Volume 29, Issue 4 (Iran South Med J 2026)                   Iran South Med J 2026, 29(4): 247-266 | Back to browse issues page


XML Persian Abstract Print


Download citation:
BibTeX | RIS | EndNote | Medlars | ProCite | Reference Manager | RefWorks
Send citation to:

Ziapour A, Khazaei M R, Niromand E, Ramezani G. Transforming the Health of Iranian Students by Integrating the Skill-Based Self-Care Course in-to the Educational System: an Evidence-Based Approach. Iran South Med J 2026; 29 (4) :247-266
URL: http://ismj.bpums.ac.ir/article-1-2646-en.html
1- Cardiovascular Research Center, Health Policy and Promotion Institute, Kermanshah University of Medical Sciences, Kermanshah, Iran & Research Center for Environmental Determinants of Health (RCEDH), Health Institute, Kermanshah University of Medical Sciences, Kermanshah, Iran
2- Fertility and Infertility Research Center, Health Technology Institute, Kermanshah University of Medical Sciences, Kermanshah, Iran
3- Center for Educational Research in Medical Sciences (CERMS), Department of Medical Education, School of Medi-cine, Iran University of Medical Sciences, Tehran, Iran , ramazani.g@iums.ac.ir
Abstract:   (418 Views)
Background: Iran is experiencing an increase in lifestyle-related risk factors among students, including overweight and obesity, physical inactivity, musculoskeletal problems, and high-risk health behaviors. Although healthis addressed in educational policies, current school-based health education is largely fragmented and theoretical, lacking a cohesive framework for cultivating self-care skills. This policy brief was developed to identify the existing policy gaps and propose strategies for integrating skill-based self-care education into Iran’s formal education system.
Materials and Methods: This policy brief is based on a targeted, comparative evidence review grounded in an evidence-based policymaking framework. A comprehensive literature search was performed in IranMedex, MagIran, SID, IranDoc, PubMed, Scopus, and Web of Science databases for studies published between 2021 and 2025. Google Scholar was used to identify relevant studies, supplementary citations, and gray literature. Additionally, national policy documents and reports from the World Health Organization (WHO), the Organization for Economic Cooperation and Development (OECD), and selected countries were reviewed for relevant information.
Results: Findings reveal significant, persistent health-related risk factors among Iranian students and a substantial structural deficit in school-based self-care education. Existing education lacks a cohesive, longitudinal, and competency-based framework necessary to translate health knowledge into daily practice. Comparative analysis of models from Japan, Finland, and Australia shows that structured, skill-oriented, and school-based approaches can contribute to the promotion of healthy behaviors, health literacy, psychosocial competencies, and long-term health outcomes. Three policy options were identified: maintaining the status quo, implementing a pilot self-care program in select schools, or implementing a nationwide skill-based self-care curriculum. Comparative evaluation among the options identified the pilot implementation as the most balanced option in terms of feasibility, risk mitigation, capacity to generate local evidence, and cultural adaptability.
Conclusion: The Iranian education system must transition from fragmented and primarily knowledge-based health curriculum to an integrated, progressive, and longitudinal approach focused on self-care competencies. However, given the limited direct empirical evidence in Iran and the contextual differences between international models and Iran’s educational system, immediate nationwide implementation of this policy under the current conditions remains premature. Consequently, adopting a phased and assessment-based approach offers a robust and pragmatic foundation for future decision-making and policy formulation.
 
Full-Text [PDF 652 kb]   (164 Downloads)    
Original: Policy Brief | Subject: Policy Summary
Received: 2025/12/16 | Accepted: 2026/08/29 | Published: 2026/09/26

