Leyi Cao, Yueting Zhang, Bing Shi
The findings provide preliminary evidence that a localized health education curriculum may improve health literacy among high school students in Qinghai Province. However, because only four clusters were included, class-level variance could not be estimated reliably and cluster-level confounding cannot be ruled out. The findings should therefore be interpreted as preliminary rather than definitive evidence of curriculum effectiveness.
BACKGROUND: This study aimed to develop and preliminarily evaluate a localized health education curriculum tailored to the cultural, environmental, and health needs of high school students in Qinghai Province, China.
METHODS: A pretest-posttest pilot cluster-randomized design was employed involving 180 Grade 11 students from four intact classes. Within both the ethnic minority and general education categories, one class was randomly assigned to the experimental group and the other to the control group. The primary outcome was the post-test overall mean health literacy score adjusted for the corresponding pre-test score. A fixed-effects model including intervention group, class type, and their interaction was used. A linear mixed model with a random intercept for class was additionally conducted as a sensitivity analysis.
RESULTS: The adjusted mean scores were 3.774 for the experimental group and 3.514 for the control group, yielding an adjusted mean difference of 0.259 [SE = 0.008, 95% CI (0.243, 0.275), F (1, 175) = 1034.856, p < 0.001, partial η2 =0.855]. The interaction between intervention group and class type was not statistically significant (p = 0.553). The differences in mean change between the experimental and corresponding control classes were 0.259 in the ethnic minority category and 0.263 in the general education category. Exploratory analyses across the seven dimensions of health literacy also showed greater improvements in the experimental group.
CONCLUSION: The findings provide preliminary evidence that a localized health education curriculum may improve health literacy among high school students in Qinghai Province. However, because only four clusters were included, class-level variance could not be estimated reliably and cluster-level confounding cannot be ruled out. The findings should therefore be interpreted as preliminary rather than definitive evidence of curriculum effectiveness.