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Systematic Review

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

[version 1; peer review: 3 approved]
PUBLISHED 05 Mar 2020
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This article is included in the Research on Research, Policy & Culture gateway.

Abstract

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.

Keywords

critical thinking, evidence-informed decision-making, evidence-based practice, evidence informed decision-making, argumentation, causal inference, cognitive biases, epistemic cognition, health literacy, logical fallacies, meta-cognition, scientific thinking, frameworks, models, concepts, competences, concepts

Introduction

The Informed Health Choices (IHC) Key Concepts Framework

Claims about what people can do to improve or protect their health (treatments) are ubiquitous. They are found in the mass media, advertisements, and everyday personal communication. Some are based on trustworthy evidence. Many are not, and many people have difficulties determining which claims to believe and act on. Acting on untrustworthy claims and not acting on ones that are trustworthy can result in unnecessary suffering and waste.

In response to these challenges, we developed the Informed Health Choices (IHC) Key Concepts as the first step in the IHC project14. The aim of the IHC project is to help people, particularly primary and secondary school students, learn to assess treatment claims and make informed health choices5.

We use ‘treatment’ to refer to any intervention or action intended to protect or improve health6. People in other fields have found the IHC Key Concepts relevant for assessing claims about the effects of other types of interventions7. This includes agricultural, educational, environmental, management, social welfare, economic, international development, nutrition, policing, and veterinary interventions.

The IHC Key Concepts provide a framework for designing curricula, learning resources, and evaluation tools5,8. We first published the framework in 20151 and have continued to update it yearly. The current (2019) framework includes 49 concepts in three groups (Table 1), 20 competences in four groups (Table 2), and 16 dispositions in four groups (Table 3)4. The concepts are principles for evaluating the trustworthiness of treatment claims and the evidence used to support these, and for making informed choices. The methods used to develop the framework are described elsewhere1,3. The framework is a starting point to help teachers, journalists, researchers and other intermediaries to identify and develop resources to help people learn to assess treatment claims and make informed choices.

Table 1. Overview of the IHC Key Concepts.

1. Claims

Claims about effects that are not supported by
evidence from fair comparisons are not necessarily
wrong, but there is an insufficient basis for
believing them.
2. Comparisons

Studies should make fair comparisons, designed
to minimize the risk of systematic errors (biases)
and random errors (the play of chance).
3. Choices

What to do depends on judgements
about a problem, the relevance
of the evidence available, and
the balance of expected benefits,
harms, and costs.
1.1 It should not be assumed that treatments are
safe or effective - or that they are not.

a)    Treatments can cause harms as well as benefits.
b)    Large, dramatic effects are rare.
c)    It is rarely possible to be certain about the effects
       of treatments.

1.2 Seemingly logical assumptions are not a
sufficient basis for claims.

a)    Treatment may not be needed.
b)    Beliefs alone about how treatments work are
       not reliable predictors of the presence or size of
       effects.
c)    Assumptions that fair comparisons of treatments
       in research are not applicable in practice can be
       misleading.
d)    An outcome may be associated with a treatment
       but not caused by it.
e)    More data is not necessarily better data.
f)     Identifying effects of treatments depends on
       making comparisons.
g)    The results of one study considered in isolation
       can be misleading.
h)    Widely used treatments or those that have been
       used for decades are not necessarily beneficial
       or safe.
i)    Treatments that are new or technologically
       impressive may not be better than available
       alternatives.
j)    Increasing the amount of a treatment does not
       necessarily increase its benefits and may cause
       harm.
k)    Earlier detection of ‘disease’ is not necessarily
       better.
l)    It is rarely possible to know in advance who will
       benefit, who will not, and who will be harmed by
       using a treatment.

1.3 Trust in a source alone is not a sufficient basis
for believing a claim.

a)    Your existing beliefs may be wrong.
b)    Competing interests may result in misleading
       claims.
c)    Personal experiences or anecdotes alone are an
       unreliable basis for most claims.
d)    Opinions alone are not a reliable basis for claims.
e)    Peer review and publication by a journal do not
       guarantee that comparisons have been fair.
2.1 Comparisons of treatments should be fair.

a)    Comparison groups should be as similar as
       possible.
b)    Indirect comparisons of treatments across
       different studies can be misleading.
c)    The people being compared should be
       cared for similarly apart from the treatments
       being studied.
d)    If possible, people should not know which
       of the treatments being compared they are
       receiving.
e)    Outcomes should be assessed in the same
       way in all the groups being compared.
f)    Outcomes should be assessed using
       methods that have been shown to be
       reliable.
g)    It is important to assess outcomes in all (or
       nearly all) the people in a study.
        h)    People’s outcomes should be counted in the
       group to which they were allocated.

2.2 Syntheses of studies need to be reliable.

a)    Reviews of studies comparing treatments
       should use systematic methods.
b)    Failure to consider unpublished results of
       fair comparisons may result in estimates of
       effects that are misleading.
c)    Treatment claims based on models may be
       sensitive to underlying assumptions.

2.3 Descriptions should clearly reflect the size
of effects and the risk of being misled by the
play of chance.

a)    Verbal descriptions of the size of effects
       alone can be misleading.
b)    Relative effects of treatments alone can be
       misleading.
c)    Average differences between treatments can
       be misleading.
d)    Small studies may be misleading.
e)    Results for a selected group of people within
       a study can be misleading.
f)    The use of p-values may be misleading;
       confidence intervals are more informative.
g)    Deeming results to be “statistically
       significant” or “nonsignificant” can be
       misleading.
h)    Lack of evidence of a difference is not the
       same as evidence of “no difference”.
3.1 Problems and options should
be clear.

a)    Be clear about what the problem
       or goal is and what the options
       are.

3.2 Evidence should be relevant.

a)    Attention should focus on all
       important effects of treatments,
       and not surrogate outcomes.
b)    Fair comparisons of treatments in
       animals or highly selected groups
       of people may not be relevant.
c)    The treatments compared should
       be similar to those of interest.
d)    There should not be important
       differences between the
       circumstances in which the
       treatments were compared and
       those of interest.

3.3 Expected advantages should
outweigh expected disadvantages.

a)    Weigh the benefits and savings
       against the harms and costs of
       acting or not.
b)    Consider the baseline risk or the
       severity of the symptoms when
       estimating the size of expected
       effects.
c)    Consider how important each
       advantage and disadvantage is
       when weighing the pros and cons.
d)    Consider how certain you can
       be about each advantage and
       disadvantage.
e)    Important uncertainties about
       the effects of treatments should
       be addressed in further fair
       comparisons.

Table 2. IHC competences.

Goal

To enable people to make good decisions* about which claims to believe about the effects of things they can do for their health,
the health of others or for other reasons, and about what to do to achieve their goals.

Competences

To achieve this goal, people should be able to:

1.    Recognise when a claim has an untrustworthy basis by:
       a)    recognising claims about the effects of treatments
       b)    questioning the basis for treatment claims
       c)    thinking carefully about treatment claims before believing them
       d)    recognising when a treatment claim is relevant and important, and warrants reflection

2.    Recognise when evidence used to support a treatment claim is trustworthy or untrustworthy by:
       a)    recognising the assumptions, evidence and reasoning behind treatment claims
       b)    recognising unfair treatment comparisons
       c)    recognising unreliable summaries of treatment comparisons
       d)    recognising when a statistical model and its assumptions are used to support a treatment claim
       e)    recognising misleading ways of presenting treatment effects
       f)    understanding how systematic errors (the risk of bias), random errors (the play of chance), and the relevance
              (applicability) of treatment comparisons can affect the degree of confidence in estimates of treatment effects
       g)    understanding the extent to which evidence does or does not support a treatment claim

3.    Make well-informed decisions about treatments by:
       a)    being aware of cognitive biases when making decisions
       b)    clarifying and understanding the problem, options, and goals when making a decision
       c)    recognising when decisions have irreversible consequences
       d)    judging the relevance of evidence used to inform decisions about treatments
       e)    weighing the advantages and disadvantages of treatments, taking into account the size of treatment effects, how
              important each outcome is, the costs, and the certainty of the evidence
       f)    communicating with others about the advantages and disadvantages of treatments

4.    Reflect on people’s competences and dispositions by:
       a)    monitoring how they decide which treatment claims to believe and what to do
       b)    monitoring how people adjust the processes they use to decide what to believe and do to fit the relevance, importance,
              and nature of different types of treatment claims and choices
       c)    being aware of when people are making treatment claims themselves

*A good decision is one that makes effective use of the information available to the decision maker at the time the decision is made. A good outcome is one that the decision maker likes. The aim of thinking critically about treatments is to increase the probability of good outcomes (and true conclusions), but many other factors affect outcomes aside from critical thinking36.

Table 3. IHC dispositions.

People should be in the habit of thinking critically about:

1.      Claims by:
          a)    being aware of treatment claims (including those you make yourself) and choices
          b)    questioning the basis for treatment claims
          c)    being aware of cognitive biases and going from fast to slow thinking before forming an opinion about a treatment claim,
                 making a claim, or taking a decision
          d)    seeking evidence to reduce uncertainty when considering a relevant and important treatment claim or decision

2.      Evidence used to support claims by:
          a)    questioning the trustworthiness of evidence used to support treatment claims
          b)    being alert to misleading presentations of treatment effects
          c)    acknowledging and accepting uncertainty about the effects of treatments
          d)    being willing to admit errors and modify their judgements when warranted by evidence or a lack of evidence

3.      Choices by:
          a)    clarifying and understanding the problem, options, and goals when making decisions about treatments
          b)    preferring evidence-based sources of information about treatment effects
          c)    considering the relevance of the evidence used to inform decisions about treatments
          d)    considering effect estimates, baseline risk, the importance of each advantage and disadvantage, the costs, and the
                 certainty of the evidence when making decisions about treatments
          e)    making informed judgements about the certainty of estimates of treatment effects
          f)    making well-informed decisions
          g)    Being aware of how people decide which treatment claims to believe and what to do

4.      People’s own thinking by:
          a)    Being aware of how people decide which treatment claims to believe and what to do

Other frameworks relevant to the IHC Key Concepts Framework

There are many other frameworks that include concepts, competences, or dispositions that are relevant to thinking critically about treatment claims, comparisons, and choices. These include critical thinking frameworks, logical fallacies and argumentation frameworks, cognitive frameworks, frameworks for scientific thinking, and frameworks related to evidence-based health care. For each category of frameworks there are disagreements about definitions and what is included. For example, learning to think critically is widely held as an aim of education9, but there is not agreement on the definition of “critical thinking” and there are several different frameworks (conceptual structures intended to serve as a support or guide) for critical thinking1014. Similarly, there are different definitions and frameworks for scientific thinking (reasoning and literacy)1518, epistemic cognition and meta-cognition19,20, health literacy2123, and various aspects of evidence-based health care2426. There is also overlap across these different framework categories, some of which have been grouped together as frameworks for “productive thinking”12.

Terminology

Definitions of terms that we use in this paper are shown in Table 4.

Table 4. Definitions of terms as used in this paper.

ChoiceA decision to do something (or not to do something) with the intention of achieving a goal, such as
improving or maintaining health
ClaimA statement about what will happen if one action (e.g. a treatment) is chosen compared to what would
happen if another action (or “no treatment”) was chosen
ComparisonExamination of the evidence for differences between two options, such as what will happen if one action is
chosen compared to what would happen if another action was chosen
CompetencyThe required skill, knowledge, or capacity to do something
ConceptIn this review, concept (an idea, object of thought, or constituent of thought) refers to a specific type of
concept: a criterion (standard for judgment) or principle (a concept that is a guide) for evaluating the
trustworthiness of claims and comparisons, and for making choices; or an issue worthy of attention or
consideration when assessing claims and making choices.
CurriculumA set of learning goals that outline the intended content and process goals of a school program
DispositionFrequent and voluntary habits of thinking and doing
DomainA group of elements within a framework
ElementOne of the components of a framework, including concepts, competences, and dispositions
Fair comparisonStudies comparing two or more treatments, which are designed, conducted, reported and interpreted
to minimize systematic errors (bias) and random errors (resulting from the play of chance) in measuring
treatment effects
FrameworkA structure, composed of elements, designed (at least in part) to support doing something or learning to do
something, such as thinking critically or learning to think critically about claims, comparisons, and choices
InterventionAny action intended to achieve a goal
SkillThe ability to do something
Thinking criticallyUsing appropriate criteria (standards for judgment, or principles for evaluation) to make judgements; for
example, about the trustworthiness of claims and comparisons, and what to do
TreatmentAny action intended to improve or maintain the health of individuals or communities

Objective

The objective of our review was to systematically compare the IHC Key Concepts Framework to other frameworks that are relevant to teaching and learning how to think critically about treatment claims, evidence, and choices. We examined similarities and differences between the IHC Key Concepts Framework and other frameworks - particularly in the context of primary and secondary school education - including:

  • The purposes and definitions of key terms

  • The elements included and domains in which they are grouped

  • How the frameworks have been developed and evaluated

  • How the frameworks have been used to develop curricula, teaching and learning resources, and assessment tools

Methods

We conducted a systematic review of frameworks relevant to teaching and learning to think critically about treatment claims, evidence used to support those claims, and choices. The protocol for the review is published on our website27.

