A pragmatic single-group evaluation of a self-determination theory-informed health literacy course for exercise behavior readiness among Japanese university students

Introduction Health literacy education may provide a pragmatic setting for supporting students’ reflection on physical activity and health behaviors when embedded within credit-bearing university courses. However, evidence from course-integrated, single-group evaluations remains limited. This exploratory study examined changes in exercise behavior readiness and related process indicators during a 15-week “Smart Health Literacy” course at The University of Osaka. Methods Forty-four first-year students engaged in weekly self-directed goal setting, inclusive physical activities, and data-driven instruction using wearable sensors. Assessments included pre- and post-course stages of exercise behavior change, weekly self-rated goal-attainment effort, free-living step counts, and session-specific affective responses during a cooperative Mölkky session. The primary outcome was analyzed using a mixed-effects ordinal regression model with participant-specific random intercepts. Results The mixed-effects ordinal regression model indicated that the post-course assessment was associated with higher exercise behavior stages compared with baseline (OR=3.89, 95% CI: 2.57–5.89; Wald-type p < 0.001). Weekly goal-attainment effort increased significantly over the semester, reflecting greater self-rated effort toward self-selected health goals. The Mölkky session elicited acute changes in both positive and negative affect among PANAS complete cases ( n = 26). In contrast, objectively measured step counts significantly decreased from early to late semester, indicating that free-living ambulatory activity did not improve during the observation period. Discussion These findings provide preliminary evidence that a course-based health literacy program may be associated with increased exercise behavior readiness and self-regulatory engagement with self-selected health goals. However, because this was a single-group pre–post evaluation without a control group, the findings should be interpreted as exploratory associations rather than evidence of causal intervention effectiveness.