School-based Health Education Research Articles

Effectiveness of the Integrated Dengue Education and Learning (iDEAL) module in improving the knowledge, attitude, practice, environmental cleanliness index, and dengue index among schoolchildren: A randomised controlled trial protocol.

Dengue is a mosquito-borne disease caused by four distinct, closely related dengue viruses (DENV). Global dengue incidence has markedly increased in the past decades. The World Health Organization reported that cases increased from 505,430 in 2000 to 5.2 million in 2019. Similarly, the total dengue cases in Malaysia increased from 7,103 in 2000 to a peak of 130,101 in 2019. Knowledge, attitude, and practice (KAP) remain the most effective dengue prevention and control tools. Furthermore, school-based health education is key to enhancing knowledge and raising awareness of the seriousness of dengue among schoolchildren and transferring knowledge and practice from classrooms to homes. Thus, it is necessary to plan an integrated module for the primary prevention of dengue infection, specifically among schoolchildren. The present study intends to develop, implement, and evaluate the effectiveness of a theory-based integrated dengue education and learning (iDEAL) module in improving the KAP, environmental cleanliness index, and dengue index among schoolchildren in Selangor and Kuala Lumpur. This study is a single-blinded, cluster randomised controlled trial to be conducted from 1 September 2023 to 31 August 2025. The study will involve 20 primary and 20 secondary schools in Selangor and Kuala Lumpur. The 1600 participants will be randomly allocated to intervention and control groups based on selected clusters to avoid contamination. A cluster is a comparable school that fulfils the inclusion and exclusion criteria. The intervention group will receive the iDEAL module, while the control group will receive standard education. The iDEAL module will be developed following a systematic procedure and delivered in-person by trained researchers to the participants. The outcome will be measured using validated, self-administered questionnaires at baseline (T0), immediately (T1), one month (T2), and three months (T3) post-intervention to measure the intervention module effectiveness. The data will be analysed using IBM Statistical Package for Social Science (SPSS) version 28 and descriptive and inferential statistics. Within-group changes over time will be compared using one-way repeated measure analysis of variance for continuous and normally distributed variables. Within-group analysis of categorical data will use Cochran's Q test. The main effect and interaction between and within the intervention and control groups at T0, T1, T2, and T3 will be tested using the generalised linear mixed model (GLMM). Hypothetically, the KAP, environmental cleanliness index, and dengue index among the intervention group will be significantly improved compared to the control group. The hypothesis will be tested using a significance level with a p-value of 0.05 and a confidence interval of 95%. The study protocol outlines developing and testing an iDEAL module for schoolchildren in Selangor and Kuala Lumpur, with no socio-demographic differences expected. The intervention aims to improve KAP, environmental cleanliness index, and dengue index, potentially reducing dengue risk. Results could inform public health policies, emphasizing school-based interventions' importance in combating diseases like dengue.

"I wouldn't have felt so alone": The sexual health education experiences of transgender and gender diverse youth living in the southeastern United States.

Transgender and gender diverse youth experience multiple disproportionate adverse sexual health outcomes. Sexual health education teaches knowledge, attitudes, and skills for promoting sexual health, including reducing risk for sexually transmitted infection, HIV acquisition, and unintended pregnancy. Provision of sexual health education may be protective, but research remains scarce. We conducted a multi-stage thematic analysis of 33 in-depth interviews among transgender and gender diverse youth (ages 15-24) living in the southeastern United States on their sexual health education experiences. Our study participants described school-based sexual health education as unhelpful due to a lack of relevant information, inadequately prepared teachers, and a perceived negative tone toward sexuality. They reported relying on online sources of sexual health information, finding relevant content and community despite some limitations. Participants desired content and pedagogy that expands beyond binary and white-centric presentations of sexuality and gender and sought resources that provide relevant, accurate, and judgment-free information while holding positive framing around sexuality and gender. There is much work needed to improve the breadth, quality, and relevance of school-based sexual health education. Sexual health education can improve by strengthening critical media literacy skills of youth; raising staff cultural competency on gender, race, and sexual identity through training and supports; using culturally relevant and inclusive curricula; and partnering with community-based organizations. Transgender and gender diverse youth would benefit from sexual health education from multiple sources which is queer-friendly, affirms their existence, and provides information on gender, race, and sexuality in positive and expansive ways.

