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Abstract Background Critical thinking about health choices is essential to avoid being misled by unreliable information and to use reliable information appropriately. The aim of this prospective meta-analysis was to synthesize the results of 1-year follow-up data from three cluster-randomized trials of an intervention designed to teach lower secondary school students to think critically about health choices. Only one other randomized trial has evaluated a school-based intervention to teach adolescents to think critically about health choices. That trial compared two teaching strategies to teach statistical reasoning. It did not assess long-term learning-retention. Methods We conducted the trials in Kenya, Rwanda, and Uganda. The intervention included providing a 2–3-day teacher training workshop and digital resources for ten lessons. The intervention focused on nine key concepts. We did not intervene in control schools. The primary outcome was a passing score on a test (≥ 9 of 18 multiple-choice questions answered correctly). We performed random effects meta-analyses to estimate the overall intervention effects. We calculated learning retention as the test results in the intervention schools after 1 year relative to just after the intervention, adjusted for chance. Results Altogether, 244 schools (11,344 students) took part in the three trials. Follow-up data was collected for 8298 students (73%). The overall odds ratio for the primary outcome after 1 year was 3.6 (95% CI: 1.9–7.1; p = 0.0001) in favor of the intervention, whereas it was 5.5 (95% CI: 3.0–10.2) just after the intervention. This corresponds to 25.6% (95% CI: 21.1–30.0%) more students in the intervention schools passing the test after 1 year versus 33.3% (95% CI: 28.7–37.8%) just after the intervention. Overall, 2273 (52.6%) of 4324 students in intervention schools had a passing score after 1 year compared to 3397 (58.1%) of 5846 students just after the intervention, indicating 88.3% learning retention. Conclusions One year after the intervention, we still found a positive effect on the ability of students to think critically about health choices, but 5.5% fewer students in the intervention schools had a passing score. The certainty of the evidence was also lower due to 27% of students being lost to follow-up. Trial registration The protocol for this prospective meta-analysis was registered with PROSPERO May 31, 2022, ID 336580. The three randomized trials were registered in the Pan African Clinical Trial Registry February 15, 2022, PACTR202203880375077; April 5, 2022, PACTR20220488391731; and April 14, 2022, PACTR202204861458660.

Background A multifaceted and interactive teaching approach is recommended for achieving proficiency in evidence-based practice, with critical thinking considered vital for connecting theory and practice. In this context, we advocate the strategic use of health claims in media to promote critical thinking and provide an accessible entry point to evidence-based practice for early-stage university healthcare students. Method We conducted a convergent mixed methods study, including a cross-sectional survey with structured and open-ended questions as well as focus group interviews, at the Faculty of Health Sciences, Oslo Metropolitan University, during the 2020-2021 academic year. Participants were bachelor’s students in bioengineering, physiotherapy, social education, and occupational therapy. We employed a blended learning approach, combining digital learning resources, teaching in critical assessment of health claims and evidence-based practice, and a concurrent group exam assignment centered around health news. The outcome measures included students’ experiences integrating health claims into evidence-based practice teaching and their experiences with teaching approaches, including the group exam. Results Out of 446 participants, 136 (30.5%) responded to the structured questions in the survey. In response to the open-ended questions within the survey, 109 (80.1%) of the respondents shared positive experiences about the course, while 98 (72%) suggested improvements. Additionally, 25 students participated in focus group interviews. Synthesizing the results, we found that students viewed the inclusion of health claim assessment as a useful entry point for learning evidence-based practice. In addition, both the blended learning design and the group exam were identified as contributors to a positive perception of learning outcomes from the course. Conclusions Integrating critical reflection on media health claims into evidence-based practice education, alongside a blended learning approach and a group exam, may be beneficial for educating bachelor’s healthcare students. However, further rigorous study designs are needed to assess the effect of the course on learning outcomes. Registration DOI 10.5281/zenodo.6985449

