Interactional Patterns of Adolescent Health Education: A Roter Interaction Analysis System‐Based Study in Moroccan Secondary Schools

BACKGROUND: Adolescence is a critical developmental period during which health-related behaviors consolidate. In Moroccan secondary schools, health education remains largely educator-guided, with limited evidence of classroom communication. This study analyzes how verbal interaction patterns structure health education delivery at middle and high school levels. METHODS: An exploratory mixed-methods study was conducted in five Moroccan secondary institutions (N = 169 students). Verbal interactions (1024 utterances) were coded using the Roter Interaction Analysis System (RIAS), adapted to the Moroccan educational context. Pre- and post-intervention questionnaires assessed short-term knowledge acquisition. Qualitative and quantitative analyses examined speech distribution, functional communication categories, and developmental differences. RESULTS: Educators produced 57.5% of utterances. Instrumental communication predominated (62%-67%), while affective exchanges represented approximately one-third of interactions. Middle school sessions combined directive guidance with experiential anchoring, whereas high school sessions demonstrated increased dialogic debate and argumentative engagement. Knowledge scores improved significantly across all sessions (p < 0.001), with improvements evident in both middle and high school interventions. IMPLICATIONS FOR SCHOOL HEALTH POLICY, PRACTICE, AND EQUITY: Findings highlight interactional competence as a measurable pedagogical skill and support the integration of structured communication training modules and developmentally adapted dialogic strategies within secondary educator preparation programs. CONCLUSION: The findings suggest that secondary health education operates as a negotiated communicative process in which language shapes participation, learning, and emerging health literacy.