Restricted accessResearch articleFirst published online 2025
Effectiveness of a School-Based Health Education Using Social Networking Media to Promote Health Behaviors in Elementary School Students: A Quasi-Experimental Study
This study examined the effectiveness of an 8-week “Health Education using Social Networking Service (HE-SNS)” intervention, led by school health teachers, on perceived social support and health behaviors among elementary school students in South Korea. Using a quasi-experimental design with class-level random assignment, 90 students from six classes were assigned to the HE-SNS group, health education (HE) group, or control group. The HE-SNS intervention, led by a school nurse, integrated classroom health education with social networking activities involving students, teachers, and parents. Linear mixed model analysis revealed significant group-by-time interaction effects on social support (F = 20.13, p < .001) and health behavior scores (F = 24.69, p < .001). Post hoc Bonferroni tests showed that the HE-SNS group demonstrated greater improvements than the HE and control groups. These findings suggest that school nurse-facilitated SNS-based health education interventions may enhance social support and health behaviors among elementary school students.
AbamechaF.SudhakarM.AbebeL.KebedeY.AlemayehuG.BirhanuZ. (2021). Effectiveness of the school-based social and behaviour change communication interventions on insecticide-treated nets utilization among primary school children in rural Ethiopia: A controlled quasi-experimental design. Malaria Journal, 20, 1–15. https://doi.org/10.1186/s12936-020-03550-9
2.
BanduraA. (1986). Social foundations of thought and action: A social cognitive theory. Prentice-Hall.
3.
BauerA.StevensM.PurtschellerD.KnappM.FonagyP.Evans-LackoS.PaulJ. (2021). Mobilising social support to improve mental health for children and adolescents: A systematic review using principles of realist synthesis. PLoS One, 16(5), e0251750. https://doi.org/10.1371/journal.pone.0251750
4.
Bektasİ.KudubeşA. A.AyarD.BektasM. (2021). Predicting the healthy lifestyle behaviors of Turkish adolescents based on their health literacy and self-efficacy levels. Journal of Pediatric Nursing, 59, e20–e25. https://doi.org/10.1016/j.pedn.2021.01.016
5.
BurdetteA. M.NeedhamB. L.TaylorM. G.HillT. D. (2017). Health lifestyles in adolescence and self-rated health into adulthood. Journal of Health and Social Behavior, 58(4), 520–536. https://doi.org/10.1177/0022146517735313
ChoiM. (2020). Association of eHealth use, literacy, informational social support, and health-promoting behaviors: Mediation of health self-efficacy. International Journal of Environmental Research and Public Health, 17(21), 7890. https://doi.org/10.3390/ijerph17217890
8.
CohenS.HobermanH. M. (1983). Positive events and social supports as buffers of life change stress 1. Journal of Applied Social Psychology, 13(2), 99–125. https://doi.org/10.1111/j.1559-1816.1983.tb02325.x
ColeD. A.NickE. A.ZelkowitzR. L.RoederK. M.SpinelliT. (2017). Online social support for young people: Does it recapitulate in-person social support; can it help?Computers in Human Behavior, 68, 456–464. https://doi.org/10.1016/j.chb.2016.11.058
11.
DabravolskajJ.MontemurroG.EkwaruJ. P.WuX. Y.StoreyK.CampbellS.VeugelersP. J.OhinmaaA. (2020). Effectiveness of school-based health promotion interventions prioritized by stakeholders from health and education sectors: A systematic review and meta-analysis. Preventive Medicine Reports, 19, 101138. https://doi.org/10.1016/j.pmedr.2020.101138
12.
DoddS.WidnallE.RussellA. E.CurtinE. L.SimmondsR.LimmerM.KidgerJ. (2022). School-based peer education interventions to improve health: A global systematic review of effectiveness. BMC Public Health, 22(1), 2247. https://doi.org/10.1186/s12889-022-14688-3
13.
DubowE. F.UllmanD. G. (1989). Assessing social support in elementary school children: The survey of children's social support. Journal of Clinical Child Psychology, 18(1), 52–64. https://doi.org/10.1207/s15374424jccp1801_7
14.
FaulF.ErdfelderE.BuchnerA.LangA.-G. (2009). Statistical power analyses using G* Power 3.1: Tests for correlation and regression analyses. Behavior Research Methods, 41(4), 1149–1160. https://doi.org/10.3758/BRM.41.4.1149
15.
FiorellaL. (2020). The science of habit and its implications for student learning and well-being. Educational Psychology Review, 32(3), 603–625. https://doi.org/10.1007/s10648-020-09525-1
16.
GardnerB.RebarA. L.LallyP. (2022). How does habit form? Guidelines for tracking real-world habit formation. Cogent Psychology, 9(1), 2041277. https://doi.org/10.1080/23311908.2022.2041277
17.
