Cite as: Oxman AD, Chalmers I, Dahlgren A (2022). Key Concepts for Informed Health Choices: 1.1 Assumptions that treatments are safe or effective can be misleading. James Lind Library (www.jameslindlibrary.org).
© Andy Oxman, Centre for Epidemic Interventions Research, Norwegian Institute of Public Health, Norway. Email: firstname.lastname@example.org
In the previous 10 essays in this series, we explained key concepts that can help you avoid being misled by claims about treatments that have an untrustworthy basis, consider whether evidence from treatment comparisons is trustworthy, and make well informed treatment choices (Table 1). These concepts are central to critical thinking and evidence-based practice [Albarqouni 2018, Chalmers 2018, Sharples 2017], both of which have broader scopes than the key concepts explained in these essays [Oxman 2020]. There are other important concepts, for example, that can help you formulate answerable questions, find answers to those questions, appraise, interpret, and apply evidence about diagnostic accuracy, prognosis, and people’s experiences, and improve the quality of care.
Why focus on these concepts?
There are several reasons for drawing attention to the specific concepts explained in these essays. First, frameworks with a broader scope than the “Informed Health Choices (IHC) Key Concepts do not provide an adequate basis (i.e., necessary concepts) for thinking critically about claims about effects and decisions about what to do. Second, the IHC Key Concepts are applicable to a great variety of claims about the effects of interventions, not just health interventions [Aronson 2019], and they are essential points of reference for deciding which claims to believe and what to do. Third, many people do not understand and apply the IHC Key Concepts [Dahlgren 2021]. Fourth, there is a substantial body of evidence supporting these concepts [Oxman 2022a].
Some of the IHC Key Concepts are already being taught to health professionals and the public. However, there are still major gaps in the extent to which these concepts are understood and used. For example, a survey in the UK found that only about one third of the public trust evidence from medical research, while about two thirds trust the experiences of friends and family [Academy of Medical Sciences 2017]. A survey of Norwegian adults found that less than 20% of respondents understood that lung cancer can be associated with drinking alcohol but not necessarily caused by it [Oxman 2017]. A more recent survey of Norwegian adults found that less than 20% of Norwegian adults understood and applied six IHC Key Concepts [Dahlgren 2021], including:
- Do not assume that a plausible explanation is sufficient.
- Do not assume that a single study is sufficient.
- Consider whether the people being compared were similar.
- Be cautious of p-values.
There is also evidence that many journalists do not understand and use the IHC Key Concepts and, as a result, frequently report untrustworthy claims about treatment effects and fail to adequately report information about treatments [Oxman 2022b]. There is also a tremendous amount of misinformation about treatment effects in social media, as well as trustworthy information [Pian 2021]. Believing and acting on untrustworthy claims and not believing and acting on trustworthy claims can lead to unnecessary suffering and wasted resources [Berwick 2012, Brownlee 2017, Ernst 2000, Frass 2012, Glasziou 2017, Jones 2003, Pierce 2016, Shrank 2019, Starr 2015].
Claims about effects that are not supported by evidence from fair comparisons are not necessarily wrong, but there is an insufficient basis for believing them.
To identify treatment effects, studies should make fair comparisons, designed to minimise the risk of systematic errors (biases) and random errors (the play of chance).
What to do depends on judgements about a problem, the relevance of the available evidence, and the balance of expected benefits, harms, and costs.
|Assumptions that treatments are safe or effective can be misleading.
Do not assume that
Seemingly logical assumptions about research can be misleading.
Do not assume that
Seemingly logical assumptions about treatments can be misleading.
Do not assume that
Trust based on the source of a claim alone can be misleading.
Do not assume that
|Comparisons of treatments should be fair.
Reviews of the effects of treatments should be fair.
Descriptions of effects should clearly reflect the size of the effects.
Be cautious of
Descriptions of effects should reflect the risk of being misled by the play of chance.
Be cautious of
|Evidence should be relevant.
Be clear about what the problem or goal is and what the options are.
Consider the relevance of
Expected advantages should outweigh expected disadvantages.
