Effects of a storyline-based health literacy program on rabies protective behavior among primary school students: A quasi-experimental study

Vollständiger Abstract

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Background and Aim: Rabies remains a major zoonotic public health problem despite being entirely preventable, with school-aged children representing one of the most vulnerable populations because of frequent contact with dogs and limited awareness of appropriate protective practices. Conventional school-based education often improves knowledge but has limited influence on sustained behavioral change. This study evaluated the effectiveness of a storyline-based educational program integrating health literacy (HL) and Protection Motivation Theory (PMT) in improving rabies health literacy (RHL) and rabies protective behavior (RPB) among upper primary school students in Kanchanaburi Province, Thailand. Materials and Methods: A quasi-experimental pre-test post-test study with a comparison group was conducted among 69 upper primary school students from two matched public primary schools. The experimental group (n = 38) participated in a Rabies-Storyline Program consisting of four weekly 45-minute sessions integrating storyline pedagogy, HL principles, PMT, and parental reinforcement through a group on the LINE messaging application (LINE Corporation, Tokyo, Japan), whereas the comparison group (n = 31) received routine school health education. RHL, comprising access, understanding, appraisal, and application domains, and RPB were assessed using validated questionnaires. Between-group differences were analyzed using multivariate analysis of covariance and analysis of covariance, whereas behavioral maintenance was examined using repeated-measures analysis of variance. Results: The intervention significantly improved overall RHL compared with the comparison group (Pillai's trace = 0.37, F(4, 62) = 9.09, p < 0.001, ηp² = 0.37). Significant improvements were observed across all four literacy domains, with the largest effect in the application domain (3.62 ± 0.30 vs. 3.03 ± 0.49; F(1, 65) = 33.68, p < 0.001, ηp² = 0.34). RPB was also significantly higher in the experimental group than in the comparison group (3.51 ± 0.41 vs. 3.17 ± 0.35; F(1, 66) = 15.61, p < 0.001, ηp² = 0.19). Within the experimental group, protective behavior increased significantly from baseline (3.03 ± 0.44) to post-intervention (3.51 ± 0.41; p < 0.001) and remained significantly higher after 4 weeks (3.38 ± 0.52; p = 0.008), indicating short-term maintenance of behavioral improvement. Conclusion: The storyline-based program effectively enhanced rabies health literacy and protective behaviors among primary school students while maintaining short-term behavioral gains. Integrating health literacy, Protection Motivation Theory, narrative pedagogy, and parental engagement provides an innovative, scalable, and child-centered educational strategy that complements One Health rabies control initiatives and supports progress toward the global "Zero by 30" objective. Keywords: behavior change, health literacy, One Health, primary school students, Protection Motivation Theory, rabies, storyline approach, zoonotic disease prevention.