Browsing by Author "Kaseje, Margaret"

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    One-year follow-up effects of the informed health choices secondary school intervention on students’ ability to think critically about health in Uganda: a cluster randomized trial
    (Springer Nature, 2025-02-26) Ssenyonga, Ronald; Oxman, Andrew D.; Nakyejwe, Esther; Chesire, Faith; Mugisha, Michael; Nsangi, Allen; Oxman, Matt; Rose, Christopher James; Rosenbaum, Sarah E.; Moberg, Jenny; Kaseje, Margaret; Nyirazinyoye, Laetitia; Dahlgren, Astrid; Lewin, Simon; Sewankambo, Nelson K.
    Introduction We assessed the effects of the Informed Health Choices (IHC) secondary school intervention on students’ ability to think critically about choices 1 year after the intervention. Methods We randomized eighty secondary schools to the intervention or control (usual curriculum). The schools were randomly selected from the central region of Uganda and included rural and urban, government, and privately-owned schools. One randomly selected class of year-2 students (ages 14–17) from each school participated in the trial. The intervention included a 2-day teacher training workshop, 10 lessons accessed online by teachers and delivered in classrooms during one school term (May–August 2022). The lessons addressed nine prioritized IHC concepts. We used two multiple-choice questions for each concept to evaluate the students’ ability to think critically about choices at both the end of the school term and again after 1 year. The primary outcome was the proportion of students with a passing score (≥ 9 of 18 questions answered correctly) on the “Critical Thinking about Health” (CTH) test. Results After 1-year, 71% (1749/2477) of the students in the intervention schools and 71% (1684/2376) of the students in the control schools completed the CTH test. In the intervention schools, 53% (934/1749) of students who completed the test had a passing score compared to 33% (557/1684) of students in the control schools (adjusted difference 22%, 95% CI 16–28). Conclusions The effect of the IHC secondary school intervention on students’ ability to assess health-related claims was largely sustained for at least 1 year. Trial registration Pan African Clinical Trial Registry PACTR202204861458660. Registered on 4 April 2022.
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    One‑year follow‑up effects of the informed health choices secondary school intervention on students’ ability to think critically about health in Uganda: a cluster randomized trial
    (Springer Nature, 2025-02-26) Ssenyonga, Ronald; Oxman, Andrew D.; Nakyejwe, Esther; Chesire, Faith; Mugisha, Michael; Nsangi, Allen; Oxman, Matt; Rose, Christopher James; Rosenbaum, Sarah E.; Moberg, Jenny; Kaseje, Margaret; Nyirazinyoye, Laetitia; Dahlgren, Astrid; Lewin, Simon; Sewankambo, Nelson K.
    Introduction: We assessed the effects of the Informed Health Choices (IHC) secondary school intervention on students’ ability to think critically about choices 1 year after the intervention. Methods: We randomized eighty secondary schools to the intervention or control (usual curriculum). The schools were randomly selected from the central region of Uganda and included rural and urban, government, and privately-owned schools. One randomly selected class of year-2 students (ages 14–17) from each school participated in the trial. The intervention included a 2-day teacher training workshop, 10 lessons accessed online by teachers and delivered in classrooms during one school term (May–August 2022). The lessons addressed nine prioritized IHC concepts. We used two multiple-choice questions for each concept to evaluate the students’ ability to think critically about choices at both the end of the school term and again after 1 year. The primary outcome was the proportion of students with a passing score (≥ 9 of 18 questions answered correctly) on the “Critical Thinking about Health” (CTH) test. Results: After 1-year, 71% (1749/2477) of the students in the intervention schools and 71% (1684/2376) of the students in the control schools completed the CTH test. In the intervention schools, 53% (934/1749) of students who completed the test had a passing score compared to 33% (557/1684) of students in the control schools (adjusted difference 22%, 95% CI 16–28). Conclusions: The effect of the IHC secondary school intervention on students’ ability to assess health-related claims was largely sustained for at least 1 year. Trial registration: Pan African Clinical Trial Registry PACTR202204861458660. Registered on 4 April 2022.
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    Participants’ experiences of potential adverse effects of an intervention to improve critical thinking about health choices: a qualitative cross-trial process evaluation in Kenya, Rwanda and Uganda
    (BMJ Publishing Group, 2025-09-29) Oxman, Matt; Chesire, Faith; Mugisha, Michael; Ssenyonga, Ronald; Nsangi, Allen; Oxman, Andrew D; Fretheim, Atle; Rosenbaum, Sarah; Kaseje, Margaret; Sewankambo, Nelson; Melby-Lervåg, Monica; Lewin, Simon
    Objectives: To explore participants’ experiences of potential adverse effects of the Informed Health Choices secondary school intervention across three trial sites and to revise a framework of potential adverse effects of interventions to improve critical thinking about health choices. Design: This was a qualitative study. We extracted and analysed relevant data from separate process evaluations in each country. Data came from surveying teachers, observing lessons and group and individual interviews with students, teachers and other stakeholders. We modified and applied framework analysis, including five stages: (1) development of an initial framework of potential adverse effects, (2) familiarisation with the data, (3) indexing, (4) abstraction and synthesis and (5) revising the framework. We applied reflexive strategies individually and as a team. Setting: Lower secondary school in five randomly sampled subcounties of Kisumu County in Kenya, districts representing all five provinces in Rwanda, and six districts in the central region of Uganda, between 2022 and 2024. Participants: Students and teachers in the intervention arms of the trials, parents of students in the intervention arms and administrators at intervention schools, as well as curriculum developers and policy-makers. Intervention: The intervention involved providing teachers with a 2–3-day training workshop, and digital classroom resources, including lesson plans for 10 lessons to be delivered over the course of one semester. Results: We generated findings about potential increases in adverse misunderstandings, anxiety related to transfer of learning, adversely experienced cognitive dissonance, work or schoolwork-related stress, inequity, conflicts and waste. The revised framework includes the same categories of potential adverse effects as our initial framework: decision-making harms, psychological harms, equity harms, group and social harms, waste and other harms. We revised other elements of the framework, including definitions of the categories and its structure. Conclusions: This study provides insight into the potential adverse effects of interventions to improve critical thinking about health choices. The findings complement those of the trials and country-level process evaluations.