Dore‐Stites 2007.

Methods	Included as process evaluation Intervention study design: quasi‐experimental single‐group intervention examining change pre‐post intervention Unit of allocation: N/A Process evaluation methods: descriptive/bivariate (hypothesis testing)
Participants	Setting: 5 elementary schools in the Detroit area, USA Age of children: 5 to 10 years (mean age, 9.1 years) Child characteristics (BME/SES): 39% African American, 14% Hispanic, and 18% mixed ethnicity children; 34.6% were from low‐income families (< USD20,000 per annum) Asthma status: asthmatic only Intervention recipients: children and parents
Interventions	School type: primary/elementary Intervention description: treatment consisted of 3 components: a computer‐based educational game (Asthma: Quest for the Code), home activities, and caregiver information. The computer game included modules on: Lung Physiology; Symptom Recognition; Trigger Recognition; Peak Flow Meter Usage; Appropriate Use of Long‐Term and Reliever Medication; Correct Usage of Common Asthma Medication; and Effect of Asthma Medications on Lungs. The study author reports: "The self‐directed activities spanned from 10 to 20 minutes per session and were presented to participants individually during their school day. Modules were embedded within a larger, multiphase game and advancement to the next level occurred contingent upon answering quiz questions correctly. Children completed one or two modules per session dependent upon progression through each section and academic schedule. At a minimum, an individual participant could complete all activities in Asthma: Quest for the Code in approximately 1.25 hours although typically children utilised the CD‐ROM for approximately 20 minutes once per week over the course of eight to nine weeks for an approximate total time of 2.5 hours in instruction" Control description: N/A Theoretical framework: not 1 overarching theory utilised, but the study draws upon several theoretical standpoints
Outcomes	Core processes evaluated (child level): attrition
Notes	Process evaluation category: integrated Breadth and depth: neither broad nor deep Voice of children given prominence: sufficient coverage Funding source: Blue Cross Blue Shield Foundation
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 stated and were related to exploring feasibility
Explicit theories underpinning and/or literature review	Unclear risk	Sufficent literature was provided to support the study, drawing upon several theoretical standpoints
Transparent and clearly stated methods and tools	Low risk	Methods and tools were clearly stated
Selective reporting	Unclear risk	Parental engagement was a key component of the study but was deemed to have not been reported in full
Harmful effects	High risk	Not fully addressed ‐ implementation data on the support needed to get children to play the game were lacking
Population and sample described well	Unclear risk	Caregiver demographics were not reported in full
Continuous evaluation	Low risk	A pre‐post design was utilised
Evaluation participation equity and sampling	Low risk	All participants involved in the programme had the opportunity to participate in the evaluation
Design and methods overall approach	Unclear risk	This was reported; however not much information was provided
Tools and methods of data collection reliable/credible	Low risk	Tools that were used were well described and were recognised tools
Tools and methods of data analysis reliable/credible	Low risk	Analytical plan seems to be appropriate for the data; however it is unclear how (or if) the hierarchical nature of the data was accounted for
Performance bias/neutrality/credibility/conformability	Unclear risk	Not addressed by the study author
Reliability of findings and recommendations	High risk	The study sample was very small, reducing the reliability of study findings
Transferability of findings	High risk	Transferability of findings is unclear; however given the small sample size, transferability of study findings should be limited
Overall risk of bias of process evaluation	High risk	Data regarding dosage and adherence are limited. Moreover, the small sample size compromised the study as a whole