Browsing by Author "Oxman, Andrew D."

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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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    Evidence summaries tailored to health policy-makers in low- and middle-income countries
    (Bulletin of the World Health Organization, 2011) Rosenbaum, Sarah E.; Glenton, Claire; Wiysonge, Charles Shey; Abalos, Edgardo; Mignini, Luciano; Young, Taryn; Althabe, Fernando; Ciapponi, Agustín; Garcia Marti, Sebastian; Meng, Qingyue; Wang, Jian; Bradford, Ana Maria De la Hoz; Kiwanuka, Suzanne N.; Rutebemberwa, Elizeus; Pariyo, George W.; Flottorp, Signe; Oxman, Andrew D.
    To describe how the SUPPORT collaboration developed a short summary format for presenting the results of systematic reviews to policy-makers in low- and middle-income countries (LMICs). Methods We carried out 21 user tests in six countries to explore users’ experiences with the summary format. We modified the summaries based on the results and checked our conclusions through 13 follow-up interviews. To solve the problems uncovered by the user testing, we also obtained advisory group feedback and conducted working group workshops. Findings Policy-makers liked a graded entry format (i.e. short summary with key messages up front). They particularly valued the section on the relevance of the summaries for LMICs, which compensated for the lack of locally-relevant detail in the original review. Some struggled to understand the text and numbers. Three issues made redesigning the summaries particularly challenging: (i) participants had a poor understanding of what a systematic review was; (ii) they expected information not found in the systematic reviews and (iii) they wanted shorter, clearer summaries. Solutions included adding information to help understand the nature of a systematic review, adding more references and making the content clearer and the document quicker to scan. Conclusion Presenting evidence from systematic reviews to policy-makers in LMICs in the form of short summaries can render the information easier to assimilate and more useful, but summaries must be clear and easy to read or scan quickly. They should also explain the nature of the information provided by systematic reviews and its relevance for policy decisions.
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    Key Concepts for Informed Health Choices: a framework for helping people learn how to assess treatment claims and make informed choices
    (BMJ Evid Based Med, 2018-01-30) Chalmers, Iain; Oxman, Andrew D.; Sewankambo, Nelson; Semakula, Daniel; Nsangi, Allen; Heneghan, Carl; Douglas, Badenoch
    Many claims about the effects of treatments, though well intentioned, are wrong. Indeed, they are sometimes deliberately misleading to serve interests other than the well-being of patients and the public. People need to know how to spot unreliable treatment claims so that they can protect themselves and others from harm. The ability to assess the trustworthiness of treatment claims is often lacking. Acquiring this ability depends on being familiar with, and correctly applying, some key concepts, for example, that’ association is not the same as causation.’ The Informed Health Choices (IHC) Project has identified 36 such concepts and shown that people can be taught to use them in decision making. A randomised trial in Uganda, for example, showed that primary school children with poor reading skills could be taught to apply 12 of the IHC Key Concepts. The list of IHC Key Concepts has proven to be effective in providing a framework for developing and evaluating IHC resources to help children to think critically about treatment claims. The list also provides a framework for retrieving, coding and organising other teaching and learning materials for learners of any age. It should help teachers, researchers, clinicians, and patients to structure critical thinking about the trustworthiness of claims about treatment effects.
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    Measuring ability to assess claims about treatment effects: a latent trait analysis of items from the ‘Claim Evaluation Tools’ database using Rasch modelling
    (BMJ open, 2017-05-17) Austvoll-Dahlgren, Astrid; Nsangi, Allen; Semakula, Daniel; Oxman, Andrew D.
    The Claim Evaluation Tools database contains multiple-choice items for measuring people’s ability to apply the key concepts they need to know to be able to assess treatment claims. We assessed items from the database using Rasch analysis to develop an outcome measure to be used in two randomised trials in Uganda. Rasch analysis is a form of psychometric testing relying on Item Response Theory. It is a dynamic way of developing outcome measures that are valid and reliable. To assess the validity, reliability and responsiveness of 88 items addressing 22 key concepts using Rasch analysis. We administrated four sets of multiple-choice items in English to 1114 people in Uganda and Norway, of which 685 were children and 429 were adults (including 171 health professionals). We scored all items dichotomously. We explored summary and individual fit statistics using the RUMM2030 analysis package. We used SPSS to perform distractor analysis. Most items conformed well to the Rasch model, but some items needed revision. Overall, the four item sets had satisfactory reliability. We did not identify significant response dependence between any pairs of items and, overall, the magnitude of multidimensionality in the data was acceptable. The items had a high level of difficulty. Most of the items conformed well to the Rasch model’s expectations. Following revision of some items, we concluded that most of the items were suitable for use in an outcome measure for evaluating the ability of children or adults to assess treatment claims.
