Effects of health education on adolescents' non-cognitive skills, life satisfaction and aspirations, and health-related quality of life: A cluster-randomized controlled trial in Vietnam

Abstract

Objective: The effectiveness of health education on adolescents has been questioned, along with a growing body of empirical studies documenting the absence of behavioral changes after the intervention. However, evidence on its impact on other crucial health domains, besides health practices, is lacking. We evaluated the causal effects of a school-based health education program on adolescents' multidimensional psychological health factors.

Design: A cluster-randomized controlled trial.

Methods: We conducted a cluster-randomized controlled trial involving 140 lower secondary schools in Vietnam. After stratifying by district, schools were randomized 1:1 to either treatment or control groups. Students enrolled in the treatment schools received monthly stand-alone health education in five topics by school teachers at the class level, but control group students did not receive any intervention. The primary outcomes of the study were students' non-cognitive skills, life satisfaction, aspirations gap, and the Health-Related Quality of Life at five-month follow-up. We estimated the intention-to-treat effects with the panel fixed effects model using student panel data.

Results: Of the 6,477 students enrolled at baseline, 2,958 (92%) treated and 2,967 (91%) control students completed the follow-up survey five months after baseline data collection from October to December 2018. Compared with controls, health education led to improved treatment school students' self-efficacy (p-value = 0.013), presumed life satisfaction five years from the present (p-value = 0.001), aspirations gap for a socially and mentally healthy future (p-value = 0.036), and the Health-Related Quality of Life (p-value = 0.036).

Conclusion: A school-based health education program enhanced students' non-cognitive skills, life satisfaction and aspirations gap, and the Health-Related Quality of Life significantly. This study proposes essential psychological factors that should be taken into account when evaluating the effectiveness of a health education program in resource-limited settings.

Fig 1. Study area.

This figure plots study schools and district boundaries in Thanh Hoa province, Vietnam. The treatment schools are denoted by solid circles, while the control schools are denoted by hollow circles. Source: Government of Viet Nam.

Fig 2. Trial profile.

The follow-up survey took place approximately five months after the baseline survey. Students who had been surveyed both at baseline and follow-up were included in the sample.

Fig 3. Treatment effects.

Coefficients and confident intervals estimated from the panel fixed effects model are plotted. Standard errors were clustered at the school level. Students’ age, the number of siblings, and the number of rooms per household member were included as control variables in addition to the student fixed effects. Continuous outcome variables were normalized by the means and standard deviations of the control group values of corresponding variables measured at baseline. Students’ knowledge levels were constructed by using the two-parameter logistic IRT model. Students who had been surveyed both at baseline and follow-up were included in the sample.