Application of the Theoretical Framework of Acceptability in Health Research: A Scoping Review

The Theoretical Framework of Acceptability (TFA) conceptualizes acceptability as a multi-component construct reflecting anticipated and experienced cognitive and emotional responses to health interventions. Since its introduction in 2017, the TFA has been widely applied, but how it is applied in practice has not been systematically examined.

We conducted a scoping review of peer-reviewed studies published between 2017 and 2025 that applied the TFA in the fields of health and healthcare. We searched PubMed, Scopus, and Embase. Data were extracted on study characteristics, construct operationalization, framework application, target population, implementation stage, and proposed extensions. Findings were synthesized descriptively.

We identified 944 records, removed 505 duplicates, and included 303 studies in the final synthesis, with 57% published between 2024 and 2025. All seven TFA constructs appeared in the literature, though unevenly. Affective attitude (98.7%), perceived effectiveness (97.4%), and burden (95.4%) were applied most frequently, while ethicality (83.2%) and opportunity costs (84.5%) were reported less often. Applications were concentrated in retrospective assessments (52.8%) and during implementation (52.1%). Patient-only populations accounted for 30.4% of studies; however, 35.3% of studies assessed acceptability across two or more target population groups. Thirty-six studies (11.9%) proposed additional acceptability dimensions, spanning relational, cultural and contextual, and economic considerations.

The TFA has been rapidly adopted in health and healthcare research, but important differences remain in how acceptability is assessed across studies. Proposed relational, cultural or contextual fit, and economic dimensions highlight potential areas for future refinement of the framework.