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Contains fulltext : 290937.pdf (Publisher’s version ) (Open Access) The increasing life expectancy leads to more older adults suffering from infectious diseases. Vaccines are available against diverse infections such as influenza, pneumococcal disease, herpes zoster and tetanus. However, vaccine acceptance is crucial for optimal preventive effect. The objective of the study is to perform a cross-country analysis of the perceptions and decision-making behaviour of older adults regarding vaccinations and their information needs. Focus groups with older adults were conducted in four countries: France, Hungary, Italy and the Netherlands. Data were analysed using thematic analysis. Demographic characteristics of participants were gathered with a questionnaire. Influenza and tetanus vaccines were commonly known, as was the disease influenza. On the contrary, the awareness of the vaccines against pneumococcal disease and herpes zoster were low. Participants also expressed a need for more information on vaccines, such as possible side effects, contra-indications and duration of protection, emphasizing that information is a condition for decision-making on vaccination. General practitioners were found to be the most important in information provision on vaccines. Perceptions on vaccines, such as effectiveness, side effects and safety, as well as perceptions on infectious diseases, such as severity, susceptibility and experiencing an infectious disease, played a role in the decision-making of older adults on vaccines. More awareness of the information needs among older adults with regard to vaccines should be raised among general practitioners and other healthcare providers. This requires appropriate knowledge about the vaccines among healthcare providers as well as communication skills to meet the information needs of older adults. 01 april 2023

Background: Cochrane’s mission is to promote evidence-informed health decision making by producing high-quality, relevant, accessible systematic reviews. But Cochrane Reviews are long and complex, posing difficulties for both review users and review producers. Goal 2 in the Cochrane Strategy to 2020 is to make Cochrane evidence accessible and useful to everybody, everywhere in the world. For Cochrane intervention reviews to be accessible to people making decisions, users need to be able to quickly find the information they need and to understand that information. What we did: From October 2017 to December 2018, we developed a prototype of a new interactive format for intervention reviews that would make them easier to navigate and understand for both expert and non-expert target audiences, as well as less time consuming for authors and editors to write and peer review. We reviewed evidence about presenting findings from systematic reviews and drew on our own experience. We used a human-centred design approach, which entailed cycles of prototype development, feedback collection, and analysis, and idea-generation. We collected feedback from a wide range of stakeholders, through queries to an Advisory Group, individual user-test interviews, and meetings at Cochrane events where we presented and discussed prototypes. Acknowledgements This project was initiated by Sasha Sheppard and Simon Lewin from the EPOC satellite in Norway, and funded by the Norwegian Institute of Public Health. The following working group from EPOC managed and carried out the project: Sarah Rosenbaum, Andy Oxman, Newton Opiyo, Simon Lewin, Claire Glenton and Sasha Sheppard. Nandi Siefried re-wrote four example reviews. Appendices 4, 5, 6, 7, and 13 are excel files. They are available on request to the corresponding author (saro@fhi.no)

Additional file 1.

The intervention Complexity Assessment Tool for Systematic Reviews (iCAT_SR) has been developed to facilitate detailed assessments of intervention complexity in systematic reviews.2 This study aimed to assess, using the iCAT_SR, the complexity of interventions aimed at improving appropriate polypharmacy in older people, as reported in studies (n = 20) included in the update of a Cochrane review. Interventions were assessed independently by two authors using the six core iCAT_SR domains: (1) ‘Active intervention components’; (2) ‘Target behaviour/actions’; (3) ‘Target organisational levels/categories’; (4) ‘Degree of tailoring’; (5) ‘Level of skill required by intervention deliverers’; (6) ‘Level of skill required by intervention recipients’.2 Attempts were made to apply the tool’s four optional domains: ‘Interaction between intervention components’; ‘Context/setting’; ‘Recipient/provider factors’; ‘Nature of causal pathway’. Disagreements were resolved by consensus discussion. The findings demonstrate that interventions in this area often comprise multiple components and target behaviours. Intermediate to high level skills were typically required by those delivering and receiving the interventions. A lack of detailed reporting in study reports precluded consistent application of the iCAT_SR’s optional domains. This study provides the first detailed assessment of complexity for interventions aimed at improving appropriate polypharmacy in older people. Further work is needed to determine if application of the iCAT_SR can help to determine whether varying levels of complexity impact on the effectiveness of interventions aimed at improving appropriate polypharmacy in older people.

As noted in the protocol, we planned to assess potential adverse effects and use of what was learned in daily life (far transfer) in the one-year follow-up studies. This addendum to the protocol describes how we will do this.

