Barbaglia 2009.

Methods	Study design: ITS
Participants	Physicians Clinical speciality: not clear Level of training: fully trained Setting/country: outpatient (e.g. ambulatory care provided by hospitals/specialists)/Spain
Interventions	The PEM was the WHI trial, published on 17 July 2002, which concluded that overall health risks exceeded benefits from use of combined oestrogen plus progestin among healthy postmenopausal women
Outcomes	4 process outcomes: prevalence of HRT use in women aged 50 to 54 years (%) prevalence HRT use in women aged 55 to 59 years (%) prevalence HRT use in women aged 60 to 64 years (%) prevalence HRT use in women aged 65 to 69 years (%)
Notes	‐
Risk of bias
Bias	Authors' judgement	Support for judgement
Intervention independent of other changes ‐ ITS	Unclear risk	No information was provided
Shape of Intervention effect pre‐specified ‐ ITS	Low risk	COMMENT: the authors describe how previous studies have shown decreases in HT use based on pharmacy data. They propose a study with direct report of HT use and a longer follow‐up period to better assess this trend
Intervention unlikely to affect data collection ‐ ITS	Low risk	Data were collected during a breast screening programme that was not affected by the release of the trial
Blinding of outcome assessors (detection bias) ‐ ITS All outcomes	Unclear risk	COMMENT: patients included in the study were interviewed at a breast cancer screening programme. The highly publicised nature of the WHI study suggests the possibility that the outcome assessor (patient) would be aware of the intervention
Incomplete outcome data (attrition bias) ‐ ITS All outcomes	Low risk	COMMENT: specific data on loss to follow‐up was not given for pre‐post‐intervention or by age group. However, a very small percentage was lost. Quote, pg. 1062: "we excluded 1,467 women (2.8%) from the analysis because of their inconsistencies in successive answers about HT use as well as 42 women (0.1%) who refused to complete the questionnaire"
Selective reporting (reporting bias) ‐ ITS	Low risk	All relevant outcomes in the methods section were reported in results section
Other bias ‐ ITS	High risk	The primary outcome is not objective (self report)