References
1. Musavian AS, Pasha A, Rahebi S-M, Roushan ZA, Ghanbari A. Health promoting behaviors among ad-olescents: A cross-sectional study. Nurs Midwifery Stud 2014; 3(1): e14560. [DOI]
2. Saffari M, Amini N, Ardebili HE, Sanaeinasab H, Mahmoudi M, Piper CN. Educational intervention on health related lifestyle changes among Iranian ado-lescents. Iran J Public Health 2013; 42(2): 172. [Article]
3. Shirzadi S, Borzu ZA, Jahanfar S, Alvani S, Balouchi M, Gerow HJ, et al. A comparative study of healthy lifestyle behaviors and related factors among Irani-an male and female adolescents: a cross-sectional study. BMC Public Health 2025; 25(1): 558. [DOI]
4. Rodgers GP, Gibbons GH. Obesity and hypertension in the time of COVID-19. JAMA 2020; 324(12): 1163–5. [DOI]
5. Kaur S, Kapil U, Singh P. Pattern of chronic diseases amongst adolescent obese children in developing countries. Current Sci 2005; 88(7): 1052–1056. [Article]
6. Bhagat A, Mehendale A, Muneshwar K. Study of obesity among adolescents in rural Wardha district. F1000Res 2024; 13: 527. [DOI]
7. Jackson SL, Yang EC, Zhang Z. Income disparities and cardiovascular risk factors among adolescents. Pediatr 2018; 142(5): e20181089. [DOI]
8. Gracious BL, Cook SR, Meyer AE, Chirieac MC, Malhi N, Fischetti AT, et al. Prevalence of overweight and obesity in adolescents with severe mental illness: a cross-sectional chart review. J Clin Psychiatry 2010; 71(7): 15470. [DOI]
9. Wheaton AG. Short sleep duration among infants, children, and adolescents aged 4 months–17 years—United States, 2016–2018. MMWR Morbidi-ty Mortality Weekly Report 2021; 70: 1315–21. [DOI]
10. Dehghani A, Molani-Gol R, Mohammadi-Narab M, Norouzy A, Abolhassani MH, Tabatabaee Jabali SM, et al. The prevalence of obesity and overweight among Iranian population: an umbrella systematic review and meta-analysis. BMC Public Health 2024; 24(1): 3377. [DOI]
11. Ahmadi P, Saghabashi-naeini N. A comparative study of status of health literacy in the curriculum of Finland and Iran. J Health Literacy 2020; 4(4): 9–17. [DOI]
12. Osman S, Hirsch C, Jalal Z, Paudyal V. Self-care ed-ucation in primary schools and related settings in England: An ethnographic study. Health Educ J 2025; 84(1): 82–94. [DOI]
13. Amerzadeh M, Takian A, Pouraram H, Sari AA, Ostovar A. Policy analysis of nutrition stewardship for prevention and control of Non-communicable diseases in Iran. BMC Health Serv Res 2023; 23(1): 79. [DOI]
14. World Health Organization. Global Accelerated Action for the Health of Adolescents (AA-HA!): guidance to support country implementation: World Health Organization; 2023. [Article]
15. World Health Organization. The adolescent health indicators recommended by the Global Action for Measurement of Adolescent Health: Guidance for monitoring adolescent health at country, regional and global levels: World Health Organization; 2024. [Article]
16. Liu G, Fernando Y. Health education in the parameter of physical in primary and secondary schools. International Journal of Innovation Research in Education, Technology Manag 2024; 1(1): 17–22. [DOI]
17. Angoorani P, Heshmat R, Ejtahed HS, Motlagh ME, Ziaodini H, Taheri M, et al. The association of parental obesity with physical activity and sedentary behaviors of their children: the CASPIAN‐V study. J De Pediatr (Versão em Português) 2018; 94(4): 410–8. [DOI]
18. Shokri A, Mohamadi A, Mohammadi D, Moradi M, Sadeghi S, Mahmoodi H, et al. The relationship between internet addiction and lifestyle among high school students: A cross sectional in the west of Iran. Plos One 2024; 19(9): e0308333. [DOI]
19. Honarvar B, Erfannia L, Rafiee F, Zahmatkeshan E, Balaghi Inaloo F, Hamzavizarghani N, et al. Over-weight and obesity and its determinants in primary school students: a population-based study from Iran. Sci Report 2025; 15(1): 21010. [DOI]
20. Mirhosseini NA, Lojje H, Dahaj FE, Namayandeh SM. Prevalence of Overweight and Obesity in Children Aged 6-12 Years in Yazd, Iran in 2022. J Nutrit Food Security 2025; 10(2): 244–7. [DOI]
