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

mental health education in schools when implementing health care reform, and recognize that peers are important factors affecting adolescents’ positive mental health. Advocate for the posi- tive development of adolescents by engaging them in engaging peer activities, rather than just health education lectures and questions. Adolescence is a time of life when many risks lurk, but because of adolescents’ curiosity and interest in learning about themselves, it also offers great opportunities to achieve sustained health and well-being through education and preven- tion efforts [70]. By combining traditional education with peer education to complement each other’s advantages, it is expected to better enhance the positive mental health of adolescents in China. Strengths and limitations First of all, to our knowledge, no studies have thoroughly explored the effect of peer education on the psychological resilience of adolescents. Secondly, this study is a clustered randomized controlled trial, which can more effectively control the contamination between the interven- tion group and the control group in the school-based intervention. Despite the potential of these findings to verify the effect of peer education based on adoles- cent health education on the resilience of adolescents, it is important to acknowledge certain limitations of the study. On the one hand, our sample is only from Qijiang District, Chong- qing. The representativeness of the sample is limited and cannot represent all children and

adolescents. Moreover, the number of clusters in this study is insufficient, which may lead to inaccurate estimation of intervention effect. Therefore, in future studies, the sample should be expanded to improve the sample representativeness. On the other hand, since the inclusion and exclusion criteria were set at the beginning of the study, and strict condition control was implemented during the intervention and follow-up process, the results may not necessarily represent the real adolescent intervention environment. Conclusions Our peer education based on adolescent health education can significantly improve target focus, emotional adjustment, interpersonal assistance and total resilience, and there are gender differences in the intervention effect. In addition, more attention should be devoted to positive cognition toward difficulties and family support to perfectly increase the resilience of adolescents. Supporting information S1 File. The effect of peer education training on pubertal knowledge and attitudes for boys and girls (n = 76). After peer education training, the training effect results showed that the correct rate of adolescent-related health knowledge and attitude scores of peer educators were significantly improved. (DOCX) S1 Table. Peer education content arrangement. Psychological health education includes the process of psychological development during adolescence and the treatment of psychological problems such as tension, anxiety and conflicts with parents, teachers, and peers; a healthy life-

style involves a balanced diet, reasonable exercise, and good sleep. (DOCX) S1 Text. The protocol of this study. (DOCX) 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 14 / 18