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False claims about healthcare treatments are frequently made in mass media and social media, as well as shared by friends and family members. But a free online resource can help people cut through the noise and make informed decisions about their treatment options.

We invited Andrew Oxman, an author of the article published in the Science Policy Research gateway on F1000research, and a member of the Informed Health Choices Group, to tell us more about this free resource, called the Informed Health Choices Key Concepts and how it can help the public.

Separating facts from fiction

Developed by researchers from Centre of Informed Health Choices, Norwegian Institute of Public Health, The Informed Health Choices (IHC) Key Concepts, is a free, online framework for identifying, developing, and evaluating resources to empower the general public to think more critically about health claims and make informed decisions about health treatments.

The set of principles was developed to include key concepts that underpin decisions the public make about their health. A refined version and a report of the changes made is available on F1000Research. 

Andy Oxman, from the Norwegian Institute of Public Health, and member of the IHC Group provided these examples of Key Concepts: “Associations are commonly incorrectly reported as causation; and benefits are exaggerated, while harms are either ignored or downplayed. This can be detrimental, resulting in overuse of ineffective or harmful treatments, and underuse of effective ones.”

Learning to think critically about health choices

The IHC Key Concepts is the first step in a research project funded by the Research Council of Norway. There are now 44 Key Concepts, compared to the original 32 when the list was first published in 2015.

The IHC created it by searching through the literature and checklists written for the public, journalists and health professionals. Andy Oxman said: “We sought feedback on the extent to which they make sense to others. We have continued to collect feedback. In addition, suggestions for improvements have come from experience using the framework, and reviewing other frameworks for teaching and learning critical thinking. Suggestions have also come from efforts to adapt the framework to other types of interventions, such as education, management, policing, and environmental interventions. Although we have received much positive feedback, we have also received many suggestions for improvements. At this time, we plan to continue updating the IHC Key Concepts yearly as long as we continue to receive suggestions for meaningful improvements.”

Children as well as adults can benefit from learning the Key Concepts

Erroneous beliefs and attitudes that develop during childhood could be resistant to change later in adult life. So, the IHC developed learning resources to teach Key Concepts to primary school children. This also has the potential to reach a large segment of the population, before they leave the education system, and to teach the concepts in a gradual and progressive way. Critical thinking is an essential skill, which is necessary for making well-informed choices about health. The IHC Key Concepts provide a framework for critical thinking about the effects of treatments (health interventions).

Because most of us are interested in health, teaching critical thinking about health claims is relevant to everyone and engages the interest of both children and adults. At the same time, the IHC Key Concepts are relevant for claims about the effects of other types of interventions. Thus, teaching people to think critically about health claims can also help them to think critically about other types of claims. A website that presents Key Concepts for other types of interventions, as well as health interventions, is under development and can be previewed here: www.thatsaclaim.org.

The primary school resources include a textbook with a comic story that introduces and explains 12 Key Concepts, instructions for classroom activities, exercises, a list of key messages, and a glossary. Meanwhile, parents are invited to listen to a podcast, which introduces them to the nine Key Concepts.

Each episode includes a short story with an example of a treatment claim, a simple explanation of a concept used to assess that claim, another example of a claim illustrating the same concept, and its corresponding explanation.

In each story there is a question about the trustworthiness of a claim, which is resolved by applying the relevant Key Concept. All episodes have a conclusion with a take-home message emphasising the concept.

Tried and tested

The IHC Group evaluated the primary school resources in 120 schools in Uganda with over 10,000 children aged 10 to 12 years old. Half of the schools were randomly allocated to use the resources and we did not intervene in the other half. There was a large improvement in the children’s ability to assess treatment claims and make informed choices (a difference of 50% in the proportion of children with a passing score on the test used to measure this). They retained what they learned for at least one year, and many children reported using what they learned in their daily lives.

Easy listening

Many of the parents in Uganda do not read well and English is a second language for most. The podcast was in both English and Luganda. It went through several versions and user testing, before the parents found it understandable and enjoyable. Listening to the podcast also had a big effect initially (a difference of 34% in the proportion of parents with a passing score), but the parents’ abilities dropped by about 1/3 after one year.

Members of the IHC Network, which includes people in about 20 different countries, are currently preparing a podcast tailored for a US audience. Other members of the Network in low, middle, and high-income countries have or are translating and contextualising the primary school resources. Somewhat surprisingly, it seems that the primary school resources can be used with minimal, if any changes.

Without delay

Andy Oxman adds: “The public has paid for this research (through the Research Council of Norway) and they should have access to the findings. Open access publishing is now a requirement for research supported by the Research Council. This was the first time we published a paper in a post publication peer review platform. The experience was fantastic, and we will be doing this more in the future. The paper was available within a week of submission, and peer reviewed, revised, and published a short time after that. All too often there are long delays with pre-publication peer review.”