Introduction of health champions through school nurse-led health education to improve adolescent health literacy in Bangladesh: A quasi-experimental study

Background Health literacy (HL) is an individual’s capacity to obtain, process, and understand health information and services to make appropriate health decisions. It is a crucial social determinant of health and is especially important during adolescence. Evidence on school nurse-led, adolescent-centered HL interventions in low-resource settings remains limited. In Bangladesh, limited school health services, the absence of school nurses, lack of engagement of adolescents for community advocacy and sociocultural barriers contribute to low adolescent HL. Therefore, this study aimed to evaluate the effectiveness of the school nurse-led adolescent health champion model in improving HL among adolescents and its potential impact on community HL. Methods A pilot study with a pre–post quasi-experimental design was conducted between February 2024 and August 2025 at a girls’ secondary school in a semi-urban area of Bangladesh. School nurses delivered a 3-month health education to 8th-grade students (n = 134). Based on midline performance, 59 students were trained as health champions and facilitated community health education under the supervision of school nurses. After 3 months of health education for the community participants, health champions and community participants were evaluated (endline). Primary outcomes included adolescents’ HL measured using the Health Literacy Scale for School-aged Children (HLSAC). Secondary outcomes included self-efficacy, health knowledge, health behaviours and reproductive HL. HL of the community participants (n = 200) were assessed using the European Health Literacy Survey Questionnaire (HLS-Q12). Results Adolescents’ mean HL score increased significantly from baseline to endline (30.9 ± 3.9 to 37.5 ± 2.1; p < 0.001). Significant improvements were also observed in self-efficacy, health knowledge, health behaviours and reproductive HL (all p < 0.001). Community participants showed marked improvement in HL with 91.7% and reached an excellent level at the endline. Qualitative analysis indicated increased confidence, leadership, and social responsibility among health champions. Conclusion A nurse-led, adolescent health champion model is a feasible and effective approach to improving adolescents' and community people’s HL in resource-limited settings. Integrating school nurses-led health education may strengthen adolescent health promotion in Bangladesh.