Effects of the Informed Health Choices secondary school intervention: A prospective meta-analysis.

AIM: The aim of this prospective meta-analysis was to synthesize the results of three cluster-randomized trials of an intervention designed to teach lower-secondary school students (age 14-16) to think critically about health choices. METHODS: We conducted the trials in Kenya, Rwanda, and Uganda. The intervention included a 2- to 3-day teacher training workshop, digital resources, and ten 40-min lessons. The lessons focused on nine key concepts. We did not intervene in control schools. The primary outcome was a passing score on a test (≥9 of 18 multiple-choice questions answered correctly). We performed random effects meta-analyses to estimate the overall adjusted odds ratios. Secondary outcomes included effects of the intervention on teachers. RESULTS: Altogether, 244 schools (11,344 students) took part in the three trials. The overall adjusted odds ratio was 5.5 (95% CI: 3.0-10.2; p < 0.0001) in favor of the intervention (high certainty evidence). This corresponds to 33% (95% CI: 25-40%) more students in the intervention schools passing the test. Overall, 3397 (58%) of 5846 students in intervention schools had a passing score. The overall adjusted odds ratio for teachers was 13.7(95% CI: 4.6-40.4; p < 0.0001), corresponding to 32% (95% CI: 6%-57%) more teachers in the intervention schools passing the test (moderate certainty evidence). Overall, 118 (97%) of 122 teachers in intervention schools had a passing score. CONCLUSIONS: The intervention led to a large improvement in the ability of students and teachers to think critically about health choices, but 42% of students in the intervention schools did not achieve a passing score.

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.

AIM: 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. METHODS: 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. RESULTS: 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%). CONCLUSIONS: 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.

Effects of the informed health choices secondary school intervention on the ability of students in Kenya to think critically about health choices: A cluster-randomized trial.

AIM: There is an overabundance of claims about the advantages and disadvantages of health interventions. People need to be able to appraise the reliability of these claims. The aim of this two-arm cluster-randomized trial was to evaluate the Informed Health Choices secondary school intervention designed to teach students to assess claims about the effects of health actions and make informed decisions. METHODS: We conducted the trial among students from 80 secondary schools in five subcounties in Kenya. We used stratified randomization to allocate schools to the intervention or control arm. The intervention included a 2-day teacher training workshop and 10 lessons that addressed nine prioritized key concepts for assessing claims about treatment effects. We did not intervene in the control schools. The primary outcome was the proportion of students with a passing score (≥ 9/18 correct answers) on the Critical Thinking about Health test, which included two multiple-choice questions for each concept. RESULTS: Between May 11, 2022, and July 8, 2022, we recruited 3362 students and 80 teachers. We allocated 1863 students and 40 teachers to the intervention and 1499 students and 40 teachers to the control arm. In the intervention schools, 1149/1863 (61.7%) of students achieved a passing score compared to 511/1499 (34.1%) in the control schools (odds ratio 3.6 (95% CI 2.5-5.2), p < 0.0001). CONCLUSIONS: The intervention had a large effect on students' ability to think critically about health interventions. It is possible to integrate the learning of critical thinking about health within Kenya secondary school curriculum.

Use of the informed health choices educational intervention to improve secondary students' ability to think critically about health interventions in Uganda: A cluster-randomized trial.

AIM: The aim was to evaluate the effect of the Informed Health Choices (IHC) educational intervention on secondary students' ability to assess health-related claims and make informed choices. METHODS: In a cluster-randomized trial, we randomized 80 secondary schools (students aged 13-17 years) in Uganda to the intervention or control (usual curriculum). The intervention included a 2-day teacher training workshop, 10 lessons accessed online by teachers and delivered in one school term. The lesson plans were developed for classrooms equipped with a blackboard or a blackboard and projector. The lessons addressed nine prioritized concepts. We used two multiple-choice questions for each concept to evaluate the students' ability to assess claims and make informed choices. The primary outcome was the proportion of students with a passing score (≥9 of 18 questions answered correctly). RESULTS: Eighty schools consented and were randomly allocated. A total of 2477 students in the 40 intervention schools and 2376 students in the 40 control schools participated in this trial. In the intervention schools, 1364 (55%) of students that completed the test had a passing score compared with 586 (25%) of students in the control schools (adjusted difference 33%, 95% CI 26%-39%). CONCLUSIONS: The IHC secondary school intervention improved students' ability to think critically and make informed choices. Well-designed digital resources may improve access to educational material, even in schools without computers or other information and communication technology (ICT). This could facilitate scaling-up use of the resources and help to address inequities associated with limited ICT access.

