Pulcini 2007.

Methods	Included as outcome evaluation Study design: clustered parallel‐group design, with schools as the unit of randomisation Setting: middle schools in Massachusetts, USA Period: number of AAPs received was recorded by the school nurse in the fall of 2005 and was reported as a total number in early 2006 at the end of data collection
Participants	Eligible sample frame: not reported Randomised: 40 students from 4 school districts ‐ 20 students in each group Completed (intervention): not reported Inclusion criteria: children were eligible if they had received a diagnosis of asthma with medications ordered at school, had no current asthma action plan on file, were from English‐speaking families, did not have any developmental disorders, and had a regular primary care provider or asthma specialist Exclusion criteria: not reported Baseline characteristics Age of children: not reported, but children in grades 6 to 8 were recruited Ethnicity: not reported Socioeconomic status: not reported Gender: not reported Asthma status: not reported
Interventions	Intervention: each student was given a peak flow meter and was educated on the correct technique for measuring lung function. Peak flow was measured for 2 weeks and scores were recorded. All scores were sent to the physician along with a request for an asthma action plan Control: school nurses in the control group continued to follow their standard procedure of requesting an AAP via the student's parents Intensity: peak flow measured and recorded on a daily basis for 2 weeks Instructor: school nurse Theoretical framework: not reported Parental engagement: not reported Child satisfaction: not reported Timing of intervention in school day: not reported
Outcomes	Extractable outcomes were collected for: None
Notes	AAPs are important but are not a part of the outcomes in this review, so they cannot be extracted Funding source: National Association of School Nurses Research Grant
Risk of bias
Bias	Authors' judgement	Support for judgement
Random sequence generation (selection bias)	High risk	Not specified, and low numbers randomised: each school district participating in the study was required to have at least 2 middle schools, which were randomly assigned to experimental or control groups
Allocation concealment (selection bias)	High risk	Not specified, and low numbers randomised: each school district participating in the study was required to have at least 2 middle schools, which were randomly assigned to experimental or control groups
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	Unclear risk	Not addressed by study authors
Selective reporting (reporting bias)	High risk	Peak flow data were collected but were not published in full
Other bias	Unclear risk	Missingness ‐ unclear risk ‐ not all data were published Baseline imbalance ‐ unclear risk ‐ not addressed in the study Risk of contamination ‐ low ‐ allocation was done on a school basis
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
Transferability of findings	Unclear risk	N/A
Overall risk of bias of process evaluation	Unclear risk	N/A