Health literacy development through primary education: Implementation and outcomes of liver fluke prevention curriculum in southern Lao PDR

School-based health education offers a promising approach to liver fluke prevention in endemic communities, yet evidence from Lao PDR remains limited, particularly regarding culturally adapted health literacy curricula in rural primary schools and their implementation across diverse school contexts. This study examined the implementation and educational outcomes of a culturally adapted health literacy curriculum in 12 rural primary schools in Champasak Province, southern Lao PDR. Using a single-arm mixed-methods pre–post design without a control group, the study involved 527 Grade 4–5 students and 52 school personnel in a 12-week curriculum integrating health knowledge, participatory learning, and teacher professional development. Student knowledge increased from 14.32 to 15.43 out of 20 (d = 0.46), with substantial variation across schools. Among school personnel with complete paired assessments (n = 36), knowledge increased from 2.27 to 4.11 out of 5 (p < .001, rank-biserial r = 0.87). Post-intervention, 80.5% of students reported avoiding raw or undercooked fish and 83.1% reported discussing health topics with family members. Qualitative findings highlighted variation in implementation and the influence of school and sociocultural contexts. The findings provide preliminary evidence of positive educational outcomes, although the absence of a control group and baseline behavioral measures limits causal interpretation.