Innovative Treatment for Cervical Precancer: A Qualitative Evaluation using the Theoretical Framework of Acceptability

Abstract Acceptability is one of the most commonly assessed implementation outcomes, but there is little consensus on how the concept is defined or measured. The Theoretical Framework of Acceptability was developed to address this gap in the context of healthcare. This framework comprises seven constructs and has been applied across various settings, although work in low and middle-income countries remains scarce. Here we utilize the Theoretical Framework of Acceptability to evaluate the acceptability of cervical precancer treatment methods in El Salvador. Cervical cancer remains a leading cause of cancer death for women in low and middle-income countries. The World Health Organization has endorsed a triple strategy of vaccination, screening, and treatment to eliminate the disease as a public health problem. While the acceptability of vaccination and screening has received some attention, evidence related to treatment is limited. From November 2021 to May 2022, we conducted semi-structured interviews with patients participating in a clinical trial comparing three cervical precancer treatment protocols. Thematic and content analysis were used to extract salient themes from interview transcripts and themes were then mapped onto the framework’s constructs. All seven constructs were represented in the data, but two of these (affective attitude and intervention coherence) captured the most significant aspects of treatment acceptability in this population. In addition, some themes (i.e., pain, side-effects, stigma) were not adequately represented by existing constructs. We suggest an expansion of the Theoretical Framework of Acceptability to increase its generalizability.