Background: Many people find it difficult to make decisions about what to believe or do regarding “health actions” (things that they can do to care for their health or the health of others). To avoid being misled by unreliable information and to make good choices, people must be able to understand and apply some basic principles (concepts). The Informed Health Choices (IHC) secondary school resources are designed to help students learn and use nine of these concepts. This is a protocol for a prospective meta-analysis of three cluster-randomized trials in Kenya, Rwanda, and Uganda. Objective: To estimate the effect of using the IHC secondary school resources in addition to the standard curriculum compared to the standard curriculum in the context where the trial is conducted) on students’ ability to think critically about health actions. Methods: The participants are lower secondary school students (age 14-16) and their teachers. The intervention is a 2-3-day teacher training workshop, a teachers’ guide, and 10 40-minute lessons taught to the students during a single school term. The comparison is the standard curriculum in each country. The primary outcome measure is the Critical Thinking about Health (CTH) Test. The test is a measure of an individual’s ability to understand and apply the nine key critical thinking concepts included in the lessons. It includes two multiple-choice questions for each concept. The primary outcome is the proportion of students with a passing score on the test. Secondary outcomes include the average score on the test, the proportion of students with a score that indicates mastery of the nine concepts, retention of what the students learned after one year, self-efficacy, intended behaviours, performance on standard, end-of-term examinations, and teachers’ ability to understand and apply the nine concepts measured using the CTH Test. Overall effects will be estimated using inverse variance methods. We will use mixed effects models with individual student data to estimate variation in effects for the primary and first two secondary outcomes in relation to three potential effect modifiers: use of a projector version compared to a blackboard version of the lessons, class size, and student performance on end-of-term examinations prior to the intervention. Strengths and limitations: Strengths of this meta-analysis are that it is prospective, allowing for collaboration on the design of the trials and certainty that all eligible trials have been included. A limitation is that the review authors are both developing and evaluating the intervention, although there are efforts to minimise bias.

Background: Young people are exposed to many claims about the effects of things they can do to protect or improve health. To make good health choices, they need the ability to assess the reliability of those claims critically. Critical thinking is a core competence in the Rwandan secondary school curriculum and in many countries. However, critical thinking about health is rarely taught in Rwanda. Digital secondary school resources for critical thinking about health can potentially address this gap and if published be widely disseminated at low cost. The objective of the planned study is to evaluate the effects of using digital secondary school resources to help students learn to think critically about health. Methods: We will conduct a two-arm cluster-randomized trial. We will randomly select 84 lower secondary schools from 10 districts representing all five provinces of Rwanda. Using stratified random allocation, we will assign 84 schools to the intervention or control arm. Schools in the intervention arm will teach 10-lessons after teacher training on the content of the secondary school resources. Schools in the control arm will not receive any training and resources. They will carry on with teaching the national curriculum. The primary outcome will be the proportion of students with a predetermined passing score on a test with multiple-choice questions from the Claim Evaluation Tools item bank. The questions measure the ability to apply key concepts related to assessing health claims and making informed health choices. The test will include two questions addressing each of the nine concepts covered by the secondary school resources. Discussion: This is one of three randomized trials to assess the effects of the Informed Health Choices secondary school resources in Rwanda, Kenya, and Uganda. The findings will inform decisions about how to promote critical thinking about health. Trial registration: Pan African Clinical Trial Registry, trial identifier: PACTR202203880375077, Registered on 15th February 2022.

Background To make well-informed choices, people must possess skills to assess the trustworthiness of health-related claims. It is important that young people learn to assess the reliability of claims to inform decisions, both when making their own choices and as citizens participating in a democracy. This trial aims to evaluate the effect of the Informed Health Choices (IHC) teaching resources on secondary school students’ ability to assess health-related claims and make informed choices. Methods This will be a two-arm cluster-randomised trial. We will randomise 80 lower secondary schools to evaluate the IHC secondary school digital teaching resources. The resources for teachers include 10 lessons to be delivered in a single school term, using lesson plans developed for classrooms equipped with only a blackboard or with a projector. Teachers in the intervention arm will be invited to a three-day teacher training workshop. Teachers in the control schools will continue teaching the national curriculum. Uganda’s National Curriculum Development Centre introduced a new competence-based curriculum in 2020. This curriculum has critical thinking as one of seven generic skills to be taught across all subjects. The curriculum does not explicitly include critical thinking about health. The IHC lessons address nine prioritised key concepts. We will use multiple choice questions – two for each key concept - to evaluate the student’s ability to assess claims and make informed choices. We will measure the proportion of students with a passing score at the end of the school term, and again after one year to assess retention of what was learned. Expected results Based on previous work done in Ugandan primary schools, we anticipate that the use of the teaching resources will lead to a large improvement in the lower secondary school students’ ability to assess claims and make informed health choices.

Background The COVID-19 pandemic has led to an increased interest in communication with the public regarding vaccination. Our recent Cochrane qualitative evidence synthesis points to several factors that could influence the implementation and success of healthcare worker communication with older adults about vaccination. However, it is often difficult to assess whether factors identified as potentially important in qualitative studies have been considered in randomized trials because of poor trial reporting. We therefore decided to use our qualitative evidence synthesis findings to encourage better reporting of vaccination communication interventions in trials by developing an elaboration of the TIDieR (Template for Intervention Description and Replication) checklist for intervention reporting. Methods We examined the findings from our Cochrane qualitative evidence synthesis on healthcare workers’ perceptions of and experiences with communicating about vaccination with adults over the age of 50 years. We identified factors that could influence the implementation and uptake, and thereby the effectiveness, of vaccination communication interventions. We then drafted a list of the information elements we would need from trial reports to assess whether these factors had been considered in the development of the interventions evaluated in these trials. Finally, we compared our list of information elements to the TIDieR checklist items. We were able to align all of our information elements with the TIDieR items. However, for several of the TIDieR items, we developed a more detailed description to ensure that relevant information would be captured sufficiently in trial reports. Results We developed elaborations for the following TIDieR items: “Why” (item 2), “What—materials” (item 3), “Who provided” (item 5), “How” (item 6), “Where” (item 7) and “Tailoring” (item 9). Conclusions Both qualitative research and trials of intervention effectiveness are critical to furthering our understanding of what works, where, for whom and through which mechanisms. However, a key ingredient for developing this understanding is adequate reporting of intervention design, content and implementation in randomized trials. We hope that this elaboration of the TIDier checklist will improve reporting of interventions in trials focused on vaccine communication with older adults, and thereby enhance the usability of this research for developing future communication strategies.

