Title: Survey of knowledge and attitude regarding induced abortion among nurses in a tertiary
hospital in Thailand after amendment of the abortion act: a cross-sectional study
Version: 2 Date: 11 Aug 2022
Reviewer's report:
This study addresses the  knowledge about abortion laws, attitudes, and willingness to provide
abortion amongst Buddhist and Muslim nurses from a single institution in Thailand. While
an interesting topic and certainly important for healthcare providers and policy makers in that
particularly region, I do not feel that the authors provide substantial argument for how this is
applicable to any other settings and therefore may not be of as much use to the international
audience of this journal. It is limited by being a single hospital survey and the impact is unclear.
It also lacks a single, clear research question and gets muddled between all of the topics included
in the survey without one that stands out.
In addition to the concerns of broader applicability, there are issues with the  presentation of the
manuscript that would require substantial revisions.
-The introduction needs to be focused on the primary research question, likely the impact of
religion on abortion knowledge and attitudes (or alternatively willingness to provide abortion
services). The background on unsafe abortion could be condensed. As a reader unfamiliar with
Thailand, more background on what abortion services are provided and in what settings, both
before and after the new laws would help ground the paper. If there is any data on increased
abortion numbers following the change in laws, that would also be important to include. One
detail is that abortion rate is the number of abortions per 1000 women vs the abortion prevalence
(total # of abortions in a year), which is what the authors presented.
-The methods should include more information about the population of nurses being sampled, if
available, such as if they were recruited from all departments within the hospital, as well as more
information about the hospital itself. Having information about if most abortions are performed
in a tertiary care hospital or in private clinics or other settings is also very important considering
that questions about referrals for abortion care are included.
-The sections on questionnaires and outcome measures can be condensed - the exact scoring
scheme does not have to be included.
-The beginning of the results section includes a lot of demographic information directly repeated
from the tables. This can be cut back and just include the most pertinent highlights, since the
reader can reference Table 1 and 2 for more details.  Since the comparison between religious
groups is an important part of the research question, including p values in table 1 for differences
in demographic factors, or at least notifying which demographic differences are significant
would be important, as these are the potential confounders addressed.
-It would help the reader to break down the results section into subheadings.
-Last paragraph page 12, the text says that "higher knowledge scores were associated with  lower
age.." etc, but no statistical data is provided to support this statement.
-Tables 4-7 show raw results without any interpretation or summarization, making it very hard to
see what is important. Results for every individual question are not as useful to see as a summary
and logistic regression.
-Table 3 only shows data for muslim participants without corresponding data for Buddhist
participants so the 2 groups cannot be compared.
-The discussion section largely reiterates the results without adding much analysis, and then
contains substantial literature review of the topic which could be moved to the introduction
section. Grounding this more in the current abortion environment in Thailand and offering
suggestions on what could be improved may be a more relevant discussion. Further discussion
of the limitations of the study should also be included.