The effect of peer education based on adolescent health education on the resilience of children and adolescents: A cluster randomized controlled trial

Discussion To date, a growing body of research has shown a sharp rise in the number of children and ado- lescents with mental health problems. Poor mental health among children and adolescents usually leads to a more positive attitude toward suicide, which in turn promotes greater sui- cidal ideation [50–52]. From the perspective of positive psychology, better resilience can help individuals overcome and work through negative stresses. In previous studies of intervention, a large body of studies increased the resilience of children and adolescents by improving cop- ing strategies, cognitive restructure, and resilience factors [53], but adolescents are a special period—adolescence—facing various physiological and psychological changes. Therefore, intervention based on adolescent health education is necessary and innovative. Then, previous intervention models were built on school and family circumstances, considering parents and teachers as carriers of increasing resilience [53]. However, adolescents spend more time with peers than with parents during adolescence, so it is worth trying to utilize peer education to improve the resilience of adolescents. Our study found that peer education based on adolescent health education could improve the target focus, emotional adjustment, and interpersonal assistance of adolescents, which is consistent with previous research [54]. Regarding target focus, the research conducted by Jac- quline Schwab and colleagues [55] implicated that the hormonal changes associated with sex

development have profound influences on self-perceived competence, which was referred to as the efficacy or skillfulness of accomplishing age-appropriate tasks to fulfil personal goals and demands successfully. Therefore, delivering positive adolescence-related knowledge, atti- tudes, and behaviors to subjects might offset the negative effect of sex maturation. Addition- ally, because of higher academic pressure, adolescents are prone to engage in less physical activity, which is associated with self-efficacy [56, 57]. There is a positive correlation between health literacy and self-efficacy [58], and self-efficacy and goal setting can help them be more purposeful in planning their activities and participating in a normal lifestyle [59]. Moreover, it has been found that in the United States, self-efficacy is considered a protective factor for increased resilience [60]. Cultivating healthy lifestyles, including a healthy diet and reasonable exercise, could enhance self-efficacy to cope with problems and improve the target focus of personal resilience. Emotional intelligence is one of the most important topics for adolescent mental health professionals [61]. With respect to emotional adjustment, Lauren and colleagues [16] found that the increased gap between physiological development and psychological devel- opment due to early pubertal timing was a risk of rumination that was characterized by the tendency to pay close attention to one’s dysphoric mood passively and repetitively, as well as

its meanings and consequence; furthermore, some studies have indicated that reasonable exer- cise can overcome emotion regulation difficulties [54]. Our intervention based on adolescent health education and a healthy lifestyle can decrease the gap and improve emotion regulation difficulties. In terms of interpersonal assistance, some studies have shown that peer-to-peer teaching can enhance communication skills [62]. In our study, a knowledge quiz game, group Table 1. (Continued) Characteristics Control (n = 881) Intervention (n = 732) P Age 12.67±1.71 12.27±1.60 <0.001b a P values were calculated using the chi-square test. b P values were calculated using the rank sum test. Quantitative data were expressed by “mean ± standard deviation”, while qualitative data were expressed by “n (%)”. https://doi.org/10.1371/journal.pone.0263012.t001 PLOS ONE The effect of peer education based on adolescent health education on resilience of children and adolescents PLOS ONE | https://doi.org/10.1371/journal.pone.0263012 February 2, 2022 10 / 18