Strengthening climate-health literacy through sustainability education among dental students: a quasi-experimental evaluation

Health systems both face escalating climate risks and contribute to emissions. Dentistry can mitigate impacts via prevention-oriented, low-carbon, and resilient practice, yet climate-health literacy is inconsistently taught. We evaluated whether a curriculum-embedded sustainability module improves climate-health literacy and action readiness among dental students. We conducted a quasi-experimental, two-site, parallel-group evaluation with pre- and post-testing in Türkiye (spring 2023–2024). Fourth-year students at Selcuk University (intervention; 14-week sustainability module) and Izmir Democracy University (control; standard curriculum) completed surveys at baseline (week 0) and post-teaching (weeks 14–15). Primary outcomes were the Climate Change Perceptions Scale for Health and Related Professionals and Students (CCPS-HARPS) total and subscales: Awareness & Consciousness, Health & Climate Change, and Advocacy & Experience. Study-specific Oral Health and Willingness-to-Act scales captured discipline-specific perceptions and readiness. Analyses included within-group paired tests, ANCOVA of post-test scores adjusted for baseline (and GPA), assumption checks with interaction probing via estimated marginal means, reliability (Cronbach’s α), and multivariable linear regression with demographic covariates. Baseline included 67 control and 83 intervention students (post-test n = 65 and n = 75, respectively). Internal consistency was acceptable-to-excellent (α = 0.64–0.89 pre; 0.79–0.92 post). In the control group, Awareness (Δ=−0.17, p=0.017), Advocacy (Δ=−0.44, p<0.001), and CCPS Total (Δ=−0.16, p=0.004) declined. The intervention group improved in Health & Climate (Δ=+0.20, p=0.002), CCPS Total (Δ=+0.12, p=0.025), and Willingness-to-Act (Δ=+0.18, p=0.009), with a borderline increase in Oral Health (Δ=+0.12, p=0.061). Adjusted post-tests favored the intervention for Awareness (p=0.025; η²ₚ=0.036), Health & Climate (p=0.001; 0.075), Advocacy (p=0.002; 0.066), CCPS Total (p<0.001; 0.091), and Willingness-to-Act (p=0.006; 0.053); Oral Health was not significant (p=0.190; 0.013). Slope non-homogeneity for Health & Climate and CCPS Total showed larger benefits at lower baselines (e.g., CCPS Total difference 0.37 at 25th percentile, p<0.001), indicating gap-narrowing effects. A semester-long, curriculum-embedded sustainability module produced small-to-moderate gains in climate-health literacy and action readiness among dental students, with the greatest benefits for those starting lower. Findings support integrating assessed, discipline-specific sustainability learning across dental curricula to enable climate-smart, prevention-oriented oral healthcare.