for newborns who do not have access to their mother's own milk. However, safety concerns, bonding and cultural issues should be addressed.Promoting breastfeeding and milk donation in communities requires addressing cultural and health concerns by utilising the service of community health workers.Education about safe breast milk banking before neonatal intensive care unit admission is also an important factor. [ABSTRACT FROM AUTHOR]

Background: A significant number of people with bulimia nervosa (BN) or binge‐eating disorder (BED) do not seek professional help. Important reasons include limited knowledge of eating disorders (EDs), feelings of shame, treatment costs, and restricted access to specialized healthcare. In this study, we explored if a novel therapy delivered in a primary care setting could overcome these barriers. We investigated factors such as motivation and expectations and included the patients' and newly trained therapists' perspectives. Method: We interviewed 10 women with BN (n = 2) or BED (n = 8), enrolled in the Physical Exercise and Dietary therapy (PED‐t) program, in a Healthy Life Center (HLC) located in a primary healthcare facility. Interview topics discussed were motivations for and expectations of therapy, and the treatment location. In addition, 10 therapists from HLC's were interviewed on their experiences with the PED‐t training program and expectations of running PED‐t within their service. The semi‐structured interviews were analyzed using reflexive thematic analysis. Results: Most patients had limited knowledge about EDs and first realized the need for professional help after learning about PED‐t. Patients exhibited strong motivations for treatment and a positive perception of both the PED‐t, the new treatment setting, and the therapists' competencies. The therapists, following a brief training program, felt confident in their abilities to treat EDs and provide PED‐t. With minor operational adjustments, PED‐t can seamlessly be integrated into national HLC service locations. Conclusion: PED‐t is an accessible therapeutic service that can be delivered in a primary care environment in a stepped‐care therapy model. Public Significance: This study investigates the views and experiences of patients and newly trained therapists of PED‐t (Physical Exercise and Dietary therapy), a new program‐led primary care therapy for binge‐eating spectrum eating disorders. The treatment and the locations for the intervention, that is, local health care centers, were found to be highly acceptable to both patients and therapists, thus PED‐t could easily be integrated as a first step into a step‐care delivery model. [ABSTRACT FROM AUTHOR]

Background: Anaemia in pregnancy causes a significant burden of maternal morbidity and mortality in sub-Saharan Africa, with prevalence ranging from 25 to 45% in Nigeria. The main treatment, daily oral iron, is associated with suboptimal adherence and effectiveness. Among pregnant women with iron deficiency, which is a leading cause of anaemia (IDA), intravenous (IV) iron is an alternative treatment in moderate or severe cases. This qualitative study explored the acceptability of IV iron in the states of Kano and Lagos in Nigeria. Methods: We purposively sampled various stakeholders, including pregnant women, domestic decision-makers, and healthcare providers (HCPs) during the pre-intervention phase of a hybrid clinical trial (IVON trial) in 10 healthcare facilities across three levels of the health system. Semi-structured topic guides guided 12 focus group discussions (140 participants) and 29 key informant interviews. We used the theoretical framework of acceptability to conduct qualitative content analysis. Results: We identified three main themes and eight sub-themes that reflected the prospective acceptability of IV iron therapy. Generally, all stakeholders had a positive affective attitude towards IV iron based on its comparative advantages to oral iron. The HCPs noted the effectiveness of IV iron in its ability to evoke an immediate response and capacity to reduce anaemia-related complications. It was perceived as a suitable alternative to blood transfusion for specific individuals based on ethicality. However, to pregnant women and the HCPs, IV iron could present a higher opportunity cost than oral iron for the users and providers as it necessitates additional time to receive and administer it. To all stakeholder groups, leveraging the existing infrastructure to facilitate IV iron treatment will stimulate coherence and self-efficacy while strengthening the existing trust between pregnant women and HCPs can avert misconceptions. Finally, even though high out-of-pocket costs might make IV iron out of reach for poor women, the HCPs felt it can potentially prevent higher treatment fees from complications of IDA. Conclusions: IV iron has a potential to become the preferred treatment for iron-deficiency anaemia in pregnancy in Nigeria if proven effective. HCP training, optimisation of information and clinical care delivery during antenatal visits, uninterrupted supply of IV iron, and subsidies to offset higher costs need to be considered to improve its acceptability. Trial registration ISRCTN registry ISRCT N6348 4804. Registered on 10 December 2020 Clinicaltrials.gov NCT04976179. Registered on 26 July 2021 Plain language summary: Low blood level in pregnancy is of public health importance and with common occurrence worldwide, but with a higher rate in low resource settings where its burden greatly affects both the mother and her baby. This low blood level is usually caused by poor intake of an iron-rich diet. It could lead to fatigue, decreased work capacity, and dizziness if not detected. Without treatment, this condition could affect the baby, possibly leading to its sudden demise in the womb, immediately after birth, or even the woman's death. The use of oral iron has been the primary treatment; however, it is associated with significant side effects, which have led to poor compliance. Fortunately, an alternative therapy in the form of a drip has been shown to overcome these challenges. However, it is not routinely used in countries like Nigeria. Moreover, being effective is different from being utilised. Therefore, this study was conducted to understand the factors that will make this treatment widely accepted. We interviewed pregnant women, family support and health care providers in 10 health facilities in Lagos and Kano States, Nigeria. Our findings revealed good attitudes to iron drip. However, its inclusion into routine antenatal health talk, training of health care providers, availability of space, drugs and health workers who will provide this care, and ensuring this drug is of low cost are some of the efforts needed for this treatment to be accepted. [ABSTRACT FROM AUTHOR]

Background: Little research exists to support the administration of corticosteroids to pregnant women with diabetes. Pregnant women are often excluded from clinical trials due to concerns of harm to the foetus. Aim: This study aimed to understand the experiences of women and clinicians of participating in the Prevention of neonatal Respiratory distress with antenatal corticosteroids before Elective Caesarean section in women with Diabetes pilot randomised controlled trial to determine the acceptability of the study protocol. Methods: Women and clinicians participating in the pilot trial were invited to complete a telephone interview regarding their experiences of participating. Qualitative data were collected and subsequently analysed using thematic analysis. Results: A total of 13 women and nine clinicians were recruited between June 2020 and May 2022 for a telephone interview. Participating in the study was deemed acceptable by women and clinicians. Women chose to participate in the study due to the perceived low risk of harm associated with the intervention and for altruistic reasons. The high level of clinical support and information provided for the duration of the pilot trial was valued by women and clinicians. All clinicians highlighted the importance of conducting the trial to inform evidence‐based practice. Conclusions: Pregnant women are more likely to participate in clinical trials when perceived risks are low and they are well‐informed during decision‐making. Clinicians will support clinical trials when they perceive a benefit to practice and feel assured that women receive extensive monitoring and support. Incorporating these factors into study protocols is more likely to be successful in recruiting pregnant women and maintaining the engagement of clinical staff for the duration of clinical trials. Patient or Public Contributions: Patients were invited to be participants in this study. A consumer has been included in the planning and oversite of the large multicentre trial. [ABSTRACT FROM AUTHOR]

Background: Dementia care in South Africa faces challenges including a paucity of published research, a prevalent medical model in healthcare, and inadequate caregiver training. Music is a meaningful psychosocial intervention in dementia care, yet its application is not always safe and effective. A training protocol was codesigned to enhance caregivers' delivery of person‐centred care through attuned, live singing. Objectives: This study explored the acceptability and caregivers' experiences of a person‐centred caregiver singing (PCCS) protocol in South Africa. Methods: A PCCS workshop was applied at seven aged care homes in Cape Town, South Africa. Forty‐one formal caregivers adhered to inclusion criteria and consented to attend one workshop on PCCS. Mixed methods data collection was obtained from questionnaires containing a Likert scale and written reflections. Quantitative data were analysed through nonparametric tests and narrative descriptions, and qualitative data through thematic content analysis. Findings were integrated deductively using seven components of acceptability. Results: Findings converged to show caregivers' positive experiences, highlighting observed improvements in residents' wellbeing, caregivers' capabilities, empathic connection, and person‐centred care beyond the one‐on‐one. Caregivers' limited song repertoire and residents' unpredictability hindered implementation, however, the skills acquired appeared useful and applicable. Conclusions: Integration of findings suggests the acceptability of PCCS as caregivers experienced PCCS as a helpful, easy‐to‐implement intervention that contributes to their delivery of person‐centred care. Further research focused on caregiver self‐efficacy, empathy, and caregivers' own personhood is needed as well as determining the most effective strategies to ensure maximum uptake and sustainability in the sector. Patient or Public Contribution: Formal caregivers participated in this study, both attending the training and implementing the singing protocol with residents in their care at their respective care homes. The people living with dementia residing at the care home were recipients of the singing protocol but not included as participants in the research. [ABSTRACT FROM AUTHOR]

