**Background:** Health education is a critical component of universal health coverage, yet there is a dearth of studies addressing parental health awareness through school platforms, particularly in low-resource settings like Pakistan. Parents who are better educated about healthcare are better equipped to meet their children's developmental needs, and children whose parents are actively involved in their health achieve better academic outcomes. Pakistan faces challenges in imparting health education due to lack of educational reforms that include parents. This study aimed to evaluate the effect of an eLearning-based school health education program in a semi-rural community setting to enhance parental awareness and promote the health of school children.
**Methods:** The study was conducted in one government school (grades ECD-VIII) in a semi-rural community in Sindh, Pakistan from 2016-2019, using a sequential explanatory mixed-methods design. The total number of students was 253. Parents were invited to voluntarily participate in a health awareness program; all parents who showed up on session days were included via universal sampling. Twelve health awareness sessions relevant to children's health were conducted over one year using MDConsults software, with sessions facilitated by healthcare professionals (nurses, physicians, nutritionists) from a private university hospital in Karachi. Sessions were held once monthly on parents' preferred day and time. Quantitative data: Parents' knowledge was assessed through pre- and post-tests (8-10 multiple-choice questions per session, developed by content experts, translated into Urdu). A paired t-test was applied to measure the effect of the intervention, with p-value <0.05 considered significant. Qualitative data: Four focus group discussions (FGDs) were conducted after completing 12 sessions—two FGDs with parents, one with community leaders, and one with teachers. Data were transcribed and translated from Urdu to English and analyzed independently by two researchers using content analysis.
**Key Results:** Quantitative: Mean participation was 21.8 parents per session (range: 13-34, SD 7.2). Significant knowledge gains were found in 8 out of 12 sessions: Vaccination (mean difference 1.59, SD 1.18, p<0.001), Diarrhea (0.38, SD 0.77, p=0.049), Puberty (0.58, SD 1.30, p=0.013), Pneumonia (0.40, SD 0.63, p=0.028), Seizures (1.17, SD 1.27, p<0.001), Personal Hygiene (1.38, SD 1.38, p=0.004), Measles (2.60, SD 1.35, p<0.001), and Cognitive Development (0.89, SD 1.51, p=0.004). No significant difference was found for Child Safety (-0.04, SD 1.20, p=0.870), Nutrition (0.13, SD 1.65, p=0.662), Substance Abuse (0.60, SD 1.91, p=0.246), and Parenting (-0.76, SD 1.20, p=0.018—significant but negative). Qualitative: Three key themes emerged: (1) Perceived usefulness of eLearning—parents reported increased awareness of common illnesses and home-based management, and valued the dual service (health and education) under one roof; (2) Barriers affecting usability—cultural issues (e.g., discussing puberty openly was considered taboo) and technology-based challenges (network connectivity drops during sessions); (3) Way forward—participants expressed desire for future sessions on family planning, mental well-being, first aid, and parent-child relationships.
**Clinical Implications:** This study demonstrates that school-based eLearning platforms can effectively enhance parental health knowledge in low-resource, semi-rural communities. The approach addresses critical barriers to healthcare access, including geographic distance (parents reported traveling 2-3 hours to reach health facilities) and cost. The significant knowledge gains across most sessions suggest that this model could be scaled to other schools in Pakistan and similar LMIC settings. However, the study did not measure subsequent impact on parental practices or child health outcomes, which is a key limitation. Cultural sensitivity around sensitive topics (e.g., puberty) and reliable internet connectivity remain important implementation considerations. The authors note that a combination of online and face-to-face modalities may be more effective than eLearning alone.