Informed health choices intervention to teach primary school children in low-income countries to assess claims about treatment effects: process evaluation

Abstract

BackgroundWe developed the informed health choices (IHC) primary school resources to teach children how to assess the trustworthiness of claims about the effects of treatments. We evaluated these resources in a randomised trial in Uganda. This paper describes the process evaluation that we conducted alongside this trial.ObjectivesTo identify factors affecting the implementation, impact and scaling up of the intervention; and potential adverse and beneficial effects of the intervention.MethodsAll 85 teachers in the 60 schools in the intervention arm of the trial completed a questionnaire after each lesson and at the end of the term. We conducted structured classroom observations at all 60 schools. For interviews and focus groups, we purposively selected six schools. We interviewed district education officers, teachers, head teachers, children and their parents. We used a framework analysis approach to analyse the data.ResultsMost of the participants liked the IHC resources and felt that the content was important. This motivated the teachers and contributed to positive attitudes. Although some teachers started out lacking confidence, many found that the children’s enthusiasm for the lessons made them more confident. Nearly everyone interviewed thought that the children learnt something important and many thought that it improved their decision-making. The main barrier to scaling up use of the IHC resources that participants identified was the need to incorporate the lessons into the national curriculum.ConclusionThe mostly positive findings reflect the trial results, which showed large effects on the children’s and the teachers’ critical appraisal skills. The main limitations of this evaluation are that the investigators were responsible for both developing and evaluating the intervention.

Development of the informed health choices resources in four countries to teach primary school children to assess claims about treatment effects: a qualitative study employing a user-centred approach

“…Researchers in Norway, the United Kingdom, Uganda, Kenya, and Rwanda collaborated to develop and evaluate learning resources for school children and their parents in 2013 to 2017. This included development of a podcast for parents [14]; development of the CLAIM Evaluation Tool for measuring people's ability to assess treatment claims [15]; a randomised trial of the effects of using the (IHC) primary school resources [16]; a randomised trial of the effects of listening to the podcast [17]; and a process evaluation [18].…”

Effects of the Informed Health Choices primary school intervention on the ability of children in Uganda to assess the reliability of claims about treatment effects, 1-year follow-up: a cluster-randomised trial

“…The contents of the book and the teachers' guide are shown in Table 2. While most teachers considered the IHC content to be new, many found the design of the IHC lessons to be compatible with their teaching styles, particularly the use of multiple examples in the teachers' guide [13]. We did not intervene in the control schools.…”

Effects of the Informed Health Choices primary school intervention on the ability of children in Uganda to assess the reliability of claims about treatment effects, one-year follow-up: a cluster-randomised trial

“…While most teachers considered the IHC content to be new, many found the design of the IHC lessons to be compatible with their teaching styles particularly the use of multiple examples in the teachers' guide 13 . We did not intervene in the control schools.…”

“…These comparisons were originally planned as part of the process evaluation. 13 We asked participating schools to provide us with school attendance records and summary score sheets containing all pupils' end of intervention term examination scores. The summary score sheet (Table 2) contains percentage scores for each end of intervention term examination and a total score across subjects (Supplementary file 2-additional table 2).…”

“…Teachers in the intervention arm of the trial were given instructions for recording adverse events and problems in journals that they were asked to keep. 13…”