Integrating mental health literacy in the English language arts middle school classroom

Mental health challenges are on the rise among today’s youth. Recent reports have noted an acute and significant need for school-based mental health education and supportive interventions for children and adolescents. Among these approaches, a growing focus has centered on improving students’ mental health literacy (MHL) as a foundational component in addressing overall mental health needs. While schools offer an ideal venue for access and implementation, there exist a variety of limitations to integrating MHL content, particularly within the middle school classroom. In this manuscript, we offer recommendations for educators, school social support workers, and administrators who are interested in teaming together to develop and embed a literature-based MHL curriculum into the middle school English Language Arts (ELA) classroom. Our suggestions offer a framework for planning, developing, and implementing such a curriculum within the confines of current school structures and processes while maintaining the teacher’s role as educator.

Effectiveness of School-Based Oral Health Education for Children and Adolescents in Low- and Middle-Income Countries: A Systematic Review and Meta-Analysis.

The global burden of oral diseases is high, but access to oral health care is still problematic, especially in low-income and middle-income countries. The prevention of oral diseases in the child and adolescent population is the key as it can be prevented and potentially reversed at its early stages. This study aims to provide evidence on the effectiveness of school-based oral health education in low-income and middle-income countries through a systematic review and meta-analysis. Eligible studies had outcomes, such as oral health knowledge, behavior, oral hygiene, gingival health, and caries index, and those published from 1995 to 2019 in English. After screening and reviewing the retrieved articles, 20 studies were included in the systematic review and six eligible studies were selected for meta-analysis. The computed effect size of school-based oral health education in low-income and middle-income countries showed improved knowledge, behavior, oral hygiene, and gingival health from the selected studies. However, most of the interventions took place for less than 1 year, and long-term evidence is still lacking. As repetition and reinforcement are critical in maintaining long-term effects, both country context and sustainability should be considered in school-based oral health education.

Evaluation of a school-based health education program on hepatitis B virus infection prevention practice in rural South-Western, Nigeria.

Hepatitis B virus (HBV) infection prevention is most effective early in childhood with vaccination programme. However, where this is missed, primary prevention modes of intervention become an alternative recommendation to be considered before the occurrence of risk exposure to the virus. This study sought to evaluate outcomes of a theory-based HBV infection prevention educational intervention among students from four selected secondary schools in Ogun state, Nigeria. A quasi-experimental design enrolling 256 consenting secondary school students from four schools in Ogun state randomized into three intervention schools consisting teacher-instructed (E1), peer-directed (E2) and combination of the two (E3) respectively with a control group ( C) was implemented. The theory-based educational intervention was for six weeks with follow-up period of 8 weeks. A 66-item validated instrument was used to collect data at three reference points and response items for variables in the study were transformed into weighted-aggregate scores of mean and standard deviation of HBV infection prevention practice of participants. Statistical analysis of ANOVA, paired-sample t-test and Cohen's D Effect Size (ES) was used to quantify the changes produced by the intervention on the outcome variable at 5% level of significance. At baseline, there was no significant difference (p > 0.05) in the mean HBV infection prevention practice scores between the four groups E1 (17.21 ± 3.03), E2 (15.57 ± 1.90), E3 (17.90 ± 3.10), and C (15.20 ± 2.44). However, at 14th week follow up, there was observed significant differences in mean scores of HBV infection prevention practices between all four groups E1 (23.09 ± 2.4), E2 (22.6 ± 3.6), E3 (23.82 ± 2.3), and C (15.25 ± 2.4). Paired-sample t-test conducted demonstrated significant differences between baseline and 14th week follow up for E1 (17.21 ± 3.07 and 23.18 ± 2.9; p = 0.001), E2(15.57 ± 1.90 and 23.53 ± 3.12; p = 0.001), E3(17.90 ± 3.10 and 25.1 ± 2.6; p < 0.001), but not for C (15.20 ± 2.44 and 15.25 ± 2.4; p = 0.92), with most significant impact (ES(95%CI) on HBV infection prevention practices observed for E2(3.106 95%CI: [2.66 to 3.55; p = 0.001]). Importantly, the participants in E2 showed more improvement in prevention practices than their counterparts from E1, E3, and control. Therefore, the intervention demonstrated proof-of-concept in facilitating behavior modification expected. Peer education can be utilized as a strategy to promote Hepatitis B infection prevention practices among adolescents.

