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Table 2 Intervention Process Evaluation Form for Assessing Fidelity for the PA and Behavioral Skills/Group Time components

From: Using process evaluation for program improvement in dose, fidelity and reach: the ACT trial experience

Program Component

Essential element categor y and Sample item

# of Items

Format

Physical Activity

1) Clarity of Rules/Expectations Explain rules and daily activities to students

1) 3

Likert Scale: 1-4

 

2) Choices

Students get to vote on physical activity games

2) 3

(1 = none, 2 = some, 3 = most, 4 = all)

 

3) Optimal Challenges

Leaders encourage participation, fairness and de-emphasizes competition

3) 8

 
 

4) Relatedness/Belonging

Leaders create a positive, interactive environment

4) 6

 
 

5) Physical Activity

Students are participating in moderate to vigorous cooperative PA activities

5) 5

 

Behavioral Skills/SSP/Group Time

1) Clarity of Rules/Expectations

Explains rules to students

1) 3

Likert Scale: 1-4

 

2) Optimal Challenges

Leaders encourage participation and individual making progress (based on goals)

2) 7

(1 = none, 2 = some, 3 = most, 4 = all)

 

3) Relatedness/Belonging

Leaders create a positive, interactive environment

3) 7

 
  1. Note: SSP = Strategic Self-Presentation