Document Type : Research Article (s)


1 Department of Educational Sciences, Tabriz Branch, Islamic Azad University, Tabriz, Iran

2 Department of Educational Sciences, Farhanghian University, East Azarbayjan, Tabriz, Iran


Background: Schools have an important role to play in helping students achieve buoyancy (AB) and healthy learning. The main purpose of this study is to predict students’ academic buoyancy based on the health literacy (HL) of school health nurses (SHN) and their performance in health promoting high schools.
Methods: This descriptive correlational study consisted of the SHN of all health promotion secondary schools of East Azarbaijan province educational districts. The statistical population of the study includes 260 SHN in schools in the 2019-2020 academic year. For sampling, 160 SHN and 320 students were selected using stratified random sampling. For data collection, we used the HL Questionnaire of the Institute of Health Sciences, the SHN Performance Questionnaire of Vaparzeh and colleagues and the AB Questionnaire of Hosseinchari and Dehghanizadeh.
Results: Estimation of the descriptive statistics and the correlation of variables based on SPSS software showed that the means of HL (141.41±18.49), performance (95.45±12.89), and AB (52.3±6.81) were higher than average. There was a significant correlation between HL, performance, and AB. The results of structural equation modeling with PLS software demonstrated that the performance of SHN and its dimensions could be predicted based on HL (p <0.001), But students’ AB is not predictable based on HL (P=0.054) and the performance of SHNs (P=0.63) or mediated by their performance (P=0.09).
Conclusion: Health literacy promotion programs for teachers and school nurses can ensure the success of schools in improving student health.


