Ahmad 2009.

Methods	Study design: randomised controlled trial Randomisation method: random‐number sampling scheme stratified by participating physicians. Before recruitment, the randomisation assignment was computer‐generated using varying block sizes of 2 and 4. Women were individually randomised Power calculation: reported Study dates: March to September 2005
Participants	Setting: urban, hospital‐affiliated, academic, family practice clinic Country: Canada Inclusion criteria: women, 18 years and over, in relationship in last 12 months, able to read and write English Exclusion criteria: none stated Number (%) of eligible recruited: 314/586 (53.6%) Numbers recruited: 314; intervention group 156, control group 158 Number of dropouts: 34; intervention group 17, control group 17 Numbers analysed (% of recruited): 280; intervention group 139 (89%), control group 141 (89%) Numbers analysed (sensitivity analysis): 293; intervention group 144, control group 149 Age: mean 44 years (SD 14 years) Marital status: married/living with a partner 74%, single 21%, separated/divorced/widowed 5% Ethnicity: outside Canada 34% Socioeconomic status: ≤ USD 40,000 28%, USD 40,001 to 60,000 18%, USD 60,001 to 80,001 14%, USD 80,001 to 100,001 16%, > USD 100,000 24% Education background: 18% ≤ high school, 33% ≤ college, 34% ≤ university, 15% ≤ postgraduate Children: children at home aged < 15 years 58% Positive IPV result exit survey 62/286; intervention group 28/140, control group 34/146
Interventions	Intervention group Computer‐assisted screening for IPV and control, which included items from the Abuse Assessment Screen and Partner Violence Screen embedded among items assessing a range of health issues. A 'yes' response to any IPV items was reported on a one‐page risk report 'Possible partner abuse‐assess for victimisation' that was provided to physicians. Relevant community referrals were printed at the end of the report Control group Standard medical care
Outcomes	Primary outcomes Initiation of discussion about risk for IPV by either participant or provider (discussion opportunity) Detection of women at risk Secondary outcomes Provider assessment of participant safety Referrals Advice for follow‐up Participant acceptance (collected in exit survey) Discussion and detection of other health risks were also measured but not relevant to this study Data collected through audio‐recording (short‐term)
Notes	Funding: Canadian Institutes of Health Research (grants IGF 63976 and FOW 68219), Institute of Gender and Health, Ontario Women's Health Council, and Strategic Training on Health Care, Place and Technology Program
Risk of bias
Bias	Authors' judgement	Support for judgement
Random sequence generation (selection bias)	Low risk	A random‐number sampling scheme for eligible women stratified by participating physician was used. The randomisation assignment was computer‐generated by an off‐site biostatistician using varying block sizes of 2 and 4
Allocation concealment (selection bias)	Low risk	Women who had provided informed consent were randomly assigned to the intervention group or control group: "Patient assignments were sealed in opaque envelopes that were marked on the outside with a physician number and sequence number. The envelopes were opened by the recruiter after patients' written consent"
Blinding of participants and personnel (performance bias) All outcomes	High risk	All physicians initially received study information and those willing to participate provided written consent. Training was provided during clinical team meetings at the time of consent. Although "Physician participants were blinded to the study's primary purpose throughout the trial by emphasizing all health risks included in the multirisk computer survey and by using a nonspecific study title", they would not have been entirely blinded to the intervention. For example, the prompt in the women's records of the intervention group would have alerted providers to who was in the intervention group and conceivably have influenced their performance. Women were blinded to the study's primary purpose by using strategies similar to those used for physician participants and embedding questions about women's risk for IPV allowed the authors to conceal the study focus from both physician and patient participants. However, the patients were still aware that the computer survey was part of the intervention that could have influenced their behaviour. Awareness of being a control group participant (i.e. not doing the computer survey) may have altered the control group participants' behaviour in some way that related to the outcome
Blinding of outcome assessment (detection bias) All outcomes	Low risk	2 people undertook primary outcome assessment, working independently to code the audio‐recordings of the clinical encounters. Although efforts were made to blind coders to the patients' group assignments, this may have been compromised by what they heard (i.e. some information during the consultation that revealed the patient's allocation). However, this was unlikely to have affected their observation of the primary outcomes (initiation of discussions on IPV and detection of IPV). After their visit, women completed a pencil‐and‐paper exit survey and received brochures on cancer screening, cardiac and mental health, and IPV, at which time the research staff disclosed the purpose of the study to women. Although women were not blinded in answering the exit surveys, the outcomes measured via the exit survey were not primary to this study or our review
Incomplete outcome data (attrition bias) All outcomes	High risk	Immediately following randomisation, 12/156 women in the intervention group and 9/158 women in the control group were excluded/withdrew. In the intervention group, 9 did not complete the computer assessment; 2 had their visits cancelled and 1 withdrew. In the control group, 2 women had their visit cancelled, and 6 women withdrew and 1 physician withdrew 1 woman who had mental health issues. The authors observed that women generally showed interest in the computer screening, and some expressed disappointment when they were not assigned to the computer‐screened group, which may have explained the higher number of withdrawals in the control group. It is unclear what the actual level of attrition was, given that individual participant numbers for analyses are inconsistent across the flowchart depiction (intervention 141, control 144), and the results text (intervention 143, control 144). Numbers in Table 3 (RR analyses: intervention 139, control 141) also differed but this was due to missing data (missing covariate values for three visits and outcomes coded as "other" in 2 cases). In the final analysis, reasons for exclusions of participants appear balanced across the 2 groups occurring due to missing data, recording failures, and language barriers. Overall the attrition rate was low at 10.8% (34/314). The sensitivity analyses suggest that the missing data were enough to potentially affect the results: "Sensitivity analyses were conducted to gauge the potential effect of missing values. 2 extreme situations were considered in which each missing value was replaced with an extreme value of the variable that was most likely to diminish the observed RR toward the null value or most likely to accentuate the observed RR away from the null. These 2 extremes provide a range of likely values for each effect." Other imputed missing data were accounted for in the appendicised reanalysed outcome data, which was undertaken by ITT
Selective reporting (reporting bias)	Low risk	None noted. Trial registered (NCT00385034) but study protocol not available
Other bias	High risk	Protection against contamination: there was a high risk of bias in terms of what the participants in the control group received. Given that the same providers delivered both conditions to different women, this suggests the way in which they interacted with women from the control group may have been influenced by their experience of delivering the intervention and thus underestimated the effect