Learning to think critically about health using digital technology in Ugandan lower secondary schools: A contextual analysis

Abstract

Introduction The world is awash with claims about the effects of health interventions. Many of these claims are untrustworthy because the bases are unreliable. Acting on unreliable claims can lead to waste of resources and poor health outcomes. Yet, most people lack the necessary skills to appraise the reliability of health claims. The Informed Health Choices (IHC) project aims to equip young people in Ugandan lower secondary schools with skills to think critically about health claims and to make good health choices by developing and evaluating digital learning resources. To ensure that we create resources that are suitable for use in Uganda’s secondary schools and can be scaled up if found effective, we conducted a context analysis. We aimed to better understand opportunities and barriers related to demand for the resources, how the learning content overlaps with existing curriculum and conditions in secondary schools for accessing and using digital resources, in order to inform resource development. Methods We used a mixed methods approach and collected both qualitative and quantitative data. We conducted document analyses, key informant interviews, focus group discussions, school visits, and a telephone survey regarding information communication and technology (ICT). We used a nominal group technique to obtain consensus on the appropriate number and length of IHC lessons that should be planned in a school term. We developed and used a framework from the objectives to code the transcripts and generated summaries of query reports in Atlas.ti version 7. Findings Critical thinking is a key competency in the lower secondary school curriculum. However, the curriculum does not explicitly make provision to teach critical thinking about health, despite a need acknowledged by curriculum developers, teachers and students. Exam oriented teaching and a lack of learning resources are additional important barriers to teaching critical thinking about health. School closures and the subsequent introduction of online learning during the COVID-19 pandemic has accelerated teachers’ use of digital equipment and learning resources for teaching. Although the government is committed to improving access to ICT in schools and teachers are open to using ICT, access to digital equipment, unreliable power and internet connections remain important hinderances to use of digital learning resources. Conclusions There is a recognized need for learning resources to teach critical thinking about health in Ugandan lower secondary schools. Digital learning resources should be designed to be usable even in schools with limited access and equipment. Teacher training on use of ICT for teaching is needed.

Potential adverse effects of an educational intervention: Development of a framework

“…In school, outside of the intervention, participants have limited opportunities to learn about how to think critically about health [12–14].…”

“…As mentioned under "Work/Schoolwork-related stress", there is substantial pressure on students, teachers, and schools to prepare as much as possible for official exams [12][13][14].…”

“…We developed the intervention in Kenya, Rwanda, and Uganda [11]. To inform the development, we first studied the contexts for teaching critical thinking about health using digital resources in those countries [12][13][14]. The final intervention has two components: training teachers and providing them with digital resources.…”

“…It might be time-consuming for participants to familiarise themselves with the content of the intervention-including terminology, concepts, and teaching and learning strategiesand the design and functionality of the digital resources. Meanwhile, there is substantial pressure on students, teachers, and schools to prepare as much as possible for official exams, which do not test the ability to apply IHC Key Concepts [12][13][14].…”

Prioritisation of Informed Health Choices (IHC) Key Concepts to be included in lower-secondary school resources: a consensus study

“…Uganda introduced its new competence-based curriculum for lower-secondary schools in 2020, and Kenya has plans to introduce a new competency-based curriculum by 2024. [18][19][20] The new curricula in all three countries include critical thinking as a core competence and they include health topics. However, critical thinking about health is not explicitly included in any of the curricula, and both critical thinking and health are taught across subjects.…”