Why should the IHC Key Concepts be taught to children?
Many of the IHC Key Concepts can be taught to children as young as 10 years-old [Nsangi 2017], and perhaps even younger [Sandoval 2014]. A randomized trial of an educational intervention to teach 12 IHC Key Concepts to primary school children (age 10-12) in Uganda found that the intervention led to a large improvement in the ability of children to assess claims about treatment effects [Nsangi 2017], and that the children retained what they learned for at least one year [Nsangi 2020b]. A priority setting process with teachers and curriculum developers in East Africa suggests that at least 29 of the IHC Key Concepts (more than half) should probably be included in lower secondary school education [Agaba 2022].
Both critical thinking skills and health are included in many primary and secondary school curricula [Care 2016, Erstad 2018, Larson 2018, Voogt 2012] . However, critical thinking about health may not be included [Chesire 2022b, Lund 2018, Mugisha 2021, Ssenyonga 2022b]. Although the IHC Key Concepts are relevant to learning goals such as understanding scientific enquiry [Chalmers 2018], they are not being taught in countries where this has been examined [Chesire 2022b, Cusack 2017, Lund 2018, Mugisha 2021, Nordheim 2016, Nordheim 2019, Ssenyonga 2022b].
There are several reasons why IHC Key Concepts should be taught in primary and secondary schools. First, children are capable of learning at least some of the concepts [Nsangi 2017], and to use the concepts in their daily lives [Nsangi 2019, Nsangi 2020b]. Second, by targeting school children, it is possible to reach a large segment of the population, before many leave the education system and become difficult to reach. School children are the citizens, policymakers, patients, and health professionals of tomorrow. It is important that they are empowered, as individuals and as citizens, to make well-informed decisions. Third, teaching children while they are in school can capitalise on the time they have available for learning. Adults, on the other hand, have increasing demands on their time and less time to learn. It becomes increasingly difficult to reach them and to teach them. Young people who have been explicitly taught critical thinking make better judgements than those who have not [Abrami 2015]. Teaching the IHC Key Concepts in primary and secondary school can provide an important foundation for future learning. In addition, beliefs, attitudes, and behaviours that adults developed as children can be resistant to change and impede their ability to learn.
The IHC Key Concepts are relevant to many other types of interventions, including agricultural, educational, environmental, policing, social welfare, and veterinary interventions [Aronson 2019]. Teaching children to think critically about the effects of health interventions is transferable to critical thinking about the effects of other types of interventions. Focusing on health makes learning the concepts directly relevant, since health is important to everyone. As one girl in a school that piloted the IHC primary school intervention noted: this is about “things we might actually use instead of things we might use when we are all grown up and by then we’ll forget” [Nsangi 2017].
There are, however, also several barriers to teaching children to think critically about health and other types of interventions. Most importantly, there is a need for affordable and effective educational resources and for ensuring that the IHC Key Concepts are integrated in the curriculum and not an add on [Cusack 2018, Nsangi 2019, Nsangi 2017].
