Does a values clarification and attitudes transformation (VCAT) workshop influence provider attitudes, knowledge, and service provision related to abortion care?: Evidence from a mixed-methods longitudinal randomised controlled trial in Ethiopia

Despite being widely implemented, little information exists on the effect of Value Clarification and Attitude Transformation (VCAT) workshops on health care provider knowledge and attitudes and abortion provision. Between 2019 and 2021, we conducted a cluster-randomised controlled trial among 101 private abortion-providing healthcare facilities in Ethiopia. We surveyed 217 providers prior to a VCAT workshop and again at 2 weeks, 6 months, and one year following VCAT workshop participation to understand abortion knowledge and attitudes, examined service statistics to assess abortion client volumes, and conducted in-depth interviews with 30 providers. We found that a VCAT workshop for providers increased abortion service provision. In the year following the workshop, intervention facilities served 13% more abortion clients than expected based on the control group trend (95% CI: 6%-21%, <i>p</i> = .01). VCAT workshops moderately improved knowledge and supportive attitudes about abortion in the short-term. The VCAT workshop worked to change providers' attitudes by highlighting the importance of abortion in protecting clients from potential death and harm, but providers were less comfortable providing care to patients in situations deemed to be less socially justified (e.g. for married clients). Results support implementing ongoing VCAT refreshers with additional emphasis on client autonomy, cultural norms, and person-centred care.Trial registration: ClinicalTrials.gov identifier: NCT04181021.