Uys 2005.
| Methods |
Study design: CBA study Duration of study: Not stated Unit of allocation: District (2 intervention, 1 control) Method of allocation: Not stated Unit of analysis: District Sampling: 3 hospitals and six clinics from each district (3 clinics randomly selected plus 3 neighbouring clinics) |
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| Participants |
Country: South Africa Income classification: Upper‐middle income Geographical scope: Three districts Rural/urban: Rural Setting: Hospital and clinics (each district with rural and district hospital) Supervisees: All category of nurses Supervisors: Head nurses, primary healthcare co‐ordinators, zone matrons and programme managers Patients/clients: General population |
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| Interventions |
Stated purpose: Assess whether supervision effects the quality of care and job satisfaction Description intervention 1: Modified matrix model and training: supervisors (from hospitals and clinics): 5 days over a 3‐month period; on 6 functions of supervision: relate, develop, evaluate, monitor, counsel and administer. Description intervention 2: CHESS model and training: supervisors (only from clinics): PHC Alma‐Ata principles and continuous quality improvement cycle (with clients and community representatives). Control: Training of supervisors Training: As described above Frequency of supervisory visits: Not stated Co‐interventions: None |
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| Outcomes |
Primary outcomes: Indicators relating to satisfaction with supervision, job satisfaction, quality of care and patient Satifisfaction Secondary outcomes: None Time points when outcomes measured: Not stated |
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| Notes |
Funding: Health Systems Trust, Durban, South Africa This is a study on the effects of different training approaches in supervision. |
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| 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 | |
| Incomplete outcome data (attrition bias) All outcomes | High risk | Varying loss to follow‐up shown in tables reporting on satisfaction with supervision, quality of care in clinics and patient satisfaction outcome measures. |
| Selective reporting (reporting bias) | High risk | Only 2 out of 5 results table show the results for the control group. "PHC data from the two areas were compared, and if a difference was found, District C was included as a control" |
| Other bias | High risk | Does not meet EPOC inclusion criteria of minimum of 2 intervention and 2 control sites |
| Baseline outcome measurements similar? | High risk | For satisfaction with supervision and job satisfaction outcomes measures, no baselines provided for Intervention Group 2 |
| Baseline characteristics similar? | Unclear risk | No data presented. "All three of these districts are typically rural and share many similarities in population and services." |
| Protection against contamination? | High risk | “...the provincial authority launched a project to train all supervisors using a handbook from the Eastern Cape Department of Health (2000); thus District C was involved in this training” “Another problem may have been staff turnover and movement of supervisors”. |
BHS: Barangay health stations CBA: controlled before and after study CHA: community health agent CHESS: Centre for Health and Social Studies DANIDA: Danish International Development Agency DHO: district health officer DHPO: district public health officer IMCI: Intergrated Management of Childhood Illness ISC: Integrated Supervisory Checklist ITT: intention‐to‐treat PCU: primary care unit PHC: primary health care RCT: randomised controlled trial RHU: rural health units USAID: United States Agency for International Development WHO: World Health Organization