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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)

Table of excluded studies for a Cochrane review

Introduction To help students think critically about health information and decisions, we developed the Informed Health Choices (IHC) secondary school intervention. We are evaluating the intervention in cluster-randomised trials, and linked process evaluations, in Kenya, Rwanda, and Uganda. The study planned herein is a qualitative evidence synthesis (QES), using data about experiences and views of adverse effects from all three process evaluations. The QES overlaps with the process evaluations. The QES will allow us to comprehensively explore, report, and discuss experiences and views of potential adverse effects, and potential mechanisms. The findings are intended to help inform decisions about whether or how to redevelop, re-evaluate, or implement the intervention. The methods and findings might also be helpful to developing, evaluating, or implementing other educational interventions—especially interventions intended to improve critical thinking, within health or other fields. Objective Explore participants’ and investigators’ experiences and views of potential adverse effects of the IHC secondary school intervention, and potential mechanisms of those effects. Methods An independent researcher will assess methodological limitations of the included studies, based on a list of domains used by the Cochrane Effective Practice and Organisation of Care (EPOC) group. We will merge and modify framework analysis as outlined by Ritchie and Spencer, framework synthesis as described by Barnett-Page et al., and “best fit” framework synthesis as outlined by Carrol et al. All three are pragmatic approaches with a deductive analysis using an a priori framework, followed by an inductive thematic analysis. We will note possible differences in how participants generally conceptualise adverse effects of educational interventions, compared to the study team, and possible differences in adverse effects across trial settings, for the purposes of future research. To assess confidence in the synthesis findings, we will apply the Grading of Recommendations Assessment, Development and Evaluation Confidence in Evidence from Reviews of Qualitative research (GRADE-CERQual) approach, using the interactive Summary of Qualitative Findings (iSoQ) tool. We will produce a Qualitative Evidence Profile, and Summary of Qualitative Findings Tables. Discussion The QES and the process evaluations overlapping and being part of the same project has methodological implications that amount to both strengths and limitations. Like in prospective meta-analyses, when planning the process evaluations, we harmonised the objectives, facilitating synthesis, while investigators in each setting still had autonomy to explore phenomena specifically for their study. Like individual patient data (IDP) meta-analyses, this study will be based on data from the process evaluations, facilitating more reliable analysis and synthesis than if it was only based on reported findings. As far as we are aware, this QES will be the first of its kind methodologically, and first empirical study of its size and rigour focusing on potential adverse effects of an educational intervention. The QES and process evaluations overlapping and being part of the same project also introduces risk of bias. Another challenge is that we are including the study team’s experiences and views. In general, to address these challenges, we will be transparent, and apply reflexivity throughout.

Additional file 1.

Background We designed the “Be smart about your health” digital resources to teach lower secondary school students how to assess the trustworthiness of claims about the effects of treatments. We shall evaluate effects of using these resources in a randomised trial in Uganda. This paper describes the process evaluation that will be conducted alongside this trial. The aim is to identify factors affecting the implementation, fidelity, effects, and scaling up use of the Be smart about your health teaching resources in Uganda and potential adverse and beneficial effects of the intervention. Methods Forty teachers from 40 schools in the intervention arm of the trial will complete a lesson evaluation questionnaire after each of the 10 lessons and at the end of the term. We will conduct structured classroom observations at all 40 schools. We will purposively select eight schools where we will conduct focus group discussions with teachers and students. We also will conduct key informant interviews among education officers (that visit the schools to monitor the implementation), teachers, head teachers, learners, and their parents. We will use a framework analysis approach to analyse the data. Expected results We anticipate that the findings from this evaluation will provide insights into factors that may impact the effectiveness of using the Be smart about your health resources, factors that can inhibit or facilitate scaling up use of the resources, and potential effects that were not measured quantitatively after the intervention, including transfer of what was learned to other contexts and adverse effects.

Background: People frequently make decisions about what can improve their health. They do this based on large amounts of information that they get from different sources, which include claims about what harms or improves health. People therefore need skills to assess the trustworthiness of health claims. The Informed Health Choices (IHC) Key Concepts framework was used to develop the ‘Be Smart about your Health’ secondary school resources to help students in lower secondary to assess health claims about the effects of treatments. We are evaluating these resources in a cluster randomized trial in 80 lower secondary schools in Kenya. This protocol is for a process evaluation that will be conducted alongside the trial. The objective of this evaluation is to explore the extent to which the intervention was delivered as planned; understand factors that facilitated or hindered the delivery and impact of the resources; and antici-pated and unanticipated effects. Study design: We will employ a mixed-methods design using quantitative and qualita-tive data. We will collect quantitative data from all schools (n=40) allocated to the in-tervention arm using lesson evaluation forms. Our qualitative data collection will in-clude: (a) structured classroom observations in all schools (n=40), with at least one lesson observed in each school. In a sample of eight schools, we shall observe more than one lesson. (b) We will conduct focus group discussions (with students (n=4), teachers (n=1) and parents (n=4). (c) Key informant interviews with policymakers in education (n=5), teachers (n=8), and with school principals (n=8)). We will purposively select these schools based on location (urban and rural) and ownership (private and public). Data analysis: We will use framework analysis to analyze qualitative data and descrip-tive analysis to analyze quantitative data. We will summarize and appraise the confi-dence of the key findings from the qualitative data using a modified version of the GRADE-CERQual approach.

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.