The Impact of Socioeconomic Factors on Pediatric Oral Health: A Review.

This narrative review examines the impact of socioeconomic status (SES) on pediatric oral health, emphasizing disparities in dental caries prevalence and oral health-related quality of life (OHRQoL) among children from different socioeconomic backgrounds. Utilizing an extensive literature search through PubMed, Google Scholar, and the chat.consensus.app plugin, we synthesized findings from studies published up to December 2023. The review highlights a consistent association between lower SES and adverse pediatric oral health outcomes, influenced by parental education, household income, food security, and neighborhood conditions. It also underscores the importance of the life-course perspective, showing how early-life socioeconomic disadvantages can have long-lasting effects on oral health. Furthermore, the review points to the critical role of school-based oral health education programs and the complex interplay between mental health, SES, and pediatric oral health. By examining the impact of socioeconomic factors across different childhood stages and the effectiveness of educational interventions, this review calls for targeted interventions and policy initiatives aimed at reducing socioeconomic inequalities in pediatric oral health. The findings advocate for a multifaceted approach to improve oral health outcomes for children across socioeconomic backgrounds, ensuring equitable access to oral health care and promoting overall well-being.

Benefits and barriers: Improving boys’ mental health education in high schools

Adolescents are facing an unprecedented mental health crisis worldwide. Yet, mental health literacy and experiences of mental illness vary significantly with gender. For example, male deaths by suicide are twice as high as females on average globally, with the trend of gender disparity in mental illness emerging in high school and continuing into adulthood. With the majority of mental illnesses also emerging in adolescence, high schools are uniquely positioned to provide timely preventative mental health education for boys. To date, however, school-based mental health education programs are predominantly gender-neutral. We conducted a narrative review of the literature in mental health education programs for high school aged boys aged 12–18 years within schools and the wider community. To address the question How can high schools provide better mental health education for their male students? searches were undertaken in four databases, ProQuest (including ERIC), Informit (including A+ Education), PsychINFO and Google Scholar, between January 2021 and November 2023. There were no restrictions on publication date. Our findings suggested that to improve mental health knowledge and attitudes towards mental health and help seeking, school-based programs should be gender transformative, draw on best practice and theory in sociology, psychology, and boys’ pedagogy, utilise co-design so that student voice can be prioritised, and be tailored to the school's sociocultural context. Recommendations for schools are discussed.

Prevalence and Correlates of Cervical Cancer Prevention Knowledge Among High School Students in Ghana.

Cervical cancer is a preventable yet highly prevalent disease in Africa. Despite female adolescents and young women being a target group for cervical cancer prevention strategies, little research has examined their knowledge of how to prevent the disease. The study aimed to describe: (a) knowledge about cervical cancer prevention and (b) sociodemographic, social, and systemic factors associated with and interacting with knowledge among female senior high school students in Ghana. A cross-sectional survey assessed knowledge about (a) risk factors and (b) primary and secondary prevention of cervical cancer among 2,400 female students from 17 public senior high schools in the Ashanti region, Ghana. Descriptive statistics were used to describe knowledge. Linear mixed-effects regression models were used to examine factors associated with knowledge scores. Knowledge gaps were observed for at least two-thirds (>65%) of students. Most students (mean age = 17) did not know that early sexual debut (before 18 years) is a risk factor for cervical cancer (72%) and that a blood test cannot detect cervical cancer (71%). Students in later stages of senior high school education and those who received sexual health education from teachers and parents had significantly greater cervical cancer knowledge scores than their counterparts. Interactive effects showed that school-based sexual health education was associated with higher knowledge scores than home-based education among students. Most female senior high school students had gaps in knowledge about cervical cancer prevention. Finding new ways to strengthen the capacity of schools and parents to deliver accurate cervical cancer prevention information is warranted.