Background: Smart nursing homes (SNHs) integrate advanced technologies, including IoT, digital health, big data, AI, and cloud computing to optimise remote clinical services, monitor abnormal events, enhance decision-making, and support daily activities for older residents, ensuring overall well-being in a safe and cost-effective environment. This study developed and validated a 24-item Expectation and Acceptability of Smart Nursing Homes Questionnaire (EASNH-Q), and examined the levels of expectations and acceptability of SNHs and associated factors among older adults in China. Methods : This was an exploratory sequential mixed methods study, where the qualitative case study was conducted in Hainan and Dalian, while the survey was conducted in Xi'an, Nanjing, Shenyang, and Xiamen. The validation of EASNH-Q also included exploratory and confirmatory factor analyses. Multinomial logistic regression analysis was used to estimate the determinants of expectations and acceptability of SNHs. Results: The newly developed EASNH-Q uses a Likert Scale ranging from 1 (strongly disagree) to 5 (strongly agree), and underwent validation and refinement from 49 items to the final 24 items. The content validity indices for relevance, comprehensibility, and comprehensiveness were all above 0.95. The expectations and acceptability of SNHs exhibited a strong correlation (r = 0.85, p < 0.01), and good test-retest reliability for expectation (0.90) and acceptability (0.81). The highest tertile of expectations (X2=28.89, p < 0.001) and acceptability (X2=25.64, p < 0.001) towards SNHs were significantly associated with the willingness to relocate to such facilities. Older adults with self-efficacy in applying smart technologies (OR: 28.0) and those expressing a willingness to move to a nursing home (OR: 3.0) were more likely to have the highest tertile of expectations compared to those in the lowest tertile. Similarly, older adults with self-efficacy in applying smart technologies were more likely to be in the highest tertile of acceptability of SNHs (OR: 13.8). Conclusions: EASNH-Q demonstrated commendable validity, reliability, and stability. The majority of Chinese older adults have high expectations for and accept SNHs. Self-efficacy in applying smart technologies and willingness to relocate to a nursing home associated with high expectations and acceptability of SNHs. [ABSTRACT FROM AUTHOR]

Background: Falls are a major concern for community-dwelling older adults. The Otago Exercise Program (OEP) is an evidence-based home program that reduces risk of falls. Exercise participation and program adherence can be challenging. Home care workers (HCWs) are well positioned to provide support for older adults. Methods: This feasibility study included: HCW training; HCW in-home support of a physiotherapist-tailored OEP; online physiotherapy consultations; older participant questionnaires and functional outcome measures; and HCW and older participant interviews. Results: Twelve older adults, eight HCWs and one physiotherapist participated. A small falls risk reduction, and improvement in falls efficacy, quality of life and functional improvement were noted. Thematic analysis showed formal and informal support was valued by older adults and HCWs. A role-ordered matrix synthesis highlighted variable ongoing independent program participation. Conclusions: By Your Side, a physiotherapist-led and home care worker-supported modified OEP provides a feasible and acceptable option for falls prevention in home care services. Collaborative teamwork, and both formal and informal support, are key aspects to optimising engagement and benefits. The Otago Exercise Program is an effective falls prevention program that improves function; however, in-home and online physiotherapy-led, and home-based home care worker (HCW) supported delivery, has not been explored. Physiotherapist collaboration, formal HCW support and informal supports engagement were important for program acceptability, ongoing engagement, and optimising benefits. The By Your Side program was feasible and acceptable within home care services, and had many benefits for older adult and HCW participants including participation, confidence, emotional and functional improvements. [ABSTRACT FROM AUTHOR]

In this study, we examined the acceptability and appropriateness of Tuning in to Kids Together (TIK-Together) from the perspective of program facilitators. TIK-Together is newly a modified version of Tuning in to Kids that specifically focuses on the coparenting relationship (i.e., how parents work together to raise their children) and requires parents to both attend sessions. Through a mixed-method design, Australian facilitators who participated in the TIK-Together pilot study provided their perspectives on the acceptability (i.e., affective attitudes, burden, program benefits) and appropriateness of the program in their communities. It is essential to involve stakeholders, such as program facilitators, in pilot studies as they can provide valuable feedback from their first-hand experience with the program. Facilitators reported that TIK-Together was enjoyable and rewarding, and although delivery was straightforward, additional preparation time was required to manage program materials. Facilitators observed several program benefits, including coparents becoming more aligned and collaborative in their approach to parenting. Certain program components were particularly helpful for parents, including activities that were experiential, interactive, and reflective. Overall, facilitators deemed TIK-Together appropriate for their communities; however, it is not suitable for parents who are uncomfortable or unwilling to work alongside each other in sessions. Given the increased focus on a coparent approach to parenting interventions, the findings provide important insights for researchers and practitioners. Highlights: The current study explores the implementation of Tuning in to Kids Together (TIK-Together), a newly modified emotion-focused coparenting program. Findings show that facilitators perceived TIK-Together to be acceptable and appropriate for their communities. Facilitators reported TIK-Together led to positive benefits (e.g., increased alignment and cohesion between coparents), but it may not be suitable for all families. [ABSTRACT FROM AUTHOR]

Purpose: This embedded qualitative study explored the acceptability, feasibility, and fidelity of two multi-level RCT interventions among office workers, aiming at improving movement behaviour to enhance mental health and cognition. The interventions addressed the organizational, environmental, and individual level. Methods: Semi-structured interviews and focus group discussions were conducted with 38 stakeholders after completion of the interventions. Data were analysed using reflexive thematic analysis. Results: The interventions were well appreciated, and office workers attributed improvements in movement behaviour and wellbeing to the interventions. Especially the cognitive behavioural therapy (CBT) based counselling and free gym access were appreciated, feasible and delivered as planned. Participants described existing workplace norms as barriers to more activity, particularly for reducing sitting. Support from managers and team support were considered crucial components. However, delivering these components was difficult. Conclusions: The findings support the design of the multi-level interventions for changing movement behaviour. Results highlight the potential of CBT for this target group and the importance of manager and team support. Desired effects of similar multi-level interventions, including CBT, might be achieved in future studies that carefully address the issues with feasibility and acceptability and the resulting low fidelity of some intervention components that were identified in this study. [ABSTRACT FROM AUTHOR]

Background: Although bundled communication interventions are recommended to address communication barriers for patients with an advanced airway in the intensive care unit (ICU) such interventions have not been evaluated in pandemic conditions. Aim: To evaluate the acceptability, appropriateness, and feasibility of a co‐designed bundled intervention to support communication with adult patients with an advanced airway in ICU in pandemic conditions. Study Design: Prospective, convergent mixed method design in a single centre medical‐surgical ICU in Toronto, Canada between September 2021–March 2022. After the use of the co‐designed bundled communication intervention quantitative data were collected from health care providers using validated acceptability, appropriateness, and feasibility measures and analysed using descriptive statistics. Qualitative data were collected from providers, patients and families using semi‐structured interviews and analysed using content analysis applying the theoretical framework of acceptability. Joint table analysis enabled the integration of the two data sets. Results: A total of 64 (41.3%) HCPs responded to the survey: 54 (84.4%) rated the intervention acceptable; 55 (85.9%) appropriate; and 49 (76.6%) feasible for use in this context. Qualitative data (23 interviews: 13 healthcare providers, 6 families and 4 patients) and the joint table analysis extended the understanding that intervention acceptability was related to positive affective attitudes and reduced communication frustration. Appropriateness and feasibility were promoted through intervention alignment with values, ability to personalize tools, and ease of access. Recommendations to improve the acceptability included adaptation for immobilized and/or restrained patients, additional education, and integration into existing workflows. Conclusions: This mixed method evaluation of a co‐designed bundled intervention to support patient communication in the ICU during pandemic conditions demonstrated high rated and described acceptability, appropriateness, and feasibility by participants. Relevance to Clinical Practice: A co‐designed communication intervention demonstrating stakeholder acceptability, appropriateness, and feasibility can be implemented into clinical practice in pandemic and other infection prevention and control contexts. [ABSTRACT FROM AUTHOR]