Background A multifaceted and interactive teaching approach is recommended for achieving proficiency in evidence-based practice, with critical thinking considered vital for connecting theory and practice. In this context, we advocate the strategic use of health claims in the media to promote critical thinking, complemented by a blended learning approach and a group exam. Method We conducted a convergent mixed methods study, including a cross-sectional survey with structured and open-ended questions as well as focus group interviews, at Oslo Metropolitan University, during the 2020-2021 academic year. Participants were bachelor’s students in healthcare. We employed a blended learning approach, combining digital learning resources, teaching in critical assessment of health claims and evidence-based practice, and a concurrent group exam assignment centered around media health claims. The outcome measures included students’ experiences integrating health claims into evidence-based practice teaching and their experiences with teaching approaches and the group exam. Results Out of 465 participants, 136 (29.2%) responded to the structured questions in the survey. In response to the open-ended questions within the survey, 109 (80.1%) of the respondents shared positive experiences about the course, while 98 (72%) suggested improvements. Additionally, 25 students participated in focus group interviews. Synthesizing the results, we found that students viewed the inclusion of health claim assessment as a useful entry point for learning evidence-based practice. In addition, the students identified both the blended learning design and the group exam as contributors to a positive perception of learning outcomes from the course. Conclusions Based on student feedback, integrating critical reflection on media health claims into evidence-based practice education, alongside a blended learning approach and a group exam, may be beneficial in teaching evidence-based practice to bachelor’s healthcare students. However, further rigorous study designs are needed to objectively assess the effect of the course on learning outcomes. Registration DOI 10.5281/zenodo.6985449

Background The Informed Health Choices (IHC) Key Concepts is a framework that provides a basis for developing educational resources and evaluating people’s ability to think critically about health actions. We developed the original Key Concepts framework by reviewing texts and checklists for the public, journalists, and health professionals and collecting structured feedback from an international advisory group. We revised the original 2015 framework yearly from 2016 to 2018 based on feedback and experience using the framework. The objectives of this paper are to describe the development of the framework since 2018 and summarise their basis. Methods For the 2019 version, we responded to feedback on the 2018 version. For the current 2022 version, in addition to responding to feedback on the 2019 version, we reviewed the evidence base for each of the concepts. Whenever possible, we referenced systematic reviews that provide a basis for a concept. We screened all Cochrane methodology reviews and searched Epistemonikos, PubMed, and Google Scholar for methodology reviews and meta-epidemiological studies. Results The original framework included 32 concepts in six groups. The 2019 version and the current 2022 version include 49 concepts in the same three main groups that we have used since 2016. There are now 10 subgroups or higher-level concepts. For each concept, there is an explanation including one or more examples, the basis for the concept, and implications. Over 600 references are cited that support the concepts, and over half of the references are systematic reviews. Conclusions There is a large body of evidence that supports the IHC key concepts and we have received few suggestions for changes since 2019.

Objective Most health literacy measures rely on subjective self-assessment. The Critical Thinking about Health Test is an objective measure that includes two multiple-choice questions (MCQs) for each of the nine Informed Health Choices Key Concepts included in the educational resources for secondary schools. The objective of this study was to determine cut-off scores for passing (the border between having and not having a basic understanding and the ability to apply the nine concepts) and mastery (the border between having mastered and not having mastered them).Design Using a combination of two widely used methods: Angoff’s and Nedelsky’s, a panel judged the likelihood that an individual on the border of passing and another on the border of having mastered the concepts would answer each MCQ correctly. The cut-off scores were determined by summing up the probability of answering each MCQ correctly. Their independent assessments were summarised and discussed. A nominal group technique was used to reach a consensus.Setting The study was conducted in secondary schools in East Africa.Participants The panel included eight individuals with 5 or more years’ experience in the following areas: evaluation of critical thinking interventions, curriculum development, teaching of lower secondary school and evidence-informed decision-making.Results The panel agreed that for a passing score, students had to answer 9 of the 18 questions and for a mastery score, 14 out of 18 questions correctly.Conclusion There was wide variation in the judgements made by individual panel members for many of the questions, but they quickly reached a consensus on the cut-off scores after discussions.

