Improving induced abortion care in Scotland: enablers and constraints.

BACKGROUND Induced abortion is the most common gynaecological procedure in Scotland. Despite several recent initiatives to improve the quality of abortion care, inappropriate variations in care remain. OBJECTIVE To identify and explore factors that enable or constrain the provision of high-quality induced abortion care in Scotland. METHODS Interviews with a range of key informants with differing perspectives and levels of involvement in abortion care. The interview framework identified factors related to recommendations, targeted individuals, or the organisation and wider environment that enable or inhibit evidence-based practice. RESULTS Induced abortion care in Scotland is generally perceived to be of good quality but the need for further action to tackle important inappropriate variations in care is recognised. Some aspects of care can be improved by tackling individual-level barriers and providing better evidence to support change. Some individual-level barriers (e.g.attitudes) are less amenable to change than others (e.g.knowledge). However, major barriers to quality improvement are rooted in organisational and social culture. CONCLUSION Tackling variations in abortion care requires a multilevel approach targeting both individual factors and organisational culture.