Influence of key components of health-promoting schools and physician ratio on health insurance education: a cross-sectional study

Background: Health-Promoting Schools (HPS) have been implemented worldwide for years. However, the influence of healthcare resources, such as physician ratio, on the attitude of students towards healthcare services remains poorly studied. This study evaluated the influence of health information education (HIE) programs on the implementation of HPS key components across various school levels and physician ratios, and explored the relationship between these factors and healthcare attitudes of students. Methods: This cross-sectional study used data from the Health Promoting Schools Performance Survey, which included 3,365 primary and secondary schools. Result: HIE programs were implemented in 2,525 schools. Primary schools had a higher HIE adoption rate than did secondary schools. HPS key components, including health policy, health life skill, and community relation, were commonly promoted. Schools conducting HIE effectiveness analysis showed significantly better implementation of HPS key components. Physician ratio, personal health life skills of students, community relations, students’ lectures, and teacher empowerment were significantly influenced by HIE. Multiple regression analysis revealed that low physician ratio was associated with an emphasis on the promotion of school health services. In schools with medium and high physician ratios, enhancement of teacher empowerment activities improved HIE. Conclusions: This study provides important insights on key components of HPS and shows that these can be customized according to physician ratio to enhance the effectiveness of HIE.