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Table 3 Risk of bias in included studies

From: Approaches to motivate physicians and nurses in low- and middle-income countries: a systematic literature review

Risk of bias Assessment of bias in studies included in the lit review General description
Random allocation of intervention Yes (1–4) Four studies randomized the intervention at a facility/district level, whereas the other three studies did not randomize allocation of intervention
No (5–7)
Not clear
Not applicable
Concealment of allocation Yes No studies concealed assignment. This is expected given the nature of health systems interventions
No (1–7)
Not clear
Follow-up of professionals Yes (7) Out of the six studies where follow-up was possible, four studies did not have the adequate 80–100% follow-up after randomization outlined by EPOC. In the other two studies, follow-up was not described
No (1,3,4)
Not clear (2,5)
Not applicable (6)
Blinded assessment of primary outcome(s) Yes None of the studies had blinded assessment of the primary outcome, as it is not possible given the nature of health systems interventions
No (1–7)
Not clear
Not applicable
Baseline measurement of outcomes in both groups Yes (4,5) Two studies included baseline measurement of outcome and differences between groups, three did not, and in two cases it was not applicable
No (1–3)
Not clear
Not applicable (6,7)
Baseline measurement of characteristics in both groups Yes (4) Most studies had unclear, or did not describe, baseline measurements of characteristics in both groups, with some reporting pooled numbers or not providing differences. One article did
No (1,3)
Not clear (2,5)
Not applicable (6,7)
Reliable primary outcome measure(s) Yes No studies presented an inter-rater reliability measure
No (1–7)
Not clear
Not applicable
Protection against contamination Yes (1,3,4,6) Almost all studies had an element of randomization, with randomization done at a facility or district level. These processes help reduce risk contamination. In the remaining two cases with comparison groups, contamination may have been compromised due to other external programs and district pairing
No
Not clear (2,5)
Not applicable (7)
No selective outcome reporting Yes (1–5, 7) Most studies reported both significant and non-significant findings. In one study, it was not clear whether there was selective reporting
No
Not clear (6)
Not applicable
  1. (1) Alhassan et al. (2016), (2) Shen et al. (2017), (3) Vermandere et al. (2017), (4) Hosseinabadi et al. (2013), (5) Aninanya et al. (2016), (6) Carasso et al. (2012), (7) Liu et al. (2017)
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