Quality of information in news media reports about the effects of health interventions: Systematic review and meta-analyses

Are popular books about diet and health written based on scientific evidence? A comparison of citations between the USA and Japan

OBJECTIVES

To describe and compare the references cited in popular books about diet and health between the USA and Japan.

DESIGN

Books were selected based on their best-seller rankings in the diet and health category of online bookstores. We identified references throughout all pages of the books and examined the number of references, reference format (identifiable or not) and presence of specific types of references, such as systematic reviews of human research. We compared the characteristics of references between the two countries and examined related factors to citation.

SETTING

Cross-sectional study.

PARTICIPANTS

Books (n 100 in each country).

RESULTS

Among 100 books from each country, sixty-five US and sixty-six Japanese books had references. Forty-five US books cited more than 100 references, against only five Japanese books. The number of books that cited systematic reviews of human research differed between the USA (n 49) and Japan (n 9). Additionally, the number of books that provided identifiable information for all references was significantly higher in the USA (n 63) than in Japan (n 42). Books whose first authors have licences of medical doctors were more likely to cite references than those without in both countries.

CONCLUSIONS

Two-thirds of books about diet and health cited references in both the USA and Japan, but Japanese books cited fewer references and were less likely to cite systematic reviews and provide identifiable references than US books. Further research into the scientific reliability of information in books about diet and health is warranted.

Effects of the Informed Health Choices secondary school intervention on the ability of students in Rwanda to think critically about health choices: A cluster-randomized trial

AIM

The aim of this trial was to evaluate the effects of the Informed Health Choices intervention on the ability of students in Rwandan to think critically and make Informed Health Choices.

METHODS

We conducted a two-arm cluster-randomized trial in 84 lower secondary schools from 10 districts representing five provinces of Rwanda. We used stratified randomization to allocate schools to the intervention or control. One class in each intervention school had ten 40-min lessons taught by a trained teacher in addition to the usual curriculum. Control schools followed the usual curriculum. The primary outcome was a passing score (≥ 9 out of 18 questions answered correctly) for students on the Critical Thinking about Health Test completed within 2 weeks after the intervention. We conducted an intention-to-treat analysis using generalized linear mixed models, accounting for the cluster design using random intercepts.

RESULTS

Between February 25 and March 29, 2022, we recruited 3,212 participants. We assigned 1,572 students and 42 teachers to the intervention arm and 1,556 students and 42 teachers to the control arm. The proportion of students who passed the test in the intervention arm was 915/1,572 (58.2%) compared to 302/1,556 (19.4%) in the control arm, adjusted odds ratio 10.6 (95% CI: 6.3-17.8), p < 0.0001, adjusted difference 37.2% (95% CI: 29.5%-45.0%).

CONCLUSIONS

The intervention is effective in helping students think critically about health choices. It was possible to improve students' ability to think critically about health in the context of a competence-based curriculum in Rwanda, despite challenging postpandemic conditions.

Piloting the informed health choices resources in Barcelona primary schools: A mixed methods study

INTRODUCTION

The main objective of the Informed Health Choices (IHC) project is to teach people to assess treatment claims and make informed health choices. For this purpose, the IHC learning resources were developed for primary school children. The aim of this study is to explore students' and teachers' experience when using the IHC resources in primary schools in Barcelona (Spain).

METHODS

We conducted a mixed methods study for piloting the IHC resources in a convenience sample of primary schools in Barcelona. The intervention included a workshop with teachers, and nine lessons with students. We collected data using multiple approaches. We performed quantitative and qualitative analyses, and integrated the findings in a joint display. Finally, we formulated recommendations for using the IHC resources in this setting.

RESULTS

Two schools, with a total of 143 students in 4th and 5th grade and six teachers, participated in the study. One school followed the suggested IHC teaching plan and competed all the lessons; the other school modified the plan substantially and did not complete all the lessons. Overall, students and teachers from both schools understood, were interested in, and were able to apply the content of the lessons. During the lessons, the textbook was useful for students; nevertheless, for the teachers, the usefulness of the IHC resources was variable. Teachers adapted the IHC resources to increase student participation and used Information and Communications Technologies tools. We observed more facilitators than barriers to teach the lessons. The teachers suggested some ideas to improve the lessons based on activities they developed and implemented. The integration analysis showed great convergence of the quantitative and qualitative findings. We propose seven recommendations for using the IHC resources in this setting.

CONCLUSIONS

Students and teachers from primary schools in Barcelona showed a positive experience when using IHC resources; however, these resources should be adapted to promote classroom participation.

