Developing School Health Champions to Increase Health Literacy Both in School Adolescents and Community People Through Providing Health Education by the School Nurses in Bangladesh: Community-based Pre- and Post-experimental Design

Study Overview
=================
Brief Summary
-----------------
Health literacy is a person's decision-making ability to improve their quality of life and prevent diseases by accessing, understanding and applying health information. Health literacy in the adolescent's period can aid them to gain and understand health information which can bring positive health outcomes. The aim of this pilot study is to examine the efficacy of health education and school health activities provided by school nurses on improving health literacy among secondary school adolescents. The study will also examine whether health education by health champions (the adolescents) is effective in improving the health literacy of the community people, and examine whether these interventions develop awareness, improve health knowledge, empower, and change behaviors of secondary school adolescents. This intervention study aims to improve health literacy in the adolescents in Bangladesh and the school-located community. The Begum Ayesha Pilot Girl's High School in Dohar, Dhaka district will be selected as a field. First, we will place school nurses at the school, provide health checkups for both the adolescents (about n=316) and community people (about n=200), and school nurses will provide weekly health education for 3 months to the adolescents. After certifying them as Health Champions, the health champions visit the community and provide health education activities to the community people. For both participant groups, health literacy will be measured as efficacy checking of this pilot study. Assent and informed consent will be obtained from the participants. Autonomy, beneficence, non-maleficence, fidelity, veracity, confidentiality, and justice of the participants will be ensured. Also, anonymity will be maintained across all stages of the study.

Official Title
-----------------
Developing School Health Champions to Increase Health Literacy Both in School Adolescents and Community People Through Providing Health Education by the School Nurses in Bangladesh: Community-based Pre- and Post-experimental Design.

Conditions
-----------------
Health Literacy

Intervention / Treatment
-----------------
* Other: pre and post test (health educational intervention)


Participation Criteria
=================
Eligibility Criteria
-----------------
Inclusion Criteria: For school adolescents: Students who are willing to participate. Students who study in class 8 (Grade 8) at the time of enrollment. Students who are female. Students whose parents or legal guardians agree to give consent and are willing to participate in the study Students who agree to receive health checkup, and are willing to respond to the questionnaire. Students who will stay in the same school till study completion. For community people: Persons who are aged at least 18 years old. Persons who are willing to participate. Persons who agree to receive health checkup, and willing to respond to the questionnaire. Persons who will attend the health education activities. Exclusion Criteria: For school adolescents: • Students who are absent from school during the health checkup periods due to severe illness or without any reason or information For community people: Persons who will not attend the education sessions physically. Persons who will not live in the community until the post-test.

Ages Eligible for Study
-----------------
Minimum Age: 11 Years
Maximum Age: 18 Years

Sexes Eligible for Study
-----------------
Female

Accepts Healthy Volunteers
-----------------
Accepts Healthy Volunteers

Study Plan
=================
How is the study designed?
-----------------

Design Details

Primary Purpose: Other
Intervention Model: Single Group Assignment
Masking: None (Open Label)


Arms and Interventions

| Participant Group/Arm | Intervention/Treatment |
| --- | --- |
| Experimental: pre and post test<br>School adolescents studying in 8th grade. | Other: pre and post test (health educational intervention)<br>* The health education will be provided the following sessions. Introduction to Global and Bangladesh Health, Health Information access (Validity), Critical Values (Vital signs, BMI, RBS etc.), Emergency Management (burn, chocking, knife cut, fainting etc.), Food (classification, healthy food, unhealthy, food label, salt intake) (NCDs from unhealthy diet), Smoking and Alcohol (NCD related, substance abuse, secondhand smoking), Physical activity (Benefits, sedentary lifestyle, NCD related), Women's health (menstruation, menstrual cycle, hygiene, STD, contraception), Hygiene (water, food, brushing, bath, toileting, healthy habits), Environmental Sanitation and Communicable disease (clean, effects on health), and Women's health and societal contribution<br>|

What is the study measuring?
-----------------
Primary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| Change in health literacy score among the secondary school students | Primary outcome will be measured by the health literacy scale for school-aged Children (HLSAC), Bangla version. | Baseline, Midline (after 3 months of baseline), Endline (after 6 months of baseline) | 

Secondary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| Change in ratio of the level of health literacy | This will be measured by HLSAC, Bangla version. | Baseline, Midline (after 3 months of baseline), Endline (after 6 months of baseline) | 
| Change in self-efficacy score | this will be measured by General Self-Efficacy Scale (GSE) | Baseline, Midline (after 3 months of baseline), Endline (after 6 months of baseline) | 
| Change in reproductive age women specific health literacy | This will be measured by using the Health literacy scale for women of reproductive age, Bangla version | Baseline, Midline (after 3 months of baseline), Endline (after 6 months of baseline) | 
| Change in awareness and knowledge score | This will be measured by the researcher-developed scale | Baseline, Midline (after 3 months of baseline), Endline (after 6 months of baseline) | 
| Change in health behavior score | this will be measured by the researcher-developed scale | Baseline, Midline (after 3 months of baseline), Endline (after 6 months of baseline) | 
| Qualitative self-evaluation attending the project and being a health champion | Data will be collected through a open qualitative questionnaire (one/two questions will be asked the participants to share their experience for being a health champion and data will be recorded using a voice recorder). | Endline (after 6 months of baseline) | 
| For community people- Change in health literacy score | This will be measured by the European Health literacy Survey Questionnaire short version (HLS-Q12), Bangla version, which is developed by Finbraten, 2018 in English | Midline (after 3 months of baseline), Endline (after 6 months of baseline) | 
| For community people- Change in awareness and knowledge score | This will be measured by the researcher-developed scale | Midline (after 3 months of baseline), Endline (after 6 months of baseline) | 
| For community people- Change in health behavior score | This will be measured by the researcher-developed scale | Midline (after 3 months of baseline), Endline (after 6 months of baseline) |