What should the standard be for passing and mastery on the Critical Thinking about Health Test? A consensus study.

OBJECTIVE: Most health literacy measures rely on subjective self-assessment. The Critical Thinking about Health Test is an objective measure that includes two multiple-choice questions (MCQs) for each of the nine Informed Health Choices Key Concepts included in the educational resources for secondary schools. The objective of this study was to determine cut-off scores for passing (the border between having and not having a basic understanding and the ability to apply the nine concepts) and mastery (the border between having mastered and not having mastered them). DESIGN: Using a combination of two widely used methods: Angoff's and Nedelsky's, a panel judged the likelihood that an individual on the border of passing and another on the border of having mastered the concepts would answer each MCQ correctly. The cut-off scores were determined by summing up the probability of answering each MCQ correctly. Their independent assessments were summarised and discussed. A nominal group technique was used to reach a consensus. SETTING: The study was conducted in secondary schools in East Africa. PARTICIPANTS: The panel included eight individuals with 5 or more years' experience in the following areas: evaluation of critical thinking interventions, curriculum development, teaching of lower secondary school and evidence-informed decision-making. RESULTS: The panel agreed that for a passing score, students had to answer 9 of the 18 questions and for a mastery score, 14 out of 18 questions correctly. CONCLUSION: There was wide variation in the judgements made by individual panel members for many of the questions, but they quickly reached a consensus on the cut-off scores after discussions.

Key concepts for informed health choices: Where's the evidence?

Background: The Informed Health Choices (IHC) Key Concepts is a framework that provides a basis for developing educational resources and evaluating people's ability to think critically about health actions. We developed the original Key Concepts framework by reviewing texts and checklists for the public, journalists, and health professionals and collecting structured feedback from an international advisory group. We revised the original 2015 framework yearly from 2016 to 2018 based on feedback and experience using the framework. The objectives of this paper are to describe the development of the framework since 2018 and summarise their basis. Methods: For the 2019 version, we responded to feedback on the 2018 version. For the current 2022 version, in addition to responding to feedback on the 2019 version, we reviewed the evidence base for each of the concepts. Whenever possible, we referenced systematic reviews that provide a basis for a concept. We screened all Cochrane methodology reviews and searched Epistemonikos, PubMed, and Google Scholar for methodology reviews and meta-epidemiological studies. Results: The original framework included 32 concepts in six groups. The 2019 version and the current 2022 version include 49 concepts in the same three main groups that we have used since 2016. There are now 10 subgroups or higher-level concepts. For each concept, there is an explanation including one or more examples, the basis for the concept, and implications. Over 600 references are cited that support the concepts, and over half of the references are systematic reviews. Conclusions: There is a large body of evidence that supports the IHC key concepts and we have received few suggestions for changes since 2019.

Research in child and adolescent anxiety and depression: treatment uncertainties prioritised by youth and professionals.

Background: A starting point for evaluating the effectiveness of treatments should be to identify evidence gaps. Furthermore, such evaluations should consider the perspectives of patients, clinicians and carers to ensure relevance and potentially influence future research initiatives. Methods: Our approach, inspired by the James Lind Alliance methods, involved three steps. First, we performed a document analysis by identifying interventions and outcomes in two recently published overviews of systematic reviews, which summarised the effects of interventions for anxiety and depression in children and adolescents. Second, we surveyed children and adolescents with personal experiences of depression or anxiety as well as clinicians, and asked them to suggest treatments and outcomes associated with uncertainty. Finally, we facilitated a consensus process where clinicians and youth mental health patient representatives were invited to prioritise research uncertainties in separate consensus processes. Results: The survey included 674 respondents who reported a total of 1267 uncertainties. Independent coding by four investigators revealed 134 suggestions for treatments of anxiety, 90 suggestions for treatments of depression, 84 for outcomes of interventions for anxiety and 71 suggestions for outcomes of interventions for depression. Two separate priority setting workshops with eight clinicians and ten youth resulted in four independent top ten priority lists. Conclusion: Top ten lists of treatments and outcome domains of anxiety and depression in children and adolescents was identified by youth and clinicians. The results may influence the research agenda, and ultimately benefit patients.