21. Moradi G, Mostafavi F, Piroozi B, Zareie B, Mahboobi M, Rasouli MA. The prevalence of physi-cal inactivity in Iranian adolescents and the impact of economic and social inequalities on it: Results of a National Study in 2018. BMC Public Health 2020; 20(1): 1499. [DOI]
22. Kelishadi R, Qorbani M, Djalalinia S, Sheidaei A, Rezaei F, Arefirad T, et al. Physical inactivity and associated factors in Iranian children and adolescents: the Weight Disorders Survey of the CASPIAN-IV study. J Cardiovasc Thoracic Res 2017; 9(1): 41. [DOI]
23. Ziaei R, Mohammadi R, Dastgiri S, Baybordi E, Rahimi VA, Sadeghi-Bazargani H, et al. The prevalence and correlates of physical activity/inactivity and sedentary behaviour among high-school adolescents in Iran: a cross-sectional study. J Public Health 2022; 30(5): 1121–31. [DOI]
24. Ghaffar MA, Rizwan I, Khan I, Ahmed RM, Muneeb S, Lakhani A, et al. Prevalence of upper back pain due to heavy school bag among students. Insights-J Health Rehabilitat 2025; 3(3 (Health & Rehabilitation)): 94–101. [DOI]
25. Ehsani-Chimeh E, Sajadi HS, Behzadifar M, Aghaei M, Badrizadeh A, Behzadifar M, et al. Current and former smokers among adolescents aged 12–17 years in Iran: a systematic review and meta-analysis. BMC Public Health 2020; 20(1): 155. [DOI]
26. Nazarianpirdosti M, Abdi A, Abdi A, Ramazani U. Smoking among high school students in Iran: a meta-analysis study. Iran J Psychiatry 2021; 16(2): 226. [DOI]
27. Aryaie M, Sharifi H, Khorrami Z, Ardalan G, Rajaei L, Heydari G, et al. Prevalence of cigarette smoking in Iranian adolescents and young adults: a systematic review and meta-analysis. Eastern Mediterranean Health J 2021; 27(6): 612–28. [DOI]
28. Bagherian S, Ghasempoor K, Baker JS, Mashhadi M. Physical activity behaviors and overweight status among Iranian school-aged students during the COVID-19 pandemic: a big data analysis. Iran J Public Health 2022; 51(3): 676. [DOI]
29. Karimiyarandi H, Khalilizad M. Prevalence of orthopedic pains in children and adolescents: A systematic review and meta-analysis. Anesthesiology Pain Med 2023; 13(4): e136616. [DOI]
30. Oudat Q, Messiah SE, Ghoneum AD. A Multi-Level Approach to Childhood Obesity Prevention and Management: Lessons from Japan and the United States. Nutrient 2025; 17(5): 838. [DOI]
31. Hong YH, Park S, Shin M, Chung S, Jung J, Sul A-R, et al. Changes in weight distribution and trends in obesity among children and adolescents in East Asia: Insights from NCD-RisC data. Plos One 2024; 19(11): e0310646. [DOI]
32. Jussila A-M, Husu P, Vähä-Ypyä H, Tokola K, Kokko S, Sievänen H, et al. Accelerometer-measured physical activity levels and patterns vary in an age and sex-dependent fashion among Finnish children and adolescents. Int J Environmental Res Public Health 2022; 19(11): 6950. [DOI]
33. Shackleton N, Jamal F, Viner RM, Dickson K, Patton G, Bonell C. School-based interventions going be-yond health education to promote adolescent health: systematic review of reviews. J Adol Health 2016; 58(4): 382–96. [DOI]
34. Kotlyk A, Kanova O, Viunnyk D. The role of extracur-ricular educational institutions in advancing sustainable development. Ukrainian J Applied Econom Technology 2025; 10(1): 46–50. [DOI]
35. Fujiwara S, Harada K, Hagiya H, Koyama T, Haseg-awa K, Tsukahara H, et al. Trends in childhood obesity in Japan: A nationwide observational study from 2012 to 2021. Clin Obesity 2024; 14(2): e12636. [DOI]
36. Ministry of Education, Culture, Sports, Science and Technology (MEXT), Japan. School Health Survey 2024 (released February 2025). 2025. [DOI]
37. Kurotani K, Shinsugi C, Miyoshi M, Takimoto H. Overviews of Shokuiku Promotion. Japanese J Nu-trit Diet 2020; 78(Supplement): S50–S9. [DOI]
38. Paakkari O, Paakkari L. Health literacy and the school curriculum: the example of Finland. International handbook of health literacy: Policy Press; 2019. p. 521–34. [Article]
