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Guide for Developing a Cochrane Protocol - Cochrane Public Health ...

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Data Extraction and Assessment Form – template (cut and paste and modify to suit your<br />

review)<br />

Study ID: Report ID : Date <strong>for</strong>m completed:<br />

First author: Year of study: Data extractor:<br />

Citation:<br />

1. General In<strong>for</strong>mation<br />

<strong>Public</strong>ation type<br />

Journal Article Abstract Other (specify e.g. book chapter)___________________<br />

Country of study:<br />

Funding source of study:<br />

Potential conflict of interest from funding? Y / N / unclear<br />

2. Study Eligibility<br />

Study Characteristics<br />

Page/<br />

Para/<br />

Figure #<br />

Type of study<br />

(Review authors<br />

to add/remove<br />

designs based on<br />

criteria specified<br />

in protocol)<br />

Randomised Controlled Trial (RCT)<br />

Cluster Randomised Controlled Trial<br />

(cluster RCT)<br />

Interrupted Time Series (ITS)<br />

At least 1 time point be<strong>for</strong>e<br />

and 1 after the intervention<br />

Clearly defined intervention<br />

point<br />

A process evaluation of an included<br />

study design<br />

Description in text:<br />

Controlled Be<strong>for</strong>e and After (CBA) study<br />

Contemporaneous data collection<br />

Comparable control site<br />

At least 2 x intervention and 2 x<br />

control clusters<br />

Other design (specify):<br />

Does the study design meet the criteria <strong>for</strong><br />

inclusion?<br />

Yes <br />

No Exclude Unclear <br />

Last updated: 24 November 2011 - 30 -

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