Development of a framework of potential adverse effects of interventions to improve critical thinking about health choices - A mixed methods study

Sep 28, 2026

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People need critical thinking skills to make well-informed health choices and avoid waste and unnecessary suffering. Educational interventions can still generate adverse effects that are often overlooked. A mixed methods study created a framework of potential harms, aiming to identify possible effects and mechanisms to guide intervention development and evaluation in Kenya, Rwanda, and Uganda.

LanguageEnglish

CategoryHealthcare

FormatPDF

Pages25

Reading Time1 h 3 min

AccessFree to download

Background

Methods

Results

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Keywords

RESEARCH ARTICLE Development of a framework of potential adverse effects of interventions to improve critical thinking about health choices: A mixed methods study. [version 1; peer review: 2 approved] Matt Oxman 1,2, Faith Chelagat Chesire3,4, Michael Mugisha4,5, Ronald Ssenyonga4,6, Benson Ngatia3, Allen Nsangi 6, Simon Lewin 1,7,8, Jenny Moberg 1, Nelson Sewankambo6, Margaret Kaseje 3, Monica Melby-Lervåg9, Atle Fretheim 1,2, Andrew David Oxman 1, Sarah Rosenbaum 1 1Centre for Epidemic Interventions Research, Norwegian Institute of Public Health, Oslo, Norway 2 Faculty of Health Sciences, Oslo Metropolitan University, Oslo, Norway 3Tropical Institute of Community Health and Development, Kisumu, Kisumu County, Kenya 4Institute of Health and Society, University of Oslo, Oslo, Norway 5School of Public Health, University of Rwanda College of Medicine and Health Sciences, Kigali, Kigali City, Rwanda 6 Makerere University College of Health Sciences, Kampala, Central Region, Uganda 7 Faculty of Medicine and Health Sciences, Norwegian University of Science and Technology, Ålesund, Norway 8 Health Systems Research Unit, South African Medical Research Council, Cape Town, South Africa 9Centre for Research on Special Needs Education and Inclusion,, University of Oslo, Oslo, Norway v1 First published: 31 Oct 2024, 13:1303 [https://doi.org/10.12688/f1000research.158042.1](https://doi.org/10.12688/f1000research.158042.1) [Latest published:](Latest published: 31 Oct 2024)[ 31 Oct 2024](Latest published: 31 Oct 2024), 13:1303 [https://doi.org/10.12688/f1000research.158042.1](https://doi.org/10.12688/f1000research.158042.1) Abstract Background People need critical thinking skills to make well-informed health choices and avoid waste and unnecessary suffering. However, educational interventions can have adverse effects, which is often overlooked. We created a framework of potential harms of interventions to improve critical thinking about health choices. The objective was to identify potential effects and articulate potential mechanisms. We intended to use the framework to inform the development and evaluation of an intervention in Kenya, Rwanda, and Uganda. Methods Open Peer Review | Approval Status | | | --- | --- | | 1 | 2 | | version 1
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31 Oct 2024 | | 1. Anke Steckelberg, Martin-Luther-Universitat Halle-Wittenberg, Halle (Saale), Germany 2. Shelly Melissa Pranic , University of Split School of Medicine, Split, Croatia Cochrane Croatia, Split, Croatia Any reports and responses or comments on the article can be found at the end of the article. We created an initial framework drawing on two earlier frameworks. We surveyed external experts using Likert-scale and open-ended items, including researchers, educators, and others, in a variety of relevant fields. We emailed the survey to an international advisory network, and all other experts recommended by respondents. We analyzed the quantitative data using descriptive statistics. We conducted a thematic analysis of the qualitative data. We revised the framework based on those results. To identify any effects missing from the revised framework, we individually interviewed a convenience sample of one teacher from each of Kenya, Rwanda, and Uganda. Results We received responses from 38 of 70 external experts (54%) . The quantitative survey data suggested respondents agreed with the initial framework overall. However, the qualitative data led to substantial revisions. The revised framework consists of categories of adverse outcomes; outcomes within each category; sub-outcomes; individuals, groups, and populations that might experience each adverse outcome; beneficial outcomes corresponding with adverse outcomes; and potential mechanisms of adverse effects. There are six categories: decision-making harms, psychological harms, equity harms, group and social harms, waste, and other harms. In the interviews with teache

FAQs

What problem does the study address?

The study addresses that people need critical thinking for health decisions, yet educational interventions may produce adverse effects that are frequently overlooked.

How was the framework developed?

Researchers surveyed external experts using Likert-scale and open-ended items, analyzed quantitative data descriptively, and conducted thematic analysis for qualitative data; they then revised the framework accordingly and conducted interviews to check for missing effects.

What main types of adverse outcomes did the revised framework include?

The revised framework includes six categories: decision-making harms, psychological harms, equity harms, group and social harms, waste, and other harms, with corresponding beneficial outcomes and potential mechanisms.

Sep 28, 2026

Uploaded by Logic