Background: Nutritional therapy has been conventionally recommended for people with prediabetes as a method to delay or halt progression to type 2 diabetes mellitus (T2DM). The extensive diversity in food culture and habits in India pose a challenge in devising a uniform low-calorie diet plan. Though there are a number of studies related to different diet therapies, there exists limited evidence on culturally contextualized low-calorie diet plans and their process in India. The objective of the study is to test the suitability, acceptability, and feasibility of a culturally contextualized low-calorie diet among women with high risk for T2DM in Kerala. Method: We employed a four-stage equal-status sequential design for this study. Firstly, in-depth interviews (n = 10) were conducted to understand the modifiable and non-modifiable components of the usual diet for diabetes prevention. Secondly, we developed a low-calorie diet plan (1500 kcal per day) based on the local preferences and availability. Thirdly, we piloted the diet plan among 18 individuals in the community to know its acceptability. Fourthly, in-depth interviews were done (n = 4) among pilot participants to understand the feasibility of pursuing it through facilitators and barriers to implementing the diet plan. Results: Low-calorie diet plan was suitable for this setting as the burden of diabetes is very high and the diet plan had dietary components similar to the usual diet. Though participants had an intrinsic motivation to follow a healthy lifestyle, several systemic challenges such as the high cost of healthy foods options (fruits and vegetables), rice addiction, and food preferences driven by peer pressure act as hurdles. Conclusion: Apart from culturally contextualizing the low-calorie diet, it is important that complementary strategic measures such as reorientation of the public distribution system and subsidizing fruit and vegetable production and cost are required for the suitability, acceptability, and feasibility of implementation. [ABSTRACT FROM AUTHOR]

Objective: The high burden of eating disorders (EDs) and limited availability of treatment speaks of a need to explore new avenues for treatment delivery. To understand if new treatment avenues are helpful and acceptable to patients, we investigated the effectiveness of Physical Exercise and Dietary Therapy (PED‐t) in participants with bulimia nervosa or binge‐eating disorder, and acceptability when the PED‐t was implemented in a Healthy Life Center in a municipal primary healthcare service. Method: Exercise physiologists and one dietitian were trained in ED literacy and to run PED‐t, before screening women for eligibility. Effectiveness (n = 16) of PED‐t and participants' experiences (n = 8) were evaluated by a mixed methods study design. Results were analyzed by relevant statistics and reflexive thematic analysis. Results: Of 19 eligible participants, 16 completed treatment. At post‐treatment, the Eating Disorder Examination Questionnaire global score, binge‐eating frequency, and symptoms of depression were lower, and nine (56% of completers) were in remission. Participants' treatment experiences were classified into two overarching themes: "competence" and "emotional support." Participants reported high acceptance for PED‐t, the local venue and group format, and felt that PED‐t provided them with coping tools and increased mental strength. However, many also spoke of an unmet need to address emotional eating. Discussion: Findings point to a potential for making an effective ED therapy more accessible, and that participants find the local low‐threshold delivery within a group‐format helpful. With small adjustments, the PED‐t could emerge as a promising first‐line treatment for bulimic EDs. Public Significance Statement: Limited access to treatment for EDs, patients' high barriers to help‐seeking, and the high rates of limited efficacy from psychotherapy speak of a need to explore new therapies and avenues for delivery. In this study, we build on findings from a controlled ED treatment trial and replicate the beneficial effects and find a high patient acceptance of "physical exercise and diet therapy" implemented in a real, non‐clinical setting. [ABSTRACT FROM AUTHOR]

To explore the acceptability and potential efficacy of orthotic shorts in people with multiple sclerosis. This mixed-methods, cross-over study utilised qualitative data to investigate acceptability, including perceived effectiveness. Quantitative data included wear times, self-selected walking speed, spatiotemporal gait parameters, and participant-perceived walking ability. Fifteen participants were assessed with and without two pairs of custom-made shorts: one designed as an orthotic and a second looser pair. Each were worn at home for two weeks. Semi-structured interviews were conducted at the first and final appointments. Quantitative data were analysed using Cohen's d; qualitative analysis used a thematic framework. A triangulation protocol integrated qualitative and quantitative data. Orthotic shorts were acceptable to most users who described improved control, stability, and function. Where shorts were less acceptable, this was due to restriction of hip flexion or appearance. Effect sizes were in the moderate category for participant-perceived walking ability and for those spatiotemporal gait parameters that reflect mediolateral stability. Small effect sizes were seen for walking speed and related spatiotemporal parameters, such as step length. Orthotic shorts are acceptable and potentially efficacious for improving walking, stability, and function in people with multiple sclerosis. Further research and design development are warranted. Orthotic shorts are a type of fabric orthosis that have not been previously researched but might assist pelvic stability. Orthotic shorts appear to be acceptable to those people with multiple sclerosis who perceive themselves to be unstable around the trunk and hips. Orthotic shorts might improve gait stability and self-perceived walking ability. [ABSTRACT FROM AUTHOR]

Continuous monitoring of glucose (CGM) via subcutaneous patch is an accurate self-monitoring tool of blood glucose, but also introduces a range of additional benefits such as real-time feedback. While its value among pregnant women with gestational diabetes mellitus (GDM) is established in high-income countries, little is known about the feasibility and acceptability among pregnant women without GDM in low-resource settings in low- and middle-income countries. This study aims to assess the feasibility and acceptability of CGM with pregnant mothers in South Africa and to explore the value of a collected data set for GDM prevention. Ten women between 12 and 18 weeks pregnant were recruited from the antenatal clinic at Chris Hani Baragwanath Academic Hospital into a prospective mixed-methods pilot study. Demographic and anthropometric data, HbA1c and a lipid panel were collected. Women then wore two consecutive Freestyle Libre 2 patches for a total of 28 days. In-depth interviews were undertaken with all 10 women on study exit to explore themes of acceptability and the use of technology during pregnancy. Thematic analysis was performed on the qualitative data while exploratory data-analysis techniques were applied to the CGM data. Pregnant women (n = 10) had a mean (SD) age of 29.81 years (4.39), with most being unemployed (8), unmarried (8) and without a tertiary degree (7). Analysis suggests that fear of use was greater than the actual discomfort experienced during use of the CGM patch. The main barrier to use was the patch falling off and women being uncomfortable to reapply it. This was borne out by all 10 women wearing the first patch for at least 12 of the 14 days, but only 4 managing the same with patch two – primarily applied by themselves at home. Women expressed support for the use of technology during pregnancy, especially as it related to feeling that their pregnancy was being monitored and that they were being supported. In this pilot study, women overwhelmingly found the wearing of a CGM patch during pregnancy to be acceptable. Feasibility was reasonable with most data being successfully retrieved from the devices over a two-week period. Longer use was found to have additional challenges. The use of CGM patches appear to be a possible candidate for inclusion in GDM prevention or behavioural interventions during pregnancy in South Africa. [ABSTRACT FROM AUTHOR]

Objectives: Suicide is a leading cause of death worldwide. People experiencing psychosis are at increased risk of death by suicide. Talking therapies can alleviate suicidal thoughts, plans, and attempts. Therapies need to also be acceptable to recipients. The aim of this study was to investigate the views on psychological therapy for people experiencing psychosis and suicidality using the Theoretical Framework of Acceptability. Design: Qualitative interview study. Methods: Participants were recruited from a randomised controlled trial comparing suicide prevention psychological therapy with treatment as usual. Individuals had a diagnosis of non‐affective psychosis and experience of suicidal thoughts, plans and/or attempts. To assess the acceptability of the therapy, semi‐structured interviews were conducted with 20 participants randomised to receive therapy. Data were deductively analysed using an adaptation of the Theoretical Framework of Acceptability. Results: Interviews (Mean = 45 min) were conducted and audio recorded with 21 participants. Data were organised into six themes: 1. Affective attitude, 2. Burden, 3. Alliance, 4. Intervention coherence, 5. Perceived effectiveness, and 6. Self‐efficacy. There was no evidence of issues relating to domains of ethicality and opportunity costs associated with receiving therapy. Conclusions: Talking about suicide was difficult and, at times, distressing, but it was perceived to be useful for understanding experiences. To be acceptable, it is important for therapists to ensure that clients' understanding of therapy aligns with expectations of effectiveness and to invest in building strong therapeutic alliances. Future research will benefit from examining therapists' experiences of delivering therapy through different modes (e.g. online, telephone). [ABSTRACT FROM AUTHOR]