Background: The Informed Health Choices (IHC) Key Concepts is a framework that provides a basis for developing educational resources and evaluating people’s ability to think critically about health actions. We developed the original Key Concepts framework by reviewing texts and checklists for the public, journalists, and health professionals and collecting structured feedback from an international advisory group. We revised the original 2015 framework yearly from 2016 to 2018 based on feedback and experience using the framework. The objectives of this paper are to describe the development of the framework since 2018 and summarise their basis. Methods: For the 2019 version, we responded to feedback on the 2018 version. For the current 2022 version, in addition to responding to feedback on the 2019 version, we reviewed the evidence base for each of the concepts. Whenever possible, we referenced systematic reviews that provide a basis for a concept. We screened all Cochrane methodology reviews and searched Epistemonikos, PubMed, and Google Scholar for methodology reviews and meta-epidemiological studies. Results: The original framework included 32 concepts in six groups. The 2019 version and the current 2022 version include 49 concepts in the same three main groups that we have used since 2016. There are now 10 subgroups or higher-level concepts. For each concept, there is an explanation including one or more examples, the basis for the concept, and implications. Over 600 references are cited that support the concepts, and over half of the references are systematic reviews. Conclusions: There is a large body of evidence that supports the IHC key concepts and we have received few suggestions for changes since 2019.

Background: A starting point for evaluating the effectiveness of treatments should be to identify evidence gaps. Furthermore, such evaluations should consider the perspectives of patients, clinicians and carers to ensure relevance and potentially influence future research initiatives. Methods: Our approach, inspired by the James Lind Alliance methods, involved three steps. First, we performed a document analysis by identifying interventions and outcomes in two recently published overviews of systematic reviews, which summarised the effects of interventions for anxiety and depression in children and adolescents. Second, we surveyed children and adolescents with personal experiences of depression or anxiety as well as clinicians, and asked them to suggest treatments and outcomes associated with uncertainty. Finally, we facilitated a consensus process where clinicians and youth mental health patient representatives were invited to prioritise research uncertainties in separate consensus processes. Results: The survey included 674 respondents who reported a total of 1267 uncertainties. Independent coding by four investigators revealed 134 suggestions for treatments of anxiety, 90 suggestions for treatments of depression, 84 for outcomes of interventions for anxiety and 71 suggestions for outcomes of interventions for depression. Two separate priority setting workshops with eight clinicians and ten youth resulted in four independent top ten priority lists. Conclusion: Top ten lists of treatments and outcome domains of anxiety and depression in children and adolescents was identified by youth and clinicians. The results may influence the research agenda, and ultimately benefit patients.

Background: Few studies have evaluated the ability of the general public to assess the trustworthiness of claims about the effects of healthcare. For the most part, those studies have used self-reported measures of critical health literacy. Methods: We mailed 4500 invitations to Norwegian adults. Respondents were randomly assigned to one of four online questionnaires that included multiple-choice questions that test understanding of Key Concepts people need to understand to assess healthcare claims. They also included questions about intended behaviours and self-efficacy. One of the four questionnaires was identical to one previously used in two randomised trials of educational interventions in Uganda, facilitating comparisons to Ugandan children, parents, and teachers. We adjusted the results using demographic data to reflect the population. Results: A total of 771 people responded. The adjusted proportion of Norwegian adults who answered correctly was > 50% for 17 of the 30 Key Concepts. On the other hand, less than half answered correctly for 13 concepts. The results for Norwegian adults were better than the results for Ugandan children in the intervention arm of the trial and parents, and similar to those of Ugandan teachers in the intervention arm of the trial. Based on self-report, most Norwegians are likely to find out the basis of treatment claims, but few consider it easy to assess whether claims are based on research and to assess the trustworthiness of research. Conclusions: Norwegian adults do not understand many concepts that are essential for assessing healthcare claims and making informed choices.Future interventions should be tailored to address Key Concepts for which there appears to be a lack of understanding.

Objectives To describe the results of a mapping review exploring the coverage of unwanted treatment effects in systematic reviews of the effects of various treatments for moderate to severe depression in children and adolescents.Setting Any context or service providing treatment for depression, including interventions delivered in local communities and school settings, as well as services provided in primary or specialist care.Participants Children and young people with moderate to severe depression (