Criteria for considering frameworks for inclusion

We included frameworks that are intended to provide a structure for teaching or learning to think critically about at least one of the following:

  • The basis (justification) for claims or arguments about the effects of interventions and the reliability of those justifications

  • The extent to which evidence used to support claims about the effects of interventions (comparisons) is fair and reliable

  • Choices about what to do in order to achieve a goal

To be included, the sources for each framework had to include:

  • a description of the purpose of the framework;

  • a list of the framework’s elements; and

  • definitions of the key terms used to describe the purpose of the framework, its elements and domains (in which elements are grouped, if there are any).

Frameworks that are modifications of another framework were considered together with the framework that had been modified.

Search methods for identification of frameworks

We began by considering 41 frameworks reviewed in Frameworks for Thinking: A Handbook for Teaching and Learning12 and frameworks with which we were already familiar2135. We searched for other relevant frameworks using Google Scholar between October 2018 and June 2019 using the search strategies found in Extended data File 1. We supplemented these searches by conducting citation searches and contacting key informants for each category of the frameworks.

Selection of frameworks

One review author (ADO) initially screened frameworks for possible inclusion. Both review authors then independently assessed full-text articles for each potentially relevant framework using an eligibility form (Extended data File 2). We discussed disagreements and reached a consensus. Frameworks that were assessed for inclusion by both authors and then excluded are listed with the reasons for exclusion in Table 5.

Table 5. Excluded frameworks.

FrameworkReason for exclusionNotes
Bloom taxonomy12Does not provide a framework for
thinking critically about claims,
comparisons or choices
This framework is a way of classifying educational goals in terms
of complexity. The initial aim was promoting “the exchange of test
materials and ideas about testing’ and of ‘stimulating research on
examining and on the relations between examining and education”
(12, p. 49). Bloom’s taxonomy consists of six levels and has a
varying amount of detail in the form of sub-categories for each
level. The IHC Key Concepts fit into the top level in the original
framework - “evaluation”.
Altshuller’s TRIZ Theory of
Inventive Problem Solving12
Does not provide a framework for
thinking critically about claims,
comparisons or choices
“TRIZ is a systematic, creativity and innovation process devised as
an aid to practical problem-solving, especially in engineering.”

(12, p. 122).
De Bono’s lateral and parallel
thinking tools12
Does not provide a framework for
thinking critically about claims,
comparisons or choices
The emphasis of this framework is on problem-solving techniques
which promote generative, or productive thinking (12, p. 133).
Jewell’s reasoning taxonomy for
gifted children12
Does not provide a framework for
thinking critically about claims,
comparisons or choices
This taxonomy is presented, largely from a philosophical
perspective, in response to a perceived need to understand how
gifted students think and reason.

(12, p. 170).
Petty’s six-phase model of the
creative process12
Does not provide a framework for
thinking critically about claims,
comparisons or choices
Consists of six phases: “inspiration; clarification; evaluation;
distillation; incubation; and perspiration” (12, p. 175).
Bailin’s intellectual resources for
critical thinking12,37
Does not provide a framework for
thinking critically about claims,
comparisons or choices
Aims at establishing clarity regarding the concept of critical
thinking and suggests proposals for an appropriate pedagogy.
(12, p. 178). Focus is on “intellectual resources” for critical
thinking, which includes “knowledge of key critical concepts”, but
these are not specified37.
American Philosophical
Association (APA) critical
thinking consensus38
Does not provide a framework for
thinking critically about claims,
comparisons or choices
This is a broad framework of skills and dispositions with marginal
details relevant to thinking critically about claims, comparisons or
choices.
Scientific Discovery as Dual
Search (SDDS) model of
scientific reasoning39
Does not provide a framework for
thinking critically about claims,
comparisons or choices
A description of learner behaviour in complex domains. The main
ingredients of this model are an elaboration of the “hypothesis
space” and “experiment space”, and a representation of learners’
knowledge states during discovery.
Styles of reasoning framework15Does not provide a framework for
thinking critically about claims,
comparisons or choices
This is a broad framework that only indirectly addresses
judgments about claims and comparisons.
Scaffolding framework for
evidence-based arguments40,41
Does not provide a framework fo
thinking critically about claims,
comparisons or choices
Provides the basis for a website that supports formulating claims
and evidence to support claims but does not provide a framework
with support for making judgements about the extent to which
evidence used to support claims about the effects of interventions
is trustworthy.
Kuhn’s developmental model of
critical thinking4247
This framework is considered
together with related
epistemological models
Focuses on how individuals respond to every day, ill-structured
problems that lack definitive solutions.
King and Kitchener’s reflective
judgment model42,48
This framework is considered
together with related
epistemological models
Focuses on the epistemic assumptions that underlie reasoning.
Problem solving49This framework is considered
together with Baron’s model of the
good thinker36
Conceptual model of the well-structured problem-solving process.

Data collection and assessment of included frameworks

For each included framework, we compiled a list of publications that describe the framework, its development and evaluation, and its use as the basis for curricula, learning resources, and assessment tools.

We recorded independently the following information for each framework, using a data collection form (Extended data File 3):

  • Its purpose

  • Its domains and elements

  • Definitions of key terms used to describe its purpose, domains, or elements

  • Methods used to develop the framework

  • Methods used to evaluate the framework (if any), and findings

  • Ways in which the framework has been used as the basis for

    • Curricula

    • Teaching and learning

    • Assessment tools

We compared the data that each of us had collected, discussed disagreements, and reached a consensus.

Based on this information, we assessed independently:

  • strengths and weaknesses of how each framework had been developed and evaluated

  • strengths and weaknesses of how each framework has been or could be used

  • any other strengths or weaknesses

We compared our assessments, discussed disagreements, and reached a consensus.

Analysis of the data

  • 1. We summarised key characteristics of the included frameworks in tables.

  • 2. Using Venn diagrams, we mapped the extent to which the purposes of the different frameworks overlap with those of the IHC Key Concepts Framework.

  • 3. We compared the concepts, competences and dispositions in each framework with those in the IHC Key Concepts Framework. We considered separately any elements that could not be categorised as concepts, competences or dispositions.

  • 4. We reflected on our assessments of the frameworks and identified implications for how we might improve the IHC Key Concepts Framework, and its usefulness.

We conducted these analyses independently and then compared our analyses, discussed disagreements, and reached consensus.

Results

We screened over 1600 references retrieved using Google Scholar (search strategy: Extended data File 1). In addition, we screened the reference lists in the articles that we retrieved. We identified over 80 frameworks and assessed 35 of these for eligibility based on one or more full-text articles (Figure 1). We excluded 13 of these (Table 5), so ended up including 22 frameworks (Table 6).

830bc12c-700a-4d97-97cd-08b073bf894f_figure1.gif

Figure 1. Flow diagram.

Frameworks that we grouped together (e.g. health literacy frameworks) are counted as single frameworks. † Frameworks for Thinking: A Handbook for Teaching and Learning (Mosely 2005) has 41 frameworks. ‡ Our primary Google Scholar searches yielded 1588 records. § These frameworks were excluded after being scanned by one of the review authors (ADO).

Table 6. Included frameworks.

Framework, who developed it, and whenPurposeBackground
Critical thinking
Taxonomy of critical thinking dispositions
and abilities

Robert Ennis, Emeritus Professor of Philosophy
of Education, University of Illinois, USA

1960's12,5059
A set of comprehensive goals for a critical
thinking curriculum and its assessment.
In deciding what to believe or do, one
is helped by having and reflectively
employing this set of critical thinking
dispositions and abilities.
In 1951 Robert Ennis, then a high
school science teacher, tried to infuse
critical thinking into his instruction. The
trouble was that he did not know what
critical thinking was, how to teach it,
nor how to test for it. He has worked on
these problems throughout his ensuing
academic career.
Model of critical thinking

Richard Paul, a philosopher and founder of the
Center for Critical Thinking at Sonoma State
University in California and the Foundation for
Critical Thinking, USA; and others

1980's12,6066
To help you achieve your goals and
ambitions, make better decisions, and
understand where others are trying to
influence your thinking
“The Center for Critical Thinking and
Moral Critique and the Foundation for
Critical Thinking — two sister educational
non-profit organizations — work closely
together to promote educational reform.
We seek to promote essential change
in education and society through the
cultivation of fair-minded critical thinking.”
List of critical thinking skills

Diane Halpern, Professor of Psychology,
Claremont McKenna College, USA

1980's12,67,68
Critical thinking skills are those strategies
for finding ways to reach a goal.
The list is based on a book published
in 1984. The original taxonomy was
intended to provide a basis for the national
assessment of critical thinking skills in
adults in the US. Halpern subsequently
revised her taxonomy and presented it, not
as a taxonomy, but as a list.
Model of the good thinker

Jonathan Baron, Department of Psychology,
University of Pennsylvania, USA

1980's12,36,6975
Using a normative theory of the nature of
good thinking and of how we tend to think
poorly to evaluate our actual thinking, and
to know how it must be improved. In this
way, we can learn to think more rationally,
that is, in a way that helps us achieve our
goals.
To arrive at a prescriptive model, we
ought to find out where people depart
from the normative model. Then we can
give practical advice to correct these
departures.
Logic and argumentation
Logical fallacies

Aristotle, Richard Whately, John Stuart Mill, and
others

300's BCE35,68,7684
A logical fallacy is a flaw in reasoning. If
you are aware of these, you will be better
prepared to recognize and defend against
them.
There are many lists and different ways of
classifying logical fallacies, dating back to
Aristotle.
Taxonomy of concepts and critical abilities
related to the evaluation of verbal arguments

Ronald Allen and a team of educators at the
Research and Development Center for Cognitive
Learning, University of Wisconsin, USA

196712,85,86
To identify concepts and clusters of
concepts which adequately define what
knowledge a student must possess if he is
to critically evaluate everyday discourse.
The authors took a "view of argument"
derived from Toulmin's presentation of
inference as a rule-constituted activity
and from the nature of the field of
ordinary discourse. It is an analysis of
concepts related to the evaluation of
ordinary argument, relevant to educators
concerned with the development of critical
thinking skills.
Evidence based reasoning framework

Nathaniel Brown, Education Research,
Measurement, and Evaluation, Lynch School of
Education, Boston College and four colleagues
with interests in assessment in science and
STEM education, USA

201087
To create an analytic tool intended as a
foundation for assessing students’ ability
to reason from evidence in writing and
classroom discussions. This framework
is intended to serve many purposes
in the elementary, middle, and high
school science classroom, including:
(a) supporting students’ and teachers’
understanding of the process of scientific
reasoning; (b) modelling exemplary
scientific reasoning; (c) diagnosing
problems and identifying pitfalls affecting
student reasoning as it develops; and
(d) assessing scientific reasoning in
the classroom both formatively and
summatively.
The authors chose not to apply
Toulmin’s framework directly to scientific
arguments. Instead, they simplified
Toulmin’s framework and then adapted
it to incorporate what is currently known
about the process of scientific inquiry.
They synthesized Toulmin's and Duschl's
frameworks to create a framework of
scientific reasoning as a distinct mode
of thought and discourse with roots in
both general argumentation and scientific
inquiry.
Cognition
Cognitive biases

Amos Tversky, cognitive and mathematical
psychologist and Daniel Kahneman,
psychologist and economist, Israel and USA;
and others

1970's36,8896
To study and document biases of intuitive
thinking in various tasks or beliefs
concerning uncertain events. People rely
on a limited number of heuristic principles
which reduce the complex tasks of
assessing probabilities and predicting
values to simpler judgmental operations.
In general, these heuristics are quite
useful, but sometimes they lead to severe
and systematic errors.
Tversky and Kahneman are recognised
as the founders of cognitive bias theory
and their 1974 Science paper was the
first codification of the area. They based
their classification on their own theory of
general judgemental heuristics. The basis
for different classifications varies, but they
all are based, at least in part, on research
evidence of the existence of the included
biases.
Framework for understanding people's
theories about their own cognition

