Ssenyonga Ronald, Lewin Simon, Nakyejwe Esther, Chelagat Faith, Mugisha Michael, Oxman Matt, Nsangi Allen, Semakula Daniel, Rosenbaum Sarah E, Moberg Jenny, Oxman Andrew D, Munthe-Kaas Heather, Holst Christine, Kaseje Margaret, Nyirazinyoye Laetitia, Sewankambo Nelson
Department of Medicine, College of Health Sciences, Makerere University, Kampala, Uganda.
Department of Epidemiology and Biostatistics, School of Public Health, Makerere University, Kampala, Uganda.
Glob Health Sci Pract. 2024 Dec 20;12(6). doi: 10.9745/GHSP-D-23-00484.
We designed the Informed Health Choices (IHC) secondary school intervention and evaluated whether it improves students' ability to assess the trustworthiness of claims about treatment effects in Uganda. We conducted a process evaluation alongside a randomized trial to identify factors that may affect the implementation, fidelity, and scaling up of the intervention in Uganda. We also explored the potential adverse and beneficial effects of the intervention.
We used mixed methods to collect, triangulate, and report data from a variety of sources. We observed at least 1 lesson in all 40 intervention schools. One teacher from each of these schools completed a teacher training evaluation form and lesson evaluation questionnaires after each lesson. We purposively selected 10 schools where we conducted a total of 10 focus group discussions with students and 1 with parents. We also conducted key informant interviews with policymakers (N=9), teachers (N=10), head teachers (N=4), and parents (N=3). We used a framework analysis approach to analyze the data.
All participants in the process evaluation felt that the IHC intervention was needed, important, and timely. Students were motivated to attend class and learn the content because it spoke to their daily life experiences and their own challenges to decide what to do or believe when faced with health claims. The training workshop gave teachers the confidence to teach the lessons. The participating students demonstrated a clear understanding of the content and use of what was learned. The content improved both students' and teachers' appreciation of the critical thinking, communication, and problem-solving competencies in the lower secondary school curriculum.
The findings of this process evaluation are consistent with the findings of the trial, which showed that the intervention improved the students' critical thinking skills. The IHC resources enabled teachers to teach this competency.
我们设计了“明智健康选择”（IHC）中学干预项目，并评估其是否能提高乌干达学生评估有关治疗效果说法的可信度的能力。我们在进行随机试验的同时开展了过程评估，以确定可能影响该干预项目在乌干达实施、保真度和推广的因素。我们还探讨了该干预项目可能产生的不利和有益影响。
我们采用混合方法从多种来源收集、整合和报告数据。我们观察了所有40所干预学校至少1节课。这些学校的每位教师在每节课后都填写了一份教师培训评估表和课程评估问卷。我们有目的地挑选了10所学校，在这些学校与学生总共进行了10次焦点小组讨论，并与家长进行了1次讨论。我们还对政策制定者（N = 9）、教师（N = 10）、校长（N = 4）和家长（N = 3）进行了关键信息访谈。我们使用框架分析方法来分析数据。
过程评估中的所有参与者都认为IHC干预是必要的、重要的且及时的。学生们有动力上课并学习相关内容，因为这与他们的日常生活经历以及在面对健康说法时决定做什么或相信什么所面临的自身挑战相关。培训工作坊让教师有信心教授这些课程。参与的学生对所学内容及其应用有清晰的理解。该内容提高了学生和教师对初中课程中批判性思维、沟通和解决问题能力的认识。
该过程评估的结果与试验结果一致，试验表明该干预提高了学生的批判性思维能力。IHC资源使教师能够教授这一能力。