Additional file 2. Intervention complexity assessments based on the iCAT_SR tool.

Additional file 1. Interview guides.

Additional file 1. Data extraction form.

Additional file 3. ICT observation checklist.

Additional file 5. COREQ checklist.

Additional file 1. Bacterial composition of the core microbiota.

Additional file 1. Additional tables.

This is a protocol for a Cochrane Review (qualitative). The objectives are as follows: To explore healthcare workers' perceptions and experiences of communication between themselves and older adults about vaccination. publishedVersion

Additional file 2: Table S1. Results for each concept one year after listening to the podcast. Table S2. Intended behaviours. Table S3. Self-efficacy. Table S4. Self-reported behaviour - awareness of treatment claims. Table S5. Self-reported behaviour - assessment of the basis of treatment claims. Table S6. Self-reported behaviour - assessment of trustworthiness of treatment claims. Table S7. Self-reported behaviour - assessment of advantages and disadvantages of treatments. Table S8. Subgroup analyses - education. Table S9. Subgroup analyses - child in school that used IHC primary school resources. Table S10. Effect of IHC primary school resources on parents.

Additional file 3. Prioritisation of Key Concepts.

Additional file 3. Distribution of scores and curves.

Additional file 1. The claim evaluation tools.

Additional file 1. The Claim Evaluation Tools.

PRISMA-ScR Checklist. (PDF 82 kb)

Additional file 2. Structured press releases and a news service

List of reviews excluded where no full-text was available. (PDF 23 kb)

Summary of the results of each review, in relation to the scoping overview objectives. (PDF 59 kb)

Full search strategy. (PDF 13 kb)

Table of funding and conflicts of interest as reported in the reviews. (PDF 38 kb)

Supplementary_file_-_Lay_health_worker_role_description for The lay health worker–patient relationship in promoting pulmonary rehabilitation (PR) in COPD: What makes it work? by Gill Gilworth, Simon Lewin, Alison J Wright, Stephanie JC Taylor, Rachel Tuffnell, Lauren Hogg, Nicholas S Hopkinson, Sally J Singh and Patrick White in Chronic Respiratory Disease

Table S4. Supplementary information: explanatory notes for Phases 3-6 to accompany Part 2 of the guidance. (DOCX 88 kb)

Table of funding and conflicts of interest as reported in the reviews. (PDF 38 kb)

Summary of the results of each review, in relation to the scoping overview objectives. (PDF 59 kb)

Plain language summary of the overview. (PDF 37 kb)

Search strategy. (DOCX 14 kb)

Criteria for assessing the reliability of included reviews. (PDF 66 kb)

Criteria for assessing the reliability of included reviews. (PDF 66 kb)

File S1. Supplementary information: the eMERGe project research design & methods. (DOCX 184 kb)

Additional file 3. Findings from user testing the IHC podcast

List of reviews excluded where no full-text was available. (PDF 23 kb)

Applicability of the evidence to LMICs, with explanations of assessments. (PDF 56 kb)

Overview of sampling stage and contribution to findings for primary studies included in the Qualitative Evidence Synthesis . This table presents an overview of each of the primary studies included in the qualitative evidence synthesis, the stage at which they were sampled and how many findings each study contributes to. (DOCX 13 kb)

Study characteristics addressed in the CERQual concept of relevance. This table presents the different study charachteristics that can be addresses when applying the CERQual concept of relevance. (DOCX 16 kb)

File S2. Supplementary information: A. 57 publications included in the systematic review for â Stage1 Identification of Standardsâ and B. Publications contributing to development of reporting criteria. (DOCX 299 kb)

Additional file 1. Idea generation and selection

List of excluded reviews assessed in full-text with reasons for exclusion. (PDF 47 kb)

Applicability of the evidence to LMICs, with explanations of assessments. (PDF 56 kb)

File S3. Supplementary information: the sample of 29 published meta-ethnographies analysed in â Stage 2 Development and Application of Standardsâ . (DOCX 27 kb)

List of excluded reviews assessed in full-text with reasons for exclusion. (PDF 47 kb)

Individual AMSTAR 2 assessments. (PDF 770 kb)

The objective of this research was to design mass media resources to enable the public to assess the trustworthiness of claims about the effects (benefits and harms) of treatments, and make appropriate health choices.