Bridging innovation and adoption: a mixed-methods investigation into stroke survivors' acceptability of...

Objective. Brain-computer interface (BCI)-based interventions show growing evidence of efficacy for post-stroke upper-limb rehabilitation by closing the sensorimotor loop and promoting neuroplasticity. Despite this promise, their clinical uptake remains limited. This study aimed to identify the determinants of BCI acceptability among stroke survivors in order to inform user-centred neurotechnology design and facilitate clinical adoption.Approach. We conducted a mixed-methods study combining a large-scale questionnaire (N= 140) and semi-structured interviews (N= 12) with stroke survivors. The questionnaire was grounded in a validated theoretical model of BCI acceptability and assessed the determinants of three core constructs:intention to use(IU),perceived usefulness(PU), andperceived ease of use(PEOU). Qualitative data were analysed using thematic framework analysis to enrich and contextualise the quantitative findings.Main Results. Overall, stroke survivors reported high acceptability of BCI-based rehabilitation, with strong IU (mean IU = 8.48/10). Quantitative analyses showed that IU was primarily driven by PU, itself strongly influenced by perceived scientific relevance and, to a lesser extent, by individual factors such as autonomy, self-efficacy, and technology-related anxiety. PEOU was mainly determined by ease of learning and computer playfulness, but did not directly predict IU. Qualitative findings complemented these results by highlighting the importance of perceived innovativeness, the perception of directly engaging brain activity, visibility of progress, and clear scientific evidence. Interviews also emphasised the need for intuitive interfaces, clear instructions, short sessions, and appropriate therapeutic support to sustain engagement.Significance. These findings underscore that successful adoption of BCI-based rehabilitation requires more than technological performance alone. Enhancing acceptability among stroke survivors calls for: (i) goal-oriented and evidence-based rehabilitation protocols; (ii) clear communication of scientific rationale and outcomes to reinforce trust and social acceptance; and (iii) user-friendly system design that supports learning, autonomy, and self-efficacy while minimising cognitive and physical burden.