# Peer-led versus routine health education for schistosomiasis knowledge improvement among primary school students in Wuhan, China

## TL;DR

Peer-led health education improved schistosomiasis knowledge more than routine methods among Chinese schoolchildren in a post-transmission area.

## Contribution

Demonstrates peer-led education's superior effectiveness for knowledge improvement in schistosomiasis control in post-transmission settings.

## Key findings

- Peer-led education significantly increased knowledge scores compared to routine education.
- Both methods improved attitudes and practices, but peer-led showed no significant advantage in these areas.
- Peer-led education increased the odds of achieving good knowledge sixfold compared to routine education.

## Abstract

Schistosomiasis, a neglected tropical disease (NTD), remains a public health concern in China. Health education is a fundamental intervention for its control. Even in transmission-interrupted areas like Wuhan, sustained awareness is crucial. However, recent literature on school-based interventions evaluating knowledge, attitudes and practices (KAP) among children in such areas is limited.

This study aimed to evaluate and compare the effectiveness of peer-led education versus routine health education in improving schistosomiasis-related KAP among elementary students in an urban area where schistosomiasis transmission has been interrupted.

A quasi-experimental school-level trial was conducted from October 2021 to January 2022 among 1013 fourth- and fifth-grade students of Yucai Hankou and Dijiao primary schools in Jiang’an district, Wuhan, China. Students were randomly assigned to two groups. Group I (n = 524) received peer-led education, while Group II (n = 489) received routine health education. Schistosomiasis-related KAP were assessed via standardized questionnaires at baseline and one month post-intervention. Statistical analyses followed the intention-to-treat principle, using multiple imputation for missing baseline data. Intervention effects were evaluated via analysis of covariance (ANCOVA) and multivariable logistic regression, adjusting for baseline scores and demographic covariates.

Following the intervention, both peer-led and routine health education interventions significantly improved schistosomiasis-related KAP scores among schoolchildren. For knowledge scores, both groups showed significant improvement from baseline to follow-up (within-group change: 2.93 for Group I vs. 0.98 for Group II, both P < 0.001). After adjusting for baseline scores, age, sex, and grade, Group I demonstrated a significantly higher adjusted mean score of 8.73 (95% CI: 8.63, 8.84) compared to Group II, which had an adjusted mean of 7.21 (95% CI: 7.10, 7.32). The adjusted mean difference (AMD) was 1.52 (95% CI: 1.37, 1.68), which was statistically significant (P < 0.001). For attitude scores, both groups exhibited small but statistically significant increases from baseline (within-group change: 0.20 for Group I vs. 0.21 for Group II, both P < 0.001). However, the between-group comparison revealed no significant difference at follow-up. For practice scores, significant within-group improvements were observed in both Group I and Group II (within-group change: 0.30 vs. 0.33, both P < 0.001). The adjusted mean was 3.95 (95% CI: 3.93, 3.97) in Group I and 3.97 (95% CI: 3.95, 4.00) in Group II. The AMD was -0.02 (95% CI: -0.06, 0.01), and this between-group difference was not statistically significant (P = 0.237). In terms of binary outcomes, the odds of achieving good knowledge were 6.04 times higher in Group I compared to Group II (aOR = 6.04, 95% CI: 4.43 to 8.24, P < 0.001), while no significant effects were observed on positive attitude or favorable practices between the two groups.

Peer-led education is more effective than routine health education in improving schistosomiasis-related knowledge among primary school students in a transmission-interrupted area. Although both approaches enhanced KAP, the peer-led model demonstrated superior knowledge gains. These findings support the integration of peer-led strategies into sustainable school-based health education programmes to maintain schistosomiasis awareness and support ongoing control efforts in post-transmission settings.

In regions like Wuhan, China, where schistosomiasis transmission has been interrupted, sustaining knowledge and preventive behaviors through health education remains a public health priority, yet evidence on optimal strategies is limited. To address this, we conducted a quasi-experimental school-level trial among 1013 primary school students, comparing a peer-led education approach to routine health education. Our study found that while both interventions successfully improved students’ attitudes and practices, peer-led education was significantly more effective at enhancing knowledge scores. These results demonstrate that participatory, peer-led methods are superior for knowledge retention and should be integrated into sustainable control programs in post-elimination settings to maintain protective behaviors and prevent resurgence among key at-risk groups like schoolchildren.