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. 2026 Feb 26;26:1084. doi: 10.1186/s12889-026-26686-w

Table 2.

Risk of bias assessment using modified Hoy tool (n = 52 Studies)*

Domain Low Risk n (%) Moderate Risk n (%) High Risk n (%) Unclear/NA n (%)
EXTERNAL VALIDITY
1. Representativeness of the sample 34 (65.4) 12 (23.1) 6 (11.5) 0 (0)
2. Sampling frame appropriateness 30 (57.7) 16 (30.8) 6 (11.5) 0 (0)
3. Random selection or census 38 (73.1) 10 (19.2) 4 (7.7) 0 (0)
4. Non-response bias 28 (53.8) 17 (32.7) 7 (13.5) 0 (0)
INTERNAL VALIDITY
5. Data collection methods 44 (84.6) 6 (11.5) 2 (3.8) 0 (0)
6. Case definition (availability/affordability) 48 (92.3) 3 (5.8) 1 (1.9) 0 (0)
7. Instrument validity and reliability 41 (78.8) 8 (15.4) 3 (5.8) 0 (0)
8. Mode consistency (data collection) 43 (82.7) 7 (13.5) 2 (3.8) 0 (0)
9. Numerator/denominator appropriateness 39 (75.0) 9 (17.3) 4 (7.7) 0 (0)
10. Statistical analysis appropriateness 36 (69.2) 12 (23.1) 4 (7.7) 0 (0)
OVERALL RISK OF BIAS ASSESSMENT 24 (46.2) 21 (40.4) 7 (13.5) 0 (0)

Percentages may not sum to 100.0% due to rounding

•Table 2 Risk of bias assessment using modified Hoy tool

•Domain-specific and overall risk of bias assessments for the 52 included studies*

Risk of bias was assessed using a modified tool based on Hoy et al. [23]. Percentages may not sum to 100.0% due to rounding*