Puberty marks a critical period of development, characterized by rapid physical, emotional, and psychological changes that can significantly influence a child's self-perception and health behaviors. Early onset of puberty, particularly among school-aged children, has been associated with an increased risk of psychosocial challenges, including low self-esteem and body image disturbances, which may contribute to unhealthy eating patterns and weight gain (1,2). These issues are particularly concerning given the global rise in childhood obesity and its associated health consequences, including metabolic disorders and cardiovascular risks (3).

Self-esteem, defined as an individual's overall evaluation of their worth, plays a crucial role in shaping behavior, motivation, and emotional resilience during adolescence (4). Children with poor self-esteem are more susceptible to peer pressure, emotional eating, sedentary habits, and academic underachievement (5). Studies have shown a bidirectional relationship between self-esteem and body mass index (BMI), where low self-esteem may lead to weight gain, and higher BMI may further exacerbate negative self-image (6).

School settings offer an optimal environment for health promotion among children, as they allow for consistent engagement and reinforcement of positive behaviors. With the integration of technology in education, digital interventions have emerged as an innovative strategy for delivering health education to children in an interactive and accessible format (7). Digital tools can offer personalized feedback, gamified learning, and multimedia content that appeal to young learners, thereby increasing their motivation and engagement with health messages (8).

Previous research has highlighted the success of digital interventions in improving dietary habits, physical activity levels, and health literacy among adolescents (9,10). However, limited studies have specifically explored their effect on psychosocial outcomes such as self-esteem, particularly in early pubertal children. Given the formative nature of this developmental stage, early intervention may be critical in shaping long-term health behaviors and psychological well-being.

Therefore, the present study aims to assess the effectiveness of a school-based digital intervention on self-esteem and BMI among early pubertal children. This research seeks to contribute to the growing body of evidence supporting technology-based health promotion in pediatric populations.

Study Design and Setting

This quasi-experimental study was conducted over a period of six months in three urban co-educational schools. The schools were selected through convenience sampling, and institutional permission and parental consent were obtained prior to the study.

Participants
A total of 180 children aged 9 to 12 years, identified as being in the early stages of puberty based on clinical signs (Tanner stage II), were enrolled. Participants were randomly assigned into two groups: the intervention group (n = 90) and the control group (n = 90). Children with chronic medical conditions, learning disabilities, or those undergoing psychiatric treatment were excluded from the study.

Intervention
Children in the intervention group participated in a structured school-based digital program, delivered weekly for 45 minutes via a tablet-based application installed on school devices. The modules included animated videos, interactive quizzes, and activities focusing on healthy eating, physical activity, body image awareness, emotional regulation, and goal-setting. Trained teachers supervised the sessions and reinforced the digital content through classroom discussions.

The control group continued with their usual school curriculum and did not receive any additional digital content related to health or self-esteem during the study period.

Data Collection Tools

Self-esteem was assessed using the Rosenberg Self-Esteem Scale (RSES), a 10-item standardized questionnaire rated on a 4-point Likert scale. BMI was calculated from height and weight measurements recorded using a stadiometer and a calibrated digital weighing scale, respectively. Measurements were taken at baseline and at the end of the 6-month period.

Statistical Analysis

Data were analyzed using SPSS version 26. Descriptive statistics were used to present demographic characteristics. Paired t-tests were applied to assess within-group differences (pre- and post-intervention), and independent t-tests were used for between-group comparisons. A p-value of less than 0.05 was considered statistically significant

A total of 180 children participated in the study, with equal distribution between the intervention group (n = 90) and the control group (n = 90). All participants completed both baseline and post-intervention assessments. The mean age of the participants was 10.6 ± 1.1 years in the intervention group and 10.4 ± 1.0 years in the control group, with no significant difference between groups (p = 0.28). Gender distribution was comparable, with 51.1% females in the intervention group and 48.9% in the control group.

Changes in Self-Esteem Scores

At baseline, the mean Rosenberg Self-Esteem Scale (RSES) scores were similar in both groups (intervention: 19.6 ± 3.2, control: 19.3 ± 3.1; p = 0.64). After six months, a significant improvement was observed in the intervention group (24.1 ± 2.8), while the control group showed a marginal increase (20.1 ± 3.0). The between-group difference in post-intervention scores was statistically significant (p < 0.001) (Table 1).

Table 1. Comparison of Self-Esteem Scores Between Groups

As shown in Table 1, the intervention group had a significantly greater improvement in self-esteem scores compared to the control group.

Changes in Body Mass Index (BMI)

Baseline BMI was comparable between the two groups (intervention: 21.8 ± 2.5 kg/m², control: 21.5 ± 2.6 kg/m²; p = 0.45). At the end of the study, the intervention group showed a modest but statistically significant decrease in BMI (20.9 ± 2.3 kg/m²; p = 0.01), whereas the control group experienced a slight, non-significant increase (21.7 ± 2.7 kg/m²; p = 0.42). The between-group difference at follow-up was statistically significant (p = 0.02) (Table 2).

Table 2. Comparison of BMI Between Groups

As evident from Table 2, the digital intervention led to a statistically significant reduction in BMI in the intervention group compared to the control.

These findings indicate that the school-based digital health education program had a positive impact on both self-esteem and BMI among early pubertal children.

This study demonstrated that a structured school-based digital intervention significantly improved self-esteem and reduced BMI in early pubertal children over a six-month period. These findings support the growing evidence that digital health tools, when integrated into the school environment, can positively influence psychosocial and physical health outcomes in children.

The improvement in self-esteem scores observed in the intervention group aligns with previous findings indicating that digital platforms promoting emotional well-being and body image awareness can positively impact self-perception in youth (1,2). The interactive nature of digital modules may foster engagement and internal motivation, which are key components in self-esteem development during puberty—a stage marked by heightened emotional sensitivity and self-awareness (3,4).

Digital health education also offers the advantage of standardization, ensuring consistent delivery of messages across diverse classrooms. Studies suggest that gamification and visual storytelling in digital tools are particularly effective in conveying complex health concepts to young learners (5,6). By incorporating such features, the intervention likely increased the children's confidence and perceived competence, contributing to the observed self-esteem enhancement (7).

The modest but statistically significant reduction in BMI in the intervention group is consistent with earlier reports showing that technology-based interventions can improve lifestyle behaviors, including dietary habits and physical activity levels (8–10). Unlike traditional programs, digital interventions allow for real-time feedback, self-monitoring, and reinforcement, which may enhance adherence and behavior change, especially in a school setting where peer influence is strong (11,12).

Notably, the control group exhibited minimal changes in both BMI and self-esteem, underscoring the role of structured digital engagement rather than passive exposure to general school routines. This finding is comparable to other controlled studies where non-intervention groups showed no significant changes in psychological or physical health markers (13).

The school environment plays a pivotal role in shaping early health behaviors. School-based interventions are cost-effective and scalable, making them attractive options for public health strategies targeting children (14). Moreover, early pubertal children represent a critical window for intervention, as they are forming long-lasting behaviors and attitudes toward body image and health (15).

Despite these promising results, certain limitations should be acknowledged. The study was limited to urban schools, which may not reflect outcomes in rural or socioeconomically diverse settings. Additionally, the follow-up period was limited to six months; long-term sustainability of the intervention's effects remains uncertain. Future studies should explore longitudinal outcomes and assess the role of parental involvement and home-based reinforcement.

In conclusion, the present study adds to the growing body of evidence supporting digital tools as effective modalities for enhancing self-esteem and promoting healthy weight management among school-aged children. Incorporating such interventions into the school curriculum may serve as a strategic approach for early prevention of obesity and psychosocial issues during adolescence.

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