Unwanted effects of treatments for depression in children and adolescents: a mapping of systematic reviews.

OBJECTIVES: To describe the results of a mapping review exploring the coverage of unwanted treatment effects in systematic reviews of the effects of various treatments for moderate to severe depression in children and adolescents. SETTING: Any context or service providing treatment for depression, including interventions delivered in local communities and school settings, as well as services provided in primary or specialist care. PARTICIPANTS: Children and young people with moderate to severe depression (<18 years). INTERVENTIONS: Systematic reviews published in 2011 or later comparing the effects of any treatment for children and adolescents with moderate to severe depression meeting the Database of Abstracts of Reviews of Effects criteria. The systematic search was performed in April 2018 and updated in December 2018. PRIMARY OUTCOMES: Any unwanted effects of treatments as defined in the systematic review. RESULTS: We included 10 systematic reviews covering 19 treatment comparisons. Unwanted effects were assessed for seven of 19. Three comparisons were evaluations of pharmaceutical interventions or combination therapy, reporting effects on 'suicidal ideation' and 'suicide risk'. Two included therapy, reporting 'self-harm', and 'suicidal ideation', and two comparisons included transcranial magnetic stimulation and electroconvulsive treatment. Unwanted effects evaluated for these treatments were mostly symptoms of physical discomfort such as headache or cramps. For the remaining treatment comparisons evaluating psychological and psychosocial therapies, unwanted effects were not evaluated or found. A limitation of overviews of systematic reviews such as this mapping study is that data extraction is done based on the reporting of results by the review authors and not on the primary studies. CONCLUSION: The unwanted effects of widely used treatments for children and young people with depression is unknown. This is a major barrier for evidence informed decision making about treatment choices for children and young people. We suggest that unwanted effects should be a reporting standard in all protocols describing evaluations of treatments, including primary studies as well as systematic reviews.

Development of the informed health choices resources in four countries to teach primary school children to assess claims about treatment effects: a qualitative study employing a user-centred approach.

BACKGROUND: People of all ages are flooded with health claims about treatment effects (benefits and harms of treatments). Many of these are not reliable, and many people lack skills to assess their reliability. Primary school is the ideal time to begin to teach these skills, to lay a foundation for continued learning and enable children to make well-informed health choices, as they grow older. However, these skills are rarely being taught and yet there are no rigorously developed and evaluated resources for teaching these skills. OBJECTIVES: To develop the Informed Health Choices (IHC) resources (for learning and teaching people to assess claims about the effects of treatments) for primary school children and teachers. METHODS: We prototyped, piloted, and user-tested resources in four settings that included Uganda, Kenya, Rwanda, and Norway. We employed a user-centred approach to designing IHC resources which entailed multiple iterative cycles of development (determining content scope, generating ideas, prototyping, testing, analysing and refining) based on continuous close collaboration with teachers and children. RESULTS: We identified 24 Key Concepts that are important for children to learn. We developed a comic book and a separate exercise book to introduce and explain the Key Concepts to the children, combining lessons with exercises and classroom activities. We developed a teachers' guide to supplement the resources for children. CONCLUSION: By employing a user-centred approach to designing resources to teach primary children to think critically about treatment claims and choices, we developed learning resources that end users experienced as useful, easy to use and well-suited to use in diverse classroom settings.

Effects of the Informed Health Choices podcast on the ability of parents of primary school children in Uganda to assess the trustworthiness of claims about treatment effects: one-year follow up of a randomised trial.

