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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.",{"@graph":14,"@context":73},[15,34,56],{"@type":16,"itemListElement":17},"BreadcrumbList",[18,23,27,31],{"item":19,"name":20,"@type":21,"position":22},"https://docshare.wps.com","Home","ListItem",1,{"item":24,"name":25,"@type":21,"position":26},"https://docshare.wps.com/document/","Document",2,{"item":28,"name":29,"@type":21,"position":30},"https://docshare.wps.com/document/healthcare/","Healthcare",3,{"item":32,"name":10,"@type":21,"position":33},"https://docshare.wps.com/document/development-of-a-framework-of-potential-adverse-effects-of-interventions-to-improve-critical-thinking-about-health-choices-a-mixed-methods-study/408877/",4,{"url":32,"name":10,"@type":35,"image":36,"author":41,"headline":10,"publisher":44,"fileFormat":47,"inLanguage":8,"description":12,"dateModified":48,"datePublished":49,"encodingFormat":47,"isAccessibleForFree":50,"interactionStatistic":51},"DigitalDocument",{"url":37,"@type":38,"width":39,"height":40},"https://docshare.wps.com/thumbnails/development-of-a-framework-of-potential-adverse-effects-of-interventions-to-improve-critical-thinking-about-health-choices-a-mixed-methods-study/408877.png","ImageObject",300,407,{"name":42,"@type":43},"Logic","Person",{"url":19,"name":45,"@type":46},"DocShare","Organization","application/pdf","2026-10-29","2026-09-28",true,{"@type":52,"interactionType":53,"userInteractionCount":55},"InteractionCounter",{"@type":54},"ViewAction",5,{"@type":57,"mainEntity":58},"FAQPage",[59,65,69],{"name":60,"@type":61,"acceptedAnswer":62},"What problem does the study address?","Question",{"text":63,"@type":64},"The study addresses that people need critical thinking for health decisions, yet educational interventions may produce adverse effects that are frequently overlooked.","Answer",{"name":66,"@type":61,"acceptedAnswer":67},"How was the framework developed?",{"text":68,"@type":64},"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.",{"name":70,"@type":61,"acceptedAnswer":71},"What main types of adverse outcomes did the revised framework include?",{"text":72,"@type":64},"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.","https://schema.org",{"og:url":32,"og:type":75,"og:title":10,"og:site_name":45,"og:description":12},"article",{"robots":77,"canonical":32},"index,follow",{"doc_id":79,"site_id":7},408877,1791448246,{"code":4,"msg":82,"data":83},"success",[84,88,92,96,100,105,109,114,119,122,126],{"id":22,"doc_module":4,"doc_module_name":25,"category_name":85,"show_sort_weight":86,"slug":87},"Story & Novel",90,"story-novel",{"id":26,"doc_module":4,"doc_module_name":25,"category_name":89,"show_sort_weight":90,"slug":91},"Literature",80,"literature",{"id":33,"doc_module":4,"doc_module_name":25,"category_name":93,"show_sort_weight":94,"slug":95},"Exam",70,"exam",{"id":55,"doc_module":4,"doc_module_name":25,"category_name":97,"show_sort_weight":98,"slug":99},"Comic",60,"comic",{"id":101,"doc_module":4,"doc_module_name":25,"category_name":102,"show_sort_weight":103,"slug":104},6,"Technology",50,"technology",{"id":106,"doc_module":4,"doc_module_name":25,"category_name":29,"show_sort_weight":107,"slug":108},7,40,"healthcare",{"id":110,"doc_module":4,"doc_module_name":25,"category_name":111,"show_sort_weight":112,"slug":113},8,"Research & Report",30,"research-report",{"id":115,"doc_module":4,"doc_module_name":25,"category_name":116,"show_sort_weight":117,"slug":118},9,"Religion & Spirituality",20,"religion-spirituality",{"id":117,"doc_module":4,"doc_module_name":25,"category_name":120,"show_sort_weight":117,"slug":121},"World