The Informed Health Choices (IHC) Network: developing and evaluating educational resources
The IHC Network is an informal collaboration that is working to improve people’s ability to make informed choices about what to believe and do [Informed Health Choices Network], including:
- engaging students, teachers, and other stakeholders in designing and evaluating resources [Nsangi 2020a, Nsangi 2020c, Semakula 2019b],
- undertaking context analyses to inform the design of resources and help ensure that their use can be scaled up if they are effective [Chesire 2022b, Mugisha 2021, Ssenyonga 2022b]
- prioritising which Key Concepts to include in resources [Agaba 2022],
- using human-centred design to ensure that students and teachers experience resources as useful, easy to use, well suited to people like them [Nsangi 2020c, Rosenbaum 2010, Rosenbaum 2019, Semakula 2019b],
- evaluating the effects of using resources in randomized trials [Chesire 2022a, Mugisha 2022b, Nsangi 2017, Nsangi 2020b, Semakula 2017a, Semakula 2020, Ssenyonga 2022a],
- conducting systematic reviews of the effects of educational interventions to improve people’s understanding and use of the Key Concepts and developing a database of resources [Castle 2017, Cusack 2018],
- conducting process evaluations to explore potential adverse and beneficial effects and factors that affect the impact and scaling up use of resources [Mugisha 2022a, Nsangi 2019, Semakula 2019a],
- measuring people’s understanding of Key Concepts and their ability to apply them [Aranza 2021, Austvoll-Dahlgren 2017a, Austvoll-Dahlgren 2019, Austvoll-Dahlgren 2017b, Dahlgren 2021, Dahlgren 2022, Davies 2017, Nsangi 2022, Pérez-Gaxiola 2018, Semakula 2017b, Wang 2019],
- translating and contextualising resources for use in different settings [Alderighi 2020, Glynn 2020, Ikireza 2016, Informed Health Choices Group 2017a, Informed Health Choices Group 2017b, Informed Health Choices Network , Martínez García 2019, Ringle 2020] Semakula, and
- collaborating across fields to promote understanding and use of the concepts beyond health choices [Aronson 2019, Stewart 2022]
There is an enormous amount of misinformation as well as trustworthy information about the effects of treatments (actions intended to improve health) and other types of interventions. Many people are unable to assess the trustworthiness of claims about effects and make well-informed choices. There is a global need for effective resources to enable people to think critically about claims, comparisons, and choices. The IHC Key Concepts provide a starting point and a framework for designing, evaluating, and scaling-up use of effective resources. It is crucial that schoolchildren learn Key Concepts so that they can start to use them in their daily lives, build a foundation for future learning, and are able to make informed choices about what to believe and do as adults.
Abrami PC, Bernard RM, Borokhovski E, Waddington DI, Wade CA, Persson T. Strategies for teaching students to think critically: a meta-analysis. Rev Educ Res. 2015;85(2):275-314. https://doi.org/10.3102%2F0034654314551063
Academy of Medical Sciences. Enhancing the use of scientific evidence to judge the potential benefits and harms of medicines. London: Academy of Medical Sciences London; 2017. https://acmedsci.ac.uk/file-download/44970096
Agaba JJ, Chesire F, Mugisha M, Nandi P, Njue J, Nsangi A, et al. Prioritisation of Informed Health Choices (IHC) Key Concepts to be included in lower-secondary school resources: a consensus study. medRxiv. 2022. https://doi.org/10.1101/2022.04.11.22273708
Albarqouni L, Hoffmann T, Straus S, Olsen NR, Young T, Ilic D, et al. Core competencies in evidence-based practice for health professionals: consensus statement based on a systematic review and Delphi survey. JAMA Netw Open. 2018;1(2):e180281. https://doi.org/10.1001/jamanetworkopen.2018.0281
Alderighi C, Rasoini R. [The naked king in the pandemic: about the production and communication of scientific knowledge at the time of SARS-CoV-2.]. Recenti Prog Med. 2020;111(7):398-401. https://doi.org/10.1701/3407.33920
Aranza D, Milavić B, Marusic A, Buzov M, Poklepović Peričić T. A cross-sectional study on adaptation and initial validation of a test to evaluate health claims among high school students: Croatian version. BMJ Open. 2021;11(8):e048754. https://doi.org/10.1136/bmjopen-2021-048754
