Understanding acceptability in the context of a text message intervention to encourage medication adherence in people with type 2 diabetes: A mixed methods study

Kiera Bartlett* (Corresponding Author), Cassandra Kenning, Jack Crosland, Nikki Newhouse, Lisa M. Miles, Veronika Williams, Jenny McSharry, Louise Locock, Andrew J. Farmer, David French

*Corresponding author for this work

Research output: Contribution to journalArticlepeer-review

6 Citations (Scopus)
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Background: Acceptability is recognised as a key concept in the development of health interventions, but there has been a lack of consensus about how acceptability should be conceptualised. The theoretical framework of acceptability (TFA) provides a potential tool for understanding acceptability. It has been proposed that acceptability measured before use of an intervention (anticipated acceptability) may differ from measures taken during and after use (experienced acceptability), but thus far this distinction has not been tested for a specific intervention. This paper1) directly compares ratings of anticipated and experienced acceptability of a text message-based intervention, 2) explores the applicability of the TFA in a technology-based intervention, and 3) uses these findings to inform suggestions for measuring acceptability over the lifespan of technology based health interventions. Methods: Data were obtained from a quantitative online survey assessing anticipated acceptability of the proposed text messages (n=59) and a 12-week proof-of-concept mixed methods study assessing experienced acceptability while receiving the text messages (n=48). Both quantitative ratings by return text message, and qualitative data from participant interviews were collected during the proof-of-concept study. Results: The quantitative analysis showed anticipated and experienced acceptability were significantly positively correlated (rs>.4). The qualitative analysis identified four of the seven constructs of the TFA as themes (burden, intervention coherence, affective attitude and perceived effectiveness). An additional two themes were identified as having an important impact on the TFA constructs (perceptions of appropriateness and participants’ role). Three suggestions are given related to the importance of appropriateness, what may affect ratings of acceptability and what to consider when measuring acceptability. Conclusions: The high correlation between anticipated and experienced acceptability was a surprising finding and could indicate that, in some cases, acceptability of an intervention can be gauged adequately from an anticipated acceptability study, prior to an expensive pilot or feasibility study. Directly exploring perceptions of appropriateness and understanding whether the acceptability described by participants is related to the intervention or the research - and is for themselves or others - is important in interpreting the results and using them to further develop interventions and predict future use.
Original languageEnglish
Article number608
Number of pages12
JournalBMC Health Services Research
Issue number1
Early online date28 Jun 2021
Publication statusPublished - 28 Jun 2021

Bibliographical note

Acknowledgements: The authors would also like to acknowledge the support of the University of Oxford Primary Care Clinical Trials Research Unit, Katherine Grady and the Research for the Future/Help BEAT campaigns (National Institute for Health Research [NIHR] Clinical Research Network Greater Manchester), Northern Care Alliance NHS Group, National Institute for Health Research [NIHR] Greater Manchester and Thames Valley and South Midlands Clinical Research Networks, participating GP surgeries, the “Support through Mobile Messaging and digital health Technology for Diabetes” (SuMMiT-D) patient and public involvement panel, Mandy Sekhon for her thoughts on the early stages of analysis and the wider SuMMiT-D team.
Funding: This publication presents independent research funded by the NIHR under its Programme Grants for Applied Research program (RP-PG-1214-20003). AF is supported by the NIHR Oxford Biomedical Research Centre and an NIHR Senior Investigator. LL is supported by the Scottish Chief Scientist Office. The views expressed are those of the authors and not necessarily those of the NIHR, or Department of Health and Social Care. The SuMMiT-D research team acknowledges the support of the NIHR Clinical Research Network.


  • Acceptability
  • mHealth
  • Type 2 Diabetes
  • text messaging


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