Stanback 2007.
| Methods |
Study design: Cluster RCT Duration of study: September 1999 to July 2000 Unit of allocation: Training area (6 out of 13 training areas selected; not specified how many in intervention or control groups) Method of allocation: Random Unit of analysis: Providers (177 at baseline; not specified how many in intervention or control groups) Sampling: Mulit‐stage. 1st stage: 6 of 13 training areas selected and randomly assigned to intervention or control. 2nd stage: all 25 hospitals and 37 out of 166 clinics selected proportional to number of centres in each district. Data obtained from 177 providers and 482 clients (before) and 176 providers and 451 clients (after). |
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| Participants |
Country: Kenya Income classification: Low‐income Geographical scope: Not specified Rural/urban: Rural Setting: Health facilities (hospitals and clinics) Supervisees: Nurses, midwives and nursing auxiliaries Supervisors: Not specified Patients/clients: Not specified |
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| Interventions |
Stated purpose: To improve family planning services through assessing provider knowledge and skills, provide feedback and help solve problems. Description intervention 1: Training of providers plus cascade training package Description intervention 2: Training of providers plus cascade training package plus supervision Control: Training of providers Training: No training of supervisors specified. One provider from each health facility received 2‐day training on family planning. Other providers received cascade training. Frequency of supervisory visits: Single supervisory visit in the intervention group one to three months after the training session Co‐interventions: Training of providers and cascade training package |
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| Outcomes |
Primary outcomes: Provider knowledge, attitudes and reported practices Secondary outcomes: None Time points when outcomes measured: 9 to 10 months after baseline |
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| Notes | Funding: USAID, Population Council | |
| Risk of bias | ||
| Bias | Authors' judgement | Support for judgement |
| Random sequence generation (selection bias) | Low risk | Used random number generator in Epi Info software |
| Allocation concealment (selection bias) | Low risk | Allocation performed at the start of the study |
| Blinding (performance bias and detection bias) All outcomes | Unclear risk | Not stated if outcome measures were assessed blindly |
| Incomplete outcome data (attrition bias) All outcomes | Low risk | Almost complete follow‐up in each of the trial arms |
| Selective reporting (reporting bias) | High risk | Methods specify that a 34‐element score was used to measure provider practices and a 19‐element score was used to assess provider knowledge and attitudes. Results only show two overall summary indicators for provider practices and knowledge/attitudes, and 10 selected individual indicators. |
| Other bias | Low risk | Cluster design taken into account. |
| Baseline outcome measurements similar? | Low risk | Tables 1 and 2 show similar baseline outcome measures in the trial arms |
| Baseline characteristics similar? | Unclear risk | No baseline characteristics provided |
| Protection against contamination? | Low risk | Supervision allocated to only selected health facilities |