Developing and Evaluating a Localized Health Education Curriculum in Qinghai, China: An Experimental Study in High Schools

Developing and Evaluating a Localized Health Education Curriculum in Qinghai, China: An Experimental Study in High Schools | Research Square window.SnipcartSettings = { analytics: { enabled: false } }; (function() { var accessVector = localStorage.getItem('access_vector') || ''; window.dataLayer = window.dataLayer || []; if (accessVector) { window.dataLayer.push({ user: { profile: { profileInfo: { snid: accessVector } } } }); } })(); (function(w,d,s,l,i){w[l]=w[l]||[];w[l].push({'gtm.start':new Date().getTime(),event:'gtm.js'});var f=d.getElementsByTagName(s)[0],j=d.createElement(s),dl=l!='dataLayer'?'&l='+l:'';j.async=true;j.src='https://www.googletagmanager.com/gtm.js?id='+i+dl;f.parentNode.insertBefore(j,f);})(window,document,'script','dataLayer','GTM-K279D39R'); Browse Preprints In Review Journals COVID-19 Preprints AJE Video Bytes Research Tools Research Promotion AJE Professional Editing AJE Rubriq About Preprint Platform In Review Editorial Policies Our Team Advisory Board Help Center Sign In Submit a Preprint Cite Share Download PDF Article Developing and Evaluating a Localized Health Education Curriculum in Qinghai, China: An Experimental Study in High Schools Leyi Cao, Yueting Zhang, Bing Shi This is a preprint; it has not been peer reviewed by a journal. https://doi.org/ 10.21203/rs.3.rs-7039741/v1 This work is licensed under a CC BY 4.0 License Status: Posted Version 1 posted You are reading this latest preprint version Abstract This study aimed to develop and evaluate a localized health education curriculum tailored to the specific cultural, environmental, and health needs of high school students in Qinghai Province, China. A quasi-experimental design was employed involving four Grade 11 classes (N = 180), including both ethnic minority and general education groups. Two classes served as experimental groups receiving the localized curriculum, while two served as control groups following the traditional curriculum. A validated self-assessment instrument measuring seven dimensions of adolescent health literacy—ranging from basic health knowledge to psychological well-being and safety awareness—was developed using expert Delphi consultation and psychometric testing. Results from pre- and post-intervention assessments indicated that students in the experimental groups showed significant improvements in overall health literacy scores compared to the control groups (p < 0.05), with particularly notable gains in health knowledge, disease prevention, and safety behaviors. While the control groups exhibited minor progress, the experimental intervention proved significantly more effective. The study provides empirical support for the efficacy of culturally and regionally adapted health education. Findings highlight the importance of context-specific curriculum development in promoting adolescent health and offer a practical model for future health education reform in similar settings. Social science/Education Humanities/Medical humanities Biological sciences/Psychology Social science/Psychology Health Education Local Curriculum Adolescent Health Literacy Experimental Study Qinghai China 1.Introduction Health literacy has emerged as a crucial determinant of public health and individual well-being, particularly among adolescents who are in a formative stage of developing lifelong health behaviors and attitudes. The World Health Organization (WHO) emphasizes the role of school-based health education in promoting equitable access to health information and competencies, especially in regions facing socioeconomic and cultural disparities. Numerous international frameworks advocate for context-sensitive and culturally relevant health education as a means of reducing health inequalities and improving population health outcomes. In China, recent policy reforms have sought to integrate health education more effectively into the national school curriculum. The Physical Education and Health Curriculum Standards for General High Schools (2017 Edition) identify health literacy as a core component of student development. However, the implementation of health education remains uneven across regions, particularly in less developed western provinces such as Qinghai. Qinghai is characterized by a unique blend of high-altitude environments, multi-ethnic populations (including Tibetan, Hui, and Mongolian communities), and distinctive health risks such as endemic infectious diseases and lifestyle-related conditions. These factors render national-level curricula insufficiently responsive to local needs. In the field of health education and curriculum development, countries such as the United States, Japan, South Korea, and the United Kingdom have produced a substantial body of research and practical experience. These international examples have offered valuable insights for the theoretical and practical advancement of health education in China, across Asia, and globally. In the current U.S. primary and secondary school curriculum, Physical Education and Health are central components of the health education framework. As part of the core curriculum, Physical Education and Health aim to cultivate students' interest in physical activity, develop their knowledge and skills related to sports and exercise, and foster social competencies through participation in sports . In addition, the curriculum emphasizes health principles and practices relevant to daily life, with the broader goal of promoting healthy and active lifestyles. These curricular goals bear notable similarity to the objectives of China’s “Physical and Health” curriculum. Moreover, the U.S. curriculum includes Social Studies, which also serves as a platform for health education by addressing topics such as social adaptation, mental health, and moral development—key components of holistic health literacy. In the United States, substantial variation exists in the structure and implementation of health education programs across states and school districts . While the federal government provides overarching curriculum standards and policy guidelines, the authority for curriculum development, implementation, and evaluation is decentralized, residing primarily with state and local education authorities, districts, and individual schools . The development of localized health education curricula refers to the process of selecting, transmitting, and adapting a region’s specific health culture within the context of education. This approach aims to make health education more relevant to students’ lived experiences and learning environments, thereby enhancing its local applicability and contextual responsiveness, and ultimately achieving the goal of health promotion. In the United States, the development of localized curricula is characterized by a high degree of pluralism. A wide range of stakeholders—including teachers, students, administrators, curriculum committees at various levels of educational governance, government officials, federal and state legislators, educational equipment and material providers, publishers, examination agencies, teacher organizations, foundations, parents, and curriculum experts—are actively involved in the design, implementation, and evaluation of local curricula . This pluralistic structure ensures the richness and effectiveness of curriculum development at the local level, and offers valuable insights for other nations pursuing similar goals. In Japan, school-based health education follows a “Health and Physical Education Model,” which integrates health instruction into the broader framework of physical education. This approach emphasizes the combination of physical activity with health-related knowledge, supported by dedicated textbooks for the health component . Since 1953, Japan officially renamed its “Physical Education” class as “Health and Physical Education,” a single subject composed of two relatively independent parts: health and physical education. Health instruction primarily focuses on knowledge and skills, and is delivered by school nurses or dedicated health educators, while physical training is conducted by teachers specialized in health and physical education. Although the curriculum structure closely resembles China’s “Physical and Health” course, Japan adopts a more refined and specialized approach to teacher assignment. Japan’s curriculum system is managed under a centralized model. National curriculum standards and the “Courses of Study” for primary and secondary schools are uniformly established and periodically revised to ensure relevance and instructional quality. However, centralization in Japan is not absolute; there is still room for locally developed curricula, particularly at the school and community levels. The United Kingdom introduced health education in schools as early as 1907. Over the decades, the UK has developed and refined a distinctive national framework for school-based health education, most notably through the introduction of the Personal, Social, and Health Education (PSHE) curriculum . This curriculum reflects the UK's holistic educational philosophy, emphasizing the integrated development of students’ spiritual, moral, social, and cultural dimensions . In practice, the PSHE framework has led to the creation of a uniquely British model of school health education characterized by a strong emphasis on whole-child development and well-being. To address the challenges of the knowledge economy in the 21st century, the UK has undertaken multiple education reforms, including the enactment of legislative acts, the establishment of national curriculum standards, and the restructuring of curriculum frameworks and assessment systems. These reforms aim to further improve the quality of education and ensure its responsiveness to contemporary societal needs. Public primary and secondary schools in the United Kingdom follow a nationally standardized curriculum and framework, which reflects a centralized approach to curriculum governance. Within this overarching structure, several specialized programs have been developed to enhance students’ emotional regulation and social adaptability, including Social and Emotional Aspects of Learning (SEAL), Curriculum for Excellence (CfE)—primarily implemented in Scotland—and Personal, Social, and Health Education (PSHE). Although these curricula are guided by national standards, they are adapted to meet regional needs and are implemented flexibly at the local level . This dynamic balance between centralized policy and localized practice illustrates the UK’s commitment to educational equity, while ensuring that school-based health education remains contextually relevant and responsive to students’ diverse social and emotional needs. Unlike some countries that offer dedicated health education courses, South Korea does not implement a standalone health education curriculum in its national education system. Instead, a combined curriculum of Physical Education and Health Education is offered at the elementary level. This integrated approach is conceptually similar to China’s "Physical and Health" curriculum, encompassing two interrelated components: physical education and basic health or hygiene education. Under South Korea’s national education framework, only a limited set of core content is designated as compulsory by the central government. The remaining components are elective and may be flexibly selected based on local conditions, school contexts, and the specific needs and characteristics of students and teachers . This design strongly reflects the principles of localized curriculum development, allowing regions and schools to adapt instruction to their unique sociocultural and environmental contexts. In Grades 1 and 2 of elementary school, health-related content is primarily embedded within other subjects such as science, social studies, and moral education . Starting from Grade 3, health education concepts are more explicitly integrated into the physical education curriculum. The primary objective of health education at the elementary level in South Korea is to equip students with the knowledge and skills necessary to protect and promote physical and mental well-being, while also cultivating proper attitudes and lifestyle habits conducive to long-term health. This threefold focus—health knowledge, health attitudes, and health behaviors—closely parallels the health education goals established in China. Both systems emphasize the development of students' competencies in managing personal health, making informed decisions, and practicing health-enhancing behaviors within and beyond the school environment. Australia adopts a three-tiered curriculum governance model encompassing the federal, state, and school levels. The implementation of health education falls under the Health and Physical Education (HPE) curriculum, which leverages the curricular strengths and contextual expertise of different states and territories . Historically, the authority over curriculum management in Australia has been concentrated at the state level, as the federal government holds no constitutional mandate over education. Similar to the United States, Australia’s federal government is responsible for formulating national curriculum frameworks and setting overarching policy principles and standards, but does not impose detailed curriculum content requirements . In practice, state and territorial governments play a pivotal intermediary role. They are not only the principal executors of federal education policies but also provide direct oversight, guidance, and support to schools in curriculum development and implementation. This decentralized structure allows for a flexible and context-sensitive approach to curriculum planning, while maintaining consistency with national policy objectives. In her research, Susan L. emphasized the importance of designing health and physical education programs tailored to the needs of Indigenous girls in remote communities, arguing that curriculum development must be responsive to both regional socio-cultural contexts and public health challenges. Her study highlights the significant contributions that Indigenous communities and local educators can make in shaping HPE curricula for Aboriginal students. Such efforts represent a compelling example of localized curriculum development within Australia’s broader national framework. Although many countries have developed relatively mature health education curricula, school-based health education remains an area of ambiguity and contention in certain national contexts. In Spain, for example, health education is still regarded as a controversial and inconsistently implemented discipline. The legal and curricular status of school health education remains vague, leading to fragmented policies and uneven delivery across schools and regions. Empirical studies have shown that students in Spain often do not perceive schools as primary sites for health learning. Instead, they consider family, peers, and digital technologies to be more influential sources of health-related knowledge and behavior. This perception tends to undermine the potential positive impact of school health education on the well-being of children and adolescents . A study by Abedian K. revealed that despite adolescents being an energetic and distinctive group, their health education needs are frequently overlooked by healthcare providers, educators, families, and public health professionals. The research identified a lack of interest among adolescents in existing health education programs as a major barrier to effectiveness. As a result, it was recommended that youth-specific strategies be integrated into broader adolescent health promotion programs to enhance engagement and relevance. Furthermore, a growing body of research on localized health education curriculum development has revealed important structural limitations. For instance, Begoray D. L. argued that many health education programs lack a clear theoretical foundation, particularly in relation to curriculum design principles. The absence of strong theoretical underpinnings can result in fragmented, inconsistent, or overly pragmatic curricular interventions that fail to align with broader educational goals or developmental needs. Many countries around the world are actively advancing health (or hygiene) education, either through standalone health education courses or by embedding health content within integrated curricular structures. In numerous national contexts, health education is delivered primarily through Health and Physical Education (HPE) courses or similar formats, which often serve as the main institutional carriers of health-related instruction. In addition, a substantial portion of health education content is incorporated into other subjects—such as science, social studies, or moral education—mirroring the multidisciplinary approach observed in China’s health education system. Despite this structural similarity, significant differences remain in the degree of curricular emphasis placed on health education, the availability of trained health education professionals, and the thematic priorities emphasized in curriculum content. The experiences of countries that have made substantial progress in this field offer valuable insights for China, other Asian nations, and the global community. Key lessons include the diversification of health education content, the development of specialized teacher training programs, and the integration of health education into national curriculum policy. Currently, in many countries, the governance of health education curricula has been elevated to the national policy level. However, the implementation strategies and development of localized health education curricula vary considerably based on national and regional contexts. While a growing number of countries have recognized the need to address regional diversity and contextual specificity in curriculum development—particularly in relation to geography, culture, and public health needs—there remains a lack of comprehensive theoretical frameworks guiding the localized development of health education curricula under the influence of natural environmental conditions.。 In summary, many countries have attached increasing importance to school-based health education, paying attention not only to top-level curriculum design, but also to content development, implementation mechanisms, management systems, and support services. Differences in curriculum richness and local curriculum development capacity are often shaped by the broader educational governance models and curriculum management systems of individual countries. In light of the absence of a mature theoretical model for localized health education curriculum development, it is both necessary and timely to incorporate environmental considerations and prioritize region-specific health concerns. Doing so can enhance the relevance, effectiveness, and theoretical advancement of health education at both the national and local levels. At its core, the issue of health education extends beyond the responsibilities of schools alone; it is a shared social responsibility that must be jointly undertaken by families, communities, and broader society. The curriculum itself is inherently dynamic and evolving, with its underlying theories continuously enriched and redefined in response to social transformation, technological advancement, and shifts in public health priorities. As societies experience rapid changes in lifestyle, values, and information ecosystems, the distribution of responsibilities in health education—between schools, families, and social institutions—may shift accordingly. What is considered the primary locus of health learning today may become secondary tomorrow, depending on changes in policy, media environments, or family structures. However, unlike these fluid and mutable social variables, the natural environment remains relatively constant over time, exerting a persistent and stable influence on human health and well-being. For this reason, the development of localized health education curricula must give due consideration to the natural environment—not only as a physical backdrop, but as a foundational and enduring dimension shaping human interaction, lifestyle risks, and ecological health literacy. In this context, the natural environment can serve as a relatively permanent and universal entry point for localized curriculum development. Current research on health education in China remains predominantly concentrated in urban areas and the more economically developed eastern regions, while comparatively less attention has been paid to rural settings and ethnic minority communities. This uneven research focus has led to a limited understanding of the specific health education needs, challenges, and contextual dynamics present in underrepresented regions. Moreover, there is a noticeable scarcity of studies that employ rigorous experimental or quasi-experimental designs to empirically evaluate the effectiveness of localized health education interventions. The lack of such evidence-based research hinders the ability to generalize findings, assess policy impact, or develop scalable health education models tailored to diverse regional contexts. This research gap presents not only a challenge for the field of health education in China but also a valuable opportunity for educational innovation, localized curriculum development, and evidence-informed policymaking. By addressing this underexplored area, future research can contribute to more equitable, culturally responsive, and contextually appropriate health education practices across China's diverse regions.。 To address this issue, the present study designed and tested a localized high school health education curriculum tailored to the ecological, cultural, and epidemiological features of Qinghai Province. The curriculum was grounded in national guidelines but extended to incorporate region-specific health concerns and culturally relevant pedagogies. A quasi-experimental study was conducted to examine whether this localized approach could significantly enhance students’ health literacy across multiple dimensions, including knowledge acquisition, behavioral skills, and psychosocial adaptation. This paper aims to contribute to the growing body of literature on regional curriculum development by offering empirical evidence of the effectiveness of a localized health education program in a multi-ethnic, underdeveloped region of China. The findings are expected to inform future policy efforts in education and public health, particularly in the development of adaptive curricula for diverse and underserved populations. 