John Flavell, developmental psychologist
specializing in children's cognitive
development, USA; Gregory Schraw and
David Moshman, Department of Educational
Psychology, University of Nebraska, USA; and
others

1970's97107
To consider how individuals consolidate
different kinds of metacognitive knowledge
and regulatory skills into systematized
cognitive frameworks, the origin and
development of those, and implications for
educational research and practice.
Schraw and Moshman103 reviewed
standard accounts of metacognition
and how metacognitive knowledge and
regulation affect cognitive performance.
Metacognition, which has been defined in
different ways, refers to both knowledge
of cognition (an awareness of variables
that influence thinking) and regulation
of cognition (the ability to regulate one's
learning). it is sometimes defined as
thinking about thinking.
Epistemological models

Jean Piaget, development psychologist,
Switzerland; William Perry Jr., educational
psychologist, Harvard, USA; and others

1950's4248,108113
To describe changes in assumptions about
sources and certainty of knowledge (the
development of epistemic assumptions)
and how decisions are justified in light
of those assumptions (how epistemic
assumptions affect the way individuals
understand and solve problems).
Epistemology is an area of philosophy
concerned with the nature and justification
of human knowledge. A growing area of
interest for psychologists and educators
is that of personal epistemological
development and epistemological beliefs:
how individuals come to know, the theories
and beliefs they hold about knowing, and
the manner in which such epistemological
premises are a part of and an influence
on the cognitive processes of thinking and
reasoning.
AIR model of epistemic cognition

Ravit Duncan, Clark Chinn, Luke Buckland,
Graduate School of Education, Rutgers
University, USA; Sarit Barzilai, Faculty
of Education, University of Haifa, Israel;
Ronald Rinehart, Department of educational
Psychology and Foundations, University of
Northern Iowa, USA

2014114117
To help account for how people evaluate
information, including inaccurate
information and the role that cognitions
play in people’s evaluation of inaccurate
(as well as accurate) information.
Educational and developmental
psychologists have investigated human
cognitions about epistemic matters.
These are cognitions about a network of
interrelated topics including knowledge, its
sources and justification, belief, evidence,
truth, understanding, explanation, and
many others. Different researchers have
used different terms for these cognitions,
including personal epistemology,
epistemological beliefs, epistemic beliefs,
epistemic positions, epistemic cognition,
epistemological reflection, and reflective
judgment.
Scientific thinking
PISA framework for scientific literacy

Organisation for Economic Co-operation
and Development (OECD). The Programme
for International Student Assessment (PISA)
is a collaborative effort among the OECD
member governments to provide a new kind
of assessment of student achievement on a
recurring basis.

1997118124
The main benefit of constructing and
validating the framework is improved
measurement. Other potential benefits
include: a common language, an analysis
of the kinds of knowledge and skills
associated with successful performance,
and identifying and understanding
particular variables that underlie
successful performance.
PISA is designed to collect information
through three-yearly cycles and presents
data on the reading, mathematical and
scientific literacy of 15-year-old students,
schools and countries. It provides
insights into the factors that influence
the development of skills and attitudes
at home and at school, and examines
how these factors interact and what the
implications are for policy development.
Framework for K-12 science education

National Research Council (NRC) Committee
on a Conceptual Framework for New K-12
Science Education Standards, USA. The
committee included professionals in the natural
sciences, mathematics, engineering, cognitive
and developmental psychology, the learning
sciences, education policy and implementation,
research on learning science in the classroom,
and the practice of teaching science.

2010125132
To articulate a broad set of expectations
for students in science. The overarching
goal is to ensure that by the end of
12th grade, all students have some
appreciation of the beauty and wonder
of science; possess sufficient knowledge
of science and engineering to engage
in public discussions on related issues;
are careful consumers of scientific and
technological information related to their
everyday lives; are able to continue to
learn about science outside school;
and have the skills to enter careers of
their choice, including (but not limited
to) careers in science, engineering, and
technology.
The framework was the first part of a
two-stage process to produce a next
generation set of science standards for
voluntary adoption by states in the USA.
Systems thinking

Ideas about holistic thinking and change
processes can be traced back to the ancient
Greeks. The start of modern systems thinking
is attributed the articulation of systems ideas
by Ludwig von Bertalanffy, an Austrian biologist
who started lecturing and writing in the 1930's
on what he called “general system theory”; and
to Aleksandr Bogdanov, a Russian revolutionary,
philosopher and scientist.

1910's133142
To understand and interpret complex
systems in order to navigate information,
make decisions, and solve problems.
Systems theory is the transdisciplinary
study of the abstract organisation
of phenomena, independent of their
substance, type, or spatial and
temporal scale. Systems can be used
to represent the complex organisation
of virtually any collection of real-world
entities into an ordered form that we can
better understand. There are several
conceptualizations of systems thinking in
education.
Model for scientific thinking

Gregory Feist, Department of Psychology,
College of William & Mary, USA; Carlo Magno,
Counselling and Educational Psychology, De La
Salle University, Philippines

1990's143,144
To investigate the relationship of the
constructs scientific thinking, self-
regulation in research, and creativity in a
measurement model.
Feist investigated whether personality traits
consistently distinguish artists from non-
artists and scientists from non-scientists.
Magno144, building on Feist's work143,
investigated the relationship between
scientific thinking, self-regulation, and
creativity.
Evidence-based health care
Health literacy frameworks

The term ‘health literacy’ was first coined in
1974 by Scott Simonds, Professor of Health
Education, University of Michigan, School of
Public Health, USA. Several frameworks have
been developed since then.

1970's2123,145149
To develop health literacy enhancing
interventions and to develop and validate
of measurement tools.
Simonds wrote in 1974 that: “Minimum
standards for 'health literacy' should be
established for all grade levels K through
12. Those school districts that fall below
standard should be provided with federal
aid to develop programs with teachers
qualified to teach health education"150,151.
Since then, it has been estimated that
approximately 80 million Americans have
limited health literacy, and multiple studies
have found that low health literacy is
associated with poorer health outcomes
and poorer use of health care services152.
Evidence-based practice (EBP) core
competencies

International EBP leaders led by team at Bond
University, Australia

201826,153
To develop a consensus-based set of core
EBP competencies that EBP teaching and
learning programs should cover
The term evidence-based medicine was
first developed in the field of medicine in
the early 1990s, but as its use expanded to
include other health disciplines, it became
known as EBP. EBP provides a framework
for the integration of research evidence
and patients’ values and preferences into
the delivery of health care. Although many
teaching strategies have been used and
evaluated, a lack of EBP knowledge and
skills is still one of the most commonly
reported barriers to practicing EBP.
One of the potential explanations is the
inconsistency in the quality and content of
the EBP teaching programs.
GRADE (and related frameworks)

The GRADE Working Group, which includes
methodologists, health researchers, systematic
review authors, guideline developers

200025,30,154160
Grading of Recommendations
Assessment, Development, and
Evaluation (GRADE) offers a transparent
and structured process for developing
and presenting summaries of evidence,
including its quality, for systematic reviews
and recommendations in health care. The
purpose of Evidence to Decision (EtD)
frameworks is to help people use evidence
in a structured and transparent way to
inform decisions in the context of clinical
recommendations, coverage decisions,
and health system or public health
recommendations and decisions.
Since the 1970s a growing number
of organisations have employed
various systems to grade the quality
(level) of evidence and the strength of
recommendations. Different organisations
have used different systems, resulting
in confusion and impeding effective
communication. The GRADE Working
Group began as an informal collaboration
of people with an interest in tackling the
shortcomings of prior grading systems.
Bradford-Hill criteria

Austin Bradford Hill, Professor Emeritus of
Medical Statistics, University of London, UK

196528,161165
To address: "What aspects of an
association between two variables should
we especially consider before deciding
that the most likely interpretation of it is
causation?"
This framework was developed to identify
the causes of diseases and particularly
to determine the role of smoking in lung
cancer, but its use has been extended to
public health decision making, a domain
where questions about causal effects
relate to the consequences of interventions
that have often been motivated by the
identification of causal factors. It has
proven useful and has driven decision
making in public health for decades.
Critical appraisal

International teachers of evidence-based health
care and research methodologists

198129,166179
To teach critical appraisal of health
research. However, some critical appraisal
tools are intended primarily for critically
appraising research in the context of
systematic reviews and some are intended
primarily for reporting standards. There is
an overlap among these tools and clear
distinctions are sometimes not made
among tools with different purposes.
“The strategies we shall suggest assume
that clinical readers are already behind in
their reading and that they will never have
more time to read than they do now. For
this reason, and because the guides that
follow call for closer attention to "Materials
and methods" and other matters that often
appear in small type, many of the guides
recommend tossing an article aside as not
worth reading, usually on the basis of quite
preliminary evidence. It is only through
the early rejection of most articles that
busy clinicians can focus on the few that
are both valid and applicable in their own
practices.”170
Cochrane risk of bias tool (and related
frameworks)

International health research methodologists

1980's29,31,33,180184
To assess the risk of bias in randomised
and non-randomised studies (sometimes
referred to as quality or internal validity).
Assessments of risk of bias are intended
to help interpret findings and explain
heterogeneity in systematic reviews;
in addition, reviews use risk-of-bias
assessments of individual studies in
grading the certainty of the evidence.
Reviews may exclude studies assessed as
high risk of bias.
"The concern about study quality
first arose in the early 1980s with the
publication of a landmark paper by Tom
Chalmers and colleagues and another
extensive work by Hemminki, who
evaluated the quality of trials done in 1965
through 1975 that were used to support
the licensing of drugs in Finland and
Sweden185.
Catalogue of biases

Centre for Evidence Based Medicine, Oxford
University, UK

201734
To obtain the least biased information,
researchers must acknowledge the
potential presence of biases and take
steps to avoid and minimise their effects.
Equally, in assessing the results of studies,
we must be aware of the different types of
biases, their potential impact and how this
affects interpretation and use of evidence
in health care decision making. To better
understand the persistent presence,
diversity, and impact of biases, we are
compiling a Catalogue of Biases, stemming
from original work by David Sackett. The
entries are a work in progress and describe
a wide range of biases – outlining their
potential impact in research studies.
David Sackett, in his 1979 paper “Bias in
Analytic Research”186, reported the first
draft of a ‘catalog of biases which may
distort the design, execution, analysis,
and interpretation of research.’ Sackett
catalogued 35 biases that arise in the
context of clinical trials and listed 56
biases potentially affecting case-control
and cohort studies. He proposed the
continued development of an annotated
catalogue of bias as a priority for research.
He suggested that each citation should
include a useful definition, a referenced
example illustrating the magnitude and
direction of its effects, and a description of
the appropriate preventive measures if any.

We included four frameworks on critical thinking, three on logic and argumentation, four on cognition, four on scientific thinking, and seven on evidence-based healthcare. We grouped several frameworks together for five types of frameworks - logical fallacies, cognitive biases, epistemological models, systems thinking, and health literacy. We also considered related frameworks together with the Grading of Recommendations Assessment, Development, and Evaluation (GRADE) framework and the Cochrane Risk of Bias Tool. The purpose and background of each of the included frameworks are shown in Table 6, and definitions of the key term for each framework are shown in Table 7.

Table 7. Definitions of the core term for each included framework.

