General characteristics of included studies (N=484)
| Characteristics | N (%) |
| EMR countries in which the studies were conducted | |
| Saudi Arabia | 143 (29.5) |
| Iran | 65 (13.4) |
| Jordan | 35 (7.2) |
| Egypt | 34 (7) |
| Bahrain | 33 (6.8) |
| Lebanon | 26 (5.4) |
| Tunisia | 24 (5) |
| United Arab Emirates | 21 (4.3) |
| Kuwait | 15 (3.1) |
| Palestine | 15 (3.1) |
| Qatar | 14 (2.9) |
| Oman | 14 (2.9) |
| Iraq | 12 (2.5) |
| Morocco | 11 (2.3) |
| Sudan | 8 (1.7) |
| Algeria | 3 (0.6) |
| Syria | 2 (0.4) |
| Yemen | 2 (0.4) |
| Comoros | 0 (0) |
| Djibouti | 0 (0) |
| Libya | 0 (0) |
| Mauritania | 0 (0) |
| Somalia | 0 (0) |
| Two or more EMR countries | 7 (1.4) |
| Country of the institution to which the first author is affiliated | |
| EMR countries | 421 (87) |
| Non-EMR countries | 63 (13) |
| Country of the institution to which the contact author is affiliated | |
| EMR countries | 400 (82.6) |
| Non-EMR countries | 79 (16.3) |
| Not reported | 5 (1) |
| Study designs | |
| Cross-sectional | 273 (56.4) |
| Chart/retrospective document review | 63 (13.0) |
| Mixed methods | 31 (6.4) |
| Qualitative | 30 (6.2) |
| Randomised controlled trial | 15 (3.1) |
| Case report | 14 (2.9) |
| Cohort | 11 (2.3) |
| Literature review | 11 (2.2) |
| Quasi-experimental | 9 (1.9) |
| Systematic review | 2 (0.4) |
| Case–control | 1 (0.2) |
| Other | 24 (5.0) |
| Descriptive vs effectiveness studies | |
| Descriptive studies | 423 (87.4) |
| Effectiveness/intervention studies | 61 (12.6) |
| Language of publication | |
| English | 463 (95.7) |
| French | 21 (4.3) |
| Dimensions and themes pertaining to quality, safety and performance management * | |
| Input | 85 (17.6) |
| Resource availability | 51 (10.5) |
| Facility environment | 28 (5.8) |
| Preferences and culture | 19 (3.9) |
| Service delivery | 446 (92.1) |
| Provider competence | 260 (53.7) |
| Performance measurement and management | 168 (34.7) |
| Trainings | 71 (14.7) |
| Patient–provider relationship | 49 (10.1) |
| Gatekeeping and referrals | 45 (9.3) |
| Patient safety | 39 (8.1) |
| Access | 37 (7.6) |
| Provider motivation | 26 (5.4) |
| Team work and leadership | 22 (4.5) |
| Information system use | 22 (4.5) |
| Comprehensiveness | 22 (4.5) |
| Community engagement and outreach | 16 (3.3) |
| PHC reforms | 14 (2.9) |
| Person-centred | 13 (2.7) |
| Provider safety | 13 (2.7) |
| Outcome | 219 (45.2) |
| Clinical outcomes | 100 (20.7) |
| Patient satisfaction | 64 (13.2) |
| Service utilisation | 41 (8.5) |
| Provider satisfaction | 22 (4.5) |
| Patient reported outcomes | 15 (3.1) |
| Coverage | 14 (2.9) |
| Knowledge/practice of patients | 10 (2.1) |
| Efficiency | 9 (1.9) |
| Equity | 9 (1.9) |
| Costs | 8 (1.7) |
*The percentages do not add to 100 as some articles included more than one dimension and theme.
EMR, Eastern Mediterranean Region; PHC, primary healthcare.