- Name: Sarah Ellen Rosenbaum
- Number of lab members or colleagues (excluding PI): 8
- Location: Oslo, Norway
- Graduation Date: 2010, Ph.D.
- H index: 19
- Twitter followers: 385
Hello! Who are you and what are you working on?
My name is Sarah Rosenbaum, and I live in Oslo, Norway. I’m actually from the USA, but I’ve been living in Norway since the end of the 70’s. I’m a graphic designer and illustrator by training but went back to school and got a Ph.D. in 2010 from AHO (Oslo School of Architecture and Design). So now I am a researcher, with a visual communication background. I’m employed at the Norwegian Institute of Public Health, Centre for Informed Health Choices. I’m one of several people in a multi-disciplinary research team in this centre – our aim is to support people’s use of evidence in decision making about health interventions. I bring a user centred/human centred design perspective to our work.
When I first got involved in this environment, I was interested in research questions about how to best present results of research evidence (about the effects of interventions) in ways that make them easier for a broad range of people to understand and use in decision making – health professionals, policy makers, or patients and the public. My Ph.D. builds on this topic. But more recently we’ve been working on developing and evaluating learning resources that can help people better understand and think critically about this kind of information, starting with younger people.
The main project I’ve been working on since 2012 is The Informed Health Choices Project. Our goal is to develop effective learning resources to help people think critically about treatments or other health interventions, and how to make informed decisions themselves, their families or their communities.
What’s your backstory and how did you come up with the idea?
Well, the backstory isn’t mine. The original idea is the brain child of my colleague, research director Andy Oxman. Andy is a public health physician and health systems researcher, and he’s been studying ways of helping people to use research in decision making for 30 years, but previously with a focus on adults.
Many years ago he was at his kids’ school, teaching about randomized trials. And he realized that the students readily grasped a lot of the basic concepts about how to test things in a fair way when you’re trying to find out whether something has an effect or not, like the need for a control group, or the need for blinding or randomization. That’s where he got the idea that this is something that we should do – teach kids these concepts instead of adults.
It seemed to him that it might be easier to teach kids about what reliable evidence in this context looks like, and how to spot bogus claims, because adults have a lot of preconceived ideas that get in the way of their learning.
Based on this idea, our team submitted a research proposal to the Norwegian Research Council back in 2012, in collaboration with Iain Chalmers in the UK and a team at Makerere University in Uganda where Andy had been a guest researcher for a year, to develop and evaluate two sets of learning resources for use in East Africa – resources for mass media and resources to be used in primary schools – but that could be generic enough to also be used in other settings. We didn’t think we would get the funding – we thought it was a bit of a crazy idea. But the Research Council approved our grant for the original five-year project, and then again in 2019 for a new project aimed at secondary school students, in collaboration with research teams in Uganda, Kenya and Rwanda, which is what we are currently working on.
A school administrator (far right) and Allen Nsangi discuss something during a pilot lesson, in Uganda. As a doctoral candidate, Allen, affiliated with Makere University and the University of Oslo, was a primary investigator in the development and evaluation of the Informed Health Choices primary school intervention. In the background, a group of children play a game that was part of the first set of prototypes. (Photo: Matt Oxman/Informed Health Choices)
Please describe the process of learning, iterating, and creating the project
We don’t just sort of get a good idea and run out and evaluate it in a trial – we spend a lot of our project time developing – getting the content and design right, and working a lot with users and other stakeholders. In a five-year project, we’ll typically spend about three years developing. Early on we conduct systematic reviews, to see what other relevant products, frameworks or strategies have been evaluated, and what we can learn from that work.
When we start to create learning resources, we use a human-centered design approach – this means we spend a lot of time understanding the context of use, engaging with stakeholders, getting ideas and feedback from teachers, students, curriculum developers, exploring user experience of our prototypes and improving them. We do a lot of iterations, both of content and format. We try to involve users – teachers and students – as much as is pragmatically possible in developing the learning resources. That can be challenging when the content is unfamiliar to them to begin with. At the very least, we can discover what they find easy or difficult, what they like or don’t like, and what might motivate them. And we learn a lot about what kind of learning resource would be suitable for use in their context.
Understanding context of use, trying out ideas early and having enough time to make mistakes is critical. Even though we work in close collaboration with partners in East Africa, we still can make wrong assumptions about what is possible or what can work in that context. For instance, when we started creating learning resources for primary school students, we had a lot of ideas that we tried out early and that didn’t work, like game-based activities that didn’t work because of the large class sizes. We made rapid prototypes, tried them out in schools, and saw they completely failed. So, we had to swing around and change our approach and our design a lot. You need to plan for time to do this kind of trying out ideas and failing. You need to build in space for this kind of testing ideas and failing already in your grant application. If you don’t have time to fail, you’ll never really be able to innovate.
When we are done with our development phase, then we evaluate the learning resources in a randomized trial. During and after the trial, we carry out a process evaluation, to better understand the results and to explore issues related to implementation and scaling up. For the primary