TITLE: Methods and instruments used in the literature to quantitatively analyze the acceptability of pharmaceutical interventions for the prevention and treatment of neglected tropical diseases: a systematic review
AUTHORS: Claudia Duguay, Katarina Ost, Alison Krentel

[DESCRIPTION]
Acceptability is one of the four core components of the right to health and one of the seven factors that are considered in formulating recommendations as part of the World Health Organization guidelines, yet it remains challenging to define and measure. Neglected tropical diseases (NTDs) are a group of 21 diseases that affect people living in vulnerable circumstances, and it is estimated that over 1.6 billion people worldwide require either preventive or curative interventions for at least one NTD. Quantitatively measuring a subjective attribute, such as the acceptability of pharmaceutical interventions for the prevention and treatment of NTDs, presents a fundamental challenge. In this systematic review, We will comprehensively outline various methodologies employed to measure and analyze acceptability of pharmaceutical interventions across different studies and NTDs. 

[STEPS]
SECTION: Review question
1. How is the acceptability of pharmaceutical interventions for the prevention and treatment of neglected tropical diseases quantitatively measured and analyzed in the literature.  
SECTION: Searches
2. MEDLINE, Embase, SCOPUS, Global health, CINAHL 
SECTION: Condition or domain being studied
3. Acceptability is one of the four core components of the right to health and one of the seven factors that are considered in formulating recommendations as part of the World Health Organization guidelines, yet it remains challenging to define and measure. Recent efforts have been made to conceptualize and define treatment acceptability, with Sekhon et al., proposing the following definition: acceptability is a multi-faceted construct that reflects the extent to which people delivering or receiving a healthcare intervention consider it to be appropriate, based on anticipated or experienced cognitive and emotional responses to the intervention. 
 
Neglected tropical diseases (NTDs) are a group of 21 diseases that affect people living in vulnerable circumstances, and it is estimated that over 1.6 billion people worldwide require either preventive or curative interventions for at least one NTD. Quantitatively measuring a subjective attribute, such as the acceptability of pharmaceutical interventions for the prevention and treatment of NTDs, presents a fundamental challenge. For instance, the acceptability of tablets for the elimination of lymphatic filariasis (one of the 21 NTDs) has been measured by both using a composite acceptability score, and as the proportion of individuals that ingested the tablets.  While objectively measurable, participation should not be used synonymously with acceptability.
SECTION: Participants/population
4. We will investigate studies that investigate the acceptability of pharmaceutical interventions for the
prevention or treatment of at least 1 of the 21 neglected tropical diseases on human population in any geographic area. 
SECTION: Intervention(s), exposure(s)
5. We will include studies that focus on the acceptability of any pharmaceutical intervention against at least 1 of the 21 neglected tropical diseases.  The pharmaceutical intervention can include current or developing interventions.
SECTION: Type of study to be included
6. Relevant articles include primary research (e.g., cross sectional, cohort, randomized control trials, cluster randomized control trials). We will exclude studies that are secondary research (e.g., literature reviews, editorials). 
SECTION: Context
7. We will include all study years published in either French or English 
SECTION: Main outcome(s)
8. The two main outcomes include 1) the instrument used to measure acceptability and 2) the method used to analyze acceptability. 
SECTION: Data extraction
9. All identified studies will be imported into COVIDENCE, a systematic review management software, to screen (title, abstract, and full text) and manage the results of the search. Two reviewers (CD and KO) will independently assess the titles and abstracts of the included articles based on the inclusion criteria. In the
event of discordance between the two reviewers, a third reviewer (AK) will review the titles and abstracts and will come to a final decision. From the included articles, CD and KO, will identify relevant publication by reviewing the full text.  Any discordance will again be resolved by AK. A PRISMA flow diagram will be used to report final numbers of articles that are included and excluded at each stage. From the included
articles, one reviewer (CD) will work independently to extract data from the articles following a pre-specified extraction sheet. The following data will be extracted from each paper into COVIDENCE: (1) author; (2) year of publication; (3) study period; (4) study design; (5) country of acceptability study; (6) NTD being investigated; (7) pharmaceutical intervention being analyzed; (8) working definition for acceptability; (9) instrument used to measure acceptability; (10) method to analyze acceptability;
(11) threshold for acceptability; and (12) stage that they assessed acceptability of the pharmaceutical intervention (e.g., development, implementation); and (13) key findings. 
SECTION: Strategy for data synthesis
10. This systematic review will comprehensively outline various methodologies employed to measure
and analyze acceptability of interventions across different studies and NTDs.