Table 4 Quality assessment using EPHPP tool for quantitative studies
From: Systematic review of interventions to improve the psychological well-being of general practitioners
Components | Gardiner et al [34] | Holt and Del Mar [36] | Gardiner et al [34] | Asuero et al. [37] |
|---|---|---|---|---|
Selection Bias 1. Are the individuals selected to participate likely to be representative of the target populations? | Self-referred/elected therefore using dictionary definition this scores 3 = NOT LIKELY | Participants were those respondents to a questionnaire found to score above a threshold. Questionnaire sent to all GPs in 8 Divisions of General Practice in Australia. 2 = Somewhat likely | Self-referred therefore using dictionary definition this scores 3 = NOT LIKELY | Self-referred/elected to attend. Subsequent stratified randomization reported. 2 = Somewhat likely |
Selection Bias 2. What percentage of the selected individuals agreed to participate? | 1 = 80-100 %. By electing to attend participants were agreeing to participate. | Baseline questionnaire response rate 819/1356 = 60 % 60 % = 2 | 69 Volunteered to attend but cannot tell how many actually participated 5 = Can’t tell | 1 = 80-100 % All eligible volunteers agreed to participate. |
SELECTION BIAS RATING | WEAK | MODERATE | WEAK | MODERATE |
Study design | Controlled before and after study | Controlled clinical trial | Controlled before and after study | Controlled clinical trial |
Was the study described as randomized? | No | Yes | No | Yes |
Was the method of randomization described? | No | No | No | No |
Was the randomization process appropriate? | Not applicable | No | Not applicable | No |
STUDY DESIGN RATING | MODERATE | MODERATE | MODERATE | MODERATE |
Were there important differences between groups prior to the intervention? | 1 = Yes Control group more likely to be in solo practice, older and had more years in practice | 3 = Can’t tell Authors report mean comparison of baseline GHQ scores showed no significant difference prior to the intervention (p = 0.09). No other information provided on pre-intervention confounders | 3 = Can’t tell. Control group for psychological well-being outcome were respondents to a survey. Control group for actual retention were entire population of rural GPs . | 3 = Can’t tell Authors report that intervention group was larger due to high interest in the intervention. |
What percentage of relevant confounders were controlled? | Can’t tell = 4 Controlling for confounders not explicit. | Can’t tell = 4 | Can’t tell = 4 | Can’t tell = 4 |
CONFOUNDERS RATING | WEAK | WEAK | WEAK | WEAK |
Were the outcome assessors aware of the intervention status of participants? | Yes = 1 | Yes = 1 | Yes = 1 | Yes = 1 |
Were the participants aware of the research question? | Yes = 1 | Yes = 1 | Yes = 1 | Yes = 1 |
BLINDING RATING | WEAK | WEAK | WEAK | WEAK |
Were data collection tools shown to be valid? | Yes = 1 | Yes = 1 | Yes = 1 | Yes = 1 |
Were data collections tools shown to be reliable? | Yes = 1 | Yes = 1 | Yes = 1 | Yes = 1 |
DATA COLLECTION RATING | STRONG | STRONG | STRONG | STRONG |
Were withdrawals and drop-outs reported in terms of numbers/reasons? | Yes = 1 | Yes = 1 | No = 2 69 volunteers, 48 questionnaires completed post-intervention. No information on those 21 given. | No = 2 Drop-outs from intervention group mentioned in baseline table. No details provided however results in scales approximate in remainder of tables. |
Percentage of participants completing the study | 84 % = 1 89 % IG 79 % CG | 161/233 = 69 % = 2 | 57 % = 3 63 % IG 51 % CG | 100 % = 1 |
WITHDRAWALS AND DROP OUTS RATING | STRONG | MODERATE | WEAK | STRONG |
What percentage of participants received the allocated intervention? | Follow-up data for 77. Cannot tell if all 86 received the intervention. | 106/120 = 88 % Score = 1 | 48/68 = 60 % Score = 2 | 100 % Score = 1 |
Was the consistency of the intervention measured? | Not explicitly Cannot tell = 3 | Not explicitly Cannot tell = 3 | Not explicitly Cannot tell = 3 | Described as ‘essentially the same’ and delivered by the same qualified instructor. No explicit report of measurement of consistency. Cannot tell = 3 |
Is it likely that subjects received an unintended intervention that may influence results? | No = 5 | Yes = 4 Concurrent educational programme which 26 of the study participants attended. Analyses were made with and without them. | No = 5 | No = 5 |
Unit of allocation | Individual | Individual | Individual | Individual |
Unit of analysis | Individual | Individual | Individual | Individual |
Are the statistical methods appropriate for the study design? | Yes = 1 | Yes = 1 | Yes = 1 | Yes = 1 |
Is the analysis performed by intervention allocation status (ITT) rather than actual intervention received? | No = 2 | Yes = 1 | No = 2 | No = 1 |