Respiratory infections significantly contribute to morbidity and school absenteeism among adolescents, making schools ideal settings for educational interventions focused on respiratory hygiene. This systematic review evaluated school-based educational interventions implemented in secondary school students between 2010 and 2025. Randomized trials, cluster randomized trials, quasi-experimental studies and pre–post intervention studies were included following PRISMA 2020 guidelines. A total of 18 studies were analyzed, revealing that structured educational programs, peer education, and integrated school campaigns effectively enhanced students’ knowledge regarding respiratory infection prevention. Improvements in attitudes and self-efficacy were noted but were more variable, with changes in preventive behaviors showing greater heterogeneity and instability. Indirect health outcomes indicated potential reductions in school absenteeism and respiratory infection rates, particularly with integrated interventions. The certainty of evidence was moderate for knowledge and indirect health outcomes, while attitudes and behaviors were supported by lower-certainty evidence. School-based educational interventions effectively improve students’ knowledge of respiratory hygiene. However, sustainable behavioral change and measurable health outcomes require integrated and organizationally supported approaches. Future research should focus on robust trial designs with long-term follow-ups to further validate these findings.
Andretta et al. (Wed,) studied this question.