An Evidence-Based Tiered Intervention Strategy for Student Physical Health: Design and Implementation

The physical and mental health of adolescents is a cornerstone of national future. However, traditional “one-size-fits-all” school health interventions often fail to address the diverse needs of students. To overcome this limitation, this research introduces an evidence-based, tiered intervention model designed to provide personalized health support. This study constructs and validates a dynamic ‘Dynamic Weighting-based Asset-Condition-Resource Allocation-Evaluation-Feedback’ (DWA-CRISPR) tiered intervention model, moving from a “triage-driven” to a “needs-driven” service delivery framework. The model is built upon a Response to Intervention (RTI)/Multi-Tiered System of Support (MTSS) three-tier structure and integrates ecological systems theory, social cognitive theory, and the health belief model. Using a quasi-experimental design with propensity score matching (PSM), the intervention’s effectiveness was evaluated on a final matched cohort of 470 students. Difference-in-differences (DID) analysis was then employed to assess the outcomes. The results demonstrate that the tiered intervention significantly reduced the BMI Z-scores of at-risk students compared to the control group. Furthermore, by employing XGBoost and SHAP, the study identified key risk factors, such as cardiorespiratory fitness and baseline BMI, enabling precise and early risk identification. Hierarchical linear models (HLMs) further clarified the multi-level factors influencing intervention outcomes. In conclusion, the DWA-CRISPR tiered model proves to be more effective than traditional approaches, providing a scientific, efficient, and personalized pathway for improving the physical health of primary and secondary school students.