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.

青少年是国家的未来，其身体状况将影响成年后的健康水平。当前，儿童青少年摄入的游离糖普遍较高，对身体造成潜在的影响。

探讨基于知信行模式和自我效能理论的健康教育对四年级小学生含糖饮料摄入行为的影响，为学校开展健康促进行动，相关部门制定含糖饮料控制策略提供理论依据。

2023年3—6月采用整群随机抽样法，从上海市长宁区下辖10个街道中随机抽取2个，在每个入选街道内随机抽取1所小学，随后通过区组随机法将2所小学整群分配至对照组（n=262）及干预组（n=230）实施平行对照试验，对照组进行常规健康教育，干预组采用以"含糖饮料摄入周行为记录册"为主的自我效能教育和知信行教育模式。根据上海市疾控中心统一设计的含糖饮料问卷于干预前和干预后4个月对干预效果进行评价，包括含糖饮料基本知识、8种常用饮料（碳酸饮料、现榨新鲜果汁、非鲜榨的定型果蔬汁饮料、植物蛋白类定型包装饮料、乳酸菌饮料、配制型乳饮料、茶饮料、奶茶）的每周饮用、消费情况以及青少年健康相关行为自我效能量表（运动控制效能分量表、饮食控制效能分量表）。

纳入研究对象492人，其中对照组262人，干预组230人。含糖饮料基本知识方面，干预组的"常喝含糖饮料不会令自己发胖""口渴时，含糖饮料是解渴的最好选择"知晓率与对照组比较，差异有统计学意义（P<0.05）。8种常用饮料每周饮用、消费情况方面，干预组的碳酸饮料、现榨新鲜果汁、非鲜榨定型果蔬汁饮料、乳酸菌饮料每周摄入频次比例和每周消费情况低于干预前（P<0.05）；干预后，对照组与干预组的现榨新鲜果汁、非鲜榨的定型果蔬汁饮料、乳酸菌饮料的每周消费情况比较，差异有统计学意义（P<0.05）。青少年健康相关行为自我效能量表评分方面，干预后，对照组与干预组的饮食控制效能维度分量表得分及自我效能总分比较，差异有统计学意义（P<0.05）；干预组干预后运动效能、饮食控制效能分量表及自我效能量表得分高于干预前（P<0.05）。干预后，干预组不喝或少喝含糖饮料自我效能较好者比例高于对照组（P<0.05）。

结合知信行模式与自我效能理论的健康教育能提高学生的知识水平，提升其控制摄入含糖饮品的意念与效果，有利于其养成健康习惯、形成健康行为，值得在未来的实践与应用中继续探索。