39. Mäki P, Kauppala T, Levälahti E, Tuovinen E, Vuorenmaa M. Developing a Monitoring System of Overweight and Obesity in Finnish Children. Europ J Public Health 2025; 35(Supplement_4): ckaf161. 1796. [DOI]
40. World Health Organization. WHO European Child-hood Obesity Surveillance Initiative (COSI): report on the sixth round of data collection, 2022– 2024. [Article]
41. Husu P, Tokola K, Vähä-Ypyä H, Sievänen H, Kokko S, Villberg J, et al. Physical activity has decreased in Finnish children and adolescents from 2016 to 2022. BMC Public Health 2024; 24(1): 1343. [DOI]
42. Peralta LR, Rowling L. Implementation of school health literacy in Australia: A systematic review. Health Edu J 2018; 77(3): 363–76. [DOI]
43. Wilson K, Soria N, Polite W. Exploring the relation-ship between social-emotional risk and literacy out-comes: evidence from a collective impact, targeted mentoring initiative. School-University Partnerships 2025; 18(1): 59–80. [DOI]
44. Hosokawa R, Matsumoto Y, Nishida C, Funato K, Mitani A. Enhancing social-emotional skills in early childhood: intervention study on the effectiveness of social and emotional learning. BMC Psychology 2024; 12(1): 761. [DOI]
45. Moulaei K, Salehi S, Shahabian M, et al. A national platform for advancing self-care processes for the most common illnesses and conditions: designing, evaluating, and implementing. BMC Med Inform Decis Mak 2024; 24(1): 331. [DOI]
46. Supreme Council of the Cultural Revolution. Fundamental Transformation Document of Education. Tehran: Supreme Council of the Cultural Revolution; 2011. (persian) [Article]
47. Organization for Educational Research and Planning, Supreme Council of Education. National Curriculum of the Islamic Republic of Iran. Tehran: Organization for Educational Research and Planning; 2012. [Article]
48. Torabi Z, Shakibazadeh E, Tajvar M, Rezaei N. Non-communicable diseases challenges and opportunities in Iran: a qualitative study. Sci Report 2025;1 5(1): 8975. [DOI]
49. Waliyanti E, Susanti AN, Faiqoturrohmah F, Wahdah IZ, Anugerah S. Health promotion as a preventive effort against non-communicable diseases in ado-lescents. Community Empower 2025; 10(9): 1861–9. [DOI]
50. Eghtesad S, Mohammadi Z, Shayanrad A, Faramar-zi E, Joukar F, Hamzeh B, et al. The PERSIAN cohort: providing the evidence needed for healthcare reform. Arch Iran Med 2017; 20(11): 691–5. [Article]
51. Alonge O, Chiumento A, Hamoda HM, Gaber E, Hu-ma Z-e-, Abbasinejad M, et al. Identifying pathways for large-scale implementation of a school-based mental health programme in the Eastern Mediterranean Region: a theory-driven approach. Health Policy Plan 2020; 35(Supplement_2): ii112–ii23. [DOI]
52. Akbari Zardkhaneh S, Rajabi M, Zanganeh AM, Namaki S, Mansourkiaee N, Jallalat Danesh M, et al. A national school-based screening program for mental health problems among children aged 6 to 12 years in Iran: scale development and psycho-metric evaluation. Mental Health, Relig Cult 2023; 26(6): 523–38. [DOI]
53. Lavis JN, Boyko JA, Oxman AD, Lewin S, Fretheim A. SUPPORT Tools for evidence-informed health Policymaking (STP) 14: Organising and using policy dialogues to support evidence-informed policymaking. Health Res Policy Syst 2009; 7 Suppl 1(Suppl 1): S14. [DOI]
54. Harden RM. The integration ladder: a tool for curriculum planning and evaluation. Med Edu 2000; 34(7): 551. [DOI]
55. Frank JR, Snell LS, Cate OT, Holmboe ES, Carraccio C, Swing SR, et al. Competency-based medical education: theory to practice. Med Teach 2010; 32(8): 638–45. [DOI]
56. Bruner JS. The process of education. Cambridge: Harvard Univer. [Article]

Send email to the article author


Rights and Permissions
Creative Commons License This work is licensed under a Creative Commons Attribution-NonCommercial 4.0 International License.

© 2026 CC BY-NC 4.0 | Iranian South Medical Journal

Designed & Developed by: Yektaweb