Peer-reviewed article

Development of a Theory-Based Adolescent Health Literacy Intervention: A Case of Nepal.

Khanal SP, Budhathoki CB, Devkota B, Maharjan SK, Okan O · 1 Jul 2026

Abstract

Background Evidence indicates a lack of school-based interventions targeting adolescents' health literacy. To date, no structured, theory-driven, Delphi-guided health literacy intervention has been designed for Nepalese adolescents. Objective This study aims to report the systematic development of a context-specific intervention to enhance adolescent health literacy and health-promoting actions. Methods Using a concurrent mixed-methods design and a comprehensive health literacy model, the research involved 501 9th grade students from four randomly selected community schools in Birendranagar Municipality, Surkhet District, as well as their health and physical education teachers (HPE) and school nurses. Quantitative data were collected using self-administered standardized questionnaires measuring health literacy, self-efficacy, perceived social support, school environment, community environment, and health-promoting actions. Qualitative data were obtained through focus group discussions with students and key informant interviews with HPE teachers and school nurses. Key results The intervention design process followed the fundamental steps of the intervention mapping approach. After engaging with the school through formal and informal means, health literacy needs were identified and prioritized. Goals were then set, focusing on the individual and interpersonal levels. Next, all components of the intervention, including objectives, content, facilitators, methods, materials, modes, and evaluation techniques, were refined through a two-round modified Delphi process, resulting in the first draft. This draft was discussed with students, teachers, and school nurses before finalizing. The completed intervention, consisting of 13 sessions, is designed to be implemented by nine interdisciplinary facilitators using 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?). Conclusions This article reports on an intervention development process, systematically using mixed methods and the Delphi process, to offer a replicable approach to enhance adolescent health literacy and health-promoting actions.