Table 3

Description of Intervention Process Evaluation Form for Assessing Dose (or completeness of delivery) for the PA and Behavioral Skills/Group Time components

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


Wilson et al. International Journal of Behavioral Nutrition and Physical Activity 2009 6:79   doi:10.1186/1479-5868-6-79

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