2. Methods 2.1 Research Design This study employed a quasi-experimental research design utilizing a pre-test/post-test control group structure to examine the effects of a localized health education curriculum intervention. The teaching experiment was implemented over the course of one academic semester (approximately 3.5 months) in a public high school located in Haibei Prefecture, Qinghai Province, China. This region was selected due to its unique geographic, cultural, and health-related characteristics, which made it an appropriate setting for testing the adaptability and relevance of a regionally tailored curriculum. The primary objective of the research was to evaluate the effectiveness of the newly developed localized health education curriculum in comparison to the existing national standard curriculum currently implemented in the region. By incorporating both a temporal (pre- and post-test) and group-based (experimental and control) structure, the design allowed for controlled comparison and causal inference regarding the impact of the intervention on students’ health literacy outcomes. All procedures were conducted in accordance with relevant institutional and national ethical guidelines. Ethical approval was obtained from the Ethics Committee of Qinghai Normal University, and written informed consent was secured from all participants and/or their legal guardians prior to data collection. 2.2 Participants A total of 180 Grade 11 students from four intact classes were recruited to participate in the study. The sample included students from two general education classes and two ethnic minority classes, the latter comprising individuals of Tibetan, Hui, Mongolian, and Han ethnic backgrounds. Within each educational category, one class was randomly assigned to the experimental group, which received the localized health education curriculum, and the other to the control group, which continued with the standard curriculum. The gender distribution of the sample included 66 male students (36.7%) and 114 female students (63.3%). To ensure consistency in instructional quality and to minimize teacher-related variability, the same health education teacher was assigned to both the experimental and control classes within each category. This design consideration helped control for extraneous variables that could potentially influence the outcomes of the intervention.. 2.3 Instrumentation To assess students’ health literacy levels, a customized self-assessment questionnaire was developed, drawing on three key sources: (1) the General High School Physical Education and Health Curriculum Standards (2017 Edition) issued by the Chinese Ministry of Education, (2) region-specific public health challenges and priorities identified in Qinghai Province, and (3) findings from semi-structured expert interviews with professionals in health education and public health. The final version of the instrument consisted of 42 items, grouped into the following seven thematic domains:(1)Basic Health Knowledge and Skills;༈2༉Nutrition and Food Safety༛༈3༉Hygiene and Disease Prevention༛༈4༉Environment, Health, and Physical Activity༛༈5༉Safe Exercise and Injury Management༛༈6༉Emergency Response and Safety Awareness༛༈7༉Mental, Moral, and Social Adaptation。Each item was measured on a 5-point Likert scale. The questionnaire underwent two rounds of expert review using the Delphi method with seven experts in health education and public health. Content validity was ensured through item revision, and reliability was tested via a pilot study. All seven domains demonstrated acceptable internal consistency (Cronbach's α ranging from 0.719 to 0.801), indicating good reliability. 2.4 Curriculum Intervention The experimental curriculum was developed in accordance with the national health education standards for high schools, but was systematically adapted to incorporate regionally specific and culturally relevant content. These localized modifications addressed key public health concerns in Qinghai Province, including the prevention of endemic diseases, health risks associated with high-altitude environments, and traditional health beliefs and practices among ethnic minority populations. To ensure the fidelity and standardization of the intervention, two instructors—one assigned to general education classes and the other to ethnic minority classes—underwent targeted professional development and training sessions prior to implementation. These sessions focused on instructional strategies, cultural sensitivity, and the pedagogical integration of localized content into existing health education frameworks. During the intervention period, teachers in the experimental groups were instructed to select and implement 3 to 5 thematic units from the localized curriculum, delivered during their regularly scheduled health education periods. In contrast, the control groups continued with the standard health education curriculum mandated by national guidelines and were not exposed to any localized content or materials developed for this study. To maintain procedural consistency and minimize confounding variables, both experimental and control groups followed the same weekly schedule, class duration, and assessment protocols throughout the intervention period. This design ensured that observed differences in outcomes could be more confidently attributed to the content of the curriculum rather than to instructional time or delivery conditions. 2.5 Data Collection and Analysis Pre- and post-intervention data were collected using the validated health literacy questionnaire described in Section 2.3 . The questionnaires were administered in person in classroom settings, under the supervision of homeroom teachers and physical education instructors, to ensure proper guidance and standardization in the administration process. To maintain participant anonymity and reduce the risk of social desirability bias, students were clearly informed that their responses would be used exclusively for research purposes and would have no bearing on their academic grades or evaluations. Participation was voluntary, and students were encouraged to answer honestly and independently. All data were analyzed using SPSS 20.0 statistical software. Descriptive statistics (means, standard deviations, and frequencies) were computed to examine the overall distribution and trends of health literacy scores. To assess between-group differences, independent samples t-tests were conducted comparing experimental and control group means for both pre- and post-test scores. Additionally, paired samples t-tests were used to examine within-group differences by comparing students’ pre-test and post-test scores individually. A significance threshold of p < 0.05 was adopted for all statistical analyses to determine the presence of statistically meaningful differences. This analytic approach enabled the researchers to evaluate both the effectiveness of the intervention and the direction and magnitude of change over time. 3. Results 3.1 Statistical Analysis of Response Reliability Across Health Education Thematic Domains To evaluate the reliability of the self-assessment questionnaire developed for this study, a pilot test was conducted with a sample of Grade 11 students from one class. The internal consistency of the instrument was assessed using Cronbach’s alpha coefficients, calculated through SPSS statistical software for each of the seven thematic domains. The results demonstrated that all seven domains—namely: (1) Basic Health Knowledge and Skills, (2) Nutrition and Food Safety, (3) Hygiene and Disease Prevention, (4) Environmental Health and Physical Activity, (5) Safe Exercise and Injury Management, (6) Emergency Response and Safety Awareness, and (7) Psychosocial Health and Social Adaptation—achieved alpha values exceeding 0.70, which is generally considered the acceptable threshold for internal reliability in educational and psychological measurement. These findings suggest that the items within each domain exhibit strong internal consistency and can be considered statistically reliable for assessing the respective dimensions of adolescent health literacy. The instrument, therefore, provides a robust foundation for subsequent empirical data collection and analysis, supporting the validity of the study’s overall measurement framework. Table 1 Reliability Analysis of Responses Across Health Education Themes Health Education Themes Cronbach's Alpha Basic health knowledge and skills 0.745 Nutrition and food safety 0.719 Hygiene and disease prevention 0.755 Environmental health and physical activity 0.774 Safe Exercise and the Prevention and Management of Common Sports Injuries 0.801 Emergency Response, Safety Awareness, and Risk Prevention Competency 0.726 Mental Health and Social Adaptation Ability 0.732 3.2 Baseline Health Literacy Comparison Between Experimental and Control Groups An initial comparison of baseline overall health literacy scores was conducted between the experimental and control groups within the ethnic minority cohort. The results of the statistical analysis indicated that the two groups exhibited highly comparable mean scores, with no statistically significant difference detected between them (p > 0.05). This suggests that prior to the intervention, the experimental and control groups were equivalent in terms of their overall health literacy levels, thereby providing a solid foundation for assessing the subsequent effects of the localized curriculum intervention. Detailed results are presented in Table 2 . Table 2 Analysis of Differences in Overall Health Literacy Between Experimental and Control Groups in the Ethnic Minority Class Themes Experimental classes Control classes T P Overall Mean Score of Health Literacy 3.548 ± 0.433 3.542 ± 0.457 0.065 0.948 As shown in Table 2 , there was no statistically significant difference in the overall mean health literacy scores between the experimental and control groups in the ethnic minority cohort. However, it is important to note that consistency in overall averages does not necessarily imply uniformity across all dimensions of health literacy, as variation may exist within specific thematic components. To obtain a more nuanced understanding of the comparability between the two groups, a further analysis was conducted by calculating the average scores for each individual across the seven thematic dimensions of health literacy. This domain-level comparison was intended to determine whether the two groups were equivalent not only in their overall scores but also in the structure and distribution of their health literacy competencies. The results indicated that there were no significant differences between the experimental and control groups across all seven domains of health literacy. These findings are presented in detail in Table 3 , and they confirm that the two groups were well matched at baseline, both in terms of overall level and across specific content areas. This strengthens the internal validity of the study and supports the reliability of subsequent comparisons following the intervention. Table 3 Comparative Analysis of Average Scores Across Health Literacy Domains Between the Experimental and Control Groups in the Ethnic Minority Cohort Health Education Themes Experimental classes Control classes T P Basic health knowledge and skills 3.258 ± 0.588 3.241 ± 0.541 0.150 0.881 Nutrition and food safety 3.251 ± 0.533 3.148 ± 0.493 0.995 0.332 Hygiene and disease prevention 3.103 ± 0.511 3.027 ± 0.511 0.741 0.461 Environmental health and physical activity 3.279 ± 0.601 3.235 ± 0.574 0.369 0.713 Safe Exercise and the Prevention and Management of Common Sports Injuries 3.000 ± 0.568 2.981 ± 0.561 0.166 0.869 Emergency Response, Safety Awareness, and Risk Prevention Competency 3.361 ± 0.505 3.364 ± 0.489 -0.03 0.976 Mental Health and Social Adaptation Ability 3.548 ± 0.433 3.542 ± 0.457 0.065 0.948 As illustrated in Table 3 , the experimental and control groups within the ethnic minority cohort demonstrated a high degree of consistency not only in their overall health literacy scores, but also across all individual thematic dimensions. This indicates that both groups were at an equivalent baseline level prior to the intervention, with no statistically significant differences detected in any of the measured domains. Such equivalence provides a strong basis for the subsequent evaluation of the effectiveness of the localized health education curriculum, ensuring that observed post-intervention differences can be more confidently attributed to the intervention itself rather than to pre-existing disparities. Following this analysis, a similar comparison was conducted between the experimental and control groups within the general education cohort. Statistical results revealed that the overall mean health literacy scores were also highly comparable, and no significant differences were observed (p > 0.05), as presented in Table 4 . These findings further support the internal validity of the study by confirming that both cohorts—ethnic minority and general education—were well-matched at baseline across experimental conditions. Table 4 Comparative Analysis of Overall Health Literacy Levels Between Experimental and Control Groups in the General Class Themes Experimental classes Control classes T P Overall Mean Score of Health Literacy 3.753 ± 0.313 3.813 ± 0.265 -0.928 0.356 As presented in Table 4 , there was no statistically significant difference in the overall mean health literacy scores between the experimental and control groups within the general education cohort. This finding suggests that both groups were comparable in terms of their overall health literacy levels prior to the intervention. To further assess the degree of equivalence between the two groups, an additional analysis was conducted comparing the average scores across the seven thematic dimensions of health literacy for each student. These dimensions included: basic health knowledge and skills, nutrition and food safety, hygiene and disease prevention, environmental health and physical activity, safe exercise and injury management, emergency response and safety awareness, and psychosocial health and social adaptation. The results of this domain-specific analysis indicated that there were no statistically significant differences between the experimental and control groups in any of the seven dimensions. This outcome confirms that the two groups were not only similar in overall health literacy, but also well matched across specific domains of health competence. Full details of the analysis are provided in Table 5 . Table 5 Comparative Analysis of Thematic Health Literacy Scores Between Experimental and Control Groups in the General Class Health Education Themes Experimental classes Control classes T P Basic health knowledge and skills 3.944 ± 0.433 3.881 ± 0.435 0.649 0.518 Nutrition and food safety 3.556 ± 0.463 3.643 ± 0.416 -0.895 0.374 Hygiene and disease prevention 3.769 ± 0.524 3.790 ± 0.454 -0.188 0.851 Environmental health and physical activity 3.795 ± 0.362 3.849 ± 0.387 -0.651 0.517 Safe Exercise and the Prevention and Management of Common Sports Injuries 3.641 ± 0.490 3.742 ± 0.392 -1.028 0.307 Emergency Response, Safety Awareness, and Risk Prevention Competency 3.782 ± 0.363 3.897 ± 0.299 -1.558 0.123 Mental Health and Social Adaptation Ability 3.813 ± 0.364 3.898 ± 0.356 -1.060 0.292 As illustrated in Table 5 , the experimental and control groups within the general education cohort exhibited a high degree of consistency not only in their overall health literacy scores but also across all seven thematic dimensions. No statistically significant differences were observed between the two groups, indicating that both were situated at a comparable baseline level prior to the intervention. When considered alongside the earlier findings from the ethnic minority cohort, these results collectively confirm that students across all four classes—namely, the experimental and control groups within both the ethnic minority and general education tracks—were equivalent in terms of their initial health literacy competencies. Such baseline equivalence is essential for ensuring the internal validity of the quasi-experimental design, as it minimizes confounding variables that might otherwise influence post-intervention outcomes. This pre-intervention alignment provides a methodologically sound foundation for the subsequent implementation and evaluation of the localized health education curriculum. It ensures that any significant differences observed after the intervention can be more confidently attributed to the curricular treatment rather than to pre-existing disparities between groups. 3.3 Post-Test Comparative Analysis of Health Literacy Levels Between the Experimental and Control Groups in the Ethnic Minority Class Determining whether statistically significant differences in health literacy levels emerge between the experimental and control groups following the teaching intervention constitutes a critical benchmark for evaluating the effectiveness of the localized health education curriculum implemented in high schools in Qinghai Province. The presence of such differences would indicate that the intervention produced measurable improvements in student outcomes, thereby offering empirical support for both the practical utility and theoretical soundness of the curriculum design. Moreover, identifying significant post-intervention gains in the experimental group would lend further credibility to the curriculum development model adopted in this study—one that emphasizes cultural relevance, regional adaptability, and environmental specificity. As such, the results serve not only as an assessment of pedagogical effectiveness but also as a validation of the broader conceptual framework underpinning localized health education in multi-ethnic and underdeveloped regions. Table 6 Post-Intervention Comparative Analysis of Health Literacy Across Thematic Dimensions Between the Experimental and Control Groups in the Ethnic Minority Class Health Education Themes Experimental classes Control classes T P Basic health knowledge and skills 3.782 ± 0.467 3.336 ± 0.489 4.616 0.000 Nutrition and food safety 3.506 ± 0.479 3.170 ± 0.471 3.491 0.001 Hygiene and disease prevention 3.458 ± 0.437 3.061 ± 0.467 4.357 0.000 Environmental health and physical activity 3.518 ± 0.510 3.261 ± 0.536 2.434 0.017 Safe Exercise and the Prevention and Management of Common Sports Injuries 3.227 ± 0.493 3.004 ± 0.533 2.162 0.033 Emergency Response, Safety Awareness, and Risk Prevention Competency 3.588 ± 0.442 3.390 ± 0.456 2.181 0.032 Mental Health and Social Adaptation Ability 3.743 ± 0.372 3.558 ± 0.439 2.262 0.026 As presented in Table 6 , statistically significant differences (p < 0.05) were observed between the experimental and control groups in the ethnic minority class across all seven thematic dimensions of health literacy following the conclusion of the teaching intervention. These findings indicate that the health literacy levels of the two groups diverged meaningfully as a result of the curriculum intervention. More specifically, the experimental group consistently achieved higher average scores than the control group in each of the assessed dimensions, including basic health knowledge and skills, nutrition and food safety, hygiene and disease prevention, environmental health and physical activity, safe exercise and injury management, emergency response and safety awareness, and psychosocial health and social adaptation. This pattern of improvement suggests that the localized health education curriculum had a positive and measurable impact on students’ health literacy development within the ethnic minority context. The results provide empirical evidence supporting the effectiveness of a culturally and regionally adapted curriculum, demonstrating that a context-sensitive approach can significantly enhance student learning outcomes in underrepresented and diverse populations. Table 7 Post-Intervention Comparative Analysis of Overall Health Literacy Scores Between the Experimental and Control Groups in the Ethnic Minority Class Themes Experimental classes Control classes T P Overall Mean Score of Health Literacy 3.541 ± 0.288 3.244 ± 0.288 5.095 0.000 As shown in Table 7 , a statistically significant difference (p < 0.05) was observed in the overall mean health literacy scores between the experimental and control groups in the ethnic minority class following the teaching intervention. This result indicates that, after the implementation of the localized curriculum, the two groups were no longer at the same level in terms of overall health literacy performance. More specifically, students in the experimental group achieved a higher overall average score than those in the control group, suggesting that the localized health education curriculum had a notable positive impact on enhancing students’ comprehensive health literacy. This finding reinforces the conclusion that the intervention was effective not only at the level of individual thematic dimensions (as indicated in Table 6 ), but also in elevating overall health literacy in a statistically and educationally meaningful way. Such outcomes provide further empirical support for the validity and effectiveness of a regionally adapted, culturally sensitive curriculum model, especially in multi-ethnic and under-resourced educational settings. 3.4 Post-Intervention Comparative Analysis of Health Literacy Levels Between Experimental and Control Groups in the General Class Table 8 Post-Intervention Comparative Analysis of Thematic Health Literacy Scores Between the Experimental and Control Groups in the General Class Health Education Themes Experimental classes Control classes T P Basic health knowledge and skills 4.287 ± 0.278 3.910 ± 0.417 4.823 0.000 Nutrition and food safety 3.855 ± 0.355 3.667 ± 0.381 2.294 0024 Hygiene and disease prevention 4.068 ± 0.413 3.817 ± 0.434 2.662 0.009 Environmental health and physical activity 4.043 ± 0.305 3.873 ± 0.371 2.237 0.028 Safe Exercise and the Prevention and Management of Common Sports Injuries 3.953 ± 0.386 3.770 ± 0.366 2.191 0.031 Emergency Response, Safety Awareness, and Risk Prevention Competency 4.051 ± 0.276 3.917 ± 0.286 2.153 0.034 Mental Health and Social Adaptation Ability 4.066 ± 0.285 3.922 ± 0.334 2.080 0.041 As shown in Table 8 , following the teaching intervention, statistically significant differences (p < 0.05) were observed between the experimental and control groups in the general education class across all seven thematic dimensions of health literacy. These results indicate that the two groups were no longer equivalent in terms of their health literacy levels after the intervention, suggesting that the localized curriculum had a discernible educational effect. More specifically, the experimental group consistently achieved higher average scores across each of the seven dimensions—ranging from basic health knowledge and skills to psychosocial well-being and safety awareness—compared to their peers in the control group. This pattern of improvement implies that the localized health education curriculum exerted a greater and more comprehensive positive impact on the students who received it, in contrast to the outcomes associated with the standard curriculum implemented in the control group. These findings further reinforce the effectiveness of the localized curriculum model, demonstrating that it can not only enhance overall student performance but also foster meaningful gains across specific domains of adolescent health literacy in non-minority, general educational contexts. Table 9 Post-Intervention Comparative Analysis of Overall Health Literacy Scores Between the Experimental and Control Groups in the General Class Themes Experimental classes Control classes T P Overall Mean Score of Health Literacy 4.041 ± 0.234 3.838 ± 0.249 3.781 0.000 As presented in Table 9 , the comparison of overall post-test health literacy scores between the experimental and control groups in the general education class revealed a statistically significant difference (p < 0.05). This indicates that, following the teaching intervention, the two groups were no longer comparable in terms of their overall health literacy levels, with the experimental group demonstrating superior performance relative to the control group. When considered in conjunction with the results from the ethnic minority cohort, these findings clearly demonstrate that, after the implementation of the localized health education curriculum, the experimental groups in both educational tracks significantly outperformed their respective control groups—not only in overall health literacy but also across all seven thematic dimensions. This consistent pattern of improvement provides compelling evidence that the localized curriculum had a broad and measurable impact on students’ health literacy development across diverse classroom contexts. The effectiveness of the localized curriculum in both general and ethnic minority settings underscores its practical utility, as well as its transferability and adaptability to different educational populations. Moreover, these findings offer robust empirical support for the validity, effectiveness, and theoretical soundness of the localized curriculum development model proposed and implemented in this study. By aligning curriculum content with regional, cultural, and environmental realities, the model has proven to be a scientifically rigorous and contextually responsive approach to advancing adolescent health education in underdeveloped and multi-ethnic regions such as Qinghai. 