FrameworksDefinitions
Critical thinking
Taxonomy of critical thinking
dispositions and abilities
Critical thinking is “reasonable reflective thinking focused on deciding what to believe or do.
http://criticalthinking.net/index.php/longdefinition/
Model of critical thinkingCritical thinking is the intellectually disciplined process of actively and skilfully conceptualizing, applying,
analysing, synthesizing, and/or evaluating information gathered from, or generated by, observation,
experience, reflection, reasoning, or communication, as a guide to belief and action.
http://www.criticalthinking.org/pages/defining-critical-thinking/766
List of critical thinking skillsCritical thinking is the use of those cognitive skills or strategies that increase the probability of a
desirable outcome. It is purposeful, reasonable, and goal directed. Also known as directed thinking68.
Model of the good thinkerThe definition of rationality as “the kind of thinking that helps us achieve our goals. A good decision is
one that makes effective use of the information available to the decision maker at the time the decision
is made. A good outcome is one that the decision maker likes. The whole point of good thinking is
to increase the probability of good outcomes (and true conclusions), but many other factors affect
outcomes aside from good thinking. Good decision making involves sufficient search for possibilities,
evidence, and goals, and fairness in the search for evidence and in inference36.
Logic and argumentation
Logical fallaciesFallacy is the use of invalid or otherwise faulty reasoning in the construction of an argument.
https://en.wikipedia.org/wiki/Fallacy
Taxonomy of concepts and
critical abilities related to the
evaluation of verbal arguments
The evaluation of verbal arguments is the process of applying higher-order concepts (i.e., rules or
principles concerning the nature, structure, and tests of argument) to arguments occurring in ordinary
verbal discourse in order to assess their acceptability. Such an evaluation requires that one understand
numerous concepts and employ diverse critical abilities85.
Evidence based reasoning
framework
To participate in arguments about scientific ideas, students must learn how to evaluate and use
evidence. That is, apart from what they may already know about the substance of an assertion, students
who are scientifically literate should be able to make judgments based on the evidence supporting or
refuting that assertion87.
Cognition
Cognitive biasesCognitive biases are systematic patterns of deviation from norm or rationality in judgment.
https://en.wikipedia.org/wiki/List_of_cognitive_biases
Framework for understanding
people's theories about their
own cognition
Metacognitive theories are theories that integrate one's knowledge about cognition and regulation of
cognition. By "theory" we mean a relatively systematic structure of knowledge that can be used to
explain and predict a broad range of empirical phenomena. By a "metacognitive theory" we mean a
relatively systematic structure of knowledge that can be used to explain and predict a broad range of
cognitive and metacognitive phenomena103.
Epistemological modelsDefinitions of critical thinking are numerous and wide-ranging. However, one non-controversial claim
we can make about critical thinking is that it entails awareness of one’s own thinking and reflection on
the thinking of self and others as an object of cognition. Metacognition, a construct that is assuming an
increasingly central place in cognitive development research, is defined in similar terms as awareness
and management of one’s own thought, or “thinking about thinking.” Metacognition originates early in
life, when children first become aware of their own and others’ minds. But like many other intellectual
skills, metacognitive skills typically do not develop to the level we would like47.
AIR model of epistemic
cognition
Epistemic cognition refers to the complex of cognitions that are related to the achievement of epistemic ends;
notable epistemic ends include knowledge, understanding, useful models, explanations, and the like116.
Scientific thinking
PISA framework for scientific
literacy
Scientific literacy is an individual’s scientific knowledge and use of that knowledge to identify questions,
to acquire new knowledge, to explain scientific phenomena, and to draw evidence-based conclusions
about science-related issues, understanding of the characteristic features of science as a form of human
knowledge and enquiry, awareness of how science and technology shape our material, intellectual,
and cultural environments, and willingness to engage in science-related issues, and with the ideas of
science, as a reflective citizen122.
Framework for K-12 science
education
Science, engineering, and the technologies they influence permeate every aspect of modern life. Indeed,
some knowledge of science and engineering is required to engage with the major public policy issues
of today as well as to make informed everyday decisions, such as selecting among alternative medical
treatments or determining how to invest public funds for water supply options. In addition, understanding
science and the extraordinary insights it has produced can be meaningful and relevant on a personal
level, opening new worlds to explore and offering lifelong opportunities for enriching people’s lives. In
these contexts, learning science is important for everyone, even those who eventually choose careers in
fields other than science or engineering. By framework we mean a broad description of the content and
sequence of learning expected of all students by the completion of high school—but not at the level of
detail of grade-by-grade standards or, at the high school level, course descriptions and standards. Instead,
as this document lays out, the framework is intended as a guide to standards developers as well as for
curriculum designers, assessment developers, state and district science administrators, professionals
responsible for science teacher education, and science educators working in informal settings32.
Systems thinkingSystem thinking is the ability to understand and interpret complex systems. Our conceptualisation of
systems thinking is based on Riess and Mischo’s definition: “as the ability to recognise, describe, model
(e.g. to structure, to organise) and to explain complex aspects of reality as systems”. According to this
definition, Riess and Mischo stressed essential aspects of systems thinking, which include the ability to
identify important elements of systems and the varied interdependency between these elements, the
ability to recognise dimensions of time dynamics, the ability to construct an internal model of reality and
the ability to give explanations, to make prognoses and to develop means and strategies of action based
on that model141.
Model for scientific thinkingScientific thinking is composed of a set of characteristics that includes practical inclination, analytical
interest, intellectual independence, and assertiveness144. Broadly defined, scientific thinking includes
the skills involved in inquiry, experimentation, evidence evaluation, and inference that are done in the
service of conceptual change or scientific understanding. Scientific thinking is defined as the application
of the methods or principles of scientific inquiry to reasoning or problem-solving situations, and involves
the skills implicated in generating, testing and revising theories, and in the case of fully developed
skills, to reflect on the process of knowledge acquisition and change. Participants engage in some or all
the components of scientific inquiry, such as designing experiments, evaluating evidence and making
inferences16.
Evidence-based health care
Health literacy frameworksThere are various definitions of health literacy. A “new ‘all inclusive’ comprehensive definition capturing
the essence of the 17 definitions identified in the literature” is: Health literacy is linked to literacy and
entails people’s knowledge, motivation and competences to access, understand, appraise, and apply
health information to make judgments and take decisions in everyday life concerning healthcare,
disease prevention and health promotion to maintain or improve quality of life during the life course22.
EBP core competenciesEvidence-Based Practice (EBP) is the integration of the best research evidence with clinical expertise
and patient’s unique values and circumstances. Core competencies are defined as the essential minimal
set of a combination of attributes, such as applied knowledge, skills, and attitudes, that enable an
individual to perform a set of tasks to an appropriate standard efficiently and effectively26.
GRADE and related
frameworks
Quality of evidence (also referred to as certainty of the evidence or certainty of the anticipated
effect) is the extent to which one can be confident that an estimate of effect is correct. Strength
of the recommendation is the degree of confidence that the desirable effects of adherence to a
recommendation outweigh the undesirable effects.
https://gdt.gradepro.org/app/handbook/handbook.html#h.svwngs6pm0f2
Bradford Hill criteriaAn association (or correlation) in statistics is a relationship between two variables in a study, e.g.
between having received a particular treatment and having experienced a particular outcome. Causation
(a causal association) is an association between two variables where a change in one makes a change
in the other one happen.
http://getitglossary.org/
Critical appraisal"Critical appraisal is the systematic evaluation of clinical research papers in order to establish:
1. Does this study address a clearly focused question?
2. Did the study use valid methods to address this question?
3. Are the valid results of this study important?
4. Are these valid, important results applicable to my patient or population?"
https://www.cebm.net/2014/06/critical-appraisal/
Risk of biasBias is the result of “flaws in design, conduct, analyses, and reporting, leading to underestimation or
overestimation of the true intervention effect”. “It is usually impossible to know the extent to which biases
have affected the results of a particular trial”31.
Catalogue of biasesBiases (systematic errors) distort effect estimates away from actual effects. Biases are caused by
inadequacies in the design, conduct, analysis, reporting, or interpretation of treatment comparisons.
Because it is generally not possible to know the degree to which an effect estimate is biased,
judgements must be made about the risk of bias using criteria that assess factors that are known, or
thought to be associated with bias, such as unconcealed allocation of participants to treatments. In
everyday language, bias has other meanings, for example ’prejudice’.
http://getitglossary.org/term/bias

Comparison of the included frameworks to the IHC Key Concepts Framework

We summarise our comparison of the included frameworks to the IHC Key Concepts Framework in Table 8. Two frameworks had a similar purpose: Ennis’ taxonomy of critical thinking dispositions and abilities12,5059 and Baron’s model of the good thinker12,36,6975. Ennis’ goal is for students to learn to think critically about what to believe or do. Baron’s goal is for students to learn to think more rationally, that is, in a way that helps them to achieve their goals. Both those goals are broader than that of the IHC Key Concepts Framework, which is to enable people to make informed decisions about which claims to believe about the effects of things they can do (interventions) for their health, the health of others or for other reasons, and about what to do to achieve their goals4. The purposes of the two other critical thinking frameworks that we included (the Model of critical thinking and List of critical thinking skills) were also somewhat like the purpose of the IHC Key Concepts Framework.

Table 8. Comparison of included frameworks to the IHC framework.

FrameworkPurpose*ScopeConceptsCompetencesDispositions
Critical thinking
Taxonomy of critical thinking
dispositions and abilities
BroaderYesYesYes
Model of critical thinkingBroaderYesYesYes
List of critical thinking skillsBroaderYesYesYes
Model of the good thinkerBroaderNoYesYes
Logic and argumentation
Logical fallaciesOverlappingYesNoNo
Taxonomy of concepts and critical
abilities related to the evaluation of
verbal arguments
OverlappingYesYesNo
Evidence based reasoning
framework
OverlappingYesNoNo
Cognition
Cognitive biasesOverlappingYesNoNo
Framework for understanding
people's theories about their own
cognition
OverlappingNoYesNo
Epistemological modelsOverlappingNoNoYes
AIR model of epistemic cognitionOverlappingYesYesYes
Scientific thinking
PISA framework for scientific literacyOverlappingYesYesYes
Framework for K-12 science
education
OverlappingYesYesNo
Systems thinkingNarrowerYesYesNo
Model for scientific thinkingNon-overlappingNoNoYes
Evidence-based health care
Health literacy frameworksBroaderNoYesNo
Evidence-based practice (EBP) core
competencies
BroaderNoYesNo
GRADE and related frameworksOverlappingYesNoNo
Bradford-Hill criteriaOverlappingYesNoNo
Critical appraisalOverlappingYesYesNo
Risk of biasNarrowerYesNoNo
Catalogue of biasesOverlappingYesNoNo

* Similarity to the IHC framework:SimilarSome similarityLittle similarityNot similar

Overlap with the IHC framework:Some overlapLittle overlapNo overlap

† Yes = included in the framework; No = not included in the framework

Figure 2 illustrates how we view the relationship between critical thinking and the IHC Key Concepts Framework. Although the IHC framework focuses specifically on critical thinking about health effects and choices, the same Key Concepts can be applied to many other types of interventions (actions) and decisions7. Because achieving our goals depends on what we do (actions), deciding what to believe about the possible effects of our actions and what to do is at the centre of critical thinking. However, critical thinking also applies to many other types of beliefs, such as beliefs about religion, history, or art.

830bc12c-700a-4d97-97cd-08b073bf894f_figure2.gif

Figure 2. Venn diagram showing the relationship between critical thinking and the IHC framework.

The goal of the IHC Key Concepts Framework is “To enable people to make good decisions about which claims to believe about the effects of things they can do for their health, the health of others or for other reasons, and about what to do to achieve their goals”4. Our formulation of that goal was influenced by how Ennis and Baron formulated their goals. We have adapted Baron’s definition of a “good decision”36 to explain what this means: a good decision is one that makes effective use of the information available to the decision maker at the time the decision is made. A good outcome is one that the decision maker likes. The aim of thinking critically about treatments is to increase the probability of good outcomes (and true conclusions), but many other factors affect outcomes aside from critical thinking.

The purpose of one of the logic and argumentation frameworks that we included had a somewhat similar purpose to that of the IHC Key Concepts Framework. The evidence-based reasoning framework87 was developed as an analytic tool intended as a foundation for assessing students’ ability to reason from evidence in writing and classroom discussions. The relationship between argumentation – critical evaluation of arguments – and the IHC Key Concepts Framework is illustrated in Figure 3. The purposes of four of the evidence-based health care frameworks were also somewhat similar to the purpose of the IHC Key Concepts Framework: health literacy2123,145149, the Evidence-based practice (EBP) core competencies26, GRADE25,30,154160, and critical appraisal tools29,166179.

830bc12c-700a-4d97-97cd-08b073bf894f_figure3.gif

Figure 3. Venn diagram showing the relationship between argumentation and the IHC framework.

Figure 4 illustrates the relationship between the evidence-based practice framework and the IHC Key Concepts Framework. Evidence-based practice is a framework for health professionals, whereas the IHC Key Concepts Framework is for young people, patients and the public, and policymakers, as well as health professionals. Evidence-based practice is a broader framework, which includes critical appraisal of other types of evidence besides evidence of effects. It also includes formulating clinical questions, acquiring evidence, and evaluating performance, which are largely outside of the scope of the IHC Key Concepts Framework. The aim of evidence-based practice is to improve health outcomes, and that depends on what health professionals, patients and the public do. Thus, the IHC Key Concepts Framework – critical thinking about effects and choices – is at the centre of evidence-based practice, in much the same way as it is at the centre of critical thinking.

830bc12c-700a-4d97-97cd-08b073bf894f_figure4.gif

Figure 4. Venn diagram showing the relationship between evidence-based practice and the IHC framework.

Health literacy also has a broader focus than the IHC Key Concepts Framework. This is most clearly illustrated by Nutbeam’s framework145,148, which divides health literacy into functional, interactive, and critical health literacy. The IHC Key Concepts Framework is most closely related to critical health literacy, as illustrated in Figure 5.