Aims: To explore healthcare professionals' perceptions of the feasibility and acceptability of family engagement in early mobilisation for adult critically ill patients. Background: Early mobilisation is beneficial to minimise intensive care unit acquired‐weakness in critically ill patients and family engagement can help with meeting early mobilisation goals, but it is not widely practiced. Understanding healthcare professionals' perceptions of feasibility and acceptability of family engagement in early mobilisation of adult critically ill patients is required to inform future implementation strategies to promote early mobilisation. Design: A descriptive qualitative study. Methods: Face‐to‐face, individual, semi‐structured interviews were conducted between August 2021 and March 2022 with healthcare professionals working in two intensive care units in Australia. The interviews were analysed using the inductive content analysis, and descriptive statistics were used to summarise participant characteristics. The COREQ checklist was followed when reporting this study. Results: Eleven ICU nurses, five physiotherapists and four physicians participated in the interviews. Three main categories were identified: (i) healthcare professionals' readiness, (ii) mediators of engagement and (iii) foundations for successful implementation. Most participants demonstrated a positive attitude towards an implementation of family engagement in early mobilisation for adult critically ill patients; however, capability and capacity of healthcare professionals, family members' willingness, availability and readiness and the care context were considered factors that could influence the successful implementation. Conclusion: From the perspectives of healthcare professionals, family engagement in early mobilisation is feasible and acceptable to enact but implementation is influenced by contextual factors including, healthcare professionals' capability and capacity and family members' willingness, availability and readiness. Collaborative teamwork and preparing family members and healthcare professionals are needed to support this practice. Relevance to Clinical Practice: The findings provide important information to further identify potential strategies of family engagement in early mobilisation and to help and mitigate factors that impede implementation. [ABSTRACT FROM AUTHOR]

The purpose of this study is to explore the acceptability of a telerehabilitation intervention provided to parents of children with motor difficulties. Sixteen parents of children were purposefully recruited to participate in semi-structured interviews aimed at assessing the acceptability of the telerehabilitation intervention. Interviews were analyzed thematically. All participants described evolving acceptability associated with their interactions with the web platform. The opportunities generated, suitability in relation to families' values and perceived effects positively impacted acceptability. The understanding and consistency of intervention delivery, the child's level of involvement, the associated parental burden of the intervention and the therapeutic alliances created also affected acceptability. Our study findings support the acceptability of a telerehabilitation intervention for families of children with motor difficulties. Telerehabilitation seems to be more acceptable to families with children without suspected or confirmed diagnoses. [ABSTRACT FROM AUTHOR]

Anxiety disorders during pregnancy are associated with poor pregnancy outcomes. Internet-based emotion-focused cognitive behavior therapy (IECBT) with husband participation approach is an alternative treatment for treatment of mental disorders in pregnant women. The study aimed to compare the acceptability, feasibility, and effectiveness of IECBT with husband participation. In a quasi-experimental study 68 pregnant women diagnosed with anxiety disorders were divided into IECBT with husband participation (n = 34) and IECBT alone (n = 34) and completed the Brief Symptom Inventory (BSI-18) Client Satisfaction Questionnaire (CSQ-8) and System usability scale (SUS) at baseline and eight weeks after the trial. Results showed that acceptability and feasibility of CO-IECBT among women and their spouses were positive. Acceptability with indices, namely women's satisfaction and average participation in sessions, was greater among IECBT with husband participation participants than among participants in IECBT alone. Feasibility was high for both therapy methods, and no significant difference was observed between the two groups. This study suggests that both IECBT with husband participation and IECBT alone are effective treatments for mitigating psychological distress in anxious pregnant women. [ABSTRACT FROM AUTHOR]

Background & Aims: Even though evidence for the use of linguistic–phonological intervention approaches in children with a cleft (lip and) palate (CP±L) is still limited, these approaches are being used by speech–language pathologists (SLPs) to treat active or compensatory cleft speech disorders in clinical practice. It is, however, unknown to what extent linguistic–phonological intervention is acceptable to SLPs. The aim of this study is to investigate the retrospective acceptability of linguistic–phonological intervention in children with a CP±L from the perspective of SLPs using the theoretical framework of acceptability (TFA). Methods & Procedures: A total of 18 female community SLPs, aged between 23 and 63 years, were included in the study. An independent interviewer conducted semi‐structured interviews. Data were analysed using a deductive coding approach. Statements of the SLPs were related to the seven constructs of the TFA: affective attitude, burden, ethicality, intervention coherence, opportunity costs, perceived effectiveness and self‐efficacy. Outcomes & Results: The affective attitude and perceived effectiveness of linguistic–phonological intervention differed among the SLPs: some therapists had positive attitudes towards these approaches, while others did not. Positive attitudes were related to the successful use of linguistic–phonological intervention in the past. The construct 'ethicality' revealed that negative attitudes towards these approaches were attributed to the limited available scientific evidence or negative experiences while using these approaches. In contrast, SLPs who had positive attitudes considered these interventions as 'important' and 'valuable'. Some SLPs had negative reflections on linguistic–phonological intervention as these approaches were considered demanding in terms of time needed to gain knowledge on using them in children with a CP±L (constructs 'burden' and 'opportunity costs'). Additionally, some SLPs doubted their self‐efficacy to use these approaches in clinical practice. Conclusions & Implications: The acceptability of linguistic–phonological intervention differed between the SLPs in this sample and was most likely related to their previous experiences with these linguistic–phonological approaches. It is important to increase not only the amount of scientific evidence for linguistic–phonological approaches but also the supply of evidence‐based workshops and training courses on this topic. These initiatives should distribute scientific information that is translated into guidelines that are immediately applicable in clinical practice. This may potentially reduce the time‐related burden that some SLPs currently experience to gain expertise in this matter. In future research, it is necessary to investigate if there exist differences in acceptability between the different types of linguistic–phonological therapy. What This Paper Adds: What is already known on this subject: Linguistic–phonological speech intervention approaches are often used by SLPs to treat active or compensatory cleft speech disorders in clinical practice. What this paper adds to existing knowledge: This study investigated whether linguistic–phonological intervention cleft speech intervention is acceptable to SLPs. Some therapists had positive attitudes towards these approaches, while others did not. Positive attitudes were related to the successful use of these approaches in the past. If SLPs indicated having negative attitudes, these negative feelings were attributed to the limited available scientific evidence or negative experiences while using these approaches. What are the potential or actual clinical implications of this work: Even though linguistic–phonological speech intervention approaches are being used in clinical practice, these approaches are not always considered acceptable by SLPs. Acceptability could be enhanced by increasing the amount of scientific evidence for linguistic–phonological approaches, but also by increasing the supply of workshops and training courses on this topic. These initiatives should distribute hands‐on information that is immediately applicable in clinical practice. This may potentially reduce the time‐related burden that some SLPs currently experience to gain expertise in this matter. [ABSTRACT FROM AUTHOR]

To explore the feasibility and acceptability of Proyecto Mariposa, a culturally-tailored survivorship care program for rural Latina breast cancer patients. Single group mixed-method approach. Feasibility of recruitment, intervention and evaluation, and perceptions about the intervention were assessed with 18 rural Latina breast cancer patients from the US/Mexico border region. Pre-post assessments evaluated change in patients' knowledge and concerns about survivorship care, and their self-efficacy about patient-physician interaction and managing chronic disease. Feasibility was generally promising but affected by the COVID-19 outbreak. Participants found the intervention to be acceptable and useful, particularly with regard to information provision and encouraging proactive behavior. There was modest pre-post improvement on self-efficacy for managing disease. This pilot study suggested feasibility and acceptability of Proyecto Mariposa for rural Latina breast cancer patients. Change in outcomes was small indicating the need for research with a larger sample to establish reliable findings. [ABSTRACT FROM AUTHOR]

Background: Donated breast milk is considered beneficial to vulnerable infants. Thus, Uganda launched its first human milk bank in November 2021 to provide breast milk to preterm, low birthweight and sick babies. However, there is a scarcity of information on the acceptability of donated breast milk in Uganda. The study sought to assess the acceptability of using donated breast milk and associated factors among pregnant women at a private and a public hospital in central Uganda. Methods: This cross-sectional study enrolled pregnant women attending antenatal care at the selected hospitals between July and October 2020. All pregnant women recruited had already given birth to at least one child. Data were collected using a semi-structured questionnaire, and we recruited participants through systematic sampling. Used frequencies, percentages and means with standard deviations to summarize variables. Assessed the association between the acceptability of donated milk and selected factors by comparing their arithmetic means using a generalized linear model to allow for clustering at the health facility level. Used a normal distribution and an identity link and calculated the adjusted mean differences together with 95% CIs [generated using robust variance estimators to correct for model misspecification]. Results: A total of 244 pregnant women with a mean age of 30 (± 5.25) years were enrolled. Sixty-one-point 5% (150/244) of the women reported that they would accept donated breast milk. Higher education (adjusted mean difference, technical versus primary level: 1.33; 95% CI 0.64, 2.02), being Muslim (adjusted mean difference, Muslim versus Christian: 1.24; 95% CI 0.77, 1.70), having heard of donated breast milk banking (adjusted mean difference, ever versus never: 0.62; 95% CI 0.18, 1.06) and presence of a serious medical condition (adjusted mean difference, preference of donated milk versus other feeds in a serious medical condition: 3.96; 95% CI, 3.28, 4.64) were associated with acceptability of donated breast milk. Conclusions: The acceptability of using donated breast milk for infant feeding was high among pregnant women. Public sensitization and education campaigns are indispensable for the acceptability of donated milk. These programs should be designed to include women with lower education levels. [ABSTRACT FROM AUTHOR]

