Objective To analyze and evaluate the effectiveness of health education interventions for echinococcosis prevention and control among primary and secondary school students in Lhasa, and to provide a basis for exploring health education models for the prevention and control of echinococcosis among students in Tibetan regions.

Methods A total of 1 440 students were randomly selected from 12 primary, junior high, and senior high schools in urban (Chengguan district), purely agricultural (Qushui county), purely pastoral (Dangxiong county), and semi-agricultural semi-pastoral (Linzhou county) regions of Lhasa. From 2020 to 2022, a three-year health education program on echinococcosis was conducted through structured knowledge lectures. Questionnaires on echinococcosis prevention knowledge and behaviors were administered before and after the intervention. The effectiveness of the intervention was evaluated by comparing pre-and post-intervention rates of core echinococcosis knowledge awareness, correct behaviors, and correct attitudes.

Results Over the three-year health education intervention, the mean awareness rate of core knowledge about echinococcosis among primary and secondary school students in Lhasa gradually increased. Compared with the pre-intervention awareness rate (44.6%), the awareness rates in the second (71.6%) and third (99.4%) years of the intervention showed statistically significant differences (both P < 0.001). Female students (55.4%, 73.0%, and 99.0%), high school students (60.9%, 78.9%, and 98.3%), and students from Chengguan district (53.3%, 74.2%, and 98.9%) exhibited significant increases in awareness rates from the first to the third intervention years, with statistically significant differences compared to pre-intervention awareness rates (42.4%, 45.9%, and 42.7%) (all P < 0.001). The mean correct rates of the students for echinococcosis prevention and control behaviors, "avoid contact with dogs"(84.8%), "maintain handwashing habits" (88.4%), "never feed dogs with raw livestock viscera" (93.0%), and attitude "won't feed dogs with raw diseased livestock viscera directly" (98.8%), showed significant improvements by the third year of the intervention, with statistically significant differences compared to pre-intervention rates (36.8%, 55.7%, 59.2%, and 86.4%) (all P < 0.001). In the third year of the intervention, the core knowledge awareness rate and the correct rate for Behavior 3 among students reached 100% in both the purely pastoral (Dangxiong county) and semi-agricultural semi-pastoral (Linzhou county) regions.

Conclusion Continuous health education interventions on echinococcosis prevention demonstrated superior effectiveness compared to one-time interventions among primary and secondary school students in Lhasa, with particularly significant improvements observed among students from purely pastoral and semi-agricultural semi-pastoral regions.