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Randomized Controlled Trial
. 2025 May 15;26(1):160.
doi: 10.1186/s13063-025-08779-w.

What is the effect of the Informed Health Choices secondary school intervention on the ability of students in Rwanda to think critically about health choices after one-year follow-up? A cluster-randomized trial

Michael Mugisha  1   2 , Laetitia Nyirazinyoye  3 , Dieudonne Kayiranga  4 , Clarisse Marie Claudine Simbi  3 , Faith Chesire  5   6 , Ronald Senyonga  5   7 , Matt Oxman  8   9 , Allen Nsangi  7 , Christopher James Rose  8 , Jenny Moberg  8 , Astrid Dahlgren  9 , Margaret Kaseje  6 , Simon Lewin  8   10   11 , Nelson K Sewankambo  7 , Sarah Rosenbaum  8 , Andrew D Oxman  8
Affiliations
Randomized Controlled Trial

What is the effect of the Informed Health Choices secondary school intervention on the ability of students in Rwanda to think critically about health choices after one-year follow-up? A cluster-randomized trial

Michael Mugisha et al. Trials. .

Abstract

Aim: The aim of this study was to evaluate the effects of the Informed Health Choices secondary school intervention on the ability of students in Rwanda to think critically and make informed health choices after 1 year.

Methods: This was a two-arm cluster-randomized trial conducted in 84 lower secondary schools from 10 districts representing five provinces of Rwanda. We used stratified randomization to allocate schools 1:1 to the intervention or control arm. 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 1 year after the intervention. We conducted an intention to treat analysis using generalized linear mixed models, accounting for the cluster design using random intercepts.

Results: After 1 year, 35 of 42 teachers (83.3%) and 1181 of 1556 students (75.9%) in the control arm completed the test. In the intervention arm, 35 of 42 teachers (83.3%) and 1238 of 1572 students (78.8%) completed the test. The proportion of students who had a passing score in the intervention arm was 625/1238 (50.5%) compared to 230/1181 (19.5%) in the control arm (adjusted odds ratio 7.6 [95% CI: 4.6-12.6], p < 0.0001). The adjusted difference in the proportion of students with a passing score was 32.2% (95% CI 24.5-39.8%).

Conclusions: The IHC secondary school intervention was effective after 1 year. However, the size of the effect was smaller than immediately after the intervention (adjusted difference 32.2% vs 37.2%) due to decay in the proportion of students in intervention schools with a passing score (50.5% vs 58.2%).

Trial registration: Pan African Clinical Trial Registry (PCTR), trial identifier: PACTR202203880375077. Registered on February 15, 2022.

Keywords: Adolescents; Critical health literacy; Health literacy; Informed health choices; Rwanda.

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Conflict of interest statement

Declarations. Ethics approval and consent to participate: This research sought ethical approval from the Rwanda National Ethics Committee (RNEC) (Approval No. 1019/RNEC/2020 and subsequent amendments No. 41/RNEC/2022 and No. 236/RNEC/2022). Before data collection, we obtained permission to conduct the study in schools from the Rwanda Basic Education Board and the Ministry of Local Government in Rwanda. All the participants signed a consent form and students under 18 years signed assent forms. Competing interests: MM, LN, CMCS, FC, RS, MO, AN, DS, JM, MK, SL, NKS, SER, and ADO both developed and evaluated the intervention.

Figures

Fig. 1
Fig. 1
Flow diagram of study participants in 1-year follow-up trial
Fig. 2
Fig. 2
Results for each key concept covered in the 1-year follow-up trial. p < 0.0001 for all comparisons. 1Number (%) of students answering both MCQs correctly. 2Adjusted odds ratios are re-expressed as adjusted risk differences. 3Intraclass correlation coefficient
See this image and copyright information in PMC

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