Supporting informed healthcare choices in low-income countries

Untrustworthy claims about what people should and should not do for their health are everywhere. People need to be able to assess the trustworthiness of claims. When they?re not able to do this, and they act based on untrustworthy claims or do not act based on ones that are trustworthy, they may suffer unnecessarily or cause others to suffer, and they waste resources. Because many people have not learned how to tell the difference between trustworthy and untrustworthy claims, millions suffer unnecessarily and billions are wasted each year. This problem is worse for people in low-income countries because they have few resources to waste. The aim of this project was to enable people in low-income countries to make informed health choices by improving their ability to recognise trustworthy and untrustworthy claims, and to use trustworthy information to inform their decisions. The project focused on two strategies to do this: teaching 10 to 12-year-old children how to assess claims about the effects of treatments and a podcast targeted at their parents. ?Treatments? include any action intended to improve the health or wellbeing of individuals or communities. As a first step in this project, we have developed a list of 36 Key Concepts that people need to understand and apply to assess claims and the evidence used to support a claim, and to make informed health choices. For example, people need to recognise that expert opinion alone is not a trustworthy basis for claims; that just because a treatment is widely used, it does not mean the treatment works or that it is safe; and that newer is not necessarily better. They need to understand that comparisons are needed to identify whatever effects a treatment has, that ?like needs to be compared with like? for those comparisons to be fair, and that the results of single studies comparing treatments can be misleading, especially when they have few participants and outcome events. To make informed choices, they also need to be able to weigh the advantages against the disadvantages of using a treatment. The Key Concepts are the starting point for developing and evaluating learning resources. The resources that we have developed to teach children these concepts include a workbook, a teachers? guide, and an activity booklet. We introduce 12 concepts to the children through a comic book story, games and activities. The resources were pilot tested in Uganda, Kenya, Rwanda and Norway. We evaluated the effects of the resources in a randomised trial (a fair comparison) in 120 schools in Uganda with over 10,000 children. The main outcome was the children?s ability to apply the concepts they were taught, measured using multiple-choice questions. We compared how well children did answering the questions in 60 schools that used the resources, to the answers given by children in schools that did not use the resources. We found 20% more correct answers in the schools that had used the resources and that more than twice as many (50% more) children had a passing score. The podcast helped listeners to understand and apply nine concepts. Each episode included a short story with an example of a treatment claim; a simple explanation of a concept used to assess that claim; and another example of a claim illustrating the same concept and its corresponding explanation. We evaluated the effects of the podcast in a second randomised trial with over 500 parents of primary school children in Uganda. The main outcome in this trial was the parents? ability to apply the concepts explained in the podcast. We compared how well parents did answering the questions after listening to the podcast to the answers given by parents who listened to a podcast with typical public health announcements. The parents who listened to the Informed Health Choices podcast answered 15% more questions correctly, and nearly twice as many (34% more) had a passing score. No adverse effects were reported by teachers, children, or parents. The learning resources are freely available. They have been translated into other languages and are being tested in Rwanda and Kenya to check that teachers and children there find them to be useful, easy to use, and suitable for use in their context. We have measured outcomes again after one year, to find out whether the children and parents retained what they learned and used what they learned to assess treatment claims and make decisions. We have interviewed children, teachers, parents, head teachers, and district education officers to learn more about potential adverse effects and possible beneficial effects. We are also using the interviews to learn more about factors that might have influenced the effects of the school resources and the podcast, and ways of scaling up their use. The results of these studies will be available early in 2018. The resources and more information about this project can be found here: www.informedhealthchoices.org.

Low health literacy is associated with poor health outcomes and poor use of health services. This research aims to enable people in low-income countries to make informed healthcare choices by improving their ability to obtain, process and understand healt h information. Objectives: To develop and evaluate interactive resources to help journalists to improve the availability of reliable health information in mass media and teachers to teach children how to appraise claims about the benefits and harms of he althcare. Methods: Teams based in medical schools in Nepal and Uganda will undertake the research, supported by teams in Norway, the UK and Australia. We will set priorities for the resources together with networks of journalists and teachers in each cou ntry and an international advisory group. We will then design mass media resources and teaching materials for those priorities using brainstorming, user testing and feedback from journalists and teachers in the country networks and our advisory group. We will also examine the potential to adapt and use each set of resources for target audiences other than the one for which they were developed, including across mass media and schools, countries, and other audiences (e.g. policymakers, healthcare students, community health workers). We will test the effects of the resources in randomized trials. We will evaluate the effects of stories prepared by practicing journalists using the resources on the comprehension, attitudes and hypothetical or intended behaviou rs of people in their target audiences. We will evaluate the effects of the teaching materials on comprehension, attitudes and hypothetical or intended behaviours of school children and their families; and the sustainability of those effects by measuring the same outcomes again after one year. Expected results: Freely available and widely disseminated resources to help people in low-income countries make well-informed healthcare choices.