Table 2 Ethics domains, challenges and guidance related to PAC research with adolescents identified in the literature

The role of local health providers, authorities and IRBs in approving PAC studies

-Difficulties in convincing local health providers or authorities to engage adolescents in PAC [16].

Recruitment of adolescents

-Challenges in recruiting adolescents in the study [14, 15, 20,21,22].

Using several sources to recruit study participants [13].

-Sampling from few clinics [20].

-Underrepresentation of women with unique characteristics such as those who find abortion stressful [20].

-Concealment of abortion affecting consent process [22].

Informed consent

-Difficulties in seeking consent from relatives or parents of adolescents who are below the consent age [15, 16].

-Vulnerability of adolescents compromising ability to make decisions [16].

-Fear of losing access to health care affecting informed consent process [16].

-Inadequate guidance on how and when to involve “the community” in informed consent processes [16].

Distribution of risks and benefits

-Selection bias such as having participants belonging to a particular group [20].

-Use of multiple methods may help reduce bias [13].

-Difficulties with generalizability and validity of policy recommendations [14].

-Using several sources to recruit study participants [13].

- Discussion of the risks and benefits of participation in the research [15].

-Use research to foster positive attention, advocacy, support on abortion [15].

Handling of confidential information

-Maintaining confidentiality and privacy of data collected [13, 20, 23, 24].

-Avoided collecting personal identifiers- give reminder card which shows date and place of interview, and telephone number of the interviewer [15].

-Disclosure of study participation very risky [20, 23, 24].

-Challenges in securing a conducive place for undertaking interviews [15].

-Creativity in identifying a secure space, which includes collecting data from an office away from the clinic [15].

-Failure to properly secure the records of the patients after interviews [13, 15, 20, 23, 24].

-Ensure that dissemination of findings does not pose a risk by masking research sites, or collaborators, masking of clinic or community and providers [15]

-Maintaining confidentiality and privacy of data may be challenging [13].

-Disclosure of study participation is very risky [20, 23, 24].

Data collection: Participants and research staff/health providers

- Challenges with regard to data collection [13, 15, 16, 21, 22, 25,26,27,28,29].

-Training providers at all in capturing of data, including referral processes on PAC [27].

-Difficulties in creating a non-prejudicial atmosphere [13].

-International researchers should always partner with local researchers [15]

-Negative health provider attitudes and practices [15, 16].

-Understanding social norms [15].

-Challenging in adhering to local norms [15, 16].

-The training and supervision of data collection staff and selecting staff with good attitude [15, 16].

-Health workers wanting to be present during data collection [16].

-Role of the researcher who observes unethical health care practices [16].

-Paternalistic practices by health workers [16].

-Difficulties in managing emotional issues among adolescents [16].

Data collection: quality of data

-The problem of social desirability bias [21], and under reporting [25, 26].

-The training and supervision of data collection staff and selecting of staff with experience working with the population [15, 16].

-Incomplete records on the number of PAC services provided [27].

-Underreporting of abortion complications [27].

-Brief health workers after the study session and or/ bring up deficiencies in management meetings [16].

-High dropout losses or attrition [22, 28].

-Cooperation is inconsistent and unreliable [22].

-Inadequate training among data collectors [16].