{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,8,27]],"date-time":"2026-08-27T02:18:56Z","timestamp":1787797136005,"version":"build-2784847793"},"reference-count":57,"publisher":"Wiley","issue":"4","license":[{"start":{"date-parts":[[2026,8,22]],"date-time":"2026-08-22T00:00:00Z","timestamp":1787356800000},"content-version":"vor","delay-in-days":21,"URL":"http:\/\/creativecommons.org\/licenses\/by\/4.0\/"},{"start":{"date-parts":[[2026,8,1]],"date-time":"2026-08-01T00:00:00Z","timestamp":1785542400000},"content-version":"tdm","delay-in-days":0,"URL":"http:\/\/doi.wiley.com\/10.1002\/tdm_license_1.1"}],"content-domain":{"domain":["onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["Health Expectations"],"published-print":{"date-parts":[[2026,8]]},"abstract":"<jats:title>ABSTRACT<\/jats:title>\n                  <jats:sec>\n                    <jats:title>Background<\/jats:title>\n                    <jats:p>Abortion stigma limits access to person\u2010centred abortion care globally. Values clarification and attitude transformation (VCAT) is widely used to address abortion stigma and recommended by the World Health Organization to train abortion providers. Yet evidence is lacking about whether and how VCAT influences healthcare providers' behaviours. This study aims to generate hypotheses regarding (a) the specific behaviours that VCAT might influence and (b) the mechanisms of change.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>This qualitative study generated hypotheses based on interviews with people who facilitated, designed and\/or participated in VCAT globally. We recruited via email and by posting on online communities. Study design was informed by two behaviour change frameworks and engaged the concepts of stigma and person\u2010centred care. We conducted semi\u2010structured interviews online and analysed data thematically to develop hypotheses about VCAT's influence on behaviours.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>The 17 interviewees (15 facilitators\/curriculum designers, 2 VCAT participants) worked in five world regions. They described five categories of person\u2010centred abortion care behaviours that VCAT can facilitate: increasing abortion\u2010related communication with colleagues; reducing delays and obstruction of abortion care; enabling abortion seekers to access abortion care; expanding own abortion provision; and engaging in high\u2010quality, non\u2010judgemental abortion care. Interviewees described distinct forms of empathy through which VCAT influenced behaviour.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Discussion<\/jats:title>\n                    <jats:p>This study helps fill an evidence gap by offering hypotheses about how abortion VCAT can lead to behaviour change and which behaviours VCAT might influence in healthcare providers. We illustrate VCAT's ability to build empathy towards and destigmatise abortion across sociocultural contexts, forms of stigma, and legal frameworks \u2013 potentially motivating behaviour change along a spectrum from opposing to supporting abortion access. These hypotheses can be tested in future evaluations to assess whether VCAT contributes to change in a range of person\u2010centred care behaviours. Our findings about VCAT's strengths and its potential gaps can inform future work to refine VCAT and develop complementary strategies to contribute to person\u2010centred abortion care provision across contexts.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Patient or Public Contribution<\/jats:title>\n                    <jats:p>One of the co\u2010investigators has lived experience implementing and designing values clarification trainings (the focus of this paper). Prior studies engaging people with lived experience of abortion care informed the design of this study. Patients, service users, care\u2010givers, people with lived experience or members of the public were not involved in the conduct of study, analysis or interpretation of the data or in preparation of the manuscript.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1111\/hex.70841","type":"journal-article","created":{"date-parts":[[2026,8,22]],"date-time":"2026-08-22T08:50:37Z","timestamp":1787388637000},"update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["\u2018Moving People up the Sympathy Spectrum\u2019: Building Hypotheses About How Abortion Values Clarification and Attitude Transformation (VCAT) Can Change Healthcare Provider Behaviours"],"prefix":"10.1111","volume":"29","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-0379-8113","authenticated-orcid":false,"given":"Shelly","family":"Makleff","sequence":"first","affiliation":[{"name":"Centre for Health Equity University of Melbourne Parkville VIC Australia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0008-4274-1276","authenticated-orcid":false,"given":"Carrie","family":"Van Rensburg","sequence":"additional","affiliation":[{"name":"Centre for Health Equity University of Melbourne Parkville VIC Australia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-9263-362X","authenticated-orcid":false,"given":"Bronwen","family":"Merner","sequence":"additional","affiliation":[{"name":"Centre for Health Equity University of Melbourne Parkville VIC Australia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-5737-0112","authenticated-orcid":false,"given":"Alexandra","family":"Wollum","sequence":"additional","affiliation":[{"name":"Ibis Reproductive Health Oakland CA USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-2963-6451","authenticated-orcid":false,"given":"Louise","family":"Keogh","sequence":"additional","affiliation":[{"name":"Centre for Health Equity University of Melbourne Parkville VIC Australia"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"311","published-online":{"date-parts":[[2026,8,22]]},"reference":[{"key":"e_1_2_11_2_1","volume-title":"Abortion Care Guideline","author":"World Health Organization","year":"2022"},{"key":"e_1_2_11_3_1","doi-asserted-by":"publisher","DOI":"10.1111\/hex.13781"},{"key":"e_1_2_11_4_1","volume-title":"Handbook for National Quality Policy and Strategy: A Practical Approach for Developing Policy and Strategy to Improve Quality of Care","author":"World Health Organization","year":"2018"},{"key":"e_1_2_11_5_1","doi-asserted-by":"publisher","DOI":"10.1097\/gco.0000000000000492"},{"key":"e_1_2_11_6_1","unstructured":"K.Cockrill S.Herold K.Blanchard D.Grossman U. 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