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Table 3 Description of Intervention Process Evaluation Form for Assessing Dose (or completeness of delivery) 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 elements # of Items Format
Dose for Snack/Welcome Greeted arriving students
Snack served
Ground rules displayed
Staff arrive on time
Staff perform assigned duties
Adult leader gave overview of week (Monday only)
Adult leader gave daily overview
7 Yes/No
Dose of Physical Activity Overview and introduction to entire activity session
PA choices listed everyday
Warm-up at beginning of PA session
Activity introduced
Cool-down
5 Yes/No
Dose of Behavioral Skills/SSP/Group Time Overview of session or activity
Topic/Skill explained
Demonstration of skill
Student involvement (brainstorm, role play, etc)
Summary/closure
5 Yes/No