GilbertF.RichardJ.-B.Lapie-LegouisP.BeckF.VercambreM.-N. (2015). Health behaviors: Is there any distinction for teachers? A cross-sectional nationwide study. PLoS One, 10(3), Article e0120040. https://doi.org/10.1371/journal.pone.0120040
18.
GoodyearV. A.WoodG.SkinnerB.ThompsonJ. L. (2021). The effect of social media interventions on physical activity and dietary behaviours in young people and adults: A systematic review. International Journal of Behavioral Nutrition and Physical Activity, 18(1), 72. https://doi.org/10.1186/s12966-021-01138-3
19.
GüntherL.SchlebergerS.PischkeC. R. (2021). Effectiveness of social media-based interventions for the promotion of physical activity: Scoping review. International Journal of Environmental Research and Public Health, 18(24), 13018. https://doi.org/10.3390/ijerph182413018
20.
HanM. H.YooA. J. (1996). The relation of stress and perceived social support to problem behavior. Korean Journal of Child Studies, 17(1), 173–188.
21.
HerlitzL.MacIntyreH.OsbornT.BonellC. (2020). The sustainability of public health interventions in schools: A systematic review. Implementation Science, 15, 1–28. https://doi.org/10.1186/s13012-019-0961-8
22.
IBM Corp. (2022). IBM SPSS statistics for Windows, Version 29.0. In (Version 29.0 ed.). IBM Corp.
JacobC. M.Hardy-JohnsonP. L.InskipH. M.MorrisT.ParsonsC. M.BarrettM.HansonM.Woods-TownsendK.BairdJ. (2021). A systematic review and meta-analysis of school-based interventions with health education to reduce body mass index in adolescents aged 10 to 19 years. International Journal of Behavioral Nutrition and Physical Activity, 18, 1–22. https://doi.org/10.1186/s12966-020-01065-9
25.
JeonG. E.KwonI. S. (2017). Factors affecting health promotion behaviors of upper grade elementary students. Child Health Nursing Research, 23(3), 319–328. https://doi.org/10.4094/chnr.2017.23.3.319
26.
JiroutJ.LoCasale-CrouchJ.TurnbullK.GuY.CubidesM.GarzioneS.EvansT. M.WeltmanA. L.KranzS. (2019). How lifestyle factors affect cognitive and executive function and the ability to learn in children. Nutrients, 11(8), 1953. https://doi.org/10.3390/nu11081953
27.
KarimiN.Saadat-GharinS.TolA.SadeghiR.YaseriM.MohebbiB. (2019). A problem-based learning health literacy intervention program on improving health-promoting behaviors among girl students. Journal of Education and Health Promotion, 8(1), 251. https://doi.org/10.4103/jehp.jehp_476_19
28.
KimE. K.LeeD. K. (2012). Effects of health education by the method of PBL (problem-based learning) on the health promoting behavior of elementary school students. The Korean Journal of Elementary Physical Education, 18(1), 37–45.
29.
KimI. S.HanT. I. (2015). A study on the learning effect of collaborative learning using SNS in computer subjects. Proceedings of the Korean Society for E-Learning Conference, 6(1), 51–54.
30.
KimY. H.ShinS. R. (2021). Development and effectiveness of a mobile health lifestyle program for university students. Journal of Korean Academy of Community Health Nursing, 32(2), 150–161. https://doi.org/10.12799/jkachn.2021.32.2.150
31.
KimY. I.ParkE. (2013). The effects of health education on health knowledge and health promoting behaviors in elementary school students. Journal of the Korean Society of School Health, 26(2), 55–61.
32.
Leahy-WarrenP. (2014). Social support theory. In FitzpatrickJ. J.McCarthyG. (Eds.), Theories guiding nursing research and practice: Making nursing knowledge development explicit (pp. 85–101). Springer Publishing Company.
33.
LeeH. Y.EomW. (2017). The effects of flipped learning using educational SNS: Focusing on mathematics in elementary school. Korean Association for Educational Information and Media, 23(1), 109–138. https://doi.org/10.15833/KAFEIAM.23.1.109
MahmoodL.Flores-BarrantesP.MorenoL. A.ManiosY.Gonzalez-GilE. M. (2021). The influence of parental dietary behaviors and practices on children’s eating habits. Nutrients, 13(4), 1138. https://doi.org/10.3390/nu13041138
36.
McPhersonA.MackayL.KunkelJ.DuncanS. (2018). Physical activity, cognition and academic performance: An analysis of mediating and confounding relationships in primary school children. BMC Public Health, 18, 1–9. https://doi.org/10.1186/s12889-018-5863-1
37.
MichaelS. L.BarnesS. P.WilkinsN. J. (2023). Scoping review of family and community engagement strategies used in school-based interventions to promote healthy behaviors. Journal of School Health, 93(9), 828–841. https://doi.org/10.1111/josh.13367
38.
Ministry of Education. (2008). Health education curriculum. https://ncic.re.kr
39.
