Educational interventions to improve people's understanding of key concepts in assessing the effects of health interventions: a systematic review

Abstract Background Health information is readily accessible but is of variable quality. General knowledge about how to assess whether claims about health interventions are trustworthy is not common, so people’s health decisions can be ill-informed, unnecessarily costly and even unsafe. This review aims to identify and evaluate studies of educational interventions designed to improve people’s understanding of key concepts for evaluating claims about the effects of health interventions. Methods/Design We searched multiple electronic databases and sources of grey literature. Inclusion criteria included all study types that included a comparison, any participants (except health professionals or health professional students) and educational interventions aimed at improving people’s understanding of one or more of the key concepts considered necessary for assessing health intervention claims. Knowledge and/or understanding of concepts or skills relevant to evaluating health information were our primary outcome measures. Secondary outcomes included behaviour, confidence, attitude and satisfaction with the educational interventions. Two authors independently screened search results, assessed study eligibility and risk of bias and extracted data. Results were summarised using descriptive synthesis. Results Among 24 eligible studies, 14 were randomised trials and 10 used other study designs. There was heterogeneity across study participants, settings and educational intervention type, content and delivery. The risk of bias was high in at least one domain for all randomised studies. Most studies measured outcomes immediately after the educational intervention, with few measuring later. In most of the comparisons, measures of knowledge and skills were better among those who had received educational interventions than among controls, and some of these differences were statistically significant. The effects on secondary outcomes were inconsistent. Conclusions Educational interventions to improve people’s understanding of key concepts for evaluating health intervention claims can improve people’s knowledge and skills, at least in the short term. Effects on confidence, attitude and behaviour are uncertain. Many of the studies were at moderate or greater risk of bias. Improvements in study quality, consistency of outcome measures and measures of longer-term effects are needed to improve confidence in estimates of the effects of educational interventions to improve people’s understanding of key concepts for evaluating health intervention claims. Systematic review registration PROSPERO CRD4201603310

Educational interventions to improve people’s understanding of key concepts in assessing the effects of health interventions: a systematic review protocol

BACKGROUND: Health information has become readily accessible through mass media, and people are playing a more active and autonomous role in their health. Much of the health information that was previously only available to health professionals is now directly accessible to the public. Consequently, people often navigate vast amounts of health information on their own, typically with little knowledge about how to evaluate it or the need to do so. Health information remains essentially unregulated, and widespread problems and concerns with the quality of health information have been noted. In addition to the variable quality of health information, inconsistent and/or inappropriate use of related terminology (e.g. ‘evidence-based’ and ‘clinically proven’) can be confusing to the public, who are ill-prepared to critically examine claims. The general public are not trained in the fundamentals of health research and do not typically possess the knowledge and skills to evaluate the accuracy and completeness of information about health interventions. Without this, the public are vulnerable to acting on inaccurate or incomplete health information and making ill-informed health decisions. With this review, we intend to identify and assess educational interventions which have been designed to improve people’s ability to understand key concepts relevant to evaluating claims about the effects of health interventions. METHODS/DESIGN: This systematic review of the literature will use a search strategy that has been developed in conjunction with a Health Sciences Librarian who has expertise in systematic review searching to identify relevant studies. Databases to be searched include the following: the Cochrane Central Register of Controlled Trials, MEDLINE, EMBASE, CINAHL, and ERIC. Attempts to identify unpublished studies and ongoing trials will also be made. Two review authors will independently screen search results and assess studies for eligibility. Studies which aim to improve participants’ understanding of the key concepts relevant to evaluating the effects (or the interpretation of results) of health interventions will be included. Randomised trials, non-randomised trials, controlled before and after studies, controlled studies with only post-test measures, and interrupted time series studies will be eligible for inclusion. We will contact study authors to clarify any missing details/data. Due to the nature of the systematic review question and the expectation of heterogeneity in study design, interventions, and outcomes, we intend to take a narrative approach to data synthesis. SYSTEMATIC REVIEW REGISTRATION: PROSPEROCRD4201603310

Establishing a library of resources to help people understand key concepts in assessing treatment claims—The “Critical thinking and Appraisal Resource Library” (CARL)

Background People are frequently confronted with untrustworthy claims about the effects of treatments. Uncritical acceptance of these claims can lead to poor, and sometimes dangerous, treatment decisions, and wasted time and money. Resources to help people learn to think critically about treatment claims are scarce, and they are widely scattered. Furthermore, very few learning-resources have been assessed to see if they improve knowledge and behavior. Objectives Our objectives were to develop the Critical thinking and Appraisal Resource Library (CARL). This library was to be in the form of a database containing learning resources for those who are responsible for encouraging critical thinking about treatment claims, and was to be made available online. We wished to include resources for groups we identified as ‘intermediaries’ of knowledge, i.e. teachers of schoolchildren, undergraduates and graduates, for example those teaching evidence-based medicine, or those communicating treatment claims to the public. In selecting resources, we wished to draw particular attention to those resources that had been formally evaluated, for example, by the creators of the resource or independent research groups. Methods CARL was populated with learning-resources identified from a variety of sources—two previously developed but unmaintained inventories; systematic reviews of learning-interventions; online and database searches; and recommendations by members of the project group and its advisors. The learning-resources in CARL were organised by ‘Key Concepts’ needed to judge the trustworthiness of treatment claims, and were made available online by the James Lind Initiative in Testing Treatments interactive (TTi) English (www.testingtreatments.org/category/learning-resources).TTi English also incorporated the database of Key Concepts and the Claim Evaluation Tools developed through the Informed Healthcare Choices (IHC) project (informedhealthchoices.org). Results We have created a database of resources called CARL, which currently contains over 500 open-access learning-resources in a variety of formats: text, audio, video, webpages, cartoons, and lesson materials. These are aimed primarily at ‘Intermediaries’, that is, ‘teachers’, ‘communicators’, ‘advisors’, ‘researchers’, as well as for independent ‘learners’. The resources included in CARL are currently accessible at www.testingtreatments.org/category/learning-resources Conclusions We hope that ready access to CARL will help to promote the critical thinking about treatment claims, needed to help improve healthcare choices