Physical activity (PA) participation is important for children born extremely preterm or extremely low birthweight as it provides opportunities to improve motor skills and cardiovascular fitness; however there is little evidence on interventions promoting PA participation for this group, particularly at preschool age. This study aims to explore the acceptability, a critical component of intervention feasibility, of a novel dance participation intervention. Semi-structured interviews explored the acceptability of Dance PREEMIE, a Dance PaRticipation intervention for Extremely prEterm children with Motor Impairment at prEschool age (trial registration ACTRN12619001266156), from the perspectives of dance teachers delivering the intervention (n = 6), and parents of participating children (n = 6). Data were analyzed using reflexive thematic analysis. Five themes were developed: 1) placing the child center-stage: a shared motivation to promote child wellbeing and development; 2) Dance PREEMIE as a catalyst for participation; 3) child development takes time, practice and exposure; 4) the value of being informed; and 5) dance teachers as architects of the learning environment. Dance PREEMIE was acceptable to both parents of participating children and dance teachers. Findings from this study may inform future interventions aiming to improve PA participation for children with motor impairment at preschool age. [ABSTRACT FROM AUTHOR]

It is increasingly recognised that many people with intellectual disabilities suffer from post‐traumatic stress disorder (PTSD). Eye‐movement desensitisation and reprocessing (EMDR) has been proposed as a potentially helpful intervention that is less reliant on verbal skills than other effective treatments for PTSD and therefore could be more effective than verbal interventions for people with intellectual disabilities. The Trauma‐AID project is a randomised clinical trial (RCT) evaluating the effectiveness of a bespoke EMDR protocol for adults with intellectual disability and PTSD, which incorporates a prolonged phase of Psycho‐Education and Stabilisation (PES) prior to the trauma confrontation phase of EMDR. The COVID‐19 pandemic struck during the feasibility phase of the Trauma‐AID project, necessitating a second feasibility study to evaluate the acceptability and feasibility of remote or hybrid delivery of the PES + EMDR protocol. To this end, we conducted two online surveys of therapists followed by interviews with clients, carers and senior therapists. The surveys were analysed descriptively. Content analysis was used for client and carer interviews, and framework analysis for therapist interviews. All stakeholders reported positive experiences of EMDR; however, some challenges were identified. The majority of clients, carers and therapists interviewed reported that the intervention, whether PES alone or the full PES‐EMDR package, had improved symptoms of PTSD and psychological well‐being, and carers also reported decreases in challenging behaviour. A full account of the data is provided in four Supplementary Digital files. PES‐EMDR therapy appears both feasible and acceptable for clients with intellectual disabilities and therapists, whether delivered face‐to‐face or in a remote or hybrid mode, though remote working appears easier for the PES phase than the EMDR phase of the intervention. [ABSTRACT FROM AUTHOR]

Background: There is limited evidence on what shapes the acceptability of population level dietary and active-travel policies in England. This information would be useful in the decision-making process about which policies should be implemented and how to increase their effectiveness and sustainability. To fill this gap, we explored public and policymakers' views about factors that influence public acceptability of dietary and active-travel policies and how to increase public acceptability for these policies. Methods: We conducted online, semi-structured interviews with 20 members of the public and 20 policymakers in England. A purposive sampling frame was used to recruit members of the public via a recruitment agency, based on age, sex, socioeconomic status and ethnicity. Policymakers were recruited from existing contacts within our research collaborations and via snowball sampling. We explored different dietary and active-travel policies that varied in their scope and focus. Interviews were transcribed verbatim and analysed using thematic reflexive analysis with both inductive and deductive coding. Results: We identified four themes that informed public acceptability of dietary and active-travel policies: (1) perceived policy effectiveness, i.e., policies that included believable mechanisms of action, addressed valued co-benefits and barriers to engage in the behaviour; (2) perceived policy fairness, i.e., policies that provided everyone with an opportunity to benefit (mentioned only by the public), equally considered the needs of various population subgroups and rewarded 'healthy' behaviours rather than only penalising 'unhealthy' behaviours; (3) communication of policies, i.e., policies that were visible and had consistent and positive messages from the media (mentioned only by policymakers) and (4) how to improve policy support, with the main suggestion being an integrated strategy addressing multiple aspects of these behaviours, inclusive policies that consider everyone's needs and use of appropriate channels and messages in policy communication. Conclusions: Our findings highlight that members' of the public and policymakers' support for dietary and active-travel policies can be shaped by the perceived effectiveness, fairness and communication of policies and provide suggestions on how to improve policy support. This information can inform the design of acceptable policies but can also be used to help communicate existing and future policies to maximise their adoption and sustainability. [ABSTRACT FROM AUTHOR]

Intervention acceptability is a multifaceted concept that results from an individual's cognitive and emotional responses to an intervention. Though often inferred, little research to date supports the assumption of acceptability of abbreviated psychological interventions as implemented in integrated primary care settings. This study aimed to characterize patients' appraisals of acceptability through a mailed survey with Likert-type ratings of intervention coherence, satisfaction, and personal use of strategies, and open-text responses on ways to improve intervention strategies. Participants included 281 Veterans who received integrated primary care services within the Department of Veterans Affairs, of whom 144 provided qualitative feedback. Data were analyzed using a complementary mixed-method paradigm. Results suggested that patients found integrated primary care interventions to be acceptable on the whole, though personal barriers in independently using intervention strategies were frequently cited. Implications to address barriers to knowledge and skill transfer are discussed in the context of patient-centered psychological care. Public Significance Statement: Primary care behavioral health, an increasingly popular model of primary care–mental health integration, offers access to brief, often time-limited psychological care within the primary care environment. Results from this survey study support that psychological interventions implemented in real-world primary care behavioral health settings are acceptable to patients and point to practical strategies to maintain and potentially improve acceptability. [ABSTRACT FROM AUTHOR]

Background: Increasing attention is paid to the effectiveness of high‐intensity speech intervention in children with a cleft (lip and) palate (CP±L). It is, however, unknown if high‐intensity intervention is acceptable to the intervention recipients. Parents have an integral role in supporting their children with intervention highlighting the importance of intervention acceptability to parents. Aims: To compare the retrospective acceptability of high‐intensity speech intervention (10 1‐hr speech therapy sessions divided over 2 weeks) with the retrospective acceptability of low‐intensity speech intervention (10 1‐hr speech therapy sessions divided over 10 weeks) for children with a CP±L from the parents' point of view. Methods & Procedures: Twelve parents of 12 children, aged 6–0 years who received high‐intensity speech intervention (n = 6) or low‐intensity speech intervention (n = 6), were invited to participate in this study. Seven parents (n = 3 in the high‐intensity group and n = 4 in the low‐intensity group) agreed to participate (total response rate: 7/12, 58.33%). A qualitative study design using semi‐structured interviews was applied. To investigate the retrospective acceptability of the two intervention intensities, deductive coding according to the Theoretical Framework of Acceptability (TFA) was used. Outcomes & Results: With regard to the TFA construct 'affective attitude', results demonstrated that parents had positive feelings about the provided speech intervention regardless of the intensity. Parents of children who received high‐intensity speech intervention reported two specific benefits related to the high intervention intensity: (1) it improved their relationship with the speech‐language pathologist and (2) it improved their child's ability to make self‐corrections in his/her speech. Even though both high‐intensive and low‐intensity speech intervention were considered burdensome (TFA construct 'burden'), parents were less likely to drop out of high‐intensity intervention because the total intervention period was kept short. Conclusions & Implications: In conclusion, high‐intensity speech intervention seemed acceptable to parents. More positive codes were identified for some of the TFA constructs in the high‐intensity intervention group than in the low‐intensity intervention group. Considering that some parents doubted their self‐efficacy to participate in high‐intensity speech intervention, speech‐language pathologists need to counsel them so that they can adhere to the high intervention intensity. Future studies should investigate whether high‐intensity speech intervention is also acceptable to the children who receive the intervention and to the speech‐language pathologists who deliver the intervention. What this paper adds: What is already known on this subject: Increasing attention is paid to the effectiveness of high‐intensity speech intervention in children with a cleft (lip and) palate (CP±L). Different quantitative studies have shown positive speech outcomes after high‐intensity cleft speech intervention. Despite this increasing attention to high‐intensity speech intervention, it is unknown whether high‐intensity intervention is also acceptable to the intervention recipients. This study compared the retrospective acceptability of high‐intensity speech intervention (10 1‐hour speech therapy sessions divided over 2 weeks) with the retrospective acceptability of low‐intensity speech intervention (10 1‐hour speech therapy sessions divided over 10 weeks) in children with a CP±L from the parents' point of view. What this paper adds to existing knowledge: More positive codes were identified for some of the TFA constructs in the high‐intensity intervention group than in the low‐intensity intervention group. Nevertheless, some parents doubted their self‐efficacy to participate in high‐intensity speech intervention. What are the potential or actual clinical implications of this work?: The findings of this study forces us to reconsider the traditional cleft speech intervention delivery models which usually consist of low‐intensity intervention. Speech‐language pathologists need to counsel parents and so that they can adhere to the high intervention intensity. [ABSTRACT FROM AUTHOR]

