McGhan 2010.

Methods	Included as outcome evaluation Study design: clustered parallel‐group design Setting: elementary schools in Edmonton, Canada Period: not reported
Participants	Eligible sample frame: all schools in Edmonton were eligible; an estimated 646 students from the 18 participating schools were eligible Randomised: 162 pupils from 18 schools: 76 pupils in the intervention group and 86 in the control group Completed (intervention): 136 pupils: 65 in the intervention group and 71 in the control group Inclusion criteria: the target population was children 7 to 12 years of age with asthma. Pupils were eligible if they had received a diagnosis of asthma from their doctor and informed consent from their parent/guardian, were able to speak Eglish, and had not previously participated in Roaring Adventures of Puff (RAP) Exclusion criteria: not reported Baseline characteristics Age of children: 5 to 10 years of age; 27.6% in the intervention group and 23.3% in the control group were 5 to 7 years old, and 61.8% in the intervention group and 57% in the control group were 8 to 10 years old Ethnicity: 81.6% of children in the intervention group and 74.4% of children in the control group were Caucasian Socio‐economic status: not reported; however 26.8% of children in the intervention group and 36.4% in the control group had a father who achieved education grade 12 or less Gender: males represented 55.3% of intervention students and 62.8% of control students Asthma status: mixed levels of severity: 62.7% of intervention children and 66.7% of control children had mild asthma; 29.3% of intervention children and 28.6% of control children had moderate asthma; 8% of intervention children and 4.8% of control children had severe asthma
Interventions	Intervention: parents and teachers in intervention schools were invited to participate in a RAP asthma awareness event at school. Parents and children in the intervention schools received information letters to share with their doctors, including suggested guidelines for a written action plan to be used at home and school. Doctors also received a summary letter from the RAP instructor at the end of the programme Control: usual care Intensity: six 60‐minute sessions Instructor: third year nursing and pharmacy students were RAP instructors under the guidance of their supervisor Theoretical framework: social cognitive theory informed the intervention Parental engagement: not reported Child satisfaction: not reported Timing of intervention in school day: not reported
Outcomes	Extractable outcomes were collected for: Asthma symptoms leading to emergency hospital visit Parent‐reported absence from school Unplanned visit to hospital or GP due to asthma symptoms Experience of daytime and night‐time symptoms Withdrawal
Notes	Considered for process evaluation: did not meet the definition of a process evaluation Funding source: Alberta Heritage Foundation for Medical Research ‐ Health Research Fund
Risk of bias
Bias	Authors' judgement	Support for judgement
Random sequence generation (selection bias)	Low risk	Schools were randomly assigned to RAP educational intervention or usual care (control group) via a random numbers table
Allocation concealment (selection bias)	Unclear risk	Selection of schools is unclear
Blinding of participants and personnel (performance bias) All outcomes	Unclear risk	Not addressed by study authors
Blinding of outcome assessment (detection bias) All outcomes	Unclear risk	Not addressed by study authors
Incomplete outcome data (attrition bias) All outcomes	High risk	Over one‐quarter of children dropped out; no reasons were provided
Selective reporting (reporting bias)	High risk	Measures of variance were not presented, hindering extraction of some outcomes
Other bias	Unclear risk	Missingness ‐ unclear risk ‐ no descriptions of missingness were provided Baseline imbalance ‐ low risk ‐ no differences between intervention and control arms are apparent Risk of contamination ‐ low ‐ randomisation at the school level
Transparent and clearly stated aims	Unclear risk	N/A
Explicit theories underpinning and/or literature review	Unclear risk	N/A
Transparent and clearly stated methods and tools	Unclear risk	N/A
Selective reporting	Unclear risk	N/A
Harmful effects	Unclear risk	N/A
Population and sample described well	Unclear risk	N/A
Continuous evaluation	Unclear risk	N/A
Evaluation participation equity and sampling	Unclear risk	N/A
Design and methods overall approach	Unclear risk	N/A
Tools and methods of data collection reliable/credible	Unclear risk	N/A
Tools and methods of data analysis reliable/credible	Unclear risk	N/A
Performance bias/neutrality/credibility/conformability	Unclear risk	N/A
Reliability of findings and recommendations	Unclear risk	N/A
Overall risk of bias of process evaluation	Unclear risk	N/A