Aronson JK, Barends E, Boruch R, Brennan M, Chalmers I, Chislett J, et al. Key concepts for making informed choices. Nature. 2019;572(7769):303-6. https://doi.org/10.1038/d41586-019-02407-9
Austvoll-Dahlgren A, Guttersrud O, Nsangi A, Semakula D, Oxman AD, Group IHC. 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. 2017a;7(5):e013185. https://doi.org/10.1136/bmjopen-2016-013185
Austvoll-Dahlgren A, Oxman AD, Chalmers I. Manual for preparing a test or questionnaire based on the Claim Evaluation Tools database. 2019. http://doi.org/10.5281/zenodo.4748379
Austvoll-Dahlgren A, Semakula D, Nsangi A, Oxman AD, Chalmers I, Rosenbaum S, et al. Measuring ability to assess claims about treatment effects: the development of the ‘Claim Evaluation Tools’. BMJ Open. 2017b;7(5):e013184. https://doi.org/10.1136/bmjopen-2016-013184
Berwick DM, Hackbarth AD. Eliminating waste in US health care. JAMA. 2012;307(14):1513-6. https://doi.org/10.1001/jama.2012.362
Brownlee S, Chalkidou K, Doust J, Elshaug AG, Glasziou P, Heath I, et al. Evidence for overuse of medical services around the world. Lancet. 2017;390(10090):156-68. https://doi.org/10.1016/S0140-6736(16)32585-5
Care E, Anderson K, Kim H. Visualizing the breadth of skills movement across education systems. Washington, DC: Brookings Institution; 2016. http://hdl.voced.edu.au/10707/440516
Castle JC, Chalmers I, Atkinson P, Badenoch D, Oxman AD, Austvoll-Dahlgren A, et al. Establishing a library of resources to help people understand key concepts in assessing treatment claims-The “Critical thinking and Appraisal Resource Library” (CARL). PLoS One. 2017;12(7):e0178666. https://doi.org/10.1371/journal.pone.0178666
Chalmers I, Oxman AD, Austvoll-Dahlgren A, Ryan-Vig S, Pannell S, Sewankambo N, et al. 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;23(1):29-33. https://doi.org/10.1136/ebmed-2017-110829
Chesire F, Kaseje M, Ochieng M, Mugisha M, Ssenyonga R, Oxman M, et al. Effect of the Informed Health Choices secondary school intervention on the ability of lower secondary students in Kenya to think critically about health information and choices: Protocol for a cluster-randomized trial. IHC Working Paper. 2022a. http://doi.org/10.5281/zenodo.6562940
Chesire F, Ochieng M, Mugisha M, Ssenyonga R, Oxman M, Nsangi A, et al. Contextualizing critical thinking about health using digital technology in secondary schools in Kenya: a qualitative analysis. Res Square. 2022b. https://doi.org/10.21203/rs.3.rs-1345080/v1
Cusack L, Del Mar CB, Chalmers I, Gibson E, Hoffmann TC. Educational interventions to improve people’s understanding of key concepts in assessing the effects of health interventions: a systematic review. Syst Rev. 2018;7(1):68. https://doi.org/10.1186/s13643-018-0719-4
Cusack L, Desha LN, Del Mar CB, Hoffmann TC. A qualitative study exploring high school students’ understanding of, and attitudes towards, health information and claims. Health Expect. 2017;20(5):1163-71. https://doi.org/10.1111/hex.12562
Dahlgren A, Furuseth-Olsen K, Rose CJ, Oxman AD. The Norwegian public’s ability to assess treatment claims: results of a cross-sectional study of critical health literacy. F1000Research. 2021;9(179). https://doi.org/10.12688/f1000research.21902.2
Dahlgren A, Semakula D, Chesire F, Oxman AD, Mugisha M, Nakyejwe E, et al. Critical thinking about treatment effects in Eastern Africa: development and evaluation of an assessment tool using Rasch analysis. PLoS One. 2022;submitted.
Davies A, Gerrity M, Nordheim L, Okebukola P, Opiyo N, Sharples J, et al. Measuring ability to assess claims about treatment effects: establishment of a standard for passing and mastery. 2017. http://doi.org/10.5281/zenodo.4748279
Ernst E. Prevalence of use of complementary/alternative medicine: a systematic review. Bull World Health Organ. 2000;78(2):252-7. http://www.ncbi.nlm.nih.gov/pmc/articles/pmc2560678/
Erstad O, Voogt J. The twenty-first century curriculum: issues and challenges. In: Voogt J, Knezek G, Christensen R, Lai K-W, editors. Second Handbook of Information Technology in Primary and Secondary Education. Cham, Switzerland: Springer International Publishing; 2018. p. 19-36.