3.5 Analysis of Health Literacy Development in the Control Groups Before and After the Intervention Table 10 Pre- and Post-Test Comparison of Thematic Health Literacy Scores in the Ethnic Minority Control Group Health Education Themes Pre-test Post-test T P Basic health knowledge and skills 3.241 ± 0.541 3.268 ± 0.516 -2.606 0.013 Nutrition and food safety 3.148 ± 0.493 3.170 ± 0.471 -2.213 0.032 Hygiene and disease prevention 3.027 ± 0.511 3.061 ± 0.467 -2.033 0.048 Environmental health and physical activity 3.235 ± 0.574 3.379 ± 0.538 -1.261 0.214 Safe Exercise and the Prevention and Management of Common Sports Injuries 2.981 ± 0.561 3.004 ± 0.533 -2.606 0.013 Emergency Response, Safety Awareness, and Risk Prevention Competency 3.364 ± 0.489 3.390 ± 0.456 -2.464 0.018 Mental Health and Social Adaptation Ability 3.542 ± 0.457 3.558 ± 0.439 -2.348 0.024 Table 11 Pre- and Post-Test Comparison of Overall Health Literacy Scores in the Ethnic Minority Control Group Themes Pre-test Post-test T P Overall Mean Score of Health Literacy 3.219 ± 0.308 3.244 ± 0.288 -4.0845 0.000 Table 12 Pre- and Post-Test Comparison of Thematic Health Literacy Scores in the General Class Control Group Health Education Themes Pre-test Post-test T P Basic health knowledge and skills 3.881 ± 0.435 3.910 ± 0.417 -2.614 0.012 Nutrition and food safety 3.643 ± 0.416 3.667 ± 0.381 -2.218 0.032 Hygiene and disease prevention 3.790 ± 0.454 3.817 ± 0.434 -2.471 0.018 Environmental health and physical activity 3.850 ± 0.387 3.873 ± 0.371 -2.218 0.032 Safe Exercise and the Prevention and Management of Common Sports Injuries 3.742 ± 0.392 3.770 ± 0.366 -2.864 0.007 Emergency Response, Safety Awareness, and Risk Prevention Competency 3.897 ± 0.299 3.917 ± 0.286 -2.354 0.023 Mental Health and Social Adaptation Ability 3.898 ± 0.356 3.922 ± 0.334 -2.471 0.018 Table 13 Pre- and Post-Test Comparison of Overall Health Literacy Scores in the General Class Control Group Themes Pre-test Post-test T P Overall Mean Score of Health Literacy 3.813 ± 0.265 3.838 ± 0.249 -5.936 0.000 As shown in Tables 10 through 13 , students in the control groups demonstrated statistically significant improvements in overall health literacy scores between the pre-test and post-test assessments. Similar trends of progress were also observed across the seven thematic dimensions, suggesting that the traditional physical education and health curriculum does offer some educational value in promoting students' health literacy. However, the magnitude of improvement observed in both overall and dimension-specific scores was relatively limited, averaging around 0.5%. The gains across the seven dimensions were generally consistent, with one notable exception: the dimension titled “Environment, Physical Activity, and Health” showed the least measurable growth, indicating a potential area of weakness in the traditional curriculum’s content or delivery. In summary, while conventional health education approaches can indeed foster incremental growth in students’ health literacy, their effectiveness appears modest, particularly in domains related to environmental awareness and active lifestyle promotion. These findings underscore the need for curriculum enhancement strategies that more explicitly integrate environmental health perspectives and physical activity components, especially in contexts where such content is currently underemphasized. 3.6 Analysis of Pre- and Post-Test Changes in Health Literacy Among Experimental Groups Table 14 Pre- and Post-Test Comparison of Thematic Health Literacy Scores in the Ethnic Minority Experimental Group Health Education Themes Pre-test Post-test T P Basic health knowledge and skills 3.258 ± 0.588 3.782 ± 0.467 -19.243 0.000 Nutrition and food safety 3.252 ± 0.533 3.506 ± 0.479 -13.554 0.000 Hygiene and disease prevention 3.103 ± 0.511 3.458 ± 0.437 -15.208 0.000 Environmental health and physical activity 3.278 ± 0.601 3.518 ± 0.510 -9.526 0.000 Safe Exercise and the Prevention and Management of Common Sports Injuries 3.000 ± 0.568 3.227 ± 0.493 -11.645 0.000 Emergency Response, Safety Awareness, and Risk Prevention Competency 3.361 ± 0.505 3.588 ± 0.442 -15.588 0.000 Mental Health and Social Adaptation Ability 3.548 ± 0.433 3.743 ± 0.372 -11.942 0.000 Table 15 Pre- and Post-Test Comparison of Overall Health Literacy Scores in the Ethnic Minority Experimental Group Themes Pre-test Post-test T P Overall Mean Score of Health Literacy 3.257 ± 0.329 3.541 ± 0.288 -28.244 0.000 Table 16 Pre- and Post-Test Comparison of Thematic Health Literacy Scores in the General Class Experimental Group Health Education Themes Pre-test Post-test T P Basic health knowledge and skills 3.944 ± 0.433 4.287 ± 0.278 -9.982 0.000 Nutrition and food safety 3.556 ± 0.463 3.855 ± 0.355 -9.045 0.000 Hygiene and disease prevention 3.769 ± 0.524 4.068 ± 0.413 -10.617 0.000 Environmental health and physical activity 3.795 ± 0.362 4.043 ± 0.305 -11.749 0.000 Safe Exercise and the Prevention and Management of Common Sports Injuries 3.641 ± 0.490 3.953 ± 0.386 -9.433 0.000 Emergency Response, Safety Awareness, and Risk Prevention Competency 3.782 ± 0.363 4.051 ± 0.276 -10.192 0.000 Mental Health and Social Adaptation Ability 3.813 ± 0.364 4.066 ± 0.285 -8.726 0.000 Table 17 Pre- and Post-Test Comparison of Overall Health Literacy Scores in the General Class Experimental Group Themes Pre-test Post-test T P Overall Mean Score of Health Literacy 3.753 ± 0.313 4.041 ± 0.234 -16.886 0.000 As shown in Tables 19 through 22, both the general and ethnic minority experimental groups exhibited statistically significant differences in their overall health literacy levels and across all thematic dimensions between the pre- and post-intervention assessments. These findings confirm that the teaching intervention led to measurable improvements in health literacy for students in both experimental and control groups. However, a comparison of the magnitude of change reveals that the experimental groups experienced substantially greater gains than the control groups. This suggests that the localized health education curriculum implemented in Qinghai Province had a stronger and more pronounced effect on promoting student health literacy. These results not only affirm the practical effectiveness of the localized curriculum but also lend empirical support to the validity and rationality of the curriculum development model adopted in this study. From a longitudinal perspective, although all seven dimensions of health literacy showed statistically significant improvement, the extent of progress varied by domain. The most notable gains were observed in areas related to health knowledge and practical skills, whereas health-related behaviors, environmental adaptation, moral health, and psychological well-being exhibited relatively modest improvements. This discrepancy may be attributed to the inherent nature of health education content. Cognitive and knowledge-based content can typically be acquired relatively quickly through direct instruction and classroom-based learning. In contrast, deeply rooted beliefs, attitudes, and behavioral patterns—particularly those related to lifestyle, mental health, and value systems—require sustained practice, reflection, and experiential learning to shift meaningfully. Given that high school students have already developed relatively stable behavioral habits and cognitive frameworks, significant behavioral or attitudinal change within a short intervention period may be difficult to achieve. Therefore, the design of localized health education curricula should emphasize a multi-tiered structure that includes: (1) health knowledge and skills, (2) health beliefs and identity, and (3) health behaviors and practical application. Such a layered approach ensures a more comprehensive and developmentally appropriate strategy for promoting long-term health literacy among adolescents. Based on the design, implementation, and comprehensive analysis of the teaching experiment evaluating the effectiveness of the localized high school health education curriculum in Qinghai Province, the following key conclusions can be drawn: (1) Statistically significant differences were observed between the experimental and control groups in both overall health literacy and across all seven thematic dimensions following the intervention. These findings provide robust empirical support for the effectiveness of the localized curriculum, while also affirming the scientific validity and conceptual soundness of the curriculum development model employed in this study. (2) Students from both the ethnic minority and general education experimental groups exhibited significant improvements across all health literacy domains after the intervention. These improvements were consistently greater than those observed in the control groups, indicating that the localized curriculum outperformed traditional health education approaches. The results further confirm the model’s adaptability and relevance across diverse student populations and educational contexts. (3) Longitudinal comparisons of pre- and post-intervention data revealed a stable pattern of improvement across the seven dimensions of health literacy. The most substantial gains were recorded in knowledge-based and skill-oriented domains, whereas dimensions related to health behavior, environmental adaptation, moral development, and psychological well-being showed more modest progress. These outcomes suggest that the design of health education curricula should adopt a multi-layered and integrated approach, systematically supporting the acquisition of health knowledge, fostering attitudinal shifts, and enabling behavioral transformation in a coordinated and developmentally appropriate manner. Collectively, these conclusions underscore the potential of localized, context-sensitive curricula to enhance adolescent health literacy in underdeveloped and multi-ethnic regions, and offer valuable insights for future curriculum innovation and education policy development. 4.Discussion This study examined the effectiveness of a localized health education curriculum developed for high school students in Qinghai Province, China. Using a quasi-experimental design with both general and ethnic minority student cohorts, the study found statistically significant improvements in health literacy among students in the experimental groups, both in overall scores and across all seven thematic dimensions. These results affirm the value of regionally adapted, culturally sensitive health education programs and contribute to the growing body of research supporting context-specific curriculum design in health education. The marked improvement in the experimental groups relative to the control groups suggests that localized content, which incorporates regional health risks (e.g., high-altitude conditions), cultural practices (e.g., traditional beliefs in Tibetan and Hui communities), and place-based pedagogy, has greater resonance with students and promotes more effective engagement and learning outcomes. A particularly noteworthy finding is the differential impact observed across health literacy domains. While gains were evident in all areas, the largest improvements occurred in knowledge- and skill-based domains, such as basic health understanding, disease prevention, and nutrition. By contrast, dimensions related to behavioral change, psychosocial health, and moral development showed more modest increases. This pattern may reflect the structural challenges of influencing deeply rooted beliefs and behaviors within a relatively short intervention period. As previous studies have indicated, behavioral and attitudinal change often requires sustained exposure, experiential learning, and reinforcement through environmental and social support mechanisms. The results also highlight important implications for curriculum development in multi-ethnic and underdeveloped regions. First, localized curricula can serve as an effective vehicle for addressing health disparities by aligning educational content with students’ lived experiences. Second, incorporating indigenous knowledge systems and cultural perspectives into curriculum design may enhance trust, participation, and the perceived legitimacy of school-based health education. Third, teacher professional development is essential to ensuring that localized content is delivered with fidelity and cultural competence. Nevertheless, several limitations should be acknowledged. The quasi-experimental design, while rigorous, does not allow for full randomization, which may introduce selection bias. The study was also limited to a single semester and a specific region, restricting the generalizability of findings. Additionally, while improvements were measured through self-reported health literacy scores, future research should incorporate objective behavioral indicators and longitudinal tracking to assess sustained impact. In summary, the study provides strong empirical evidence that a localized, culturally responsive health education curriculum can significantly enhance adolescent health literacy in under-resourced and ethnically diverse regions. It underscores the necessity of shifting from standardized, one-size-fits-all curricula toward more adaptive models that reflect the sociocultural and environmental realities of students. Future studies should expand the geographic scope, integrate mixed-method evaluations, and explore the long-term behavioral effects of localized health education interventions. Declarations Acknowledgements This research was funded by A provincial philosophy and social sciences project of Qinghai Province: Research on the Current Situation and Improvement Paths of Health Literacy among Primary and Secondary School Students in Qinghai Province, grant number 23ZCY040. Funding This study was funded by a Qinghai Province Philosophy and Social Science Planning Project (Grant No. 23ZCY040). Competing interests The authors declare no competing interests. Author Contribution Conceptualization, L.C. and B.S.; methodology, Y.Z.; validation, B.S.; data curation, L.C.; writing—original draft preparation, L.C.; writing—review and editing, Y.Z; supervision, B.S. All authors read and approved the final manuscript. Data Availability The datasets used and/or analysed during the current study are not publicly available due to the sensitive nature of the data involving adolescents and ethnic minority groups, but are available from the corresponding author on reasonable request and subject to appropriate ethical approval. References Dyment,Morse,Shaw,et al. Curriculum development in outdoor education: Tasmanian teachers’ perspectives on the new pre-tertiary Outdoor Leadership course[J].Journal of Adventure Education & Outdoor Learning, 2014,14(1).82–99. 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Robin Banerjee,Kathcrine Weare,William Fair.working with “Social and Emotional Aspects of Learning” associatis with school ethos,pupil social experiences,attendance,and attainment[J],British Educational Research Journal 2014,8:718–742. Hyunjoon Lee, Harold H Lee, Augustine Kang, Yoojin Cha, Don Operario.Psychological stress, smoking, and hazardous drinking behaviors in South Korea: findings from the Korea National Health and Nutrition Examination Survey[J]. Journal of Substance Use,2021,26(01).13–20. Kim Young Ju,Kim Jung Soon. Analysis of the contents related to health education of the 7th education course for elementary schools[J]. Journal of the Korean Society of School Health,2003,16(02).71–84. Dawn Penney. Health and Physical Education in Australia: A defining time?.2010,1(01):5–12. Louise McCuaig, Peter J. Hay. Principled pursuits of ‘the good citizen’ in health and physical education. 2013, 18(3):282–297. Susan L. Whatman, Parlo Singh. Constructing health and physical education curriculum for indigenous girls in a remote Australian community[J].Physical Education and Sport Pedagogy.2015,20(02):215–230. Cala, Verónica C.|Soriano-Ayala, Encarnación|González, Antonio J. Adolescents Perceptions of Health Education in Secondary Schools: The Need for a Dialectical, Practical and Transcultural Proposal.[J]. Practice & Theory in Systems of Education,2016,11(01):27–35. Abedian K, Shahhosseini Z. Barriers to health education in adolescents: health care providers' perspectives compared to high school adolescents[J]. Int J Adolesc Med Health, 2015, 27(04):433–436. Begoray Deborah L, Banister E. Using curriculum design principles to improve health education for adolescent girls[J]. Health Care for Women International, 2005, 26(04):295–307. Additional Declarations No competing interests reported. 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Also discoverable on Platform About Our Team In Review Editorial Policies Advisory Board Help Center Resources Author Services Accessibility API Access RSS feed Manage Cookie Preferences © Research Square 2026 | ISSN 2693-5015 (online) Privacy Policy Terms of Service Do Not Sell My Personal Information {"props":{"pageProps":{"initialData":{"identity":"rs-7039741","acceptedTermsAndConditions":true,"allowDirectSubmit":true,"archivedVersions":[],"articleType":"Article","associatedPublications":[],"authors":[{"id":506546761,"identity":"3b9b1570-f4d4-461a-89e1-f0beda8105c5","order_by":0,"name":"Leyi Cao","email":"","orcid":"","institution":"Qinghai Normal University","correspondingAuthor":false,"prefix":"","firstName":"Leyi","middleName":"","lastName":"Cao","suffix":""},{"id":506546763,"identity":"0f8f6b0a-0ef5-49c1-aa59-14bfdb6f3a3b","order_by":1,"name":"Yueting Zhang","email":"data:image/png;base64,iVBORw0KGgoAAAANSUhEUgAAAZAAAAAyAQMAAABI0h/eAAAABlBMVEX///8AAABVwtN+AAAACXBIWXMAAA7EAAAOxAGVKw4bAAAA50lEQVRIie3QsWoCQRCA4TkW1mbg2hHxHRYWNilEX2WXgGkktVVcCGin7Qk+xD3CyII2F2yvFAJWKQzpk3iQKoQ906XYvxzmg2EAUql/WC4Es/ug2ep7kPk20l3MHZ/lbbb21xJVVXpbyGlW8rUEaqsCIgl9eN69IAz6JYvTMSaywtqARNLUD/caYaxLljcqRgRZDqgITY2mhxBcySgpRiQ5H9AS6VXVkM92ghhgWzApBZOGcDuhzhz4zZOlemK6G3Wn10GaKBmF/P3s/KPNL4fR63TYX+6fTlHyo+ZV4g/7qVQqlfq9LxoAR94aLx/nAAAAAElFTkSuQmCC","orcid":"","institution":"Shannxi Normal University","correspondingAuthor":true,"prefix":"","firstName":"Yueting","middleName":"","lastName":"Zhang","suffix":""},{"id":506546764,"identity":"39615ece-7351-465f-af6c-dc229054cf31","order_by":2,"name":"Bing Shi","email":"","orcid":"","institution":"Shannxi Normal University","correspondingAuthor":false,"prefix":"","firstName":"Bing","middleName":"","lastName":"Shi","suffix":""}],"badges":[],"createdAt":"2025-07-03 15:38:05","currentVersionCode":1,"declarations":"","doi":"10.21203/rs.3.rs-7039741/v1","doiUrl":"https://doi.org/10.21203/rs.3.rs-7039741/v1","draftVersion":[],"editorialEvents":[],"editorialNote":"","failedWorkflow":false,"files":[{"id":106278220,"identity":"2c4b4e88-047a-4e50-8404-cd286740c609","added_by":"auto","created_at":"2026-04-07 04:56:03","extension":"pdf","order_by":0,"title":"","display":"","copyAsset":false,"role":"manuscript-pdf","size":1276856,"visible":true,"origin":"","legend":"","description":"","filename":"manuscript.pdf","url":"https://assets-eu.researchsquare.com/files/rs-7039741/v1/7b5dfb1a-49d6-4f52-aa94-1e7031d241a1.pdf"}],"financialInterests":"No competing interests reported.","formattedTitle":"Developing and Evaluating a Localized Health Education Curriculum in Qinghai, China: An Experimental Study in High Schools","fulltext":[{"header":"1.Introduction","content":"\u003cp\u003eHealth literacy has emerged as a crucial determinant of public health and individual well-being, particularly among adolescents who are in a formative stage of developing lifelong health behaviors and attitudes. The World Health Organization (WHO) emphasizes the role of school-based health education in promoting equitable access to health information and competencies, especially in regions facing socioeconomic and cultural disparities. Numerous international frameworks advocate for context-sensitive and culturally relevant health education as a means of reducing health inequalities and improving population health outcomes.\u003c/p\u003e\u003cp\u003eIn China, recent policy reforms have sought to integrate health education more effectively into the national school curriculum. The Physical Education and Health Curriculum Standards for General High Schools (2017 Edition) identify health literacy as a core component of student development. However, the implementation of health education remains uneven across regions, particularly in less developed western provinces such as Qinghai. Qinghai is characterized by a unique blend of high-altitude environments, multi-ethnic populations (including Tibetan, Hui, and Mongolian communities), and distinctive health risks such as endemic infectious diseases and lifestyle-related conditions. These factors render national-level curricula insufficiently responsive to local needs.\u003c/p\u003e\u003cp\u003eIn the field of health education and curriculum development, countries such as the United States, Japan, South Korea, and the United Kingdom have produced a substantial body of research and practical experience. These international examples have offered valuable insights for the theoretical and practical advancement of health education in China, across Asia, and globally.