The Norwegian public’s ability to assess treatment claims: results of a cross-sectional study of critical health literacy

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.

Audit and feedback with or without training in-practice targeting antibiotic prescribing (TiPTAP): a study protocol of a cluster randomised trial in dental primary care

Background Antimicrobial resistance is an increasingly serious threat to global public health and patient safety. Overuse of antibiotics has aggravated this issue. Around 7% of all antibiotics in Scotland are prescribed by dentists. Audit and feedback has been shown to decrease these prescriptions, but there is evidence that dentists still prescribe unnecessarily. Our aim is to compare the effectiveness of a theory-informed in-practice training session (TiPTAP) in addition to individualised audit and feedback, with audit and feedback alone for reducing antibiotic prescribing by NHS dentists working in NHS primary care dental practices. Methods We will conduct a 2-arm parallel cluster randomised trial: out of 228 practices, 114 will be randomised to the theory-informed in-practice training session targeting antibiotic prescribing and individualised audit and feedback; 114 practices will be randomised to audit and feedback alone. The theory-informed session will include (a) an introductory session including several behaviour change techniques; (b) problem solving discussion, setting and recording action plans; (c) practice-level prescribing feedback discussion. The primary outcome is the number of antibiotic items per 100 NHS treatment claims over a 1-year period post-randomisation for each dentist. Secondary outcomes are the number of amoxicillin 3 g and broad spectrum antibiotics prescribed per 100 NHS treatment claims over a 1-year period; amoxicillin 3 g and broad spectrum antibiotics defined daily doses of antibiotics per 100 claims. Process measures include fidelity, knowledge, and confidence. Primary and secondary outcomes will be obtained using routine data. Discussion This study provides the opportunity to robustly assess the effect of adding an in-practice training co-intervention to audit and feedback. Its behaviour change theory-informed content will allow replication of the different components and can inform future training interventions. Trial registration ISRCTN, ISRCTN12345678. Registered 18 June 2020.

Refuting Spurious COVID-19 Treatment Claims Reduces Demand and Misinformation Sharing

The COVID-19 pandemic has seen a surge of health misinformation, which has had serious consequences including direct harm and opportunity costs. We investigated (N = 678) the impact of such misinformation on hypothetical demand (i.e., willingness-to-pay) for an unproven treatment, and propensity to promote (i.e., like or share) misinformation online. This is a novel approach, as previous research has used mainly questionnaire-based measures of reasoning. We also tested two interventions to counteract the misinformation, contrasting a tentative refutation based on materials used by health authorities with an enhanced refutation based on best-practice recommendations. We found prior exposure to misinformation increased misinformation promotion (by 18%). Both tentative and enhanced refutations reduced demand (by 18% and 25%, respectively) as well as misinformation promotion (by 29% and 55%). The fact that enhanced refutations were more effective at curbing promotion of misinformation highlights the need for debunking interventions to follow current best-practice guidelines.

The Norwegian public’s ability to assess treatment claims: results of a cross-sectional study of critical health literacy

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.

Comparison of the Informed Health Choices Key Concepts Framework to other frameworks relevant to teaching and learning how to think critically about health claims and choices: a systematic review

Background: The Informed Health Choices (IHC) Key Concepts are principles for evaluating the trustworthiness of claims about treatment effects. The Key Concepts provide a framework for developing learning-resources to help people use the concepts when treatment claims are made, and when they make health choices. Objective: To compare the framework provided by the IHC Key Concepts to other frameworks intended to promote critical thinking about treatment (intervention) claims and choices. Methods: We identified relevant frameworks from reviews of frameworks, searching Google Scholar, citation searches, and contact with key informants. We included frameworks intended to provide a structure for teaching or learning to think critically about the basis for claims, evidence used to support claims, or informed choices. For a framework to be included, there had to be a description of its purpose; a list of concepts, competences, or dispositions; and definitions of key terms. We made independent assessments of framework eligibility and extracted data for each included framework using standardised forms. Results: Twenty-two frameworks met our inclusion criteria. The purpose of the IHC Framework is similar to that of two frameworks for critical thinking and somewhat similar to that of a framework for evidence-based practice. Those frameworks have broader scopes than the IHC Framework. An important limitation of broad frameworks is that they do not provide an adequate basis (concepts) for deciding which claims to believe and what to do. There was at most some overlap between the concepts, competences, and dispositions in each of the 22 included frameworks and those in the IHC Framework. Conclusions: The IHC Key Concepts Framework appears to be unique. Our review has shown how it and other frameworks can be improved by taking account of the ways in which other related frameworks have been developed, evaluated, and made useful.

Claims of ‘no difference’ or ‘no effect’ in Cochrane and other systematic reviews

Estimates of treatment effects/differences derived from controlled comparisons are subject to uncertainty, both because of the quality of the data and the play of chance. Despite this, authors sometimes use statistical significance testing to make definitive statements that ‘no difference exists between’ treatments. A survey to assess abstracts of Cochrane reviews published in 2001/2002 identified unqualified claims of ‘no difference’ or ‘no effect’ in 259 (21.3%) out of 1212 review abstracts surveyed. We have repeated the survey to assess the frequency of such claims among the abstracts of Cochrane and other systematic reviews published in 2017. We surveyed the 643 Cochrane review abstracts published in 2017 and a random sample of 643 abstracts of other systematic reviews published in the same year. We excluded review abstracts that referred only to a protocol, lacked a conclusion or did not contain any relevant information. We took steps to reduce biases during our survey. 'No difference/no effect' was claimed in the abstracts of 36 (7.8%) of 460 Cochrane reviews and in the abstracts of 13 (6.0%) of 218 other systematic reviews. Incorrect claims of no difference/no effect of treatments were substantially less common in Cochrane reviews published in in 2017 than they were in abstracts of reviews published in 2001/2002. We hope that this reflects greater efforts to reduce biases and inconsistent judgements in the later survey as well as more careful wording of review abstracts. There are numerous other ways of wording treatment claims incorrectly. These must be addressed because they can have adverse effects on healthcare and health research.

Words Matter: How WTO Rulings Handle Controversy

The rulings of internationals courts are often reduced to “who won?,” but much more is at stake. Like other institutions, the World Trade Organization (WTO) offers rulings that balance legal discipline against political constraints. We argue that one way in which the WTO handles politically sensitive issues is by increasing the amount of affect in their rulings. In doing so, judges provide national governments with discursive resources to persuade their domestic audiences of the legitimacy of compliance. To test our expectations, we conduct a text analysis of all rulings rendered by the institution since 1995. Specifically, we find that more politically charged decisions, such as the ones concerning nonfiscal rather than fiscal aspects of national treatment claims, are explained in qualitatively different terms. We also find that, as an issue gets ruled on repeatedly, the amount of affect deployed progressively decreases. In sum, the WTO chooses its words strategically to persuade litigants, and their domestic audiences, of the legitimacy of compliance in politically fraught disputes.