Frass M, Strassl RP, Friehs H, Müllner M, Kundi M, Kaye AD. Use and acceptance of complementary and alternative medicine among the general population and medical personnel: a systematic review. Ochsner J. 2012;12(1):45-56. http://www.ncbi.nlm.nih.gov/pmc/articles/pmc3307506/
Glasziou P, Straus S, Brownlee S, Trevena L, Dans L, Guyatt G, et al. Evidence for underuse of effective medical services around the world. Lancet. 2017;390(10090):169-77. https://doi.org/10.1016/s0140-6736(16)30946-1
Glynn D. Contextualising the Informed Health Choices (IHC) programme and resources for delivery in the Irish Primary School System: National University of Ireland, Galway; 2020.
Ikireza A. A qualitative study exploring the suitability of Informed Health Choices resources translated into Kinyarwanda for use in primary schools: Case Of Remera Protestant Primary School In Kigali City. Kigali: College of Medicine and Health Sciences, University of Rwanda; 2016. https://www.informedhealthchoices.org/wp-content/uploads/2019/12/IKIREZI-ALINE_masters-thesis_UofRwanda_2019.pdf
Informed Health Choices Group. Guide for piloting the Informed Health Choices (IHC) school resources. 2017a. http://doi.org/10.5281/zenodo.4748323
Informed Health Choices Group. Guide for translating and adapting the Informed Health Choices (IHC) podcast. 2017b. http://doi.org/10.5281/zenodo.4748287
Informed Health Choices Network. IHC by country, https://www.informedhealthchoices.org/ihc-by-country/
Jones G, Steketee RW, Black RE, Bhutta ZA, Morris SS. How many child deaths can we prevent this year? Lancet. 2003;362(9377):65-71. https://doi.org/10.1016/s0140-6736(03)13811-1
Larson L, Forzani E, Leu DJ. New Literacies: Curricular Implications. In: Voogt J, Knezek G, Christensen R, Lai K-W, editors. Second Handbook of Information Technology in Primary and Secondary Education. Cham, Switzerland: Springer International Publishing; 2018. p. 19-36.
Lund HM, Mathisen PE, Rekkavik ME, Voll E. Teaching critical thinking about health claims: market analysis for Norwegian primary and lower secondary school. Zenodo. 2018. http://doi.org/10.5281/zenodo.4748281
Martínez García L, Alonso-Coello P, Asso Ministral L, Ballesté-Delpierre C, Canelo Aybar C, de Britos C, et al. Learning to make informed health choices: Protocol for a pilot study in schools in Barcelona. F1000Res. 2019;8:2018. https://doi.org/10.12688/f1000research.21292.3
Mugisha M, Nyirazinyoye L, Oxman AD, Simbi CMC, Chesire F, Ssenyonga R, et al. Use of the Informed Health Choices digital resources for teaching lower sec-ondary school students in Rwanda to think critically about health: protocol for a process evaluation (Version 3). Zenodo. 2022a. https://doi.org/10.5281/zenodo.6874985
Mugisha M, Nyirazinyoye L, Simbi CMC, Chesire F, Ssenyonga R, Oxman M, et al. Effects of Informed Health Choices secondary school resources on the ability of Rwandan students to think critically about health: protocol for a cluster-randomised trial. IHC Working Paper. 2022b. http://doi.org/10.5281/zenodo.6562788
Mugisha M, Uwitonze AM, Chesire F, Senyonga R, Oxman M, Nsangi A, et al. Teaching critical thinking about health using digital technology in lower secondary schools in Rwanda: A qualitative context analysis. PLoS One. 2021;16(3):e0248773. https://doi.org/10.1371/journal.pone.0248773
Nordheim L, Pettersen KS, Flottorp S, Hjälmhult E. Critical appraisal of health claims: science teachers’ perceptions and practices. Health Educ. 2016. https://doi.org/10.1108/HE-04-2015-0016
Nordheim LV, Pettersen KS, Espehaug B, Flottorp SA, Guttersrud Ø. Lower secondary school students’ scientific literacy and their proficiency in identifying and appraising health claims in news media: a secondary analysis using large-scale survey data. BMJ Open. 2019;9(10):e028781. https://doi.org/10.1136/bmjopen-2018-028781
Nsangi A, Aranza D, Asiimwe R, Munaabi-Babigumira S, Nantongo J, Nordheim L, et al. Measuring lower secondary school students’ ability to assess claims about treatment effects: establishment of a standard for passing and mastery. BMJ Open. 2022; submitted.
