Mugisha Michael, Oxman Andrew D, Nyirazinyoye Laetitia, Uwitonze Anne Marie, Simbi Clarisse Marie Claudine, Chesire Faith, Ssenyonga Ronald, Oxman Matt, Nsangi Allen, Semakula Daniel, Kaseje Margaret, Sewankambo Nelson K, Rosenbaum Sarah, Lewin Simon
Institute of Health and Society, Faculty of Medicine, University of Oslo, Norway.
School of Public Health, College of Medicine and Health Sciences, University of Rwanda, Kigali, Rwanda.
Glob Health Sci Pract. 2024 Dec 20;12(6). doi: 10.9745/GHSP-D-23-00483.
We evaluated the Informed Health Choices secondary school intervention in a cluster randomized trial in Rwanda. The intervention was effective in helping students to think critically about health. In parallel to the trial, we conducted a process evaluation to assess factors affecting the implementation, impacts, and scale-up of the intervention.
We used a mixed methods approach that included quantitative and qualitative methods. We collected quantitative data from teachers to evaluate the teacher training and each lesson. We conducted focus group discussions with students (n=10) and their parents/guardians (n=5). We conducted lesson observations (n=16) and key informant interviews with teachers (n=10) and school administrators (n=10) from intervention schools and policymakers (n=2). We analyzed the quantitative data using descriptive statistics. We used framework analysis and thematic content analysis to analyze the qualitative data.
Teachers noted that the teacher training supported their delivery of the intervention and that they made only small adaptations to fit student, teacher, or contextual needs. Students reported obtaining important skills, including recognizing health claims, understanding the need for research, and "thinking twice" before deciding. Participants saw the design of the intervention, students' and teachers' motivation, and school and home support as key facilitators for the implementation and impact of the intervention. Implementation barriers identified included the content of the lessons not being included in national examinations, competing priorities, and time constraints. Participants identified several factors that could facilitate intervention scale-up, including the need for the skills taught in the lessons and compatibility of the intervention with the national curriculum.
We found that it was feasible to implement the intervention in Rwandan secondary schools and that students benefited from the intervention. Scaling up the intervention will likely require addressing the barriers identified in this study.
我们在卢旺达的一项整群随机试验中评估了“知情健康选择”中学干预措施。该干预措施在帮助学生批判性地思考健康问题方面是有效的。在进行试验的同时，我们开展了一项过程评估，以评估影响该干预措施实施、影响及推广的因素。
我们采用了混合方法，包括定量和定性方法。我们从教师那里收集定量数据，以评估教师培训和每堂课的情况。我们与学生（n = 10）及其家长/监护人（n = 5）进行了焦点小组讨论。我们对干预学校的教师（n = 10）、学校管理人员（n = 10）和政策制定者（n = 2）进行了课堂观察（n = 16）和关键信息访谈。我们使用描述性统计分析定量数据。我们使用框架分析和主题内容分析来分析定性数据。
教师指出，教师培训有助于他们实施干预措施，并且他们只需进行微小调整就能满足学生、教师或情境的需求。学生报告称获得了重要技能，包括识别健康声明、理解研究的必要性以及在做决定前“三思”。参与者认为干预措施的设计、学生和教师的积极性以及学校和家庭的支持是干预措施实施和产生影响的关键促进因素。确定的实施障碍包括课程内容未纳入国家考试、相互竞争的优先事项和时间限制。参与者确定了几个有助于扩大干预规模的因素，包括对课程中所教授技能的需求以及干预措施与国家课程的兼容性。
我们发现，在卢旺达中学实施该干预措施是可行的，并且学生从该干预措施中受益。扩大干预规模可能需要解决本研究中确定的障碍。