INTRODUCTION: Earlier, we designed and evaluated an educational mass media intervention for improving people's ability to think more critically and to assess the trustworthiness of claims (assertions) about the benefits and harms (effects) of treatments. The overall aims of this follow-up study were to evaluate the impact of our intervention 1 year after it was administered, and to assess retention of learning and behaviour regarding claims about treatments. METHODS: We randomly allocated consenting parents to listen to either the Informed Health Choices podcast (intervention) or typical public service announcements about health issues (control) over 7-10 weeks. Each intervention episode explained how the trustworthiness of treatment claims can be assessed by using relevant key concepts of evidence-informed decision-making. Participants listened to two episodes per week, delivered by research assistants. We evaluated outcomes immediately, and a year after the intervention. Primary outcomes were mean score and the proportion with a score indicating a basic ability to apply the key concepts (> 11 out of 18 correct answers) on a tool measuring people's ability to critically appraise the trustworthiness of treatment claims. Skills decay/retention was estimated by calculating the relative difference between the follow-up and initial results in the intervention group, adjusting for chance. Statistical analyses were performed using R (R Core Team, Vienna, Austria; version 3.4.3). RESULTS: After 1 year, the mean score for parents in the intervention group was 58.9% correct answers, compared to 52.6% in the control (adjusted mean difference of 6.7% (95% CI 3.3% to 10.1%)). In the intervention group, 47.2% of 267 parents had a score indicating a basic ability to assess treatment claims compared to 39.5% of 256 parents in the control (adjusted difference of 9.8% more parents (95% CI 0.9% to 18.9%). These represent relative reductions of 29% in the mean scores and 33% in the proportion of parents with a score indicating a basic ability to assess the trustworthiness of claims about treatment effects. CONCLUSIONS: Although listening to the Informed Health Choices podcast initially led to a large improvement in the ability of parents to assess claims about the effects of treatments, our findings show that these skills decreased substantially over 1 year. More active practice could address the substantial skills decay observed over 1 year. TRIAL REGISTRATION: Pan African Clinical Trial Registry (www.pactr.org), PACTR201606001676150. Registered on 12 June 2016.

Effects of the Informed Health Choices primary school intervention on the ability of children in Uganda to assess the reliability of claims about treatment effects, 1-year follow-up: a cluster-randomised trial.

INTRODUCTION: We evaluated an intervention designed to teach 10- to 12-year-old primary school children to assess claims about the effects of treatments (any action intended to maintain or improve health). We report outcomes measured 1 year after the intervention. METHODS: In this cluster-randomised trial, we included primary schools in the central region of Uganda that taught year 5 children (aged 10 to 12 years). We randomly allocated a representative sample of eligible schools to either an intervention or control group. Intervention schools received the Informed Health Choices primary school resources (textbooks, exercise books and a teachers' guide). The primary outcomes, measured at the end of the school term and again after 1 year, were the mean score on a test with two multiple-choice questions for each of the 12 concepts and the proportion of children with passing scores. RESULTS: We assessed 2960 schools for eligibility; 2029 were eligible, and a random sample of 170 were invited to recruitment meetings. After recruitment meetings, 120 eligible schools consented and were randomly assigned to either the intervention group (n = 60 schools; 76 teachers and 6383 children) or the control group (n = 60 schools; 67 teachers and 4430 children). After 1 year, the mean score in the multiple-choice test for the intervention schools was 68.7% compared with 53.0% for the control schools (adjusted mean difference 16.7%; 95% CI, 13.9 to 19.5; P < 0.00001). In the intervention schools, 3160 (80.1%) of 3943 children who completed the test after 1 year achieved a predetermined passing score (≥ 13 of 24 correct answers) compared with 1464 (51.5%) of 2844 children in the control schools (adjusted difference, 39.5%; 95% CI, 29.9 to 47.5). CONCLUSION: Use of the learning resources led to a large improvement in the ability of children to assess claims, which was sustained for at least 1 year. TRIAL REGISTRATION: Pan African Clinical Trial Registry (www.pactr.org), PACTR201606001679337. Registered on 13 June 2016.

The Norwegian public's ability to assess treatment claims: results of a cross-sectional study of critical health literacy.

