Children are not invisible: contextualizing the Informed Health Choices critical skills curriculum in Italian schools

Raffaele Rasoini1, Rebecca De Fiore1, Fabio Ambrosino1, Maria Grazia Celani1, Giulio Formoso1, Camilla Alderighi1

1Associazione Alessandro Liberati - Cochrane Affiliate Centre.

Poster presentato al Convegno “4words2023”, Roma 11 maggio 2023.


The Informed health choices (Ihc) Group1 developed learning resources for 10 to 12 years-old students with the aim of laying the foundations of a critical health literacy curriculum. To assess the effectiveness of these resources, the Ihc team conducted a cluster randomized trial of 120 schools in Uganda. The trial showed that students who had been taught with these resources developed a better ability to think critically about health messages and to make informed health choices than students not taught with these resources2.

After translating the Ihc resources to Italian in 2019 (figure 1)3, we have been carrying out contextualization activities of these resources with the objective to assess the feasibility of introducing the Ihc curriculum in Italian schools.


In the 2019-2020 schoolyear we carried out a first pilot study through nine one-hour lessons in two fifth grade classes (46 students) of a public primary school in Florence4. To improve the generalizability of the first study, during the 2021-2022 schoolyear we conducted a second contextualization study in 5 public schools from the north, the centre, and the south of Italy (132 students). To explore our objective, we used both qualitative and quantitative methods.


Results of qualitative analysis from the first study showed that the schoolteachers and the students considered the Ihc resources comprehensible, appealing, and stimulating and no one reported major or minor issues with the resources. Main findings from quantitative analysis are reported in the figure 2.

In sum, findings from our first study indicated that the Ihc critical health literacy curriculum is well-suited for students and teachers in a primary school context and consistent with the Italian school curriculum. Data analysis from the second study is ongoing.


Throughout the pandemic, children’s lives have been subjected to many restrictions, but the impact of these interventions on their lives has not been adequately assessed in health studies. In one word, they remained invisible. The Ihc project embodies a different attitude, which is focused on early educational interventions to foster critical health literacy in children, empowering tomorrow’s adults to make informed health choices.


2. Nsangi A, Semakula D, Oxman AD, et al. Effects of the Informed Health Choices primary school intervention on the ability of children in Uganda to assess the reliability of claims about treatment effects: a cluster-randomised controlled trial. Lancet 2017; 390: 374-88.

3. Oxman M, Rosenbaum S, Nsang A, et al. Il libro delle decisioni sulla salute: imparare a riflettere sui trattamenti. (trad. it). Roma: Il Pensiero Scientifico Editore, 2019. Disponibile su: [ultimo accesso 18 luglio 2023].

4. Alderighi C, Rasoini R, Formoso G, Celani MG, Rosenbaum SE. Feasibility of contextualizing the Informed Health Choices learning resources in Italy: a pilot study in a primary school in Florence [version 1; peer review: 2 approved]. F1000Research 2022; 11: 1167.