Al‐Sheyab 2012a.

Methods	Included as process evaluation Intervention study design: non‐experimental design with post‐test only evaluation of feasibility among intervention groups Unit of allocation: N/A Process evaluation methods: surveys and focus groups among key stakeholders
Participants	Setting: a private girl's high school in Jordan Age of children: students in years 7 to 11 received the intervention delivered by children in years 10 and 11 Child characteristics (BME/SES): no information Asthma status: no information Intervention recipients: children only
Interventions	School type: high school (private girl's high school) Intervention description: study authors report that the Adolescent Asthma Action (Triple A) programme uses a 3‐step cascade process from senior to junior students to deliver asthma education and has well‐developed resources, including standardised training manuals, educational videos, asthma‐related models and devices, and first aid kits. Trained health workers provide initial training for peer leaders and facilitate the steps of the programme. Programme content covers management of asthma exacerbations, resisting pressure to smoke, and asthma medication and triggers. Programme delivery occurs through interactive teaching and learning activities, including role‐play and group discussion, all of which are said to be more effective than traditional didactic education for adolescents Control description: N/A ‐ feasibility study with no control group Theoretical framework: study authors report that Triple A is grounded in universally applicable theoretical concepts including peer leadership, self‐efficacy, and empowerment, suggesting its potential for use in different cultural contexts
Outcomes	Core processes evaluated (child level): the intervention explores child satisfaction in‐depth, with the intervention ostensibly implemented as intended
Notes	Process evaluation category: stand‐alone; core process questions were central Breadth and depth: neither broad nor deep Voice of children given prominence: featured but not sufficiently; unclear about the extent to which children were able to express negative views of the intervention Funding source: not reported
Risk of bias
Bias	Authors' judgement	Support for judgement
Random sequence generation (selection bias)	Unclear risk	N/A
Allocation concealment (selection bias)	Unclear risk	N/A
Blinding of participants and personnel (performance bias) All outcomes	Unclear risk	N/A
Blinding of outcome assessment (detection bias) All outcomes	Unclear risk	N/A
Incomplete outcome data (attrition bias) All outcomes	Unclear risk	N/A
Selective reporting (reporting bias)	Unclear risk	N/A
Other bias	Unclear risk	N/A
Transparent and clearly stated aims	Low risk	Study aims were clearly reported
Explicit theories underpinning and/or literature review	Unclear risk	Literature was sufficient to support the direction of the intervention, but a specific theory was not named to provide evidence of a sound theoretical basis
Transparent and clearly stated methods and tools	Unclear risk	Data collection methods and tools were reported; however data analysis methods are unclear
Selective reporting	High risk	Absence of outcome data (e.g. asthma‐related emergencies) directly related to the aims of the programme
Harmful effects	High risk	No evidence that any harmful effects were considered
Population and sample described well	High risk	Difficulty in distinguishing between numbers involved in the intervention and numbers involved in the process evaluation
Continuous evaluation	High risk	Data collected only post intervention
Evaluation participation equity and sampling	Unclear risk	Although the voice of young people was given prominence, it is unclear whether intervention sessions required school lessons to be moved, and how teachers felt about this
Design and methods overall approach	High risk	Description of research design and methods was limited, particularly with regards to the analysis, as study authors stated that this was beyond the scope of the study
Tools and methods of data collection reliable/credible	Low risk	Instruments used were suitable for the study and have been implemented elsewhere
Tools and methods of data analysis reliable/credible	High risk	Study authors did not report on an analytical framework and did not describe the methods used for data analysis
Performance bias/neutrality/credibility/conformability	Unclear risk	Unclear whether this was addressed during the study
Reliability of findings and recommendations	High risk	Study authors considered this to be a feasibility study, and the paper suggests that it was conducted successfully. However, the data presented do not support this in all instances
Transferability of findings	High risk	Study authors acknowledged that findings were limited in transferability, as the sample was derived from a single private girl's school, where English was not studied extensively
Overall risk of bias of process evaluation	High risk	This study had many unclear or high risk of bias classifications