Background and Aims: Access to safe and sufficient drinking Water, Sanitation, and good Hygiene (WASH) facilities in schools play a crucial role in preventing students from numerous Neglected Tropical Diseases, improving the learning environment in schools, and creating resilient communities living in a healthy environment. This study aims to explore the impact of combining WASH facilities on students' health status, school attendance, and educational achievements.Methods: Four schools, two with improved and two without improved WASH facilities, were selected purposively from Dhanusha and Chitwan districts of Nepal. A total of 24 participants, 16 students, and eight teachers were also purposively selected based on the Theory of Data Saturation. The participants were interviewed face‐to‐face using study guidelines; Key Informants Interview for teachers and In‐depth Interview for students. The data were audio recorded and analyzed thematically using Dedoose 9.0.17 qualitative data management and analysis software.Results: School WASH facilities have a significant impact on students' health and well‐being. Poor school‐WASH facilities hindered students' school attendance, particularly for menstruating girls. School without separate toilets for girls, including menstruation hygiene facilities, lack of water and soap, sanitary pad, and secure toilet's door often have higher rates of absenteeism among girls. Poor teacher and students' relationships, students' low interest in education, household chores, and participation in social customs also contribute to students' absence from school and low educational performance. It is important to note that inadequate WASH facilities affect not only students, but also teachers in the same school.Conclusion: The lack of safe and sufficient drinking water, unimproved sanitation, and poor hygiene facilities were seen by students and teachers as reducing their health and well‐being, school attendance, and academic performance. Thus, schools need prioritize and promote the provision of improved WASH facilities for the betterment of students' health, attendance, and educational proficiency.

Background: Health-promoting actions might benefit from adolescent health literacy (AHL), however, there is scant research on it in Nepal. This study identifies adolescent students’ health literacy (HL) needs and trials an intervention to improve their HL and intention to take health-promoting actions.Methods: This study employs a pre-and post-test mixed-method intervention involving three phases. First, we will conduct a formative and summative evaluation to identify participants’ HL needs and design an intervention using quantitative and qualitative methods. Second, the intervention will be administered to the intervention group. Finally, formative and summative post-tests will be conducted to assess the effectiveness of the intervention. We will select four community schools from Birendranagar municipality based on random sampling. In quantitative research, data will be collected from adolescents selected through a census with standardized scales such as the HLS-Child-Q15, self-efficacy, social support, and health-promoting actions. A framework analysis was conducted to analyze qualitative data collected from focus group discussions with purposively chosen adolescents and key informant interviews with Health and Physical Education teachers and school nurses. Thedifference in differenceapproach will be used to analyze the intervention’s outcome, i.e., the participants’ improved HL, and health-promoting actions.Discussion: This is one of the first studies to explore HL in this group in Nepal. This study will provide the first insights into the overall level of AHL, potential AHL determinants, and the relationship between AHL and the intention to participate in health-promoting activities. The data can then be used to inform health promotion and health literacy initiatives.

Background: The literature has identified gaps in adolescent health literacy (AHL) measurements, as well as how the health literacy (HL) level is related to health promotion (HP) aspects. This study aimed to examine the tools used to measure HL and determine its relation with HP among adolescents. Methods: Three online databases (HINARI, PubMed, and DOAJ) were searched to conduct a systematic assessment of papers published between January 1, 2016, and January 1, 2021. In this review, 373 articles were identified from these databases. After removing duplicates and screening titles and abstracts of articles, 49 full texts were selected for full-text reading. After comprehensive reading, 23 papers were appraised for qualitative synthesis. Results: Of the 23 reviewed papers, 21 focused on assessing AHL measures, and 15 addressed the association between AHL and HP. Seven studies used the HL School-Aged Children instrument. The findings suggested that the methodological and conceptual underpinnings of HL measures are insufficient. Furthermore, HL acts as an independent and positive mediator for many facets of HP. Conclusion: This review offers a warning to practitioners and educationists interested in measuring HL as the number of measurement tools is quite huge with different tools applying different scales.