Impact of COVID-19 on cardiovascular testing in the United States versus the rest of the world

Objectives: This study sought to quantify and compare the decline in volumes of cardiovascular procedures between the United States and non-US institutions during the early phase of the coronavirus disease-2019 (COVID-19) pandemic. Background: The COVID-19 pandemic has disrupted the care of many non-COVID-19 illnesses. Reductions in diagnostic cardiovascular testing around the world have led to concerns over the implications of reduced testing for cardiovascular disease (CVD) morbidity and mortality. Methods: Data were submitted to the INCAPS-COVID (International Atomic Energy Agency Non-Invasive Cardiology Protocols Study of COVID-19), a multinational registry comprising 909 institutions in 108 countries (including 155 facilities in 40 U.S. states), assessing the impact of the COVID-19 pandemic on volumes of diagnostic cardiovascular procedures. Data were obtained for April 2020 and compared with volumes of baseline procedures from March 2019. We compared laboratory characteristics, practices, and procedure volumes between U.S. and non-U.S. facilities and between U.S. geographic regions and identified factors associated with volume reduction in the United States. Results: Reductions in the volumes of procedures in the United States were similar to those in non-U.S. facilities (68% vs. 63%, respectively; p = 0.237), although U.S. facilities reported greater reductions in invasive coronary angiography (69% vs. 53%, respectively; p < 0.001). Significantly more U.S. facilities reported increased use of telehealth and patient screening measures than non-U.S. facilities, such as temperature checks, symptom screenings, and COVID-19 testing. Reductions in volumes of procedures differed between U.S. regions, with larger declines observed in the Northeast (76%) and Midwest (74%) than in the South (62%) and West (44%). Prevalence of COVID-19, staff redeployments, outpatient centers, and urban centers were associated with greater reductions in volume in U.S. facilities in a multivariable analysis. Conclusions: We observed marked reductions in U.S. cardiovascular testing in the early phase of the pandemic and significant variability between U.S. regions. The association between reductions of volumes and COVID-19 prevalence in the United States highlighted the need for proactive efforts to maintain access to cardiovascular testing in areas most affected by outbreaks of COVID-19 infection

Blood type diets lack supporting evidence: a systematic review

Background: Diets that are based on the ABO blood group system have been promoted over the past decade and claim to improve health and decrease risk of disease. To our knowledge, the evidence to support the effectiveness of blood type diets has not previously been assessed in the scientific literature. Objective: In this current systematic review, published studies that presented data related to blood type diets were identified and critically appraised by using the Grading of Recommendations, Assessment, Development and Evaluation (GRADE) approach. Design: A systematic search was performed to answer the following question: In humans grouped according to blood type, does adherence to a specific diet improve health and/or decrease risk of disease compared with nonadherence to the diet? The Cochrane Library, MEDLINE, and Embase were systematically searched by using sensitive search strategies. Results: Sixteen articles were identified from a total of 1415 screened references, with only one article that was considered eligible according to the selection criteria. The identified article studied the variation between LDL-cholesterol responses of different MNS blood types to a low-fat diet. However, the study did not directly answer the current question. No studies that showed the health effects of ABO blood type diets were identified. Conclusions: No evidence currently exists to validate the purported health benefits of blood type diets. To validate these claims, studies are required that compare the health outcomes between participants adhering to a particular blood type diet (experimental group) and participants continuing a standard diet (control group) within a particular blood type population

Calibration and analysis of the telluric O2-bands: A spectropolarimetric approach for aerosol and cloud analysis

Earthshine observations are a classical benchmark for the studies of the atmospheres of exo-earth type planets. For this kind of observations, background subtraction is a critical and challenging task to disentangle the effects of atmospheric scattering from atmospheric transmission of molecular lines. In fact, although usually neglected, the background itself carries information on the composition of our atmosphere, and further crucial information may be extracted from the analysis of spectropolarimetric observations of the O2 lines at sunset. In this talk we will first discuss the surprisingly high variability of telluric lines in Earthshine spectra. With full vector radiative transfer calculations of the Earth\u2019s atmosphere we show the impact of aerosol and cloud properties on the spectropolarimetric appearance of the O2 band. They demonstrate that high spectral resolution observations allow to constrain high clouds and aerosols with high sensitivity. We suggest to use HARPS in polarimetric mode to observe the sky at zenith during sunset various times in order to obtain a larger sample of different sky polarisation spectra at high resolution in the O2B spectral band for further modelling.Astrodynamics & Space Mission