Sennun 2006.

Methods	Study design: CBA study Duration of study: September 2003 to February 2004 Unit of allocation: PCU (1 intervention, 1 control) Method of allocation: Not specified Unit of analysis: PCU Sampling: Two PCUs selected from a semi‐district, based on a set of inclusion criteria. 195 patients aged 15 to 60 selected from each PCU. Three health officers selected from each PCU based on their work performance and meeting minimum target indicators.
Participants	Country: Thailand Income classification: Low‐income Geographical scope: Semi‐district in Thailand Rural/urban: Rural/urban Setting: PCUs (upgraded health centres at sub‐district level providing frontline services by health officers) Supervisees: 3 health officers from each PCU Supervisors: 5 supervisors (4 graduate nurses and 1 technical officer) Patients/clients: Patients aged 15 to 60 at each PCU
Interventions	Stated purpose: Assess the effect of two models of supervision on the health promotion capacity of PCU health officers and the community Description intervention: Same as control plus addition of involvement of community leaders in the supervisory process (e.g. teacher, village leader and representatives from community groups and organisations) Control: PCU health officers' full participation in supervision with the district level supervisors and had "equal voices" to their supervisors Training: District supervisors in both groups received participatory training to enhance their supervisory knowledge and ability (length of duration not specified) Frequency of supervisory visits: Not specified Co‐interventions: None
Outcomes	Primary outcomes: Indicators relating to health officer job satisfaction, client perception of service quality and clients care satisfaction Secondary outcomes: None Time points when outcomes measured: 6 months after baseline
Notes	Funding: Partially funded by the Faculty of Graduate Studies, Mahidol University and Payap University.
Risk of bias
Bias	Authors' judgement	Support for judgement
Random sequence generation (selection bias)	High risk	CBA study
Allocation concealment (selection bias)	High risk	CBA study
Blinding (performance bias and detection bias) All outcomes	High risk	Outcome measures were not objective or assessed blindly
Incomplete outcome data (attrition bias) All outcomes	Low risk	All health officers followed up and same number of patients before and after the study
Selective reporting (reporting bias)	Low risk	All outcomes were reported on
Other bias	High risk	Does not meet EPOC inclusion criteria of minimum of 2 intervention and 2 control sites The cluster design was not taken into account in the statistical analyses. “One potential source of bias in this study was selection bias, because we only included supervisors with a good knowledge of, and enthusiasm for, supervision, and only health officers whose work performance achieved the minimum requirements of the PCU target indicators in the study. This was likely to partially affect the positive outcomes of the participatory supervisory model” “..the client sample groups before and after implementing supervision were different, which may have affected measurements of client’s perceived service quality and care satisfaction.” “?during the study period, some influential incidents occurred that affected the study results and the performance of the officers. There were many distracting events, such as the SARS epidemics, a new policy on narcotics suppression, a call for public health officers to set up camp to treat drug addicts, the ‘avian flu’ epidemics, and a Tambon Administrative Organisation (TAO) committee election”
Baseline outcome measurements similar?	Low risk	No significant differences between intervention 1 and 2 at baseline for client perception of service quality and care satisfaction. Job satisfaction of health workers similar at baseline.
Baseline characteristics similar?	High risk	“PCU was a smaller size and had pre‐existing health promotion in the form of a quality of life development club”.
Protection against contamination?	Low risk	Control group unlikely to have received the intervention