Background: Children and young people with long‐term physical health conditions (LTC) are known to have higher levels of co‐morbid mental health problems than medically healthy children. Evidence‐based treatments for mental health problems are effective in children who also have an LTC. This study aimed to explore the factors associated with participants' perceived acceptability and impact of a transdiagnostic mental health centre offering brief psychological assessment and treatment for children and young people and/or their families with mental health needs in the context of long term physical conditions. Methods: One‐hundred twenty‐eight patients attending the drop‐in centre were invited to participate. Overall, 35 participated (31 parents/carers; 4 children and young people) in semi‐structured interviews (either in person or by phone) exploring their experience of the centre. Interviews were audio‐recorded, transcribed and checked. Framework analysis was then conducted on all transcripts. Results: Overall, participants found the drop‐in centre highly acceptable and reported a positive experience. Reasons for this varied but broadly focused around four themes: (1) efficient sufficiency; (2) autonomy; (3) fusion of process and content factors and (4) (dis)parities of esteems and 'seeing both sides of the coin'. Conclusions: Participants found the intervention acceptable. A mental health drop‐in centre in a paediatric hospital appears to be a positive and valued adjunct to supplement existing mental health services. [ABSTRACT FROM AUTHOR]

It is important to identify valid and acceptable outcome measures so that interventions evaluating common mental health problems can be assessed appropriately. Some advocate the use of generic preference-based measures claimed to be applicable for all health interventions, but others argue that they are insensitive for common mental health problems. The aim of this paper is to evaluate the Clinical Outcomes in Routine Evaluation-Outcome Measure (CORE-OM), to be used in cost-effectiveness studies in people with common mental health problems. The CORE-OM measure was tested for completeness, acceptability and responsiveness in a pilot study. Analyses for missing data, distribution of scores, and standardised response means (SRMs) were calculated. Missing data did not exceed 5% for any of the CORE-6D items both at baseline and follow-up. The overall comprehension rate was high, and only 19 participants (14%) requested clarifications to complete the questionnaire. As expected in a feasibility study, there was a small and non-significant SRM. CORE-OM is a valid and acceptable instrument to evaluate quality of life for people with common mental health problems. More research is needed with larger sample sizes to compare CORE-6D with other condition specific quality of life instruments. [ABSTRACT FROM AUTHOR]

Sexual and dating violence (SDV) is a social and health but preventable public issue. Most evidence-based prevention programs have been evaluated using an in-person delivery mechanism. Project Dream, Own and Tell (DOT) is a 13- to 18-week SDV prevention program targeting youth from traditionally underserved communities in New York City that shifted from in-person to online delivery in response to social distancing requirements during the COVID-19 pandemic. The aim of the current study was to understand how youth perceive learning SDV prevention in an online environment (acceptability and feasibility of the online DOT program). A mixed methods triangulation design was used including responses to Ecological Momentary Assessments (n = 25), a brief post survey with Likert-scale items (n = 18), and semi-structured interviews with 12 participants. The sample comprised Latinx/Hispanic, Asian American, Arab American, and African American youth between the ages of 15 and 21 from urban communities. Youth indicated both strengths and challenges of the online format. Strengths included ease of fitting the program into their schedules, avoiding long commutes, and the potential to create a safe online space for participants to engage in sexual violence prevention discussions and thus, feel less exposed. Challenges included internet connectivity issues, difficulties in building trustworthy relationships with other participants when not sharing the same physical space, some characteristics of the program's activities, and the lack of adequate space from which to attend the program (i.e., shared spaces). Findings suggest that synchronous online prevention program delivery is a feasible and acceptable strategy for engaging adolescents in relationship violence prevention. [ABSTRACT FROM AUTHOR]

To explore patient perspectives of participating in a pilot RCT evaluating feasibility and effect of anabolic steroid, physiotherapy and nutritional supplement following hip fracture. Semi-structured telephone-based interviews of 16 women and three men (average age 73 years) were conducted at baseline and after a 12-week intervention. Qualitative content analysis was performed. Two main categories were identified: (1) Trust and hope for a positive change with three sub-categories; reflections on anabolic steroids, anticipation of extra attention, lack of energy. (2) Curiosity, care, and commitment with four sub-categories; a sense of anabolic steroids, feeling of exclusivity and privileges, challenges and sense of obligation, and perspectives on personal gain. Findings suggest high acceptability of the intervention. Participants motivated their participation on a trust that the intervention would "do more good than harm". They found the randomization and possibility of receiving anabolic steroids intriguing, and especially valued trial participation because of their experience of getting extra care and "deluxe" rehabilitation including close contact and support by health professionals. Our findings may help inform future research recruiting older patients and generally considered relevant for health professionals in rehabilitation, emphasizing the impact of professional guidance and social support to encourage self-efficacy. With muscle enhancing medicine being suggested as a supplement in rehabilitation following hip fracture, exploring patients' perspectives is warranted and may help inform future trials in this area. Factors reported as important by older adults for engaging in rehabilitation trials are: simple but thorough information, friendly and trustful relation with study staff and opportunities of extra care and attention. Older patients with hip fracture highly valued professional guidance and support by health professionals during the rehabilitation intervention. High acceptability was identified for the supervised outpatient rehabilitation, where especially the individually structured progressive strength training was highlighted as the "active ingredient" accelerating recovery and potentially promoted self-efficacy. [ABSTRACT FROM AUTHOR]

Purpose: The Childhood Trauma Questionnaire—Short Form (CTQ-SF) is a widely used retrospective screening tool for childhood maltreatment in adults. Its properties are less known in adolescents. The objective was to investigate acceptability and psychometric properties when used in adolescents. Method: A community sample of adolescents (n=1885) in four waves (from 13 or 14 to 17 years old) and a clinical sample (n=74, mean age 18), both from Sweden, were used to assess acceptability and different aspects of validity and reliability. Results: The CTQ-SF was found to be well-accepted. As expected, the community sample scored lower than the clinical sample on all maltreatment-scales and showed stability over-time. In the community sample, internal consistencies were substantial or excellent for all scales except Physical neglect, and in the clinical sample this was found for all scales. One-year test-retest consistencies of subscales were substantial or almost perfect, and for all scales, they increased from early to mid-adolescence. Directed inconsistencies on item level decreased from early to mid-adolescence. Convergent validity was shown in relation to scales on family climate, parental relations, and emotional health also from early adolescence. Discriminant analyses showed more moderate discriminatory ability although almost seven times better than by-chance. Conclusions: The CTQ is well accepted and can be trusted to provide consistent and valid self-reports from the age of 14 on childhood maltreatment. Some caution is advised when used with younger adolescents, since the test-retest stability is then weaker, and the interpretation of the M/D scale is more ambiguous. [ABSTRACT FROM AUTHOR]

