Process Evaluation of Teaching Critical Thinking About Health Using the Informed Health Choices Intervention in Uganda: A Mixed Methods Study

Ronald Ssenyonga; Simon Lewin; Esther Nakyejwe; Faith Chelagat; Michael Mugisha; Matt Oxman; Allen Nsangi; Daniel Semakula; Sarah E. Rosenbaum; Jenny Moberg; Andrew D. Oxman; Heather Munthe-Kaas; Christine Holst; Margaret Kaseje; Laetitia Nyirazinyoye; Nelson Sewankambo

doi:10.9745/GHSP-D-23-00484

Key Findings

Students, teachers, head teachers, and policymakers valued the lessons and recognized their importance in helping people cope with an overload of health information and in making informed health choices. Both students and teachers could relate to the health issues that the lessons addressed.
Finding time to teach the lessons impeded their delivery. It may also affect scaling up the intervention. Factors, such as a busy school term that included sports, drama, and patriotic clubs, meant moving lessons around. This often led to teaching 2 lessons in 1 week rather than once a week as planned.
The lessons were not in the curriculum and were not nationally examined. This may have affected teachers’ preparation for lessons, students’ attendance, and head teachers’ prioritization of the lessons.

Key Implications

All participating stakeholders recognized the need to be able to assess the reliability of health claims and make informed choices and appreciated the intervention. This may improve the chances of scaling up the intervention.
However, scaling up the intervention may require incorporating the Information Health Choices lessons in the curriculum and national examinations.

ABSTRACT

Introduction:

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.

Methods:

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.

Findings:

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.

Conclusion:

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.

Received: November 16, 2023.
Accepted: November 5, 2024.
Published: December 20, 2024.

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