Kouba 2012.

Methods	Included as process evaluation Intervention study design: quasi‐experimental single‐group study examining change pre‐post intervention Unit of allocation: N/A Process evaluation methods: descriptive and bivariate methods of analyses of survey‐based data (as well as administrative records)
Participants	Setting: 2 urban high schools in the USA Age of children: ninth through 12th grade; average age was 15.9 years Child characteristics (BME/SES): 92% African American, 4% Hispanic, 4% mixed ethnicity. Combined median family income ranged from USD30,000 to USD39,000 Asthma status: asthmatic only; 66% of children were deemed to have control of their asthma at baseline according to ACT tests Intervention recipients: children only (targeted overweight/obese children)
Interventions	School type: 2 high schools Intervention description: I Can Control Asthma and Nutrition Now (ICAN): the ICAN programme was developed as an adaptation of an existing intervention and is composed of 3 elements: (I) asthma education; (ii) coping skills training; and (iii) nurse practitioner‐reinforcement visits. In this study, 60% of students were overweight or obese. Because of concerns about the increasing prevalence of both youth asthma and obesity, study authors added a nutrition component to the intervention, so that the intervention could address these comorbidities. The ICAN programme is thus composed of 4 elements: (I) asthma education, (ii) nutrition education synthesised with CST, targeting obesity prevention and management, (iii) reinforcement visits with a registered nurse (RN) and a dietetic intern, and (iv) a family information meeting Control description: N/A Theoretical framework: Orem's self‐care deficit theory (SCDT)
Outcomes	Core processes evaluated (child level): attrition, dosage
Notes	Process evaluation category: integrated within outcome evaluation Breadth and depth: depth ‐ not breadth Voice of children given prominence: voice and views of children not featured Funding source: Loyola University Chicago Niehoff School of Nursing
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
Explicit theories underpinning and/or literature review	Low risk	Orem's self‐care deficit theory guided the intervention
Transparent and clearly stated methods and tools	Low risk	Methods and tools were fully described
Selective reporting	Low risk	All planned outcomes were reported on
Harmful effects	Unclear risk	Generalisability was not considered. Some of the challenges of working with obese kids who are not adherent were not reported
Population and sample described well	Low risk	Population demographics were clearly described
Continuous evaluation	Low risk	Two follow‐ups post intervention
Evaluation participation equity and sampling	Unclear risk	No evidence of satisfaction evaluation and no child perspectives given
Design and methods overall approach	Unclear risk	Everything required for a good process evaluation was not captured
Tools and methods of data collection reliable/credible	Unclear risk	Nothing suggests that this study was at high risk of bias; however no study steps were described
Tools and methods of data analysis reliable/credible	Low risk	All methods of data analysis are appropriate for the study
Performance bias/neutrality/credibility/conformability	Unclear risk	Not much evidence of this; however analysis was carried out by research associates under the supervision of the statistician
Reliability of findings and recommendations	Unclear risk	This included a small sample, and the voice of children did not feature prominently
Transferability of findings	High risk	Small sample size limits the transferability of findings
Overall risk of bias of process evaluation	Unclear risk	As a process evaluation, this study was limited, and the breadth of the study in including nutrition alongside asthma education was not evaluated