Re-envisioning Youth Sexual Health Care: Supporting Sex Positivity in a Digital World

BackgroundYouth in a digital world face challenges to healthy development of their sexuality from exposure to sexting, pornography, and other sexually explicit media. School-based sexual health education does not cover digital sexual content and the impact on sexuality and sexual relationships. Youth often avoid discussing sexual health with parents or other trusted adults, thus often relying on peers, making them ill-prepared to navigate the complexities (e.g., socially, emotionally, and romantically) of sexually explicit content. MethodsA review of emerging evidence for application into clinical practice. Clinical ImplicationsThis paper provides nurse practitioners (NPs) with resources and information to incorporate this re-envisioned approach to sexual healthcare into practice, to provide current, timely, and holistic youth sexual healthcare. ConclusionYouth sexual healthcare must be re-envisioned. NPs can improve youth sexual health by incorporating pornography and sexual media literacy, safe sexting, and concepts of consent into care using a sex-positive lens.

Evaluation of Yantiin Kalabara – 5 Ways to a Healthier You: A primary school-based education program targeting healthy living choices through interactive workshops

The aim of this study was to develop, implement and evaluate the novel one-day, school-based health education program Yantiin Kalabara that embedded Aboriginal and Torres Strait Islander culture and perspectives within a series of interactive learning stations. In consultation with local Aboriginal and Torres Strait Islander community members, the program was designed to encourage healthy lifestyle choices and promote strong, sustainable and mutually respectful relationships between Aboriginal and Torres Strait Islander peoples and non-Aboriginal Australians. It involved five primary schools within the Awabakal, Wonnarua, Darkinjung and Worimi Countries (Australia) in movement-based and culturally rich learning activities. The feasibility of the program for use in primary schools and preliminary efficacy for affecting change in key health behaviours (physical activity, nutrition, screen-time) was assessed using student questionnaires. Yantiin Kalabara was delivered by the Hunter Primary Care team and volunteers. Students reported that it helped them improve their overall health, physical activity, eating habits and screen-time patterns. We have demonstrated that the program can be feasibly delivered in primary schools, and that the program was efficacious in affecting positive changes in key health behaviours of participating children. However, further evaluation in larger and more diverse populations using a randomised controlled trial is warranted.

Developing a Traditional Oral Health Education Folktale for Primary School Pupils in Ibadan, Oyo State, Nigeria

BACKGROUND: Worldwide oral diseases are a major public health problem among children. Oral health education directed at major aetiological factors such as diet, oral hygiene and dental clinic attendance has helped to reduce the burden of oral diseases in children. Folklore, which includes folktales, puppet shows, dramas, folk music, and dance, appears to be a promising tool that could gain and engage young people's interest. Traditional folktale in school-based health education in Nigeria has not yet undergone much research or evaluation.&#x0D; AIM: This paper aims to report how a local traditional folktale for oral health education among primary school pupils was developed with a view to providing information on how the folktale can be developed in other languages as well as how other oral health education folktales can be developed.&#x0D; METHOD: Oral health professionals, linguist and theater arts experts from the University of Ibadan, Nigeria, developed a traditional folktale represented on a graphically designed banner (comic strips) for use as an oral health education tool for primary school pupils. Developing the tool involved certain processes which were validated and evaluated at every step. These processes included developing oral health messages on adequate dietary and oral hygiene practices as well as good dental clinic attendance. The messages were used to develop a folktale using improvisation circle method.&#x0D; RESULTS: A banner of 6 feet by 4 feet containing graphically designed illustrations (comic strips) of the traditional folktale was developed. The message of which was basically diet, oral hygiene and dental clinic attendance instructions aimed at improving the attitude and practice of primary school pupils in Ibadan to oral health. The folktale was primarily developed in English language, the official language in Nigeria, then translated to Yoruba, the indigenous language of the people of Ibadan. Many skills such as team-building, effective communication and leadership were developed from the many phases and meetings required in the development of the folktale.&#x0D; CONCLUSIONS: The early years are the formative years. Hence developing a tool to improve the oral health education of children using traditional folktale is a valuable and culturally advantageous project which has substantial future potentials.