Ministry of Health and Welfare [MOHW]. (2024). 2023 National survey on the situation of children in Korea: Summary report. Ministry of Health and Welfare. https://www.mohw.go.kr/
40.
MontgomeryS. C.DonnellyM.BhatnagarP.CarlinA.KeeF.HunterR. F. (2020). Peer social network processes and adolescent health behaviors: A systematic review. Preventive Medicine, 130, 105900. https://doi.org/10.1016/j.ypmed.2019.105900
41.
NaJ. H.ChooJ. (2019). Effects of an experiential learning activities-focused smoking prevention program in elementary school students: On the basis of the attitude-social influence-efficacy model. Korean Journal of Health Promotion, 19(2), 96–106. https://doi.org/10.15384/kjhp.2019.19.2.96
42.
Nagy-PénzesG.VinczeF.BíróÉ (2022). A school intervention’s impact on adolescents’ health-related knowledge and behavior. Frontiers in Public Health, 10, 822155. https://doi.org/10.3389/fpubh.2022.822155
43.
NahJ. Y.KimY. I.KimH. S. (2011). The effects of systematic health education on health knowledge and health promotion behavior in elementary school students. Journal of the Korean Society of School Health, 24(2), 173–180.
NutbeamD. (2000). Health literacy as a public health goal: A challenge for contemporary health education and communication strategies into the 21st century. Health Promotion International, 15(3), 259–267. https://doi.org/10.1093/heapro/15.3.259
46.
RuiJ. R. (2023). Health information sharing via social network sites (SNSs): Integrating social support and socioemotional selectivity theory. Health Communication, 38(11), 2430–2440. https://doi.org/10.1080/10410236.2022.2074779
47.
RyuJ. E.KimY.-S.KimH. S. (2012). Effects of cooperative learning methods on sex education among primary school students. Journal of the Korean Society of School Health, 25(1), 122–132.
48.
School Health Act. (2022). § 9-2: National Law Information Center. https://www.law.go.kr
49.
SeoH. M.HahY. S. (2004). A study of factors influencing on health promoting lifestyle in the elderly: Application of Pender’s health promotion model. Journal of Korean Academy of Nursing, 34(7), 1288–1297. https://doi.org/10.4040/jkan.2004.34.7.1288
50.
ShoesmithA.HallA.WolfendenL.SheltonR. C.PowellB. J.BrownH.McCrabbS.SutherlandR.YoongS.LaneC. (2021). Barriers and facilitators influencing the sustainment of health behaviour interventions in schools and childcare services: A systematic review. Implementation Science, 16(1), 62. https://doi.org/10.1186/s13012-021-01134-y
51.
Solera-SanchezA.Adelantado-RenauM.Moliner-UrdialesD.Beltran-VallsM. R. (2021). Health-related quality of life in adolescents: Individual and combined impact of health-related behaviors (DADOS study). Quality of Life Research, 30, 1093–1101. https://doi.org/10.1007/s11136-020-02699-9
WalkerS. N.SechristK. R.PenderN. J. (1987). The health-promoting lifestyle profile: Development and psychometric characteristics. Nursing Research, 36(2), 76–81. https://doi.org/10.1097/00006199-198703000-00002
54.
WangM.HanX.FangH.XuC.LinX.XiaS.YuW.HeJ.JiangS.TaoH. (2018). Impact of health education on knowledge and behaviors toward infectious diseases among students in Gansu Province, China. BioMed Research International, 2018(1), 6397340. https://doi.org/10.1155/2018/6397340
55.
WooO.-Y.KimD.-Y.ShinM.-S.KimM.-K.WooY.-M. ParkS.-A.HanH.-J.KimY.-S.KimM.-Y.KimH.-J.JooA.-Y. (2021). Together in health: Health education textbook for grades 5 and 6. YBM.
56.
WoodW.NealD. T. (2016). Healthy through habit: Interventions for initiating & maintaining health behavior change. Behavioral Science & Policy, 2(1), 71–83. https://doi.org/10.1177/237946151600200109
57.
World Health Organization[WHO] (2009). Milestones in health promotion: Statements from global conferences. World Health Organization.
World Health Organization [WHO]. (2021). Guideline on school health services.
60.
WuX.OhinmaaA.VeugelersP. J.MaximovaK. (2024). Health-related quality of life in relation to health behaviour patterns among Canadian children. Children, 11(3), 346. https://doi.org/10.3390/children11030346
61.
WyattT. H.BaylessA. K.KrauskopfP.GaylordN. (2021). Using mHealth applications to promote self-managed health behaviors among teens. Journal of Pediatric Nursing, 59, 164–172. https://doi.org/10.1016/j.pedn.2021.04.025
ZhouZ.ChengQ. (2022). Relationship between online social support and adolescents’ mental health: A systematic review and meta-analysis. Journal of Adolescence, 94(3), 281–292. https://doi.org/10.1002/jad.12031