Background: Self-harm and suicide in children and adolescents are of serious consequence and increase during the adolescent years. Consequently, there is need for interventions that prevent such behaviour. The objective of this paper: to evaluate the effects of interventions preventing self-harm and suicide in children and adolescents in an overview of systematic reviews. Methods: We conducted an overview of systematic reviews (OoO). We included reviews evaluating any preventive or therapeutic intervention. The methodological quality of the included reviews was assessed independently, and data was extracted by two reviewers. We report the review findings descriptively. The certainty of evidence was assessed using Grading of Recommendations Assessment, Development and Evaluation (GRADE). Results: Moderate certainty evidence suggests that school-based interventions prevent suicidal ideation and attempts short term, and possibly suicide attempts long term. The effects of community-based interventions following suicide clusters and local suicide plans are unknown, as are the benefits and harms of screening young people for suicide risk. The effects of most interventions targeting children and adolescents with known self-harm are unknown. However, low certainty evidence suggests that dialectical behavioural therapy and developmental group therapy are equally as effective on repetition of self-harm as enhanced treatment as usual. Conclusions: Research on several recommended practices, such as local suicide plans, prevention of suicide clusters and approaches to risk assessment, is lacking. When such interventions are implemented, the effects should be closely evaluated. There is also need for more research on treatment of repeated self-harm. Further research should include long term follow-up, and investigate possible adverse effects. In prevention of self-harm and suicide in children and adolescents, policy makers and health providers should consider evidence from population-based studies with mixed-age samples, adult samples, and studies on conditions associated with self-harm and/or suicidality, such as depression and psychosis. PROSPERO registration: CRD42019117942 08/02/19

Background We developed the informed health choices (IHC) primary school resources to teach children how to assess the trustworthiness of claims about the effects of treatments. We evaluated these resources in a randomised trial in Uganda. This paper describes the process evaluation that we conducted alongside this trial.Objectives To identify factors affecting the implementation, impact and scaling up of the intervention; and potential adverse and beneficial effects of the intervention.Methods All 85 teachers in the 60 schools in the intervention arm of the trial completed a questionnaire after each lesson and at the end of the term. We conducted structured classroom observations at all 60 schools. For interviews and focus groups, we purposively selected six schools. We interviewed district education officers, teachers, head teachers, children and their parents. We used a framework analysis approach to analyse the data.Results Most of the participants liked the IHC resources and felt that the content was important. This motivated the teachers and contributed to positive attitudes. Although some teachers started out lacking confidence, many found that the children’s enthusiasm for the lessons made them more confident. Nearly everyone interviewed thought that the children learnt something important and many thought that it improved their decision-making. The main barrier to scaling up use of the IHC resources that participants identified was the need to incorporate the lessons into the national curriculum.Conclusion The mostly positive findings reflect the trial results, which showed large effects on the children’s and the teachers’ critical appraisal skills. The main limitations of this evaluation are that the investigators were responsible for both developing and evaluating the intervention.

Background A multifaceted and interactive teaching approach is recommended for achieving proficiency in evidence-based practice, with critical thinking considered vital for connecting theory and practice. In this context, we advocate the strategic use of health claims in media to promote critical thinking and provide an accessible entry point to evidence-based practice for early-stage university healthcare students. Method We conducted a convergent mixed methods study, including a cross-sectional survey with structured and open-ended questions as well as focus group interviews, at the Faculty of Health Sciences, Oslo Metropolitan University, during the 2020-2021 academic year. Participants were bachelor’s students in bioengineering, physiotherapy, social education, and occupational therapy. We employed a blended learning approach, combining digital learning resources, teaching in critical assessment of health claims and evidence-based practice, and a concurrent group exam assignment centered around health news. The outcome measures included students’ experiences integrating health claims into evidence-based practice teaching and their experiences with teaching approaches, including the group exam. Results Out of 446 participants, 136 (30.5%) responded to the structured questions in the survey. In response to the open-ended questions within the survey, 109 (80.1%) of the respondents shared positive experiences about the course, while 98 (72%) suggested improvements. Additionally, 25 students participated in focus group interviews. Synthesizing the results, we found that students viewed the inclusion of health claim assessment as a useful entry point for learning evidence-based practice. In addition, both the blended learning design and the group exam were identified as contributors to a positive perception of learning outcomes from the course. Conclusions Integrating critical reflection on media health claims into evidence-based practice education, alongside a blended learning approach and a group exam, may be beneficial for educating bachelor’s healthcare students. However, further rigorous study designs are needed to assess the effect of the course on learning outcomes. Registration DOI 10.5281/zenodo.6985449

