Process Evaluation of Teaching Critical Thinking About Health Using the Informed Health Choices Intervention in Uganda: A Mixed Methods Study

Introduction: We designed the Informed Health Choices (IHC) secondary school intervention and evaluated whether it improves students' ability to assess the trustworthiness of claims about treatment effects in Uganda. We conducted a process evaluation alongside a randomized trial to identify factors that may affect the implementation, fidelity, and scaling up of the intervention in Uganda. We also explored the potential adverse and beneficial effects of the intervention. Methods: We used mixed methods to collect, triangulate, and report data from a variety of sources. We observed at least 1 lesson all 40 intervention schools. One teacher from each of these schools completed a teacher training evaluation form and lesson evaluation questionnaires after each lesson. We purposively selected 10 schools where we conducted a total of 10 focus group discussions with students and 1 with parents. We also conducted key informant interviews with policymakers (N1/49), teachers (N1/410), head teachers (N1/44), and parents (N1/43). We used a framework analysis approach to analyze the data. Findings: All participants in the process evaluation felt that the IHC intervention was needed, important, and timely. Students were motivated to attend class and learn the content because it spoke to their daily life experiences and their own challenges to decide what do or believe when faced with health claims. The training workshop gave teachers the confidence to teach the lessons. The participating students demonstrated a clear understanding of the content and use of what was learned. The content improved both students' and teachers' appreciation of the critical thinking, communication, and problem-solving competencies in the lower secondary school curriculum. Conclusion: The findings of this process evaluation are consistent with the findings of the trial, which showed that the intervention improved the students' critical thinking skills. The IHC resources enabled teachers to teach this competency.