Spencer 2000.

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: survey‐based methods with descriptive/bivariate analyses of results
Participants	Setting: the study included 40 schools from 8 school districts throughout New York State, USA Age of children: wide range of ages, with children 6 to 13 years old Child characteristics (BME/SES): 36% of children were receiving free or reduced price lunch Asthma status: asthmatic only Intervention recipients: children and parents
Interventions	School type: primary/elementary Intervention description: Open Airways for Schools (OAS) described by study authors as consisting of "six weekly (40‐minute) hands‐on sessions for the children, one or two sessions for the children's parents, and a graduation ceremony for both parents and children. The children's portion of the program covered such areas as: (I) basic information and feelings about asthma; (ii) recognizing and managing asthma symptoms; (iii) solving problems with medicines and deciding how bad symptoms are; (iv) finding and controlling asthma triggers; (v) getting enough exercise; and (vi) doing well at school. The parents' program briefly covered content similar to the children's sessions. Parents also received letters that familiarized them with the children's classroom content" Control description: N/A Theoretical framework: no information
Outcomes	Core processes evaluated (child level): adherence
Notes	Process evaluation category: integrated Breadth and depth: neither broad nor deep Voice of children given prominence: not featured 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	Unclear risk	Aims of OAS were clearly stated, but aims of the study were not explained
Explicit theories underpinning and/or literature review	High risk	No literature or theoretical framework was provided
Transparent and clearly stated methods and tools	Unclear risk	Not much detail provided on tools for parents and nurses
Selective reporting	High risk	Not everything was reported; instruments were poorly reported
Harmful effects	High risk	No evidence of provision for measuring harmful effects
Population and sample described well	Unclear risk	No information about asthma severity
Continuous evaluation	Low risk	Pre‐post assessment was implemented
Evaluation participation equity and sampling	Unclear risk	How almost half the sample of kids dropped out remains unclear
Design and methods overall approach	High risk	Limited detail on design and methods was provided; problems with internal validity were noted
Tools and methods of data collection reliable/credible	High risk	Not all tools were clearly described
Tools and methods of data analysis reliable/credible	High risk	No indication that clustering was accounted for; not enough information (mean cluster size) was provided to estimate this
Performance bias/neutrality/credibility/conformability	High risk	No attempt at blinding was presented
Reliability of findings and recommendations	High risk	This study was not reported well enough to warrant that findings were reliable
Transferability of findings	High risk	Details about context were lacking, making the findings difficult to transfer
Overall risk of bias of process evaluation	High risk	Issues surround the tools and methods used to collect study data