Theory-Based School Program to Improve Health Literacy Among Primary School Children

Health literacy is a key determinant of children's health and well-being, enabling them to access, understand, evaluate, and use health information to make informed health-related decisions. Middle childhood represents a critical developmental period for strengthening these competencies; however, evidence regarding theory-based school interventions designed to improve health literacy in this age group remains limited. This cluster randomized controlled trial aims to evaluate the effectiveness of a six-week, theory-based school health literacy program developed for children aged 9-10 years. The intervention was designed by integrating Nutbeam's Health Literacy Model and Piaget's Theory of Cognitive Development and incorporates interactive, child-centered educational strategies, including educational games, storytelling, role-playing, problem-solving activities, and classroom discussions. Third- and fourth-grade students attending public primary schools in Burdur, Türkiye, were randomly assigned at the school level to either the intervention or control group. Health literacy outcomes are assessed using the Health Literacy Survey Questionnaire for Children-Turkish Version (HLS-Child-Q15-TR) before and after the intervention. The findings are expected to provide evidence regarding the effectiveness of theory-based school health literacy interventions and to inform future school health promotion programs.

Inclusion Criteria: * Children aged 9-10 years. * Enrolled in the third or fourth grade of a participating public primary school. * Able to understand and complete the study questionnaires. * Written informed consent obtained from a parent or legal guardian. * Child provided verbal assent to participate. Exclusion Criteria: * Participation in a structured health literacy education program with similar content within the previous 6 months. * Inability to participate in the intervention sessions because of prolonged absence from school. * Attendance at \