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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.

Additional file 1. Interview guides.

Additional file 3. ICT observation checklist.

Additional file 5. COREQ checklist.

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.

Additional file 2. Structured press releases and a news service

Additional file 3. Findings from user testing the IHC podcast

Additional file 1. Idea generation and selection

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.

School authority (headteacher) Informed Consent Form â English. (DOCX 29Â kb)

Data collection form for teachers. (DOCX 15Â kb)

Consent form Podcast trial English version. (DOCX 27 kb)

SPIRIT 2013 Checklist: IHC School Trialsâ Checklist. (DOC 120Â kb)

Setting a standard for the ‘Claim 12’ and ‘Claim 9’. (DOCX 25 kb)

Research participant (teacherâ s) Informed Consent Form â English. (DOCX 27Â kb)

Setting a standard for the “Claim 12” and “Claim 9”. (DOCX 28 kb)

Safety Monitoring and Adverse Events Form. (DOCX 28Â kb)

The Claim Evaluation Tools. (PDF 997Â kb)

Consent form Podcast trial Luganda translated version. (DOCX 29 kb)

Short list of Key Concepts. (DOCX 14 kb)

Search strategy. (DOCX 30 kb)

Additional file 2: Table S1. Comparisons related to self-reported behaviours in the 1-year follow-up. Table S2. Ranges of marks and points awarded for each subject. Table S3. Exclusion criteria for self-reported behaviours. Table S4. Number of missing values for each question. Table S5. Attendance and national examinations. Table S6. Sensitivity analyses – 1-year follow-up. Table S7. Attrition, differences in test scores across strata of schools. Table S8. Intended behaviours – 1-year follow-up. Table S9. Self-efficacy. Table S10. Self-reported behaviour – awareness of treatment claims. Table S11. Self-reported behaviour – assessment of trustworthiness of treatment claims. Table S12. Consistent (correct) answers regarding certainty about treatment claims. Table S13. Self-reported behaviour – assessment of the basis of treatment claims. Table S14. Self-reported behaviour – assessment of advantages and disadvantages of treatments. Table S15. Subgroup analysis – reading skills. Table S16. Differences in reading skills. Table S17. Subgroup analysis – parent who listened to the podcast. Table S18. Exploratory analyses – P values for differences between first (end of intervention term) and second (1-year follow-up) effects. Table S19. Exploratory analyses excluding children who did not take the test both times.

Additional file 5. User Experiences of the IHC resources.

Additional file 2. Structured Observation Form- Chapter one.

Additional file 2: Table S1. Comparisons related to self-reported behaviours in the 1-year follow-up. Table S2. Ranges of marks and points awarded for each subject. Table S3. Exclusion criteria for self-reported behaviours. Table S4. Number of missing values for each question. Table S5. Attendance and national examinations. Table S6. Sensitivity analyses – 1-year follow-up. Table S7. Attrition, differences in test scores across strata of schools. Table S8. Intended behaviours – 1-year follow-up. Table S9. Self-efficacy. Table S10. Self-reported behaviour – awareness of treatment claims. Table S11. Self-reported behaviour – assessment of trustworthiness of treatment claims. Table S12. Consistent (correct) answers regarding certainty about treatment claims. Table S13. Self-reported behaviour – assessment of the basis of treatment claims. Table S14. Self-reported behaviour – assessment of advantages and disadvantages of treatments. Table S15. Subgroup analysis – reading skills. Table S16. Differences in reading skills. Table S17. Subgroup analysis – parent who listened to the podcast. Table S18. Exploratory analyses – P values for differences between first (end of intervention term) and second (1-year follow-up) effects. Table S19. Exploratory analyses excluding children who did not take the test both times.

Additional file 4. Prototyping.

Additional file 1. Overview of the development

Additional file 2. Structured Observation Form- Chapter one.

Additional file 4. Prototyping.