2. Outcomes for the comparison between supervision and enhanced supervision.
| Outcomes | Outcome measurement | Arms | N | Pre | Change | P‐values | Review Authors’ Interpretation | Comments |
| Providers practice | ||||||||
| Rowe 2009 – I: training on IMCI for health workers + enhanced supervision + enhanced package of support. C: training on IMCI for health workers + routine supervision + usual support package | ||||||||
| % of children receiving recommended care | Observation of consultations, exit interviews, clinical re‐examination, health facility assessment and health worker interviews | I | Not stated | 16% | +24% | > 0.05 (I vs C) | No evidence that enhanced supervision with a package of support improves outcomes |
|
| C | Not stated | 22% | +13% | |||||
| % of children receiving recommended or adequate care | I | Not stated | 24% | +19% | > 0.05 (I vs C) | |||
| C | Not stated | 27% | +19% | |||||
| Mean % of needed IMCI tasks that were performed per child | I | Not stated | 24% | +30% | > 0.05 (I vs C) | |||
| C | Not stated | 24% | +31% | |||||
| Uys 2005 – I1: training of supervisors using Modified Matrix (MM) model. I2: training of supervisors using CHESS model. C: routine training of supervisors. | ||||||||
| Quality of care in clinics for diabetes and hypertension management. Overall score, maximum 15. | Checklist based on standard treatment guidelines and essential drugs list | I1 | B: 59; A: 48 (clinics) | 11 | +1 | P > 0.05 (BA change in groups) | No evidence that CHESS or MM training of supervisors improves quality of care in clinics | Data for control group not stated. No significant differences in quality of care in clinics between MM and CHESS models of supervisor training (P > 0.05) |
| I2 | B: 22; A: 47 (clinics) | 10 | +1 | |||||
| C | Not assessed | ‐ | ‐ | |||||
| Provider satisfaction | ||||||||
| Sennun 2006 – I: community leaders involvement in supervision. C: routine supervision. | ||||||||
| Health officer job satisfaction. Overall score, maximum 165 | 33 item questionnaire. | I | 3 (providers) | 109.7 | +16.6 | P > 0.05 (Sample size too small) | No evidence that involving community leaders in supervision improves provider job satisfaction | Greater improvement in job satisfaction in intervention arm, although not significant at P < 0.05 due to small numbers of health officers surveyed |
| C | 3 (providers) | 105.3 | +8.4 | |||||
| Uys 2005 – I1: training of supervisors using Modified Matrix (MM) model. I2: training of supervisors using Centre for Health and Social Studies (CHESS) model. C: routine training of supervisors. | ||||||||
| Nurse perceptions on supervision. Overall score, maximum 60. | 12 items supervision rating scale | I1 | B: 70; A: 45 (providers) | 33 | ‐1 | P > 0.05 (BA change in groups) | No evidence that CHESS training of supervisors improves provider perception of supervision | No before data for the MM model. |
| I2 | B: 0; A: 11 (providers) | ‐ | ‐ | |||||
| C | B: 12; A: 31 (providers) | 20 | +16 | |||||
| Nurse job satisfaction. Overall score, maximum 190 | Based on Traynor and Wade 1993 with Likert scale | I1 | Not stated | 122 | ‐47 | ‐ | No evidence that CHESS training of supervisors improves provider job satisfaction |
No data for control group. No before data for MM model. |
| I2 | Not stated | ‐ | 75.5 (end score) | |||||
| C | Not stated | ‐ | ‐ | |||||
| User satisfaction | ||||||||
| Sennun 2006 – I: community leaders involvement in supervision. C: routine supervision. | ||||||||
| Client’s perception of service quality. Overall score, maximum 95 | 19 items questionnaire | I | 195 (clients) | 80.8 | +0.1 | P = 0.001 (after scores in both groups) | No evidence that community involvement in supervision improves clients perception of service quality | No improvement in the intervention group demonstrated |
| C | 195 (clients) | 80.5 | ‐2.7 | |||||
| Clients care satisfaction (maximum score 90) | 18 items questionnaire | I | 195 (clients) | 72.7 | +3.3 | P = 0.001 (after scores in both groups) | Some evidence that community involvement in supervision improves clients care satisfaction | Small improvement in clients care satisfaction in the intervention arm compared to control with similar baselines (P = 0.001) |
| C | 195 (clients) | 74 | ‐2.5 | |||||
| Uys 2005 – I1: training of supervisors using Modified Matrix (MM) model. I2: training of supervisors using CHESS model. C: routine training of supervisors. | ||||||||
| Patient satisfaction. Overall score, maximum 28. | 36 items questionnaire | I1 | B: 123; A: 20 (patients) | 11 | +4 | P > 0.05 (BA change in groups) | No evidence that CHESS or MM training of supervisors improves patient satisfaction | Data for control group not stated. No significant differences in patient satisfaction between MM and CHESS models of supervisor training (P > 0.05) |
| I2 | B: 52; A: 30 (patients) | 14 | 0 | |||||
| C | Not stated | ‐ | ‐ | |||||
| Other | ||||||||
| Ayele 1993 – I: intensive monthly supervision. C: routine supervision. | ||||||||
| Mean functional status of community health agents (CHAs): 13 indicators (10 quality of care, 3 management activities). Overall score, maximum not stated | Checklist completed by CHAs and supervisors. | I | 50 (providers) | 13.1 | +6.2 | < 0.001 (between groups) | Some evidence that increasing intensity of supervision to monthly improves performance of community health workers. | Significant improvement in overall functional status score in intervention group compared to the control group at six months following baseline (P < 0.05). 10 of the 13 indicators were significantly higher in the intervention group compared to the control group at 6 months (P < 0.05). |
| C | 52 (providers) | 12.1 | ‐2.6 | |||||
| Loevinsohn 1995 – I: supervision with training of supervisors and use of checklist. C: routine supervision with no training or checklists. | ||||||||
| Overall performance score of midwives. Overall score, maximum 60 | 20 indicators from checklist used by supervisors. | I | 49 (health facility) | 26 | +11.3 | P = 0.003 (I vs C) | Some evidence that checklists with training improves performance. The intervention increased frequency of supervision. | Greater improvement in 16 of the 20 individual indicators in the intervention group compared to the control group (data presented for only 6 indicators); statistical significance not available. |
| C | 63 (health facility) | 27 | +4.9 | |||||
| Uys 2005 – I1: training of supervisors using Modified Matrix (MM) model. I2: training of supervisors using CHESS model. C: routine training of supervisors. | ||||||||
| Quality of patient documentation in hospitals – score (%) | Patient records (82 criteria on Nursing Records Standard sheets) | I1 | B: 45; A: 46 (records) | 15 | ‐3.9 | P > 0.05 (BA change in groups) | No evidence that CHESS or MM training of supervisors improves quality of patient documentation | No statistically significant difference between comparison groups (P > 0.05) |
| I2 | B: 45; A: 45 (records) | 16.5 | ‐5.5 | |||||
| C | B: 44; A: 45 (records) | 13 | ‐2 | |||||
A: after; B: before; C: Control; I: Intervention.