Lee 2011.

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: qualitative and quantitative data collection; descriptive/bivariate, thematic/grounded theory, narrative data analysis
Participants	Setting: selected schools (67 schools) in Cleveland Metropolitan School District Age of children: 8 to 11 years old Child characteristics (BME/SES): no information Asthma status: asthmatic only Intervention recipients: children only
Interventions	School type: primary/elementary Intervention description: Open Airways for Schools (also testing the feasibility of undergraduate nursing students as instructors). The study author described that "the curriculum consists of six 40‐minute group lessons held during the school day. These lessons use group discussion, stories, role‐playing, and games to help the children understand more about asthma and to engage them more in the empowerment of managing their disease. The topics that are included in the program are basic information about asthma, recognizing and managing asthma symptoms, using medication, avoiding asthma triggers, getting enough exercise, and doing well in school. Each lesson focuses on one of the above topics with a review of previous information for enforcement of the skills and knowledge learned. The overall goals of the program are to (a) improve asthma self‐management skills, (b) decrease asthma emergencies, (c) raise awareness among parents/guardians, and (d) promote broader asthma management coordination among physicians, parents, and schools" Control description: N/A Theoretical framework: functional context approach
Outcomes	Core processes evaluated (child level): explored some indicators of adherence
Notes	Process evaluation category: integrated within outcome evaluation Breadth and depth: neither broad nor deep Voice of children given prominence: featured but not sufficiently 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 stated
Explicit theories underpinning and/or literature review	Low risk	Functional context approach guided development of the intervention
Transparent and clearly stated methods and tools	Unclear risk	In terms of the outcome evaluation and information collected from children, lack of transparency surrounds the sample frame and tools
Selective reporting	High risk	Many instruments were not presented
Harmful effects	Unclear risk	Some elements that could be negative were included, but nothing from the children is included
Population and sample described well	High risk	Not much information was included on participants, and some details of the children were not described. More information was provided about the schools themselves
Continuous evaluation	Unclear risk	Pre‐post assessment, but post hoc only for nurses
Evaluation participation equity and sampling	Unclear risk	Nothing from the teachers was reported
Design and methods overall approach	High risk	Structured data about implementation ‐ e.g. attrition, adherence ‐ are insufficient
Tools and methods of data collection reliable/credible	High risk	Lack of transparency is evident among the methods used to assess child outcomes
Tools and methods of data analysis reliable/credible	High risk	Quantitative data were not analysed fully ‐ e.g. lack of subgroup analyses
Performance bias/neutrality/credibility/conformability	High risk	How aspects around neutrality were addressed is unclear
Reliability of findings and recommendations	High risk	Study design did not support the research question ‐ results from different instructors were not compared
Transferability of findings	High risk	Generalisability was not explicitly considered in enough detail
Overall risk of bias of process evaluation	High risk	Study has several limitations, including reporting bias and lack of transparency