Introduction: Māori, Pasifika and Asian women are less likely to attend cervical screening and Māori and Pasifika women are more likely to be diagnosed with later‐stage cervical cancer than other women in Aotearoa New Zealand. This study—with under‐screened women taking part in a randomized‐controlled trial comparing self‐testing and standard screening—explored the acceptability of a human papillomavirus (HPV) self‐test kit and the preferred method for receiving it. Methods: Māori, Pasifika and Asian women (N= 376) completed a cross‐sectional postal questionnaire. Twenty‐six women who had not accepted the trial invitation were interviewed to understand their reasons for nonparticipation. Results: Most women found the self‐test kit easy and convenient to use and reported that they did not find it painful, uncomfortable or embarrassing. This was reflected in the preference for a self‐test over a future smear test on the same grounds. Most women preferred to receive the kit by mail and take the test themselves, rather than having it done by a doctor or nurse. There was a range of preferences relating to how to return the kit. Phone calls with nonresponders revealed that, although most had received the test kit, the reasons for not choosing to be involved included not wanting to, being too busy or forgetting. Conclusion: HPV self‐testing was acceptable for Māori, Pasifika and Asian women in Aotearoa New Zealand. HPV self‐testing has considerable potential to reduce the inequities in the current screening programme and should be made available with appropriate delivery options as soon as possible. Patient or Public Contribution: This study explored the acceptability of HPV self‐testing and their preferences for engaging with it among Māori, Pasifika and Asian women. Thus, women from these underserved communities were the participants and focus of this study. [ABSTRACT FROM AUTHOR]

Teenage siblings of children with autism spectrum disorder (ASD) are at risk of worse mental health outcomes than their peers, yet there have been few interventions focused on improving their psychosocial wellbeing. This study explored the acceptability of an 8-session virtual group mind-body resiliency intervention for teen siblings of children with ASD. We used mixed methods to assess quantitative and qualitative survey results. Participants reported that the intervention had the right amount of sessions (88%), structure (74%), and duration (89%). Most participants felt comfortable during sessions (74%), found it helpful to learn mind-body exercises (74%), and that the intervention helped in coping with stress (71%). Though participants were satisfied with the opportunity to meet peers, they desired more social connection. [ABSTRACT FROM AUTHOR]

Objective: To explore the acceptability and influencing factors of an Internet-based Tinnitus Multivariate Integrated Sound Therapy (iT-MIST). The individually tailored sound therapy used narrowband noise centered on the patient's tinnitus frequency in combination with natural sounds and relaxing music. Design: Patients with tinnitus were given a 1-week trial of iT-MIST. Semistructured interviews were then carried out and a thematic analysis used to analyze, identify, organize, and report factors discovered in the data. Study Sample: Semistructured interviews were carried out with 11 participants, 2 women and 9 men, mean age 39.82 years. Results: The first theme identified from patient interview analysis was their motivation to undertake and expectations of iT-MIST. Nearly half of the participants indicated that advice from the physician was considered very important and professional. Benefits acknowledged by most participants from their iT-MIST experience were accessibility, convenience, time- and cost-effectiveness, and emotional benefit. However, a few participants with poor understanding of tinnitus and iT-MIST showed a negative acceptability with doubtful thoughts and complaints about technical issues such as being easily interrupted by messages and phone calls. Conclusion: Patients with tinnitus in this study were not universally accepting of the iT-MIST therapy. Concerns about their tinnitus and ability to comply with doctor's recommendations were the main influencing factors. Attitude or willingness to explore new therapies facilitated its use. Emotional benefits, for example, relaxation and comfort, were seen to sustain motivation, while doubtful thoughts and technical problems negatively affected acceptability. [ABSTRACT FROM AUTHOR]

Background: Studies evaluating task sharing in postabortion care have mainly focused on women in first trimester and many lack a qualitative component. We aimed to evaluate patient acceptability of treatment of incomplete second trimester abortion using misoprostol provided by midwives compared with physicians and also gained a deeper understanding of the patients' lived treatment experiences in Uganda.Methods: Our mixed methods study combined 1140 structured interview data from a randomized controlled equivalence trial and in-depth interviews (n = 28) among women managed with misoprostol for second trimester incomplete abortion at 14 public health facilities in Uganda. Acceptability, our main outcome, was measured at the 14-day follow-up visit using a structured questionnaire as a composite variable of: 1) treatment experience (as expected/ better than expected/ worse than expected), and 2) satisfaction - if patient would recommend the treatment to a friend or choose the method again. We used generalized mixed effects models to obtain the risk difference in acceptable post abortion care between midwife and physician groups. We used inductive content analysis for qualitative data.Results: From 14th August 2018 to 16th November 2021, we assessed 7190 women for eligibility and randomized 1191 (593 to midwife and 598 to physician). We successfully followed up 1140 women and 1071 (94%) found the treatment acceptable. The adjusted risk difference was 1.2% (95% CI, - 1.2 to 3.6%) between the two groups, and within our predefined equivalence range of - 5 to + 5%. Treatment success and feeling calm and safe after treatment enhanced acceptability while experience of side effects and worrying bleeding patterns reduced satisfaction.Conclusions: Misoprostol treatment of uncomplicated second trimester incomplete abortion was equally and highly acceptable to women when care was provided by midwives compared with physicians. In settings that lack adequate staffing levels of physicians or where midwives are available to provide misoprostol, task sharing second trimester medical PAC with midwives increases patient's access to postabortion care services.Trial Registration: ClinicalTrials.gov NCT03622073. [ABSTRACT FROM AUTHOR]

This descriptive qualitative study explored Latinx fathers' awareness, knowledge, and acceptability of the human papillomavirus (HPV) vaccine for their adolescent children. Data were collected through individual, semi-structured interviews and analysed using a hybrid method of thematic analysis that incorporated deductive and inductive approaches. Nineteen, majority foreign-born Latinx fathers participated. Four main themes and two subthemes emerged from the analyses. Results found fathers' low awareness and knowledge of HPV and the HPV vaccine. Results also identified fathers' positive attitudes toward vaccines in general. Moreover, results revealed fathers trust in healthcare providers and high willingness to vaccinate their children against HPV if recommended by their child's primary healthcare provider. Findings indicate the need for increased efforts to raise awareness and knowledge among Latinx fathers of HPV and the HPV vaccine. Given the limited research focused on Latinx fathers, the study's findings are valuable in building a knowledge foundation for developing future studies and interventions to promote the HPV vaccine targeting Latinx fathers living in the United States. Future research should quantify Latinx fathers' awareness, knowledge, and acceptability of the HPV vaccine for their sons and daughters and assess fathers' role in the decision-making process to vaccinate their children against HPV. [ABSTRACT FROM AUTHOR]

Introduction: Fibromyalgia guidelines recommend multi‐modal, non‐pharmacological interventions but there is limited evidence on the optimal programme. The Fibromyalgia Active Management and Exercise programme (FAME) aimed to improve function and quality of life. It consisted of 12 sessions delivered by a multidisciplinary team and incorporated education, exercise, Cognitive Behavioural Therapy and mindfulness approaches. This qualitative service evaluation explored the experience and acceptability of FAME from the perspective of the patients' and healthcare practitioners' (HCP). Methods: All patients and HCP involved in the first FAME programme were invited to attend either one audio‐recorded focus group or an individual semi‐structured interview. Topic guides were developed a priori. Data were transcribed verbatim and analysed thematically. Results: Thirteen participants (six HCP (three physiotherapists, two nurses, one psychologist)) and seven patients (mean age 46 (7.5) years, all female,) were enroled. FAME was acceptable to HCP participants but not to all patient participants. Where patient participants understood and anticipated the aims of FAME, the programme was found to be acceptable. Whereas, patient participants who did not fully understand the aims of the programme reported lower acceptability. Three themes were generated: expectations and preparation for FAME, the value of socialsupport, and FAME as a learning opportunity. The themes could be explained by five constructs of the Theoretical Framework of Acceptability. Conclusion: FAME was acceptable to HCPs but not to all patient participants. Patient and HCP participants valued social support and regarded this as central to their learning. Further adaptation of FAME is required to optimise acceptability. [ABSTRACT FROM AUTHOR]

