Storying health: the impact of illustrated narratives on children’s attitudes toward COVID-19 prevention in early education

This study examined the effectiveness of illustrated stories in promoting positive health attitudes related to COVID-19 prevention among fourth-grade students in Oman and explored students’ perceptions of using stories as tools for peer education. Guided by a mixed-methods explanatory sequential design, the study integrated quantitative and qualitative approaches to capture both behavioral outcomes and experiential insights. Forty-four fourth-grade students from Al-Shamael Basic Education School participated in a single-group pretest–posttest intervention involving four illustrated stories, The Dangerous Virus, The Smart Attack, Safe Return, and Protect Yourself, supported by a teacher guide emphasizing dialogic reading and active learning strategies. Data were collected using the COVID-19 Health Attitude Scale and semi-structured interviews with seven volunteer participants. Quantitative findings revealed a statistically significant increase in overall attitude scores from pretest ( M = 2.27, SD = 0.41) to posttest ( M = 2.49, SD = 0.38), t (43) = −3.77, p = 0.001, with notable improvement on the preventive behavior subscale. No significant gender differences were found, suggesting that story-based instruction engaged both male and female learners equitably. Thematic analysis of interview data identified three major themes: engagement and emotional connection, empowerment through peer teaching, and creativity in future story development. The convergence of findings indicates that illustrated stories provide a developmentally appropriate, culturally relevant, and emotionally resonant medium for health education in early primary grades. This study contributes novel evidence from the Omani context, demonstrating that illustrated narratives can serve as effective pedagogical tools for fostering health-promoting behaviors and advancing global health literacy goals in early childhood education.