Background: Few studies have evaluated the ability of the general public to assess the trustworthiness of claims about the effects of healthcare. For the most part, those studies have used self-reported measures of critical health literacy. Methods: We mailed 4500 invitations to Norwegian adults. Respondents were randomly assigned to one of four online questionnaires that included multiple-choice questions that test understanding of Key Concepts people need to understand to assess healthcare claims. They also included questions about intended behaviours and self-efficacy. One of the four questionnaires was identical to one previously used in two randomised trials of educational interventions in Uganda, facilitating comparisons to Ugandan children, parents, and teachers. We adjusted the results using demographic data to reflect the population. Results: A total of 771 people responded. The adjusted proportion of Norwegian adults who answered correctly was < 50% for 17 of the 30 Key Concepts. On the other hand, less than half answered correctly for 13 concepts. The results for Norwegian adults were better than the results for Ugandan children in the intervention arm of the trial and parents, and similar to those of Ugandan teachers in the intervention arm of the trial. Based on self-report, most Norwegians are likely to find out the basis of treatment claims, but few consider it easy to assess whether claims are based on research and to assess the trustworthiness of research. Conclusions: Norwegian adults do not understand many concepts that are essential for assessing healthcare claims and making informed choices. Future interventions should be tailored to address Key Concepts for which there appears to be a lack of understanding.

Informed Health Choices media intervention for improving people's ability to critically appraise the trustworthiness of claims about treatment effects: a mixed-methods process evaluation of a randomised trial in Uganda.

We developed the Informed Health Choices podcast to improve people's ability to assess claims about the effects of treatments. We evaluated the effects of the podcast in a randomised trial. OBJECTIVES: We conducted this process evaluation to assess the fidelity of the intervention, identify factors that affected the implementation and impact of the intervention and could affect scaling up, and identify potential adverse and beneficial effects. SETTING: The study was conducted in central Uganda in rural, periurban and urban settings. PARTICIPANTS: We collected data on parents who were in the intervention arm of the Informed Health Choices study that evaluated an intervention to improve parents' ability to assess treatment effects. PROCEDURES: We conducted 84 semistructured interviews during the intervention, 19 in-depth interviews shortly after, two focus group discussions with parents, one focus group discussion with research assistants and two in-depth interviews with the principal investigators. We used framework analysis to manage qualitative data, assessed the certainty of the findings using the GRADE-CERQual (Grading of Recommendations, Assessment, Development and Evaluations-Confidence in the Evidence from Reviews of Qualitative Research) approach, and organised findings in a logic model. OUTCOMES: Proportion of participants listening to all episodes; factors influencing the implementation of the podcast; ways to scale up and any adverse and beneficial effects. RESULTS: All participants who completed the study listened to the podcast as intended, perhaps because of the explanatory design and recruitment of parents with a positive attitude. This was also likely facilitated by the podcast being delivered by research assistants, and providing the participants with MP3 players. The podcast was reportedly clear, understandable, credible and entertaining, which motivated them to listen and eased implementation. No additional adverse effects were reported. CONCLUSIONS: Participants experienced the podcast positively and were motivated to engage with it. These findings help to explain the short-term effectiveness of the intervention, but not the decrease in effectiveness over the following year.

Informed health choices intervention to teach primary school children in low-income countries to assess claims about treatment effects: process evaluation.

BACKGROUND: We developed the informed health choices (IHC) primary school resources to teach children how to assess the trustworthiness of claims about the effects of treatments. We evaluated these resources in a randomised trial in Uganda. This paper describes the process evaluation that we conducted alongside this trial. OBJECTIVES: To identify factors affecting the implementation, impact and scaling up of the intervention; and potential adverse and beneficial effects of the intervention. METHODS: All 85 teachers in the 60 schools in the intervention arm of the trial completed a questionnaire after each lesson and at the end of the term. We conducted structured classroom observations at all 60 schools. For interviews and focus groups, we purposively selected six schools. We interviewed district education officers, teachers, head teachers, children and their parents. We used a framework analysis approach to analyse the data. RESULTS: Most of the participants liked the IHC resources and felt that the content was important. This motivated the teachers and contributed to positive attitudes. Although some teachers started out lacking confidence, many found that the children's enthusiasm for the lessons made them more confident. Nearly everyone interviewed thought that the children learnt something important and many thought that it improved their decision-making. The main barrier to scaling up use of the IHC resources that participants identified was the need to incorporate the lessons into the national curriculum. CONCLUSION: The mostly positive findings reflect the trial results, which showed large effects on the children's and the teachers' critical appraisal skills. The main limitations of this evaluation are that the investigators were responsible for both developing and evaluating the intervention.

