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Development of a Theory-Based Adolescent Health Literacy Intervention: A Case of Nepal.

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Title: Development of a Theory-Based Adolescent Health Literacy Intervention: A Case of Nepal.
Authors: Khanal SP; Faculty of Education, Tribhuvan University, Kathmandu, Nepal., Budhathoki CB; Faculty of Education, Tribhuvan University, Kathmandu, Nepal., Devkota B; Faculty of Education, Tribhuvan University, Kathmandu, Nepal., Maharjan SK; Faculty of Education, Tribhuvan University, Kathmandu, Nepal., Okan O; Technical University, Munich, School of Medicine and Health, Center for Health and Medicine in Society, Center for Health Promotion in Childhood and Adolescence, Munich, Germany.
Source: Health literacy research and practice [Health Lit Res Pract] 2026 Jul; Vol. 10 (3), pp. e117-e129. Date of Electronic Publication: 2026 Sep 07.
Publication Type: Journal Article
Language: English
Journal Info: Publisher: Slack Incorporated Country of Publication: United States NLM ID: 101712185 Publication Model: Print-Electronic Cited Medium: Internet ISSN: 2474-8307 (Electronic) Linking ISSN: 24748307 NLM ISO Abbreviation: Health Lit Res Pract Subsets: MEDLINE
Imprint Name(s): Original Publication: Thorofare, NJ : Slack Incorporated, [2017]-
MeSH Terms: Health Literacy*/methods , Health Literacy*/standards , Program Development*/methods, Focus Groups/methods ; Health Promotion/methods ; Humans ; Adolescent ; Nepal ; Female ; Male ; Surveys and Questionnaires ; Delphi Technique ; Qualitative Research
Abstract: Background: Evidence indicates a lack of school-based interventions targeting adolescents' health literacy. To date, no structured, theory-driven, Delphi-guided health literacy intervention has been designed for Nepalese adolescents.
Objective: This study aims to report the systematic development of a context-specific intervention to enhance adolescent health literacy and health-promoting actions.
Methods: Using a concurrent mixed-methods design and a comprehensive health literacy model, the research involved 501 9th grade students from four randomly selected community schools in Birendranagar Municipality, Surkhet District, as well as their health and physical education teachers (HPE) and school nurses. Quantitative data were collected using self-administered standardized questionnaires measuring health literacy, self-efficacy, perceived social support, school environment, community environment, and health-promoting actions. Qualitative data were obtained through focus group discussions with students and key informant interviews with HPE teachers and school nurses.
Key Results: The intervention design process followed the fundamental steps of the intervention mapping approach. After engaging with the school through formal and informal means, health literacy needs were identified and prioritized. Goals were then set, focusing on the individual and interpersonal levels. Next, all components of the intervention, including objectives, content, facilitators, methods, materials, modes, and evaluation techniques, were refined through a two-round modified Delphi process, resulting in the first draft. This draft was discussed with students, teachers, and school nurses before finalizing. The completed intervention, consisting of 13 sessions, is designed to be implemented by nine interdisciplinary facilitators using the SHOWED questioning framework (What do you see here? What is happening? How does this relate to our lives? Why does the problem exist? What can we do?).
Conclusions: This article reports on an intervention development process, systematically using mixed methods and the Delphi process, to offer a replicable approach to enhance adolescent health literacy and health-promoting actions.
Competing Interests: Disclosure: The authors have disclosed no potential conflicts of interest, financial or otherwise.
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Contributed Indexing: Local Abstract: [plain-language-summary] We developed a school health literacy program, using the comprehensive model of health literacy to improve the school adolescents' ability to handle health information and health activities. A hard mixed-methods design identified the HL needs, and a modified Delphi study was used to refine the main components of the intervention. This development process resulted in a total of 13 sessions. The sessions were planned to be carried out using a dialogical pedagogy by facilitators from different interrelated areas in the schools. The program provides schools with a simple, cheap, and suitable method of educating adolescents on health literacy and health-promoting actions. It provides a realistic example, which can be adopted by other schools.
Entry Date(s): Date Created: 20260904 Date Completed: 20260904 Latest Revision: 20260908
Update Code: 20260908
PubMed Central ID: PMC13541296
DOI: 10.3928/24748307-20260413-01
PMID: 42696373
Database: MEDLINE
Description
ISSN:2474-8307
DOI:10.3928/24748307-20260413-01