\u003c/p\u003e\u003cp\u003eIn the current U.S. primary and secondary school curriculum, Physical Education and Health are central components of the health education framework. As part of the core curriculum, Physical Education and Health aim to cultivate students' interest in physical activity, develop their knowledge and skills related to sports and exercise, and foster social competencies through participation in sports\u003ca class=\"FNLink\" href=\"#Fn1\" id=\"#FNLinkFn1\"\u003e\u003c/a\u003e. In addition, the curriculum emphasizes health principles and practices relevant to daily life, with the broader goal of promoting healthy and active lifestyles. These curricular goals bear notable similarity to the objectives of China\u0026rsquo;s \u0026ldquo;Physical and Health\u0026rdquo; curriculum.\u003c/p\u003e\u003cp\u003eMoreover, the U.S. curriculum includes Social Studies, which also serves as a platform for health education by addressing topics such as social adaptation, mental health, and moral development\u0026mdash;key components of holistic health literacy. In the United States, substantial variation exists in the structure and implementation of health education programs across states and school districts\u003ca class=\"FNLink\" href=\"#Fn2\" id=\"#FNLinkFn2\"\u003e\u003c/a\u003e. While the federal government provides overarching curriculum standards and policy guidelines, the authority for curriculum development, implementation, and evaluation is decentralized, residing primarily with state and local education authorities, districts, and individual schools\u003ca class=\"FNLink\" href=\"#Fn3\" id=\"#FNLinkFn3\"\u003e\u003c/a\u003e.\u003c/p\u003e\u003cp\u003eThe development of localized health education curricula refers to the process of selecting, transmitting, and adapting a region\u0026rsquo;s specific health culture within the context of education. This approach aims to make health education more relevant to students\u0026rsquo; lived experiences and learning environments, thereby enhancing its local applicability and contextual responsiveness, and ultimately achieving the goal of health promotion.\u003c/p\u003e\u003cp\u003eIn the United States, the development of localized curricula is characterized by a high degree of pluralism. A wide range of stakeholders\u0026mdash;including teachers, students, administrators, curriculum committees at various levels of educational governance, government officials, federal and state legislators, educational equipment and material providers, publishers, examination agencies, teacher organizations, foundations, parents, and curriculum experts\u0026mdash;are actively involved in the design, implementation, and evaluation of local curricula\u003ca class=\"FNLink\" href=\"#Fn4\" id=\"#FNLinkFn4\"\u003e\u003c/a\u003e. This pluralistic structure ensures the richness and effectiveness of curriculum development at the local level, and offers valuable insights for other nations pursuing similar goals.\u003c/p\u003e\u003cp\u003eIn Japan, school-based health education follows a \u0026ldquo;Health and Physical Education Model,\u0026rdquo; which integrates health instruction into the broader framework of physical education. This approach emphasizes the combination of physical activity with health-related knowledge, supported by dedicated textbooks for the health component\u003ca class=\"FNLink\" href=\"#Fn5\" id=\"#FNLinkFn5\"\u003e\u003c/a\u003e. Since 1953, Japan officially renamed its \u0026ldquo;Physical Education\u0026rdquo; class as \u0026ldquo;Health and Physical Education,\u0026rdquo; a single subject composed of two relatively independent parts: health and physical education. Health instruction primarily focuses on knowledge and skills, and is delivered by school nurses or dedicated health educators, while physical training is conducted by teachers specialized in health and physical education. Although the curriculum structure closely resembles China\u0026rsquo;s \u0026ldquo;Physical and Health\u0026rdquo; course, Japan adopts a more refined and specialized approach to teacher assignment.\u003c/p\u003e\u003cp\u003eJapan\u0026rsquo;s curriculum system is managed under a centralized model. National curriculum standards and the \u0026ldquo;Courses of Study\u0026rdquo; for primary and secondary schools are uniformly established and periodically revised to ensure relevance and instructional quality. However, centralization in Japan is not absolute; there is still room for locally developed curricula, particularly at the school and community levels.\u003c/p\u003e\u003cp\u003eThe United Kingdom introduced health education in schools as early as 1907. Over the decades, the UK has developed and refined a distinctive national framework for school-based health education, most notably through the introduction of the Personal, Social, and Health Education (PSHE) curriculum\u003ca class=\"FNLink\" href=\"#Fn6\" id=\"#FNLinkFn6\"\u003e\u003c/a\u003e. This curriculum reflects the UK's holistic educational philosophy, emphasizing the integrated development of students\u0026rsquo; spiritual, moral, social, and cultural dimensions\u003ca class=\"FNLink\" href=\"#Fn7\" id=\"#FNLinkFn7\"\u003e\u003c/a\u003e. In practice, the PSHE framework has led to the creation of a uniquely British model of school health education characterized by a strong emphasis on whole-child development and well-being.\u003c/p\u003e\u003cp\u003eTo address the challenges of the knowledge economy in the 21st century, the UK has undertaken multiple education reforms, including the enactment of legislative acts, the establishment of national curriculum standards, and the restructuring of curriculum frameworks and assessment systems. These reforms aim to further improve the quality of education and ensure its responsiveness to contemporary societal needs.\u003c/p\u003e\u003cp\u003ePublic primary and secondary schools in the United Kingdom follow a nationally standardized curriculum and framework, which reflects a centralized approach to curriculum governance. Within this overarching structure, several specialized programs have been developed to enhance students\u0026rsquo; emotional regulation and social adaptability, including Social and Emotional Aspects of Learning (SEAL), Curriculum for Excellence (CfE)\u0026mdash;primarily implemented in Scotland\u0026mdash;and Personal, Social, and Health Education (PSHE). Although these curricula are guided by national standards, they are adapted to meet regional needs and are implemented flexibly at the local level\u003ca class=\"FNLink\" href=\"#Fn8\" id=\"#FNLinkFn8\"\u003e\u003c/a\u003e. This dynamic balance between centralized policy and localized practice illustrates the UK\u0026rsquo;s commitment to educational equity, while ensuring that school-based health education remains contextually relevant and responsive to students\u0026rsquo; diverse social and emotional needs.\u003c/p\u003e\u003cp\u003eUnlike some countries that offer dedicated health education courses, South Korea does not implement a standalone health education curriculum in its national education system. Instead, a combined curriculum of Physical Education and Health Education is offered at the elementary level. This integrated approach is conceptually similar to China\u0026rsquo;s \"Physical and Health\" curriculum, encompassing two interrelated components: physical education and basic health or hygiene education.\u003c/p\u003e\u003cp\u003eUnder South Korea\u0026rsquo;s national education framework, only a limited set of core content is designated as compulsory by the central government. The remaining components are elective and may be flexibly selected based on local conditions, school contexts, and the specific needs and characteristics of students and teachers\u003ca class=\"FNLink\" href=\"#Fn9\" id=\"#FNLinkFn9\"\u003e\u003c/a\u003e. This design strongly reflects the principles of localized curriculum development, allowing regions and schools to adapt instruction to their unique sociocultural and environmental contexts.\u003c/p\u003e\u003cp\u003eIn Grades 1 and 2 of elementary school, health-related content is primarily embedded within other subjects such as science, social studies, and moral education\u003ca class=\"FNLink\" href=\"#Fn10\" id=\"#FNLinkFn10\"\u003e\u003c/a\u003e. Starting from Grade 3, health education concepts are more explicitly integrated into the physical education curriculum. The primary objective of health education at the elementary level in South Korea is to equip students with the knowledge and skills necessary to protect and promote physical and mental well-being, while also cultivating proper attitudes and lifestyle habits conducive to long-term health.\u003c/p\u003e\u003cp\u003eThis threefold focus\u0026mdash;health knowledge, health attitudes, and health behaviors\u0026mdash;closely parallels the health education goals established in China. Both systems emphasize the development of students' competencies in managing personal health, making informed decisions, and practicing health-enhancing behaviors within and beyond the school environment.\u003c/p\u003e\u003cp\u003eAustralia adopts a three-tiered curriculum governance model encompassing the federal, state, and school levels. The implementation of health education falls under the Health and Physical Education (HPE) curriculum, which leverages the curricular strengths and contextual expertise of different states and territories\u003ca class=\"FNLink\" href=\"#Fn11\" id=\"#FNLinkFn11\"\u003e\u003c/a\u003e. Historically, the authority over curriculum management in Australia has been concentrated at the state level, as the federal government holds no constitutional mandate over education. Similar to the United States, Australia\u0026rsquo;s federal government is responsible for formulating national curriculum frameworks and setting overarching policy principles and standards, but does not impose detailed curriculum content requirements\u003ca class=\"FNLink\" href=\"#Fn12\" id=\"#FNLinkFn12\"\u003e\u003c/a\u003e. In practice, state and territorial governments play a pivotal intermediary role. They are not only the principal executors of federal education policies but also provide direct oversight, guidance, and support to schools in curriculum development and implementation. This decentralized structure allows for a flexible and context-sensitive approach to curriculum planning, while maintaining consistency with national policy objectives. In her research, Susan L. emphasized\u003ca class=\"FNLink\" href=\"#Fn13\" id=\"#FNLinkFn13\"\u003e\u003c/a\u003e the importance of designing health and physical education programs tailored to the needs of Indigenous girls in remote communities, arguing that curriculum development must be responsive to both regional socio-cultural contexts and public health challenges. Her study highlights the significant contributions that Indigenous communities and local educators can make in shaping HPE curricula for Aboriginal students. Such efforts represent a compelling example of localized curriculum development within Australia\u0026rsquo;s broader national framework.\u003c/p\u003e\u003cp\u003eAlthough many countries have developed relatively mature health education curricula, school-based health education remains an area of ambiguity and contention in certain national contexts. In Spain, for example, health education is still regarded as a controversial and inconsistently implemented discipline. The legal and curricular status of school health education remains vague, leading to fragmented policies and uneven delivery across schools and regions. Empirical studies have shown that students in Spain often do not perceive schools as primary sites for health learning. Instead, they consider family, peers, and digital technologies to be more influential sources of health-related knowledge and behavior. This perception tends to undermine the potential positive impact of school health education on the well-being of children and adolescents\u003ca class=\"FNLink\" href=\"#Fn14\" id=\"#FNLinkFn14\"\u003e\u003c/a\u003e. A study by Abedian K. revealed\u003ca class=\"FNLink\" href=\"#Fn15\" id=\"#FNLinkFn15\"\u003e\u003c/a\u003e that despite adolescents being an energetic and distinctive group, their health education needs are frequently overlooked by healthcare providers, educators, families, and public health professionals. The research identified a lack of interest among adolescents in existing health education programs as a major barrier to effectiveness. As a result, it was recommended that youth-specific strategies be integrated into broader adolescent health promotion programs to enhance engagement and relevance.\u003c/p\u003e\u003cp\u003eFurthermore, a growing body of research on localized health education curriculum development has revealed important structural limitations. For instance, Begoray D. L. argued\u003ca class=\"FNLink\" href=\"#Fn16\" id=\"#FNLinkFn16\"\u003e\u003c/a\u003e that many health education programs lack a clear theoretical foundation, particularly in relation to curriculum design principles. The absence of strong theoretical underpinnings can result in fragmented, inconsistent, or overly pragmatic curricular interventions that fail to align with broader educational goals or developmental needs.\u003c/p\u003e\u003cp\u003eMany countries around the world are actively advancing health (or hygiene) education, either through standalone health education courses or by embedding health content within integrated curricular structures. In numerous national contexts, health education is delivered primarily through Health and Physical Education (HPE) courses or similar formats, which often serve as the main institutional carriers of health-related instruction. In addition, a substantial portion of health education content is incorporated into other subjects\u0026mdash;such as science, social studies, or moral education\u0026mdash;mirroring the multidisciplinary approach observed in China\u0026rsquo;s health education system. Despite this structural similarity, significant differences remain in the degree of curricular emphasis placed on health education, the availability of trained health education professionals, and the thematic priorities emphasized in curriculum content. The experiences of countries that have made substantial progress in this field offer valuable insights for China, other Asian nations, and the global community. Key lessons include the diversification of health education content, the development of specialized teacher training programs, and the integration of health education into national curriculum policy. Currently, in many countries, the governance of health education curricula has been elevated to the national policy level. However, the implementation strategies and development of localized health education curricula vary considerably based on national and regional contexts. While a growing number of countries have recognized the need to address regional diversity and contextual specificity in curriculum development\u0026mdash;particularly in relation to geography, culture, and public health needs\u0026mdash;there remains a lack of comprehensive theoretical frameworks guiding the localized development of health education curricula under the influence of natural environmental conditions.。\u003c/p\u003e\u003cp\u003eIn summary, many countries have attached increasing importance to school-based health education, paying attention not only to top-level curriculum design, but also to content development, implementation mechanisms, management systems, and support services. Differences in curriculum richness and local curriculum development capacity are often shaped by the broader educational governance models and curriculum management systems of individual countries. In light of the absence of a mature theoretical model for localized health education curriculum development, it is both necessary and timely to incorporate environmental considerations and prioritize region-specific health concerns. Doing so can enhance the relevance, effectiveness, and theoretical advancement of health education at both the national and local levels.\u003c/p\u003e\u003cp\u003eAt its core, the issue of health education extends beyond the responsibilities of schools alone; it is a shared social responsibility that must be jointly undertaken by families, communities, and broader society. The curriculum itself is inherently dynamic and evolving, with its underlying theories continuously enriched and redefined in response to social transformation, technological advancement, and shifts in public health priorities. As societies experience rapid changes in lifestyle, values, and information ecosystems, the distribution of responsibilities in health education\u0026mdash;between schools, families, and social institutions\u0026mdash;may shift accordingly. What is considered the primary locus of health learning today may become secondary tomorrow, depending on changes in policy, media environments, or family structures. However, unlike these fluid and mutable social variables, the natural environment remains relatively constant over time, exerting a persistent and stable influence on human health and well-being. For this reason, the development of localized health education curricula must give due consideration to the natural environment\u0026mdash;not only as a physical backdrop, but as a foundational and enduring dimension shaping human interaction, lifestyle risks, and ecological health literacy. In this context, the natural environment can serve as a relatively permanent and universal entry point for localized curriculum development.\u003c/p\u003e\u003cp\u003eCurrent research on health education in China remains predominantly concentrated in urban areas and the more economically developed eastern regions, while comparatively less attention has been paid to rural settings and ethnic minority communities. This uneven research focus has led to a limited understanding of the specific health education needs, challenges, and contextual dynamics present in underrepresented regions. Moreover, there is a noticeable scarcity of studies that employ rigorous experimental or quasi-experimental designs to empirically evaluate the effectiveness of localized health education interventions. The lack of such evidence-based research hinders the ability to generalize findings, assess policy impact, or develop scalable health education models tailored to diverse regional contexts. This research gap presents not only a challenge for the field of health education in China but also a valuable opportunity for educational innovation, localized curriculum development, and evidence-informed policymaking. By addressing this underexplored area, future research can contribute to more equitable, culturally responsive, and contextually appropriate health education practices across China's diverse regions.。\u003c/p\u003e\u003cp\u003eTo address this issue, the present study designed and tested a localized high school health education curriculum tailored to the ecological, cultural, and epidemiological features of Qinghai Province. The curriculum was grounded in national guidelines but extended to incorporate region-specific health concerns and culturally relevant pedagogies. A quasi-experimental study was conducted to examine whether this localized approach could significantly enhance students\u0026rsquo; health literacy across multiple dimensions, including knowledge acquisition, behavioral skills, and psychosocial adaptation.\u003c/p\u003e\u003cp\u003eThis paper aims to contribute to the growing body of literature on regional curriculum development by offering empirical evidence of the effectiveness of a localized health education program in a multi-ethnic, underdeveloped region of China. The findings are expected to inform future policy efforts in education and public health, particularly in the development of adaptive curricula for diverse and underserved populations.\u003c/p\u003e"},{"header":"2. Methods","content":"\u003cdiv id=\"Sec3\" class=\"Section2\"\u003e\u003ch2\u003e2.1 Research Design\u003c/h2\u003e\u003cp\u003eThis study employed a quasi-experimental research design utilizing a pre-test/post-test control group structure to examine the effects of a localized health education curriculum intervention. The teaching experiment was implemented over the course of one academic semester (approximately 3.5 months) in a public high school located in Haibei Prefecture, Qinghai Province, China. This region was selected due to its unique geographic, cultural, and health-related characteristics, which made it an appropriate setting for testing the adaptability and relevance of a regionally tailored curriculum.\u003c/p\u003e\u003cp\u003eThe primary objective of the research was to evaluate the effectiveness of the newly developed localized health education curriculum in comparison to the existing national standard curriculum currently implemented in the region. By incorporating both a temporal (pre- and post-test) and group-based (experimental and control) structure, the design allowed for controlled comparison and causal inference regarding the impact of the intervention on students\u0026rsquo; health literacy outcomes.\u003c/p\u003e\u003cp\u003e All procedures were conducted in accordance with relevant institutional and national ethical guidelines. Ethical approval was obtained from the Ethics Committee of Qinghai Normal University, and written informed consent was secured from all participants and/or their legal guardians prior to data collection.\u003c/p\u003e\u003c/div\u003e\u003cdiv id=\"Sec4\" class=\"Section2\"\u003e\u003ch2\u003e2.2 Participants\u003c/h2\u003e\u003cp\u003eA total of 180 Grade 11 students from four intact classes were recruited to participate in the study. The sample included students from two general education classes and two ethnic minority classes, the latter comprising individuals of Tibetan, Hui, Mongolian, and Han ethnic backgrounds. Within each educational category, one class was randomly assigned to the experimental group, which received the localized health education curriculum, and the other to the control group, which continued with the standard curriculum.\u003c/p\u003e\u003cp\u003eThe gender distribution of the sample included 66 male students (36.7%) and 114 female students (63.3%). To ensure consistency in instructional quality and to minimize teacher-related variability, the same health education teacher was assigned to both the experimental and control classes within each category. This design consideration helped control for extraneous variables that could potentially influence the outcomes of the intervention..