Acceptability refers to the degree to which a partner believes the intervention is palatable, agreeable, or satisfactory for a given issue. In the context of acupuncture for chronic pain, acceptability has been measured through interviews of individuals who recently underwent acupuncture treatment to determine elements that shape treatment acceptability. Patients generally found acupuncture acceptable; facilitators included pain relief, improved activity, relaxation, psychological benefit, and reduced reliance on medications. Barriers included aversion to needles, cost, and temporary worsening of symptoms.

Additional qualitative work to understand the provider perspective indicates that providers report strong support for acupuncture in pain management. Facilitators included observable patient benefit and patient demand for acupuncture. Reported barriers included time constraints and perceptions of financial barriers, among others.

Fidelity refers to the degree to which an intervention is followed as designed. In one study, investigators assessed intervention fidelity by first creating a responsive acupuncture protocol through a modified Delphi process involving acupuncturists. This process resulted in a protocol to adhere to for subsequent acupuncture visits. Fidelity to the protocol was closely monitored through surveys administered to providers, which enabled investigators to assess how closely care delivery aligned with the protocol. Findings suggest that protocols can assist with high intervention fidelity (98%). This study suggests that when adequate care delivery protocols, training, and resources are provided, high treatment fidelity is attainable. Fidelity in this context is an essential measure of providers’ ability to standardize treatment in future clinical trials, thereby better identifying treatment effects. Most clinical trials of acupuncture are semi-structured, focusing less on strict adherence to protocol and more on individualized treatment tailored to client needs. However, outside the clinical trial context, fidelity to a protocol should not be overemphasized as an essential metric for implementing acupuncture care. Acupuncture, like other modalities of care, can benefit from a general outline to guide practitioners, which may then be tailored to the needs of the individual care recipient.

Feasibility refers to the extent to which an innovation can be successfully used or carried out within a given agency or setting. In a recent study, the feasibility of Auricular Point Acupressure (APA) was assessed through open-ended semi-structured interviews across domains of feasibility, including acceptability, usability, and practicality. The study team interviewed 25 adults with chronic pain who were able to self-administer APA treatment. The intervention involved an app with instructional videos on APA, supplemented by Zoom-based individual consultations with acupuncturists for proper self-administration. Participants received kits that included all the materials needed for self-administered treatment—a probe to identify correct pressure points, “seeds” to apply to the skin for pressure, and tape to secure the seeds. The intervention lasted 4 weeks in total. Findings suggest that users believed virtual APA delivery was highly feasible. Participants reported that they enjoyed a nonpharmacological pain management option that may help reduce reliance on medication, found the app and Zoom sessions to be appropriately helpful in self-administering care, and appreciated the practicality of treatment at home compared to expensive or otherwise burdensome in-office treatment.