830bc12c-700a-4d97-97cd-08b073bf894f_figure5.gif

Figure 5. Venn diagram showing the relationship between health literacy and the IHC framework.

The GRADE framework overlaps substantially with the IHC Framework with respect to critical thinking about evidence of intervention effects and decisions about what to do, as illustrated in Figure 6. However, the GRADE framework is designed primarily for judgements by authors of systematic reviews, guideline developers, and policymakers.

830bc12c-700a-4d97-97cd-08b073bf894f_figure6.gif

Figure 6. Venn diagram showing the relationship between GRADE and the IHC framework.

Logical fallacies35,68,7684 and cognitive biases36,8896 are both highly relevant to the IHC Key Concepts Framework. However, there is little similarity between the purposes of either of those types of frameworks and the purpose of the IHC Key Concepts Framework (Figure 7 and Figure 8). Recognising the use of faulty reasoning in the construction of an argument overlaps with recognising faulty logic underlying claims about effects. However, most logical fallacies are not directly relevant to this. Similarly, recognising systematic patterns of deviation from rational judgements (cognitive biases) overlaps with judgements about effects and choices, but most cognitive biases are not directly relevant. In addition, most of the IHC Key Concepts are not logical fallacies or cognitive biases.

830bc12c-700a-4d97-97cd-08b073bf894f_figure7.gif

Figure 7. Venn diagram showing the relationship between logical fallacies frameworks and the IHC framework.

830bc12c-700a-4d97-97cd-08b073bf894f_figure8.gif

Figure 8. Venn diagram showing the relationship between cognitive biases frameworks and the IHC framework.

There was at most some overlap between the concepts, competences, and dispositions in the included frameworks and those in the IHC Key Concepts Framework (Table 8). In seven of the 16 frameworks that included concepts, there was some overlap with the IHC Key Concepts Framework. Of the 13 frameworks that included competences, there was some overlap with the IHC Key Concepts Framework in five. There was very little overlap with the dispositions included in eight frameworks.

Development of the frameworks

The methods used to develop the frameworks were clearly described for only 10 of the 22 included frameworks, and the basis was clear for only six (Table 9). In total, 11 of the 22 were based in part on another framework, three on a model or theory, four on a systematic review, nine on an unsystematic review, three on a formal consensus process, and seven on an informal consensus process. The evidence-based practice core competences and Cochrane Risk of Bias Tool were the most systematically developed frameworks. Both were based in part on systematic and unsystematic reviews. The evidence-based practice core competences used a formal consensus process, whereas the Cochrane Risk of Bias Tool used an informal process.

Table 9. Methods used to develop the frameworks.

FrameworkClear
methods
Clear basisAnother
framework
Model or
theory
Systematic
review
Unsystematic reviewFormal
consensus
Informal
consensus
Something else
Critical thinking
Taxonomy of critical
thinking dispositions and
abilities
YesSomewhatDewey'sYes
Model of critical thinkingNoNo
List of critical thinking
skills
NoNo
Model of the good thinkerNoSomewhatDewey's
Logic and
argumentation
Logical fallacies*Yes for
some
VariesVariousYes for someLogic
Taxonomy of concepts
and critical abilities
related to the evaluation
of verbal arguments
YesYesToulmin's
Evidence based
reasoning framework
NoSomewhatToulmin'sYesYes
Cognition
Cognitive biases*NoVariesVariousVariousYes for someYes for
some
Yes
for some
Qualitative analysis
Framework for
understanding people's
theories about their own
cognition
NoNo
Epistemological models*YesYesVariousInterviews & a survey
AIR model of epistemic
cognition
NoNo
Scientific thinking
PISA framework for
scientific literacy
NoSomewhatYesInternational input, feedback, and
experience
Framework for K-12
science education
YesYesPrevious U.S.
frameworks
An iterative process with input and
feedback from partner organisations,
design teams, experts, and open
public comment
Systems thinking*NoVariesVariousDeveloped over several decades in
several different disciplines
Model for scientific
thinking
YesYesA previous study143 and principal
components analysis for a
measurement instrument
Evidence-based health care
Health literacy
frameworks*
Yes for someVariesYes for
some
Yes for someYes for
some
Concept mapping146
Evidence-based practice
(EBP) core competencies
YesYes5 steps of EBPYesYesYes
GRADENoSomewhatPreceding systems
for grading
evidence and
recommendations
YesYesYesTesting criteria against examples.
It has gone from an informal
consensus process to having
explicit decision rules [https://www.
gradeworkinggroup.org/docs/Pub-
rules-20170928.pdf]
Bradford-Hill criteriaNoNo
Critical appraisal*Yes for someVariesPreceding
checklists
Yes for someYes for
some
Yes for
some
Surveys, pilot validation testing
Cochrane risk of bias toolYesYesPrevious checklistsYesYesYesPilot testing
Catalogue of biasesNoNoAlthough the
catalogue was
inspired by David
Sackett's list of
biases, it is not
clear what methods
were used to create
this list.
N “yes” or “yes for
some”
1061134937
Percent45%27%50%14%18%41%14%32%

* More than one framework was considered.

Although more than one framework was considered, the assessment applies to this specific framework

Yes or yes for some for “clear methods”; yes for other bases

Evaluations of the frameworks

Key findings of formal and informal evaluations of the included frameworks are summarised in Table 10. We found formal evaluations of seven of the 22 included frameworks. Methods used to formally evaluate the frameworks included factor analysis143,146,187; extensive feedback (including online surveys)32; principal components and Rasch analysis143; systematic reviews24,29,157,175,181,185,188; an agreement study189 and an assessment of the effect of training on reliability182; and an assessment of usability using focus groups and online surveys183. Two frameworks were evaluated both formally and informally, were found to be useful, and are widely used: the GRADE framework24,157,188,189 and the Cochrane Risk of Bias Tool181183,184,185.

Table 10. Key findings of formal and informal evaluations of the frameworks.

NameFormally
evaluated
Key findingsInformally
evaluated
Findings
Critical thinking
Taxonomy of
critical thinking
dispositions and
abilities
NoYesThe underpinning values of Ennis’ work are those of rationality and logical
thinking, with little attention paid to the impact of feelings on thinking.
Elsewhere, Ennis defends critical thinking against cultural bias, whilst
accepting that culture and context have serious implications for such an
approach. Ennis aimed to produce a taxonomy which enables critical
thinking to be used practically. He says that his taxonomy is ‘simple and
comprehensible’ and considers that it can be implemented successfully in
different ways, though he acknowledges that it needs further research to
validate detailed aspects12.
Model of critical
thinking
NoYesPaul's lists of abilities and traits do not have any significant omissions
when compared with those of Ennis or Perkins, Jay and Tishman. Nosich
believes that it is because Paul’s model of critical thinking is concept-
based (as opposed to having rules, procedures or steps to follow), that
it is effective in curriculum development. The model is extremely flexible,
applicable to any subject matter and to any level of thinking. Paul’s major
contribution to the area of critical thinking is his idea of ‘weak’ versus
‘strong sense’ critical thinking. The latter is what Paul refers to as the ability
to discover and contest one’s own egocentric and socio-centric habits
of thought. Paul claims that his nine traits of thought, which are moral
commitments and intellectual virtues, transfer thinking from ‘a selfish,
narrow-minded foundation to a broad open-minded foundation’12.
List of critical
thinking skills
NoYesHalpern does not claim to have provided comprehensive lists of critical
thinking skills. It is possible to identify many gaps in her lists. More than
any author whose work we have reviewed, Halpern has endeavoured
to translate theory and research from cognitive psychology into a form
where it can be useful in everyday life. There is up-to-date teaching
material to accompany the main text. She has also drawn on relevant
sources outside psychology. Halpern is a strong believer in the application
of rational methods in problem-solving, including the use of
controlled experiments. She points to the need for people to learn how to learn and to
be critically selective in responding to the barrage of information (including
advertisements and political rhetoric) around them. She argues that
teaching and assessing critical thinking will improve the quality of teaching
and learning at college level and will increase social capital and economic
competitiveness. These are pragmatic arguments, in support of which she
cites several studies to illustrate the transferability of critical thinking skills12.
Model of the good
thinker
NoYesWhen compared with other critical thinking theorists, there are some
serious gaps in their enumeration of the qualities of a good thinker.
Empathy, humility, respect for other points of view, clarity and integrity
are signally absent. It is also surprising that building understanding,
justification, seeking consensus, and formal problem-solving are not
included in the list of ‘common’ types of thinking. The list of the general
characteristics of the good thinker is of limited value in determining what
counts as the rational pursuit of goals in a situation. It is almost a truism that
irrational, impulsive, rigid, restricted, self-satisfied and biased thinking are
to be avoided. Baron provides clear definitions and examples from diverse
domains, including real-life problems. His model is easy for teachers and
learners to understand, but the most valuable part of it is the simplest: the
idea of thinking and learning as enquiry12.
Logic and
argumentation
Logical fallaciesNoYesThere does not appear to be agreement on a framework.
Taxonomy of
concepts and
critical abilities
related to the
evaluation of verbal
arguments
YesA factor analytic study of the Wisconsin Tests of Testimony
and Reasoning Assessment (WISTTRA)187: Subject matter
specialists in speech developed a taxonomy of concepts
and abilities related to verbal argument as used in ordinary
discourse. It was the purpose of this study to use data
collected to assess these hypothesized abilities to determine,
using factor analytic procedures, the construct validity of
the taxonomy. Both derived orthogonal and derived oblique
factor solutions were obtained for each of three initial factor
methods. The major conclusion was that the tests based upon
the taxonomy have construct validity at a level of specificity.
YesThis is a distinctive model in that brings together in an economical form
a set of concepts and abilities which can be used in many content areas.
The scope of the model is rather narrow, covering only a subset of the 15
critical thinking abilities identified by Ennis12.
Evidence based
reasoning
framework
NoYesIt may be useful as a framework for assessment - evaluation of the quality
of arguments87.
Cognition and
epistemology
Cognitive biasesNoYesA systematic review of the literature revealed a total of 76 differently named
decision biases or sources of decision biases. An examination of the
biases suggests that there are several similarities, and possible overlap,
among many of the biases, despite being assigned different names by
different researchers. While some researchers have attempted to create
classification schemes of decision biases, all the existing categorizations
are based on subjective groupings, and none are mutually exclusive
and exhaustive. To support further research in the fields of economics,
psychology, and managerial decision-making, and to more effectively
introduce these biases to the supply management discipline, the authors
developed a taxonomy of these decision biases using a systematic,
scientifically valid methodology which results in a classification which is
both mutually exclusive and exhaustive. The authors are unaware of any
other research which has used a scientifically valid set of methodologies
to develop a mutually exclusive and exhaustive taxonomy of decision
biases190.
Framework for
understanding
people's theories
about their own
cognition
NoNo
Epistemological
models
NoYesThere were numerous limitations to Perry’s original study. The scheme's
lower positions are more explicitly epistemological than the upper
positions, which shift "away from spatial-cognitive restructuring to
emotional and aesthetic assessments". Thus, while the epistemological
movement from dualism to relativism is clearly noted, how knowledge is
construed beyond these positions is less well defined. Perry's work came
under attack in the late 1970s for the limitations of generalizing from an
elite male sample to the general population of college students. One of
the persistent difficulties faced by those who wished to utilize the scheme
as more than a theoretical lens has been the difficulty in operationalizing
the scheme and in measuring change. Perry did not conduct further
research to explore linkages between his conception of epistemological
development and student learning, but he did speculate in later work on
possible connections among cognitive styles, learning strategies, and
development. "When students radically revise their notions of knowledge,
would they not be likely to change their ways of going about getting it?"

Baxter Magolda attempted to explore gender-related patterns of
epistemological development by studying both men and women
conducted a longitudinal study of college students at one institution.
Epistemology, as it appears to have been defined in this study, largely
consisted of student perceptions of learning experiences.

It may be problematic that actual reflective judgment, noted in Stages 6
and 7 of King and Kitchener’s framework appears to have been attained by
only a minute fraction of those interviewed and has appeared consistently
only among advanced graduate students. Responses to the hypothetical
problems posed in the interviews may tell us little about how student beliefs
are aroused in actual experiences. We know little about how reflective
judgment develops in context and just how education makes a difference

Kuhn appears to use a simplified three-stage representation of Perry's
scheme and offers little information as to the empirical validation of this
scheme, but in the connection of epìstemological theories to reasoning.
Kuhn's work seems least clear in the definition of elements that comprise
epìstemological theories.