1. Shinde S, Pereira B, Khandeparkar P, Sharma A, Patton G, Ross DA, et al. The development and pilot testing of a multicomponent health promotion intervention (SEHER) for secondary schools in Bihar, India. Global health action. 2017;10(1):1385284-. doi:10.1080/16549716.2017.1385284. ## 2. Pearson M, Chilton R, Wyatt K, Abraham C, Ford T, Woods HB, et al. Implementing health promotion programmes in schools: a realist systematic review of research and experience in the United Kingdom. Implement Sci. 2015;10:149. doi:10.1186/s13012-015-0338-6. ## 3. McIsaac JL, Mumtaz Z, Veugelers PJ, Kirk SF. Providing context to the implementation of health promoting schools: A case study. Eval Program Plann. 2015;53:65-71. doi:10.1016/j.evalprogplan. 2015.08.003. PubMed PMID: 26310497. ## 4. World Healh Organization. The Ottawa charter for health promotion. Copenhagen: WHO Regional Office for Europe; 1986. ## 5. Ramezani H, Nik Bakht Nr, Shirvani S, Ahooie K, Mohsenian H. Impact of Health Promoter Schools Program on Babol City Schools. . Health & Health Care. 2013;(5). 547-556. ## 6. Hirvonen R, Yli-Kivistö L, Putwain DW, Ahonen T, Kiuru N. School-related stress among sixth-grade students – Associations with academic buoyancy and temperament. Learning and Individual Differences. 2019; 70:100-8. doi:10.1016/j.lindif.2019.01.012. ## 7. Putwain, D. W., Symes, W., Connors, L., & Douglas-Osborn, E. Is academic buoyancy anything more than adaptive coping? Anxiety, Stress and Coping, 2012.25 (3), 349–358. PubMed PMID: 21644112. ## 8. Sarah, M., Paul, C., & Lisa. K. M. Well-being, Academic buoyancy and educational achievement in primary school student. International Journal of Educational Research, 2013: 62, 239-248. ## 9. Puolakanaho A, Lappalainen R, Lappalainen P, Muotka JS, Hirvonen R, Eklund KM, et al. Reducing Stress and Enhancing Academic Buoyancy among Adolescents Using a Brief Web-based Program Based on Acceptance and Commitment Therapy: A Randomized Controlled Trial. J Youth Adolesc. 2019;48(2):287-305.doi:10.1007/s10964-018-0973-8. PubMed PMID: 30560515; PubMed Central PMCID: PMC6394525. ## 10. Comerford J, Batteson T, Tormey R. Academic Buoyancy in Second Level Schools: Insights from Ireland. Procedia - Social and Behavioral Sciences. 2015;197:98-103. doi:10.1016/j.sbspro.2015.07.061. ## 11. Putwain DW, Daly AL. Do clusters of test anxiety and academic buoyancy differentially predict academic performance? Learning and Individual Differences. 2013;27:157-62. doi:10.1016/j.lindif.2013.07.010. ## 12. Collie RJ, Martin AJ, Malmberg LE, Hall J, Ginns P. Academic buoyancy, student's achievement, and the linking role of control: A cross-lagged analysis of high school students. The British journal of educational psychology. 2015;85(1):113-30. doi:10.1111/bjep.12066. ## 13. Nemat Shahrabaki B, Fallahi A. Explaining the Needs of Health Educators in Teaching Health Behaviors to Students: A Qualitative Study, Social Health. 2017. Volume 4, Number 4, Autumn, Pages 286 to 297. ## 14. Madariaga L, Nussbaum M, Burq I, Marañón F, Salazar D, Maldonado L, et al. Online survey: A national study with school principals. Computers in Human Behavior, 2017. 74, 35-44. doi:10.1016/j.chb.2017.03.067. ## 15. Chen H, Su Y, Zheng Q, Li L. Towards an operationalized and effective school self-evaluation system: An ongoing action research study in Chinese secondary schools since 2011.Studies in Educational Evaluation, 2019.60, 117-129. doi:10.1016/j.stueduc.2018.12.005. ## 16. Aaby A, Friis K, Christensen B, Maindal HT. Health Literacy among People in Cardiac Rehabilitation: Associations with Participation and Health-Related Quality of Life in the Heart Skills Study in Denmark. International journal of environmental research and public health. 2020;17(2). doi:10.3390/ijerph17020443. ## 17. Sorensen K, Van den Broucke S, Fullam J, Doyle G, Pelikan J, Slonska Z, et al. Health literacy and public health: a systematic review and integration of definitions and models. BMC Public Health. 2012;12:80. doi:10.1186/1471-2458-12-80. ## 18. Huhta AM, Hirvonen N, Huotari ML. Health Literacy in Web-Based Health Information Environments: Systematic Review of Concepts, Definitions, and Operationalization for Measurement. J Med Internet Res. 2018;20 (12):e10273.doi: 10.2196/10273 . PubMed PMID: 30567690; PubMed Central PMCID: PMC6315258. ## 19. Gase LN, Gomez LM, Kuo T, Glenn BA, Inkelas M, Ponce NA. Relationships Among Student, Staff, and Administrative Measures of School Climate and Student Health and Academic Outcomes. J Sch Health. 2017;87(5):319-28. doi:10.1111/josh.12501. PubMed PMID: 28382671; PubMed Central PMCID: PMC5876042. ## 20. Moghaddam Hosseini, S., Talebi, B. A Partial Least Squares Path Model of Principals’ Performance in School Health Services Based on Spiritual Intelligence in Tabriz Female High Schools. International Journal of School Health, 2018; 5(3): 1-8. doi: 10.5812/intjsh.77217. ## 21. Rathmann K, Herke M, Hurrelmann K, Richter M. [Class Climate, Academic Well-Being and Self-Rated Health Among School Children in Germany: Findings of the National Educational Panel Study (NEPS)]. Gesundheitswesen. 2018;80(4):332-41. doi:10.1055/s-0043- 121886. PubMed PMID: 29539650. ## 22. Vaparzeh F, Talebi B, Sameri M. Analysis of school principals' performance based on professional ethics mediated by job characteristics in health-promoting schools. School Management, 2019; 7 (3): 195-212. doi: 10.34785 / J010.1398.502. ## 23. Montazeri A, Tavousi M, Rakhshani F, Azin S A, Jahangiri K, Ebadi M, et al . Health Literacy for Iranian Adults (HELIA): development and psychometric properties. Payesh. 2014; 13 (5):589-599. Persian. ## 24. Dehghanizadeh M H, Hossein Chari M. Academic buoyancy and perception of family communication pattern; mediating role of self-efficacy. Journal of Teaching and Learning Studies, 2012; 4 (2): 21-47. doi: 10.22099 / jsli.2013.1575. ## 25. Khodabandeh, M, Maleki Avarsin, Sh, Nick Niaz, L. The Relationship between Health Literacy, Perceived Self-efficacy and Self-Care Performance of Secondary School Girls' Students in Middle School Health Promoters 2016-96. 2 (3): 164-176. doi: 10.22038 / jhl.2017.10937. ## 26. Haverinen-Shaughnessy U, Shaughnessy RJ, Cole EC, Toyinbo O, Moschandreas DJ. An assessment of indoor environmental quality in schools and its association with health and performance. Building and Environment. 2015; 93:35-40. doi:10.1016/j.buildenv.2015.03.006. ## 27. Bohnenkamp JH, Hoover SA, Connors EH, Wissow L, Bobo N, Mazyck D. The Mental Health Training Intervention for School Nurses and Other Health Providers in Schools. The Journal of school nursing : the official publication of the National Association of School Nurses. 2019; 35(6):422-33. doi:10.1177/1059840518785437. ## 28. Kim RE, Becker KD, Stephan SH, Hakimian S, Apocada D, Escudero PV, et al. Connecting Students to Mental Health Care: Pilot Findings from an Engagement Program for School Nurses. Adv Sch Ment Health Promot. 2015; 8(2):87-103. doi:10.1080/1754730X.2015.1021821. PubMed PMID: 26251671; PubMed Central PMCID: PMC4523380. ## 29. Fretian A, Bollweg TM, Okan O, Pinheiro P, Bauer U. Exploring Associated Factors of Subjective Health Literacy in School-Aged Children. Int J Environ Res Public Health. 2020; 17(5):1720. doi:10.3390/ijerph17051720. PubMed PMID: 32155711; PubMed Central PMCID: PMC7084889. ## 30. Palumbo R. Examining the impacts of health literacy on healthcare costs. An evidence synthesis. Health Serv Manage Res. 2017;30(4):197-212. doi:10.1177/0951484817733366. PubMed PMID: 29034727. ## 31. Doi L, Wason D, Malden S, Jepson R. Supporting the health and well-being of school-aged children through a school nurse programme: a realist evaluation. BMC health services research. 2018; 18(1):664-. doi:10.1186/s12913-018-3480-4. ## 32. Denuwara HMBH, Gunawardena NS. Level of health literacy and factors associated with it among school teachers in an education zone in Colombo, Sri Lanka. BMC public health. 2017; 17(1):631-. doi:10.1186/s12889-017-4543-x. ## 33. Paakkari L, George S. Ethical underpinnings for the development of health literacy in schools: ethical premises ('why'), orientations ('what') and tone ('how'). BMC public health. 2018; 18(1):326-. doi:10.1186/s12889-018-5224-0. ## 34. Brach C. The Journey to Become a Health Literate Organization: A Snapshot of Health System Improvement. Studies in health technology and informatics. 2017;240:203-3. PubMed PMID: 28972519; PubMed Central PMCID: PMC5666686. ##