\u003c/p\u003e\u003c/div\u003e\u003cdiv id=\"Sec5\" class=\"Section2\"\u003e\u003ch2\u003e2.3 Instrumentation\u003c/h2\u003e\u003cp\u003eTo assess students\u0026rsquo; health literacy levels, a customized self-assessment questionnaire was developed, drawing on three key sources: (1) the General High School Physical Education and Health Curriculum Standards (2017 Edition) issued by the Chinese Ministry of Education, (2) region-specific public health challenges and priorities identified in Qinghai Province, and (3) findings from semi-structured expert interviews with professionals in health education and public health. The final version of the instrument consisted of 42 items, grouped into the following seven thematic domains:(1)Basic Health Knowledge and Skills;༈2༉Nutrition and Food Safety༛༈3༉Hygiene and Disease Prevention༛༈4༉Environment, Health, and Physical Activity༛༈5༉Safe Exercise and Injury Management༛༈6༉Emergency Response and Safety Awareness༛༈7༉Mental, Moral, and Social Adaptation。Each item was measured on a 5-point Likert scale. The questionnaire underwent two rounds of expert review using the Delphi method with seven experts in health education and public health. Content validity was ensured through item revision, and reliability was tested via a pilot study. All seven domains demonstrated acceptable internal consistency (Cronbach's α ranging from 0.719 to 0.801), indicating good reliability.\u003c/p\u003e\u003c/div\u003e\u003cdiv id=\"Sec6\" class=\"Section2\"\u003e\u003ch2\u003e2.4 Curriculum Intervention\u003c/h2\u003e\u003cp\u003eThe experimental curriculum was developed in accordance with the national health education standards for high schools, but was systematically adapted to incorporate regionally specific and culturally relevant content. These localized modifications addressed key public health concerns in Qinghai Province, including the prevention of endemic diseases, health risks associated with high-altitude environments, and traditional health beliefs and practices among ethnic minority populations.\u003c/p\u003e\u003cp\u003eTo ensure the fidelity and standardization of the intervention, two instructors\u0026mdash;one assigned to general education classes and the other to ethnic minority classes\u0026mdash;underwent targeted professional development and training sessions prior to implementation. These sessions focused on instructional strategies, cultural sensitivity, and the pedagogical integration of localized content into existing health education frameworks.\u003c/p\u003e\u003cp\u003eDuring the intervention period, teachers in the experimental groups were instructed to select and implement 3 to 5 thematic units from the localized curriculum, delivered during their regularly scheduled health education periods. In contrast, the control groups continued with the standard health education curriculum mandated by national guidelines and were not exposed to any localized content or materials developed for this study.\u003c/p\u003e\u003cp\u003eTo maintain procedural consistency and minimize confounding variables, both experimental and control groups followed the same weekly schedule, class duration, and assessment protocols throughout the intervention period. This design ensured that observed differences in outcomes could be more confidently attributed to the content of the curriculum rather than to instructional time or delivery conditions.\u003c/p\u003e\u003c/div\u003e\u003cdiv id=\"Sec7\" class=\"Section2\"\u003e\u003ch2\u003e2.5 Data Collection and Analysis\u003c/h2\u003e\u003cp\u003ePre- and post-intervention data were collected using the validated health literacy questionnaire described in Section \u003cspan refid=\"Sec5\" class=\"InternalRef\"\u003e2.3\u003c/span\u003e. The questionnaires were administered in person in classroom settings, under the supervision of homeroom teachers and physical education instructors, to ensure proper guidance and standardization in the administration process. To maintain participant anonymity and reduce the risk of social desirability bias, students were clearly informed that their responses would be used exclusively for research purposes and would have no bearing on their academic grades or evaluations. Participation was voluntary, and students were encouraged to answer honestly and independently.\u003c/p\u003e\u003cp\u003eAll data were analyzed using SPSS 20.0 statistical software. Descriptive statistics (means, standard deviations, and frequencies) were computed to examine the overall distribution and trends of health literacy scores. To assess between-group differences, independent samples t-tests were conducted comparing experimental and control group means for both pre- and post-test scores. Additionally, paired samples t-tests were used to examine within-group differences by comparing students\u0026rsquo; pre-test and post-test scores individually. A significance threshold of p\u0026thinsp;\u0026lt;\u0026thinsp;0.05 was adopted for all statistical analyses to determine the presence of statistically meaningful differences. This analytic approach enabled the researchers to evaluate both the effectiveness of the intervention and the direction and magnitude of change over time.\u003c/p\u003e\u003c/div\u003e"},{"header":"3. Results","content":"\u003cdiv id=\"Sec9\" class=\"Section2\"\u003e\u003ch2\u003e3.1 Statistical Analysis of Response Reliability Across Health Education Thematic Domains\u003c/h2\u003e\u003cp\u003eTo evaluate the reliability of the self-assessment questionnaire developed for this study, a pilot test was conducted with a sample of Grade 11 students from one class. The internal consistency of the instrument was assessed using Cronbach\u0026rsquo;s alpha coefficients, calculated through SPSS statistical software for each of the seven thematic domains. The results demonstrated that all seven domains\u0026mdash;namely: (1) Basic Health Knowledge and Skills, (2) Nutrition and Food Safety, (3) Hygiene and Disease Prevention, (4) Environmental Health and Physical Activity, (5) Safe Exercise and Injury Management, (6) Emergency Response and Safety Awareness, and (7) Psychosocial Health and Social Adaptation\u0026mdash;achieved alpha values exceeding 0.70, which is generally considered the acceptable threshold for internal reliability in educational and psychological measurement. These findings suggest that the items within each domain exhibit strong internal consistency and can be considered statistically reliable for assessing the respective dimensions of adolescent health literacy. The instrument, therefore, provides a robust foundation for subsequent empirical data collection and analysis, supporting the validity of the study\u0026rsquo;s overall measurement framework.\u003c/p\u003e\u003cp\u003e\u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab1\" border=\"1\"\u003e\u003ccaption language=\"En\"\u003e\u003cdiv class=\"CaptionNumber\"\u003eTable 1\u003c/div\u003e\u003cdiv class=\"CaptionContent\"\u003e\u003cp\u003eReliability Analysis of Responses Across Health Education Themes\u003c/p\u003e\u003c/div\u003e\u003c/caption\u003e\u003ccolgroup cols=\"2\"\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e\u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e\u003cthead\u003e\u003ctr\u003e\u003cth align=\"left\" colname=\"c1\"\u003e\u003cp\u003eHealth Education Themes\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c2\"\u003e\u003cp\u003eCronbach's Alpha\u003c/p\u003e\u003c/th\u003e\u003c/tr\u003e\u003c/thead\u003e\u003ctbody\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eBasic health knowledge and skills\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e0.745\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eNutrition and food safety\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e0.719\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eHygiene and disease prevention\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e0.755\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eEnvironmental health and physical activity\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e0.774\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eSafe Exercise and the Prevention and Management of Common Sports Injuries\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e0.801\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eEmergency Response, Safety Awareness, and Risk Prevention Competency\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e0.726\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eMental Health and Social Adaptation Ability\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e0.732\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003c/tbody\u003e\u003c/colgroup\u003e\u003c/table\u003e\u003c/div\u003e\u003c/p\u003e\u003c/div\u003e\u003cdiv id=\"Sec10\" class=\"Section2\"\u003e\u003ch2\u003e3.2 Baseline Health Literacy Comparison Between Experimental and Control Groups\u003c/h2\u003e\u003cp\u003eAn initial comparison of baseline overall health literacy scores was conducted between the experimental and control groups within the ethnic minority cohort. The results of the statistical analysis indicated that the two groups exhibited highly comparable mean scores, with no statistically significant difference detected between them (p\u0026thinsp;\u0026gt;\u0026thinsp;0.05). This suggests that prior to the intervention, the experimental and control groups were equivalent in terms of their overall health literacy levels, thereby providing a solid foundation for assessing the subsequent effects of the localized curriculum intervention. Detailed results are presented in Table\u0026nbsp;\u003cspan refid=\"Tab2\" class=\"InternalRef\"\u003e2\u003c/span\u003e.\u003c/p\u003e\u003cp\u003e\u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab2\" border=\"1\"\u003e\u003ccaption language=\"En\"\u003e\u003cdiv class=\"CaptionNumber\"\u003eTable 2\u003c/div\u003e\u003cdiv class=\"CaptionContent\"\u003e\u003cp\u003eAnalysis of Differences in Overall Health Literacy Between Experimental and Control Groups in the Ethnic Minority Class\u003c/p\u003e\u003c/div\u003e\u003c/caption\u003e\u003ccolgroup cols=\"5\"\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c5\" colnum=\"5\"\u003e\u003c/div\u003e\u003cthead\u003e\u003ctr\u003e\u003cth align=\"left\" colname=\"c1\"\u003e\u003cp\u003eThemes\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c2\"\u003e\u003cp\u003eExperimental classes\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c3\"\u003e\u003cp\u003eControl classes\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c4\"\u003e\u003cp\u003eT\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c5\"\u003e\u003cp\u003eP\u003c/p\u003e\u003c/th\u003e\u003c/tr\u003e\u003c/thead\u003e\u003ctbody\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eOverall Mean Score of Health Literacy\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e3.548\u0026thinsp;\u0026plusmn;\u0026thinsp;0.433\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e3.542\u0026thinsp;\u0026plusmn;\u0026thinsp;0.457\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e0.065\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e0.948\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003c/tbody\u003e\u003c/colgroup\u003e\u003c/table\u003e\u003c/div\u003e\u003c/p\u003e\u003cp\u003eAs shown in Table\u0026nbsp;\u003cspan refid=\"Tab2\" class=\"InternalRef\"\u003e2\u003c/span\u003e, there was no statistically significant difference in the overall mean health literacy scores between the experimental and control groups in the ethnic minority cohort. However, it is important to note that consistency in overall averages does not necessarily imply uniformity across all dimensions of health literacy, as variation may exist within specific thematic components. To obtain a more nuanced understanding of the comparability between the two groups, a further analysis was conducted by calculating the average scores for each individual across the seven thematic dimensions of health literacy. This domain-level comparison was intended to determine whether the two groups were equivalent not only in their overall scores but also in the structure and distribution of their health literacy competencies. The results indicated that there were no significant differences between the experimental and control groups across all seven domains of health literacy. These findings are presented in detail in Table\u0026nbsp;\u003cspan refid=\"Tab3\" class=\"InternalRef\"\u003e3\u003c/span\u003e, and they confirm that the two groups were well matched at baseline, both in terms of overall level and across specific content areas. This strengthens the internal validity of the study and supports the reliability of subsequent comparisons following the intervention.\u003c/p\u003e\u003cp\u003e\u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab3\" border=\"1\"\u003e\u003ccaption language=\"En\"\u003e\u003cdiv class=\"CaptionNumber\"\u003eTable 3\u003c/div\u003e\u003cdiv class=\"CaptionContent\"\u003e\u003cp\u003eComparative Analysis of Average Scores Across Health Literacy Domains Between the Experimental and Control Groups in the Ethnic Minority Cohort\u003c/p\u003e\u003c/div\u003e\u003c/caption\u003e\u003ccolgroup cols=\"5\"\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e\u003cdiv align=\"char\" char=\"\u0026plusmn;\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e\u003cdiv align=\"char\" char=\"\u0026plusmn;\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e\u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e\u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c5\" colnum=\"5\"\u003e\u003c/div\u003e\u003cthead\u003e\u003ctr\u003e\u003cth align=\"left\" colname=\"c1\"\u003e\u003cp\u003eHealth Education Themes\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c2\"\u003e\u003cp\u003eExperimental classes\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c3\"\u003e\u003cp\u003eControl classes\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c4\"\u003e\u003cp\u003eT\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c5\"\u003e\u003cp\u003eP\u003c/p\u003e\u003c/th\u003e\u003c/tr\u003e\u003c/thead\u003e\u003ctbody\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eBasic health knowledge and skills\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c2\"\u003e\u003cp\u003e3.258\u0026thinsp;\u0026plusmn;\u0026thinsp;0.588\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c3\"\u003e\u003cp\u003e3.241\u0026thinsp;\u0026plusmn;\u0026thinsp;0.541\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\u003cp\u003e0.150\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e\u003cp\u003e0.881\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eNutrition and food safety\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c2\"\u003e\u003cp\u003e3.251\u0026thinsp;\u0026plusmn;\u0026thinsp;0.533\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c3\"\u003e\u003cp\u003e3.148\u0026thinsp;\u0026plusmn;\u0026thinsp;0.493\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\u003cp\u003e0.995\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e\u003cp\u003e0.332\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eHygiene and disease prevention\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c2\"\u003e\u003cp\u003e3.103\u0026thinsp;\u0026plusmn;\u0026thinsp;0.511\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c3\"\u003e\u003cp\u003e3.027\u0026thinsp;\u0026plusmn;\u0026thinsp;0.511\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\u003cp\u003e0.741\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e\u003cp\u003e0.461\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eEnvironmental health and physical activity\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c2\"\u003e\u003cp\u003e3.279\u0026thinsp;\u0026plusmn;\u0026thinsp;0.601\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c3\"\u003e\u003cp\u003e3.235\u0026thinsp;\u0026plusmn;\u0026thinsp;0.574\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\u003cp\u003e0.369\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e\u003cp\u003e0.713\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eSafe Exercise and the Prevention and Management of Common Sports Injuries\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c2\"\u003e\u003cp\u003e3.000\u0026thinsp;\u0026plusmn;\u0026thinsp;0.568\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c3\"\u003e\u003cp\u003e2.981\u0026thinsp;\u0026plusmn;\u0026thinsp;0.561\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\u003cp\u003e0.166\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e\u003cp\u003e0.869\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eEmergency Response, Safety Awareness, and Risk Prevention Competency\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c2\"\u003e\u003cp\u003e3.361\u0026thinsp;\u0026plusmn;\u0026thinsp;0.505\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c3\"\u003e\u003cp\u003e3.364\u0026thinsp;\u0026plusmn;\u0026thinsp;0.489\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\u003cp\u003e-0.03\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e\u003cp\u003e0.976\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eMental Health and Social Adaptation Ability\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c2\"\u003e\u003cp\u003e3.548\u0026thinsp;\u0026plusmn;\u0026thinsp;0.433\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c3\"\u003e\u003cp\u003e3.542\u0026thinsp;\u0026plusmn;\u0026thinsp;0.457\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\u003cp\u003e0.065\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e\u003cp\u003e0.948\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003c/tbody\u003e\u003c/colgroup\u003e\u003c/table\u003e\u003c/div\u003e\u003c/p\u003e\u003cp\u003eAs illustrated in Table\u0026nbsp;\u003cspan refid=\"Tab3\" class=\"InternalRef\"\u003e3\u003c/span\u003e, the experimental and control groups within the ethnic minority cohort demonstrated a high degree of consistency not only in their overall health literacy scores, but also across all individual thematic dimensions. This indicates that both groups were at an equivalent baseline level prior to the intervention, with no statistically significant differences detected in any of the measured domains. Such equivalence provides a strong basis for the subsequent evaluation of the effectiveness of the localized health education curriculum, ensuring that observed post-intervention differences can be more confidently attributed to the intervention itself rather than to pre-existing disparities.\u003c/p\u003e\u003cp\u003eFollowing this analysis, a similar comparison was conducted between the experimental and control groups within the general education cohort. Statistical results revealed that the overall mean health literacy scores were also highly comparable, and no significant differences were observed (p\u0026thinsp;\u0026gt;\u0026thinsp;0.05), as presented in Table\u0026nbsp;\u003cspan refid=\"Tab4\" class=\"InternalRef\"\u003e4\u003c/span\u003e. These findings further support the internal validity of the study by confirming that both cohorts\u0026mdash;ethnic minority and general education\u0026mdash;were well-matched at baseline across experimental conditions.\u003c/p\u003e\u003cp\u003e\u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab4\" border=\"1\"\u003e\u003ccaption language=\"En\"\u003e\u003cdiv class=\"CaptionNumber\"\u003eTable 4\u003c/div\u003e\u003cdiv class=\"CaptionContent\"\u003e\u003cp\u003eComparative Analysis of Overall Health Literacy Levels Between Experimental and Control Groups in the General Class\u003c/p\u003e\u003c/div\u003e\u003c/caption\u003e\u003ccolgroup cols=\"5\"\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c5\" colnum=\"5\"\u003e\u003c/div\u003e\u003cthead\u003e\u003ctr\u003e\u003cth align=\"left\" colname=\"c1\"\u003e\u003cp\u003eThemes\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c2\"\u003e\u003cp\u003eExperimental classes\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c3\"\u003e\u003cp\u003eControl classes\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c4\"\u003e\u003cp\u003eT\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c5\"\u003e\u003cp\u003eP\u003c/p\u003e\u003c/th\u003e\u003c/tr\u003e\u003c/thead\u003e\u003ctbody\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eOverall Mean Score of Health Literacy\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e3.753\u0026thinsp;\u0026plusmn;\u0026thinsp;0.313\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e3.813\u0026thinsp;\u0026plusmn;\u0026thinsp;0.265\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e-0.928\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e0.356\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003c/tbody\u003e\u003c/colgroup\u003e\u003c/table\u003e\u003c/div\u003e\u003c/p\u003e\u003cp\u003eAs presented in Table\u0026nbsp;\u003cspan refid=\"Tab4\" class=\"InternalRef\"\u003e4\u003c/span\u003e, there was no statistically significant difference in the overall mean health literacy scores between the experimental and control groups within the general education cohort. This finding suggests that both groups were comparable in terms of their overall health literacy levels prior to the intervention. To further assess the degree of equivalence between the two groups, an additional analysis was conducted comparing the average scores across the seven thematic dimensions of health literacy for each student. These dimensions included: basic health knowledge and skills, nutrition and food safety, hygiene and disease prevention, environmental health and physical activity, safe exercise and injury management, emergency response and safety awareness, and psychosocial health and social adaptation. The results of this domain-specific analysis indicated that there were no statistically significant differences between the experimental and control groups in any of the seven dimensions. This outcome confirms that the two groups were not only similar in overall health literacy, but also well matched across specific domains of health competence. Full details of the analysis are provided in Table\u0026nbsp;\u003cspan refid=\"Tab5\" class=\"InternalRef\"\u003e5\u003c/span\u003e.