Conceptually, the theoretical rationale for the four dimensions
in Schommer’s framework is somewhat problematic. Measuring
epistemological beliefs in paper-and-pencil questionnaire format is an
attractive and expedient alternative to interviews. However, considerable
questions remain about this approach, as well as about this particular use
of survey methodology.

There are several important conceptual and methodological issues to be
resolved in future research. We believe that one of the most important
issues is the definition and delineation of the construct of epistemological
beliefs and thinking42.

AIR model of
epistemic cognition
NoNo
Scientific thinking
PISA framework for
scientific literacy
NoYes The framework was reviewed by expert panels in each of the participating
countries, but their feedback was not reported123.

“Procedural and epistemic knowledge are very important for interpreting
claims from researchers, for instance in media reports. Just content
knowledge is not sufficient to understand how science works. However,
the description of knowledge is fairly theoretical and might be read as
a syllabus for a course on the philosophy of science. I am convinced that
this is not the intention, so the main challenge for PISA 2015 is to write test
items which are feasible for 15-year olds at various ability levels”191.

“The OECD sets out to determine scientific literacy for future adult
life through a longitudinal international study, although this has been
criticised, not least because its measures are through written tests and
questionnaires, which generally show developing countries to be in poor
shape to meet such a goal.” “In this paper it is suggested that retaining
the use of scientific literacy is still appropriate, but it is necessary to relate
scientific literacy to an appreciation of the nature of science, personal
learning attributes including attitudes and also to the development of
social values. For this, relevance of the learning plays a role and teaching
materials, striving toward student enhancement of scientific literacy, need
to consider a societal frame, introduction of conceptual science on a need
to know basis, and to embrace the socioscientific situation that provides
the relevance for responsible citizenship.” “The trend in defining scientific
literacy is suggested as away from the short term product approach, in
which the facts and skills are paramount, towards the inclusion of issue-
based teaching, the need to go beyond scientific problem solving to
encompass socioscientific decision making, and the recognition that
scientific literacy relates to enabling citizens to effectively participate in
the real world. The trend indicates a movement that gives less attention
to scientific literacy being viewed as the possession of conceptual
understanding of pure science abstract ideas and emphasises more
the ability to make decisions related to the technological applications
of scientific ideas or socioscientific issues facing society, these being
recognized as crucial learning components”121.

There is a widespread critique of many aspects of PISA in academic
articles, and from many different disciplines192.

Framework for
K-12 science
education
YesThere was extensive feedback on a draft32. In general, the
feedback about the draft framework indicated support for
the overall approach. In the online surveys, many individuals
commented that they were impressed with the document
and thought it provided a good next step toward refining
standards for K-12 science education. At the same time, there
were many critiques and suggestions for how to improve it. In
looking across all the modes of gathering feedback, some key
overarching issues emerged:

• concerns about the purpose, audience, and voice;

• suggestions of additional fields or topics to include;

• how best to incorporate and describe ideas in engineering
and technology;

• concerns that there was too much material;

• lack of guidance or examples about how to convey the
integration of crosscutting concepts, core ideas, and
practices;

• insufficient indication of connections to other topics or
issues, such as mathematics and literacy;

• need for a stronger statement about science for all and
insufficient attention to diversity and equity;

• lack of “standards” for curriculum, programs, assessment,
and professional development similar to those that were
included in the National Science Education Standards; and

• lack of attention to the challenges inherent in implementing
the framework.

No
Systems thinkingNoYesSee above
Model for scientific
thinking
YesA measurement tool based on the model was evaluated
using principal components analysis, the Rasch model, and
confirmatory factor analysis. There was good fit for the “Scale
for Scientific Thinking”. “The factors confirmed for scientific
thinking and self-regulation in conducting research together
with creativity were structured in a measurement model to
test if they are related. It was previously hypothesized that
the constructs scientific thinking, self-regulation in research,
and creativity converge with each other. Their point of
convergence was primarily explained in the social cognitive
theory and field theory. The hypothesis was supported in
the present study. The constructs scientific thinking, self-
regulation in research, and creativity were significantly
correlated in the measurement model”143.
No
Evidence-based
health care
Health literacy
frameworks
YesOn the basis of questionnaire data, a “quantitative”
structural model was created by first applying exploratory
factor analyses and then cross-validating the model with
confirmatory factor analyses. “The questionnaire proved to
be reliable and valid, and the structural model was replicated
and cross-validated via structural equation modelling with
different samples.” “The model presented here adds to the
picture of health literacy derived empirically by Jordan et al.
which also relied on concept mapping. In that study, Jordan
developed the construct of health literacy from a patient
perspective. While the patient perspective is important,
Jordan et al. stated, “in addressing health literacy the focus
should not lie solely with the patient.” Our study addresses
this point by expanding the perspective on health literacy
with input from experts in healthcare and demonstrates where
the different perspectives (patient vs. provider) share similar
ideas about health literacy”146.
YesThere is not a consensus on a definition or a model.
EBP core
competencies
NoNo
GRADE and
related frameworks
YesThere have been comparisons to other systems and
agreement studies. All the approaches used to grade
levels of evidence and the strength of recommendations
prior to GRADE had important shortcomings188. A review of
systems for rating the quality (certainty) of evidence found
that GRADE was unique in its comprehensive guidance,
rigorous development, and dissemination strategy157. A review
of decision-making frameworks for coverage decisions24
found that: “Although no modifications to the GRADE EtD
framework for coverage decisions appeared necessary
to address the situation of effective but expensive and
desirable interventions, modifications to some parts of the
seven-construct framework - burden of disease, benefits and
harms, values and preferences, resource implications, equity,
acceptability, and feasibility - would increase its applicability
in a range of political and health systems. Suggested
modifications to the GRADE EtD framework include adding
the consideration of limitations of the alternative technologies
in use (as an elaboration of benefits and harms) and,
more importantly, broadening acceptability and feasibility
constructs to include political and health system factors.
Findings of an agreement study suggest that trained
individuals using the GRADE approach improves reliability
in comparison to intuitive judgments about the QoE and that
two individual raters can reliably assess the QoE using the
GRADE system189 .
YesAlthough there have been criticisms of the GRADE approach, it is
now the most widely used and highly cited approach. [https://www.
gradeworkinggroup.org/]
Bradford Hill
criteria
NoYes The framework does not reflect the current, more clearly articulated
view of causal processes. Additionally, the guidelines used to evaluate
evidence have not changed for decades, even as the causal questions
have become more complex, beyond the original intent of this framework.
One important limitation of the classic view of disease causation arising
from the Hill criteria has been the lack of a formal basis for evaluating
causal hypotheses. Only in the past several decades have investigators
explored more formally the foundational mathematical and conceptual
issues required for rigorous estimation of causal effects, particularly in
circumstances where randomization of treatment assignment that ensures
exchangeable comparison groups is unfeasible.

The inference about cause became the rationale for intervention, but the
causal conclusions were not couched in the consequences of specific
actions to reduce or eliminate cigarette smoking. And later, public health
action was aimed at the individual smoker, rather than at the upstream
system of cigarette manufacture, advertising, and distribution. This
limited focus is a key characteristic of the traditional approach; causal
determinations were made by epidemiologists and others in public health
about various risk factors without considering the effect of a specific way of
changing them.

The utility of long-used, familiar approaches for statistical analysis and
causal inference to interpret the broad sweep of evidence on the causal
determinants of human health is diminishing. Public health practitioners
and researchers must understand the limitations of those162.

They have to some extent withstood the test of time, in that they are still
widely recognised and taught, but they are increasingly being replaced by
GRADE (and other frameworks) and they are, in some ways, not consistent
with GRADE165.

Critical appraisalYesKatrak29 reported a systematic review of critical appraisal tools.
Many published critical
appraisal tools are available to critically
appraise research reports. Many of the tools were reported to
be modifications of other published tools or reflected specialty
concerns in specific clinical or research areas, without attempts
to justify inclusion criteria. Few of the generic critical appraisal
tools could be usefully applied to any health research. Forty-two
different items were extracted from the six critical appraisal
tools that could be used to evaluate randomised and non-
randomised studies. The majority of the critical appraisal tools
were developed for a specific research design (87%), with most
designed for use on randomised studies (38%). There is also
a considerable number of critical appraisal tools for systematic
reviews (N = 26).

There is a lack of information on tool development processes
in most cases. Only 14 out of 121 instruments (12%) were
reported as having been constructed using a specified
empirical approach. Few critical appraisal tools had
documented evidence of validity of their items, or reliability
of use. Face validity was established in nine critical appraisal
tools, seven of which were developed for use on experimental
studies and two for systematic reviews. Intra-rater reliability
was established for only one critical appraisal tool as part
of its empirical development process, whereas inter-rater
reliability was reported for two systematic review tools (for one
of these as part of the developmental process) and seven
experimental critical appraisal tools (for two of these as part
of the developmental process).

Hyde175 reported a systematic review of evaluations of the
effects of critical appraisal workshops, most of which use
checklists. Sixteen studies met the inclusion criteria. One
study was an RCT, 8 were non-randomised between group
studies, and 7 were before-and-after studies. The impact of
critical appraisal teaching on clinicians’ behaviour (principally
reading behaviour) was mixed. Of the eight comparisons for
this outcome six had major threats to validity. Most, but not
all, of the comparisons showed benefit of critical appraisal
teaching, two acting in the opposite direction. Critical appraisal
teaching was seen to consistently increase skills: fourteen of
the sixteen comparisons for this outcome showed a positive
effect. The strength of the effect remained when self-assessed
comparisons were removed. Five comparisons were thought
not to be subject to major flaws: four of these indicated a benefit
of critical appraisal teaching. The strongest and most consistent
impact of critical appraisal teaching was seen on knowledge
outcomes: 7 of the 12 studies showed a statistically significant
positive effect. However, consideration of the size of the benefit
revealed heterogeneity. There were four comparisons of the
impact on attitudes - all were positive, but it was not possible
to separate out real effects from a tendency for participants to
respond in a “desired” manner. There were inadequate data to
assess whether there was variation in outcome according to the
mode of delivery of the educational intervention.

YesThere is variation among available critical appraisal tools.
Risk of biasYesWest et al.185 and Bai et al.181 assessed whether instruments
considered all or most of the elements for each domain and
did not omit any element defined as essential. Savovic
et al.183 assessed the usability of the Cochrane risk of bias
tool by means of focus groups, online surveys and a face.to-
face meeting. Da Costa et al.182 assessed whether intensive,
standardized training on risk of bias assessment improved
the reliability of the Cochrane risk of bias tool. The Cochrane
RoB tool was experienced positively by users and its reliability
could be improved by training. There appears to be broad
agreement regarding the criteria included in the Cochrane
RoB tools.
YesZeng et al.184 considered the Cochrane RoB tool the best available tool for
randomised trials. Viswanathan et al.180 provided general guidance without
recommending a specific tool.
Catalogue of
biases
NoNo

Our assessment of the elements (concepts, competences or dispositions) in the 22 frameworks is summarised in Table 11. Only one framework, the framework for K-12 science education, had clear inclusion criteria for one of three dimensions (“core ideas”). We judged the elements to be coherent in five frameworks, distinct in nine, and organised logically in eight. There were no inappropriate elements in seven frameworks and no missing elements in two. Overall, the evidence-based reasoning framework86 was the only framework that we assessed positively for all five criteria (coherent elements, distinct elements, no inappropriate elements, no missing elements, and logical grouping of the elements). That framework is a relatively simple analytic model of arguments about scientific ideas.

Table 11. Assessment of the frameworks.

