Intervening factors in health care professionals’ attitudes and behaviours towards comprehensive abortion care in the workplace: a comparative case study of Tanzania and Ethiopia

Figures & data

Table 1. Factors influencing individual attitudes and behaviours.

Main category	Sub-category	Generic category
Personal Factors	Images and anchoring	Use of personal experiences and personal preferences
	Religious beliefs	Invocation of faith to justify actions
	Predispositions	Interpretation of norms, rules, and laws
	Fear of social exclusion	Loss of family support, accommodation, social relationships
	Stigma	Name-calling in the workplace
Institutional	Competence	Training and knowledge
	Interpersonal Interactions	Professionals’ perceptions of others and their actions
	Exposure	Lived experiences, witness accounts, responsibility, accountability
	Resource Scarcity	Human capital, material resource shortages
	Occupational support	Counselling services, incentives, sustenance
	Legal and Political Factors	Fear of prosecution, political discourses, legal instruments, institutional policies

Figure 1. Material screening using PRISMA-ScR flow diagram.

Figure 2. Categorisation of attitudes and behaviours.

Figure 3. An illustration of attitudes, behaviours and how they evolve when exposed to workplace factors.

Table

Inclusion	Exclusion
Participants:
All qualified health care providers at any level of health care service provision, women, and girls, informants working for organisations involved in the abortion care topic	Non-health care professionals, men and other individuals not involved in the abortion discourse either through employment or lived experience (e.g., husbands, family members)
Intervention/comparator:
All types of abortion care services within the comprehensive abortion care package. Types of abortion, gestational weeks. Includes behaviours and attitudes of providers in first or third-person perspectives.	Clandestine and unsafe terminations by non-health care professionals. Exclude behaviours and attitudes of non-providers, professionals, or workers.
Outcomes: safety, respect, timeliness, site etc
Study design:
All published, grey, newspaper articles, English language, published between 2015 and 2020, study setting should be Tanzania and or Ethiopia	Any type of systematic reviews, published before or after the inclusion time frame, includes other countries other than the two compared cases, not published in English

Table

Database	Search terms	Hits
PubMed	(abortion) AND (Ethiopia) Filters: from 2015–2020	254
	(abortion) AND (Tanzania) Filters: from 2015–2020	73
Google Scholar	abortion in Tanzania, doctors, nurses, tba, pharmacists, midwives, health care providers	154
	abortion in Ethiopia, doctors, nurses, tba, pharmacists, midwives, health care providers	3000

Table

Study method and source type	Quality Criteria	Scoring
Qualitative	Qualitative objective or question	1/6
	Appropriate qualitative approach or design or method	1/6
	Description of context	1/6
	Description of participants and justification of sampling	1/6
	Description of qualitative data collection and analysis	1/6
	Discussion of researchers’ reflexivity	1/6
Quantitative Experimental	Appropriate sequence generation and/or randomisation	1/3
	Allocation concealment and/or blinding	1/3
	Complete outcome data and/or low withdrawal/drop-out	1/3
Observational	Appropriate sampling and sample	1/3
	Justification of measurements (validity and standards)	1/3
	Control of confounding variables	1/3
Mixed Methods	Justification of the mixed methods design	1/3
	Combination of qualitative and quantitative data collection-analysis techniques or procedures	1/3
	Integration of qualitative and quantitative data or results 1/3 + methodological quality criteria of quantitative (x/3). and qualitative studies (x/6) (see listed earlier in 1., 2. and 3.)	1/3
Text and Opinions (newspaper	Is the source of the opinion clearly identified?	1/6
	Does the source of opinion have standing in the field of expertise?	1/6
	Are the interests of the relevant population the central focus of the opinion?	1/6
	Is the stated position the result of an analytical process, and is there logic in the opinion expressed?	1/6
	Is there reference to the extant literature?	1/6
	Is any incongruence with the literature/sources logically defended?	1/6

Table

Inclusion/Exclusion Criteria
Population	Women, girls, clients, informants, providers, professionals
Intervention/Comparator	Abortion intervention?
Study Design	Quantitative, qualitative, mixed methods, texts, and opinions (see Appendix 4)
Types of evidence source	How was data gathered
Evidence source Details and Characteristics
Citation details	Author/s, date, title, journal, volume, issue, pages
Country	Tanzania or Ethiopia
Context	Specific location, culture, socioeconomic
Participants	age/sex and number
Details/Results extracted from source of evidence (in relation to the concept of the study)
Quality of Life Domains assessed
Number of items in tool

Table

Parameter	Results	Sources
Numbers of publications	10 sources of evidence, (of which 1 was a cross-national study between the 2 cases plus Zambia (data on Zambia was excluded from study (Blystad, A. et al. (2019)) henceforth, (n = 10 + 1) All publications were between 2015 and 2020 Number of publications by year: 2016 (n = 1), 2018 (n = 1), 2019 (n = 6), 2020 (n = 2)
Types of studies by methodology	Quantitative (n = 1): from Ethiopia	1) Taddele, T. et al. (2019)
	Qualitative (n = 6): of which 1 was a cross-national including Ethiopia and Tanzania) henceforth, shall be counted as two separate studies.	2) Blystad, A. et al. (2019),3) Ewnetu, D. B. et al. (2020), 4) Kebede, M. T., Middelthon, A. L. and Hilden, P. K. (2018), 5) McLean, E. et al. (2019), 6) Sambaiga, R. et al. (2019), 7) Solheim, I. H. et al. (2020)
	Mixed methods (n = 2): both from Tanzania	8) Baynes, C. et al. (2019), 9) Yegon, E. et al. (2019)
	Newspaper (n = 1): from Tanzania	10) Deutsche Welle (2016)
Population/s identified, and sources of perspectives share in included materials by population	Women and girls: Ethiopia (n = 2), Tanzania (n = 3)
	Informants: Ethiopia (n = 1), Tanzania (n = 2)
	Providers: Ethiopia (n = 3), Tanzania (n = 3)
Quality of life domains	Physical Emotional Social Attitudes Behaviour Governance