Piloting primary school teaching resources for informed health care choices in an urban school setting in Kigali

Abstract

Introduction Nearly everyone must make health care decisions that affect their health during their lifetime. People make health decisions based on claims they are exposed to in their community. Health care decision making starts at a young age. The Informed Health Care project (IHC) developed school resources to teach young children to assess treatment claims. We aimed to pilot teaching resources developed for use in Uganda and evaluate their applicability in Rwanda. Methods We used an iterative development approach that is grounded in a user-centered design. We used three qualitative methods: non-participatory observations, user test interviews, and focus group discussions. We used a convenient sampling strategy to select a school and purposive sampling to select children and the teacher. We used thematic analysis in three stages, organized according to the objectives: to explore the user experience of the teacher and children on the use of IHC school resources, to identify barriers and facilitators to implementing the resources in Rwanda, and to identify perceived user suggestions to improve the IHC resources. Results We conducted 10 cycles of non-participatory observations with at least two observers for each lesson, 10-test interviews with the teacher and 10 focus group discussions with the children including 3 participants each. The main problematic themes that emerged through the user experience analysis were “understandability” and “identification”. Children and the teacher experienced the use of IHC resources in a positive way with findings related to desirability, usability, and usefulness. The study highlighted several barriers related to use of IHC resources, among others literacy, beliefs, and understanding of content, clarity of the material. Facilitators for using IHC resources were the children’s motivation to learn, attitudes towards IHC resources (such as positive reception of the comic format) and teacher’s self-efficacy. Users suggested clearer presentation of the contents, key terms, and lesson instructions. Conclusion Overall the IHC resources appear to be feasible in the Rwanda context. This pilot test has shed light on the usefulness of piloting of health education resources in Rwanda. The study highlighted preliminary factors to consider when planning implementation of such resources in Rwanda.