Delk 2014.

Study characteristics
Methods	Trial name: brief intervention conducted as part of the Central Texas CATCH. The larger scope of the Central Texas CATCH programme (reported by Hoelscher and colleagues 2001 and Springer and colleagues 2012) was excluded as the programme did not report implementation outcomes appropriate for this review. Study design: cluster‐RCT Intervention duration: 2009–2012 Length of follow‐up from baseline: assessment occurred at 2 measurement periods, once in March and April 2011, and again in March and April 2012, during the second and third years of CATCH implementation, respectively. Differences in baseline characteristics: schools were matched in size and composition of student ethnicity and economic disadvantage. Baseline demographic characteristics were reported to be similar between groups. Unit of allocation: schools Unit of analysis: school teachers
Participants	School type: middle school (grades 6–8) Region: Central Texas, USA Demographic/socioeconomic characteristics: multi‐ethnic sample Inclusion criteria ‐ Grades (6–8) Number of services allocated: 30 Numbers by trial group: 30 central‐Texas middle schools were assigned to 1 of 3 conditions: training‐only (Basic), training plus facilitator support (Basic Plus), and training/facilitator support and a social marketing campaign (Basic Plus SM). There were 10 schools in each condition. Recruitment Schools: middle schools were selected to participate in the evaluation of the CATCH Middle School programme Recruitment rate Schools:30/32 = 94%
Interventions	Number of experimental conditions: 3 (3 intervention groups) Policies, practices or programmes targeted by the intervention To promote the adoption of ABs by classroom teachers Implementation strategies Training‐only (Basic) received EPOC: local consensus process and clinical practice guidelines ‐ A CATCH Middle School Abs guide was developed wherein PE and classroom teachers assisted in developing the guide by reviewing ABs from a variety of sources for ease of use and potential to generate PA and reinforce academic content. The guide included 55 ABs. Each school received 10 hard copies of the ABs and an electronic version to upload on the school's shared drive so that all teachers could access them. EPOC: local consensus process and educational meetings ‐ A CATCH Team was developed at each school. The CATCH Team comprised faculty and staff members, parents and community members, with 1 member designated the CATCH Champion. The team was charged with overseeing the implementation of the CATCH programme at their school, which included encouraging teachers to conduct ABs. CATCH programme training's took place to promote the adoption of ABs by classroom teachers. Schools were required to send representatives from their CATCH Team to 8 CATCH training's conducted at regular intervals from September 2009 to January 2012. At these training sessions, CATCH Team members were introduced to the concept of ABs and were provided with research that supports the use of ABs to enhance academic performance. In addition to the aforementioned EPOC strategies the Basic Plus groups also received: EPOC: educational outreach visits and tailored interventions ‐ A CATCH facilitator was assigned and conducted monthly visits at these schools. During these visits they helped CATCH Teams devise strategies to promote ABs on their campus. These strategies included faculty meeting presentations explaining the benefits of ABs and regular teacher‐led demonstrations of ABs to faculty; placement of ABs on the school’s shared drive so teachers could access them easily; periodic e‐mail reminders to teachers; and scheduling of a school‐wide time to conduct ABs. In addition to all the aforementioned implementation strategies, the Basic Plus SM group also received: EPOC: other ‐ Social marketing campaigns to promote PA. Theoretical underpinning: not reported Description of control: there was no control group. All groups received varying amounts of implementation support (strategies).
Outcomes	Outcome relating to the implementation of school policies, practices or programmes Teacher reported frequency of AB implementation including: ‐ Have you conducted ≥ 1 AB this year? ‐ % of teachers that conducted ABs weekly (%, n) ‐ Last week, did you conduct an AB on ≥ 1 day? (%, n) Data collection method: survey. Survey was a 15‐item, self‐administered questionnaire that included items on teacher implementation of ABs, encouragement of specific health behaviours, and other process evaluation measures for the CATCH programme. Validity of measures used: not reported/self‐report methods. Outcome relating to cost: not reported Outcome relating to adverse consequences: not reported Outcome relating to child diet, PA or weight status: not reported
Notes	Research funding: Michael & Susan Dell Foundation. Conflicts of interest: not reported
Risk of bias
Bias	Authors' judgement	Support for judgement
Random sequence generation (selection bias)	Unclear risk	Schools were matched on size and composition of student ethnicity and economic disadvantage and then randomly assigned to 1 of the 3 study conditions – no other information.
Allocation concealment (selection bias)	Unclear risk	No information provided.
Blinding of participants and personnel (performance bias) Implementation outcome	High risk	Little information. Unclear if blinding of key study participants and personnel attempted, but likely that the blinding could have been broken, and the outcome was likely to be influenced by lack of blinding.
Blinding of outcome assessment (detection bias) Implementation outcome	High risk	Blinding of outcome assessment unclear, but likely that the blinding could have been broken, or the outcome measurement was likely to be influenced by lack of blinding. The CATCH Teacher Survey was created to assess the implementation of the CATCH programme, including ABs, by classroom teachers. The survey is a 15‐item, self‐administered questionnaire that included items on teacher implementation of ABs, encouragement of specific health behaviours and other process evaluation measures for the CATCH programme.
Incomplete outcome data (attrition bias) Implementation outcome	High risk	Response rates varied among the conditions (Basic = 56.2%, Basic Plus = 69.7% and Basic Plus SM = 83.2%, in measurement period 1 and Basic = 59.1%, Basic Plus = 48.9% and Basic Plus SM = 75.4% in measurement period 2). All surveys from 1 Basic condition school, 15 surveys in total, were excluded from analysis at both measurement periods due to a low response rate (9%, n = 6) at measurement period 1. Additionally, 54 surveys from measurement period 1 and 58 surveys from measurement period 2 were excluded from analysis because the teacher only taught PE or athletics (or both).
Selective reporting (reporting bias)	Unclear risk	No study protocol, therefore, it was unclear if there was selective outcome reporting.
Other bias	Unclear risk	Unclear if contamination occurred at training session between groups.
Recruitment to cluster	Unclear risk	Insufficient information provided.
Baseline imbalance	Low risk	The demographic characteristics of students and schools across the 3 conditions were similar at baseline.
Loss of cluster	High risk	All surveys from 1 Basic condition school, 15 surveys in total, were excluded from analysis at both measurement periods due to a low response rate (9%, n = 6) at measurement period 1.
Incorrect analysis	High risk	No account of clustering. Significant differences across conditions within each measurement period, and by conditions across measurement periods, were assessed by Chi2 for categorical outcomes and by analysis of variance (ANOVA) with a Scheffe post hoc test for continuous outcomes.
Compatibility with individually randomised RCTs	Unclear risk	Unable to determine if a herd effect existed.
Overall risk of bias assessment	Unclear risk	Most domains were at unclear risk of bias.