经过一年的随访，“明智健康选择”中学干预措施对卢旺达学生批判性思考健康选择能力的影响如何？一项整群随机试验。
What is the effect of the Informed Health Choices secondary school intervention on the ability of students in Rwanda to think critically about health choices after one-year follow-up? A cluster-randomized trial.
作者信息
Mugisha Michael, Nyirazinyoye Laetitia, Kayiranga Dieudonne, Simbi Clarisse Marie Claudine, Chesire Faith, Senyonga Ronald, Oxman Matt, Nsangi Allen, Rose Christopher James, Moberg Jenny, Dahlgren Astrid, Kaseje Margaret, Lewin Simon, Sewankambo Nelson K, Rosenbaum Sarah, Oxman Andrew D
机构信息
School of Public Health, College of Medicine and Health Sciences, University of Rwanda, KG 11 Ave Gasabo, Kigali, Rwanda.
Department of Community Medicine and Global Health, Institute of Health and Society, Faculty of Medicine, University of Oslo, Oslo, Norway.
出版信息
Trials. 2025 May 15;26(1):160. doi: 10.1186/s13063-025-08779-w.
AIM
The aim of this study was to evaluate the effects of the Informed Health Choices secondary school intervention on the ability of students in Rwanda to think critically and make informed health choices after 1 year.
METHODS
This was a two-arm cluster-randomized trial conducted in 84 lower secondary schools from 10 districts representing five provinces of Rwanda. We used stratified randomization to allocate schools 1:1 to the intervention or control arm. One class in each intervention school had ten 40-min lessons taught by a trained teacher in addition to the usual curriculum. Control schools followed the usual curriculum. The primary outcome was a passing score (≥ 9 out of 18 questions answered correctly) for students on the Critical Thinking about Health Test completed 1 year after the intervention. We conducted an intention to treat analysis using generalized linear mixed models, accounting for the cluster design using random intercepts.
RESULTS
After 1 year, 35 of 42 teachers (83.3%) and 1181 of 1556 students (75.9%) in the control arm completed the test. In the intervention arm, 35 of 42 teachers (83.3%) and 1238 of 1572 students (78.8%) completed the test. The proportion of students who had a passing score in the intervention arm was 625/1238 (50.5%) compared to 230/1181 (19.5%) in the control arm (adjusted odds ratio 7.6 [95% CI: 4.6-12.6], p < 0.0001). The adjusted difference in the proportion of students with a passing score was 32.2% (95% CI 24.5-39.8%).
CONCLUSIONS
The IHC secondary school intervention was effective after 1 year. However, the size of the effect was smaller than immediately after the intervention (adjusted difference 32.2% vs 37.2%) due to decay in the proportion of students in intervention schools with a passing score (50.5% vs 58.2%).
TRIAL REGISTRATION
Pan African Clinical Trial Registry (PCTR), trial identifier: PACTR202203880375077. Registered on February 15, 2022.
目的
本研究旨在评估“健康明智选择”中学干预措施对卢旺达学生在1年后批判性思考和做出明智健康选择能力的影响。
方法
这是一项双臂整群随机试验，在代表卢旺达五个省的10个地区的84所初中进行。我们采用分层随机化将学校按1:1分配到干预组或对照组。每所干预学校的一个班级除常规课程外，由一名经过培训的教师授课10节，每节40分钟。对照学校遵循常规课程。主要结局是干预1年后学生在《健康批判性思维测试》中获得及格分数（18道题中至少答对9道）。我们使用广义线性混合模型进行意向性分析，并使用随机截距考虑整群设计。
结果
干预1年后，对照组42名教师中的35名（83.3%）和1556名学生中的1181名（75.9%）完成了测试。在干预组，42名教师中的35名（83.3%）和1572名学生中的1238名（78.8%）完成了测试。干预组获得及格分数的学生比例为625/1238（50.5%），而对照组为230/1181（19.5%）（调整后的优势比为7.6 [95%置信区间：4.6 - 12.6]，p < 0.0001）。获得及格分数的学生比例的调整后差异为32.2%（95%置信区间24.5 - 39.8%）。
结论
“健康明智选择”中学干预措施在1年后是有效的。然而，由于干预学校中获得及格分数的学生比例下降（50.5%对58.2%），其效果大小比干预刚结束时小（调整后差异32.2%对37.2%）。
试验注册
泛非临床试验注册中心（PCTR），试验标识符：PACTR202203880375077。于2022年2月15日注册。
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