There is a gap in theory-based interventions targeting adolescent health literacy. This study evaluated the impact of a school-based health literacy intervention on self-efficacy, health literacy awareness, situation, and intentions to take health-promoting actions among adolescents in community schools in Surkhet, Nepal. This study followed a pre-test post-test quasi-experimental design. Based on identified health literacy needs, this study employed a five-step intervention mapping approach to design, implement, and evaluate health literacy interventions. A modified Delphi survey with interdisciplinary health experts was conducted to validate its main components, ensuring contextualisation. It was implemented over 13 classroom sessions in the intervention groups via 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?), led by nine interdisciplinary facilitators. Of the N = 468 participants, 144 participated in the intervention group and 324 participated in the non-intervention group. To evaluate the intervention’s effectiveness, the same self-administered questionnaires, such as HL awareness, HLS-Child-24-Nep, health-promoting actions, and self-efficacy, were used in the pre- and post-test. The intervention’s effectiveness was analysed via percentages for binary responses and paired t-tests for normally distributed responses. The generalised estimation equation model (GEE) ensured its effectiveness on the outcomes. The intervention significantly improved HL awareness, self-efficacy, and overall health literacy, including four dimensions (access, understanding, appraising, and applying health information) across three health domains (health care, disease prevention, and health promotion). Furthermore, the intervention significantly led to the intention to take health-promoting action and its five constructs. GEE analysis confirmed the intervention’s effectiveness in terms of self-efficacy, health-promoting actions, and health literacy (p < 0.001), excluding exercise behaviour (p > 0.05). The study revealed that a multicomponent intervention improves adolescent health literacy and health-promoting actions. This study suggests that adolescent health literacy can be enhanced by empowering teachers, parents, and schools through multilevel interventions.

The present study aims to examine the multi-level barriers to utilize by the youth-friendly reproductive health services (YFRHS) among the school-going youths of the Surkhet valley of Nepal. This study is based on the sequential explanatory research design under mixed-method research. The quantitative data were collected using the self- administered questionnaire from the 249 youths, aged between the 15-24 years, those selected by using random sampling. The qualitative data were collected using the Focus Group Discussions (FGDs) from the 12 participants who were selected purposively. The study confirmed that school-going youths do not have appropriate utilization of YFHS due to multi-layered barriers. However, the utilization of the service was higher among females, those the older age group, studying in the upper classes, the upper castes, and married youths. The key findings and themes are recognized as multi-layered barriers including personal-level, health system-level, community-level, and policy-level on the entire socio-ecological field. Among them, the existing health system is the foremost barrier. Multi-level interventions are, therefore, required to increase the YFRHS utilization and improve concerns for school-going-youths.

Evidence shows that the seasonal migrants returned from India have been a source of COVID-19, which helped spread it across Nepal. This cross-sectional study, guided by the Health Belief Model (HBM) model, that people's underlying believes in this case around COVID-19, is determined by a large extend their subsequent behaviors. This study aimed to examine the association between personal characteristics and perceived threats regarding COVID-19 among 384 seasonal migrants who had returned from India and were staying in a quarantine center in Surkhet, Nepal. A questionnaire was used with the help of three health workers working in the Quarantine Center. A five-point sequential grade Likert scale was constructed based on two HBM constructs, like 'perceived susceptibility' and ‘severity.' A score ≥ of 50% was designated as high, and ≤ 50% as a perceived low level of threat. Univariate and bivariate analyses were performed to interpret the data using SPSS 20 version. Generally, participants regarded the threat of COVID-19 as low. The severity of COVID-19 was thought to be greater than the vulnerability of the subjects. Gender, age, caste, education, health status, and perceived susceptibility did not correlate with perceived susceptibility. However, the participants’ demographic characteristics were associated with their perceived level of severity. Therefore, this study calls for proper risk communication to people who returned from abroad, as this is essential in promoting protective behavior during a pandemic outbreak.