\u003c/p\u003e\u003cp\u003e\u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab5\" border=\"1\"\u003e\u003ccaption language=\"En\"\u003e\u003cdiv class=\"CaptionNumber\"\u003eTable 5\u003c/div\u003e\u003cdiv class=\"CaptionContent\"\u003e\u003cp\u003eComparative Analysis of Thematic Health Literacy Scores Between Experimental and Control Groups in the General Class\u003c/p\u003e\u003c/div\u003e\u003c/caption\u003e\u003ccolgroup cols=\"5\"\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e\u003cdiv align=\"char\" char=\"\u0026plusmn;\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e\u003cdiv align=\"char\" char=\"\u0026plusmn;\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e\u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e\u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c5\" colnum=\"5\"\u003e\u003c/div\u003e\u003cthead\u003e\u003ctr\u003e\u003cth align=\"left\" colname=\"c1\"\u003e\u003cp\u003eHealth Education Themes\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c2\"\u003e\u003cp\u003eExperimental classes\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c3\"\u003e\u003cp\u003eControl classes\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c4\"\u003e\u003cp\u003eT\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c5\"\u003e\u003cp\u003eP\u003c/p\u003e\u003c/th\u003e\u003c/tr\u003e\u003c/thead\u003e\u003ctbody\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eBasic health knowledge and skills\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c2\"\u003e\u003cp\u003e3.944\u0026thinsp;\u0026plusmn;\u0026thinsp;0.433\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c3\"\u003e\u003cp\u003e3.881\u0026thinsp;\u0026plusmn;\u0026thinsp;0.435\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\u003cp\u003e0.649\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e\u003cp\u003e0.518\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eNutrition and food safety\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c2\"\u003e\u003cp\u003e3.556\u0026thinsp;\u0026plusmn;\u0026thinsp;0.463\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c3\"\u003e\u003cp\u003e3.643\u0026thinsp;\u0026plusmn;\u0026thinsp;0.416\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\u003cp\u003e-0.895\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e\u003cp\u003e0.374\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eHygiene and disease prevention\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c2\"\u003e\u003cp\u003e3.769\u0026thinsp;\u0026plusmn;\u0026thinsp;0.524\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c3\"\u003e\u003cp\u003e3.790\u0026thinsp;\u0026plusmn;\u0026thinsp;0.454\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\u003cp\u003e-0.188\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e\u003cp\u003e0.851\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eEnvironmental health and physical activity\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c2\"\u003e\u003cp\u003e3.795\u0026thinsp;\u0026plusmn;\u0026thinsp;0.362\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c3\"\u003e\u003cp\u003e3.849\u0026thinsp;\u0026plusmn;\u0026thinsp;0.387\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\u003cp\u003e-0.651\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e\u003cp\u003e0.517\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eSafe Exercise and the Prevention and Management of Common Sports Injuries\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c2\"\u003e\u003cp\u003e3.641\u0026thinsp;\u0026plusmn;\u0026thinsp;0.490\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c3\"\u003e\u003cp\u003e3.742\u0026thinsp;\u0026plusmn;\u0026thinsp;0.392\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\u003cp\u003e-1.028\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e\u003cp\u003e0.307\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eEmergency Response, Safety Awareness, and Risk Prevention Competency\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c2\"\u003e\u003cp\u003e3.782\u0026thinsp;\u0026plusmn;\u0026thinsp;0.363\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c3\"\u003e\u003cp\u003e3.897\u0026thinsp;\u0026plusmn;\u0026thinsp;0.299\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\u003cp\u003e-1.558\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e\u003cp\u003e0.123\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eMental Health and Social Adaptation Ability\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c2\"\u003e\u003cp\u003e3.813\u0026thinsp;\u0026plusmn;\u0026thinsp;0.364\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c3\"\u003e\u003cp\u003e3.898\u0026thinsp;\u0026plusmn;\u0026thinsp;0.356\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\u003cp\u003e-1.060\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e\u003cp\u003e0.292\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003c/tbody\u003e\u003c/colgroup\u003e\u003c/table\u003e\u003c/div\u003e\u003c/p\u003e\u003cp\u003eAs illustrated in Table\u0026nbsp;\u003cspan refid=\"Tab5\" class=\"InternalRef\"\u003e5\u003c/span\u003e, the experimental and control groups within the general education cohort exhibited a high degree of consistency not only in their overall health literacy scores but also across all seven thematic dimensions. No statistically significant differences were observed between the two groups, indicating that both were situated at a comparable baseline level prior to the intervention. When considered alongside the earlier findings from the ethnic minority cohort, these results collectively confirm that students across all four classes\u0026mdash;namely, the experimental and control groups within both the ethnic minority and general education tracks\u0026mdash;were equivalent in terms of their initial health literacy competencies. Such baseline equivalence is essential for ensuring the internal validity of the quasi-experimental design, as it minimizes confounding variables that might otherwise influence post-intervention outcomes. This pre-intervention alignment provides a methodologically sound foundation for the subsequent implementation and evaluation of the localized health education curriculum. It ensures that any significant differences observed after the intervention can be more confidently attributed to the curricular treatment rather than to pre-existing disparities between groups.\u003c/p\u003e\u003cp\u003e\u003cb\u003e3.3 Post-Test Comparative Analysis of Health Literacy Levels Between the Experimental and Control Groups in the Ethnic Minority Class\u003c/b\u003e\u003c/p\u003e\u003cp\u003eDetermining whether statistically significant differences in health literacy levels emerge between the experimental and control groups following the teaching intervention constitutes a critical benchmark for evaluating the effectiveness of the localized health education curriculum implemented in high schools in Qinghai Province. The presence of such differences would indicate that the intervention produced measurable improvements in student outcomes, thereby offering empirical support for both the practical utility and theoretical soundness of the curriculum design. Moreover, identifying significant post-intervention gains in the experimental group would lend further credibility to the curriculum development model adopted in this study\u0026mdash;one that emphasizes cultural relevance, regional adaptability, and environmental specificity. As such, the results serve not only as an assessment of pedagogical effectiveness but also as a validation of the broader conceptual framework underpinning localized health education in multi-ethnic and underdeveloped regions.\u003c/p\u003e\u003cp\u003e\u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab6\" border=\"1\"\u003e\u003ccaption language=\"En\"\u003e\u003cdiv class=\"CaptionNumber\"\u003eTable 6\u003c/div\u003e\u003cdiv class=\"CaptionContent\"\u003e\u003cp\u003ePost-Intervention Comparative Analysis of Health Literacy Across Thematic Dimensions Between the Experimental and Control Groups in the Ethnic Minority Class\u003c/p\u003e\u003c/div\u003e\u003c/caption\u003e\u003ccolgroup cols=\"5\"\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e\u003cdiv align=\"char\" char=\"\u0026plusmn;\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e\u003cdiv align=\"char\" char=\"\u0026plusmn;\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e\u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e\u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c5\" colnum=\"5\"\u003e\u003c/div\u003e\u003cthead\u003e\u003ctr\u003e\u003cth align=\"left\" colname=\"c1\"\u003e\u003cp\u003eHealth Education Themes\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c2\"\u003e\u003cp\u003eExperimental classes\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c3\"\u003e\u003cp\u003eControl classes\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c4\"\u003e\u003cp\u003eT\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c5\"\u003e\u003cp\u003eP\u003c/p\u003e\u003c/th\u003e\u003c/tr\u003e\u003c/thead\u003e\u003ctbody\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eBasic health knowledge and skills\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c2\"\u003e\u003cp\u003e3.782\u0026thinsp;\u0026plusmn;\u0026thinsp;0.467\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c3\"\u003e\u003cp\u003e3.336\u0026thinsp;\u0026plusmn;\u0026thinsp;0.489\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\u003cp\u003e4.616\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e\u003cp\u003e0.000\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eNutrition and food safety\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c2\"\u003e\u003cp\u003e3.506\u0026thinsp;\u0026plusmn;\u0026thinsp;0.479\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c3\"\u003e\u003cp\u003e3.170\u0026thinsp;\u0026plusmn;\u0026thinsp;0.471\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\u003cp\u003e3.491\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e\u003cp\u003e0.001\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eHygiene and disease prevention\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c2\"\u003e\u003cp\u003e3.458\u0026thinsp;\u0026plusmn;\u0026thinsp;0.437\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c3\"\u003e\u003cp\u003e3.061\u0026thinsp;\u0026plusmn;\u0026thinsp;0.467\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\u003cp\u003e4.357\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e\u003cp\u003e0.000\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eEnvironmental health and physical activity\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c2\"\u003e\u003cp\u003e3.518\u0026thinsp;\u0026plusmn;\u0026thinsp;0.510\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c3\"\u003e\u003cp\u003e3.261\u0026thinsp;\u0026plusmn;\u0026thinsp;0.536\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\u003cp\u003e2.434\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e\u003cp\u003e0.017\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eSafe Exercise and the Prevention and Management of Common Sports Injuries\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c2\"\u003e\u003cp\u003e3.227\u0026thinsp;\u0026plusmn;\u0026thinsp;0.493\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c3\"\u003e\u003cp\u003e3.004\u0026thinsp;\u0026plusmn;\u0026thinsp;0.533\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\u003cp\u003e2.162\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e\u003cp\u003e0.033\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eEmergency Response, Safety Awareness, and Risk Prevention Competency\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c2\"\u003e\u003cp\u003e3.588\u0026thinsp;\u0026plusmn;\u0026thinsp;0.442\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c3\"\u003e\u003cp\u003e3.390\u0026thinsp;\u0026plusmn;\u0026thinsp;0.456\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\u003cp\u003e2.181\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e\u003cp\u003e0.032\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eMental Health and Social Adaptation Ability\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c2\"\u003e\u003cp\u003e3.743\u0026thinsp;\u0026plusmn;\u0026thinsp;0.372\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c3\"\u003e\u003cp\u003e3.558\u0026thinsp;\u0026plusmn;\u0026thinsp;0.439\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\u003cp\u003e2.262\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e\u003cp\u003e0.026\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003c/tbody\u003e\u003c/colgroup\u003e\u003c/table\u003e\u003c/div\u003e\u003c/p\u003e\u003cp\u003eAs presented in Table\u0026nbsp;\u003cspan refid=\"Tab6\" class=\"InternalRef\"\u003e6\u003c/span\u003e, statistically significant differences (p\u0026thinsp;\u0026lt;\u0026thinsp;0.05) were observed between the experimental and control groups in the ethnic minority class across all seven thematic dimensions of health literacy following the conclusion of the teaching intervention. These findings indicate that the health literacy levels of the two groups diverged meaningfully as a result of the curriculum intervention. More specifically, the experimental group consistently achieved higher average scores than the control group in each of the assessed dimensions, including basic health knowledge and skills, nutrition and food safety, hygiene and disease prevention, environmental health and physical activity, safe exercise and injury management, emergency response and safety awareness, and psychosocial health and social adaptation. This pattern of improvement suggests that the localized health education curriculum had a positive and measurable impact on students\u0026rsquo; health literacy development within the ethnic minority context. The results provide empirical evidence supporting the effectiveness of a culturally and regionally adapted curriculum, demonstrating that a context-sensitive approach can significantly enhance student learning outcomes in underrepresented and diverse populations.\u003c/p\u003e\u003cp\u003e\u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab7\" border=\"1\"\u003e\u003ccaption language=\"En\"\u003e\u003cdiv class=\"CaptionNumber\"\u003eTable 7\u003c/div\u003e\u003cdiv class=\"CaptionContent\"\u003e\u003cp\u003ePost-Intervention Comparative Analysis of Overall Health Literacy Scores Between the Experimental and Control Groups in the Ethnic Minority Class\u003c/p\u003e\u003c/div\u003e\u003c/caption\u003e\u003ccolgroup cols=\"5\"\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c5\" colnum=\"5\"\u003e\u003c/div\u003e\u003cthead\u003e\u003ctr\u003e\u003cth align=\"left\" colname=\"c1\"\u003e\u003cp\u003eThemes\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c2\"\u003e\u003cp\u003eExperimental classes\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c3\"\u003e\u003cp\u003eControl classes\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c4\"\u003e\u003cp\u003eT\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c5\"\u003e\u003cp\u003eP\u003c/p\u003e\u003c/th\u003e\u003c/tr\u003e\u003c/thead\u003e\u003ctbody\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eOverall Mean Score of Health Literacy\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e3.541\u0026thinsp;\u0026plusmn;\u0026thinsp;0.288\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e3.244\u0026thinsp;\u0026plusmn;\u0026thinsp;0.288\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e5.095\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e0.000\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003c/tbody\u003e\u003c/colgroup\u003e\u003c/table\u003e\u003c/div\u003e\u003c/p\u003e\u003cp\u003eAs shown in Table\u0026nbsp;\u003cspan refid=\"Tab7\" class=\"InternalRef\"\u003e7\u003c/span\u003e, a statistically significant difference (p\u0026thinsp;\u0026lt;\u0026thinsp;0.05) was observed in the overall mean health literacy scores between the experimental and control groups in the ethnic minority class following the teaching intervention. This result indicates that, after the implementation of the localized curriculum, the two groups were no longer at the same level in terms of overall health literacy performance. More specifically, students in the experimental group achieved a higher overall average score than those in the control group, suggesting that the localized health education curriculum had a notable positive impact on enhancing students\u0026rsquo; comprehensive health literacy. This finding reinforces the conclusion that the intervention was effective not only at the level of individual thematic dimensions (as indicated in Table\u0026nbsp;\u003cspan refid=\"Tab6\" class=\"InternalRef\"\u003e6\u003c/span\u003e), but also in elevating overall health literacy in a statistically and educationally meaningful way. Such outcomes provide further empirical support for the validity and effectiveness of a regionally adapted, culturally sensitive curriculum model, especially in multi-ethnic and under-resourced educational settings.\u003c/p\u003e\u003cp\u003e\u003cb\u003e3.4 Post-Intervention Comparative Analysis of Health Literacy Levels Between Experimental and Control Groups in the General Class\u003c/b\u003e\u003c/p\u003e\u003cp\u003e\u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab8\" border=\"1\"\u003e\u003ccaption language=\"En\"\u003e\u003cdiv class=\"CaptionNumber\"\u003eTable 8\u003c/div\u003e\u003cdiv class=\"CaptionContent\"\u003e\u003cp\u003ePost-Intervention Comparative Analysis of Thematic Health Literacy Scores Between the Experimental and Control Groups in the General Class\u003c/p\u003e\u003c/div\u003e\u003c/caption\u003e\u003ccolgroup cols=\"5\"\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e\u003cdiv align=\"char\" char=\"\u0026plusmn;\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e\u003cdiv align=\"char\" char=\"\u0026plusmn;\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e\u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c5\" colnum=\"5\"\u003e\u003c/div\u003e\u003cthead\u003e\u003ctr\u003e\u003cth align=\"left\" colname=\"c1\"\u003e\u003cp\u003eHealth Education Themes\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c2\"\u003e\u003cp\u003eExperimental classes\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c3\"\u003e\u003cp\u003eControl classes\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c4\"\u003e\u003cp\u003eT\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c5\"\u003e\u003cp\u003eP\u003c/p\u003e\u003c/th\u003e\u003c/tr\u003e\u003c/thead\u003e\u003ctbody\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eBasic health knowledge and skills\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c2\"\u003e\u003cp\u003e4.287\u0026thinsp;\u0026plusmn;\u0026thinsp;0.278\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c3\"\u003e\u003cp\u003e3.910\u0026thinsp;\u0026plusmn;\u0026thinsp;0.417\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\u003cp\u003e4.823\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e0.000\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eNutrition and food safety\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c2\"\u003e\u003cp\u003e3.855\u0026thinsp;\u0026plusmn;\u0026thinsp;0.355\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c3\"\u003e\u003cp\u003e3.667\u0026thinsp;\u0026plusmn;\u0026thinsp;0.381\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\u003cp\u003e2.294\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e0024\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eHygiene and disease prevention\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c2\"\u003e\u003cp\u003e4.068\u0026thinsp;\u0026plusmn;\u0026thinsp;0.413\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c3\"\u003e\u003cp\u003e3.817\u0026thinsp;\u0026plusmn;\u0026thinsp;0.434\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\u003cp\u003e2.662\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e0.009\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eEnvironmental health and physical activity\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c2\"\u003e\u003cp\u003e4.043\u0026thinsp;\u0026plusmn;\u0026thinsp;0.305\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c3\"\u003e\u003cp\u003e3.873\u0026thinsp;\u0026plusmn;\u0026thinsp;0.371\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\u003cp\u003e2.237\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e0.028\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eSafe Exercise and the Prevention and Management of Common Sports Injuries\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c2\"\u003e\u003cp\u003e3.953\u0026thinsp;\u0026plusmn;\u0026thinsp;0.386\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c3\"\u003e\u003cp\u003e3.770\u0026thinsp;\u0026plusmn;\u0026thinsp;0.366\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\u003cp\u003e2.191\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e0.031\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eEmergency Response, Safety Awareness, and Risk Prevention Competency\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c2\"\u003e\u003cp\u003e4.051\u0026thinsp;\u0026plusmn;\u0026thinsp;0.276\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c3\"\u003e\u003cp\u003e3.917\u0026thinsp;\u0026plusmn;\u0026thinsp;0.286\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\u003cp\u003e2.153\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e0.034\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eMental Health and Social Adaptation Ability\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c2\"\u003e\u003cp\u003e4.066\u0026thinsp;\u0026plusmn;\u0026thinsp;0.285\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c3\"\u003e\u003cp\u003e3.922\u0026thinsp;\u0026plusmn;\u0026thinsp;0.334\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\u003cp\u003e2.080\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e0.041\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003c/tbody\u003e\u003c/colgroup\u003e\u003c/table\u003e\u003c/div\u003e\u003c/p\u003e\u003cp\u003eAs shown in Table\u0026nbsp;\u003cspan refid=\"Tab8\" class=\"InternalRef\"\u003e8\u003c/span\u003e, following the teaching intervention, statistically significant differences (p\u0026thinsp;\u0026lt;\u0026thinsp;0.05) were observed between the experimental and control groups in the general education class across all seven thematic dimensions of health literacy. These results indicate that the two groups were no longer equivalent in terms of their health literacy levels after the intervention, suggesting that the localized curriculum had a discernible educational effect. More specifically, the experimental group consistently achieved higher average scores across each of the seven dimensions\u0026mdash;ranging from basic health knowledge and skills to psychosocial well-being and safety awareness\u0026mdash;compared to their peers in the control group. This pattern of improvement implies that the localized health education curriculum exerted a greater and more comprehensive positive impact on the students who received it, in contrast to the outcomes associated with the standard curriculum implemented in the control group. These findings further reinforce the effectiveness of the localized curriculum model, demonstrating that it can not only enhance overall student performance but also foster meaningful gains across specific domains of adolescent health literacy in non-minority, general educational contexts.