Nsangi A, Oxman AD, Oxman M, Rosenbaum SE, Semakula D, Ssenyonga R, et al. 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. 2020a;15(10):e0239985. https://doi.org/10.1371/journal.pone.0239985
Nsangi A, Semakula D, Glenton C, Lewin S, Oxman AD, Oxman M, et al. Informed health choices intervention to teach primary school children in low-income countries to assess claims about treatment effects: process evaluation. BMJ Open. 2019;9(9):e030787. https://doi.org/10.1136/bmjopen-2019-030787
Nsangi A, Semakula D, Oxman AD, Austvoll-Dahlgren A, Oxman M, Rosenbaum S, et al. 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: a cluster-randomised controlled trial. Lancet. 2017;390(10092):374-88. https://doi.org/10.1016/s0140-6736(17)31226-6
Nsangi A, Semakula D, Oxman AD, Austvoll-Dahlgren A, Oxman M, Rosenbaum S, et al. 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. Trials. 2020b;21(1):27. https://doi.org/10.1186/s13063-019-3960-9
Nsangi A, Semakula D, Rosenbaum SE, Oxman AD, Oxman M, Morelli A, et al. 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. Pilot Feasibility Stud. 2020c;6:18. https://doi.org/10.1186/s40814-020-00565-6
Oxman AD, Austvoll-Dahlgren A, Garratt A, Rosenbaum S. Understanding of key concepts relevant to assessing claims about treatment effects: a survey of Norwegian adults. 2017. http://doi.org/10.5281/zenodo.4748270
Oxman AD, Chalmers I, Dahlgren A, Informed Health Choices Group. Key Concepts for Informed Health Choices: a framework for enabling people to think critically about health claims (Version 2022). IHC Working Paper. 2022a. http://doi.org/10.5281/zenodo.6611932
Oxman AD, Garcia LM. Comparison of the Informed Health Choices Key Concepts Framework to other frameworks relevant to teaching and learning how to think critically about health claims and choices: a systematic review. F1000Res. 2020;9:164. https://doi.org/10.12688/f1000research.21858.1
Oxman M, Larun L, Gaxiola GP, Alsaid D, Qasim A, Rose CJ, et al. Quality of information in news media reports about the effects of health interventions: systematic review and meta-analyses. F1000Res. 2022b;10:433. https://doi.org/10.12688/f1000research.52894.2
Pérez-Gaxiola G, Austvoll-Dahlgren A. [Psychometric validation of a questionnaire to measure the ability of the public to evaluate claims about treatments]. Gac Med Mex. 2018;154(4):480-95. https://www.medigraphic.com/cgi-bin/new/resumenI.cgi?IDARTICULO=83655
Pian W, Chi J, Ma F. The causes, impacts and countermeasures of COVID-19 “Infodemic”: A systematic review using narrative synthesis. Inf Process Manag. 2021;58(6):102713. https://doi.org/10.1016/j.ipm.2021.102713
Pierce H, Gibby AL, Forste R. Caregiver Decision-Making: Household Response to Child Illness in sub-Saharan Africa. Popul Res Policy Rev. 2016;35(5):581-97.
Ringle VAM. Developing and testing the effects of an educational podcast to improve critical appraisal of healthcare claims. Doctoral dissertation. Miami: University of Miami; 2020.