Background A multifaceted and interactive teaching approach is recommended for achieving proficiency in evidence-based practice, with critical thinking considered vital for connecting theory and practice. In this context, we advocate the strategic use of health claims in the media to promote critical thinking, complemented by a blended learning approach and a group exam. Method We conducted a convergent mixed methods study, including a cross-sectional survey with structured and open-ended questions as well as focus group interviews, at Oslo Metropolitan University, during the 2020-2021 academic year. Participants were bachelor’s students in healthcare. We employed a blended learning approach, combining digital learning resources, teaching in critical assessment of health claims and evidence-based practice, and a concurrent group exam assignment centered around media health claims. The outcome measures included students’ experiences integrating health claims into evidence-based practice teaching and their experiences with teaching approaches and the group exam. Results Out of 465 participants, 136 (29.2%) responded to the structured questions in the survey. In response to the open-ended questions within the survey, 109 (80.1%) of the respondents shared positive experiences about the course, while 98 (72%) suggested improvements. Additionally, 25 students participated in focus group interviews. Synthesizing the results, we found that students viewed the inclusion of health claim assessment as a useful entry point for learning evidence-based practice. In addition, the students identified both the blended learning design and the group exam as contributors to a positive perception of learning outcomes from the course. Conclusions Based on student feedback, integrating critical reflection on media health claims into evidence-based practice education, alongside a blended learning approach and a group exam, may be beneficial in teaching evidence-based practice to bachelor’s healthcare students. However, further rigorous study designs are needed to objectively assess the effect of the course on learning outcomes. Registration DOI 10.5281/zenodo.6985449

Background A multifaceted and interactive teaching approach is recommended for achieving proficiency in evidence-based practice, with critical thinking considered vital for connecting theory and practice. In this context, we advocate the strategic use of health claims in media to promote critical thinking and provide an accessible entry point to evidence-based practice for early-stage university healthcare students. Method We conducted a convergent mixed methods study, including a cross-sectional survey with structured and open-ended questions as well as focus group interviews, at the Faculty of Health Sciences, Oslo Metropolitan University, during the 2020-2021 academic year. Participants were bachelor’s students in bioengineering, physiotherapy, social education, and occupational therapy. We employed a blended learning approach, combining digital learning resources, teaching in critical assessment of health claims and evidence-based practice, and a concurrent group exam assignment centered around health news. The outcome measures included students’ experiences integrating health claims into evidence-based practice teaching and their experiences with teaching approaches, including the group exam. Results Out of 446 participants, 136 (30.5%) responded to the structured questions in the survey. In response to the open-ended questions within the survey, 109 (80.1%) of the respondents shared positive experiences about the course, while 98 (72%) suggested improvements. Additionally, 25 students participated in focus group interviews. Synthesizing the results, we found that students viewed the inclusion of health claim assessment as a useful entry point for learning evidence-based practice. In addition, both the blended learning design and the group exam were identified as contributors to a positive perception of learning outcomes from the course. Conclusions Integrating critical reflection on media health claims into evidence-based practice education, alongside a blended learning approach and a group exam, may be beneficial for educating bachelor’s healthcare students. However, further rigorous study designs are needed to assess the effect of the course on learning outcomes. Registration DOI 10.5281/zenodo.6985449

Background The Informed Health Choices (IHC) Key Concepts is a framework that provides a basis for developing educational resources and evaluating people’s ability to think critically about health actions. We developed the original Key Concepts framework by reviewing texts and checklists for the public, journalists, and health professionals and collecting structured feedback from an international advisory group. We revised the original 2015 framework yearly from 2016 to 2018 based on feedback and experience using the framework. The objectives of this paper are to describe the development of the framework since 2018 and summarise their basis. Methods For the 2019 version, we responded to feedback on the 2018 version. For the current 2022 version, in addition to responding to feedback on the 2019 version, we reviewed the evidence base for each of the concepts. Whenever possible, we referenced systematic reviews that provide a basis for a concept. We screened all Cochrane methodology reviews and searched Epistemonikos, PubMed, and Google Scholar for methodology reviews and meta-epidemiological studies. Results The original framework included 32 concepts in six groups. The 2019 version and the current 2022 version include 49 concepts in the same three main groups that we have used since 2016. There are now 10 subgroups or higher-level concepts. For each concept, there is an explanation including one or more examples, the basis for the concept, and implications. Over 600 references are cited that support the concepts, and over half of the references are systematic reviews. Conclusions There is a large body of evidence that supports the IHC key concepts and we have received few suggestions for changes since 2019.

