Improving critical thinking about health: Development and evaluation of the Informed Health Choices secondary school intervention in Rwanda

Abstract

Claims about health actions we can take to prevent, treat, or improve health conditions are abundant. Social and mass media are full of information about health actions, including lots of misleading information, much of which is targeted at young people. This thesis explored how students in Rwanda can learn to make informed health choices. With colleagues, I have developed and evaluated an intervention to teach critical thinking about health to lower secondary school students in Rwanda. In a context analysis, I found that the introduction of a competence-based curriculum in Rwanda triggered the demand for teaching critical thinking skills and presented an opportunity to teach critical thinking about health. The context analysis informed the design of the intervention, which included 10 digital lesson plans for teaching students to make informed health choices. In a randomized trial, half of 84 lower secondary schools (1,572 eighth grade students and 42 teachers) were assigned to use the informed health choices secondary school resources (the intervention). The other half (1,556 students and 42 teachers) taught the standard curriculum (the control). At the end of the term when the 10 lessons were taught, the students in both schools took a Critical Thinking about Health test. I found that more than half (58%) of the students in the intervention schools achieved a passing score and 23% achieved a mastery score, compared to less than 20% and 1% respectively in the control schools. In a process evaluation, I found that the intervention was largely implemented as intended. Teachers, students, and other stakeholders perceived the intervention as useful, valuable, interesting, and engaging, and this facilitated its implementation. The main barriers to effectively implementing the intervention were difficulty understanding some of the concepts taught in the lessons, time constrains, the content not being included in national exams and therefore not prioritized, and competing priorities. In this thesis, I have shown that it is possible to teach lower secondary school students in Rwanda to think critically about health using digital educational resources that teachers can easily access with a computer or a smartphone. The intervention was effective and perceived positively by teachers, students, and other stakeholders.