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

Faith Chesire; Andrew D. Oxman; Margaret Kaseje; Violet Gisore; Michael Mugisha; Ronald Ssenyonga; Matt Oxman; Allen Nsangi; Daniel Semakula; Laetitia Nyirazinyoye; Nelson K. Sewankambo; Heather Munthe-Kaas; Christine Holst; Sarah Rosenbaum; Simon Lewin

doi:10.9745/GHSP-D-23-00485

Key Findings

The Informed Health Choices secondary school intervention was largely implemented as planned, but extended time for teaching and the use of Swahili were needed.
Factors that facilitated the effective implementation included teacher training; perceived value of the intervention by students, teachers, and policymakers; and support from education officials, school managers, and administration. Time constraints, heavy workloads, and the lessons not being included in the curriculum are factors that may have adversely affected implementation of the intervention.
Both teachers and students were able to recognize claims about the effects of health actions, assess them, and make informed choices about what to believe and do.

Key Implication

Scale-up of the intervention in Kenya is feasible but may depend on adjusting the time allocated to teaching the lessons, revision of the 2 lessons that teachers and students found difficult, teaching the difficult lessons toward the end of the secondary school education, and including lesson objectives in the national curriculum and teacher training.

ABSTRACT

Introduction:

We evaluated the Informed Health Choices secondary school intervention to help students in Kenya think critically about health choices. We conducted this process evaluation to explore if the intervention was implemented as planned, identify factors that facilitated or hindered implementation, potential benefits of the intervention, and how to scale up the intervention beyond the trial.

Methods:

This was a mixed methods process evaluation nested in a cluster-randomized trial of the Informed Health Choices intervention. We analyzed quantitative data from teacher training evaluation forms completed by 39 teachers, 10 lesson evaluation forms completed by 40 teachers allocated to the intervention, and 72 structured classroom observation forms. We conducted a framework analysis of qualitative data from 14 group interviews (with 96 students, 23 teachers, and 18 parents) and 22 individual interviews (with 8 teachers, 5 school principals, 6 curriculum developers, and 3 policymakers). We assessed confidence in our findings from the qualitative analysis using a modified version of Confidence in the Evidence from Reviews of Qualitative Research.

Results:

Lesson objectives were achieved with minimal adaptations. Factors that might have facilitated the implementation of the intervention include teacher training; perceived value of the intervention by students, teachers, and policymakers; and support from school administration. Time constraints, teachers’ heavy workloads, and the lessons not being included in the curriculum or national examination are factors that might have impeded implementation. Both students and teachers demonstrated the ability to apply key concepts that were taught to health choices and other choices. However, they experienced difficulties with 2 of the lessons.

Conclusion:

Scale-up of this intervention in Kenyan schools is feasible but may depend on adjusting the time allocated to teaching the lessons, modifying the 2 lessons that teachers and students found difficult, and including the lesson objectives and assessment in the national curriculum.

Received: November 17, 2023.
Accepted: November 5, 2024.
Published: December 20, 2024.

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