Evaluating people's ability to assess treatment claims: Validating a test in Mandarin from Claim Evaluation Tools database.

OBJECTIVE: To describe the psychometric testing using Rasch analysis of a test in Mandarin developed from the Claim Evaluation Tools database. METHODS: We translated selected MCQs from the IHC Claim Evaluation Tools database to Mandarin and created a test including 24 MCQs covering 11 key concepts. We used purposeful sampling and surveyed children and adults in the Lanzhou area. In total 389 responses were entered into the analysis. We evaluated the psychometric properties of the test using Rasch analysis and the RUMM2030 software, testing for internal construct validity (multidimensionality), invariance of the items (item-person interaction), and item bias (differential item functioning). RESULTS: Overall, the psychometric properties of the test were found to be satisfactory. Based on findings from the Rasch analysis, we deleted three MCQs with suboptimal fit. CONCLUSIONS: The resulting test includes 21 MCQs and can be used in school and other teaching settings, in randomized trials evaluating outcomes of educational interventions, or in cross-sectional studies in Mandarin-speaking populations in China.

The James Lind Initiative: books, websites and databases to promote critical thinking about treatment claims, 2003 to 2018.

BACKGROUND: The James Lind Initiative (JLI) was a work programme inaugurated by Iain Chalmers and Patricia Atkinson to press for better research for better health care. It ran between 2003 and 2018, when Iain Chalmers retired. During the 15 years of its existence, the JLI developed three strands of work in collaboration with the authors of this paper, and with others. WORK THEMES: The first work strand involved developing a process for use by patients, carers and clinicians to identify shared priorities for research - the James Lind Alliance. The second strand was a series of articles, meetings, prizes and other developments to raise awareness of the massive amounts of avoidable waste in research, and of ways of reducing it. The third strand involved using a variety of approaches to promote better public and professional understanding of the importance of research in clinical practice and public health. JLI work on the first two themes has been addressed in previously published reports. This paper summarises JLI involvement during the 15 years of its existence in giving talks, convening workshops, writing books, and creating websites and databases to promote critical thinking about treatment claims. CONCLUSION: During its 15-year life, the James Lind Initiative worked collaboratively with others to create free teaching and learning resources to help children and adults learn how to recognise untrustworthy claims about the effects of treatments. These resources have been translated in more than twenty languages, but much more could be done to support their uptake and wider use.

The effects of interventions preventing self-harm and suicide in children and adolescents: an overview of systematic reviews.

Background: Self-harm and suicide in children and adolescents are of serious consequence and increase during the adolescent years. Consequently, there is need for interventions that prevent such behaviour. The objective of this paper: to evaluate the effects of interventions preventing self-harm and suicide in children and adolescents in an overview of systematic reviews. Methods: We conducted a review of systematic reviews (OoO). We included reviews evaluating any preventive or therapeutic intervention. The quality of the included reviews was assessed independently, and data was extracted by two reviewers. We report the review findings descriptively. The certainty of the evidence was assessed using Grading of Recommendations Assessment, Development and Evaluation (GRADE). Results: Moderate certainty evidence suggests that school-based interventions prevent suicidal ideation and attempts short term, and possibly with long term effects on suicide attempts. The effects of community-based interventions following suicide clusters and local suicide plans are uncertain, as are the benefits and harms of screening young people for suicide risk. The effects of most interventions targeting children and adolescents with known self-harm are uncertain. However, low certainty evidence suggests that dialectical behavioural therapy and developmental group therapy are equally as effective on repetition of self-harm as enhanced treatment as usual. Conclusions: Research on several recommended practices, such as local suicide plans, prevention of suicide clusters and approaches to risk assessment, is lacking. When implemented, these interventions should be closely evaluated. There also is need for more research on treatment for repeated self-harm, including long term follow-up, and in general: possible harmful effects. Policy makers and health providers should consider evidence from population-based studies and adults in preventing self-harm and suicide in children and adolescents. Also, approaches showing promise in treatment of conditions associated with self-harm and/or suicidality, such as depression and psychosis, should be considered. PROSPERO registration:  CRD42019117942 08/02/19.

