Table 3.

Summary of quality and confidence of included studies

Review finding		Relevant paper	Confidence in the evidence	Explanation of confidence in the evidence assessment
Intrapersonal factor
Information	Lack of information about syphilis or, other STIs before testing, lack of information about STIs epidemiology	34–46	High confidence	Very likely to be a factor in a variety of settings
Fear, belief, motivation and experience	Fear and shame: fear of a positive result; shame of having a test	35 41–43 50–61	Moderate confidence	‘Fear of positive result’ is a strong factor. A bit of concerns about the adequacy of data on the subtheme of ‘shame of taking the test’.
	Belief and motivation: HIV/syphilis test is good for the baby; syphilis and other STI were minimally significant compared with HIV	34 53 57 62 63	Moderate confidence	A bit of concerns about the adequacy of data
	Experience help to relief the anxiety of performing test	54 57 64–67
Characterstics of the patient	Financial statue: the direct and indirect cost of service acted as a barrier for pregnant women engagement with maternal HIV/STIs testing services	36 37 41 42 51 57 64 67 69–72	Moderate confidence	High conference data. A bit of concern about the adequacy of data.
	Age: a low proportion of adolescent and young mothers had fully utilised HIV services	42 59 63	Low confidence	High concerns about the adequacy of data and coherence
Interpersonal factors
Healthcare worker’s attitude	Positive attitude: helpful, kind, open to being asked questions, and being who could be trusted; negative attitude: impatient, uncaring or rude; women felt be neglected, threatened, or exposed to physical or verbal abused; health worker justified their action as compensation for dealing with high patient workload	37 40 42 51 57–59 61 62 69 71–76	High confidence	High coherence and adequacy data. Very likely to be a factor in a variety of settings
Support	Support from friends, familys, and male partners has a significant positive impact on women’s decision-making process	35 39 42 44 50 51 56 58 62 65 69 73 78–80 83	Moderate confidence	A bit of concern about the adequacy of data on ‘support from friends or family.’
Organisational factors
Resources	Availability of material resources; availability of human resources; availability of funding	34 36 39 47 53 55 57 63 65–67 72 73 78 81–86	Moderate confidence	High coherence and adequacy data. A bit of concern about relevance. Likely to be relevant in African LMICs.
Training and supervision	Informative training session: being interactive, flexible, comprehensive and enriching based on the previous experience; peer trainings or support groups are effective to supplement the regular training session	36 39 41 47 53 57 65–67 78 79 81 82 89	High confidence	A bit of concern about relevance and adequacy data on peer training or support groups
Contextual factors
Sociocultural norms	Traditional generally inhibit testing; gender roles and gender norms of women in society performed as a key factor that influencing women’s acceptance of HIV/STI testings	35 36 39 41 46 51 57 63 69 70 75 80 92–96	Moderate confidence	A bit of concern about coherence and relevance.Likely to be relevant in a specific rural area
Policy factors	Biomedical model: Programme targets still focused on the clinical target; Programme coverage need to extend to private health facilities; Importance to have comprehensive and standard guidelines	34 37 48 49 55 62 63 68 71 73 74 78 80–83 95 97 98	Moderate confidence	A bit of concerns about coherence and relevance, particularly for the subtheme of ‘programme coverage.’

LMICs, low-incoome and middle-income countries; STIs, sexually transmitted infections.