Improving Health Literacy Among School-Aged Children on Chronic Disease Prevention: A Systematic Review of Relevant Intervention Studies in the United States and Canada to Inform Efficacious School-Based Strategies in South Florida

Improving Health Literacy Among School-Aged Children on Chronic Disease Prevention: A Systematic Review of Relevant Intervention Studies in the United States and Canada to Inform Efficacious School-Based Strategies in South Florida | 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 Systematic Review Improving Health Literacy Among School-Aged Children on Chronic Disease Prevention: A Systematic Review of Relevant Intervention Studies in the United States and Canada to Inform Efficacious School-Based Strategies in South Florida DILSHAD ARA ZANNAT, MD SAMAUN KHALID, ANDREA MAGGIONI, SUSMITA CHOWDHURY, and 2 more This is a preprint; it has not been peer reviewed by a journal. https://doi.org/ 10.21203/rs.3.rs-6942843/v2 This work is licensed under a CC BY 4.0 License Status: Posted Version 2 posted You are reading this latest preprint version Show more versions Abstract Background: Health literacy (HL) is a foundational determinant of child and adolescent health, shaping lifelong trajectories in disease prevention, self-management, and health equity. School-based HL interventions are increasingly recognized as critical public health strategies, particularly in underserved regions such as South Florida. However, intervention studies, which evaluated the domain-specific effectiveness of school HL interventions across multiple health areas in the United States (US) and Canada, have not been systematically reviewed. Methods: To address this, we have conducted a systematic review in accordance with PRISMA 2020 guidelines and registered with PROSPERO. Peer-reviewed studies published between 2008 and 2025 were identified via PubMed, ERIC, and CINHAL. Inclusion criteria focused on U.S. and Canada-based school intervention studies targeting HL among students aged 3–18y. Data from the included studies were systematically reviewed across eight predefined health domains, including mental health, nutrition, chronic disease, and media literacy. Findings: From 1,287 screened articles, 42 studies met inclusion, yielding 114 analytic outcome rows. Strongest effects were observed in literacy related to chronic disease and mental health management, with significant post-intervention increases in biological risk factors management, knowledge about depression, stigma reduction, active help-seeking, and asthma self-regulation (p < 0.001-0.01). Nutrition and physical activity programs showed reductions in sugar-sweetened beverage intake and moderate increases in Moderate-to-Vigorous Physical Activity (MVPA). Additionally, digital literacy yielded moderate improvements in screen use behavior (ES = 0.45). Across domains, multi-modal delivery, school–home integration, and culturally tailored strategies enhanced the impacts significantly. However, variation in follow-up duration, fidelity reporting, and equity disaggregation limited generalizability. Only three studies could be found on relevant HL interventions in South Florida. Interpretation: In summary, school-based HL interventions are effective, adaptable, and capable of addressing diverse public health priorities in US and Canadian school-aged populations. For high-need settings like South Florida, embedding HL curricula within core education systems—coupled with youth co-design, family engagement, and culturally responsive delivery—offers a promising avenue for scalable, equity-driven health promotion. However, relevant evidence from randomized intervention studies for these HL interventions were very limited from South Florida and highlights a major unmet need. Funding: None. health literacy school health child health Full Text Additional Declarations The authors declare no competing interests. Supplementary Files PRISMAFlowDiagram.png NUMBER OF INCLUDED AND EXCLUDED STUDIES Cite Share Download PDF Status: Posted Version 2 posted You are reading this latest preprint version Show more versions Research Square lets you share your work early, gain feedback from the community, and start making changes to your manuscript prior to peer review in a journal. As a division of Research Square Company, we’re committed to making research communication faster, fairer, and more useful. We do this by developing innovative software and high quality services for the global research community. Our growing team is made up of researchers and industry professionals working together to solve the most critical problems facing scientific publishing. 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-6942843","acceptedTermsAndConditions":true,"allowDirectSubmit":true,"archivedVersions":[],"articleType":"Systematic Review","associatedPublications":[],"authors":[{"id":475652163,"identity":"ab91e88b-c5df-46bf-b28b-e28537c75f85","order_by":0,"name":"DILSHAD ARA ZANNAT","email":"","orcid":"","institution":"MIAMI DADE COUNTY PUBLIC SCHOOLS","correspondingAuthor":false,"prefix":"","firstName":"DILSHAD","middleName":"ARA","lastName":"ZANNAT","suffix":""},{"id":475652164,"identity":"aa30065a-403b-4d17-bf06-2a2ef479a69f","order_by":1,"name":"MD SAMAUN 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School-based HL interventions are increasingly recognized as critical public health strategies, particularly in underserved regions such as South Florida. However, intervention studies, which evaluated the domain-specific effectiveness of school HL interventions across multiple health areas in the United States (US) and Canada, have not been systematically reviewed.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eMethods:\u003c/strong\u003e To address this, we have conducted a systematic review in accordance with PRISMA 2020 guidelines and registered with PROSPERO. Peer-reviewed studies published between 2008 and 2025 were identified via PubMed, ERIC, and CINHAL. Inclusion criteria focused on U.S. and Canada-based school intervention studies targeting HL among students aged 3–18y. Data from the included studies were systematically reviewed across eight predefined health domains, including mental health, nutrition, chronic disease, and media literacy.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eFindings:\u003c/strong\u003e From 1,287 screened articles, 42 studies met inclusion, yielding 114 analytic outcome rows. Strongest effects were observed in literacy related to chronic disease and mental health management, with significant post-intervention increases in biological risk factors management, knowledge about depression, stigma reduction, active help-seeking, and asthma self-regulation (p \u0026lt; 0.001-0.01). Nutrition and physical activity programs showed reductions in sugar-sweetened beverage intake and moderate increases in Moderate-to-Vigorous Physical Activity (MVPA). Additionally, digital literacy yielded moderate improvements in screen use behavior (ES = 0.45). Across domains, multi-modal delivery, school–home integration, and culturally tailored strategies enhanced the impacts significantly. However, variation in follow-up duration, fidelity reporting, and equity disaggregation limited generalizability. Only three studies could be found on relevant HL interventions in South Florida.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eInterpretation:\u003c/strong\u003e In summary, school-based HL interventions are effective, adaptable, and capable of addressing diverse public health priorities in US and Canadian school-aged populations. For high-need settings like South Florida, embedding HL curricula within core education systems—coupled with youth co-design, family engagement, and culturally responsive delivery—offers a promising avenue for scalable, equity-driven health promotion. 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