Rosenbaum S. Improving the user experience of evidence: a design approach to evidence-informed health care. Oslo: The Oslo School of Architecture and Design; 2010. http://hdl.handle.net/11250/93062
Rosenbaum S, Oxman M, Oxman AD, Chelagat F, Mugisha M, Ssenyonga R, et al. Human-centred design development of Informed Health Choices (IHC) learning resources for secondary school students: protocol. IHC Working Paper. 2019. https://doi.org/10.5281/zenodo.4748445
Sandoval WA, Sodian B, Koerber S, Wong J. Developing children’s early competencies to engage with science. Educ Psychol. 2014;49(2):139-52. http://dx.doi.org/10.1080/00461520.2014.917589
Semakula D, Nsangi A, Oxman A, Glenton C, Lewin S, Rosenbaum S, et al. 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. BMJ Open. 2019a;9(12):e031510. http://dx.doi.org/10.1136/bmjopen-2019-031510
Semakula D, Nsangi A, Oxman AD, Oxman M, Austvoll-Dahlgren A, Rosenbaum S, et al. Effects of the Informed Health Choices podcast on the ability of parents of primary school children in Uganda to assess claims about treatment effects: a randomised controlled trial. Lancet. 2017a;390(10092):389-98. https://doi.org/10.1016/s0140-6736(17)31225-4
Semakula D, Nsangi A, Oxman AD, Oxman M, Austvoll-Dahlgren A, Rosenbaum S, et al. 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. Trials. 2020;21(1):187. https://doi.org/10.1186/s13063-020-4093-x
Semakula D, Nsangi A, Oxman AD, Sewankambo NK, Guttersrud Ø, Austvoll-Dahlgren A. Measuring ability to assess claims about treatment effects in English and Luganda: evaluation of multiple-choice questions from the “Claim Evaluation Tools” database using Rasch modelling. 2017b. http://doi.org/10.5281/zenodo.4748274
Semakula D, Nsangi A, Oxman M, Rosenbaum SE, Oxman AD, Austvoll-Dahlgren A, et al. 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. Pilot Feasibility Stud. 2019b;5:155. https://doi.org/10.1186/s40814-019-0540-4
Sharples JM, Oxman AD, Mahtani KR, Chalmers I, Oliver S, Collins K, et al. Critical thinking in healthcare and education. BMJ. 2017;357:j2234. https://doi.org/10.1136/bmj.j2234
Shrank WH, Rogstad TL, Parekh N. Waste in the US health care system: estimated costs and potential for savings. JAMA. 2019;322(15):1501-9. https://doi.org/10.1001/jama.2019.13978
Ssenyonga R, Oxman AD, Nakyejwe E, Mugagga SK, Nsangi A, Semakula D, et al. Does the use of the Informed Health Choices secondary school resources improve critical thinking about the effects of health among secondary school students in Uganda? A cluster-randomised trial protocol. IHC Working Paper. 2022a. http://doi.org/10.5281/zenodo.6560218
Ssenyonga R, Sewankambo NK, Mugagga SK, Nakyejwe E, Chesire F, Mugisha M, et al. Learning to think critically about health using digital technology in Ugandan lower secondary schools: a contextual analysis. PLoS One. 2022b;17(2):e0260367. https://doi.org/10.1371/journal.pone.0260367
Starr RR. Too little, too late: ineffective regulation of dietary supplements in the United States. Am J Public Health. 2015;105(3):478-85. https://doi.org/10.2105/ajph.2014.302348
Stewart R, Aronson, J.K., Barends, E., Boruch, R., Brennan, M., Chislett, J., Cunliffe-Jones, P., Maynard, B., Oxman M, Pullin, A., Randall, N., Sharples, J., Stott, J., Vale, L. Lessons from working across fields to develop a framework for informed choices. Research for All. 2022;6(1). https://doi.org/10.14324/RFA.06.1.05
Voogt J, Roblin NP. A comparative analysis of international frameworks for 21st century competences: Implications for national curriculum policies. J Curric Stud. 2012;44(3):299-321. https://doi.org/10.1080/00220272.2012.668938
Wang Q, Austvoll-Dahlgren A, Zhang J, Yu Y, Zhou Q, Yang N, et al. Evaluating people’s ability to assess treatment claims: Validating a test in Mandarin from Claim Evaluation Tools database. J Evid Based Med. 2019;12(2):140-6. https://doi.org/10.1111/jebm.12343