Online information in Spanish on probiotics, yoghurt, kefir, kombucha, fibre and prebiotics: an analysis of the quality of information and the certainty of the evidence supporting health claims

OBJECTIVE

To examine the certainty of the evidence supporting health claims about probiotics, yoghurt, kefir, kombucha, fibre and prebiotics, and to assess the quality of online information in Spanish.

DESIGN

Content analysis.

METHODS

We compiled a data set of 114 web pages by searching six popular search phrases in Spanish relating to probiotics, yoghurt, kefir, kombucha, fibre and prebiotics on Google.es and coded them for typology and health claims. We examined the certainty of the evidence for health claims from systematic reviews. Information quality was assessed according to 10 criteria, where a web page: mentions scientific publications and reports their conclusions; quantifies relative and absolute effects; acknowledges some limitations; discusses certainty of evidence; reports the potential harms, alternatives and costs; and does not argue based on personal experiences.

RESULTS

Gastrointestinal health (86.0%), general health (57.9%), cardiovascular health (53.5%) and immune system health (50.9%) were the most widely mentioned topics. Half of claims (52.6%, 70/133) were supported by evidence from systematic reviews. Probiotics had the highest number of claims supported by evidence and kombucha the lowest. The highest certainty was found for antibiotic-associated diarrhoea, necrotising enterocolitis and otitis (moderate) in probiotics and yoghurt, infectious diarrhoea and hepatic encephalopathy (moderate) in prebiotics, and cardiovascular health (high to moderate) and colorectal cancer (moderate) in fibre. On a scale of 0-10, the median information quality score for all web pages was 3. Only 18.4% reported study conclusions, 7.9% quantified the effects, 28.9% acknowledged some limitations in the research and 42.1% reported potential harms.

CONCLUSIONS

Most online health claims for dietary interventions intended for improving health through the gut microbiome are supported by low or very low certainty of evidence. Online information does not align with the evidence and is incomplete or unbalanced.

Interventions to improve media coverage of medical research: a codesigned feasibility and acceptability study with Australian journalists

OBJECTIVES

Although the media can influence public perceptions and utilisation of healthcare, journalists generally receive no routine training in interpreting and reporting on medical research. Given growing evidence about the problems of medical overuse, the need for quality media reporting has become a greater priority. This study aimed to codesign and assess the feasibility of a multicomponent training intervention for journalists in Australia.

DESIGN

A small pragmatic feasibility study using a pre- and postdesign.

SETTING

90 min online workshop.

PARTICIPANTS

Eight journalists currently working in Australia, recruited through the study's journalist advisor and existing contacts of the researchers.

INTERVENTION

The training intervention covered a range of topics, including study designs, conflicts of interest, misleading medical statistics, population screening and overdiagnosis. The intervention also provided tools to help journalists with reporting, including a Tip Sheet and list of expert contacts in health and medicine. Preworkshop and postworkshop questionnaires were administered via Qualtrics.

MEASURES

Acceptability and feasibility of the intervention, and journalists' knowledge of overdiagnosis and common issues with health stories. Quantitative results were analysed descriptively using SPSS. Qualitative data were thematically analysed.

RESULTS

All participants completed preworkshop and postworkshop questionnaires, and 6 completed the 6-week follow-up (75% retention). Feasibility findings suggest the intervention is acceptable and relevant to journalists, with participants indicating the workshop increased confidence with reporting on medical research. We observed increases in knowledge preworkshop to postworkshop for all knowledge measures on overdiagnosis and common issues with media coverage of medicine. Analysis of free-text responses identified several areas for improvement, such as including more examples to aid understanding of the counterintuitive topic of overdiagnosis and more time for discussion.

CONCLUSIONS

Piloting suggested the multicomponent training intervention is acceptable to journalists and provided important feedback and insights to inform a future trial of the intervention's impact on media coverage of medicine.

Health communication in and out of public health emergencies: to persuade or to inform?

Much health communication during the COVID-19 pandemic has been designed to persuade people more than to inform them. For example, messages like “masks save lives” are intended to compel people to wear face masks, not to enable them to make an informed decision about whether to wear a face mask or to understand the justification for a mask mandate. Both persuading people and informing them are reasonable goals for health communication. However, those goals can sometimes be in conflict. In this article, we discuss potential conflicts between seeking to persuade or to inform people, the use of spin to persuade people, the ethics of persuasion, and implications for health communication in the context of the pandemic and generally. Decisions to persuade people rather than enable them to make an informed choice may be justified, but the basis for those decisions should be transparent and the evidence should not be distorted. We suggest nine principles to guide decisions by health authorities about whether to try to persuade people.