\u003c/p\u003e\u003cp\u003e\u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab9\" border=\"1\"\u003e\u003ccaption language=\"En\"\u003e\u003cdiv class=\"CaptionNumber\"\u003eTable 9\u003c/div\u003e\u003cdiv class=\"CaptionContent\"\u003e\u003cp\u003ePost-Intervention Comparative Analysis of Overall Health Literacy Scores Between the Experimental and Control Groups in the General Class\u003c/p\u003e\u003c/div\u003e\u003c/caption\u003e\u003ccolgroup cols=\"5\"\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c5\" colnum=\"5\"\u003e\u003c/div\u003e\u003cthead\u003e\u003ctr\u003e\u003cth align=\"left\" colname=\"c1\"\u003e\u003cp\u003eThemes\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c2\"\u003e\u003cp\u003eExperimental classes\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c3\"\u003e\u003cp\u003eControl classes\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c4\"\u003e\u003cp\u003eT\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c5\"\u003e\u003cp\u003eP\u003c/p\u003e\u003c/th\u003e\u003c/tr\u003e\u003c/thead\u003e\u003ctbody\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eOverall Mean Score of Health Literacy\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e4.041\u0026thinsp;\u0026plusmn;\u0026thinsp;0.234\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e3.838\u0026thinsp;\u0026plusmn;\u0026thinsp;0.249\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e3.781\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e0.000\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003c/tbody\u003e\u003c/colgroup\u003e\u003c/table\u003e\u003c/div\u003e\u003c/p\u003e\u003cp\u003eAs presented in Table\u0026nbsp;\u003cspan refid=\"Tab9\" class=\"InternalRef\"\u003e9\u003c/span\u003e, the comparison of overall post-test health literacy scores between the experimental and control groups in the general education class revealed a statistically significant difference (p\u0026thinsp;\u0026lt;\u0026thinsp;0.05). This indicates that, following the teaching intervention, the two groups were no longer comparable in terms of their overall health literacy levels, with the experimental group demonstrating superior performance relative to the control group.\u003c/p\u003e\u003cp\u003eWhen considered in conjunction with the results from the ethnic minority cohort, these findings clearly demonstrate that, after the implementation of the localized health education curriculum, the experimental groups in both educational tracks significantly outperformed their respective control groups\u0026mdash;not only in overall health literacy but also across all seven thematic dimensions. This consistent pattern of improvement provides compelling evidence that the localized curriculum had a broad and measurable impact on students\u0026rsquo; health literacy development across diverse classroom contexts. The effectiveness of the localized curriculum in both general and ethnic minority settings underscores its practical utility, as well as its transferability and adaptability to different educational populations. Moreover, these findings offer robust empirical support for the validity, effectiveness, and theoretical soundness of the localized curriculum development model proposed and implemented in this study. By aligning curriculum content with regional, cultural, and environmental realities, the model has proven to be a scientifically rigorous and contextually responsive approach to advancing adolescent health education in underdeveloped and multi-ethnic regions such as Qinghai.\u003c/p\u003e\u003c/div\u003e\u003cdiv id=\"Sec11\" class=\"Section2\"\u003e\u003ch2\u003e3.5 Analysis of Health Literacy Development in the Control Groups Before and After the Intervention\u003c/h2\u003e\u003cp\u003e\u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab10\" border=\"1\"\u003e\u003ccaption language=\"En\"\u003e\u003cdiv class=\"CaptionNumber\"\u003eTable 10\u003c/div\u003e\u003cdiv class=\"CaptionContent\"\u003e\u003cp\u003ePre- and Post-Test Comparison of Thematic Health Literacy Scores in the Ethnic Minority Control Group\u003c/p\u003e\u003c/div\u003e\u003c/caption\u003e\u003ccolgroup cols=\"5\"\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e\u003cdiv align=\"char\" char=\"\u0026plusmn;\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e\u003cdiv align=\"char\" char=\"\u0026plusmn;\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e\u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e\u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c5\" colnum=\"5\"\u003e\u003c/div\u003e\u003cthead\u003e\u003ctr\u003e\u003cth align=\"left\" colname=\"c1\"\u003e\u003cp\u003eHealth Education Themes\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c2\"\u003e\u003cp\u003ePre-test\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c3\"\u003e\u003cp\u003ePost-test\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c4\"\u003e\u003cp\u003eT\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c5\"\u003e\u003cp\u003eP\u003c/p\u003e\u003c/th\u003e\u003c/tr\u003e\u003c/thead\u003e\u003ctbody\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eBasic health knowledge and skills\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c2\"\u003e\u003cp\u003e3.241\u0026thinsp;\u0026plusmn;\u0026thinsp;0.541\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c3\"\u003e\u003cp\u003e3.268\u0026thinsp;\u0026plusmn;\u0026thinsp;0.516\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\u003cp\u003e-2.606\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e\u003cp\u003e0.013\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eNutrition and food safety\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c2\"\u003e\u003cp\u003e3.148\u0026thinsp;\u0026plusmn;\u0026thinsp;0.493\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c3\"\u003e\u003cp\u003e3.170\u0026thinsp;\u0026plusmn;\u0026thinsp;0.471\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\u003cp\u003e-2.213\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e\u003cp\u003e0.032\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eHygiene and disease prevention\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c2\"\u003e\u003cp\u003e3.027\u0026thinsp;\u0026plusmn;\u0026thinsp;0.511\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c3\"\u003e\u003cp\u003e3.061\u0026thinsp;\u0026plusmn;\u0026thinsp;0.467\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\u003cp\u003e-2.033\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e\u003cp\u003e0.048\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eEnvironmental health and physical activity\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c2\"\u003e\u003cp\u003e3.235\u0026thinsp;\u0026plusmn;\u0026thinsp;0.574\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c3\"\u003e\u003cp\u003e3.379\u0026thinsp;\u0026plusmn;\u0026thinsp;0.538\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\u003cp\u003e-1.261\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e\u003cp\u003e0.214\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eSafe Exercise and the Prevention and Management of Common Sports Injuries\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c2\"\u003e\u003cp\u003e2.981\u0026thinsp;\u0026plusmn;\u0026thinsp;0.561\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c3\"\u003e\u003cp\u003e3.004\u0026thinsp;\u0026plusmn;\u0026thinsp;0.533\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\u003cp\u003e-2.606\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e\u003cp\u003e0.013\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eEmergency Response, Safety Awareness, and Risk Prevention Competency\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c2\"\u003e\u003cp\u003e3.364\u0026thinsp;\u0026plusmn;\u0026thinsp;0.489\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c3\"\u003e\u003cp\u003e3.390\u0026thinsp;\u0026plusmn;\u0026thinsp;0.456\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\u003cp\u003e-2.464\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e\u003cp\u003e0.018\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eMental Health and Social Adaptation Ability\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c2\"\u003e\u003cp\u003e3.542\u0026thinsp;\u0026plusmn;\u0026thinsp;0.457\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c3\"\u003e\u003cp\u003e3.558\u0026thinsp;\u0026plusmn;\u0026thinsp;0.439\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\u003cp\u003e-2.348\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e\u003cp\u003e0.024\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003c/tbody\u003e\u003c/colgroup\u003e\u003c/table\u003e\u003c/div\u003e\u003c/p\u003e\u003cp\u003e\u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab11\" border=\"1\"\u003e\u003ccaption language=\"En\"\u003e\u003cdiv class=\"CaptionNumber\"\u003eTable 11\u003c/div\u003e\u003cdiv class=\"CaptionContent\"\u003e\u003cp\u003ePre- and Post-Test Comparison of Overall Health Literacy Scores in the Ethnic Minority Control Group\u003c/p\u003e\u003c/div\u003e\u003c/caption\u003e\u003ccolgroup cols=\"5\"\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c5\" colnum=\"5\"\u003e\u003c/div\u003e\u003cthead\u003e\u003ctr\u003e\u003cth align=\"left\" colname=\"c1\"\u003e\u003cp\u003eThemes\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c2\"\u003e\u003cp\u003ePre-test\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c3\"\u003e\u003cp\u003ePost-test\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c4\"\u003e\u003cp\u003eT\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c5\"\u003e\u003cp\u003eP\u003c/p\u003e\u003c/th\u003e\u003c/tr\u003e\u003c/thead\u003e\u003ctbody\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eOverall Mean Score of Health Literacy\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e3.219\u0026thinsp;\u0026plusmn;\u0026thinsp;0.308\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e3.244\u0026thinsp;\u0026plusmn;\u0026thinsp;0.288\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e-4.0845\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e0.000\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003c/tbody\u003e\u003c/colgroup\u003e\u003c/table\u003e\u003c/div\u003e\u003c/p\u003e\u003cp\u003e\u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab12\" border=\"1\"\u003e\u003ccaption language=\"En\"\u003e\u003cdiv class=\"CaptionNumber\"\u003eTable 12\u003c/div\u003e\u003cdiv class=\"CaptionContent\"\u003e\u003cp\u003ePre- and Post-Test Comparison of Thematic Health Literacy Scores in the General Class Control Group\u003c/p\u003e\u003c/div\u003e\u003c/caption\u003e\u003ccolgroup cols=\"5\"\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e\u003cdiv align=\"char\" char=\"\u0026plusmn;\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e\u003cdiv align=\"char\" char=\"\u0026plusmn;\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e\u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e\u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c5\" colnum=\"5\"\u003e\u003c/div\u003e\u003cthead\u003e\u003ctr\u003e\u003cth align=\"left\" colname=\"c1\"\u003e\u003cp\u003eHealth Education Themes\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c2\"\u003e\u003cp\u003ePre-test\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c3\"\u003e\u003cp\u003ePost-test\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c4\"\u003e\u003cp\u003eT\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c5\"\u003e\u003cp\u003eP\u003c/p\u003e\u003c/th\u003e\u003c/tr\u003e\u003c/thead\u003e\u003ctbody\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eBasic health knowledge and skills\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c2\"\u003e\u003cp\u003e3.881\u0026thinsp;\u0026plusmn;\u0026thinsp;0.435\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c3\"\u003e\u003cp\u003e3.910\u0026thinsp;\u0026plusmn;\u0026thinsp;0.417\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\u003cp\u003e-2.614\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e\u003cp\u003e0.012\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eNutrition and food safety\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c2\"\u003e\u003cp\u003e3.643\u0026thinsp;\u0026plusmn;\u0026thinsp;0.416\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c3\"\u003e\u003cp\u003e3.667\u0026thinsp;\u0026plusmn;\u0026thinsp;0.381\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\u003cp\u003e-2.218\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e\u003cp\u003e0.032\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eHygiene and disease prevention\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c2\"\u003e\u003cp\u003e3.790\u0026thinsp;\u0026plusmn;\u0026thinsp;0.454\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c3\"\u003e\u003cp\u003e3.817\u0026thinsp;\u0026plusmn;\u0026thinsp;0.434\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\u003cp\u003e-2.471\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e\u003cp\u003e0.018\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eEnvironmental health and physical activity\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c2\"\u003e\u003cp\u003e3.850\u0026thinsp;\u0026plusmn;\u0026thinsp;0.387\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c3\"\u003e\u003cp\u003e3.873\u0026thinsp;\u0026plusmn;\u0026thinsp;0.371\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\u003cp\u003e-2.218\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e\u003cp\u003e0.032\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eSafe Exercise and the Prevention and Management of Common Sports Injuries\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c2\"\u003e\u003cp\u003e3.742\u0026thinsp;\u0026plusmn;\u0026thinsp;0.392\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c3\"\u003e\u003cp\u003e3.770\u0026thinsp;\u0026plusmn;\u0026thinsp;0.366\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\u003cp\u003e-2.864\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e\u003cp\u003e0.007\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eEmergency Response, Safety Awareness, and Risk Prevention Competency\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c2\"\u003e\u003cp\u003e3.897\u0026thinsp;\u0026plusmn;\u0026thinsp;0.299\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c3\"\u003e\u003cp\u003e3.917\u0026thinsp;\u0026plusmn;\u0026thinsp;0.286\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\u003cp\u003e-2.354\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e\u003cp\u003e0.023\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eMental Health and Social Adaptation Ability\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c2\"\u003e\u003cp\u003e3.898\u0026thinsp;\u0026plusmn;\u0026thinsp;0.356\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c3\"\u003e\u003cp\u003e3.922\u0026thinsp;\u0026plusmn;\u0026thinsp;0.334\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\u003cp\u003e-2.471\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e\u003cp\u003e0.018\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003c/tbody\u003e\u003c/colgroup\u003e\u003c/table\u003e\u003c/div\u003e\u003c/p\u003e\u003cp\u003e\u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab13\" border=\"1\"\u003e\u003ccaption language=\"En\"\u003e\u003cdiv class=\"CaptionNumber\"\u003eTable 13\u003c/div\u003e\u003cdiv class=\"CaptionContent\"\u003e\u003cp\u003ePre- and Post-Test Comparison of Overall Health Literacy Scores in the General Class Control Group\u003c/p\u003e\u003c/div\u003e\u003c/caption\u003e\u003ccolgroup cols=\"5\"\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c5\" colnum=\"5\"\u003e\u003c/div\u003e\u003cthead\u003e\u003ctr\u003e\u003cth align=\"left\" colname=\"c1\"\u003e\u003cp\u003eThemes\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c2\"\u003e\u003cp\u003ePre-test\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c3\"\u003e\u003cp\u003ePost-test\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c4\"\u003e\u003cp\u003eT\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c5\"\u003e\u003cp\u003eP\u003c/p\u003e\u003c/th\u003e\u003c/tr\u003e\u003c/thead\u003e\u003ctbody\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eOverall Mean Score of Health Literacy\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e3.813\u0026thinsp;\u0026plusmn;\u0026thinsp;0.265\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e3.838\u0026thinsp;\u0026plusmn;\u0026thinsp;0.249\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e-5.936\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e0.000\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003c/tbody\u003e\u003c/colgroup\u003e\u003c/table\u003e\u003c/div\u003e\u003c/p\u003e\u003cp\u003eAs shown in Tables\u0026nbsp;\u003cspan refid=\"Tab10\" class=\"InternalRef\"\u003e10\u003c/span\u003e through \u003cspan refid=\"Tab13\" class=\"InternalRef\"\u003e13\u003c/span\u003e, students in the control groups demonstrated statistically significant improvements in overall health literacy scores between the pre-test and post-test assessments. Similar trends of progress were also observed across the seven thematic dimensions, suggesting that the traditional physical education and health curriculum does offer some educational value in promoting students' health literacy.\u003c/p\u003e\u003cp\u003eHowever, the magnitude of improvement observed in both overall and dimension-specific scores was relatively limited, averaging around 0.5%. The gains across the seven dimensions were generally consistent, with one notable exception: the dimension titled \u0026ldquo;Environment, Physical Activity, and Health\u0026rdquo; showed the least measurable growth, indicating a potential area of weakness in the traditional curriculum\u0026rsquo;s content or delivery.\u003c/p\u003e\u003cp\u003eIn summary, while conventional health education approaches can indeed foster incremental growth in students\u0026rsquo; health literacy, their effectiveness appears modest, particularly in domains related to environmental awareness and active lifestyle promotion. These findings underscore the need for curriculum enhancement strategies that more explicitly integrate environmental health perspectives and physical activity components, especially in contexts where such content is currently underemphasized.\u003c/p\u003e\u003c/div\u003e\u003cdiv id=\"Sec12\" class=\"Section2\"\u003e\u003ch2\u003e3.6 Analysis of Pre- and Post-Test Changes in Health Literacy Among Experimental Groups\u003c/h2\u003e\u003cp\u003e\u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab14\" border=\"1\"\u003e\u003ccaption language=\"En\"\u003e\u003cdiv class=\"CaptionNumber\"\u003eTable 14\u003c/div\u003e\u003cdiv class=\"CaptionContent\"\u003e\u003cp\u003ePre- and Post-Test Comparison of Thematic Health Literacy Scores in the Ethnic Minority Experimental Group\u003c/p\u003e\u003c/div\u003e\u003c/caption\u003e\u003ccolgroup cols=\"5\"\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e\u003cdiv align=\"char\" char=\"\u0026plusmn;\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e\u003cdiv align=\"char\" char=\"\u0026plusmn;\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e\u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e\u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c5\" colnum=\"5\"\u003e\u003c/div\u003e\u003cthead\u003e\u003ctr\u003e\u003cth align=\"left\" colname=\"c1\"\u003e\u003cp\u003eHealth Education Themes\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c2\"\u003e\u003cp\u003ePre-test\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c3\"\u003e\u003cp\u003ePost-test\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c4\"\u003e\u003cp\u003eT\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c5\"\u003e\u003cp\u003eP\u003c/p\u003e\u003c/th\u003e\u003c/tr\u003e\u003c/thead\u003e\u003ctbody\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eBasic health knowledge and skills\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c2\"\u003e\u003cp\u003e3.258\u0026thinsp;\u0026plusmn;\u0026thinsp;0.588\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c3\"\u003e\u003cp\u003e3.782\u0026thinsp;\u0026plusmn;\u0026thinsp;0.467\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\u003cp\u003e-19.243\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e\u003cp\u003e0.000\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eNutrition and food safety\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c2\"\u003e\u003cp\u003e3.252\u0026thinsp;\u0026plusmn;\u0026thinsp;0.533\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c3\"\u003e\u003cp\u003e3.506\u0026thinsp;\u0026plusmn;\u0026thinsp;0.479\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\u003cp\u003e-13.554\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e\u003cp\u003e0.000\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eHygiene and disease prevention\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c2\"\u003e\u003cp\u003e3.103\u0026thinsp;\u0026plusmn;\u0026thinsp;0.511\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c3\"\u003e\u003cp\u003e3.458\u0026thinsp;\u0026plusmn;\u0026thinsp;0.437\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\u003cp\u003e-15.208\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e\u003cp\u003e0.000\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eEnvironmental health and physical activity\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c2\"\u003e\u003cp\u003e3.278\u0026thinsp;\u0026plusmn;\u0026thinsp;0.601\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c3\"\u003e\u003cp\u003e3.518\u0026thinsp;\u0026plusmn;\u0026thinsp;0.510\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\u003cp\u003e-9.526\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e\u003cp\u003e0.000\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eSafe Exercise and the Prevention and Management of Common Sports Injuries\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c2\"\u003e\u003cp\u003e3.000\u0026thinsp;\u0026plusmn;\u0026thinsp;0.568\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c3\"\u003e\u003cp\u003e3.227\u0026thinsp;\u0026plusmn;\u0026thinsp;0.493\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\u003cp\u003e-11.645\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e\u003cp\u003e0.000\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eEmergency Response, Safety Awareness, and Risk Prevention Competency\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c2\"\u003e\u003cp\u003e3.361\u0026thinsp;\u0026plusmn;\u0026thinsp;0.505\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c3\"\u003e\u003cp\u003e3.588\u0026thinsp;\u0026plusmn;\u0026thinsp;0.442\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\u003cp\u003e-15.588\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e\u003cp\u003e0.000\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eMental Health and Social Adaptation Ability\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c2\"\u003e\u003cp\u003e3.548\u0026thinsp;\u0026plusmn;\u0026thinsp;0.433\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c3\"\u003e\u003cp\u003e3.743\u0026thinsp;\u0026plusmn;\u0026thinsp;0.372\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\u003cp\u003e-11.942\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e\u003cp\u003e0.000\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003c/tbody\u003e\u003c/colgroup\u003e\u003c/table\u003e\u003c/div\u003e\u003c/p\u003e\u003cp\u003e\u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab15\" border=\"1\"\u003e\u003ccaption language=\"En\"\u003e\u003cdiv class=\"CaptionNumber\"\u003eTable 15\u003c/div\u003e\u003cdiv class=\"CaptionContent\"\u003e\u003cp\u003ePre- and Post-Test Comparison of Overall Health Literacy Scores in the Ethnic Minority Experimental Group\u003c/p\u003e\u003c/div\u003e\u003c/caption\u003e\u003ccolgroup cols=\"5\"\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c5\" colnum=\"5\"\u003e\u003c/div\u003e\u003cthead\u003e\u003ctr\u003e\u003cth align=\"left\" colname=\"c1\"\u003e\u003cp\u003eThemes\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c2\"\u003e\u003cp\u003ePre-test\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c3\"\u003e\u003cp\u003ePost-test\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c4\"\u003e\u003cp\u003eT\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c5\"\u003e\u003cp\u003eP\u003c/p\u003e\u003c/th\u003e\u003c/tr\u003e\u003c/thead\u003e\u003ctbody\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eOverall