The Effect of a School Nurse-Led Symptom Awareness and Appropriate Help-Seeking Program on Health Behaviors of Middle School Students: A Randomized Controlled Pilot Study

Middle school years represent a critical developmental period during which health behaviors and help-seeking patterns begin to take shape. Middle school students frequently experience common physical symptoms such as headache, abdominal pain, dizziness, and fatigue; however, they may have difficulty recognizing these symptoms as meaningful body signals and deciding when and from whom to seek help. Inadequate symptom awareness and inappropriate help-seeking behaviors in this age group may lead to delayed care, increased health risks, and ineffective use of school health services. Therefore, school-based interventions targeting symptom awareness and appropriate help-seeking behaviors are essential in school health nursing practice.

This study is designed as a cluster randomized controlled pilot trial to evaluate the effectiveness of a school nurse-led symptom awareness and appropriate help-seeking program on the health behaviors of middle school students (approximately aged 10-13 years). Randomization will be conducted at the class level to minimize contamination between students within the same school environment. Classes will be randomly assigned to either the intervention group or the control group.

The intervention group will receive a structured education program delivered by a school nurse over four sessions. The program focuses on recognizing body signals, understanding common symptoms, interpreting symptom severity, and making appropriate help-seeking decisions within the school context (e.g., seeking help from a teacher, school nurse, or family member). The content is designed to be age-appropriate, interactive, and supportive of students' active participation. The control group will continue with routine school activities without receiving any additional intervention.

Data will be collected at two time points: baseline (pre-test) and post-intervention (post-test). The primary outcome is help-seeking behavior, assessed using a scenario-based help-seeking test. Secondary outcomes include help-seeking attitudes and school health office visit records. The scenario-based assessment evaluates students' ability to recognize symptom severity and choose appropriate help-seeking strategies in common school-related situations.

The findings of this study are expected to provide preliminary evidence regarding the effectiveness and feasibility of school nurse-led interventions in improving symptom awareness and help-seeking behaviors among middle school students. The results will contribute to the development of evidence-based school health programs and support the role of school nurses in promoting early recognition of health problems and appropriate use of health services.