Adolescents represent the future of a nation, and their current physical health status will significantly impact their health in adulthood. Currently, the intake of free sugars among children and adolescents is generally high, posing potential risks to their health.

To explore the impact of health education based on the Knowledge-Attitude-Practice (KAP) model and self-efficacy theory on the sugar-sweetened beverage (SSB) consumption behavior of fourth-grade primary school students. This study aimed to provide a theoretical basis for schools to implement health promotion actions and for relevant departments to formulate strategies for controlling SSB consumption.

From March to June 2023, a cluster randomized sampling method was employed. Two streets were randomly selected from the 10 sub-districts under Changning District in Shanghai, and one primary school was randomly selected from each of the chosen streets. Subsequently, the two schools were cluster-randomized into a control group (n=262) and an intervention group (n=230) using block randomization for a parallel controlled trial. The control group received routine health education, while the intervention group adopted a self-efficacy and KAP education model centered on a "Weekly Behavior Log for SSB Intake". The evaluation of the intervention effects was conducted using a standardized sugary beverage questionnaire designed by the Shanghai Center for Disease Control and Prevention, both before the intervention and four months after. This included basic knowledge about sugary beverages, weekly consumption of eight common types of drinks (carbonated beverages, freshly squeezed fruit juice, non-freshly squeezed fruit and vegetable juice drinks, plant protein-based packaged drinks, probiotic drinks, formulated milk beverages, tea drinks, and milk tea), as well as a self-efficacy scale related to health behaviors among adolescents (exercise control efficacy scale and dietary control efficacy scale) .

A total of 492 participants were included in the study, with 262 in the control group and 230 in the intervention group. Regarding basic knowledge about sugary beverages, the intervention group had a statistically significant higher awareness compared to the control group on statements such as "Regularly drinking sugary beverages will not make me gain weight" and "Sugary beverages are the best choice for quenching thirst" (P<0.05). In terms of weekly consumption of eight common beverages, the frequency and consumption of carbonated drinks, freshly squeezed juice, non-freshly squeezed standardized fruit and vegetable juice, and yogurt drinks in the intervention group were lower compared to before the intervention (P<0.05). After the intervention, the comparison of weekly consumption of freshly squeezed juice, non-freshly squeezed standardized fruit and vegetable juice, and yogurt drinks between the control and intervention groups showed statistically significant differences (P<0.05). In terms of scores on the self-efficacy scale for health-related behaviors among adolescents, after the intervention, there were statistically significant differences between the control and intervention groups in the dietary control efficacy subscale scores and the overall self-efficacy score (P<0.05) ; the intervention group had higher scores in exercise efficacy, dietary control efficacy subscales, and overall self-efficacy after the intervention compared to before (P<0.05). After the intervention, the proportion of participants in the intervention group who reported not drinking or drinking less sugary beverages was significantly higher than that in the control group (P<0.05) .

Health education combining the KAP model and self-efficacy theory can improve students' knowledge, enhance their intention and ability to control SSB consumption, and facilitate the development of healthy habits and behaviors. This approach is worthy of further exploration in future practice and application.