Mean Score of Health Literacy\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e3.257\u0026thinsp;\u0026plusmn;\u0026thinsp;0.329\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e3.541\u0026thinsp;\u0026plusmn;\u0026thinsp;0.288\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e-28.244\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e0.000\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003c/tbody\u003e\u003c/colgroup\u003e\u003c/table\u003e\u003c/div\u003e\u003c/p\u003e\u003cp\u003e\u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab16\" border=\"1\"\u003e\u003ccaption language=\"En\"\u003e\u003cdiv class=\"CaptionNumber\"\u003eTable 16\u003c/div\u003e\u003cdiv class=\"CaptionContent\"\u003e\u003cp\u003ePre- and Post-Test Comparison of Thematic Health Literacy Scores in the General Class Experimental Group\u003c/p\u003e\u003c/div\u003e\u003c/caption\u003e\u003ccolgroup cols=\"5\"\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e\u003cdiv align=\"char\" char=\"\u0026plusmn;\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e\u003cdiv align=\"char\" char=\"\u0026plusmn;\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e\u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e\u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c5\" colnum=\"5\"\u003e\u003c/div\u003e\u003cthead\u003e\u003ctr\u003e\u003cth align=\"left\" colname=\"c1\"\u003e\u003cp\u003eHealth Education Themes\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c2\"\u003e\u003cp\u003ePre-test\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c3\"\u003e\u003cp\u003ePost-test\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c4\"\u003e\u003cp\u003eT\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c5\"\u003e\u003cp\u003eP\u003c/p\u003e\u003c/th\u003e\u003c/tr\u003e\u003c/thead\u003e\u003ctbody\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eBasic health knowledge and skills\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c2\"\u003e\u003cp\u003e3.944\u0026thinsp;\u0026plusmn;\u0026thinsp;0.433\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c3\"\u003e\u003cp\u003e4.287\u0026thinsp;\u0026plusmn;\u0026thinsp;0.278\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\u003cp\u003e-9.982\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e\u003cp\u003e0.000\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eNutrition and food safety\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c2\"\u003e\u003cp\u003e3.556\u0026thinsp;\u0026plusmn;\u0026thinsp;0.463\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c3\"\u003e\u003cp\u003e3.855\u0026thinsp;\u0026plusmn;\u0026thinsp;0.355\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\u003cp\u003e-9.045\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e\u003cp\u003e0.000\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eHygiene and disease prevention\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c2\"\u003e\u003cp\u003e3.769\u0026thinsp;\u0026plusmn;\u0026thinsp;0.524\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c3\"\u003e\u003cp\u003e4.068\u0026thinsp;\u0026plusmn;\u0026thinsp;0.413\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\u003cp\u003e-10.617\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e\u003cp\u003e0.000\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eEnvironmental health and physical activity\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c2\"\u003e\u003cp\u003e3.795\u0026thinsp;\u0026plusmn;\u0026thinsp;0.362\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c3\"\u003e\u003cp\u003e4.043\u0026thinsp;\u0026plusmn;\u0026thinsp;0.305\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\u003cp\u003e-11.749\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e\u003cp\u003e0.000\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eSafe Exercise and the Prevention and Management of Common Sports Injuries\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c2\"\u003e\u003cp\u003e3.641\u0026thinsp;\u0026plusmn;\u0026thinsp;0.490\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c3\"\u003e\u003cp\u003e3.953\u0026thinsp;\u0026plusmn;\u0026thinsp;0.386\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\u003cp\u003e-9.433\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e\u003cp\u003e0.000\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eEmergency Response, Safety Awareness, and Risk Prevention Competency\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c2\"\u003e\u003cp\u003e3.782\u0026thinsp;\u0026plusmn;\u0026thinsp;0.363\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c3\"\u003e\u003cp\u003e4.051\u0026thinsp;\u0026plusmn;\u0026thinsp;0.276\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\u003cp\u003e-10.192\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e\u003cp\u003e0.000\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eMental Health and Social Adaptation Ability\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c2\"\u003e\u003cp\u003e3.813\u0026thinsp;\u0026plusmn;\u0026thinsp;0.364\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c3\"\u003e\u003cp\u003e4.066\u0026thinsp;\u0026plusmn;\u0026thinsp;0.285\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\u003cp\u003e-8.726\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e\u003cp\u003e0.000\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003c/tbody\u003e\u003c/colgroup\u003e\u003c/table\u003e\u003c/div\u003e\u003c/p\u003e\u003cp\u003e\u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab17\" border=\"1\"\u003e\u003ccaption language=\"En\"\u003e\u003cdiv class=\"CaptionNumber\"\u003eTable 17\u003c/div\u003e\u003cdiv class=\"CaptionContent\"\u003e\u003cp\u003ePre- and Post-Test Comparison of Overall Health Literacy Scores in the General Class Experimental Group\u003c/p\u003e\u003c/div\u003e\u003c/caption\u003e\u003ccolgroup cols=\"5\"\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c5\" colnum=\"5\"\u003e\u003c/div\u003e\u003cthead\u003e\u003ctr\u003e\u003cth align=\"left\" colname=\"c1\"\u003e\u003cp\u003eThemes\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c2\"\u003e\u003cp\u003ePre-test\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c3\"\u003e\u003cp\u003ePost-test\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c4\"\u003e\u003cp\u003eT\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c5\"\u003e\u003cp\u003eP\u003c/p\u003e\u003c/th\u003e\u003c/tr\u003e\u003c/thead\u003e\u003ctbody\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eOverall Mean Score of Health Literacy\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e3.753\u0026thinsp;\u0026plusmn;\u0026thinsp;0.313\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e4.041\u0026thinsp;\u0026plusmn;\u0026thinsp;0.234\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e-16.886\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e0.000\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003c/tbody\u003e\u003c/colgroup\u003e\u003c/table\u003e\u003c/div\u003e\u003c/p\u003e\u003cp\u003eAs shown in Tables\u0026nbsp;19 through 22, both the general and ethnic minority experimental groups exhibited statistically significant differences in their overall health literacy levels and across all thematic dimensions between the pre- and post-intervention assessments.\u003c/p\u003e\u003cp\u003eThese findings confirm that the teaching intervention led to measurable improvements in health literacy for students in both experimental and control groups. However, a comparison of the magnitude of change reveals that the experimental groups experienced substantially greater gains than the control groups. This suggests that the localized health education curriculum implemented in Qinghai Province had a stronger and more pronounced effect on promoting student health literacy. These results not only affirm the practical effectiveness of the localized curriculum but also lend empirical support to the validity and rationality of the curriculum development model adopted in this study.\u003c/p\u003e\u003cp\u003eFrom a longitudinal perspective, although all seven dimensions of health literacy showed statistically significant improvement, the extent of progress varied by domain. The most notable gains were observed in areas related to health knowledge and practical skills, whereas health-related behaviors, environmental adaptation, moral health, and psychological well-being exhibited relatively modest improvements. This discrepancy may be attributed to the inherent nature of health education content. Cognitive and knowledge-based content can typically be acquired relatively quickly through direct instruction and classroom-based learning. In contrast, deeply rooted beliefs, attitudes, and behavioral patterns\u0026mdash;particularly those related to lifestyle, mental health, and value systems\u0026mdash;require sustained practice, reflection, and experiential learning to shift meaningfully. Given that high school students have already developed relatively stable behavioral habits and cognitive frameworks, significant behavioral or attitudinal change within a short intervention period may be difficult to achieve. Therefore, the design of localized health education curricula should emphasize a multi-tiered structure that includes: (1) health knowledge and skills, (2) health beliefs and identity, and (3) health behaviors and practical application. Such a layered approach ensures a more comprehensive and developmentally appropriate strategy for promoting long-term health literacy among adolescents.\u003c/p\u003e\u003cp\u003eBased on the design, implementation, and comprehensive analysis of the teaching experiment evaluating the effectiveness of the localized high school health education curriculum in Qinghai Province, the following key conclusions can be drawn:\u003c/p\u003e\u003cp\u003e(1) Statistically significant differences were observed between the experimental and control groups in both overall health literacy and across all seven thematic dimensions following the intervention. These findings provide robust empirical support for the effectiveness of the localized curriculum, while also affirming the scientific validity and conceptual soundness of the curriculum development model employed in this study.\u003c/p\u003e\u003cp\u003e(2) Students from both the ethnic minority and general education experimental groups exhibited significant improvements across all health literacy domains after the intervention. These improvements were consistently greater than those observed in the control groups, indicating that the localized curriculum outperformed traditional health education approaches. The results further confirm the model\u0026rsquo;s adaptability and relevance across diverse student populations and educational contexts.\u003c/p\u003e\u003cp\u003e(3) Longitudinal comparisons of pre- and post-intervention data revealed a stable pattern of improvement across the seven dimensions of health literacy. The most substantial gains were recorded in knowledge-based and skill-oriented domains, whereas dimensions related to health behavior, environmental adaptation, moral development, and psychological well-being showed more modest progress. These outcomes suggest that the design of health education curricula should adopt a multi-layered and integrated approach, systematically supporting the acquisition of health knowledge, fostering attitudinal shifts, and enabling behavioral transformation in a coordinated and developmentally appropriate manner.\u003c/p\u003e\u003cp\u003eCollectively, these conclusions underscore the potential of localized, context-sensitive curricula to enhance adolescent health literacy in underdeveloped and multi-ethnic regions, and offer valuable insights for future curriculum innovation and education policy development.\u003c/p\u003e\u003c/div\u003e"},{"header":"4.Discussion","content":"\u003cp\u003e This study examined the effectiveness of a localized health education curriculum developed for high school students in Qinghai Province, China. Using a quasi-experimental design with both general and ethnic minority student cohorts, the study found statistically significant improvements in health literacy among students in the experimental groups, both in overall scores and across all seven thematic dimensions. These results affirm the value of regionally adapted, culturally sensitive health education programs and contribute to the growing body of research supporting context-specific curriculum design in health education.\u003c/p\u003e\u003cp\u003eThe marked improvement in the experimental groups relative to the control groups suggests that localized content, which incorporates regional health risks (e.g., high-altitude conditions), cultural practices (e.g., traditional beliefs in Tibetan and Hui communities), and place-based pedagogy, has greater resonance with students and promotes more effective engagement and learning outcomes.\u003c/p\u003e\u003cp\u003eA particularly noteworthy finding is the differential impact observed across health literacy domains. While gains were evident in all areas, the largest improvements occurred in knowledge- and skill-based domains, such as basic health understanding, disease prevention, and nutrition. By contrast, dimensions related to behavioral change, psychosocial health, and moral development showed more modest increases. This pattern may reflect the structural challenges of influencing deeply rooted beliefs and behaviors within a relatively short intervention period. As previous studies have indicated, behavioral and attitudinal change often requires sustained exposure, experiential learning, and reinforcement through environmental and social support mechanisms.\u003c/p\u003e\u003cp\u003eThe results also highlight important implications for curriculum development in multi-ethnic and underdeveloped regions. First, localized curricula can serve as an effective vehicle for addressing health disparities by aligning educational content with students\u0026rsquo; lived experiences. Second, incorporating indigenous knowledge systems and cultural perspectives into curriculum design may enhance trust, participation, and the perceived legitimacy of school-based health education. Third, teacher professional development is essential to ensuring that localized content is delivered with fidelity and cultural competence.\u003c/p\u003e\u003cp\u003eNevertheless, several limitations should be acknowledged. The quasi-experimental design, while rigorous, does not allow for full randomization, which may introduce selection bias. The study was also limited to a single semester and a specific region, restricting the generalizability of findings. Additionally, while improvements were measured through self-reported health literacy scores, future research should incorporate objective behavioral indicators and longitudinal tracking to assess sustained impact.\u003c/p\u003e\u003cp\u003eIn summary, the study provides strong empirical evidence that a localized, culturally responsive health education curriculum can significantly enhance adolescent health literacy in under-resourced and ethnically diverse regions. It underscores the necessity of shifting from standardized, one-size-fits-all curricula toward more adaptive models that reflect the sociocultural and environmental realities of students. Future studies should expand the geographic scope, integrate mixed-method evaluations, and explore the long-term behavioral effects of localized health education interventions.\u003c/p\u003e"},{"header":"Declarations","content":"\u003cp\u003e\u003cstrong\u003eAcknowledgements\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThis research was funded by A provincial philosophy and social sciences project of Qinghai Province: Research on the Current Situation and Improvement Paths of Health Literacy among Primary and Secondary School Students in Qinghai Province, grant number 23ZCY040.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eFunding\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThis study was funded by a Qinghai Province Philosophy and Social Science Planning Project (Grant No. 23ZCY040).\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eCompeting interests\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe authors declare no competing interests.\u003c/p\u003e\u003ch2\u003eAuthor Contribution\u003c/h2\u003e\u003cp\u003eConceptualization, L.C. and B.S.; methodology, Y.Z.; validation, B.S.; data curation, L.C.; writing\u0026mdash;original draft preparation, L.C.; writing\u0026mdash;review and editing, Y.Z; supervision, B.S. All authors read and approved the final manuscript.\u003c/p\u003e\u003ch2\u003eData Availability\u003c/h2\u003e\u003cp\u003eThe datasets used and/or analysed during the current study are not publicly available due to the sensitive nature of the data involving adolescents and ethnic minority groups, but are available from the corresponding author on reasonable request and subject to appropriate ethical approval.\u003c/p\u003e"},{"header":"References","content":"\u003col\u003e\u003cli\u003e\u003cspan\u003e Dyment,Morse,Shaw,et al. Curriculum development in outdoor education: Tasmanian teachers\u0026rsquo; perspectives on the new pre-tertiary Outdoor Leadership course[J].Journal of Adventure Education \u0026amp; Outdoor Learning, 2014,14(1).82\u0026ndash;99.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003e Maziarz Lauren N, Dake Joseph A, Glassman Tavis. Sex Education, Condom Access, and Contraceptive Referral in U.S. High Schools.. 2019, :1059840519872785.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003e Maziarz Lauren N,Dake Joseph A,Glassman Tavis. Sex Education, Condom Access, and Contraceptive Referral in U.S. High Schools [J]. The Journal of school nursing : the official publication of the National Association of School Nurses, 2019,36(5):325\u0026ndash;329.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003e Jean Helen Young .Participation in Curriculum Development: An Inquiry into the Responses of Teachers[J].Curriculum Inquiry,1985,15(4):387\u0026ndash;414.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003e Ji Liu. Introduction to the Teaching Guidelines for Health and Physical Education in Japan [J]. China School Physical Education,2002(05):73\u0026ndash;74.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003e Helen Emerson, PSHE at Dorothy Stringer[J]. 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Health Care for Women International, 2005, 26(04):295\u0026ndash;307.\u003c/span\u003e\u003c/li\u003e\u003c/ol\u003e"}],"fulltextSource":"","fullText":"","funders":[],"hasAdminPriorityOnWorkflow":false,"hasManuscriptDocX":true,"hasOptedInToPreprint":true,"hasPassedJournalQc":"","hasAnyPriority":false,"hideJournal":true,"highlight":"","institution":"","isAcceptedByJournal":false,"isAuthorSuppliedPdf":false,"isDeskRejected":"","isHiddenFromSearch":false,"isInQc":false,"isInWorkflow":false,"isPdf":false,"isPdfUpToDate":true,"isWithdrawnOrRetracted":false,"journal":{"display":true,"email":"[email protected]","identity":"researchsquare","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":true,"externalIdentity":"","sideBox":"","snPcode":"","submissionUrl":"/submission","title":"Research Square","twitterHandle":"researchsquare","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"","reportingPortfolio":"","inReviewEnabled":false,"inReviewRevisionsEnabled":true},"keywords":"Health Education, Local Curriculum, Adolescent Health Literacy, Experimental Study, Qinghai, China","lastPublishedDoi":"10.21203/rs.3.rs-7039741/v1","lastPublishedDoiUrl":"https://doi.org/10.21203/rs.3.rs-7039741/v1","license":{"name":"CC BY 4.0","url":"https://creativecommons.org/licenses/by/4.0/"},"manuscriptAbstract":"\u003cp\u003e This study aimed to develop and evaluate a localized health education curriculum tailored to the specific cultural, environmental, and health needs of high school students in Qinghai Province, China. A quasi-experimental design was employed involving four Grade 11 classes (N\u0026thinsp;=\u0026thinsp;180), including both ethnic minority and general education groups. Two classes served as experimental groups receiving the localized curriculum, while two served as control groups following the traditional curriculum. A validated self-assessment instrument measuring seven dimensions of adolescent health literacy\u0026mdash;ranging from basic health knowledge to psychological well-being and safety awareness\u0026mdash;was developed using expert Delphi consultation and psychometric testing. Results from pre- and post-intervention assessments indicated that students in the experimental groups showed significant improvements in overall health literacy scores compared to the control groups (p\u0026thinsp;\u0026lt;\u0026thinsp;0.05), with particularly notable gains in health knowledge, disease prevention, and safety behaviors. While the control groups exhibited minor progress, the experimental intervention proved significantly more effective. The study provides empirical support for the efficacy of culturally and regionally adapted health education. Findings highlight the importance of context-specific curriculum development in promoting adolescent health and offer a practical model for future health education reform in similar settings.\u003c/p\u003e","manuscriptTitle":"Developing and Evaluating a Localized Health Education Curriculum in Qinghai, China: An Experimental Study in High Schools","msid":"","msnumber":"","nonDraftVersions":[{"code":1,"date":"2025-08-28 18:46:16","doi":"10.21203/rs.3.rs-7039741/v1","editorialEvents":[{"type":"communityComments","content":0}],"status":"published","journal":{"display":true,"email":"[email protected]","identity":"researchsquare","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":true,"externalIdentity":"","sideBox":"","snPcode":"","submissionUrl":"/submission","title":"Research Square","twitterHandle":"researchsquare","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"","reportingPortfolio":"","inReviewEnabled":false,"inReviewRevisionsEnabled":true}}],"origin":"","ownerIdentity":"60160de9-b634-41ce-b9db-93ffd1799e4f","owner":[],"postedDate":"August 28th, 2025","published":true,"recentEditorialEvents":[],"rejectedJournal":[],"revision":"","amendment":"","status":"posted","subjectAreas":[{"id":53806187,"name":"Social science/Education"},{"id":53806188,"name":"Humanities/Medical humanities"},{"id":53806189,"name":"Biological sciences/Psychology"},{"id":53806190,"name":"Social science/Psychology"}],"tags":[],"updatedAt":"2026-04-07T04:55:40+00:00","versionOfRecord":[],"versionCreatedAt":"2025-08-28 18:46:16","video":"","vorDoi":"","vorDoiUrl":"","workflowStages":[]},"version":"v1","identity":"rs-7039741","journalConfig":"researchsquare"},"__N_SSP":true},"page":"/article/[identity]/[[...version]]","query":{"redirect":"/article/rs-7039741","identity":"rs-7039741","version":["v1"]},"buildId":"8U1c8b4HqxoKbykW_rLl7","isFallback":false,"isExperimentalCompile":false,"dynamicIds":[84888],"gssp":true,"scriptLoader":[]}