Browsing by Author "Mugisha, Michael"

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    Contextualizing critical thinking about health using digital technology in secondary schools in Kenya: a qualitative analysis
    (Pilot and Feasibility Studies, 2022-10-06) Chesire, Faith; Mugisha, Michael; Nsangi, Allen; Sewankambo, Nelson K.; Rosenbaum, Sarah
    Good health decisions depend on one’s ability to think critically about health claims and make informed health choices. Young people can learn these skills through school-based interventions, but learning resources need to be low-cost and built around lessons that can fit into existing curricula. As a first step to developing and evaluating digital learning resources that are feasible to use in Kenyan secondary schools, we conducted a context analysis to explore interest in critical thinking for health, map where critical thinking about health best fits in the curriculum, explore conditions for introducing new learning resources, and describe the information and communication technology (ICT) infrastructure available for teaching and learning.
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    Effects of the Informed Health Choices secondary school intervention on the ability of students in Rwanda to think critically about health choices: A cluster-randomized trial
    (Journal of Evidence‐Based Medicine, 2023-09-21) Mugisha, Michael; Nyirazinyoye, Laetitia; Senyonga, Ronald; Semakula, Daniel; Oxman, Andrew D.
    The aim of this trial was to evaluate the effects of the Informed Health Choices intervention on the ability of students in Rwandan to think critically and make Informed Health Choices. We conducted a two-arm cluster-randomized trial in 84 lower secondary schools from 10 districts representing five provinces of Rwanda. We used stratified randomization to allocate schools to the intervention or control. 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 within 2 weeks after the intervention. We conducted an intention-to-treat analysis using generalized linear mixed models, accounting for the cluster design using random intercepts. Between February 25 and March 29, 2022, we recruited 3,212 participants. We assigned 1,572 students and 42 teachers to the intervention arm and 1,556 students and 42 teachers to the control arm. The proportion of students who passed the test in the intervention arm was 915/1,572 (58.2%) compared to 302/1,556 (19.4%) in the control arm, adjusted odds ratio 10.6 (95% CI: 6.3–17.8), p < 0.0001, adjusted difference 37.2% (95% CI: 29.5%–45.0%). The intervention is effective in helping students think critically about health choices. It was possible to improve students’ ability to think critically about health in the context of a competence-based curriculum in Rwanda, despite challenging postpandemic conditions.
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    Learning to think critically about health using digital technology in Ugandan lower secondary schools: A contextual analysis
    (PLoS One,, 2022-02-02) Ssenyonga, Ronald; Sewankambo, Nelson K.; Mugagga, Solomon Kevin; Mugisha, Michael; Semakula, Daniel; Rosenbaum, Sarah
    The world is awash with claims about the effects of health interventions. Many of these claims are untrustworthy because the bases are unreliable. Acting on unreliable claims can lead to waste of resources and poor health outcomes. Yet, most people lack the necessary skills to appraise the reliability of health claims. The Informed Health Choices (IHC) project aims to equip young people in Ugandan lower secondary schools with skills to think critically about health claims and to make good health choices by developing and evaluating digital learning resources. To ensure that we create resources that are suitable for use in Uganda’s secondary schools and can be scaled up if found effective, we conducted a context analysis. We aimed to better understand opportunities and barriers related to demand for the resources, how the learning content overlaps with existing curriculum and conditions in secondary schools for accessing and using digital resources, in order to inform resource development. We used a mixed methods approach and collected both qualitative and quantitative data. We conducted document analyses, key informant interviews, focus group discussions, school visits, and a telephone survey regarding information communication and technology (ICT). We used a nominal group technique to obtain consensus on the appropriate number and length of IHC lessons that should be planned in a school term. We developed and used a framework from the objectives to code the transcripts and generated summaries of query reports in Atlas.ti version 7. Critical thinking is a key competency in the lower secondary school curriculum. However, the curriculum does not explicitly make provision to teach critical thinking about health, despite a need acknowledged by curriculum developers, teachers and students. Exam oriented teaching and a lack of learning resources are additional important barriers to teaching critical thinking about health. School closures and the subsequent introduction of online learning during the COVID-19 pandemic has accelerated teachers’ use of digital equipment and learning resources for teaching. Although the government is committed to improving access to ICT in schools and teachers are open to using ICT, access to digital equipment, unreliable power and internet connections remain important hinderances to use of digital learning resources. There is a recognized need for learning resources to teach critical thinking about health in Ugandan lower secondary schools. Digital learning resources should be designed to be usable even in schools with limited access and equipment. Teacher training on use of ICT for teaching is needed.
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    Prioritisation of Informed Health Choices (IHC) key concepts to be included in lower secondary school resources: A consensus study
    (PLoS One, 2023-04-07) Agaba, Joseph Jude; Mugisha, Michael; Nsangi, Allen; Oxman, Andrew David
    The Informed Health Choices Key Concepts are principles for thinking critically about healthcare claims and deciding what to do. The Key Concepts provide a framework for designing curricula, learning resources, and evaluation tools.
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    Process Evaluation of Teaching Critical Thinking About Health Using the Informed Health Choices Intervention in Rwanda: A Mixed Methods Study
    (Global Health: Science and Practice, 2024-02-26) Mugisha, Michael; Nyirazinyoye, Laetitia; Ssenyonga, Ronald; Kaseje, Margaret; Lewin, Simon
    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.
