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.

Teaching critical thinking about health information and choices in secondary schools: human-centred design of digital resources.

Background: Learning to thinking critically about health information and choices can protect people from unnecessary suffering, harm, and resource waste. Earlier work revealed that children can learn these skills, but printing costs and curricula compatibility remain important barriers to school implementation. We aimed to develop a set of digital learning resources for students to think critically about health that were suitable for use in Kenyan, Rwandan, and Ugandan secondary schools. Methods: We conducted work in two phases collaborating with teachers, students, schools, and national curriculum development offices using a human-centred design approach. First, we conducted context analyses and an overview of teaching strategies, prioritised content and collected examples. Next, we developed lessons and guidance iteratively, informed by data from user-testing, individual and group interviews, and school pilots. Results: Final resources include online lesson plans, teachers' guide, and extra resources, with lesson plans in two modes, for use in a classroom equipped with a blackboard/flip-chart and a projector. The resources are accessible offline for use when electricity or Internet is lacking. Teachers preferred the projector mode, as it provided structure and a focal point for class attention. Feedback was largely positive, with teachers and students appreciating the learning and experiencing it as relevant. Four main challenges included time to teach lessons; incorrect comprehension; identifying suitable examples; and technical, logistical, and behavioural challenges with a student-computer mode that we piloted. We resolved challenges by simplifying and combining lessons; increasing opportunities for review and assessment; developing teacher training materials, creating a searchable set of examples; and deactivating the student-computer mode. Conclusion: Using a human-centred design approach, we created digital resources for teaching secondary school students to think critically about health actions and for training teachers. Be smart about your health resources are open access and can be translated or adapted to other settings.

Early parental loss in childhood and depression in adults: A systematic review and meta-analysis of case-controlled studies.

BACKGROUND: Many researchers have concluded that early parental loss during childhood is a risk factor for depression in late life of adults; however others didn't find any association. The objective of this systematic review is to assess whether this association exists or not by conducting a meta-analysis of published studies. METHODS: Nine published case-controlled studies were chosen through literature searches in PUBMED, and LIBRARY GENESIS. Newcastle-Ottawa Scale (NOS) have been used to assess the quality of studies included. Thereafter, data were extracted from each study and analysed using ProMeta. RESULTS: Nine case-controlled studies (representing n = 2784, cases=716 and controls=2068) were included in meta-analysis. The overall random effects model results of parental loss [OR = 2.18, 95% CI, 1.63-2.90, p < 0.00; I2 = 15.79%, df = 8, p = 0.302], parental death [OR = 1.76, 95% CI, 1.13-2.73, p = 0.012; I2 = 0.00%, df = 3, p = 0.600] and parental separation [OR = 3.14, 95% CI, 1.92-5.15, p < 0.001; I2 = 0.00%, df = 2, p = 0.675] showed a strong positive effect on developing depression in adults. Egger's linear regression test [t = 0.14, p = 0.895] and Begg and Mazumdar's rank correlation test [z = 0.63, p = 0.532] confirmed absence of publication bias of studies included in this meta-analysis. LIMITATIONS: This systematic review was limited by a small number of case-controlled studies included in meta-analysis due to the differences in methodological designs of studies. CONCLUSION: The study concluded that parental loss, parental death, and parental separation before age 18 are risk factors of depression in adulthood.