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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