Effects of health education on adolescents' non-cognitive skills, life satisfaction and aspirations, and health-related quality of life: A cluster-randomized controlled trial in Vietnam.

Sangchul Yoon,Le Thanh Tuan,Jongwook Lee,Dave Haeyun Noh,Shinki An,Lindsay Stark

doi:10.1371/journal.pone.0259000

Abstract

The effectiveness of health education on adolescents has been questioned, along with a growing body of empirical studies documenting the absence of behavioral changes after the intervention. However, evidence on its impact on other crucial health domains, besides health practices, is lacking. We evaluated the causal effects of a school-based health education program on adolescents' multidimensional psychological health factors. A cluster-randomized controlled trial. We conducted a cluster-randomized controlled trial involving 140 lower secondary schools in Vietnam. After stratifying by district, schools were randomized 1:1 to either treatment or control groups. Students enrolled in the treatment schools received monthly stand-alone health education in five topics by school teachers at the class level, but control group students did not receive any intervention. The primary outcomes of the study were students' non-cognitive skills, life satisfaction, aspirations gap, and the Health-Related Quality of Life at five-month follow-up. We estimated the intention-to-treat effects with the panel fixed effects model using student panel data. Of the 6,477 students enrolled at baseline, 2,958 (92%) treated and 2,967 (91%) control students completed the follow-up survey five months after baseline data collection from October to December 2018. Compared with controls, health education led to improved treatment school students' self-efficacy (p-value = 0.013), presumed life satisfaction five years from the present (p-value = 0.001), aspirations gap for a socially and mentally healthy future (p-value = 0.036), and the Health-Related Quality of Life (p-value = 0.036). A school-based health education program enhanced students' non-cognitive skills, life satisfaction and aspirations gap, and the Health-Related Quality of Life significantly. This study proposes essential psychological factors that should be taken into account when evaluating the effectiveness of a health education program in resource-limited settings.

Highlights

Adolescents are a vulnerable group in public health, along with rapid physical and emotional changes resulting from increased hormones and social context changes during puberty
This study proposes essential psychological factors that should be taken into account when evaluating the effectiveness of a health education program in resource-limited settings
We examined the effects of a health education program on non-cognitive skills, life satisfaction, aspirations gap, and Health-Related Quality of Life (HRQoL) besides health KAP

Summary

Introduction

Adolescents are a vulnerable group in public health, along with rapid physical and emotional changes resulting from increased hormones and social context changes during puberty. Transitioning from primary to secondary schools, the chance of engaging in risky health behaviors surges substantially as teenagers encounter older students with distinct group norms and peer pressure. Adolescents often initiate risky behaviors without knowing potential consequences of such actions. Most of the teenagers’ sexual activities are unprotected [1], while sexual debut during adolescence [2] and an increasing proportion of the young population experiencing premarital sex [3] are widely reported. The majority of the cigarette smoking population starts smoking from adolescence [4], when peer pressure plays a significant role. Teenagers tend to show low adherence levels in exercising preventive measures, such as handwashing [5] and physical activities [6] to avoid infectious diseases, myopia, and obesity

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Results

Conclusion