Estimating standard error of intra-class correlation coefficients up to three level unbalanced nested clinical trials

Very often researchers plan a balanced design for cluster randomization clinical trials in conducting medical research, but unavoidable circumstances lead to unbalanced data. By adopting three or more levels of nested designs, they usually ignore the higher level of nesting and consider only two levels, this situation leads to underestimation of variance at higher levels. While calculating the sample size for three-level nested designs, in order to achieve desired power, intra-class correlation coefficients (ICCs) at individual level as well as higher levels need to be considered and must be provided along with respective standard errors. In the present paper, the standard errors of analysis of variance (ANOVA) estimates of ICCs for three-level unbalanced nested design are derived. To conquer the strong appeal of distributional assumptions, balanced design, equality of variances between clusters and large sample, general expressions for standard errors of ICCs which can be deployed in unbalanced cluster randomization trials are postulated. The expressions are evaluated on real data as well as highly unbalanced simulated data.