MEST : A School- Based Health Literacy Intervention Trial

A Cluster- Randomized Controlled Trial Evaluating the MEST Work Strategy to Improve Health Literacy Among Upper Secondary School Students

The purpose of this study is to evaluate the effectiveness of the MEST work strategy in upper secondary schools. MEST is a school based, health promoting intervention delivered by school health services and designed to strengthen students' health literacy and mental well being. The study assesses whether implementation of the MEST work strategy results in improved health literacy and mental well being compared with usual school health services.

This study is a cluster randomized superiority trial in which upper secondary schools are assigned either to an intervention group implementing the MEST work strategy or to a control group continuing with school health services as usual. Student reported outcomes are collected using digitally administered questionnaires during school hours at baseline, prior to initiation of the intervention, and at 4 and 9 months following intervention initiation (end of the school year).

Study Overview

• Status: Not yet recruiting
• Conditions: Adolescent Health; Health Literacy
• Intervention / Treatment: Other: MEST Work Strategy

Detailed Description

This study is a cluster randomized controlled trial conducted in upper secondary schools, with schools serving as the unit of randomization to minimize contamination between students. A matched pair allocation design is used to ensure balance between trial arms. The anticipated enrollment is 12 schools (clusters).

Simulation based power analyses indicated that the primary analytic models yielded approximately 0.62-0.72 power to detect an effect size of d = 0.30 and were generally close to or exceeded 0.80 when the post test effect size was larger (d = 0.40).

The MEST work strategy is implemented during regular school hours by school health services and is designed to enhance students' ability to access, understand, evaluate, and apply health related information, with a specific focus on health literacy and mental well being. Data are collected using digitally administered questionnaires at baseline (T0), 4 months (T1), and 9 months (T2) following initiation of the intervention.

The primary outcome is general health literacy. Secondary outcomes include mental health literacy and mental well being. Prespecified secondary subgroup/moderator analyses will examine potential effect modification by gender, socioeconomic status, and minority, Indigenous, or immigrant background. Additional exploratory analyses will assess whether the dose of the MEST work strategy delivered is associated with outcomes. Outcome data are reported by students, while information on intervention dose is obtained from the school health services.

• Study Type: Interventional
• Enrollment (Estimated): 1800
• Phase: Not Applicable

Contacts and Locations

• Study Contact: Name: Hanne N Bjørnsen, RN, MS, MPH, PhD; Phone Number: 004790107526; Email: hanne.nissen.bjornsen@fhi.no
• Study Contact Backup: Name: Hilde E Toreid, RN, MS; Phone Number: 004790874102; Email: hilde.elisabeth.toreid@fhi.no

Study Locations

• Norway
  • Trøndelag
    • Levanger, Trøndelag, Norway, 7600
      • Norwegian Institute of Public Health (NIPH)
      • Contact: Hilde E Toreid, RN, MS; Phone Number: 004790874102; Email: hilde.elisabeth.toreid@fhi.no
      • Contact: Boye Welde, Dr.Philos; Phone Number: 004799357696; Email: boye.welde@fhi.no
      • Principal Investigator: Hilde E Toreid, RN, MS

Participation Criteria

Eligibility Criteria

• Ages Eligible for Study: Child; Adult
• Accepts Healthy Volunteers: Yes

Description

Inclusion Criteria:

• Students 16-24 years
• Students enrolled in upper secondary school classes
• Provided informed consent

Exclusion Criteria:

- Students <16 years and > 24 years

Study Plan

How is the study designed?

Design Details

• Primary Purpose: Health Services Research
• Allocation: Randomized
• Interventional Model: Parallel Assignment
• Masking: Single

Number of Arms

2

Arms and Interventions

Participant Group / Arm	Intervention / Treatment
Experimental: MEST Work Strategy; Schools assigned to the intervention arm receive the MEST work strategy delivered by school health services during regular school hours over one school year. The intervention is designed to strengthen students' general health literacy through structured learning activities, facilitated discussions, and individual follow up when needed.	Other: MEST Work Strategy; The MEST work strategy is needs based and adaptive. An anonymous, digitally administered MEST survey conducted prior to intervention initiation informs the selection and tailoring of intervention topics throughout the school year. This survey is used solely to guide intervention delivery and is not included in the outcome evaluation. Intervention activities may include classroom based sessions, school wide seminars, small thematic group activities, and individual consultations provided by the school health services, depending on identified student needs. All activities are conducted on school premises using existing school facilities and digital infrastructure.
No Intervention: Control- School Health Servics as usual; Schools assigned to the control arm continue with school health services as usual throughout the study period. Usual care includes routine health promotion activities and access to individual consultations provided within the existing school health services. Schools in the control arm are not exposed to the MEST work strategy during the study period.

What is the study measuring?

Primary Outcome Measures

Outcome Measure	Measure Description	Time Frame
General Health Literacy	General health literacy assessed using the Health Literacy Survey 2019 - Young Persons 12-item scale (HLS19 YP12). The instrument consists of 12 items, each rated on a 4 point scale. Total scores range from 12 to 48, with higher scores indicating higher (better) levels of health literacy.	Baseline, 4 months, 9 months

Secondary Outcome Measures

Outcome Measure	Measure Description	Time Frame
Mental Health Literacy	Mental health literacy using the Mental Health Learning Scale (MHLS-9). The instrument consists of 9 items, each rated on a 5- point likert scale, giving a total score from 9 to 45, with higher scores indicating higher (better) levels of mental health literacy.	Baseline, 4 months, 9 months
Mental Well-Being	Mental well-being assessed using the Short Warwick-Edinburgh Mental Well-Being Scale (SWEMWBS). The instrument consist of 7 items, each rated on a 5- point scale. It ranges from 7 to 35 points, with higher scores indicating better mental well- being.	Baseline, 4 months, 9 months

Collaborators and Investigators

• Sponsor: Norwegian Institute of Public Health
• Investigators: Principal Investigator: Hanne N Bjørnsen, RN, MS, MPH, PhD, Norwegian Institute of Public Health

Publications and helpful links

General Publications

• Bjornsen HN, Ringdal R, Espnes GA, Eilertsen MB, Moksnes UK. Exploring MEST: a new universal teaching strategy for school health services to promote positive mental health literacy and mental wellbeing among Norwegian adolescents. BMC Health Serv Res. 2018 Dec 29;18(1):1001. doi: 10.1186/s12913-018-3829-8.

Study record dates

Study Major Dates

• Study Start (Estimated): August 17, 2026
• Primary Completion (Estimated): June 30, 2027
• Study Completion (Estimated): September 30, 2027

Study Registration Dates

• First Submitted: April 22, 2026
• First Submitted That Met QC Criteria: May 18, 2026
• First Posted (Actual): May 22, 2026

Study Record Updates

• Last Update Posted (Actual): May 22, 2026
• Last Update Submitted That Met QC Criteria: May 18, 2026
• Last Verified: May 1, 2026

More Information

Terms related to this study

• Keywords: Health Promotion; School Health Services; Upper Secondary School
• Other Study ID Numbers: SDAM_FOR555624 /NIPH 6107-6107

Plan for Individual participant data (IPD)

• Plan to Share Individual Participant Data (IPD)?: NO
• IPD Plan Description: We collect sensitive information about health litearcy, mental health litearcy and mental well- being, hence we will not share IPD.

Drug and device information, study documents

• Studies a U.S. FDA-regulated drug product: No
• Studies a U.S. FDA-regulated device product: No