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    Process Evaluation of Teaching Critical Thinking About Health Using the Informed Health Choices Intervention in Uganda: A Mixed Methods Study
    (Global Health: Science and Practice, 2024-12-20) Ssenyonga,Ronald; Ssenyonga,Ronald; Chelagat, Faith; Mugisha, Michael; Sewankambo, Nelson
    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 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.
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    Protocol for assessing stakeholder engagement in the development and evaluation of the Informed Health Choices resources teaching secondary school students to think critically about health claims and choices
    (PLoS One, 2020-10-12) Nsangi, Allen; Semakula, Daniel; Ssenyonga, Ronald; Mugisha, Michael; Nyirazinyoye, Leaticia; Sewankambo, Nelson Kaulukusi
    As part of a five year plan (2019–2023), the Informed Health Choices Project, is developing and evaluating resources for helping secondary school students learn to think critically about health claims and choices. We will bring together key stakeholders; such as secondary school teachers and students, our main target for the IHC secondary school resources, school administrators, policy makers, curriculum development specialists and parents, to enable us gain insight about the context.
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    Teaching critical thinking about health information and choices in secondary schools: human-centred design of digital resources
    (F1000Research, 2024-05-11) Rosenbaum, Sarah; Mugisha, Michael; Ssenyonga, Ronald; Ochieng, Marlyn A.; Sewankambo, Nelson; Oxman, Matt
    Learning to thinking critically about health information and choices can protect people from unnecessary suffering, harm, and resource waste. Earlier work revealed that children can learn these skills, but printing costs and curricula compatibility remain important barriers to school implementation. We aimed to develop a set of digital learning resources for students to think critically about health that were suitable for use in Kenyan, Rwandan, and Ugandan secondary schools. We conducted work in two phases collaborating with teachers, students, schools, and national curriculum development offices using a human-centred design approach. First, we conducted context analyses and an overview of teaching strategies, prioritised content and collected examples. Next, we developed lessons and guidance iteratively, informed by data from user-testing, individual and group interviews, and school pilots. Final resources include online lesson plans, teachers’ guide, and extra resources, with lesson plans in two modes, for use in a classroom equipped with a blackboard/flip-chart and a projector. The resources are accessible offline for use when electricity or Internet is lacking. Teachers preferred the projector mode, as it provided structure and a focal point for class attention. Feedback was largely positive, with teachers and students appreciating the learning and experiencing it as relevant. Four main challenges included time to teach lessons; incorrect comprehension; identifying suitable examples; and technical, logistical, and behavioural challenges with a student-computer mode that we piloted. We resolved challenges by simplifying and combining lessons; increasing opportunities for review and assessment; developing teacher training materials, creating a searchable set of examples; and deactivating the student-computer mode. Using a human-centred design approach, we created digital resources for teaching secondary school students to think critically about health actions and for training teachers. Be smart about your health resources are open access and can be translated or adapted to other settings.
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    Teaching critical thinking about health using digital technology in lower secondary schools in Rwanda: A qualitative context analysis
    (PLoS One, 2021-03-22) Mugisha, Michael; Senyonga, Ronald; Nsangi, Allen; Semakula, Daniel; Rosenbaum, Sarah
    Adolescents encounter misleading claims about health interventions that can affect their health. Young people need to develop critical thinking skills to enable them to verify health claims and make informed choices. Schools could teach these important life skills, but educators need access to suitable learning resources that are aligned with their curriculum. The overall objective of this context analysis was to explore conditions for teaching critical thinking about health interventions using digital technology to lower secondary school students in Rwanda. We undertook a qualitative descriptive study using four methods: document review, key informant interviews, focus group discussions, and observations. We reviewed 29 documents related to the national curriculum and ICT conditions in secondary schools. We conducted 8 interviews and 5 focus group discussions with students, teachers, and policy makers. We observed ICT conditions and use in five schools. We analysed the data using a framework analysis approach. Two major themes found. The first was demand for teaching critical thinking about health. The current curriculum explicitly aims to develop critical thinking competences in students. Critical thinking and health topics are taught across subjects. But understanding and teaching of critical thinking varies among teachers, and critical thinking about health is not being taught. The second theme was the current and expected ICT conditions. Most public schools have computers, projectors, and internet connectivity. However, use of ICT in teaching is limited, due in part to low computer to student ratios. There is a need for learning resources to develop critical thinking skills generally and critical thinking about health specifically. Such skills could be taught within the existing curriculum using available ICT technologies. Digital resources for teaching critical thinking about health should be designed so that they can be used flexibly across subjects and easily by teachers and students.
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    Use of the Informed Health Choices digital resources for teaching lower secondary school students in Rwanda to think critically about health: protocol for a process evaluation
    (Zenodo, 2022-07-04) Mugisha, Michael; Nyirazinyoye, Laetitia; Simbi, Clarisse Marie Claudine; Ssenyonga, Ronald; Lewin, Simon
    The Informed Health Choices (IHC) network is a group of researchers aiming to develop the public’s critical thinking skills and help them make informed health choices. We started with young people and developed the primary and secondary school resources for teaching critical thinking about health choices. The “Be Smart about your Health” secondary school resources are designed for lower secondary students and will be evaluated in randomized trials in three countries: Kenya, Rwanda, and Uganda. This protocol is for a process evaluation that will be conducted alongside the trial in Rwanda. The aim is to assess the implementation process, impacts of the intervention, and factors affecting the impacts and scaling up use of the resources.