FrameworkClear inclusion
criteria
Coherent
elements§
Distinct
elements**
Inappropriate
elements††
Missing
elements‡‡
Logical
grouping§§
Critical thinking
Taxonomy of critical thinking
dispositions and abilities
NoSomewhatSomewhatPossiblyPossiblyPossibly
Model of critical thinkingNoYesYesPossiblyPossiblyPossibly
List of critical thinking skillsNoNoSomewhatPossiblyPossiblyPossibly
Model of the good thinkerNoNot clearNo (except for
dispositions)
NoYesPossibly
Logic and argumentation
Logical fallacies*NoVariesNoPossiblyPossiblyYes (although
the logic that is
used varies)
Taxonomy of concepts and
critical abilities related to
the evaluation of verbal
arguments
NoNoYesNoYesYes
Evidence based reasoning
framework
NoYesYesNoNoYes
Cognition
Cognitive biases*VariesVariesNoPossiblyPossiblyPossibly
(although the
logic that is
used varies)
Framework for understanding
people's theories about their
own cognition
NoNoYesNot clearPossiblyPossibly
Epistemological modelsNoSomewhatSomewhatNoNoYes
AIR model of epistemic
cognition
NoNoYesNoYesYes
Scientific thinking
PISA framework for scientific
literacy
NoNoSomewhatNoPossiblyPossibly
Framework for K-12 science
education
For one
dimension (core
ideas) only
Yes within
each
dimension,
not across
dimensions
YesPossiblyYesNot clear
Systems thinking*NoSomewhatSomewhatPossiblyPossiblyPossibly
Model for scientific thinkingBased on
principle
components
analysis
YesYesPossiblyPossiblyPossibly
Evidence-based health
care
Health literacy frameworks*NoVariesYes (within
different models)
PossiblyPossiblyPossibly
Evidence-based practice
(EBP) core competencies
There was a
predefined
consensus
level (70%),
but no explicit
criteria for the
people making
judgements.
SomewhatSomewhatPossiblyPossiblyYes
GRADENoSomewhatSomewhatPossiblyPossiblyYes
Bradford-Hill criteriaNoSomewhatSomewhatYesYesPossibly
Critical appraisal*NoVariesPossibly (within
checklists),
not across
checklists
VariesPossiblyPossibly
Cochrane risk of bias toolNoYesYesNoPossiblyYes
Catalogue of biasesNoNoNoYesPossiblyNo
N frameworks "yes"1 (partially)597 (no)2 (no)8
Percent5%23%41%32%9%36%

* More than one framework was considered.

Although more than one framework was considered, the assessment applies to this specific framework

Yes or yes for some for “clear methods”; yes for “coherence”, “distinct”, and “logical grouping”; no for “inappropriate elements” and “missing elements”

§ Does not mix type(s) and specificity of concepts, competencies, or dispositions

** Included concepts, competencies, or dispositions are clearly different from each other

†† Concepts, competencies, or dispositions included in the framework that should not have been

‡‡ Concepts, competencies, or dispositions not included in the framework that should have been

§§ Concepts, competencies, or dispositions organised in a way that makes sense

Use of the frameworks

Information about how the 22 frameworks have been used is summarised in Extended data File 4. We found evidence that most of the frameworks were being used. For four (the taxonomy of concepts and critical abilities related to the evaluation of verbal arguments, the evidence-based reasoning framework, the AIR model of epistemic cognition, and the model for scientific thinking) we found little evidence of use. Two had only been available for one or two years (the evidence-based practice core competences and the Catalogue of Biases), and we were uncertain about their use. Twelve of the frameworks appeared to be intended primarily for teachers and students, and we found learning resources based on 14 of the frameworks.

Nine of the frameworks appeared to be intended primarily for researchers. One (the evidence-based practice core competences) appeared to be intended primarily for curriculum developers26. We found at least some evidence that six other frameworks were used for curriculum development, including three of the critical thinking frameworks. We found evidence that 12 of the frameworks were used as the basis for one or more assessment tools. Other ways in which the frameworks have been used or have been proposed for use include: self-teaching; by parents, institutions, and government; by employers developing training programs; professional development; establishing norms or standards; developing ways of protecting against cognitive biases; theory development; intervention design; policy advice; and reporting standards.

Strengths and weaknesses of the frameworks

Strengths and weaknesses of each framework and ideas for further development of the IHC Key Concepts Framework are summarised in Table 12. Strengths of the frameworks related to their development include international collaboration, support from international or national organisations, continued development over a long period of time, well described and systematic development, research evidence to support all of the concepts, elicitation of extensive feedback, and formal comparisons to similar frameworks. Strengths related to their usability include simplicity, a user-friendly structure for describing each concept, and wide use.

Table 12. Strengths, weaknesses, and ideas for IHC Key Concepts.

FrameworkStrengthsWeaknessesIdeas for IHC Key Concepts
Critical thinking
Taxonomy of critical
thinking dispositions
and abilities
Continued development over more than 40 years.No formal evaluation. It has a broad
focus and may be difficult to apply to
thinking critically about health claims and
choices or other specific decisions about
what to believe or do.
Trace the origins of the IHC Key Concepts back
to clinical epidemiology, critical appraisal, and
evidence-based practice.

Ennis analyses different approaches to assessing
critical thinking, rejecting multiple-choice
assessment for all but self-assessment and
research. He also questions performance-based
assessment on grounds of cost, focus and context
(the more realistic the performance the more
complex the problem).

“Reasonable reflective thinking focused on deciding
what to believe or do” is a good way of describing
the aim of the IHC Key Concepts.

Consider using a figure or model for organising the
concepts
Model of critical thinkingEstablishment of a centre, scholars, and an annual
conference (www.criticalthinking.org).

Outline of a spiral curriculum193
Unclear development methods

No formal evaluation
IHC annual conference, fellows, guides, online
courses, library

Clarification of what is outside of the IHC scope,
including “fair mindedness” / ethics

Consider different audiences.

Consider the extent to which IHC approach may
conflict with Paul approach.
List of critical thinking
skills
Used and refinement based on feedback between 1984
and 2014.

Translation of cognitive psychology theory and research
into a form where it can be useful in everyday life.

Halpern is a strong believer in the application of rational
methods in problem-solving, including the use of controlled experiments.
Unclear development methods

Developed by a single author with a
background in cognitive psychology

No formal evaluation
Seek feedback from people with a strong
background in critical thinking

Consider reframing concepts as skills and adding
examples of use.

Consider developing a textbook for older students
and teachers.
Model of the good
thinker
The purpose of rational (critical) thinking is explained
nicely, the basic framework is simple and logical,
focusing on thinking and learning as enquiry, and there
are some useful definitions. The textbook introduces
relevant theories and approaches to critical thinking, and
uses examples from diverse domains, including real-life
problems.
Unclear development methods

No formal evaluation

There is not a clear list of concepts or
competences that should be learned
and very little about how they should be
learned or evaluated.
Consider adapting some of the text and definitions
used to describe good thinking.
Logic and argumentation
Logical fallaciesThey are based on logic and are useful for analysing
arguments and recognising logical fallacies.
No formal evaluation

There is more than one logic that can
be used to organise logical fallacies.
None of the frameworks (lists) seem to
have been developed systematically
for teaching and learning, and the
ones that are for teaching and learning
seem more ad hoc, without an obvious
underlying logic. Many lists are long, and
it is not clear how they are learned and
remembered.

Lack of an appropriately selected,
labelled, explained and organised list
that is optimised for teaching/learning,
remembering and using
Systematically consider all the logical fallacies and
clarify why some logical fallacies are excluded from
the Key Concepts.

Consider the logic we have used to organise the
IHC Key Concepts and ways of making the Key
Concepts easier to learn and remember.

Explore how a logician would approach evaluating
the IHC framework.

Clarify similarities and differences between the Key
Concepts and logical fallacies

Consider lessons from the School of Thought
website, cards, and poster, which have gone viral.
Taxonomy of concepts
and critical abilities
related to the evaluation
of verbal arguments
Broad focus on a framework that can be applied to any
type of argument (including causal claims)

Builds on a simple model for arguments
Because the framework is so broad, it is
inadequate as a framework for assessing
claims about effects.

Assumption that “The layman cannot,
under normal circumstances, verify
(in any rigorous sense) the technical
information he must use.”

The 5th critical ability (“Recognizing
testimony offered as justification”) and
6th (“Appraising testimony in terms of
internal and external criteria”) are based
on the authority of the person offering
testimony.
Develop a model that organises the Key Concepts
logically

Determine whether the difference between ‘critical
abilities’ (skills or proficiencies) and competence
(the required skill, knowledge, or capacity to do
something) is important and whether IHC should
specify one or the other or both, if there is an
important distinction
Evidence based
reasoning framework
Collaboration of an international consortium that piloted
using the framework for assessments of scientific
reasoning

It is a simple model
Unclear development methods

No concepts or criteria for assessing the
trustworthiness of evidence or claims,
or for going from claims to decisions,
and it is unclear how the model could
be used as a starting point for concepts,
competences, or dispositions other than
as a possible way of organising these.

It appears to be like teaching sentence
structure. While it might be useful for
analysis, it is not obvious how useful it is
for teaching and learning.

No formal evaluation
International collaboration in further development

Consider assessing the impact of using IHC
learning-resources on argumentation, using a tool
based on this framework or other tools.

Consider using the IHC Concepts as a framework
for making claims as well as for assessing claims
made by others.

Consider whether there is a simple model or figure
that could be used to illustrate the Key Concepts
Cognition
Cognitive biasesStrategies for being aware of and protecting against
cognitive biases

All the biases are based on research evidence.
Unclear development methods

There does not seem to be agreement
or any attempt to reach a consensus
or develop an optimal framework for
cognitive biases for teaching and
learning. Several frameworks are long
lists without a widely appealing way of
grouping, remembering and using the
concepts.

No formal evaluation
Incorporate evidence for relevant cognitive biases
in systematic summaries of the evidence for each
IHC Key Concept

A popular book like Kahneman’s92, poster and
website like School of Thought94, and a Wikipedia
page

Address why some cognitive biases are included,
and others are not, and the relation of Key
Concepts to cognitive biases.
Framework for
understanding people's
theories about their own
cognition
Unclear development methods

No formal evaluation
Consider developing a formal metacognitive theory.

Consider implications for teaching the IHC Key
Concepts: “We believe that schools should
actively promote metacognitive theorizing among
all students. Research indicates that theorizing
improves both performance and understanding
of one's performance. Research further supports
the claim that metacognitive theorizing can be
facilitated by self-talk and peer interactions that
focus on the process rather than the product of
learning.”

Consider incorporating discussion of tacit theories
about how students decide what to believe and
what to do, helping them to become aware of
their tacit theories and to develop formal theories:
“Perhaps the most salient aspect of a tacit
metacognitive theory as opposed to an explicit one
is that an individual is not readily aware of either
the theory itself or evidence that supports or refutes
it. Thus, tacit theories are not readily distinguished
from, or tested against, relevant data. To the extent
that they remain tacit, metacognitive theories
may be persistent even when they are false and
maladaptive.” “One potential advantage of a formal
metacognitive theory is that it allows the individual
to make informed choices about self-regulatory
behaviors.”103
Epistemological models"Kuhn's contribution to the literature on epìstemological
understanding has been in the connection of
epìstemological theories to reasoning. The skills of
argument appear predicated on a level of epìstemological
understanding that requires contemplation, evaluation,
and judgment of alternative theories and evidence."
It "is notable in its focus on ill-structured problems
from everyday life and in the use of a broad sample of
participants across the life span. This sampling of a
broader population on non-academic issues removes
epistemological beliefs from the realm of the classroom
and separates issues of knowing from those of teaching
and learning processes42.
No formal evaluation

"We know little about how reflective
judgment develops in context and just
how education makes a difference."42
Consider epistemological development in designing
a spiral curriculum, deciding the order and when
Key Concepts should be taught, and how.

Consider organising the Key Concepts in relation
to stages of development + exercises designed
to help students move from one stage to the next.
Also, consider the use of ill-structured problems
(problems about which reasonable people
reasonably disagree)111. “In concluding, it is worth
noting that the timing of educational efforts may
have important consequences.”43
AIR model of epistemic
cognition
Potentially useful for informing the design of interventionsLargely theoretical at this time, with little
practical use

There is very little description of how the
model was developed.

No formal evaluation
Consider implications for addressing when and
how people should assess claims and evidence
and take the time to analyse a decision, when they
should ignore claims or evidence, and when they
should rely on others.
Scientific thinking
PISA framework for
scientific literacy
International development and input, informed by triennial
testing of 15-year-old students in many different countries
Development of the framework is poorly
described

No formal evaluation
International input

International comparisons - Compare how well
students do on PISA science to how well they do on
a Claim test.

Consider using PISA to measure impact of IHC
school resources on scientific literacy.
Framework for K-12
science education
Extensive feedback + a summary of the feedback and
responses32
Too little focus on applied science,
practical understanding and use of
science by non-scientists, and what
children will remember and make use of.

"In the K-12 context, science is generally
taken to mean the traditional natural
sciences: physics, chemistry, biology,
and (more recently) earth, space,
and environmental sciences. In this
document, we include core ideas for
these disciplinary areas, but not for all
areas of science”32.

Although it appears to be having a big
impact in the U.S., it is unclear whether it
is having much of an impact outside the
U.S. This may reflect a downside of the
way in which it was developed without
international engagement.
More extensive feedback, including feedback from
relevant organisations and focus groups

Clarify how our focus fits with broader science
framework, need for focus on using research and
making informed choices versus doing research.
Clarify important goals for science education that
are outside of the IHC scope.

