Effects of the Informed Health Choices secondary school intervention: A prospective meta-analysis

Abstract

Aim: The aim of this prospective meta-analysis was to synthesize the results of three cluster-randomized trials of an intervention designed to teach lower-secondary school students (age 14–16) to think critically about health choices. Methods: We conducted the trials in Kenya, Rwanda, and Uganda. The intervention included a 2- to 3-day teacher training workshop, digital resources, and ten 40-min lessons. The lessons focused on nine key concepts. We did not intervene in control schools. The primary outcome was a passing score on a test (≥9 of 18 multiple-choice questions answered correctly). We performed random effects meta-analyses to esti- mate the overall adjusted odds ratios. Secondary outcomes included effects of the intervention on teachers. Results: Altogether, 244 schools (11,344 students) took part in the three trials. The overall adjusted odds ratio was 5.5 (95% CI: 3.0–10.2; p < 0.0001) in favor of the inter- vention (high certainty evidence). This corresponds to 33% (95% CI: 25–40%) more students in the intervention schools passing the test. Overall, 3397 (58%) of 5846 stu- dents in intervention schools had a passing score. The overall adjusted odds ratio for teachers was 13.7(95% CI: 4.6–40.4; p < 0.0001), corresponding to 32% (95% CI: 6%– 57%) more teachers in the intervention schools passing the test (moderate certainty evidence). Overall, 118 (97%) of 122 teachers in intervention schools had a passing score. Conclusions: The intervention led to a large improvement in the ability of students and teachers to think critically about health choices, but 42% of students in the intervention schools did not achieve a passing score.