Development of mass media resources to improve the ability of parents of primary school children in Uganda to assess the trustworthiness of claims about the effects of treatments: a human-centred design approach.

BACKGROUND: Claims about what we need to do to improve our health are everywhere. Most interventions simply tell people what to do, and do not empower them to critically assess health information. Our objective was to design mass media resources to enable the public to critically appraise the trustworthiness of claims about the benefits and harms of treatments and make informed health choices. METHODS: Research was conducted between 2013 and 2016 across multiple iterative phases. Participants included researchers, journalists, parents, other members of the public. First, we developed a list of 32 key concepts that people need to understand to be able to assess the trustworthiness of claims about treatment effects. Next, we used a human-centred design approach, to generate ideas for resources for teaching the key concepts, and developed and user-tested prototypes through qualitative interviews. We addressed identified problems and repeated this process until we had a product that was deemed relevant and desirable by our target audience, and feasible to implement. RESULTS: We generated over 160 ideas, mostly radio-based. After prototyping some of these, we found that a podcast produced collaboratively by health researchers and journalists was the most promising approach. We developed eight episodes of the Informed Health Choices podcast, a song on critical thinking about treatments and a reminder checklist. Early versions of the podcast were reportedly too long, boring and confusing. We shortened the episodes, included one key concept per episode, and changed to story-telling with skits. The final version of the podcast was found to be useful, understandable, credible and desirable. CONCLUSION: We found many problems with various prototypes of mass media resources. Using a human-centred design approach, we overcame those problems. We have developed a guide to help others prepare similar podcasts.

Validación de un cuestionario para medir la habilidad de la población general para evaluar afirmaciones acerca de tratamientos médicos.

INTRODUCCIÓN: Todos los días, las personas se enfrentan a afirmaciones acerca de tratamientos en medios de comunicación, redes sociales o por viva voz. OBJETIVO: Validar un cuestionario en español para medir las habilidades de un individuo para evaluar afirmaciones acerca de tratamientos. MÉTODO: Veintidós preguntas de opción múltiple de la base de datos Claim Evaluation Tools fueron traducidas y aplicadas a 172 niños y 268 adultos. Mediante un modelo Rasch se exploró el ajuste promedio e individual por reactivo, el potencial comportamiento diferencial del reactivo (basado en el género, edad y modo de aplicación), la multidimensionalidad y la independencia local. RESULTADOS: El ajuste promedio por reactivo fue apropiado. Cuatro preguntas de opción múltiple mostraron pobre ajuste. La fiabilidad del cuestionario fue satisfactoria, con un índice de separación de 0.7. Las preguntas de opción múltiple fueron unidimensionales, y no hubo dependencia específica. CONCLUSIÓN: Se obtuvo un conjunto de 18 preguntas de opción múltiple con ajuste satisfactorio. El cuestionario es el primero disponible y validado en español para medir las habilidades de los individuos para evaluar afirmaciones acerca de tratamientos. INTRODUCTION: Every day, people are faced with claims about treatment effects through mass media, social media, or by word of mouth. OBJECTIVE: To validate a Spanish-language questionnaire to measure the ability of an individual to assess claims about treatments effects. METHOD: A set of 22 multiple choice questions taken from the claim evaluation tools database were translated and applied to 172 children and 268 adults. Using a Rasch model, overall and individual item-person fit was explored, as well as the potential item differential functioning (based on gender, age and mode of administration), multidimensionality and local independence. RESULTS: Overall item-person fit was appropriate. Four multiple-choice questions showed a poor fit. Reliability of the questionnaire was satisfactory with a person separation index of 0.7. Multiple-choice questions were unidimensional, and there was no specific dependency. CONCLUSION: A set of 18 multiple-choice questions with satisfactory fit was obtained. This is the first available questionnaire validated in Spanish to measure individuals' ability to assess claims about treatment effects.