Background: Young people with mental illness should be offered evidence-based treatments. In 2018, we developed a national evidence portal in Norway providing mental health professionals and others with living evidence summaries. This immense work has been an important contribution to mental health care in Norway but is also a rich data source for exploring the characteristics and evidence gaps of the existing research internationally. At the time of this study, eight overviews of systematic reviews (OoOs) had been published. These addressed treatments for attention deficit / hyperactivity disorder (ADHD), anxiety, depression, bipolar disorder, psychosis, obsessive compulsive disorder (OCD), self-harm and trauma/ post-traumatic stress disorder. The objective of this study was to do a secondary analysis of this evidence to describe the state-of-the art in this field, and to map: treatments evaluated for each patient group and the longest time of follow-up treatment comparisons evaluated for more than one patient group Methods: We performed a mapping review of the eight OoOs. Data extraction was performed by one author and double-checked by another. All data was entered into Excel. Findings were visualized in descriptive tables and using Sunburst-diagrams. We used statistical thresholds to determine the size of effect and report the associated certainty. Results: We identified 200 treatment comparisons including a wide variety of interventions. Some mental illnesses are treated mostly with pharmacological or combination therapies and others solely with psychological or psychosocial treatments or with more diversity. The evidence supporting most treatments is of low to very low certainty. Ten percent of the comparisons included follow-up assessments beyond 12 months. Cognitive behavioural therapy, dialectic behavioural therapy, physical activity and mindfulness interventions were effective across populations. Conclusions: The evidence supporting treatment of mental illness in young people has important limitations. Future research efforts should address these evidence gaps.

Background: The Informed Health Choices (IHC) Key Concepts is a framework that provides a basis for developing educational resources and evaluating people’s ability to think critically about health actions. We developed the original Key Concepts framework by reviewing texts and checklists for the public, journalists, and health professionals and collecting structured feedback from an international advisory group. We revised the original 2015 framework yearly from 2016 to 2018 based on feedback and experience using the framework. The objectives of this paper are to describe the development of the framework since 2018 and summarise their basis. Methods: For the 2019 version, we responded to feedback on the 2018 version. For the current 2022 version, in addition to responding to feedback on the 2019 version, we reviewed the evidence base for each of the concepts. Whenever possible, we referenced systematic reviews that provide a basis for a concept. We screened all Cochrane methodology reviews and searched Epistemonikos, PubMed, and Google Scholar for methodology reviews and meta-epidemiological studies. Results: The original framework included 32 concepts in six groups. The 2019 version and the current 2022 version include 49 concepts in the same three main groups that we have used since 2016. There are now 10 subgroups or higher-level concepts. For each concept, there is an explanation including one or more examples, the basis for the concept, and implications. Over 600 references are cited that support the concepts, and over half of the references are systematic reviews. Conclusions: There is a large body of evidence that supports the IHC key concepts and we have received few suggestions for changes since 2019.

Background: A starting point for evaluating the effectiveness of treatments should be to identify evidence gaps. Furthermore, such evaluations should consider the perspectives of patients, clinicians and carers to ensure relevance and potentially influence future research initiatives. Methods: Our approach, inspired by the James Lind Alliance methods, involved three steps. First, we performed a document analysis by identifying interventions and outcomes in two recently published overviews of systematic reviews, which summarised the effects of interventions for anxiety and depression in children and adolescents. Second, we surveyed children and adolescents with personal experiences of depression or anxiety as well as clinicians, and asked them to suggest treatments and outcomes associated with uncertainty. Finally, we facilitated a consensus process where clinicians and youth mental health patient representatives were invited to prioritise research uncertainties in separate consensus processes. Results: The survey included 674 respondents who reported a total of 1267 uncertainties. Independent coding by four investigators revealed 134 suggestions for treatments of anxiety, 90 suggestions for treatments of depression, 84 for outcomes of interventions for anxiety and 71 suggestions for outcomes of interventions for depression. Two separate priority setting workshops with eight clinicians and ten youth resulted in four independent top ten priority lists. Conclusion: Top ten lists of treatments and outcome domains of anxiety and depression in children and adolescents was identified by youth and clinicians. The results may influence the research agenda, and ultimately benefit patients.