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    Priority setting for resources to improve the understanding of information about claims of treatment effects in the mass media
    (Journal of Evidence-Based Medicine, 2015-05-08) Semakula, Daniel; Nsangi, Allen; Oxman, Andrew D.; Sewankambo, Nelson K.
    Claims about benefits and harms of treatments are common in the media. We engaged health journalists in prioritizing concepts of evidence-based medicine that we believe the public needs to understand to be able to assess claims about treatment effects; and which could improve how journalists report such information. We conducted a three-day workshop with a group of Ugandan journalists in which we presented and explained the concepts. We asked journalists to prioritize groups of related concepts using four pre-specified criteria i.e. relevance of the concepts to journalists and their audiences; ease of comprehension; feasibility of developing resources for teaching the concepts and, whether such resources would potentially have an impact. Using a modified Delphi technique, participants ranked each group of concepts using these criteria on a scale of one to six (one = lowest; 6 = highest). We analyzed the rankings in real time using STATA statistical software. All six groups of concepts were considered relevant and comprehensible with scores of five and six on a scale of one to six. Twenty two out of 25 participants reported having understood the concepts well, with subjective scores of above 75 on a scale of one to 100. Journalists in Uganda recognize the importance of evidence-based medicine concepts in assessing claims about benefits and harms of treatments to them and their audiences. They should be empowered to use these and similar concepts in order to improve how information about effects of treatments is relayed in the media.
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    Teaching children in low-income countries to assess claims about treatment effects: prioritization of key concepts
    (Journal of evidence-based medicine, 2015-09-10) Nsangi, Allen; Semakula, Daniel; Oxman, Andrew D.; Sewankambo, Nelson K.
    Health-related knowledge and behaviours developed during childhood are increasingly being recognized as foundational, deeply rooted and resistant to change as children mature into adulthood. The aim of this study was to engage stakeholders in prioritizing key concepts that children need to understand when assessing claims about treatment effects.
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    The effects of teaching strategies on learning to think critically in primary and secondary schools: an overview of systematic reviews
    (F1000Research, 2024-11-26) Oxman, Andrew D.; Nsangi , Allen; Kaseje , Margaret; Semakula, Daniel; Munthe-Kaas, Heather; Rosenbaum, Sarah E.
    We conducted an overview of systematic reviews about the effects of teaching strategies that can be used to teach primary and secondary school students to think critically. Our objective was to inform decisions about what teaching strategies to use in resources that we developed to teach critical thinking about health in secondary schools. We mapped characteristics of systematic reviews of teaching strategies and summarised findings from the most relevant reviews to teaching students to think critically about health. We included reviews that assessed the effects of teaching strategies that could potentially be used in primary or secondary schools to teach students to think critically, had a Methods section with explicit selection criteria, reported at least one outcome measure of the ability to undertake one of four basic types of cognitive tasks (memory, procedural, comprehension, or opinion), and were published after 1999. We included 326 systematic reviews. The reviews evaluated a wide range of teaching strategies for a variety of purposes. Important limitations of the reviews included not considering adverse effects (99% of the reviews), not assessing the risk of bias for included studies (93% of the reviews), and not assessing the credibility of subgroup effects (100% of the reviews). We summarised the findings for 37 teaching strategies that we considered most relevant. The certainty of the evidence of the effects varied from very low to moderate. We used 12 of the strategies in resources that we developed to teach secondary students to think critically about health. A tremendous amount of work has gone into evaluating the effects of a wide range of teaching strategies. The results of this research can inform decisions about how to teach critical thinking and future research. However, well-designed, up-to-date systematic reviews are still needed for many teaching strategies.