Implementation of Mother's School to Prevent Stunting "Secanting" among Mothers in Bange Village, Sanggau Ledo District

Background: Mothers have a relatively low level of education, lack of knowledge and understanding about the importance of care during pregnancy to maintain the health of the mother and baby and nutritional needs during pregnancy and for the baby/child, failure to provide exclusive breastfeeding, early marriage, and early pregnancy due to unwanted pregnancies, pregnancies that are too close together, anemia in pregnant women are thought to be triggers for stunting. The Secanting program and health education for teenagers is an alternative action to help minimize the incidence of stunting. Objective: Increase knowledge, attitudes, and behavior of pregnant women and teenagers to prevent stunting by optimizing community empowerment for independence in health. Method: The mapping intervention approach in community-based implementation in program development is packaged in the form of maternal schools to prevent stunting abbreviated as "Secanting" and school-based sexual health education activities for teenagers in high school. Results: Before being given the Secanting program, pregnant women had an average knowledge score of 69.09±11.36, and after being given an average knowledge score of 86.36±8.09. There is a difference in the average score, amounting to 17.27 ± 13.48. The results of observations made regarding the skills of pregnant women in selecting, processing nutritious food ingredients, preparing menus, and serving, showed that before participating in the program, pregnant women had skills with an average score of 58.18 ± 7.5 and after being given the average score skills 81.81±7.5. There is a difference in the average score, amounting to 23.64 ± 8.08. There is an increase in knowledge and skills in pregnant women after being given the Secanting program. The program for adolescents shows that, before being given health education, adolescents know with an average score of 78.67 ± 4.24, and after being given an average knowledge score of 98.44 ± 11.40. There is a difference in the average score, amounting to 19.77 ± 10.33. There is an increase in knowledge in adolescents after being given health education. Conclusion: The Secanting program has proven effective in increasing knowledge in pregnant women and health education has proven effective in increasing knowledge in adolescents.

Evaluating a Peer-Support Mobile App for Mental Health and Substance Use Among Adolescents Over 12 Months During the COVID-19 Pandemic: Randomized Controlled Trial.

Although it is well known that adolescents frequently turn to their friends for support around mental health and substance use problems, there are currently no evidence-based digital programs to support them to do this. The aim of this study was to evaluate the efficacy of the Mind your Mate program, a digital peer-support program, in improving mental health symptoms, reducing the uptake of substance use, and increasing help seeking. The Mind your Mate program consists of a 40-minute web-based classroom lesson and a companion smartphone mobile app. The active control group received school-based health education as usual. A cluster randomized controlled trial was conducted with 12 secondary schools and 166 students (mean age 15.3, SD 0.41 years; 72/166, 43.4% female; and 133/166, 80.1% born in Australia). Participants completed self-reported questionnaires assessing symptoms of mental health (depression, anxiety, and psychological distress), substance use (alcohol and other drug use), and help-seeking measures at baseline and at 6-month and 12-month follow-ups. Students who received the Mind your Mate program had greater reductions in depressive symptoms over a 12-month period than controls (b=-1.86, 95% CI -3.73 to 0.02; Cohen d=-0.31). Anxiety symptoms decreased among students in the intervention group; however, these reductions did not meet statistical significance thresholds. No differences were observed in relation to psychological distress or help-seeking. Small to moderate reductions in depression symptoms were observed among students allocated to receive the Mind your Mate intervention. Although the current results are encouraging, there is a need to continue to refine, develop, and evaluate innovative applied approaches for the prevention of mental disorders in real-world settings. Australian New Zealand Clinical Trials Registry (ANZCTR) ACTRN12620000753954; https://anzctr.org.au/Trial/Registration/TrialReview.aspx?ACTRN=12620000753954. RR2-10.2196/26796.

Using Health Education to Address Student Physical Activity and Nutrition: Evidence and Implications to Advance Practice.