Background: Few studies have evaluated the ability of the general public to assess the trustworthiness of claims about the effects of healthcare. For the most part, those studies have used self-reported measures of critical health literacy. Methods: We mailed 4500 invitations to Norwegian adults. Respondents were randomly assigned to one of four online questionnaires that included multiple-choice questions that test understanding of Key Concepts people need to understand to assess healthcare claims. They also included questions about intended behaviours and self-efficacy. One of the four questionnaires was identical to one previously used in two randomised trials of educational interventions in Uganda, facilitating comparisons to Ugandan children, parents, and teachers. We adjusted the results using demographic data to reflect the population. Results: A total of 771 people responded. The adjusted proportion of Norwegian adults who answered correctly was > 50% for 17 of the 30 Key Concepts. On the other hand, less than half answered correctly for 13 concepts. The results for Norwegian adults were better than the results for Ugandan children in the intervention arm of the trial and parents, and similar to those of Ugandan teachers in the intervention arm of the trial. Based on self-report, most Norwegians are likely to find out the basis of treatment claims, but few consider it easy to assess whether claims are based on research and to assess the trustworthiness of research. Conclusions: Norwegian adults do not understand many concepts that are essential for assessing healthcare claims and making informed choices.Future interventions should be tailored to address Key Concepts for which there appears to be a lack of understanding.

Background: Few studies have evaluated the ability of the general public to assess the trustworthiness of claims about the effects of healthcare. For the most part, those studies have used self-reported measures of critical health literacy. Methods: We mailed 4500 invitations to Norwegian adults. Respondents were randomly assigned to one of four online tests that included multiple-choice questions that test understanding of Key Concepts people need to understand to assess healthcare claims. They also included questions about intended behaviours and self-efficacy. One of the four tests was identical to one previously used in two randomised trials of educational interventions in Uganda, facilitating comparisons to Ugandan children, parents, and teachers. We adjusted the results using demographic data to reflect the population. Results: A total of 771 people responded. We estimate that at least half of Norwegian adults understand 18 of the 30 Key Concepts (i.e. the adjusted proportion of correct answers was > 50%). On the other hand, less than half understood 13 of the concepts. The results for Norwegian adults were better than the results for Ugandan children in the intervention arm of the trial and parents, and similar to those of Ugandan teachers in the intervention arm of the trial. Based on self-report, most Norwegians are likely to find out the basis of treatment claims, but few consider it easy to assess whether claims are based on research and to assess the trustworthiness of research. Conclusions: Norwegian adults do not understand many concepts that are essential for assessing healthcare claims and making informed choices. This can result in poorly informed decisions, underuse of effective interventions, and overuse of ineffective or harmful interventions.

Background: Self-harm and suicide in children and adolescents are of serious consequence and increase during the adolescent years. Consequently, there is need for interventions that prevent such behaviour. The objective of this paper: to evaluate the effects of interventions preventing self-harm and suicide in children and adolescents in an overview of systematic reviews. Methods: We conducted a review of systematic reviews (OoO). We included reviews evaluating any preventive or therapeutic intervention. The quality of the included reviews was assessed independently, and data was extracted by two reviewers. We report the review findings descriptively. The certainty of the evidence was assessed using Grading of Recommendations Assessment, Development and Evaluation (GRADE). Results: Moderate certainty evidence suggests that school-based interventions prevent suicidal ideation and attempts short term, and possibly with long term effects on suicide attempts. The effects of community-based interventions following suicide clusters and local suicide plans are uncertain, as are the benefits and harms of screening young people for suicide risk. The effects of most interventions targeting children and adolescents with known self-harm are uncertain. However, low certainty evidence suggests that dialectical behavioural therapy and developmental group therapy are equally as effective on repetition of self-harm as enhanced treatment as usual. Conclusions: Research on several recommended practices, such as local suicide plans, prevention of suicide clusters and approaches to risk assessment, is lacking. When implemented, these interventions should be closely evaluated. There also is need for more research on treatment for repeated self-harm, including long term follow-up, and in general: possible harmful effects. Policy makers and health providers should consider evidence from population-based studies and adults in preventing self-harm and suicide in children and adolescents. Also, approaches showing promise in treatment of conditions associated with self-harm and/or suicidality, such as depression and psychosis, should be considered. PROSPERO registration: CRD42019117942 08/02/19.