Health promotion and hydration education in secondary and higher education settings: A systematic review

Abstract

This study aimed to examine how hydration is addressed in secondary and higher education settings, with particular attention given to health education practices, educational interventions, assessed indicators, and reported individual and social impacts. A systematic review was conducted following the Preferred Reporting Items for Systematic reviews and Meta-Analyses 2020 guidelines. The review focused on formal secondary and higher education settings. Searches were conducted in the Web of Science Core Collection. The final sample included 15 international studies published between 2019 and 2023. A thematic narrative synthesis was used to analyse study objectives, methodologies, pedagogical practices, curriculum integration, hydration-related indicators, and intervention outcomes. Most studies focused on secondary education and used quantitative approaches to assess hydration habits, knowledge, and perceptions. The findings showed that many students did not meet recommended water intake levels and that a gap persisted between knowledge and behaviour. Educational interventions generally improved awareness and attitudes towards hydration, although changes in actual water consumption were limited when interventions were not supported by school- or institution-level conditions and sustained curricular integration. Hydration education remains unevenly integrated into secondary and higher education. More comprehensive approaches are needed to connect health education, supportive school environments, curriculum integration, and sustainability-oriented practices.