School-based health education can provide students with learning experiences that improve knowledge, attitudes, and perceptions (KAP) and behaviors regarding physical activity and nutrition. We conducted a 2-phase systematic review. Phase 1 was a review of reviews (ie, systematic reviews or meta-analyses) that were published 2010-2018. Phase 2 was a search for individual articles published 2010-2020 addressing topics relevant to our review; we searched for articles that had not been part of a sufficiently relevant or recent review or that had been part of a review that concluded that too few articles were available to assert sufficient evidence. Forty-three studies were assessed: 20 randomized controlled trials and 23 quasi-experimental designs. Collectively, interventions had a favorable impact on students' PA and nutrition KAP, but behavioral and secondary outcome results (eg, body mass index) were mixed. Using the evidence-based health education strategies identified in this review can help contribute to improvements in students' KAP and behaviors.

Digital applications as a means for promotion of healthy behaviours among Albanian children.

Digital applications can be effective tools for strengthening school-based health education programs as they can provide valuable health information to children through interactive videos, quizzes and games. We aimed at assessing the change in the prevalence of healthy behaviours among children exposed to digital applications (intervention) employed for promoting healthy behaviours. We conducted a cross-sectional study before the intervention in March 2022 including a representative sample of 1500 Albanian schoolchildren (≈54% girls) aged 12-15 years. In June 2022, after 4-month exposure to digital applications aimed at promoting healthy behaviours (intervention), we carried out a second cross-sectional study in the same sample of schoolchildren. In both survey rounds, an anonymous and structured self-administered questionnaire inquired children about a range of behavioural practices including nutrition, oral health, physical activity and hygiene practices. After the intervention, overall, there was evidence of a significant increase in the prevalence of all healthy behavioural practices measured: ~9% for breakfast consumption and/or environmental protection, 12% for toothbrushing, 14% for handwashing, 15% for leisure time physical exercise and 24% for adequate fruit and vegetable intake (all p < 0.001). Engagement in healthy behaviours only after the intervention was higher among rural children (from 18% for breakfast consumption to 37% for handwashing and/or adequate fruit and vegetable intake) and especially those pertinent to Roma/Egyptian communities (from 18% for breakfast consumption to 46% for adequate fruit and vegetable intake), except for engagement in safe environmental protection which was more prevalent among urban residents (28% vs. 15% among rural children) and ethnic Albanian children (24% vs. 13% among Roma/Egyptian children). Our findings from Albania indicate that digital applications can be useful for strengthening school-based health promotion programs.

Validation of School-Based Health Education on Knowledge and Attitude of Female Students towards Female Genital Mutilation

Validation of School-Based Health Education on Knowledge and Attitude of Female Students towards Female Genital Mutilation

Effectiveness of School-Based Health Education on Prevention of Childhood Obesity is Effective among Teachers Working in English Medium Schools, Urban Maharashtra

Effectiveness of School-Based Health Education on Prevention of Childhood Obesity is Effective among Teachers Working in English Medium Schools, Urban Maharashtra

Validation of School-Based Health Education on Knowledge and Attitude of Female Students towards Female Genital Mutilation

Validation of School-Based Health Education on Knowledge and Attitude of Female Students towards Female Genital Mutilation

Classroom voices: youth perspectives to direct school-based sexual health education

ABSTRACT Sexual health education is a well-known, evidence-based intervention that can improve adolescent health outcomes, increase protective health behaviours, and decrease risky health behaviours. Providing sexual health education in schools offers opportunities to discuss critical health topics and can improve the school environment. However, not all sexual health education is taught equitably. As part of a mixed-methods study to describe school-based sexual health education, we conducted focus groups and interviews with recent high school graduates in a geographically and ethnically diverse state in the US Southwest. Thirty-one young people shared their experiences, explored the content they had been taught, and offered recommendations to improve sexual health education. Three key themes emerged: young people wanted and needed sexual health education taught in school; current sexual health education is not helpful and sometimes harmful; and the individuals who teach sexual health education are critically important. These findings can help address barriers to school-based sexual health education delivery, particularly for schools within communities with limited resources. The results support including youth as stakeholders in the planning and evaluation of school-based sexual health education, and the development of sexual health education teacher training with the goal of improving youth health outcomes.

Health literacy among adolescents and young adults in the Eastern Mediterranean region: a scoping review

ObjectivesFor adolescents and young adults, most health literacy research has been conducted in Western countries, but few studies have been conducted in the Eastern Mediterranean region (EMR). This review aimed...