Finding #7
Health professionals, including doctors, nurses, policymakers and other healthcare providers, believed that doctor‐nurse substitution led to improvements in the quality of care.
Assessment for each CERQual component
Methodological limitations	Minor concerns because 1 study did not report reflexivity, ethical considerations and data analysis; 1 study did not report sampling strategies; 2 other studies did not report reflexivity.
Coherence	Minor concerns because in 1 study based in LMICs (Malawi, Uganda and Zimbabwe), nurses perceived that delivering new services had increased their workload that might hinder the provision of the quality of service.
Relevance	No or very minor concerns. In 9 studies, participants were nurses; in 9 studies, they were doctors; in 5 studies, they were other healthcare providers and in 4 studies, they were policymakers/managers.
Adequacy	No or very minor concerns, although data were relatively few, many studies from several regions reported this finding.
Overall CERQual assessment
Moderate confidence	Due to minor concerns about methodological limitations and coherence.
Contributing studies/setting
Sub‐Saharan Africa (2); Oceania (4); Europe ( 5); North America (3) Abbott 2013: Australia, general practices Boyle 2016: Australia, general practice Carryer 2017: New Zealand, primary care Coulter 2000: USA, managed care organisation‐multispeciality group practices Dierick‐van Daele 2010a: Netherland, general practice Kaasalainen 2013: Canada, long‐term care homes (primary care) Leipert 2011; Canada, primary care Ljungbeck 2017: Sweden, municipal healthcare Lorch 2015: Australia, chlamydia testing Marsden 2004: UK, practices Nkhata 2016: Malawi, Uganda and Zimbabwe, ART Perry 2005: UK, personal medical services Rustagi 2015a: Mozambique, N/A Stenner 2010: UK, primary care