Application of the Theoretical Framework of Acceptability in healthcare interventions: a scoping review and proposed reporting checklist

Abstract

The Theoretical Framework of Acceptability (TFA) assesses how interventions are perceived by those who deliver and receive them. However, there has been no systematic mapping of how the framework is conceptualised, operationalised, and reported in healthcare intervention research. To examine how the TFA is used to assess acceptability in healthcare intervention research. A scoping review was conducted using JBI methodology and reported in accordance with PRISMA-ScR. Searches were undertaken across MEDLINE, EMBASE, CINAHL, Cochrane Library, ClinicalTrials.gov and ISRCTN from 2017 to July 2025. Empirical studies, trial registrations, and published protocols were included if they applied the TFA to assess the acceptability of patient-facing healthcare interventions. Data were extracted and synthesised using descriptive and narrative approaches. Use of the TFA has increased over time and spans diverse clinical contexts. When findings were aggregated across source types, acceptability was most commonly assessed, or planned to be assessed, using questionnaires and was typically positioned as a post-intervention outcome. Assessments were predominantly conducted with patients or service users at a single time point. Sensitivity analysis restricted to empirical studies showed that assessment was predominantly qualitative and interview-based, while outcome positioning and post-intervention timing remained common. Non-specification of TFA constructs was concentrated among trial registrations. In the overall sample, the TFA most frequently informed data collection, whereas among empirical studies it was most often applied during analysis, reporting and interpretation. Despite widespread adoption, application of the TFA remains variable and reporting does not always provide sufficient detail to support appraisal and comparison. This limits the ability to compare acceptability across studies, identify key drivers, or use findings to inform intervention development and implementation. Greater transparency in how acceptability is conceptualised, assessed and reported may enhance the utility of the TFA. A reporting checklist may support more consistent interpretation, clearer appraisal of framework use, and improved comparability across studies. Not applicable.