Teaching secondary school students to think critically about health information and choices: cluster-randomized trials in Kenya, Rwanda, and Uganda.
2School of Public Health, College of Medicine and Health Sciences, University of Rwanda, Rwanda
3Department of Medicine, Makerere University, College of Health Sciences, Uganda
4Centre for Epidemic Interventions Research, Norwegian Institute of Public Health, Norway
Background: Many people find it difficult to make decisions about what to believe or do regarding their own and others’ health. To avoid being misled by misinformation and to make good choices, people must be able to understand and apply some basic concepts. The Informed Health Choices (IHC) secondary school resources are designed to help students learn and use nine such concepts.
Objectives: To estimate the effect of using the IHC secondary school resources on students’ ability to think critically about health actions.
Methods: We conducted three cluster-randomized trials in Kenya, Rwanda, and Uganda. Participants were lower secondary school students (age 14-16) and their teachers. Intervention: 2-3-day teacher training workshop, teachers’ guide, and 10 40-minute lessons taught to the students during a single school term. Comparator: the standard curriculum in each country. The primary outcome was a passing score (≥9 of 18 questions correct) on the Critical Thinking about Health (CTH) Test, which assesses an individual’s ability to understand and apply the nine concepts taught in the lessons. We performed random effects meta-analyses of the results of the three trials to estimate overall adjusted odds ratios for passing the test.
Results: Altogether, 244 schools with over 11,000 students took part in the three trials. The overall adjusted odds ratio was 5.5 (95% CI: 3.0 to 10.2; p-value < 0.0001) in favour of the intervention. This corresponds to 33% (95% CI: 25 to 40) more intervention students passing the test. The intervention had a larger relative effect on teachers (overall adjusted odds ratio 13.7; 95% CI: 4.6 to 40.4; p-value < 0.0001) but a similar absolute difference (32%; 95% CI: 6 to 57) because control teachers were more likely to understand the concepts.
Conclusions: The results show that it is possible to teach secondary school students to think critically about health actions. Relevance to public: Teaching young people to think critically about health actions has the potential to protect them from unnecessary suffering, harm, and resource waste. Patient, public, and/or healthcare consumer involvement: Using a human-centred design approach, teachers, students, and curriculum developers were continuously involved in developing the intervention.