Consider goals.
Systems thinkingUnclear development methods

Lack of systematic development of any
framework for systems thinking, so far as
we are aware

No formal evaluation
May be relevant for assessments of models when
they are used to evaluate interventions, specifically
models that are based on systems thinking

Clarify the application of the Key Concepts to
system interventions
Model for scientific
thinking
Consideration of how scientific thinking, self-regulation in
research, and creativity relate to each other
Focus on traits or behaviours, not on
competencies or concepts. Not used
for teaching and unclear implications for
teaching
Evidence-based health care
Health literacy
frameworks
Systematic reviews

Support of international and national organisations such
as the World Health Organization and the U.S. National
Academy of Sciences

Epidemiological studies showing association between
health literacy and health outcomes
More attention appears to have
been given to measurement than
to intervention development and
evaluation194.
Consider framing purpose of IHC Key Concepts in
terms of critical health literacy.

Clarify why we have excluded obtaining and
understanding information.

Consider developing a model that includes
moderators and mediators, building on process
evaluations.

Consider Rasch analysis as a way of validating IHC
Key Concepts framework.
Evidence-based
practice (EBP) core
competencies
Well described, systematic development methodsThe broad approach across professions
might limit the relevance to specific
professions. “Although we selected
Delphi participants to represent a
diverse range of health professionals
and expertise, they may not adequately
represent the full spectrum of views
held by individuals within a single
profession”26.

No formal evaluation
GRADE and related
frameworks
Consensus developed over a long period of time involving
people who were responsible for developing and using
other systems, open meetings, wide use, and ongoing
development

Formal comparison to other approaches, study of
agreement among people applying the approach

It could potentially be used as a framework for helping
people to make judgements about the trustworthiness of
evidence and for making informed choices.
Development of the framework is not well
described

GRADE is often experienced as complex.
Involvement of a diverse group of people with
relevant experience and expertise over a long time,
with regular meetings

Application of the framework to multiple examples
(of claims, comparisons, and choices) that
challenge our thinking

Consider the extent to which GRADE criteria should
be incorporated that may not clearly be within the
scope of the Key Concepts.

Consider the pros and cons of how the Key
Concepts are organised in relation to GRADE
criteria.

Training workshops on using the Key Concepts

Identify target audiences for the Key Concepts,
engage them, and make the Key Concepts more
accessible and useful to them.
Bradford-Hill criteriaHas provided a useful structure for reviewing evidence,
such as evidence of the harmful effects of smoking

Widely used
There is almost no description of how the
framework was developed.

No formal evaluation

“The framework does not reflect the
current, more clearly articulated view
of causal processes. Additionally, the
guidelines used to evaluate evidence
have not changed for decades, even as
the causal questions have become more
complex, beyond the original intent of
this framework”162.
Consider creating subsets of Key Concepts for
specific purposes; e.g. risk of bias, certainty of the
evidence.
Critical appraisalChecklists have been widely used as teaching tools in
critical appraisal and evidence-based practice workshops
and have evolved based on experience with their use195.
Lack of explicit selection criteria and, for
the most part, little if any description of
how most of the checklists (particularly
those that are intended to be teaching
tools) were developed29.
Systematically review checklists designed as
teaching tools or decision aids.

Use of subsets of Key Concepts as a framework
for developing tools such as checklists for specific
purposes; e.g. assessing claims or figuring out
what to do.

Consider evaluating the Key Concepts as a
framework for developing learning resources.
Cochrane risk of bias
tool
Well described, systematic development

and formal evaluation
Use of the Key Concepts related to the risk of bias
to assess the overall risk of bias

Assess usability and reliability of subsets of IHC
Key Concepts
Catalogue of biasesThe structure for each entry (background, example,
impact, preventive steps)
There is little transparency regarding
how the list was developed and it does
not appear to have been developed
systematically.
Use some of the references as evidence to support
relevant Key Concepts.

Consider a more structured presentation of each
concept, drawing on the headings used in the
catalogue.

Consider a more user-friendly presentation of
the Key Concepts (e.g. with a summary table
(something like the Nature table) and one page for
each concept, instead of the current table, which
people find overwhelming.

Weaknesses of the frameworks include unclear development methods, lack of formal evaluation, multiple frameworks with the same focus and no apparent agreement or effort to reach a consensus on an optimal framework, and complexity or many included concepts or competences.

Ideas for further development of the IHC Key Concepts Framework

We identified several ways in which the IHC Key Concepts Framework might potentially be improved (Table 12). These include making the evidence that supports each IHC Key Concept explicit, including evidence of the extent to which each IHC Key Concept is not widely understood or applied; designing a website to popularise teaching and learning about, understanding of, and application of the IHC Key Concepts Framework; and developing a visual model of the IHC Key Concepts Framework.

Overall, our review of the concepts, competences, and dispositions in the 22 frameworks led us to add four new concepts to the IHC Key Concepts Framework, to modify 16, and to add 10 new competences and four new dispositions4.

Discussion

We identified 22 frameworks that overlap with the IHC Key Concepts Framework. We found that the purpose of the IHC Key Concepts Framework is most like two frameworks for critical thinking: Ennis’ taxonomy of critical thinking dispositions and abilities and Baron’s model of the good thinker. However, in terms of concepts and competences, there was more overlap with Halpern’s list of critical thinking skills. Although the IHC framework drew on evidence-based health care frameworks, there was at most some similarity with the purposes of those frameworks and the purpose of the IHC Key Concepts Framework. There was some overlap in terms of concepts with GRADE, critical appraisal tools, and the Catalogue of Bias. There was overlap in terms of competences with health literacy, the evidence-based practice core competences, and critical appraisal tools.

We found the IHC Key Concepts Framework to be central to critical thinking and evidence-based practice, both of which have broader scopes than the IHC Key Concepts Framework. An important weakness we found with these and other broad frameworks, such as those that focus on argumentation, is that they do not provide an adequate basis (concepts) for thinking critically about claims about the effects of interventions and decisions about what to do. As noted by Dewey: “It would be impossible to over-estimate the educational importance of arriving at conceptions: that is, meanings that are general because applicable in a great variety of different instances in spite of their difference. They are known points of reference by which we get our bearings when we are plunged into the strange and unknown. Without this conceptualizing, nothing is gained that can be carried over to the better understanding of new experiences”196. The IHC Key Concepts are applicable to a great variety of claims about the effects of interventions, not just health interventions7, and they are essential points of reference for deciding which claims to believe and what to do.

We did not find any overlap between the IHC Key Concepts and those included in the framework for K-12 science education, and little overlap in the competences. That framework places little focus on applied science, practical understanding and use of science by non-scientists, and what children will remember and make use of in their daily lives. This may be the case for many national science curricula.

Our review has helped us to clarify the goal of the IHC Key Concepts Framework and led us to add four new concepts, 10 new competences, and four new dispositions. In addition, we have identified ways in which we can improve the methods we use to further develop and evaluate the IHC Key Concepts Framework and make it more useful.

Previous systematic and unsystematic reviews have reviewed different types of frameworks with similar purposes, including frameworks for cognitive biases190, epistemic cognition42, health literacy22, assessments of the certainty of evidence and recommendations or decisions24,157,193, causal inference162, critical appraisal29, and assessment of the risk of bias181,185. Moseley and colleagues12 conducted a comprehensive review of frameworks for thinking, which overlaps with and informed our review. However, we are unaware of other reviews with the same scope as this review, whether in terms of the included frameworks or the data that were collected for each included framework.

We used explicit inclusion criteria for frameworks and two review authors independently collected data from included frameworks using a data collection form. Both the eligibility assessments and the data collection required judgement. Although we frequently disagreed, most of our disagreements were minor and all our disagreements were easily resolved. We did not conduct an exhaustive search for relevant frameworks. There may be other frameworks that meet our inclusion criteria. It is possible that other frameworks could add to our findings, but unlikely that they would otherwise substantially change the findings of this review.

Conclusions

As defined by Moseley and colleagues: “Framework is a general term for a structure that provides support”12. We have systematically considered 22 frameworks that are relevant to supporting critical thinking about claims about the effects of interventions (actions), comparisons (evidence used to support those claims), and decisions about what to do. We have found that the IHC Key Concepts Framework is unique and that it can be improved by building on the ways in which other related frameworks have been developed, evaluated, and made useful. Much of what we have found can also inform the development and evaluation of other frameworks.

Data availability

Underlying data

All data underlying the results are available as part of the article and no additional source data are required.

Extended data

Norwegian Centre for Research Data, Enabling Sustainable Public Engagement in Improving Health and Health Equity, https://doi.org/10.18712/NSD-NSD2817-V1197.

This project contains the following extended data:

  • - File 1: Search strategy

  • - File 2: Critical thinking frameworks eligibility form

  • - File 3: Critical thinking frameworks data collection form

  • - File 4: Use of the frameworks

  • - File 5: PRISMA checklist

Data are available under the terms of the Creative Commons Attribution 4.0 International license (CC-BY 4.0).

Reporting guidelines

The PRISMA checklist for ‘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’, https://doi.org/10.18712/NSD-NSD2817-V1197.

Information about this dataset can be found in English here: http://nsddata.nsd.uib.no/webview/index.jsp?v=2&submode=ddi&study=http%3A%2F%2Fnsddata.nsd.uib.no%2Fobj%2FfStudy%2FNSD2817&mode=documentation

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Oxman AD and García LM. 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 [version 1; peer review: 3 approved]. F1000Research 2020, 9:164 (https://doi.org/10.12688/f1000research.21858.1)
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ApprovedThe paper is scientifically sound in its current form and only minor, if any, improvements are suggested
Approved with reservations A number of small changes, sometimes more significant revisions are required to address specific details and improve the papers academic merit.
Not approvedFundamental flaws in the paper seriously undermine the findings and conclusions
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Reviewer Report 30 Nov 2020
Julia Lühnen, Institute for Health and Nursing Science, Medical Faculty, al Faculty, Martin Luther University Halle-Wittenberg, Halle (Saale), Germany 
Approved
VIEWS 5
Thanks to the authors for this important and interesting paper.

The Informed Health Choices (IHC) project aims to support people to evaluate the trustworthiness of health claims and to make informed choices. The IHC Key Concepts provide ... Continue reading
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CITE
HOW TO CITE THIS REPORT
Lühnen J. Reviewer Report For: 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 [version 1; peer review: 3 approved]. F1000Research 2020, 9:164 (https://doi.org/10.5256/f1000research.24099.r74232)
NOTE: it is important to ensure the information in square brackets after the title is included in all citations of this article.
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Reviewer Report 16 Nov 2020
Loai Albarqouni, The Institute for Evidence-Based Healthcare, Faculty of Health Sciences and Medicine, Bond University, Gold Coast, Qld, Australia 
Approved
VIEWS 10
Thanks for inviting me to review this interesting systematic review. The authors of this article systematically review and compare frameworks relevant to teaching and learning of critical thinking about claims, evidence, and choices. This is a great article that is ... Continue reading
CITE
CITE
HOW TO CITE THIS REPORT
Albarqouni L. Reviewer Report For: 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 [version 1; peer review: 3 approved]. F1000Research 2020, 9:164 (https://doi.org/10.5256/f1000research.24099.r73961)
NOTE: it is important to ensure the information in square brackets after the title is included in all citations of this article.
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14
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Reviewer Report 03 Nov 2020
Declan Devane, Health Research Board - Trials Methodology Research Network, National University of Ireland Galway, Galway, Ireland;  School of Nursing and Midwifery, National University of Ireland Galway, Galway, Ireland;  Evidence Synthesis Ireland, National University of Ireland Galway, Galway, Ireland;  Cochrane Ireland, National University of Ireland Galway, Galway, Ireland 
Approved
VIEWS 14
The authors of this paper have done a good job in conducting a systematic review of frameworks that overlap with, or potentially overlap with, the IHC key concepts framework.

The Informed Health Choices (IHC) Key Concepts Framework ... Continue reading
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HOW TO CITE THIS REPORT
Devane D. Reviewer Report For: 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 [version 1; peer review: 3 approved]. F1000Research 2020, 9:164 (https://doi.org/10.5256/f1000research.24099.r73960)
NOTE: it is important to ensure the information in square brackets after the title is included in all citations of this article.

Comments on this article Comments (0)

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Alongside their report, reviewers assign a status to the article:
Approved - the paper is scientifically sound in its current form and only minor, if any, improvements are suggested
Approved with reservations - A number of small changes, sometimes more significant revisions are required to address specific details and improve the papers academic merit.
Not approved - fundamental flaws in the paper seriously undermine the findings and conclusions
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