Joseph 2010.

Methods	Included as process evaluation Intervention study design: parallel‐group randomised controlled trial Unit of allocation: child Process evaluation methods: survey based, including multi‐variate analyses of outcomes
Participants	Setting: 6 high schools in Detroit, Michigan, USA Age of children: mean age, 15.3 years Child characteristics (BME/SES): 97% of students were African American; 52% were eligible for federal school lunch programmes Asthma status: asthmatic only; severity unclear Intervention recipients: children only
Interventions	School type: high schools Intervention description: tailored computer programme (Puff City): the web‐based programme focuses on 3 core behaviours, namely, controller medication adherence, rescue inhaler availability, and smoking cessation/reduction, and consists of 4 consecutive educational computer sessions that make use of both normative ("compared with other students") and ipsative ("compared with your last session") feedback. Messages are voiced over to accommodate low literacy. Participant‐specific information necessary for tailoring is obtained at baseline and during the 4 sessions. Control description: students randomised to the control group were directed to existing generic asthma websites Theoretical framework: not 1 single framework was named, but theories around content were mentioned
Outcomes	Core processes evaluated (child level): attrition, dosage, adherence
Notes	Process evaluation category: stand‐alone and integrated (2 papers) Breadth and depth: breadth and depth Voice of children given prominence: featured but not sufficiently Note: study is not included as an outcome evaluation because the comparison group received asthma education (this study evaluated the added impact of providing tailored messaging) Funding source: National Heart, Lung, and Blood Institute, National Institutes of Health
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	Each paper includes clearly stated aims
Explicit theories underpinning and/or literature review	Low risk	Not a single theory, but some aspects of learning are grounded in pedagogical techniques
Transparent and clearly stated methods and tools	Low risk	All methods were clearly stated
Selective reporting	Unclear risk	Data were apparently collected at different time points, but only follow‐up data were presented. Otherwise no evidence indicates that data collected were not presented
Harmful effects	Unclear risk	Some consideration of negative factors in the design ‐ e.g. access to the referral co‐ordinator. However, whether the analysis fully accounts for this is unclear
Population and sample described well	Unclear risk	Characteristics of the population were generally described well ‐ but ambiguities between papers that ostensibly describe the same study population surround the numbers involved
Continuous evaluation	Low risk	Data were collected at different time points, but only follow‐up data were presented
Evaluation participation equity and sampling	High risk	High level of non‐participation is a matter of concern
Design and methods overall approach	Unclear risk	Evaluation took into account multiple time points (all data were not necessarily presented): however data from multiple stakeholders were not collected
Tools and methods of data collection reliable/credible	Low risk	Tools and methods used were reliable
Tools and methods of data analysis reliable/credible	Low risk	Analysis was straightforward, in part because of the relatively straightforward research design
Performance bias/neutrality/credibility/conformability	Low risk	One of the papers explicitly addressed negative cases
Reliability of findings and recommendations	Unclear risk	Taken together, the 3 papers associated with this study present an accurate description of the processes undertaken, but numerous children did not participate and no clear explanation for this was provided
Transferability of findings	Unclear risk	Study authors did not address transferability, but the data are rich enough for exploration of contextual factors, etc. No explanation is provided as to why so many children did not participate
Overall risk of bias of process evaluation	Unclear risk	This study was well conducted in most respects, but it is unclear why so many children failed to participate