Al‐Sheyab 2012.

Methods	Included as outcome evaluation Study design: clustered parallel‐group design with schools selected as the unit of randomisation Setting: study was conducted in 4 public high schools in the Irbid region of northern Jordan ‐ 2 schools randomised to intervention arm and 2 to control arm Period: dates in which study was conducted ‐ intervention and subsequent data collection ‐ not clear
Participants	Eligible sample frame: 261 pupils found to be eligible Randomised: 261 pupils randomised at the school level: 132 to the treatment group and 129 to the control group Completed (intervention): 244 pupils completed the trial Inclusion criteria: students were eligible for participation in the study if they had reported wheezing in the last 12 months as identified by the Arabic version of the ISAAC written questionnaire; were physically and cognitively capable of completing the survey; were able to read and converse in both Arabic and English; and regularly attended school classes Exclusion criteria: students with other diseases that could affect quality of life measures or who were concurrently involved in another health‐related study were not eligible Baseline characteristics Age of children: exact age not given; all children in years 8, 9, and 10 (usually 12 to 15 years old) Ethnicity: not reported Socio‐economic status: not reported Gender: 113 female participants (43.3%); note intervention and control took place in single‐sex schools (1 of each in treatment and control arms) Asthma status: 184 students (70.5%) had a formal asthma diagnosis; 87 students (33.3%) reported use of reliever medication; and 57 students (21.8%) reported use of preventer medication
Interventions	Intervention: bilingual health workers trained peer leaders from year 11 to deliver 3 Triple‐A lessons. The content of Triple‐A is not described here, but typical topics in Triple‐A include basic information on asthma, its triggers, and management; and barriers to optimal asthma management, including risk‐taking behaviours such as smoking (see earlier description of Triple A provided in Gibson 1998) Control: not clearly stated (usual care) Intensity: target asthmatic students received 3 lessons from peer leaders (year 11 students) Instructor: peers Theoretical framework: theories involving self‐efficacy underpinned the intervention Parental engagement: not reported Child satisfaction: not reported Timing of intervention in school day: not reported
Outcomes	Extractable outcomes were collected for: Health‐related quality of life (measured through the Paediatric Asthma Quality of Life Questionnaire) Withdrawal
Notes	This intervention tests a model of asthma self‐management education developed elsewhere, although modifications to the intervention are not fully described Considered as a process evaluation but excluded as did not seek to address process evaluation research questions Funding source: Jordan University of Science and Technology (Irbid, Jordon) and Nursing Council
Risk of bias
Bias	Authors' judgement	Support for judgement
Random sequence generation (selection bias)	Low risk	Low risk ‐ closed‐envelope technique used to select initial schools that were stratified by gender
Allocation concealment (selection bias)	High risk	Closed envelope, although no further details were provided and only a small number of schools (4) were involved, potentially compromising the concealment of allocation
Blinding of participants and personnel (performance bias) All outcomes	Unclear risk	No further details were given around blinding of personnel and participants
Blinding of outcome assessment (detection bias) All outcomes	Unclear risk	No further details were given around blinding of outcome assessment
Incomplete outcome data (attrition bias) All outcomes	Low risk	Low levels of attrition, roughly spread across intervention and control arms
Selective reporting (reporting bias)	Low risk	All stated outcomes were reported upon
Other bias	Unclear risk	Missingness ‐ low risk ‐ low levels of missingness Baseline imbalance ‐ high risk ‐ differences in asthma reliever therapies at baseline between groups Risk of contamination ‐ low ‐ school‐based randomisation minimises the potential for contamination between intervention and control groups
Transparent and clearly stated aims	Unclear risk	N/A
Explicit theories underpinning and/or literature review	Unclear risk	N/A
Transparent and clearly stated methods and tools	Unclear risk	N/A
Selective reporting	Unclear risk	N/A
Harmful effects	Unclear risk	N/A
Population and sample described well	Unclear risk	N/A
Continuous evaluation	Unclear risk	N/A
Evaluation participation equity and sampling	Unclear risk	N/A
Design and methods overall approach	Unclear risk	N/A
Tools and methods of data collection reliable/credible	Unclear risk	N/A
Tools and methods of data analysis reliable/credible	Unclear risk	N/A
Performance bias/neutrality/credibility/conformability	Unclear risk	N/A
Reliability of findings and recommendations	Unclear risk	N/A
Transferability of findings	Unclear risk	N/A
Overall risk of bias of process evaluation	Unclear risk	N/A