Potential adverse effects of an educational intervention: Development of a framework

Abstract

AbstractBackgroundResearchers often overlook potential adverse effects of educational and public health interventions (increases in adverse outcomes, or decreases in beneficial outcomes, attributed to the intervention). To help us identify potential adverse effects of an educational intervention intended to improve critical thinking about health choices, we developed a framework. We also did a preliminary prioritisation of outcomes in the framework for randomised trials of the intervention, and associated process evaluations.MethodsBased on relevant evidence and theory, we developed an initial framework. For feedback on the initial framework, we sent a survey to 70 external experts. We conducted a thematic analysis of the qualitative survey data. After revising the framework based on the survey findings, we interviewed teachers in the context where we are evaluating the intervention, to help identify any effects still missing from the framework, and preliminarily prioritise potential outcomes for the evaluation.ResultsWe received responses from 38 of the 70 external experts (54%), including researchers and others with a variety of expertise within health, education, and design. Overall, the responses were positive. However, they also included critical feedback that led to substantial revisions of the framework’s content and presentation. The revised framework has six categories of potential adverse effects: decision-making harms, psychological harms, equity harms, group and social harms, waste, and other harms. We interviewed three teachers, who did not suggest any missing outcomes. Based on the interview findings, we prioritised three outcomes for the evaluation of the intervention: work-related stress; wasted time or resources; and conflict, in particular between students and family.DiscussionAs far as we are aware, the framework presented in this article is the first tool of its kind in education research. The framework is a “living” tool, which can be improved upon, as well as adapted. We have used it to inform the development of interview and observation guides, and we are using it to inform the development of outcome measures. Important limitations of the framework include limits to its comprehensiveness, and the use of terminology with different meanings or interpretations depending on the context. Our approach to identifying and evaluating potential adverse effects of an educational intervention can have value to other researchers.ConclusionRigorous evaluations of potential adverse effects of educational and public health interventions can be time and resource-intensive. However, that cost might be small compared to the cost of implementing harmful interventions.