Cup","world-cup",{"id":123,"doc_module":4,"doc_module_name":25,"category_name":124,"show_sort_weight":123,"slug":125},10,"Lifestyle","lifestyle",{"id":127,"doc_module":4,"doc_module_name":25,"category_name":128,"show_sort_weight":55,"slug":129},19,"General","general",{"code":4,"msg":82,"data":131},{"doc_id":79,"user_id":132,"nickname":42,"user_avatar":133,"doc_module":4,"category_id":106,"category_name":29,"doc_title":10,"doc_description":12,"doc_content":134,"file_id":135,"file_url":136,"file_type":137,"file_size":138,"view_count":55,"is_deleted":4,"is_public":22,"is_downloadable":22,"audit_status":22,"page_count":139,"language":140,"language_code":8,"site_id":7,"html_lang":8,"table_of_contents":141,"faqs":142,"seo_title":143,"seo_description":12,"update_tm":144,"read_time":145,"preview_page_count":4},1099513958762,"https://ap-avatar.wpscdn.com/avatar/1000023916a998db790?x-image-process=image/resize,m_fixed,w_180,h_180&k=1784791008015729253","RESEARCH ARTICLE  \nDevelopment of a framework of potential adverse effects of interventions to improve critical thinking about health choices: A mixed methods study.  \n[version 1; peer review: 2 approved]  \nMatt Oxman 1,2, Faith Chelagat Chesire3,4, Michael Mugisha4,5,  \nRonald Ssenyonga4,6, Benson Ngatia3, Allen Nsangi 6, Simon Lewin 1,7,8,  \nJenny Moberg 1, Nelson Sewankambo6, Margaret Kaseje 3,  \nMonica Melby-Lervåg9, Atle Fretheim 1,2, Andrew David Oxman 1, Sarah Rosenbaum 1  \n1Centre for Epidemic Interventions Research, Norwegian Institute of Public Health, Oslo, Norway  \n2 Faculty of Health Sciences, Oslo Metropolitan University, Oslo, Norway  \n3Tropical Institute of Community Health and Development, Kisumu, Kisumu County, Kenya  \n4Institute of Health and Society, University of Oslo, Oslo, Norway  \n5School of Public Health, University of Rwanda College of Medicine and Health Sciences, Kigali, Kigali City, Rwanda  \n6 Makerere University College of Health Sciences, Kampala, Central Region, Uganda  \n7 Faculty of Medicine and Health Sciences, Norwegian University of Science and Technology, Ålesund, Norway  \n8 Health Systems Research Unit, South African Medical Research Council, Cape Town, South Africa  \n9Centre for Research on Special Needs Education and Inclusion,, University of Oslo, Oslo, Norway  \nv1  \nFirst published: 31 Oct 2024, 13:1303  \n[https://doi.org/10.12688/f1000research.158042.1](https://doi.org/10.12688/f1000research.158042.1)  \n[Latest published:](Latest published: 31 Oct 2024)[ 31 Oct 2024](Latest published: 31 Oct 2024), 13:1303  \n[https://doi.org/10.12688/f1000research.158042.1](https://doi.org/10.12688/f1000research.158042.1)  \nAbstract  \nBackground  \nPeople 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.  \nMethods  \nOpen Peer Review  \n\n| Approval Status  |  |\n| --- | --- |\n| 1 | 2 |\n| version 1  \u003Cbr>view view\u003Cbr>31 Oct 2024 |  |\n\n1. Anke Steckelberg, Martin-Luther-Universitat Halle-Wittenberg, Halle (Saale), Germany  \n2. Shelly Melissa Pranic , University of Split School of Medicine, Split, Croatia Cochrane Croatia, Split, Croatia  \nAny reports and responses or comments on the  \narticle can be found at the end of the article.  \nWe 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.  \nResults  \nWe 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","cbCaiaweKMn8pfdj","https://ap.wps.com/l/cbCaiaweKMn8pfdj","pdf",444886,25,"English","# Background\n# Methods\n# Results\n# Conclusions\n# Keywords","[{\"question\":\"What problem does the study address?\",\"answer\":\"The study addresses that people need critical thinking for health decisions, yet educational interventions may produce adverse effects that are frequently overlooked.\"},{\"question\":\"How was the framework developed?\",\"answer\":\"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.\"},{\"question\":\"What main types of adverse outcomes did the revised framework include?\",\"answer\":\"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.\"}]","Development of a framework of potential adverse effects of interventions to improve critical thinking about health choices - A mixed methods study | PDF",1790580845,63]