Introduction: Access to public rehabilitation services for patients with non‐urgent conditions ‐ which suffer mainly from musculoskeletal disorders ‐ is problematic around the world. Remote rehabilitation services are recognized as effective means to increase accessibility. Patient acceptability is an important element in the successful implementation of such clinical innovations and has not yet been studied thoroughly in this context. Thus, the aim of this study was to evaluate and compare the acceptability of two remote consultation modalities ‐ phone and teleconsultation ‐ for patients waiting for public outpatient non‐urgent rehabilitation services. Methods: We conducted a qualitative descriptive study nested within a randomized clinical trial in which participants received either phone or teleconsultation follow‐ups with a physiotherapist after a first systematic face‐to‐face evaluation. Semi‐structured interviews were conducted with participants of both groups selected with purposive sampling. Sekhon's acceptability metaframework was used and interviews were transcribed and coded with thematic analysis. Ethic approval: The research protocol was approved by the Research Ethics Board of the Centre intégré universitaire de santé et de services sociaux – Centre hospitalier universitaire de Sherbrooke (CIUSSS de l'Estrie – CHUS) (#2019–2919). Results: Twenty participants were recruited. Results show both follow‐up modalities have a good level of acceptability for participants; however, teleconsultation stands out because its visual dimension offers higher quality human contact and satisfactorily meets greater needs for support. Conclusion: Systematic in‐person assessment and advice combined with telephone or teleconsultation follow‐up can contribute to diversifying the services offered in physiotherapy outpatient clinics. Offering a range of service modalities with different resource requirements may shorten wait times. Such an approach seems to be well accepted by patients, especially with teleconsultation. ClinicalTrials.gov ID: NCT03991858 [ABSTRACT FROM AUTHOR]

Repeat attempts increase risk of death by suicide. The Psychosocial/psychoeducational Intervention for People with recurrent Suicide Attempts (PISA)/Skills for Safer Living (SfSL) is a group intervention targeting repeat attempts. To evaluate the acceptability of PISA/SfSL to clients and identify key model components influencing this. This exploratory mixed-methods study involved adults who completed PISA/SfSL (N = 16). Participants completed semi-structured interviews and a satisfaction questionnaire post-intervention, and self-report outcome measures of population specific challenges pre and post-intervention and at 6-month follow-up. Qualitative themes illuminate three interrelated response processes; connection with each other and the model, taking control of life, and gaining a sense of value. Quantitative outcome measures indicated positive trends in suicidality, hopelessness, alexithymia, and problem-solving. High satisfaction levels indicated its quality, relevancy, applicability and helpfulness. Key components influencing responses were PISA/SfSL's; psychosocial group format and processes, psychoeducational and skill development content, and ethos. Results suggest PISA/SfSL was acceptable to those with repeat suicide attempts. The study highlights the usefulness of group work and the importance of consistency with guidelines in suicide intervention. It supports the view that recovery in suicidality and engagement in treatment are complex processes. It adds to previous research demonstrating acceptability among facilitators. [ABSTRACT FROM AUTHOR]

Introduction: Arthroplasty is an effective, yet costly, surgical procedure for end‐stage osteoarthritis. Shorter stays in hospital are being piloted in Australia. In some countries, short stay is established practice, associated with improving perioperative care and enhanced recovery after surgery practices. Exploring the acceptability to patients of a short stay care pathway in hospital postarthroplasty is important for informing health policy, adoption and potential scalability of this model of care. Methods: Consecutive patients at one site, at least 3 months post total joint arthroplasty, were invited to participate in theory‐informed semi‐structured qualitative interviews. The Theoretical Framework of Acceptability (TFA) informed development of the interview guide. Interview data were analysed using the Framework Method. Results: Eighteen patients were invited. Fifteen consented to be contacted and were interviewed. Short‐stay post arthroplasty was highly acceptable to patients who had the supports necessary to recover safely at home. Key findings were as follows: flexibility of short‐stay care pathway was essential and valued; prior beliefs and expectations informed acceptability; and the absence of out‐of‐pocket expenses had an incentivizing effect, but was not the primary reason for patients choosing this care pathway. Further themes analysed within the TFA constructs highlighted nuances of acceptability relating to this model of care. Conclusions: A short stay in hospital post arthroplasty appeared to be acceptable to patients who had experienced this care pathway. Our thematic findings identified aspects of the short‐stay care pathway that enhanced acceptability and some aspects that limited acceptability. These findings can inform refinement of the short‐stay care pathway. Patient or Public Contribution: Patients/people with lived experience were not involved in the study design or conduct of this preliminary work; as this short‐stay model of care was recently introduced, only a small group of patients was eligible to participate in this study. This study is the first step towards understanding the experiences of patients about a short‐stay model of care post arthroplasty. The findings will help inform future patient and public involvement in expanding the programme. [ABSTRACT FROM AUTHOR]

Objectives: We tested the impact of different messages about the rationale for extended cervical screening intervals on acceptability of an extension.Methods: Women in England aged 25-49 years (n = 2931) were randomised to a control group or one of 5 groups given different messages about extending cervical screening intervals from 3 to 5 years. Outcome measures were general acceptability and six components from the Theoretical Framework of Acceptability (TFA).Results: The groups who saw additional messages (47-63%) were more likely to find the change acceptable than controls (43%). Messages about interval safety, test accuracy and speed of cell changes resulted in more positive affective-attitudes, higher ethicality beliefs, a better understanding of the reasons for extended intervals and greater belief in the safety of 5-year intervals. Being up-to-date with screening and previous abnormal results were associated with finding 5-yearly screening unacceptable.Conclusions: Emphasising the slow development of cell changes following an HPV negative result and the safety of longer intervals, alongside the accuracy of HPV primary screening is important.Practical Implications: Campaigns explaining the rationale for extended cervical screening intervals are likely to improve acceptability. Though women who feel at increased risk, may remain worried even when the rationale is explained. [ABSTRACT FROM AUTHOR]

Background The opioid epidemic worsened during the coronavirus disease 2019 (COVID-19) pandemic. Synthetic opioids (primarily fentanyl) comprise the most common drugs involved in overdose (OD) death. A vaccine that blocks fentanyl from reaching the brain to prevent OD is under development, and insight is needed into its acceptability. Methods Using a semi-structured interview guide, persons with opioid use disorder (OUD), family, professionals, and the public were interviewed about attitudes and concerns regarding a fentanyl vaccine. Reactions to fictional clinical vignettes of persons at risk of OUD because of pain and/or substance use histories were collected, analyzed, and quantified for favorability. Interviews were transcribed, coded, and analyzed thematically. Results Among N = 64 participants, (70.3% female, average age 32.4 years), attitudes were favorable toward a fentanyl vaccine, with preference for lifelong durability (76% of n = 55 asked). Perceived benefits centered on the potential for a life-saving intervention, suffering averted, healthcare dollars saved, and the utility of a passive harm reduction strategy. Concerns centered on uncertainty regarding vaccine safety, questions about efficacy, worry about implications for future pain management, stigma, and need for supportive counseling and guidance to personalize decision making. Reactions to vignettes revealed complex attitudes toward fentanyl vaccination when considering recipient age, health history, and future risks for addiction and pain. Conclusions Positive responses to a fentanyl vaccine were found along with appreciation for the complexity of a vaccine strategy to prevent OD in the setting of pain and uncertain durability. Further research is needed to elucidate operational, ethical, and communications strategies to advance the model. [ABSTRACT FROM AUTHOR]

Evidence suggests that multiple micronutrient and balanced energy protein (BEP) supplementation during pregnancy can decrease the risk of stillbirth and small‐for‐gestational‐age births and increase birth weight. We conducted a mixed‐methods formative research study to identify the most acceptable among a range of 11 candidates fortified BEP supplements for use in pregnancy and lactation in a rural district in Nepal. Forty pregnant women aged 15–40 years participated in a test meal tasting of 11 different sweet and savoury candidate BEP supplements. Each participant rated the products on organoleptic properties using a 7‐point hedonic scale (1 = Dislike it very much to 7 = Like it very much), ranked her 'top 3' most liked supplements, and subsequently discussed each product with peers in focus group discussions (FGDs). Five supplements (sweet lipid‐based nutrient supplement (LNS), savoury LNS, sweet vanilla biscuits, vanilla instant drinks and seasoned pillows) achieved the maximum overall median hedonic score of 7, with sweet LNS and seasoned pillows ranking as the top 2. This was consistent with the assessments in FGDs. Women in the FGDs expressed dislike of the smell and taste of the cocoa drink, savoury masala bar, sweet mango bar and savoury curry biscuit, which was consistent with the hedonic scale scores. This study provides valuable insights into our understanding of women's acceptance of different BEP supplements during pregnancy in rural Nepal and has helped identify the two most accepted BEP supplements to be used in a two‐month home trial to assess utilisation and compliance in this setting. Key messages: Understanding the acceptability of balanced energy protein supplements by pregnant women along with the potential facilitators and barriers to their use is vital to ensure regular consumption and compliance.Pregnant women in rural Nepal liked both the sweet and savoury products and suggested having the option to choose from more than one type of product would facilitate its daily consumption throughout pregnancy.Concerns regarding the cost of the supplements, strong aversion to smell/taste of certain supplements, and the inability to eat the supplement in private were some of the deterrents for possibly not being able to eat the supplement daily [ABSTRACT FROM AUTHOR]